Vol 37, No 5 (2020)

Cover Page

Original studies

Mycoplasma as one of causal factors of exacerbation of community-acquired pneumonia

Shirinova F.V.


Objective. To improve the effectiveness of treatment in exacerbation of community-acquired pneumonia among military recruits with chronic inflammatory respiratory tract processes.

Materials and methods. The study included the data from 266 medical histories of military recruits aged 18-26, who had community-acquired pneumonia confirmed clinically and X-ray, as well as concomitant chronic respiratory diseases and a spectrum of isolated microorganisms in the sputum. When pneumonia worsened in patients who were admitted to the hospital, the level of blood serum antibodies to M. hominis was measured.

Results. The study results showed that in military recruits, suffering from community-acquired pneumonia with concomitant chronic respiratory diseases, in case of undetected microorganisms in the sputum, the measurement of blood serum IgM antibodies to Mycoplasma hominis has a clinical value.

Conclusions. Mycoplasma hominis occupies a special place in the etiological structure of pathology among patients with community-acquired pneumonia.

Perm Medical Journal. 2020;37(5):5-11
pages 5-11 views

Clinical laboratory and anamnestic features of extremely premature newborns with hemodynamically significant arterial duct

Porodikov A.A.


Objective. To study the clinical laboratory and anamnestic features in extremely premature newborns with hemodynamically significant functioning arterial duct.

Prematurity is an actual medical and social problem. Functioning arterial duct (FAD) is one of the most significant manifestations of cardiovascular system immaturity in extremely premature newborns.

Materials and methods. The study involved the data from 100 premature newborns (birth body mass 500 to 1500 and gestation age <32 weeks), who were born from October 2018 to April 2020 in Perm Regional Perinatal Center. According to standard EchoCG criteria, patients were divided into 2 groups: main group – patients with hemodynamically significant open arterial duct (HS FAD) and comparison group – those with insignificant FAD. All clinical laboratory studies were implemented on the third day of life.

Results. The main group included 46 extremely premature infants with hemodynamically significant FAD, the comparison group – 54 with hemodynamically insignificant FAD. Parity of labor reliably differed: 73.9 % (34/46) of mothers in the main group were primiparas and 40.7 % (22/54) in the comparison group, (p = 0.001). Pregnancy course with the threat of miscarriage was significantly more often noted in the main group – 73.9 % (34/46) of cases and 38.9 % (21/54) of cases in the comparison group, (р = 0.001). Comparative analysis of peripheral blood indices detected significant differences in thrombocytopenia, which occurred more often in the main group than in the comparison group: 52.2 % (24/46) versus 29.6 % (16/54), (p = 0.022).

Conclusions. Significant differences were established according to the parity of labor, threat of miscarriage. The threat of miscarriage reliably rises chances for giving birth to a child with HS FAD by 3.5 times, in the first labor the chance for giving birth to a child with HS FAD is increased by 4.3 times. Thrombocytopenia occurred more often in the main group versus the comparison group.

Perm Medical Journal. 2020;37(5):12-19
pages 12-19 views

State of lipid metabolism in patients receiving androgen replacement therapy

Popov P.S., Kournikova I.A., Torshin V.I., Malyutina N.N.


Objective. To assess the state of lipid metabolism indicators and predict cardiovascular risk in patients with secondary (acquired) hypogonadism on the background of androgen replacement therapy. Testosterone replacement therapy is often used in modern medicine for diagnosed androgen deficiency in patients of any age group. There are quite a lot of publications devoted to diagnosis and treatment, but the effectiveness and safety of any therapy is determined by several factors, of which two were considered in the presented study – dose-dependent effect and compliance.

Material and methods. Sixty two patients aged 30 to 52 years with androgen deficiency and a low risk of developing cardiovascular diseases were examined according to the Princeton Consensus criteria. Patients were divided into groups depending on the severity of androgen deficiency and the duration of therapy. Complaints, objective status, muscle strength, daily blood pressure and heart rate monitoring data, lipidogram and sex hormone indicators were evaluated.

Results. The obtained data suggest that androgen replacement therapy in doses that lead to an increase in the level of testosterone in the blood above the upper limit of reference values had a negative impact on the lipid spectrum and increased cardiovascular risk for this group of patients.

Conclusions. The analyzed approach to therapy of androgen deficiency should provide an individual adjustment of dosage on the background of determining the target blood testosterone level.

