A. Akopov, Акопов Андрей Леонидович, M. Kovalev, Ковалев Михаил Генрихович
Aim. To present the experience in a new approach for the surgical treatment of cicatricial cervical tracheal stenosis — tracheal resection without using an endotracheal tube. Methods. The technique includes preliminary metal stent placement instead of bougienage in the stenosis zone; introduction of the supraglottic airway device I-Gel instead of the endotracheal tube and; jet ventilation through the supraglottic airway device. The stent is removed together with the resected trachea. The technique of cervical tracheal resection using the supraglottic airway device was implemented in 22 patients with cicatricial tracheal stenosis. Results. The resection length ranged from 15 to 45 mm (on average, 27±3 mm). The duration of surgical interventions ranged from 65 to 180 minutes (on average, 109±9 minutes). Preliminary stenting excluded preoperative bougienage of the trachea and facilitated intraoperative assessment of the extent of the stenosis. The absence of an endotracheal tube facilitated the formation of anastomosis of the trachea, eliminated the risk of trauma to the anastomosis during tube removal. There were no complications in the early postoperative period. The length of postoperative hospital stay ranged from10 to 14 days (on average, 12±2 days). No restenosis was detected at long term follow-up. Conclusion. Performing tracheal resection without intubation allows the surgeon to work comfortably, observing the safety conditions for ensuring airway patency throughout the operation by installing a supraglottic airway device.
{"title":"Cervical tracheal resection without intubation","authors":"A. Akopov, Акопов Андрей Леонидович, M. Kovalev, Ковалев Михаил Генрихович","doi":"10.17816/KMJ2021-381","DOIUrl":"https://doi.org/10.17816/KMJ2021-381","url":null,"abstract":"Aim. To present the experience in a new approach for the surgical treatment of cicatricial cervical tracheal stenosis — tracheal resection without using an endotracheal tube. Methods. The technique includes preliminary metal stent placement instead of bougienage in the stenosis zone; introduction of the supraglottic airway device I-Gel instead of the endotracheal tube and; jet ventilation through the supraglottic airway device. The stent is removed together with the resected trachea. The technique of cervical tracheal resection using the supraglottic airway device was implemented in 22 patients with cicatricial tracheal stenosis. Results. The resection length ranged from 15 to 45 mm (on average, 27±3 mm). The duration of surgical interventions ranged from 65 to 180 minutes (on average, 109±9 minutes). Preliminary stenting excluded preoperative bougienage of the trachea and facilitated intraoperative assessment of the extent of the stenosis. The absence of an endotracheal tube facilitated the formation of anastomosis of the trachea, eliminated the risk of trauma to the anastomosis during tube removal. There were no complications in the early postoperative period. The length of postoperative hospital stay ranged from10 to 14 days (on average, 12±2 days). No restenosis was detected at long term follow-up. Conclusion. Performing tracheal resection without intubation allows the surgeon to work comfortably, observing the safety conditions for ensuring airway patency throughout the operation by installing a supraglottic airway device.","PeriodicalId":17798,"journal":{"name":"Kazanskiy meditsinskiy zhurnal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83370359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. L. Blashkova, E. Krikun, I. G. Mustafin, I. Valeeva, J. V. Blashkova
Aim. To determine the dynamics of clinical changes and indicators of local immunity in integrating the diode laser into the treatment of the endo-periodontal lesion. Methods. We performed a prospective study of 110 patients of both sexes aged 2555 years with endo-periodontal lesions. The patients were randomized into two groups the main group (n=54), whose received root canal treatment and periodontal pockets with a diode laser in addition to standard therapy, which included endodontic and periodontal treatment, and control group (n=56), whose patients received only standard treatment. The GreenVermillion oral hygiene index and Russells periodontal index, as well as the levels of immunoglobulin (Ig) A, tumor necrosis factor-alpha (TNF-alpha) and cytokine interleukin-10 (IL-10) in the mixed saliva of patients, were determined during the study. Quantitative data were described using median, lower and upper quartiles. These data were visualized using boxplots. The MannWhitney U test was used to compare differences between an independent set of quantitative data. Differences were considered significant at a confidence level of p 0.05. Results. The median oral hygiene index decreased from 2.9 to 1.0 (p 0.001) in the main group and from 2.9 to 1.6 (p 0.001) in the control group. The median Russell's periodontal index decreased from 3.38 to 1.3 (p 0.001) in the main group and from 3.95 to 2.0 (p 0.001) in the control group. The median immunoglobulin A content decreased from 5.25 to 3.13 mg/L (p 0.001) in the main group and from 5.23 to 4.21 mg/L (p 0.001) in the control group. The tumor necrosis factor-alpha level decreased from 16.65 pg/ml in the main group and 18.28 pg/ml in the control group to 3.96 and 8.44 pg/ml (p 0.001), respectively. The median cytokine interleukin-10 levels increased from 0.83 to 2.94 pg/ml (p 0.001) in the main group and from 1.29 to 2.13 pg/ml (p 0.001) in the control group. Conclusion. The use of a diode laser in the treatment of endo-periodontal lesions has a positive effect on the dynamics of clinical and immunological parameters, as evidenced by a statistically significant decrease in clinical indices, as well as the normalization of the immunoglobulin A and cytokine levels in mixed saliva.
