Vol 79, No 2 (2024)

Flexible workday arrangement is a common management practice in the modern technology intensive society. The impact of shift work in night hours on human health has been a subject of a broad range of fundamental and applied studies in occupational medicine and in other fields. Epidemiological data and a body of research findings suggest that shift workers are prone to various pathologies. This paper summarizes current views on the link between shift and night work and the risk of chronic noncommunicable diseases (NCDs), which are a leading cause of morbidity and mortality among working population and are therefore a top priority. Systematic reviews and meta-analyses present strong evidence that shift workers have a higher risk of malignant tumors (breast cancer, prostate cancer, colorectal cancer), coronary heart disease, and type 2 diabetes compared to daytime-only workers. There are, however, individual differences in the risk of NCDs that may depend on the length of employment and other circumstances. Also, factors are discussed that can modify the impact of shift work on the risk of associated pathologies, such as chronotype, changing length of night shifts, proper shift rotation, sufficient rest between shifts, etc. Mechanisms of genetic regulation of individual circadian rhythms and sleep-wake cycle are a crucial element in the conceptual model of influence of night work on body. Insufficient adaptation and plasticity of the circadian system may cause desynchronization between external time and inner biorhythms in shift workers; this is accompanied with changes in circadian genes expression and may lead to pathologies. If disturbed circadian rhythms are the main factor of etiopathogenesis, the term “circadian-related disease” should be used. Deep understanding of the link between circadian desynchronosis and health problems in shift workers is important to implement ‘circadian safety’ measures, i.e. to protect workers from negative consequences of disturbed individual biorhythms that may affect their work capacities and life quality. This will require standard protocols to study circadian disturbances, standard tools and methods to diagnose circadian rhythms in workers, resolving issues of interpretation in respect of occupational capacity, research on proneness and tolerance of workers to circadian-related problems, finding pharmacological and physical approaches to reduce circadian disturbances, considering special aspects of drug therapy of desynchronosis.

Background. Sarcopenia is a generalised, progressive decline in skeletal muscle mass, strength and performance leading to reduced quality of life, increased risk of falls, hospitalisation and mortality. Primary sarcopenia results from age-related changes in muscle tissue. In certain cases, sarcopenia develops secondary as a consequence of diseases including ulcerative colitis (UC), which is associated with a systemic inflammatory process, malabsorption syndrome, restriction of patients’ physical activity and nutrient deficiencies. The term “dynapenia” or “probable sarcopenia” has been proposed to describe the decrease in muscle strength. Studies have demonstrated that muscle strength is a more relevant marker for predicting adverse outcomes because its measurement is more practical, whereas muscle mass is technically difficult to measure.

Aims — to increase the effectiveness of the diagnosis of dinapenia, to assess the prevalence and risk factors of its formation in patients with UC.

Methods. A single-centre, observational cross-sectional study included 80 UC patients. To identify factors associated with the development of dinapenia, patients with dinapenia were compared with patients without dinapenia. The investigated parameters in patients: sex, age, body mass index, peculiarities of the course of the disease, ongoing treatment, concomitant pathology, peculiarities of nutrition, nutritional deficiency, malabsorption syndrome, bad habits, psychological stress and sleep duration, physical activity, laboratory indicators of inflammation, myokine-adipokine profile. Statistical parameters were calculated using Statistica 10.0.1011.0 programme.

Results. Dinapenia is present in 32.5% of UC patients. Risk factors for the formation of dinapenia in UC patients include female sex (p = 0.0003); nutritional insufficiency (p = 0.021); low physical activity (p = 0.010); artificial feeding in infancy (p = 0.024); inflammation, namely C-reactive protein, autoantibodies of class G against double-stranded DNA (p = 0.006; p = 0.002 respectively). Patients with UC with dinapenia significantly more often gave a positive answer to the questionnaire question “Does daily activity cause you a lot of stress?” (p = 0.048). In the group of UC patients with dinapenia, the level of cortisol in evening saliva was significantly higher than in the comparison group (p = 0.005).

