Vol 35, No 3 (2018)

Cover Page
Articles
Postoperative extremity metallosteosynthesis complications
Samartsev V.A., Kadyntsev I.V., Voluzhenkov E.G.
Abstract

Aim. To carry out the qualitative analysis of metal implant, inserted into the bone, determine tactics for treatment of inflammatory process in the postoperative period of metallosteosynthesis.

Materials and methods. The treatment of 1325 patients with the developing posttraumatic osteomyelitis of the upper and lower extremities in the Department of Complicated Traumatology of City Clinical Hospital № 6 and traumatology departments of Perm for 10 years (2004–2014) was analyzed.

Results. Metallosis was observed in 227 (17.2 %) persons. Matallosis was manifested by suppuration and fistula formation in the region of screw 2–3 months after operative treatment of fracture in 177 (76.3 %) patients, and in 50 (27.7 %) patients – by acute purulent inflammatory process immediately after the surgery. In 34 (15 %) patients, computed tomography and MRI demonstrated metal bone impregnations. All these 227 (17.2 %) patients underwent elimination of metal constructions. The postoperative wounds after elimination of metal constructions healed primarily in 152 (66 %) patients. Secondary healing of the postoperative wounds was noted in 75 (44 %) persons. The long-term results were studied during 3 years in 189 (83 %) patients. The development of the postoperative osteomyelitic process, connected with late removal of metal construction, was registered in 8 (4.4 %) persons. False joint was formed in 1 (0.5 %) patient with tibial fracture. Positive long-term result was reached in 180 (95.2 %) persons.

Conclusions. Timely diagnosis, correctly chosen technique of treatment permit to provide full restoration of the structure and function, and obtain positive medical and social rehabilitation in this category of patients.

Perm Medical Journal. 2018;35(3):5-8
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Significance of biomechanical indices assessment in orthopedic correction of motor disorders in patients following cerebral stroke
Schekolova N.B., Bronnikov V.A., Ladeischikov V.M., Zinoviev A.M.
Abstract

Aim. To study the biomechanical peculiarities of orthopedic disorders in patients after cerebral stroke and estimate possibilities for their correction.

Materials and methods. One hundred and thirty two persons in the late rehabilitation period after the cerebral stroke were examined. The state of loco-motor system biomechanics was assessed, using the rehabilitation complexes “TRUST-M” and “ST-150”.

Results. The late rehabilitation period of stroke was characterized by decrease in walking rate and time, rise in step cycle. Speed of movement was disturbed. Combined pain, spasticity, contracture and functional asymmetry of the extremities length determined the formation of individual variant of patient’s pathological locomotor stereotype. When implementing correlation analysis, marked correlation between the severity of orthopedic disorders and the asymmetry of pelvis and extremities length was detected. To correct biomechanical disorders, it was recommended to use complex orthopedic treatment by means of prosthetic-orthopedic devices, which permitted to move and provided stable holding of extremity segments in the desired position.

Conclusion. 1. Biomechanical indices characterize the severity of orthopedic pathology in the late rehabilitation period following cerebral stroke. 2. Biomechanical disorders are connected with decreased walking rate and time, raised step cycle, impaired speed of movement. 3. Timely biomechanical orthopedic diagnosis and adequacy of applying prosthetic-orthopedic devices guarantee efficiency of rehabilitation measures in patients after cerebral stroke.

Perm Medical Journal. 2018;35(3):9-14
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Opportunities of magnetic resonance imaging in diagnosis of microstructural changes of articular cartilage in osteoarthritis
Kabalyk M.A.
Abstract

Aim. To estimate the opportunities of proton density-weighed magnetic resonance tomograms in diagnosis of microstructural changes of articular cartilage (AC) in osteoarthritis (OA) on the basis of proton density (PD) variability analyzed.

Materials and methods. Sixty two patients with OA and 8 volunteers without OA were examined. All the patients underwent MRI of the knee joints, using tomograph with magnetic field intensity equal to 1.5 tesla. To assess MR images, semiquantitative measurements of articular tissues on the basis of WORMS protocols were used. To estimate the proton density, manual segmentation of PDFS-weighed images of the knee joint medial condyle was implemented. The proton density was estimated, applying 3-D histogram (0–255).