{"title":"Dynamics of clinical and immunological parameters in the integrated management of endo-periodontal lesions, including laser therapy","authors":"S. L. Blashkova, E. Krikun, I. G. Mustafin, I. Valeeva, J. V. Blashkova","doi":"10.17816/KMJ2021-322","DOIUrl":"https://doi.org/10.17816/KMJ2021-322","url":null,"abstract":"Aim. To determine the dynamics of clinical changes and indicators of local immunity in integrating the diode laser into the treatment of the endo-periodontal lesion. \u0000Methods. We performed a prospective study of 110 patients of both sexes aged 2555 years with endo-periodontal lesions. The patients were randomized into two groups the main group (n=54), whose received root canal treatment and periodontal pockets with a diode laser in addition to standard therapy, which included endodontic and periodontal treatment, and control group (n=56), whose patients received only standard treatment. The GreenVermillion oral hygiene index and Russells periodontal index, as well as the levels of immunoglobulin (Ig) A, tumor necrosis factor-alpha (TNF-alpha) and cytokine interleukin-10 (IL-10) in the mixed saliva of patients, were determined during the study. Quantitative data were described using median, lower and upper quartiles. These data were visualized using boxplots. The MannWhitney U test was used to compare differences between an independent set of quantitative data. Differences were considered significant at a confidence level of p 0.05. \u0000Results. The median oral hygiene index decreased from 2.9 to 1.0 (p 0.001) in the main group and from 2.9 to 1.6 (p 0.001) in the control group. The median Russell's periodontal index decreased from 3.38 to 1.3 (p 0.001) in the main group and from 3.95 to 2.0 (p 0.001) in the control group. The median immunoglobulin A content decreased from 5.25 to 3.13 mg/L (p 0.001) in the main group and from 5.23 to 4.21 mg/L (p 0.001) in the control group. The tumor necrosis factor-alpha level decreased from 16.65 pg/ml in the main group and 18.28 pg/ml in the control group to 3.96 and 8.44 pg/ml (p 0.001), respectively. The median cytokine interleukin-10 levels increased from 0.83 to 2.94 pg/ml (p 0.001) in the main group and from 1.29 to 2.13 pg/ml (p 0.001) in the control group. \u0000Conclusion. The use of a diode laser in the treatment of endo-periodontal lesions has a positive effect on the dynamics of clinical and immunological parameters, as evidenced by a statistically significant decrease in clinical indices, as well as the normalization of the immunoglobulin A and cytokine levels in mixed saliva.","PeriodicalId":17798,"journal":{"name":"Kazanskiy meditsinskiy zhurnal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87253051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Baranova, L. A. Aschina, A. V. Fedin, N. Shkurova, S. V. Sergeev
Aim. To develop a method for predicting the development of complications in rhinosinusitis patients based on the cytokine profile study. Methods. We examined 110 patients with rhinosinusitis and 30 healthy donors (control group). The patients were divided into the group without a complicated course of rhinosinusitis (first group, n=65) and the group with a complicated course of rhinosinusitis (second group, n=45). The blood serum levels of interleukin (IL)-1, IL-4, IL-8, IL-10, IL-17, IL-18, interferon (IFN)- were determined by enzyme immunoassay. Statistical analysis of the results was performed by using Microsoft Excel 2013 and Statistica 12.0 software. Statistically significant differences between the compared groups were determined by using the MannWhitney U-test, and p 0.05 was considered significant. Multivariate analysis included correlation analysis and stepwise regression analysis. The mathematical model consistency was determined by using Fisher's F-test, and p 0.05 was considered significant. Results. Changes in cytokine profile manifested by a decrease in the level of interleukin-1 (p=0.00001), interleukin-4 (p=0.045) and an increase in the level of interleukin-18 (p=0.00001) were revealed in patients with uncomplicated course of rhinosinusitis. The complicated course of rhinosinusitis was characterized by a decrease