Vol 40, No 6 (2023)

Introduction. Pancreatic cancer is characterized by an extremely unsatisfactory prognosis, despite the development of technologies for the treatment of this pathology. In more than 80 % of patients at the time of the initial request for medical care, the disease is represented by a locally advanced or metastatic stage. Currently used methods of treatment of this nosology are most effective at the early stages of the disease. The absence of characteristic clinical, instrumental and laboratory symptoms, as well as organizational measures for the early detection of this neoplasia creates certain difficulties for effective treatment. Type 2 diabetes is probably one of the risk factors for the development of pancreatic cancer. Epidemiological studies have shown that newly diagnosed type 2 diabetes is associated with a 1.5–2.0-fold increased risk of developing pancreatic cancer in patients over 50 years of age. Insulin resistance and its associated hyperglycemia, hyperinsulinemia, and inflammation are thought to be the main mechanisms contributing to the development of diabetes-related pancreatic cancer. New-onset type 2 diabetes mellitus may be a preclinical sign of pancreatic cancer, and patients with newly diagnosed diabetes may constitute a population in which pancreatic cancer can be detected at an early stage, that will significantly improve the results of treatment.

Objective. To analyze the relationship between new-onset type 2 diabetes mellitus and the development of pancreatic cancer.

Material and methods. A retrospective analysis of the medical records of patients with a confirmed diagnosis of pancreatic cancer, who were treated at the Academician A.M. Granov Russian Scientific Center of Radiology and Surgical Technologies from 2019 to 2022, was carried out. As a source of information, data from medical records of inpatient and outpatient treatment cards were used. In total, the data of 203 persons were studied: morphologically confirmed pancreatic ductal adenocarcinoma was diagnosed in 172 patients (group I), in 31 patients pancreatic tumors had a different histological structure: acinar carcinoma, neuroendocrine tumors (group II). Group I excluded 8 patients without diabetes mellitus who were taking medications, which affect the blood glucose levels. The frequency of occurrence of type 2 diabetes mellitus in the groups was analyzed and then the statistical significance was assessed using the calculation of Fisher's exact test. Group I was analyzed by sex and age, then patients from group I aged 50–75 years were divided into 3 subgroups depending on the glycemic profile: 1) patients with long-term type 2 diabetes mellitus (anamnesis more than 3 years); 2) patients with new-onset type 2 diabetes mellitus (anamnesis less than 3 years); 3) patients without disorders of glucose metabolism. In the subgroup of patients with a long history of type 2 diabetes mellitus, the fact of disease decompensation was additionally assessed.

Results. Type 2 diabetes mellitus was more common in patients with pancreatic ductal adenocarcinoma (p < 0.01, Fisher's exact test p = 0.0012) than in other pancreatic neoplasms. The age of patients in group I ranged from 36 to 81 years. The average age of men was 61 ± 8.5 years. The average age of women was 58.9 ± 8.2 years. Among patients of group I aged 50–75 years, new-onset type 2 diabetes mellitus occurred in 78 (68.4 %) persons, type 2 diabetes mellitus with an anamnesis of more than 3 years was detected in 19 (16.6 %) patients, normal metabolism of glucose was observed in 17 (14 %) patients. Of 19 patients with a long anamnesis of type 2 diabetes mellitus (more than 3 years), decompensation in the form of impaired glycemic control was observed in 12 (63.2 %) patients before the diagnosis of pancreatic cancer, in 7 (36.8 %) patients no signs of decompensation of the course of type 2 diabetes mellitus were registered.

Conclusions. New-onset type 2 diabetes mellitus occurred in 78 (64.4 %) patients over 50 years of age with pancreatic ductal adenocarcinoma. The data obtained indicate the feasibility of conducting studies to identify patients aged 50–70 years with newly diagnosed type 2 diabetes in the risk group for the development of pancreatic cancer and examine this contingent at the stage of primary health care. Further retrospective as well as prospective multicenter studies on the association between newly diagnosed type 2 diabetes mellitus and the risk of developing pancreatic cancer are required.

Relevance. There are limited data on the long-term outcomes of patients with myocardial infarction (MI) and impaired glucose tolerance (IGT) during the novel coronavirus disease (COVID-19) pandemic in 2020.

Objective. To assess the 24-month survival rate among patients with IGT and previous myocardial infarction in 2020 during the COVID-19 pandemic compared to the same period in 2019.

Materials and methods. We assessed the two-year survival rate of patients with MI and IGT from 10/1/2020 to12/10/2020 during the indirect influence of the pandemic compared to the same period in pre-pandemic 2019. The study was single-center, retrospective.