Results. At stage I of osteoarthritis, fall in density H+ in the peripheral zone of AC was observed, but it was preserved in the contact part, exposed to maximum statodynamic loadings. At stage II, significant progressing decrease in H+ density peaks in the AC regions, subjected to lesser loads, with preservation of high spectral peaks in the region of elevated friction was stated. Stage III of gonarthrosis was characterized by decrease in H+-spectra as a whole, especially in the loading regions of AC. At stage IV of OA, global reduction in PD intensity was observed along the whole cartilaginous plate surface.

Conclusions. The detected patterns of changes in proton density spectra reflect the known degenerative process in AC with osteoarthritis. This property of proton-weight MR-images can be used for assessment of microstructural changes in the articular cartilage with OA.

Perm Medical Journal. 2018;35(3):15-23
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Significance of biochemical markers in diagnosis of bone remodeling disturbances among diabetic mellitus persons
Safarova S.S.
Abstract

Aim. To assess the influence of changes, observed in men and women with type 1and 2 diabetes mellitus (DM1, DM2) on the state of bone metabolism markers; to determine the directions of changes in bone remodeling serum markers among patients of both genders, suffering from this disease.

Materials and methods. The cross-sectional study of patients, diagnosed DM1 (n = 98) and DM2 (n = 137) was conducted; the control group included 82 persons. In all patients, calciotropic hormones, the serum markers of bone remodeling, were studied.

Results. The obtained results, regarding assessment of bone metabolism markers content in blood of DM1 and DM2 patients compared to the control, indicated the presence of pathological changes in bone remodeling processes in the form of decrease in osteogenesis marker PINP for patients with DM1 by 16 %, DM 2 – by 12 %, compared with the control group, and increase in bone resorption marker b-CTx in 32 % of patients with DM1 and 25 % with DM2; inconsistency of changes in bone remodeling processes in DM1 patients, with preferential alterations of bone resorption indices, was determined in 28 % of cases. Patients with DM2 had lower PINP and b-CTx levels that reflects the lower bone tissue metabolism, compared to DM1 patients, irrespective of age and duration of disease.

Conclusions. The bone mass loss in the majority of the examined patients with diabetes is connected with suppression of osteogenesis and to a significantly lesser extent – with bone tissue resorption. Bone remodeling marker values in patients with DM2 are lower than with DM1. Such factors as glycemic profile compensation, duration of diabetes and presence of diabetic nephropathy are able to influence bone metabolism.

Perm Medical Journal. 2018;35(3):24-31
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Improvement of reparative regeneration in surgery
Plecheva D.V., Okroyan V.P., Ibragimov T.R., Galimov O.V., Khanov V.O.
Abstract

Aim. To improve the reparative tissue regeneration, applying oxymethyluracil in surgical patients.

Materials and methods. The impact of 5-oxymethyluracil-2,4-dioxo-5-hydroxy-6-methyl-1,2,3,4-tetrahydropirimidine (5-OMU) on the processes of regeneration stimulation in the tissues was studied in 4 groups, including different organs and systems of the body. The analysis of the results of using 5-OMU for torpid wounds in general surgery included 145 patients, erosive-ulcerous lesion of the upper parts of gastrointestinal tract – 126, reparative surgeries on GIT – 105 and revasculizing interventions on the heart – 63. To develop experimental models, mature rats, aged 11–12 months, with the body mass 2.9 ± 1.7 kg were used. Two sets of experiments with cut and burn wounds were implemented.

Results. The experimental studies, aimed at investigation of histological and histochemical preparations, demonstrated positive influence of oxymethyluracil on the healing of skin wounds.

Conclusions. On the basis of the studies carried out, the preparation is also recommended for use in other fields of surgery for the treatment of erosive-ulcerous lesions of the upper part of gastrointestinal tract, for intestinal anastomoses and when performing revasculizing surgeries on the heart. Different drug forms of this preparation were developed to reach its maximum concentration in the tissues, clinical trials were conducted and its efficient use in clinical practice was confirmed.

Perm Medical Journal. 2018;35(3):32-38
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Informative value of McIsaac scale for diagnosis of pediatric scarlatina
Permyakova A.V., Lvova I.I., Pospelova N.S., Galimova A.I.
Abstract

Aim. To estimate the statistical indices of informative value of clinical McIsaac scale at the example of scarlatina in children.

Materials and methods. Retrospective cliniсostatistical analysis was carried out on the basis of 30 medical cards of children, hospitalized to children’s unit of Perm Regional Clinical Infectious Hospital in 2017 with diagnosis of scarlatina. The control group consisted of 25 children with moderately severe tonsillopharyngitis.