in the level of interleukin-1 (p=0.00002), interleukin-4 (p=0.049) and an increase in the level of interleukin-8 (p=0.023), interleukin-17 (p=0.00015) and interleukin-18 (p=0.0002). Comparative analysis of the first and the second groups of patients showed an increased level of interleukin-8 (p=0.00001), interleukin-17 (p=0.0001) and reduced levels of interleukin-18 (p=0.00045) in the group of patients with complicated course of rhinosinusitis. Based on interleukin-17, interleukin-8 and interleukin-18 levels, the mathematical model for predicting the development of complications in patients with rhinosinusitis was developed. Conclusion. The complicated course of rhinosinusitis was characterized by decreased levels of interleukin-1, interleukin-4 and increased levels of interleukin-17, interleukin-8 and interleukin-18, indicating a more pronounced inflammatory process; for personalized therapy, an approach based on interleukin-17, interleukin-8 and interleukin-18 levels was developed on which the development of a complicated course in patients with rhinosinusitis can be predicted.
{"title":"Predicting the development of complications in patients with rhinosinusitis by cytokine profile indicators","authors":"N. Baranova, L. A. Aschina, A. V. Fedin, N. Shkurova, S. V. Sergeev","doi":"10.17816/KMJ2021-307","DOIUrl":"https://doi.org/10.17816/KMJ2021-307","url":null,"abstract":"Aim. To develop a method for predicting the development of complications in rhinosinusitis patients based on the cytokine profile study. \u0000Methods. We examined 110 patients with rhinosinusitis and 30 healthy donors (control group). The patients were divided into the group without a complicated course of rhinosinusitis (first group, n=65) and the group with a complicated course of rhinosinusitis (second group, n=45). The blood serum levels of interleukin (IL)-1, IL-4, IL-8, IL-10, IL-17, IL-18, interferon (IFN)- were determined by enzyme immunoassay. Statistical analysis of the results was performed by using Microsoft Excel 2013 and Statistica 12.0 software. Statistically significant differences between the compared groups were determined by using the MannWhitney U-test, and p 0.05 was considered significant. Multivariate analysis included correlation analysis and stepwise regression analysis. The mathematical model consistency was determined by using Fisher's F-test, and p 0.05 was considered significant. \u0000Results. Changes in cytokine profile manifested by a decrease in the level of interleukin-1 (p=0.00001), interleukin-4 (p=0.045) and an increase in the level of interleukin-18 (p=0.00001) were revealed in patients with uncomplicated course of rhinosinusitis. The complicated course of rhinosinusitis was characterized by a decrease in the level of interleukin-1 (p=0.00002), interleukin-4 (p=0.049) and an increase in the level of interleukin-8 (p=0.023), interleukin-17 (p=0.00015) and interleukin-18 (p=0.0002). Comparative analysis of the first and the second groups of patients showed an increased level of interleukin-8 (p=0.00001), interleukin-17 (p=0.0001) and reduced levels of interleukin-18 (p=0.00045) in the group of patients with complicated course of rhinosinusitis. Based on interleukin-17, interleukin-8 and interleukin-18 levels, the mathematical model for predicting the development of complications in patients with rhinosinusitis was developed. \u0000Conclusion. The complicated course of rhinosinusitis was characterized by decreased levels of interleukin-1, interleukin-4 and increased levels of interleukin-17, interleukin-8 and interleukin-18, indicating a more pronounced inflammatory process; for personalized therapy, an approach based on interleukin-17, interleukin-8 and interleukin-18 levels was developed on which the development of a complicated course in patients with rhinosinusitis can be predicted.","PeriodicalId":17798,"journal":{"name":"Kazanskiy meditsinskiy zhurnal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85388522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Borodulin, Бородулин Владимир Иосифович, V. Albitsky, Альбицкий Валерий Юрьевич
