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Vol 77, No 6 (2022)

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Clinical Anatomical Characteristics of Patients with Rhino-Orbit-Cerebral Mucormycosis

Kolsanov A.V., Zelter P.M., Zeleva O.V., Ivanova O.V., Lyamin A.V., Sidorov E.A., Vladimirova T.Y., Kozlov A.V., Pyshkina Y.S.


Background. Postponed coronavirus infection (COVID-19), accompanied by an immunosuppressive state and associated with the risk of secondary diseases such as mucormycosis. Diabetes mellitus is an independent risk factor for both severe COVID-19 and mucormycosis.

Aims — our aim was to experience the diagnosis and treatment of rhino-orbitocerebral mucormycosis in post-COVID-19 patients.

Materials. A single-center, observational, non-randomized, cohort comparative study was conducted. We assessed the clinical features, risk factors, diagnosis and outcomes of mucormycosis among recovered COVID-19 patients with hospitalisation in the otorhinolaryngology department of the Samara State Medical University Clinics, Samara, from September–December 2021. CT examinations were performed on Revolution EVO CT scanner (GE, Russia) and MRI on Aera MR scanner 1.5 T (Siemens, Germany). Materials for microbiological and histopathological examination were taken from all examined patients intraoperatively.

Results. The experience of diagnosing and treating rhinoorbitocerebral mucormycosis in patients after a new coronavirus infection was analyzed, the influence of the complex use of radiation diagnostic methods, histopathological and microbiological methods on the development and effectiveness of mucormycosis treatment was determined.

Conclusions. The effectiveness of disease management directly depends on the early initiation of etiotropic treatment, while the role of complex radiological diagnostics, histopathological and microbiological methods is important for early confirmation of the fungal etiology of the disease.

Annals of the Russian academy of medical sciences. 2022;77(6):381-390
pages 381-390 views

The History of the Global Spread of the Causative Agent of Anthrax Based on the Whole Genome Phylogenetic Analysis of Bacillus anthracis

Onishchenko G.G., Kulichenko A.N., Eremenko E.I., Pisarenko S.V.


The review presents current data on the history of distribution, phylogeography, population structure, features of the evolution of the causative agent of anthrax. The results of foreign publications and our own original materials on the territorial distribution of genetic lines of Bacillus anthracis, the genetic relationship of variants isolated in Russia and abroad, the ways of distribution of variants of the pathogen in Russia and neighboring countries summarized. Based on the limited possibilities of spreading anthrax infection with sick animals and the high stability of pathogen spores in the environment, the leading role of human activity in the spread of B. anthracis shown. The probable ways of spread of the pathogen over long distances described, determined by the historical migration of people, the routes of conquerors, trade routes and the import of livestock products. The spread of the causative agent of anthrax on the territory of the Russian Federation began with Eastern Siberia and through the south of Siberia reached the European part of the Russian Federation, including the North Caucasus.

Annals of the Russian academy of medical sciences. 2022;77(6):391-397
pages 391-397 views


Clinical Significance of the Characteristics of Microembolic Signals Recorded in the Recovery Period of Ischemic Stroke, a Cross-Sectional Observational Study

Orlova E.V., Berdalin A.B., Lelyuk V.G.


Background. Microembols detected during transcranial Doppler monitoring with microembolodetection (TCDM with MED) are different in nature and, accordingly, in structure, as well as in size and consequences of their impact on the cerebral vessels. The following biophysical characteristics of microembolic signals (MES) can be assessed during TCDM with MED: frequency, which indirectly reflects the structure of the microembolus, duration, which indirectly reflects the size of the microembolus, and power, which is an integral characteristic. The issues of the relationship between characteristics of MES and clinical indicators have been little studied according to literature.

Aims — study of the biophysical characteristics of microembolic signals recorded in patients with ischemic stroke, as well as the factors affecting these characteristics, the clinical and prognostic significance of microembolism.