Perm Medical Journal. 2020;37(5):20-26
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Assessment of tuberculocidal efficiency of disinfectants according to manufacturers’ 'instructions and results of experimental studies using reference test strain mycobacterium terrae

Sergevnin V.I., Tukacheva O.V., Sibiryakova О.R., Sarmometov E.V., Ovchinnikov K.V.


Objective. The aim of the study was to investigate the tuberculocidal efficacy of disinfectants according to the manufacturers’ instructions and the results of experimental studies using a test strain of Mycobacterium terrae.

Materials and methods. The instructions for 150 disinfectants (DS) were studied. An experimental evaluation of the tuberculocidal efficacy of 6 DS was carried out using the reference strain M. terrae.

Results. A study of the documentation for the DS showed that from the number of DS produced before 2010, only 38.2 % of the drugs were recertified after 2010. Of these, only in 50.0 % of cases it was noted in the instructions that the recertification was carried out using the test microorganism M. terrae. From the number of DS produced after 2010, only 49.2 % of the drugs were certified using the M. terrae test strain. According to the results of laboratory assessment of DS, it was shown that drugs that did not pass re-certification using M. terrae have low tuberculocidal efficacy.

Conclusions. It has been established that many manufacturers of DS during certification and recertification of drugs do not test the modes of their tuberculocidal efficacy on the regulated microorganism M. terrae. In the course of laboratory assessment of the tuberculocidal effect of DS, it was confirmed that the least effective drug was the one that did not pass re-certification using M. terrae.

Perm Medical Journal. 2020;37(5):27-34
pages 27-34 views

Obstetric and gynecological anamnesis in postmenopausal women with ovarian tumors

Kobaidze E.G., Shashurina Y.A.


Relevance. Etiology, prevention and treatment of ovarian tumors in postmenopausal patients is an actual scientific issue.

Materials and methods. The paper presents the data of obstetric and gynecological anamnesis, obtained in retrospective study of case histories of postmenopausal patients with benign ovarian tumors (n = 120);

The data regarding patients’ basic complaints are given, the period from the moment of addressing for medical aid to the moment of surgical treatment was analyzed.

Results. The study results showed that ovarian tumors were predominantly diagnosed in patients at late menopause (stage +2 по STRAW+10, Stages of Reproductive Aging Workshop). In most patients, chronic inflammatory diseases of the ovaries and uterus neck were detected in anamnesis. It is important to note that for the examined patients, frequent combination of ovarian tumors with endometrial pathology was not typical, hyperplasia cases had mostly benign course, however atypical hyperplasia of the endometrium was verified in 3 patients out of 120. The basic complaints were pains in the lower parts of the abdomen. The time from the moment of addressing for medical aid to the moment of surgery was on average 5–6 months.

Conclusions. Ovarian tumors were predominantly revealed in patients of late postmenopausal age with concomitant gynecological pathology in anamnesis.

Perm Medical Journal. 2020;37(5):35-42
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Review of literature

Prospects of development in aortic surgery: literature review

Kadyraliev B.K., Arutyunyan V.B., Askadinov M.N., Kucherenko S.V.


Foreign sources of literature regarding the issue of aortic surgery are analyzed. Special attention is paid to aortic valve replacement using the Ozaki technique.

The first replacement of aortic valve cusps with synthetic material was implemented by H. Th. Bahnson in 1959; he implanted the neocusp from Teflon. Nowadays, so as to replace the aortic valve, mechanical, biological valves, homotransplants, autotransplants and valves imitated endovascularly are actively applied. All the above mentioned types of the valves have both merits and demerits, therefore each patient should have an individual approach. When choosing the prosthesis and type of surgical intervention, cardiosurgeons take into account the following factors: patient’s age, availability of concomitant diseases (atrial fibrillation, chronic renal disease, malignant tumors), presence of small aortic ring, aortic dilatation, availability of other valve diseases, infectious endocarditis, first or repeated surgery on the valve as well as pregnancy or planning of pregnancy. In 2007, Shigeyuki Ozaki proposed the technique for replacement of all aortic valve cusps from autopericardium treated with 0.6 % glutaraldehyde solution. This surgery permits to form the aortic valve with excellent hemodynamic characteristics and low rate of reoperation in the early and remote periods. Aortic valve replacement using Ozaki technique is a perspective technique and good alternative for surgical treatment of aortic valve along with prostheses.