Results. 179 persons in 2020 and 261 persons in 2019 with MI and IGT applied to a regional center to perform percutaneous coronary intervention (PCI center). There was an increase in mortality from MI and IGT from 4.1 % in 2019 to 9.9 % (p = 0.04) in the “pandemic” year of 2020. The relapse-free survival of patients was analyzed using the Kaplan – Meier curve method. By the end of the first year in 2020, 82.1 % of patients remained from the original, and in 2019 – 88.1 %, (p = 0.001), at the end of the 24-month observation period – 78.2 % among patients with MI in 2020 and 83.5 % in 2019, (p = 0.0015).

Conclusions. A retrospective analysis of cases with MI and IGT during a pandemic in Russia showed the worst prognoses for the two-year survival rate among patients, more severe heart attacks with increased number of complications.

In the recent years, close attention has been paid to the study of depression in general medical practice, in particular, among patients with myocardial infarction (MI). Two large groups of factors, which presumably cause such a relationship, are discussed. The first group includes direct pathophysiological factors, the second – indirect, "behavioral" reactions modifying other risk factors for coronary artery disease and reduce patient adherence to prescribed therapy. The age of patients in the observed populations, as well as the predominant type of MI in patients, may have a certain influence on the results of studies. Besides, today, no unambiguous view has been formed on the question of the relationship between the androgenic status of men and the development of coronary artery disease. Among the articles analyzing the effect of androgen levels on the course of coronary heart disease, most of the studies are devoted to androgen content in the blood serum among men with stable angina, while there are relatively few studies evaluating androgen status in acute myocardial infarction and postinfarction cardiosclerosis. On the one hand, it is assumed that age-related androgen deficiency in middle-aged men with coronary heart disease may be a compensatory response to a severe general disease and can contribute to better long-term results of myocardial revascularization in them. On the other hand, it was found that men with coronary heart disease and age-related hypogonadism are characterized by more pronounced manifestations of myocardial ischemia, dysfunction of the autonomic nervous system, and more severe atherosclerosis of the coronary arteries. A review of the latest evidence is presented, summarizing clinical data on the impact of depression and androgen deficiency in the development of myocardial infarction in young men.

Objective. To analyze the immediate and medium-term results of prosthetics of the aortic valve (AV) using biological prosthesis in elderly patients.

Material and methods. The study included 198 patients with AV pathology [85 men (42.9 %)/113 women (57.1 %)]. The median age was 70 [66–73] years. There were 175 (88.4 %) patients with sclerodegenerative AV, 5 (2.5 %) – with infectious endocarditis and 30 patients (15.2 %) had bicuspid AV.

Results. The hospital mortality was 4.5 %. The causes of mortality were multiple organ failure syndrome, in 1 case – developed peritonitis. In 14 patients (7.1 %) there was a rhythm disturbance in the form of AF, in 9 (4.5 %) – a complete AV block, in connection with which a permanent pacemaker was implanted. Four patients (2 %) underwent resternotomy for bleeding. Two patients (1 %) underwent pericardiocentesis. 8 (4 %) patients developed a stroke. No wound complications were detected. In the long-term period, 31 patients died. The causes of mortality were the following: cardiovascular diseases – 13 patients, malignant neoplasms – 5 patients, gastrointestinal diseases – 2, urinary system disease – 1 patient, COVID-19 – 1 patient, unknown cause – 9 patients. Thus, the five-year survival rate after the surgery was 63 %, respectively. During the follow-up period, 2 patients (2.9 %) underwent repeated intervention on AV.

Conclusions. The five-year freedom from re-operation was 97.1 %. The five-year survival rate was 63 % due to the presence of a history of severe concomitant pathology as well as the middle age of patients 70 years.

Objective. To study the incidence of postmortem tuberculosis in the recent years.

Materials and methods. According to the data of the Federal Forms of Statistical Reports for 2013–2022, the tuberculosis incidence and mortality, frequency of postmortem diagnoses of tuberculosis cases, medical aid appealability of population, and coverage of preventive fluorographic examinations were studied on the territory of Perm Region.

Results. It was found that against the background of a decrease in tuberculosis morbidity and mortality from this infection for 2020–2022, the total of all first identified cases showed an increase in the proportion of the postmortem cases of tuberculosis. It was revealed that late diagnostics of tuberculosis is associated with a decrease in the number of requests for medical assistance and the coverage of fluorographic examinations due to COVID-19 epidemic.

Conclusions. The increase in the share of postmortem diagnoses of tuberculosis cases has been noted in the total of all first identified tuberculosis cases for the period of 2020–2022 against the background of a new coronavirus infection epidemic.