Methods. This is a cross-sectional observational study that is part of a prospective cohort study. Data on 28 patients in the recovery period of ischemic stroke are included, in whom the biophysical characteristics of MES were analyzed (the total number of cases in the cohort study was 1600), and who underwent: duplex scanning of the brachiocephalic arteries, transcranial duplex scanning, TCDM with MED, transthoracic echocardiography, magnetic-resonance tomography of the brain, electrocardiography. Study enrollment was carried out in the period from 2019 to 2021. The MES characteristics included frequency, duration, power, energy index (the product of power and duration), of which the MES power was the main one.

Results. MES characteristics correlated with anthropometric parameters: average duration - with the patient’s age (r = 0.421; p = 0.029); average frequency — with body surface area (r = 0.624; p = 0.010). The average power, duration and energy index of MES were significantly higher in persons with intraluminal masses in the carotid arteries (p < 0.05). Correlations of biophysical characteristics of MES with blood flow velocities in brain vessels (inverse correlation between the duration of the MES and the value of the peak systolic velocity in the M2 segment of the right MCA r = –0.529, p = 0.02; correlations between the power of MES, as well as the duration of MES with peak systolic and end-diastolic velocities in the V4 segment of the right VA r = 0.481–0.572, p = 0.027–0.007), as well as with signs of atrophy of the temporal and occipital lobes of the brain were identified (inverse correlation between MES frequency and regional atrophy in the right temporal lobe r = –0.434, p = 0.038; inverse correlation between MES frequency and regional atrophy in the left temporal lobe r = –0.422, p = 0.045; inverse correlation between MES frequency and regional atrophy in the left occipital lobe r = –0.465, p = 0.025). Significant differences were found in the number of MES and their average power, duration, energy index in the presence and absence of atrial fibrillation (p < 0.05).

Conclusions. Age and, apparently, weight, as well as signs of atherosclerosis of the brachiocephalic arteries, influence the development of microembolism. In the presence of atrial fibrillation, material microembolism is observed predominantly, and the number of MES and their characteristics which reflect the size of microemboli are significantly higher. The relationship between the duration of MES and the characteristics reflecting the blood supply in the basin of the middle cerebral artery, as well as between the frequency of MES and the presence of regional atrophy in the temporal and occipital lobes of the brain according to magnetic resonance imaging was revealed.

Annals of the Russian academy of medical sciences. 2022;77(6):398-407
pages 398-407 views


Systemic Inflammatory Response as a Prognostic Factor in Breast Cancer. Part II. Hematological Markers of Inflammation

Sergeeva N.S., Karmakova T.A., Polyak M.A., Alentov I.I.


Chronic inflammation is one of the recognized factors contributing to the onset and progression of malignant neoplasms. At the systemic level, a chronic inflammatory process is accompanied by an increased levels of inflammatory mediators and a change in hematological parameters of peripheral blood. According to numerous clinical studies, the change in the ratio of blood cell populations in cancer patients is an independent prognostic factor in malignant tumors of various localizations. This review is devoted to hematological parameters of the systemic inflammatory response (SIR) in breast cancer (BC). The review presents the characteristics of blood cells used for calculations of hematological indices (neutrophils, lymphocytes, monocytes, platelets); approaches for assessing SIR using these indices (NLR, PLR, LMR, etc.); comparative analysis of data on the association of the hematological indices with the clinical and morphological features of BC, patient survival and tumor response to chemotherapy. The data indicating the benefit of SIR hematological markers investigation during monitoring after treatment are summarized. Complex algorithms, including clinical, morphological and hematological factors, which are proposed to improve the quality of prognosis assessment, are considered. The information accumulated to date suggests that hematological indices reflecting SIR activity in BC patients can serve as additional independent prognostic factors. The development of the prognostic algorithms that are informative for certain clinical groups of BC patients is a promising area of research.

Annals of the Russian academy of medical sciences. 2022;77(6):408-419
pages 408-419 views

99mTc-Labelled Low Molecular Weight Inhibitors of Prostate-Specific Membrane Antigen

Tishchenko V.K., Petriev V.M., Vlasova O.P., Pankratov A.A., Morozova N.B., Shegai P.V., Ivanov S.A., Kaprin A.D.