Results. Clinical peculiar features of scarlatina were studied in 30 children, hospitalized to children’s infectious unit in 2017. Nowadays, scarlatina was revealed to have a typical course with characteristic clinical symptoms, including punctate rash, intoxication with increased temperature up to 38–39, acute tonsillitis, absence of cough in the acute period, moderate regional lymphadenitis. At the hospital stage, there predominate moderately severe forms of this disease. Bacteriological verification of Streptococcus pyogenes (at admittance to the hospital) in the investigated group was 74 %. Typical punctate rash remains the basic clinical symptom of scarlatina. Informative value of McIsaac scale for diagnosis of BHSA-tonsillitis with scarlatina infection was assessed. Specificity of assessment was 92 %.

Conclusions. Clinicodiagnostic McIsaac scale is highly informative for diagnosis of BHSA-tonsillitis among children.

Perm Medical Journal. 2018;35(3):39-44
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Ecologoepidemiological connection of lung cancer morbidity with atmospheric air pollution by carcinogens in petrochemical profile regions
Maksimov G.G., Aznabaeva Y.G., Kirillova E.V., Lipatov O.N., Akhmetov V.M.
Abstract

Aim. To study the dynamics of lung cancer (LC) morbidity among the population of five cities of the Republic of Bashkortostan over the period from 2010 to 2016 and the structure of industrial emissions for grounding of adequate integral index, connected with LC morbidity and development of preventive measures to decrease malignant neoplasms.

Materials and methods. The structure of gross emissions of industrial enterprises and ecologohygienic assessment of atmospheric air was conducted according to the materials of the Department of Rospotrebnadzor in Bashkortostan for 2010–2016. Lung cancer morbidity in the above mentioned territories was studied by the materials of Republican Clinical Oncological Dispensary. To estimate the influence of gross emissions on LC morbidity, modeling technique, adequate to panel analysis of spatially dynamic structural data, was applied.

Results. The assessment of carcinogenic risk of atmospheric air emissions, taking into account not separate carcinogens, but their combined effect as substances with similarly directed impact, detected accurate correlation of dependence of high LC morbidity on the resultant carcinogens action.

Conclusions. High LC morbidity in the cities of Bashkortostan is connected with high gross emission of carcinogens into the atmospheric air. Information on gross emissions of carcinogens and their structure can serve as an integral criterion of atmospheric pollution impact on lung cancer morbidity.

Perm Medical Journal. 2018;35(3):45-57
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Specifics of follow-up observation regarding one disease
Sandakov Y.P.
Abstract

Aim. To study the specifics of addressing for medical care among patients under follow-up observation, regarding one disease.

Materials and methods. The data, obtained from copies of medical records of 402 ambulatory patients under follow-up observation for one disease, were analyzed, using the methods of descriptive and inductive statistics.

Results. The studied group included 60 % of women and 77.5 % of pensioners. There were more able-bodied men, than able-bodied women (φ*emp = 3.242, р ˂ 0.001). Patients’ mean age was 68.3 ± 16.4 years. In 81 % of cases, the cause of follow-up observation were cardiovascular diseases. A mean duration of disease for the main disease was 10.5 ± 6.4 years, duration of follow-up – 6.4 ± 2.6 years (t = 10.0, p < 0.001). A mean number of planned visits to a doctor was 2.0 ± 0.34, real – 1.8 ± 0.5 (t = 5.5, p < 0.001). Frequency of real visits to a doctor does not depend on age (χ2 = –0.04, р = 0.6), gender (t = 0.3, p = 0.8), duration of disease (χ2 = 0.02, р = 0.8), duration of follow-up (χ2 = –0.04, р = 0.6), associated diseases (χ2 = 0.02, р = 0.1). Exacerbations were registered in 87.5 % of patients, disability – 43.5 %, emergency calls – 28.5 %, hospitalizations – 28.5 %, including urgent ones – 35.7 %.

Conclusions. The able-bodied men form the risk group for the development of noninfectious chronic diseases; follow-up quality is unsatisfactory; great influence of associated diseases on medical aid appealability; regularity of asking for medical care is higher among persons, who had two planned visits a year; patients’ loyalty to treatment depends on patient’s psychological characteristic; follow-up, conducted by narrow specialists, is not more effective, than that by therapeutists.