The article highlights the formation of scientific therapeutic schools in Kazan using the comparative-historical method from the position of the modern concept of “scientific school”. Founded by the first of Botkin's student N.A. Vinogradov, the “affiliate” Botkin's scientific school initiated the creation of therapeutic schools at Kazan University in the first half of the XX century, originating in the second or third generation directly from S.P. Botkin. The activities of prominent Kazan therapists and their role in the formation of scientific schools are considered based on the approach of the social history of medicine — the impact of the social changes in Russia in 1917 and the beginning of the Civil War. Having established a center for the development of the scientific heritage of the great Russian clinician in Kazan, the clinical schools of A.N. Kazem-Bek, S.S. Zimnitsky, M.N. Cheboksarov, and N.K. Goryaev played a huge role in the development of Botkin’s direction of domestic internal medicine.
{"title":"The role of Kazan therapists in the development of the direction of Botkin's scientific research and clinical practice in the first half of the twentieth century","authors":"V. Borodulin, Бородулин Владимир Иосифович, V. Albitsky, Альбицкий Валерий Юрьевич","doi":"10.17816/KMJ2021-395","DOIUrl":"https://doi.org/10.17816/KMJ2021-395","url":null,"abstract":"The article highlights the formation of scientific therapeutic schools in Kazan using the comparative-historical method from the position of the modern concept of “scientific school”. Founded by the first of Botkin's student N.A. Vinogradov, the “affiliate” Botkin's scientific school initiated the creation of therapeutic schools at Kazan University in the first half of the XX century, originating in the second or third generation directly from S.P. Botkin. The activities of prominent Kazan therapists and their role in the formation of scientific schools are considered based on the approach of the social history of medicine — the impact of the social changes in Russia in 1917 and the beginning of the Civil War. Having established a center for the development of the scientific heritage of the great Russian clinician in Kazan, the clinical schools of A.N. Kazem-Bek, S.S. Zimnitsky, M.N. Cheboksarov, and N.K. Goryaev played a huge role in the development of Botkin’s direction of domestic internal medicine.","PeriodicalId":17798,"journal":{"name":"Kazanskiy meditsinskiy zhurnal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78301572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. V. Bulashova, Булашова Ольга Васильевна, A. A. Nasybullina, Насыбуллина Алсу Анваровна, E. V. Khazova, Хазова Елена Владимировна, V. M. Gazizyanova, Газизянова Виолетта Маратовна, V. Oslopov, Ослопов Владимир Николаевич
Aim. To analyze clinical and echocardiographic characteristics and prognosis in patients with heart failure mid-range ejection fraction. Methods. The study included 76 patients with stable heart failure I–IV functional class, with a mean age of 66.1±10.4 years. All patients were divided into 3 subgroups based on the left ventricular ejection fraction: the first group — heart failure patients with reduced ejection fraction (below 40%), 21.1%; the second group — patients with mid-range ejection fraction (from 40 to 49%), 23.7%; the third group — patients with preserved ejection fraction (>50%), 55.3%. The clinical characteristics of all groups were compared. The quality of life was assessed by the Minnesota Satisfaction Questionnaire (MSQ), the clinical condition was determined by using the clinical condition assessment scale (Russian “Shocks”). The prognosis was studied according to the onset of cardiovascular events one year after enrollment in the study. The endpoints were cardiovascular mortality, myocardial infarction (MI), stroke, hospitalization for acutely decompensated heart failure, thrombotic complications. Statistical analysis was performed by using IBM SPSS Statistics 20 software. Normal distribution of the data was determined by the Shapiro–Wilk test, nominal indicators were compared between groups by using chi-square tests, normally distributed quantitative indicators — by ANOVA. The Kruskal–Wallis test was performed to