High morbidity and mortality rates of prostate cancer (PCa) determine the requirement of looking for new methods of its early diagnosis. Methods of nuclear medicine have a special place in addressing this problem as they allow functional, metabolic and other processes imaging in body, which occur during the cancer development. This approach supposes the use of radiopharmaceuticals (RP), which are capable of selective binding to a specific biological target, for example, prostate-specific membrane antigen (PSMA), which is known to be overexpressed in PCa. Current development of new radiotracers for PCa imaging is focused on low molecular weight PSMA inhibitors due to their high specific binding to PSMA and rapid urinary excretion. Technetium-99m remains the appropriate radionuclide for diagnostic studies due to its optimal nuclear properties, ease of production and versatile coordination chemistry. Therefore, single-photon emission computed tomography (SPECT) imaging with 99mTc-PSMA radioligands can be a cost effective alternative to PET with 68Ga- or 18F-labeled RP. The aim of this review is to summarize and analyze currently available data on 99mTc-labeled low molecular weight PSMA inhibitors for metastatic PCa imaging.

Annals of the Russian academy of medical sciences. 2022;77(6):420-436
pages 420-436 views


The First Domestic Experience of Detecting the Association of Anaerobic Bacteria Filifactor Alocis and Porphyromonas Gingivalis by Molecular Biological Methods in Periodontal Diseases and Comorbid Pathology (Comparative Research)

Yanushevich O.O., Tsarev V.N., Nikolaeva E.N., Balmasova I.P., Ippolitov E.V., Tsareva T.V., Podporin M.S., Ponomareva A.G.


Background. The widespread global increase in the incidence of periodontitis and the role of its pathogens in comorbid pathology and systemic complications determines the need to create new molecular genetic systems for diagnosis and the use of metagenomic and bioinformatic analysis methods.

Aims — to use methods of microbiological genodiagnostics and bioinformatic analysis to prove the etiological role of the key periodontal pathogens Filifactor alocis and Porphyromonas gingivalis, characterizing the degree of progression of chronic periodontitis, and its association with a systemic pathological process (type 2 diabetes mellitus).

Methods. A comparative assessment of the identification of key periodontopathogenic species P. gingivalis and F. alocis in different forms of periodontitis according to the degree of progression (84 people) using a previously patented system of primers in patients in 4 comparison groups, differing in the degree of progression. 16S sequencing and bioinformatic analysis were performed in 69 patients (including 38 with type 2 diabetes mellitus). All nondiabetic patients were required to have HbA1c level 6.0%.

Results. A higher frequency of detection of periodontal pathogens was established in patients of group C with a pronounced tendency to progression (93 and 100% respectively). The simultaneous presence of P. gingivalis and F. alocis in chronic periodontitis of grade B was noted in 20% of cases, and in grade C — in 93% of cases.

Conclusions. The proposed method can be used to effectively determine the degree of periodontitis progression based on the determination of oligonucleotide primers of P. gingivalis and F. alocis, including comorbid pathology — periodontitis and type 2 diabetes mellitus.

Annals of the Russian academy of medical sciences. 2022;77(6):437-446
pages 437-446 views


Arctic Stress: Mechanisms and Experimental Models

Gmoshinski I.V., Nikityuk D.B.