Perm Medical Journal. 2018;35(3):58-66
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Alysis of demographic processes in Perm Krai
Olina A.A., Sadykova G.K., Meteleva T.A.
Abstract

Aim. To estimate the dynamics of the main demographic indices (population, gender and age composition of population, number of born and dead, natural population increase (loss), migration growth of population) in Perm and Perm Krai (PK) over the period of 1990–2016.

Materials and methods. The data, presented by the department of population census and demographic statistics of Territorial Board of the Federal Service for State Statistics in PK (Permstat) were analyzed.

Results. In Perm Krai – in 2013 and in Perm – in 2012, there was registered increase in the population, confirming the end of depopulation period, observed since the nineties of the XX century. The analyzed period is characterized by growth in birth rate and fall in death rate in Perm and Perm Krai. However, the natural population increase remains insignificant. The detailed characteristic of gender and age structure is presented in the paper; it permits to assess the reproductive potential of the region.

Conclusions. The detected tendencies make it possible to determine the strategic directions for improvement of medicodemographic situation in Perm Krai.

Perm Medical Journal. 2018;35(3):67-73
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Complex treatment efficiency, analyzed in children with congenital cleft lip and palate, using international classification of functioning
Aleksandrova L.I.
Abstract

Aim. To determine the structure of functional disorders and their dynamic changes in children with congenital cleft lip and palate from the position of International Classification of Functioning.

Materials and methods. The indices, included into International Classification of Functioning, were assessed in 77 children (age range 1 to 6 years) with congenital cleft lip and palate, who received a complex five-stage therapy.

Results. Direct correlation between the type of cleft and the value of disorders in classification constituents “function” and “structure” was revealed. Thus, in patients with bilateral cleft lip and palate, disorders of functions reached 82 %, in children with one-sided cleft lip and palate – 45 %. In children of group I, more marked structural disorders were observed, forming from 24 to 96 %, in children of groups 2 and 3 – from 5 to 49 %. In children with bilateral cleft lip and palate, there were observed more marked abnormalities in the category “activity and participation” (25–95 %) compared to children of groups 2 and 3 (0–24 %).

Conclusions. Application of International Classification of Functioning for children with congenital cleft lip and palate shows a wide range of the assessed functional disorders and the possibility of using it for dynamic analysis of efficiency and treatment.

Perm Medical Journal. 2018;35(3):74-78
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Structural changes in prostate of reproductive age rats under immunosuppression
Kaschenko S.A., Zakharov A.A.
Abstract

Aim. To establish the structural changes in the prostate of reproductive experimental animals in conditions of long immunosuppression.

Materials and methods. Sixty white rats of reproductive age were studied. The state of immunosuppression was modeled with intramuscular introduction of cyclophosphamide in the dose of 1.5 mg/kg of the body mass during 10 days. Linear sizes and volume of the organ were determined. At the microscopic level, height and width of epithelial cells, their volume as well as large and small diameters and cell nuclei volumes were determined.

Results. In response to long immunosuppressive impact, organometric indices of the prostate both in the early (on days 7, 15) and late (on day 30) observation periods decreased owing to indirect cytotoxic impact of cyclophosphamide on the glandular and stromal components of the organ.

Conclusions. The decreased values of linear-volumetric micromorphometric indices within the same observation periods confirm the dynamics of organometric parameters of the gland and prove intensive response of the organ at micro-and-submicroscopic level.

Perm Medical Journal. 2018;35(3):79-86
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Noncompact left ventricular myocardium (Clinical case)
Tuev A.V., Vasilets L.M., Khlynova O.V., Nekrutenko L.A., Nazipova Y.I., Chainikova T.V.
Abstract

The paper presents the clinical case of a 28-year-old patient, diagnosed noncompact myocardium of the left ventricle. The disease debuted from heart rate disturbance; Lown’s grade 4B ventricular premature beats were revealed according to the results of durable electrocardiogram monitoring. In echocardiography, significant decrease in the left ventricular ejection fraction was stated. After magnetic resonance imaging of the heart, the presence of two layers of myocardium, compact and noncompact with the latter exceeding the compact layer more than twofold was diagnosed. The patient underwent slow titration of the dose of angiotensin-converting enzyme inhibitors up to the maximum under the arterial pressure control. The following recommendations were given: anticoagulants for primary prevention of thromboembolic complications, planned implantation of a two-chamber artificial cardioaverter-defibrillator for primary prevention of sudden heart death.