comparing data with non-normal distribution. Results. Analysis showed that the most of clinical characteristics (etiological structure, age, gender, quality of life, results on the clinical condition assessment scale for patients with chronic heart failure and a 6-minute walk test, distribution by functional classes of heart failure) in patients with mid-range ejection fraction (HFmrEF) were similar to those in patients with reduced ejection fraction (HFrEF). At the same time, they significantly differed from the characteristics of patients with preserved ejection fraction (HFpEF). Echocardiographic data from patients with mid-range ejection fraction ranks in the middle compared to patients with reduced and preserved ejection fraction. In heart failure patients with mid-range ejection fraction, the incidence of adverse outcomes during the 1st year also was intermediate between heart failure patients with preserved ejection fraction and patients with reduced ejection fraction: for all cardiovascular events in the absence of significant differences (17.6; 10.8 and 18.8%, respectively), myocardial infarction (5,9; 0 and 6.2%), thrombotic complications (5.9; 5.4 and 6.2%). Heart failure patients with mid-range ejection fraction in comparison to patients with preserved ejection fraction and reduced ejection fraction had significantly lower cardiovascular mortality (0; 2.7 and 12.5%, p >0.05) and the number of hospitalization for acutely decompensated heart failure (0; 2,7 and 6.2%). Conclusion. Clinical characteristics of
{"title":"Heart failure patients with mid-range ejection fraction: clinical features and prognosis","authors":"O. V. Bulashova, Булашова Ольга Васильевна, A. A. Nasybullina, Насыбуллина Алсу Анваровна, E. V. Khazova, Хазова Елена Владимировна, V. M. Gazizyanova, Газизянова Виолетта Маратовна, V. Oslopov, Ослопов Владимир Николаевич","doi":"10.17816/KMJ2021-293","DOIUrl":"https://doi.org/10.17816/KMJ2021-293","url":null,"abstract":"Aim. To analyze clinical and echocardiographic characteristics and prognosis in patients with heart failure mid-range ejection fraction. Methods. The study included 76 patients with stable heart failure I–IV functional class, with a mean age of 66.1±10.4 years. All patients were divided into 3 subgroups based on the left ventricular ejection fraction: the first group — heart failure patients with reduced ejection fraction (below 40%), 21.1%; the second group — patients with mid-range ejection fraction (from 40 to 49%), 23.7%; the third group — patients with preserved ejection fraction (>50%), 55.3%. The clinical characteristics of all groups were compared. The quality of life was assessed by the Minnesota Satisfaction Questionnaire (MSQ), the clinical condition was determined by using the clinical condition assessment scale (Russian “Shocks”). The prognosis was studied according to the onset of cardiovascular events one year after enrollment in the study. The endpoints were cardiovascular mortality, myocardial infarction (MI), stroke, hospitalization for acutely decompensated heart failure, thrombotic complications. Statistical analysis was performed by using IBM SPSS Statistics 20 software. Normal distribution of the data was determined by the Shapiro–Wilk test, nominal indicators were compared between groups by using chi-square tests, normally distributed quantitative indicators — by ANOVA. The Kruskal–Wallis test was performed to comparing data with non-normal distribution. Results. Analysis showed that the most of clinical characteristics (etiological structure, age, gender, quality of life, results on the clinical condition assessment scale for patients with chronic heart failure and a 6-minute walk test, distribution by functional classes of heart failure) in patients with mid-range ejection fraction (HFmrEF) were similar to those in patients with reduced ejection fraction (HFrEF). At the same time, they significantly differed from the characteristics of patients with preserved ejection fraction (HFpEF). Echocardiographic data from patients with mid-range ejection fraction ranks in the middle compared to patients with reduced and preserved ejection fraction. In heart failure patients