Conclusions. Sarcopenia and UC are multifactorial conditions with common developmental mechanisms that can burden each other. Dynamometry is not technically difficult and is justified from an economic point of view. The timely detection of dinapenia and its correction will additionally affect the mechanisms of UC pathogenesis in order to improve the quality of life and prognosis of patients.

Background. Chromosomal abnormalities of the embryo are the most common cause of miscarriage. However, at least 100 thousand cases of repeated pregnancy losses occur annually in the world, in which cytogenetic methods determine the chromosome euploid set in the abortive material. One of the causes of miscarriage is probably the loss of function of certain genes. It is assumed that the detection of genetic factors determining the etiology of pregnancy loss can help to develop personalized methods of diagnosis and preconception care in cases where the classical approach with chromosomal analysis is insufficient.

Aims — to analyze the experience of genetic testing of euploid embryos and identify the most significant genetic variants in miscarriage.

Methods. A search was conducted for sources of scientific literature in the PubMed and RSCI (elibrary) databases. The search for full-text articles was carried out on the websites of journals and using the ResearchGate database. The review included articles published in peer-reviewed scientific publications in the period from 2013 to 2023.

Results. Studies conducted on animals and analysis of human embryos during miscarriage have revealed a list of genes which loss of function may be associated with embryolethality. Analyzing the data of the scientific literature, we concluded that a number of genes potentially related to miscarriage can lead to various diseases in the postnatal period.

Conclusions. Scientific research aimed at finding monogenic causes of miscarriage is of great scientific and practical importance, since it can contribute to improving the algorithm of examination and pre-conception preparation of married couples with a history of pregnancy loss.

Background. Given the high prevalence of Bordetella pertussis, patients with respiratory disorders are at risk of getting infected with this pathogen and developing pertussis. Therefore, they should be considered a target group for vaccination against this infection.

Aims — the objective of the study was to assess vaccine-induced immunity against pertussis in lung transplant candidates.

Methods. Twenty-four patients with severe bronchopulmonary diseases, aged 18 to 60, were vaccinated against pertussis with Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine. Five patients underwent lung transplantation. Immunoglobulin G (IgG) antibodies (Abs) were measured using the RIDASCREEN^® Bordetella IgG test system.

Results. In the post-vaccination period, only 8.3% of the patients developed such local reactions as tenderness and induration at the injection site. The proportions of patients who were seropositive for pertussis before vaccination, one month and one year after vaccination were 71, 100 and 100%, respectively (p = 0.02). A significant increase in anti-pertussis IgG Ab levels was identified one month after a single vaccine dose, and was still observed after 12 months. In the group of two-dose vaccination, there was no statistical difference between the levels of IgG Abs one month after the first dose and one month after the second dose. A significant increase in anti-Bordetella pertussis IgG Ab levels was observed in the group of initially seronegative patients compared to seropositive patients (p = 0.03). A year after vaccination, there was no statistically significant difference in IgG Ab levels between the patients with and without a history of lung transplantation.

Conclusions. The majority (71%) of patients with severe bronchopulmonary disease was seropositive for B. pertussis. Single-dose vaccination against pertussis was safe; it induced the production of additional specific Abs and an increase in their levels in all patients. Therapy administered after lung transplantation did not significantly affect the levels of vaccine-induced Abs.

Atrial fibrillation (AFib) and chronic heart failure (CHF) are frequently encountered cardiovascular conditions that share common causes and tend to coexist in some patients. Such coexistence represents a major issue due to augmentation of symptoms severity, rapid deterioration, and poor prognosis. Management of patients with AFib and CHF is challenging due to limitations in pharmacotherapy and decreased efficacy of cardiac interventions. In this review we focus on crucial pathogenic components of AFib and CHF coexistence, key treatment approaches and discuss potential for implementation of artificial intelligence.

Background. The surgical stage remains the main one in the combined and complex treatment of breast cancer. Radical mastectomy and reconstructive plastic surgery are the main option for surgical treatment of vast majority patients. Radiation therapy can lead to the development of complications after breast reconstruction, and vice versa, the reconstructed mammary gland can cause technical difficulties for the radiologist to properly adjust the required dose of irradiation.