Perm Medical Journal. 2018;35(3):87-92
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Favorable outcome of large left atrium myxoma with frequent syncopal states
Khovaeva Y.B., Zinkovskaya T.M., Moiseenko N.P.
Abstract

The paper presents a case of the outcome of the left atrium myxoma of large sizes, complicated by syncopal states in an elderly woman, which was followed by myxoma removal.

Perm Medical Journal. 2018;35(3):93-98
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Monocytic chemotactic protein-1 in physiology and medicine (review of literature)
Kolotov K.A., Rasputin P.G.
Abstract

Monocytic chemotactic protein-1-cytokin, attributed to the group of chemokins, is the most powerful factor of monocyte chemotaxis in the body of mammalians as well as memory T-cells and dendrite cells to inflammatory foci and is produced upon tissue damages or infection introduced. MCP-1 is mainly secreted by monocytes, macrophages and dendrite cells. Clinical significance of MCP-1 consists in participation of some diseases in pathogenesis: psoriasis, rheumatoid arthritis, atherosclerosis. MCP-1 is involved into the processes of developing central nervous system diseases, which are characterized by neuronal degeneration. Besides, this cytokine plays a significant role in vascular complications of type 2 diabetes mellitus and formation of obesity insulin resistance.

Perm Medical Journal. 2018;35(3):99-105
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Hygienic study of West Ural potassium salt natural factors
Barannikov V.G., Kirichenko L.V., Ryazanova E.A., Sidorova D.A., Selivanova S.A., Khokhryakova V.P.
Abstract

The presented review gives the main stages of speleotherapy formation in West Ural, the knowledge of which is necessary for improvement of the system of professional training of physicians – experts in sanitary service.

Perm Medical Journal. 2018;35(3):106-111
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HYGIENIC RESEARCHES OF POTASH SALTS NATURAL FACTORS OF WESTERN URAL
Selivanova S., Barannikov V., Kirichenko L., Riazanova E., Sidorova D., Kchokchryakova V.
Abstract

HYGIENIC RESEARCHES OF POTASH SALTS NATURAL FACTORS OF WESTERN URAL

Barannikov V.G.1, Kirichenko L.V.1, Riazanova E.A.1, Sidorova D.A.1, Selivanova S.A.1*, Kchokchryakova V.P.1

1 Perm state medical university named after academician E.A. Vagner; Perm; Russia.

            The lecture contains information about basic stages of speleotherapy developments in Western Ural. This knowledge is necessary for perfection of professional preparation system of sanitary experts. The lecture is elements of communal hygiene teaching for 6-years students of medical-preventive facylty and for sanitary doctors at the postgraduate stage.

Perm Medical Journal. 2018;35(3):
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Analysis of demographic processes in Perm Region
Olina A.A., Sadykova G.K., Meteleva T.A.
Abstract

The analysis of demographic indicators (population size, sex, age composition of the population, number of births and deaths, natural increase (decrease) in the population, migration growth of the population) in Perm and Perm Region (PR) for the period 1990 - 2016 Department of Population Censuses and Demographic Statistics of the Territorial Body of the Federal Service of State Statistics for PR (PERMSTAT).
In the Perm Region in 2013, and in Perm in 2012, an increase in the population was recorded, which indicates the end of the depopulation period that has been observed since the 1990s. XX century. The analyzed period in Perm and the PR is characterized by an increase in the birth rate and a decrease in mortality. However, the natural increase in the population remains insignificant.
The article gives a detailed description of the gender and age structure of the female population, which makes it possible to assess the reproductive potential of the region.
The revealed regularities and trends allow defining strategic directions for improving the medical and demographic situation in the Perm Region.

Perm Medical Journal. 2018;35(3):
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HYGIENIC RESEARCHES OF POTASH SALTS NATURAL FACTORS OF WESTERN URAL
Barannikov V., Kirichenko L., Riazanova E., Sidorova D., Selivanova S., Kchokchryakova V.
Abstract

Barannikov V.G.1, Kirichenko L.V.1, Riazanova E.A.1, Sidorova D.A.1, Selivanova S.A.1*, Kchokchryakova V.P.1

1 Perm state medical university named after academician E.A. Vagner; Perm; Russia.

            The lecture contains information about basic stages of speleotherapy developments in Western Ural. This knowledge is necessary for perfection of professional preparation system of sanitary experts. The lecture is elements of communal hygiene teaching for 6-years students of medical-preventive facylty and for sanitary doctors at the postgraduate stage.