Human’s stay in the Polar regions results in the development of stress caused by a combination of factors such as low air temperature, hypodynamia, hypoxia, and disruption of the daylight cycle. All this strongly indicates the increased requirements for health protection and prevention of morbidity in the population of the Arctic. The problem is topical of search for optimal biological models of Arctic stress intended for preclinical testing of pharmacological and dietary correction of its consequences. Aim — analysis of literature data on the pathophysiological mechanisms of polar stress, existing methods for its modeling in the experiment, informative biomarkers and prospects for dietary correction. Selection by keywords and analysis of literary sources using PubMed, Web of Science and Scopus online resources for the period, mainly, 2010–2022. The reaction to adverse environmental conditions in the Arctic is based on universal mechanisms associated with the excitation of midbrain centers (primarily the hypothalamus) with the development of a subsequent hormonal response from peptide hormones, corticosteroids, catecholamines, and thyroid hormones. The secondary targets of these effects are muscle tissue, endothelium, white and brown adipose tissue, cells of the immune system, in which changes occur aimed at neutralizing external adverse effects. A number of laboratory animal models have been developed to reproduce conditions associated with polar stress, including various types of acute, subacute and chronic cold exposure, as well as its combination with forced physical activity and additional stress factors. Sensitive biomarkers that allow monitoring the severity of polar stress are, firstly, the content of corticosteroids, catecholamines, neuropeptides, micro-RNA (miR-210) in blood plasma, organs and compartments of the brain, expression levels of uncoupling proteins (UCP) in brown adipose tissue, indicators of oxidative stress (lipoperoxide and malondialdehyde content, activity of antioxidant defense enzymes — GPX, GR, SOD, catalase and others), levels of bioantioxidants (vitamin E, ascorbic acid, carotenoids, GSH), cytokines and chemokines, including IL-1β, IL-6, IL-10, IL-17, IL-33, RANTES, FGF21 and various forms of their receptors, gene expression of signaling molecules (proteinkinases). In the issue of dietary correction of disorders caused by polar stress, the main place is given to the use of dietary antioxidant factors (vitamins E and C, selenium, zinc, coenzyme Q10, cinnamic acids and bioflavonoids). The data available in the world literature form the basis for further study of the molecular mechanisms of polar stress and pathogenetically substantiated methods of its dietary correction.

Annals of the Russian academy of medical sciences. 2022;77(6):447-457
pages 447-457 views


The Influence of Obesity and Sedentary Lifestyle on Testosterone Level and the Main Indicators of the Metabolic Status in Young Men

Osadchuk L.V., Osadchuk A.V.


Background. It is considered an established fact that there is an adverse trend in the male reproductive potential, which has been observed in various countries over the past decades. It is assumed that it can be formed due to the influence of individual lifestyle factors, in particular, a decrease in the level of physical activity and excessive nutrition, leading to obesity. However, the effect of obesity combined with sedentary or physically active lifestyle on the reproductive hormone level and metabolic homeostasis has not been studied well.

Aims — the aim of the work was to study the effects of obesity combined with sedentary or active physical lifestyle on the level of reproductive hormones and the main indicators of metabolic status of young men.

Methods. In young male volunteers (median age — 23 years, n = 295) from the general population, anthropometry was performed, which included body height and weight, waist and hip circumference, and body mass index (BMI); and they were also asked to fill out a questionnaire containing questions about individual lifestyle. In addition, serum concentrations of follicle stimulating and luteinizing hormones, testosterone, estradiol, inhibin B and triglycerides, total cholesterol, high and low density lipoprotein cholesterol, glucose, uric acid were evaluated.

Results. The most important lipid metabolism disorders observed in overweight and obesity included an increase in triglycerides, total cholesterol, low-density lipoprotein cholesterol and a decrease in high-density lipoprotein cholesterol. Overweight and obesity in men was accompanied by an increase in waist and hip circumference, a decrease in the serum level of testosterone and inhibin B reaching in obese men the testosterone values characteristic for hypogonadism. Sedentary obese men had the increased waist circumference, lower testosterone level (median — 13.6 vs. 18.0 nmol/L), elevated glucose level (median — 5.8 vs. 4.9 mmol/L) compared to physically active obese men or those who prefer sports or physical recreation.

Conclusions. In men, obesity negatively affects the serum level of testosterone and glucose, increases the accumulation of visceral fat, but a physically active lifestyle and sports give significant advantages to obese men, as it contributes to an increase in testosterone levels and normalization of metabolic parameters.

Annals of the Russian academy of medical sciences. 2022;77(6):458-466
pages 458-466 views

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