Bulletin of RSMU

ISSN Print 2500–1094 ISSN Online 2542–1204

Bulletin of RSMU

BIOMEDICAL JOURNAL OF PIROGOV UNIVERSITY (MOSCOW, RUSSIA)

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Gerasimova AA, Klimenko PA

The problem of ovarian tumor differential diagnosis is solved using comprehensive ultrasound examination at different levels of efficiency. However, ultrasound imaging is an operator-dependent technique due to subjective interpretation of results. The study was aimed to assess the ultrasound signs of benign and malignant ovarian germ cell tumors (OGCTs) in pregnant women in order to determine the feasibility of surgical treatment and chemotherapy. The study was carried out using the logistic regression models. A group of 199 pregnant women with benign and malignant OGCTs were enrolled. Of them, 183 patients had benign, and nine patients had malignant tumors. In order to assess menstrual function and fertility, seven pregnant women were enrolled, who had previously received treatment for malignant OGCTs. Pre-operative assessment results were compared with morphological assessment data. Organ-preserving surgical treatment was performed (unilateral adnexectomy); if necessary, the patients received cisplatin-based chemotherapy. Perinatal outcomes were assessed. The median observation time between the malignant OGCT detection and the end of the study was 66 months (12–240 months). It was found that comprehensive ultrasound examination and logistic regression models (sensitivity 100%, specificity 92.3%, overall accuracy 92.8%) enabled differential diagnosis of benign and malignant OGCTs. The number of unnecessary surgical procedures in patients with benign OGCTs was been limited, the pregnancy and childbirth outcomes were improved. Nine pregnant women received organ-preserving surgical treatment for malignant OGCTs, and three patients received chemotherapy after surgery, which allowed the patients to realize their reproductive potential.

Received: 2021-03-15

Published online: 2021-04-28

DOI: 10.24075/brsmu.2021.018

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VIEWS 2435

Kopetskiy IS, Meskhiya NG, Kopetskaya AI, Eremin DA, Orekhova DD

Changing the vestibulo-oral inclination (torque) of the frontal teeth is an important component of orthodontic treatment. Cone-beam computed tomography is recommended as an accurate diagnostic tool allowing the orthodontist to estimate the safety of frontal tooth movement and inclination. This tool is helpful in measuring bone thickness at different levels of the tooth root and estimating incisal inclination and position. The aim of our study was to analyze bone thickness in patients with pathologically and normally inclined teeth using CT images and to create a universal table that will provide useful information about the thickness of the bone around different segment of the root required for a safe change in tooth inclination. Using the proposed table, the orthodontist can assess the feasibility of the planned tooth movement in the setting of changed tooth inclination, with due account of critical bone deficit regions. This will ensure the safety of tooth movement, stable retention and a positive treatment outcome.

Received: 2021-03-16

Published online: 2021-04-27

DOI: 10.24075/brsmu.2021.015

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VIEWS 2362

Masyutina AA, Gumenyuk LN, Fatovenko YuV, Sorokina LE, Bayramova SS, Alekseenko AI, Shavrov YuV, Romanova AA, Seydametova DI

The relationship between the gut microbiota and chronic insomnia remains understudied. The aim of this paper was to investigate changes in the taxonomic composition of the gut microbiota and their associations with the levels of cortisol, melatonin and IL6 in patients with chronic insomnia. Our comparative prospective cross-sectional study enrolled 55 patients with chronic insomnia, who formed the main group (female patients: 58.2%, male patients: 41.8%; mean age 31.6 ± 7.4 years), and 50 healthy volunteers, who comprised the control group (females: 68.0%, males: 32.0%; mean age 33.2 ± 6.6 years). The taxonomic composition of the gut microbiota was profiled using 16S rRNA gene sequencing. Plasma cortisol and IL 6 and urine melatonin were measured by means of ELISA. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). In patients with chronic insomnia, the abundance of Faecalibacterium (p = 0.048), Prevotella 9 (p < 0.001) and Lachnospira (p = 0.036) was lower, whereas the abundance of Blautia (p = 0.012) and Eubacteriumhallii (p = 0.003) was higher than in healthy volunteers. Significant correlations were established between the levels of IL6 and the abundance of Faecalibacterium (r = –0.44; p = 0.001) and Blautia (r = 0.42; p < 0.001), as well as between cortisol concentrations and the abundance of Lachnospira (r = –0.41; p = 0.048). The abundance of Faecalibacterium and Blautiaс was correlated with higher PSQI (r = –0.47, p = 0.001; r = 0.45, p < 0.001, respectively). Our study contributed to the pool of data about changes in the gut microbiota and their associations with some endocrine and inflammation markers in patients with chronic insomnia. These data can be exploited to propose new strategies for the diagnosis and personalized treatment of insomnia aimed at normalizing the patient’s gut microbiota.