with mid-range ejection fraction, the incidence of adverse outcomes during the 1st year also was intermediate between heart failure patients with preserved ejection fraction and patients with reduced ejection fraction: for all cardiovascular events in the absence of significant differences (17.6; 10.8 and 18.8%, respectively), myocardial infarction (5,9; 0 and 6.2%), thrombotic complications (5.9; 5.4 and 6.2%). Heart failure patients with mid-range ejection fraction in comparison to patients with preserved ejection fraction and reduced ejection fraction had significantly lower cardiovascular mortality (0; 2.7 and 12.5%, p >0.05) and the number of hospitalization for acutely decompensated heart failure (0; 2,7 and 6.2%). Conclusion. Clinical characteristics of ","PeriodicalId":17798,"journal":{"name":"Kazanskiy meditsinskiy zhurnal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82395407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Saetgaraev, I. Maximov, I. Zakirov, I. V. Shaymardanov, I. Grigoreva, M. E. Guryleva
Aim. To study the influence of the trained environment of geriatric onco-surgical patients on the quality of the interventions in the complex of early postoperative rehabilitation in the Intensive Care Unit (ICU). Methods. The 96 patients aged 73.37.1 years operated on in the emergency onco-surgery clinic of the Tatarstan Cancer Center of the Ministry of Health of the Republic of Tatarstan between 2016 and 2020. Patients, similar in age and condition (American Society of Anaesthesiologists Physical Status category IIIE) were divided into three equal groups: the first group generally accepted measures for early rehabilitation were carried out by medical staff; the second group the prepared relatives of the patient was additionally involved in rehabilitation; the control group early rehabilitation was not carried out. The quality of nutritional support and measures to prevent pressure ulcers, cognitive function were assessed. Statistical processing was performed by using Microsoft Excel 2007 and IBM SPSS Statistics version 20 software. The statistical significance of data was determined by using the chi-square test at p 0.05. Results. The involvement of previously trained relatives made it possible to reduce the incidence of pressure ulcers grade IV to 0%. There was a significant difference in the volume of assimilated enteral oral feeding (180.620.8; 240.620.8; 80.510.2; p 0.05) and the serum albumin level by 11 days after surgery (26.81.5; 28.91.2; 24.21.1 g/L, respectively; p 0.05). Assimilation of enteral oral feeding improved 3 times compared with the control group and 1.5 times compared with the first group (p 0.05). Indicators of cognitive status by the Mini Mental State Examination (MMSE) on the 6th day were 23.31.1; 25.31.1; 21.21.2 (p 0.05), respectively. Conclusion. A rationally organized preparation of the patient's environment for the implementation of care, participation in rehabilitation measures and the prevention of complications can improve outcomes of medical intervention and reduce the incidence of postoperative complications.
{"title":"Inclusion of the prepared patient relatives in the process of early rehabilitation of onco-surgical patients in the department of anesthesiology and intensive care","authors":"A. Saetgaraev, I. Maximov, I. Zakirov, I. V. Shaymardanov, I. Grigoreva, M. E. Guryleva","doi":"10.17816/KMJ2021-373","DOIUrl":"https://doi.org/10.17816/KMJ2021-373","url":null,"abstract":"Aim. To study the influence of the trained environment of geriatric onco-surgical patients on the quality of the interventions in the complex of early postoperative rehabilitation in the Intensive Care Unit (ICU). \u0000Methods. The 96 patients aged 73.37.1 years operated on in the emergency onco-surgery clinic of the Tatarstan Cancer Center of the Ministry of Health of the Republic of Tatarstan between 2016 and 2020. Patients, similar in age and condition (American Society of Anaesthesiologists Physical Status category IIIE) were divided into three equal groups: the first group generally accepted measures for early rehabilitation were carried out by medical staff; the second group the