Aim — to choose the optimal method of breast reconstruction using various implants, as well as endoprostheses to minimize post-radiation complications and maintain a high level of quality of life for patients after breast cancer treatment.

Methods. The retrospective study was conducted in the department of oncology and reconstructive plastic surgery of the breast and skin in the P.A. Herzen Moscow Research Oncology Institute from June 2013 to November 2017. There were performed 132 operations: 111 subcutaneous mastectomy with one-stage reconstruction with an endoprothesis and 21 mastectomy with a one-stage reconstruction with an endoprothesis. The distribution by stages: I — 57, IIA — 39, IIB — 17, IIIA — 13, IIIC 4; 2 cases of breast sarcoma. Prophylactic mastectomy of the contralateral gland was performed in 22 patients, mastopexy in 8, augmentation in 20. Polyurethane implants were applied in 82 cases (62%). Radiation therapy was performed in 47 patients with total dose 45 Gy. Bilateral reconstruction was performed in 22 patients.

Results. The mean follow-up period was 28.44 ± 14.66 months (from 6 to 48 months). The most frequent complication in the postoperative period was the development of capsular contracture: seroma — 20 patients, hematoma — 2, edge necrosis — 6, protrusion — 6, infection — 2 patients. The most common capsular contracture by Baker was III degree, n = 18. The average period of development of capsular contracture was 7.6 ± 11.65 months.

Conclusion. Despite the greater number of complications during the one-stage reconstruction, the implants remain in advantage in choosing a method of treating breast cancer by both the patient and the surgeon.

Background. The using of artificial intelligence (AI) in healthcare has particular importance for primary medical care. The market for AI in healthcare is actively developing, and Russian companies offer their products and services in this area. The federal project to create a single digital contour in healthcare includes the implementation of medical devices based on AI technology in healthcare of the regions of the Russian Federation. The AI services may or may not be medical devices. It is necessary to understand the organizational and economic effects for the healthcare system and a certain medical organization in order to select a service. There is no consolidation of regional experience on AI-enabled services in healthcare in the Russian Federation today.

Aims — consolidation of experience in the using of the AI services in healthcare sector in the regions of the Russian Federation.

Methods. We conducted an online survey of representatives of regional executive authorities and medical information and analytical centers in the regions of the Russian Federation through the “Yandex Forms” platform and also they were interviewed.

Results. We surveyed 84 regions of the Russian Federation to consolidate the experience of using the AI services, and the information on Moscow was obtained from open sources. The analysis showed that the AI services that are not medical devices are more common than the AI services that are medical devices. Based on the results of the study, we have formed a classification of the AI services that are not medical devices used in healthcare in the Russian Federation, identified the reasons why, according to the regions, it is difficult to implement the AI services, as well as determined the conditions of use of the AI services that are not medical devices.

Conclusions. On the basis of the study, we determined the algorithm for the implementation of the AI services in the Russian healthcare.

Background. Despite the fact that the study of the olfactory system is still difficult, the detection of dysosmia is promising for the diagnosis of a number of diseases. As a screening method, tests for the identification of various odors can be used. However, similar tests are developed and used for adults. In pediatrics, the use of such methods causes difficulty due to the cognitive and linguistic functions of the child, which are in the stage of development.

Aim — to study olfactory function in children using an identification test.

Methods. A diagnostic prospective study of 30 healthy children with no complaints of decreased olfactory function, living in the middle zone of the Russian Federation, mainly in the Moscow Metropolitan area, aged 11 to 14 y.o. was held. All children underwent a study of olfactory function using the University of Pennsylvania Smell Identification Test (UPSIT). To control all children, olfactometry was performed using a patented method for assessing the thresholds of olfaction in children, based on the use of various concentrations of aqueous solutions of valerian tincture, ammonia and acetic acid.

Results. In the study of sense of smell with the help of an UPSIT test, hyposmia was detected in 30% of children, which was not confirmed later with the help of a threshold test. At the same time, when presenting some odorants, most of the answers were incorrect.

Conclusions. The use of olfactory tests developed for adults in children does not reflect the real state of the olfactory system. It is required to create kits for the study of the olfactory function specifically for the children’s category of patients.