Perm Medical Journal. 2018;35(3):
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Noncompaction of the left ventricular myocardium
Chainikova T.
Abstract

The article presents the clinical case of a 28-year-old female patient who was diagnosed with a noncompact myocardium of the left ventricle. The disease debuted with clinical signs of cardiac rhythm disturbance, according to long-term monitoring of electrocardiogram results a ventricular extrasystole equivalent to Lown 4b was detected. On echocardiography, a sharp decrease in the ejection fraction of the left ventricle was of particular significance .A diagnosis was made after magnetic resonance imaging of the heart, the presence of two layers of myocardium was detected: compact and noncompact layer, the latter exceeding the former in thickness greater than two times. The patient was recommended slow titration of  a dose of angiotensin-converting enzyme inhibitors up to the maximum tolerable dose under the control of blood pressure; addition  of anticoagulants on the basis of primary prevention of thromboembolic complications; elective implantation of a bi-chamber artificial cardioverter-defibrillator for the primary prevention of sudden cardiac death.

Perm Medical Journal. 2018;35(3):
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noncompact myocardium of the left ventricle
Викторовна Ч.Т.
Abstract

The article presents the clinical case of a 28-year-old female patient who was diagnosed with a noncompact myocardium of the left ventricle. The disease debuted with clinical signs of cardiac rhythm disturbance, according to long-term monitoring of electrocardiogram results a ventricular extrasystole equivalent to Lown 4b was detected. On echocardiography, a sharp decrease in the ejection fraction of the left ventricle was of particular significance .A diagnosis was made after magnetic resonance imaging of the heart, the presence of two layers of myocardium was detected: compact and noncompact layer, the latter exceeding the former in thickness greater than two times. The patient was recommended slow titration of  a dose of angiotensin-converting enzyme inhibitors up to the maximum tolerable dose under the control of blood pressure; addition  of anticoagulants on the basis of primary prevention of thromboembolic complications; elective implantation of a bi-chamber artificial cardioverter-defibrillator for the primary prevention of sudden cardiac death.

Perm Medical Journal. 2018;35(3):
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Noncompaction of the left ventricular myocardium
Chainikova Т.
Abstract

The article presents the clinical case of a 28-year-old female patient who was diagnosed with a noncompact myocardium of the left ventricle. The disease debuted with clinical signs of cardiac rhythm disturbance, according to long-term monitoring of electrocardiogram results a ventricular extrasystole equivalent to Lown 4b was detected. On echocardiography, a sharp decrease in the ejection fraction of the left ventricle was of particular significance .A diagnosis was made after magnetic resonance imaging of the heart, the presence of two layers of myocardium was detected: compact and noncompact layer, the latter exceeding the former in thickness greater than two times. The patient was recommended slow titration of  a dose of angiotensin-converting enzyme inhibitors up to the maximum tolerable dose under the control of blood pressure; addition  of anticoagulants on the basis of primary prevention of thromboembolic complications; elective implantation of a bi-chamber artificial cardioverter-defibrillator for the primary prevention of sudden cardiac death.

Perm Medical Journal. 2018;35(3):
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NONCOMPACT LEFT VENTRICULAR MYOCARDS (CLINICAL CASE)
Chainikova T.V.
Abstract

The article presents a clinical case of a 28-year-old female patient who was diagnosed with a noncompact myocardium of the left ventricle. The disease debuted with a cardiac rhythm disturbance clinic, according to the results of a long-term monitoring of the electrocardiogram, ventricular extrasystole Laun 4b was detected. In echocardiography, a sharp decrease in the fraction of the ejection of the left ventricle attracted attention. The diagnosis was made after the magnetic resonance tomography of the heart, the presence of two layers of the myocardium was revealed: compact and noncompact, more than twice the thickness of the compact layer. The patient is recommended a slow titration of the dose of angiotensin-converting enzyme inhibitors up to the maximum tolerable under the control of blood pressure; connection of anticoagulants in the framework of primary prevention of thromboembolic complications; implantation of a two-chamber artificial cardioverter-defibrillator in a planned order for the primary prevention of sudden cardiac death.

Perm Medical Journal. 2018;35(3):
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Original studies
The value of biochemical markers in the diagnostics of diabetes-related bone remodeling disorders
Safarova S.
Abstract

AIMS: to assess the effect of changes in the body in men and women with type 1 and 2 diabetes on the state of markers of bone metabolism.. Determination of the directionality of changes in serum markers of bone remodeling and bone mineral density in both sexes in this disease.