prepared relatives of the patient was additionally involved in rehabilitation; the control group early rehabilitation was not carried out. The quality of nutritional support and measures to prevent pressure ulcers, cognitive function were assessed. Statistical processing was performed by using Microsoft Excel 2007 and IBM SPSS Statistics version 20 software. The statistical significance of data was determined by using the chi-square test at p 0.05. \u0000Results. The involvement of previously trained relatives made it possible to reduce the incidence of pressure ulcers grade IV to 0%. There was a significant difference in the volume of assimilated enteral oral feeding (180.620.8; 240.620.8; 80.510.2; p 0.05) and the serum albumin level by 11 days after surgery (26.81.5; 28.91.2; 24.21.1 g/L, respectively; p 0.05). Assimilation of enteral oral feeding improved 3 times compared with the control group and 1.5 times compared with the first group (p 0.05). Indicators of cognitive status by the Mini Mental State Examination (MMSE) on the 6th day were 23.31.1; 25.31.1; 21.21.2 (p 0.05), respectively. \u0000Conclusion. A rationally organized preparation of the patient's environment for the implementation of care, participation in rehabilitation measures and the prevention of complications can improve outcomes of medical intervention and reduce the incidence of postoperative complications.","PeriodicalId":17798,"journal":{"name":"Kazanskiy meditsinskiy zhurnal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77888963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The review outlines the current understanding of the clinical syndrome of heart disease in patients with liver cirrhosis and the development of cirrhotic cardiomyopathy. Patients with cirrhosis of the liver often notice chest pain, palpitations, complaints of arterial hypotension and rapid fatigue. Echocardiography shows that the left ventricular ejection fraction in cirrhosis is preserved at rest and decreases under stress. In some patients with viral liver cirrhosis, there is a decrease in global myocardial deformation (the presence of latent systolic dysfunction). More pronounced impairment of left ventricular diastolic function is recorded in patients with ascites and patients with ChildPugh class B and C. In patients with ascites, unfavorable left ventricular remodeling, left heart cavities enlargement, dilatation of the pulmonary artery and its branches are more common. There is an increase in pulmonary artery pressure, the development of portopulmonary hypertension and hepatopulmonary syndrome in patients with liver cirrhosis. Тhe development of these syndromes leads to a sharp decrease in the quality of life of patients with relatively preserved liver function and a worsening of the prognosis for orthotopic liver transplantation. Аpproximately half of patients with liver cirrhosis have electrophysiological disorders: prolongation of the QT interval, tachycardia, supraventricular and ventricular extrasystoles. To date, there are no clinical guidelines for the management of cirrhotic cardiomyopathy. If a patient with liver cirrhosis develops clinically significant heart failure, then general principles of management of such patients are necessary. It is necessary to limit the use of angiotensin-converting enzyme inhibitors and cardiac glycosides. The combined use of nonselective beta-blockers and nitrates reduce cardiac output and QT interval. The use of potassium canrenoate, lisinopril helps reverse the development of structural and functional changes in left ventricle. The positive effect of antiviral therapy on cardiac hemodynamics in patients with viral cirrhosis was noted. Liver transplantation is known to be an effective treatment for cirrhotic cardiomyopathy, but this treatment may worsen latent heart failure. Thus, in patients with liver cirrhosis, heart damage occurs with the development of cirrhotic cardiomyopathy, while the mechanisms of the development of myocardial dysfunction are not fully understood. Further studies of the development of the syndrome are required for timely diagnosis and clinical intervention to improve the survival of patients.