A clinical description of Urbach – Wiethe disease (lipoid proteinosis), an extremely rare pathology, is presented, currently only 300 cases are known. This hereditary disease, transmitted by an autosomal recessive type, is associated with a mutation of the extracellular matrix 1 (ECM1) gene located on chromosome 1, locus 1q21. It is based on a violation of collagen synthesis and deposition of hyaline in the dermis along the collagen fibers, in the mucous membranes, sometimes in the internal organs. The chemical composition of hyaline is not completely determined; it is noted that it includes collagen, glycoproteins, lipids, proteoglycans. The disease begins in early childhood and is characterized by changes in the ENT organs and skin, confirmed by histological examination, which reveals thickening of the dermis, degeneration of collagen fibers, hyalinosis with deposition around the vessels, in their walls, around the sweat glands of ribbon-like, weakly eosinophilic, homogeneous substances, which include phospholipids, sometimes there may be cracks with deposition of lipids.

Patient V., born in 1990, the disease began almost from birth with the appearance of polymorphic rashes on the skin and hoarseness of the voice. In 1999, a histological examination of the affected skin was performed, confirming the diagnosis of lipoid proteinosis of Urbach – Wiethe. The skin pathological process is widespread, symmetrical, on the face it is represented by reticulated telangiectatic erythema, along the edge of the lower eyelids there are miliary nodules similar to a string of pearls. Hypoplasia and stagnant erythema of the auricles are determined. There are yellowish lenticular papules on the trunk and limbs, waxy translucent plaques of a dense consistency in the area of the extensor surface of the elbow joints. Besides, secondary hyperpigmentation and foci of atrophy were detected on the face, trunk and limbs. Skin changes are accompanied by lesion of the ENT organs in the form of bilateral maxillary sinusitis, frontitis, chronic pharyngitis, chronic laryngitis. Concomitant pathology is important: polyvalent sensitization, chronic hepatitis B, biliary dyskinesia against the background of gallbladder deformation, chronic gastroduodenitis. The patient has been on disability since 2000, needs dispensary supervision and correction of all identified violations.

A clinical case of highly aggressive multiple sclerosis in a patient with a family history of demyelinating disease is presented. The effectiveness of early pathogenetic therapy by blocking the adhesion molecules of lymphocytes is demonstrated.

Objective. The range of peptide drugs is expanding, but no drug with immunosuppressive activity has yet been found. Considering the fact that the trophoblastic β1-glycoprotein (PSG) is a fetoplacental protein with immunosuppressive activity, short peptide fragments of this protein were studied in the formation of an immune response in a situation of allogeneic cell transplantation. To study the effect of PSG peptides (YECE, YQCE, YVCS, and YACS) on the levels of peripheral and local T-regulatory cells (Treg) during the formation of an immune response to the introduction of allogeneic bone marrow cells (BM) in a dynamic experiment on Wistar rats.

Materials and methods. We used an original host-versus-graft model in male Wistar rats without preconditioning of recipients. Animals were injected with PSG peptide fragment composition against a background of allogeneic intraperitoneal transplantation of BM cells in a dynamic experiment, in which the following parameters were evaluated: the level of peripheral "true" Tregs (CD4⁺CD25⁺FOXP3⁺), CD4⁺CD25^-FOXP3⁺ cells, and FOXP3 expression in mesenteric lymph nodes. Material was collected on days 3 and 21 of the experiment.

Results. PSG peptide administration against a background of allogeneic BM cells was found to reduce the absolute and relative amount of Treg in the peripheral blood of rats on days 3 and 21 of the experiment. PSG peptides against the background of the introduction of allogeneic BM cells reduced the absolute and relative amounts of CD4⁺CD25^-FOXP3⁺ cells on the day 3 of the experiment. The introduction of PSG peptides against the background of the introduction of BM cells resulted in a relative decrease in FOXP3 expression in the T zone of mesenteric lymph nodes on the day 21 of the experiment.

Conclusions. Thus, the PSG peptides did not have the expected effect on the level of peripheral and local Treg cells; moreover, the presence of the peptides led to a decrease in the number of these cells.

The article is devoted to the 110^th anniversary of the birth of Anna Timofeevna Faidysh – Doctor of Medical Sciences, Professor, Head of the Department of Epidemiology of Perm Medical Institute (1960–1973), honorary member of the Memorial Complex dedicated to the Battle of Stalingrad. Anna Timofeevna graduated with honors from the First Kharkov Medical Institute and took postgraduate studies at the Department of Microbiology. In June 1941, the Great Patriotic War began. For her participation in the military actions, she was awarded two orders and six medals. From 1960 to 1973, Anna Timofeevna worked as the Head of the Department of Epidemiology at Perm Medical institute. In 1965, she defended her doctoral dissertation and became a professor. A.T. Faidysh introduced a course of military epidemiology into the educational process. She is the author of more than 100 scientific papers. Under her leadership, four PhD theses were defended.

The article is devoted to Professor of the Department of Normal Anatomy Elizaveta Nikolaevna Olenyova, her life and activity. When Elizaveta Nikolaevna headed the department, the study of lymphatic system of the body in norm, experiment and pathology became the main scientific trend. Thus in these years, the work of E.N. Olenyova and her colleagues laid the basis for clinical lymphology.