METHODS: A cross-sectional study was conducted of patients diagnosed with T1DM (n = 98) and T2DM (n = 137); control group, consisted of 82 persons. Calcitropic homons, serum markers of bone remodeling were studied in all patients.

RESULTS: the results of the evaluation of the content of markers of serum bone metabolism in patients with DM1and DM2 in comparison with the control group indicate the presence of pathological changes in the processes of bone remodeling in the form of a decrease in the bone formation marker PINP in patients with DM1 by 16%, with DM2 by 12% compared with the control and enhancement of the marker of bone resorption of b-CTx in 32% of patients with DM1 and 25% of patients with DM2; as well as inconsistency of changes in bone remodeling processes in patients with DM1, with a predominant change in bone resorption, determined in 28% of cases. Patients with DM1 had lower levels of P1NP and b-CTx, which reflects a lower bone metabolism compared to patients with DM1, regardless of age and duration of the disease.

CONCLUSIONS: the loss of bone mass in the majority of the examined patients with diabetes, is associated with the suppression of bone formation and, to a much lesser extent, of bone resorption. In this case, the values ​​of bone remodeling markers in patients with DM2 are lower than in patients with DM1. Factors such as the compensation of the glycemic profile, the duration of diabetes and the presence of diabetic nephropathy can affect bone metabolism.

Perm Medical Journal. 2018;35(3):
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The possibilities of magnetic resonance imaging in the diagnosis of microstructural changes in articular cartilage in osteoarthritis
Kabalyk M.A.
Abstract

Aim. To assess the potential of the magnetic resonance imaging (PDFS) weighted by the proton density in the diagnosis of microstructural changes in articular cartilage (AC) in osteoarthritis (OA) based on the analysis of the variability of the proton density (PD).

Materials and methods. 62 patients with OA and 8 volunteers without OA were examined. All patients underwent MRI of knee joints on a high-field tomograph with a magnetic field strength of 1.5 Tesla. Semi-quantitative measurements of joint tissues based on the WORMS protocol were used to evaluate MR images. To evaluate PD manually, segmentation of PDFS-weighted images of the medial condyle of the knee joint was performed. The proton density was estimated from a 3-D histogram on a scale of 0 to 255.

Results. At the first stage of OA, a decrease in the density of H+ in the peripheral zone of AC was observed, but was retained in the contact part experiencing the maximum static-dynamic loads. In stage II of OA, a significant progressive decrease in the H+-dtensity peaks in AC regions undergoing lower loads was observed, while maintaining high spectral peaks in the region of increased friction. III stage of gonarthrosis was characterized by a decrease in the entire plan of H+-spectrum, especially in the load regions of AC. At the IV stage of OA, a global decrease in the intensity of PD over the entire surface of the cartilaginous plate was observed.

Conclusions. The revealed regularity of changes in the proton density spectrum reflects the well-known degenerative process in AC with OA. This property of proton-weighted MR images can be used in the assessment of microstructural changes in AC in OA.

Perm Medical Journal. 2018;35(3):
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CHANGES IN THE STRUCTURE OF THE PROSTATE GLAND OF REPRODUCTIVE-AGE RATS UNDER IMMUNOSUPPRESSION CONDITIONS
Zakharov A.A., Kashchenko S.A.
Abstract

The aim of the study was to establish a change in the structure of the prostate gland of experimental animals of reproductive age under conditions of prolonged immunosuppression. The study was carried out on 60 white rats of reproductive age. The state of immunosuppression was modeled using cyclophosphamide at a dosage of 1.5 mg/kg body weight intramuscularly for 10 days. The linear dimensions and volume of the organ were determined. At the microscopic level, the height and width of the epithelial cells, their volume, as well as the larger and smaller diameters and the volume of the cell nuclei were measured. In response to long-term immunosuppressive effects, the organometric parameters of the prostate are decreased both at the early (7, 15 days) and late (30 days) observations due to the direct cytotoxic effect of cyclophosphamide on the glandular-stromal components of the organ. The decrease in the values ​​of linear-volume micromorphometric parameters at the same time of observation confirms the dynamics of the organometric parameters of the gland and indicates an intensive organ response at the micro- and submicroscopic level.

Perm Medical Journal. 2018;35(3):
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