Perm Medical Journal. 2020;37(5):43-51
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Aortic valve leaflet replacement using autopericardium as an alternative approach of aortic valve stenosis treatment: literature review

Askadinov M.N., Kadyraliev B.K., Lilotkhia S.H., Musaev O.G., Arutyunyan V.B.


Regarding degenerative defects of the aortic valve, the main method of treatment is dissection of malformed leaflets and placement of prosthetic valve. In most cases, mechanical and biological prostheses are used. Each type of prosthesis has shortcomings related to both the implantation technique and essential medication support to keep it functioning. Patients with implanted mechanical prosthesis need lifelong anticoagulation therapy and constant monitoring of blood coagulation rates, where on the one hand there is a risk of occurring thromboembolic complications, and on the other hand – haemorrhagic complications. The peculiarity of biological prostheses is a high probability of degeneration and the need for re-operation, especially in young patients, therefore the implantation of such prostheses is mainly carried out in elderly patients. Despite continuous change and modification of artificial valves, the ideal aortic valve prosthesis does not exist today. Various attempts to replace aortic valve leaflets with artificial and biological materials have not succeeded or gained great recognition. In 2007, Shigeyuki Ozaki introduced a technique to replace the aortic valve leaflets with an autopericardium treated with 0.6 % glutar aldehyde solution. Inspite of the encouraging mid-term results, this surgery has not yet become widespread among cardiac surgeons due to the complicated operating technique and lack of long-term results. Considering the research of literature, experience of different cardiosurgical centers in this field as well as our own experience, there is a need to systematize the results of Ozaki procedure, among patients with aortic valve pathology, presented in the recent publications.

Perm Medical Journal. 2020;37(5):52-60
pages 52-60 views

Features of using accelerated rehabilitation protocols in obstetrics: literature review

Benyan A.S., Nechaeva M.V., Kalinkina O.B., Tezikov Y.V., Aravina O.R., Stulova S.V.


Accelerated postoperative rehabilitation and reduction of hospitalization periods and faster recovery are modern principles of surgical treatment that are widely implemented in practical healthcare. This approach is especially relevant in obstetrics and gynecology, where the share of abdominal delivery reaches up to 80% in some countries of the world. The advantages of accelerated rehabilitation protocols to reduce the number of days of hospital stay, reduce postoperative pain, and need for analgesia, rapid recovery of bowel function, fewer complications, increased patient satisfaction. This approach has direct economic benefits for health care institutions and is carried out in the interests of the child. The article is a review of the available literature on accelerated rehabilitation and recovery of patients in the world practice, as well as the experience of implementation in some healthcare institutions of the Russian Federation.

Perm Medical Journal. 2020;37(5):61-78
pages 61-78 views

Methods of diagnosis and technologies

Preparation of primary glial tumor cell lines

Shamova T.V., Sitkovskaya A.O., Rostorguev E.E., Kuznetsova N.S., Kavitsky S.E.


Objective. The aim of this work was to obtain the primary cell lines of brain malignant tumors using the explant method.

Materials and methods. Thirteen patients of both sexes, aged 22 to 66, were recruited. The tumor material of the patients was fragmented and placed in flasks with complete nutrient medium for glial tumor cells. Subsequently, the material was photographed at various stages of cultivation, the cell morphology was determined, and the rate of monolayer formation at the zero and first passages was assessed.

Results. As a result, thirteen primary human cell lines of glial tumors were obtained: six glioblastoma lines, two glioblastoma lines with anaplastic astrocytoma, one anaplastic oligodendroglioma line, one diffuse astrocytoma line, one oligoastrocytoma line and one diffuse protoplasmic astrocytoma line, one anaplastic astrocytoma line. In the culture of diffuse astrocytoma, there were observed the cells forming a network at the bottom of the flask. In the culture of anaplastic astrocytoma at a confluence of 30–50 %, fibroblast-like cells were presented, and at a confluence of 100 %, a monolayer was formed with cells intimately adjacent to each other. In the culture of oligoastrocytoma, both fibroblast-like cells and islets of closely intertwined fusiform cells were observed. The same was typical for the cells of diffuse protoplasmic astrocytoma. Anaplastic oligodendroglioma during the first week of cultivation was represented mainly by round cells with a contrast agent, which subsequently attached and actively proliferated. At a confluence of 30–80 %, fibroblast-like cells were observed, and at 100 %, spindle-shaped cells closely adjacent to each other. In cultures of glioblastomas, no specific character of cell growth was revealed: spindle-shaped, fibroblast-like cells and cells with long processes forming a network were encountered. Glioblastoma cultures against the background of anaplastic astrocytoma were represented by a network of cells with long processes.