Received: 2021-03-07

Published online: 2021-04-27

DOI: 10.24075/brsmu.2021.017

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VIEWS 2756

Ishikhov IM, Kolomiets KV, Gamidov FM, Gantsgorn EV

Lacertus fibrosus entrapment of the median nerve at the elbow, or Lacertus syndrome, is a rare pathology, which is difficult to detect by instrumental examination methods. Literary sources provide no information on the syndrome prevalence, as well as on precise diagnosis and treatment algorithms, which makes it difficult to establish the diagnosis and appoint the effective treatment. Lacertus syndrome is characterized by positive scratch collapse test; differential diagnosis is required to distinguish it from carpal tunnel syndrome. Clinical case of bilateral lacertus fibrosus entrapment of the median nerve at the elbow is reported, Lacertus syndrome diagnosis criteria and surgical treatment method are set out. The results of the surgical tactics used are as follows: pain, paresthesia and numbness in the innervation field of the median nerve have vanished, the muscle strength has been restored to level М5 in accordance with MRC muscle strength scale. These results demonstrate high efficiency of the proposed lacertus syndrome surgical treatment.

Received: 2021-03-16

Published online: 2021-04-25

DOI: 10.24075/brsmu.2021.016

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VIEWS 2852

Osmolovsky IS, Zarubina TV, Shostak NA, Kondrashov AA, Klimenko AA

Gout is a chronic systemic disease characterized by the deposition of monosodium urate crystals in various tissues and inflammation. In Russia, time to diagnosis may be as long as 8 years. This leads to serious complications, such as urate nephropathy, and disability. Effective strategies are needed to improve the quality of medical care for gout patients. One of such strategies is creation of an expert system to aid the clinician in establishing the diagnosis and selecting adequate therapy. The cornerstone of an expert system is a knowledge base. The aim of this paper was to develop a medical nomenclature and algorithms for the diagnosis and treatment of gout that will be used to create an expert system in the future. A total of 1,174 entities were selected that laid the basis for 40 diagnostic and 50 treatment algorithms for gout patients. All informational models were verified by the expert panel.

Received: 2021-03-03

Published online: 2021-04-17

DOI: 10.24075/brsmu.2021.014

Comments 0

VIEWS 2554

Ivashchenko AV, Yablokov AE, Tlustenko VS, Postnikov MA, Popov NV, Tlustenko VP, Tugushev VV, Cherezova NI, Mukhina AA, Belanov GN

In the early 21st century, robot-assisted dental implant surgery became a popular alternative to classic implant placement protocols. Postoperative complications are often provoked by poor compliance with surgical guidelines for implant placement, resulting in the overheating of the osteotomy site. The aim of this study was to measure the temperature of osseous tissue at the dental implant site during classic and robot-assisted dental implant placement performed at different cooling modes. Avital skeletonized mandibles of Vietnamese pot-bellied pigs were used as an experimental model. The recipient bed was prepared following the classic surgical protocol. Three cooling modes were tested: no irrigation, irrigation with sterile saline at 25–30 ml/min and standard 75 ml/min irrigation recommended by the standard surgical protocol. The temperature of the isotonic solution was 25 °С. The study showed that both classic and robot-assisted dental implant placement techniques are safe if there is sufficient irrigation and good compliance with the surgical protocol.

Received: 2021-02-08

Published online: 2021-04-08

DOI: 10.24075/brsmu.2021.013

Comments 0

VIEWS 2483

Khramov VV, Kogaeva KP, Arkhipova LU, Alekseeva VO, Lukyanova MI

The importance of post-stroke rehabilitation cannot be overestimated. The aim of this study was to assess the effectiveness of a standardized post-stroke rehabilitation program for patients with moderate impairments. A total of 122 stroke survivors participated in the study. Group 1 (the comparison group) consisted of 59 patients undergoing standard rehabilitation. Group 2 (the main group) consisted of 63 patients participating in a specially designed social rehabilitation program. The functional, cognitive, psychological and emotional states and the level of social activity were monitored for 6 months. Group 2 demonstrated more pronounced improvement than group 1 after 6 months of follow-up, confirmed by higher Rivermead (p = 0.011) and SS-QOL (p < 0.05) scores and lower DASH and Beck scores (p = 0.015 and p < 0.001, respectively). In both groups, MMSE (cognitive function) scores slightly increased, but the differences between the groups were insignificant. The proposed post-stroke rehabilitation program is effective in helping patients regain their independence and improve social adaptation. The scales and scores used in the study, especially DASH and SS-QOL, are sensitive to changes in the functional state of stroke survivors with moderate impairments.

Received: 2021-02-25

Published online: 2021-03-31

DOI: 10.24075/brsmu.2021.012

Comments 0

VIEWS 2546

Gaydin TY, Rozhnova SA

The problem of compulsory licensing (CL) in the pharmaceutical industry is being discussed worldwide. The aim of this paper was to analyze the effects of using CL for pharmaceutical drugs (PD) as part of competitive policies aimed at safeguarding the life and health of the population. Using PEST-analysis, we identify the main political, economic, social and technological problems associated with using CL in the pharmaceutical industry. We demonstrate the potential of CL as a tool for countering the threats to public health caused by the abuse of market dominance by pharmaceutical patent holders. At present, both developers of pharmaceutical innovations (patent-holders) and other entities involved in drug circulation are protected by law. There is ongoing debate about the efficacy of CL as a tool ensuring the implementation of competitive policies aimed at safeguarding the rights to life and health. However, in Russia CL is applied only under exceptional circumstances. An economic balance should be sought between the incentives for innovation, long-term profits from selling PDs and PD accessibility.

Received: 2021-02-09

Published online: 2021-03-09

DOI: 10.24075/brsmu.2021.011

Comments 0

VIEWS 2633