At the zero passage, the rate of formation of a 100 % confluence monolayer ranged from 22 to 85 days. At the first passage, the cells reached a full monolayer within 4 to 25 days. At the zero passage, the longest time among all the samples to form the monolayer with a 100 % confluence needed glioblastoma lines – on average 59 days. The shortest time to reach a 100 % confluence was required for cells of diffuse astrocytoma, anaplastic oligodendroglioma and glioblastoma against the background of anaplastic astrocytoma – 22–24 days.

Conclusions. In our work, it was shown that the explant method ensures the production of viable cells of glial tumors and the possibility of their further cultivation.

Perm Medical Journal. 2020;37(5):79-89
pages 79-89 views

Practical significance of remote functional diagnosis methods in system of “Russian railways – medicine” of Sverdlovsk railway

Yui N.D., Malyutina N.N., Chernikova D.A.


Objective. To estimate the efficiency of using remote technologies and provision of unique service of functional diagnosis in the framework of corporative system of the net of medical institutions, territorially distant from each other.

Nowadays, a wide introduction of IT-technologies in medicine has a perspective and priority significance in conditions of unfavorable epidemiological situation including sickness rate of a new coronavirus infection COVID-19.

Materials and methods. The efficiency of remote methods was analyzed and assessed using the results of studies among the workers of “RZhD” and contractual enterprises.

Results. Remote consultations permit to increase the number of applied methods of investigation, give the opportunity to obtain qualified conclusions, consolidate information in general database allowing to fill up medical staff deficiency.

Conclusions. Thus, patients obtain operatively made unified medical conclusions, which are transferred via defended channels of “Internet”.

Perm Medical Journal. 2020;37(5):90-94
pages 90-94 views

Preventive and social medicine

Personal features and functional state of organism in railway power dispatchers

Serikov V.V., Rubtsov M.Y.


Objective. The work of railway power dispatchers requires high professionalism. Criteria of successful work are health status, level of psychoemotional tension and adaptability, situational functional status. Assessment of significance in providing professional capacity for work and determination of personal psychological characteristics is of special interest.

The aim was to analyze the functional state of an organism and personal psychological parameters in railway power dispatchers so as to determine the possibility of their use as criteria for evaluating stress tolerance and capacity for work including gender features.

Materials and methods. The studies on express diagnosis of functional state and individual psychological testing using the method of Cettell’s sixteen-factor personality questionnaire were implemented among 59 power dispatchers (36 men and 23 women; mean age 40.17 ± 1.37years, record of service 13.4 ± 1.3 years)

Results. Express testing of functional state showed the presence of chronic fatigue, distress state and other unfavorable changes in the functional state. Statistically significant differences among the errors while implementing the task by men and women (p < 0.05) demonstrate the deeper manifestations of professional stress in women power dispatchers. The obtained data regarding psychological characteristics of power dispatchers mainly satisfy the requirements for implementation of their duties including the tension of labor of class 3.2 regarding communicative and intellectual properties as well, but there was detected the risk for changed emotional and regulatory properties of a person connected, probably, with fatigue and overfatigue as manifestations of professional stress that can cause reduction of the capacity for work.

Conclusions. There was demonstrated an adequacy of using the methods for assessment of functional state and psychological parameters of a person as additional criteria for estimation of stress tolerance and capacity for work including gender features.

Perm Medical Journal. 2020;37(5):95-104
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Anniversaries and information on events

Professor Vladimir Nikiforovich Savelyev – 85th anniversary

Popova N.M., Shubin L.L., Shabardin A.M.


The paper presents a description of life, scientific and professional way of V.N. Savelyev – a surgeon, Minister of Public Health of the Republic of Udmurtiya, Professor of the Department of Public Health and Healthcare, a teacher.

Perm Medical Journal. 2020;37(5):105-111
pages 105-111 views

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