{"title":"Heart damage in patients with cirrhosis of the liver","authors":"M. V. Chistyakova, A. Govorin, T. V. Kalinkina","doi":"10.17816/KMJ2021-342","DOIUrl":"https://doi.org/10.17816/KMJ2021-342","url":null,"abstract":"The review outlines the current understanding of the clinical syndrome of heart disease in patients with liver cirrhosis and the development of cirrhotic cardiomyopathy. Patients with cirrhosis of the liver often notice chest pain, palpitations, complaints of arterial hypotension and rapid fatigue. Echocardiography shows that the left ventricular ejection fraction in cirrhosis is preserved at rest and decreases under stress. In some patients with viral liver cirrhosis, there is a decrease in global myocardial deformation (the presence of latent systolic dysfunction). More pronounced impairment of left ventricular diastolic function is recorded in patients with ascites and patients with ChildPugh class B and C. In patients with ascites, unfavorable left ventricular remodeling, left heart cavities enlargement, dilatation of the pulmonary artery and its branches are more common. There is an increase in pulmonary artery pressure, the development of portopulmonary hypertension and hepatopulmonary syndrome in patients with liver cirrhosis. Тhe development of these syndromes leads to a sharp decrease in the quality of life of patients with relatively preserved liver function and a worsening of the prognosis for orthotopic liver transplantation. Аpproximately half of patients with liver cirrhosis have electrophysiological disorders: prolongation of the QT interval, tachycardia, supraventricular and ventricular extrasystoles. To date, there are no clinical guidelines for the management of cirrhotic cardiomyopathy. If a patient with liver cirrhosis develops clinically significant heart failure, then general principles of management of such patients are necessary. It is necessary to limit the use of angiotensin-converting enzyme inhibitors and cardiac glycosides. The combined use of nonselective beta-blockers and nitrates reduce cardiac output and QT interval. The use of potassium canrenoate, lisinopril helps reverse the development of structural and functional changes in left ventricle. The positive effect of antiviral therapy on cardiac hemodynamics in patients with viral cirrhosis was noted. Liver transplantation is known to be an effective treatment for cirrhotic cardiomyopathy, but this treatment may worsen latent heart failure. Thus, in patients with liver cirrhosis, heart damage occurs with the development of cirrhotic cardiomyopathy, while the mechanisms of the development of myocardial dysfunction are not fully understood. Further studies of the development of the syndrome are required for timely diagnosis and clinical intervention to improve the survival of patients.","PeriodicalId":17798,"journal":{"name":"Kazanskiy meditsinskiy zhurnal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75941962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Valiullin, A. E. Khairullin, A. Eremeev, A. Teplov, A. Shaĭkhutdinova, N. M. Kashtanov, S. N. Grishin
Aim. To study the dynamics of neuromotor regulation of the contractile function of fast and slow muscles in rodents during spinal shock by spinal cord transection at the level Тh11Тh12. Methods. The experiments were carried out on laboratory rats weighing 140180 g. The animals were divided into two groups: Control (8 rats) and Spinal shock (6 rats). The lower leg muscles, m. soleus and m. extensor digitorum longus (m. EDL), were dissected by partially isolating without disrupting the connection with the body's circulatory system. The sciatic nerve was stimulated with single electrical impulses (10 V, 0.5 ms). Contractions of both muscles caused by electrical stimulation of the sciatic nerve before and after the injection of the substances into the femoral artery tubocurarine (1 mM) or norepinephrine (10 mM) were recorded in animals of both groups. After spinalization, muscle contractions were re-recorded during electrical stimulation of the sciatic nerve before and 10 minutes after the injection of tubocurarine or noradrenaline into the femoral artery in the same concentrations. Results. After spinalization of the animal, the contraction force of the muscle m. EDL fibers increased to 0.430.03 g (p=0.040), but the temporal parameters remained unchanged. M. soleus, on the contrary, showed a decrease in the contraction time to 0.0530.005 s (p=0.045), and no change in the contraction force was observed under these conditions. Intra-arterial administration of norepinephrine in the control group resulted in an increase of m. soleus contractions up to 1.210.17 g (p=0.048), and m. EDL up to 0.570.07 g (p=0.043). The administration of norepinephrine in spinalized animals caused an increase in the contraction of m. soleus up to 1.210.09 g (p=0.047), and m. EDL up to 0.660.05 g (p=0.043). The blocker of postsynaptic cholinergic receptors tubocurarine administration reduced the force of contraction of both muscle types in both control [m. soleus up to 0.390.03 g (p=0.039), m. EDL up to 0.110.02 g (p=0.042)] and spinalized [m. soleus up to 0.340.05 g (p=0.039), m. EDL up to 0.150.04 g (p=0.040)] animals. Conclusion. The data obtained demonstrate the presence of significant differences in the mechanisms of control of contractile activity in the fast and slow skeletal muscles of warm-blooded animals; the persistence of the similar effect of the basic modulators on the contraction of both muscles with such a striking reaction to spinalization highlights the contribution of neurotrophic control to the functioning of fast and slow motor units.
的目标。通过水平脊髓横断研究脊髓休克时啮齿动物快肌和慢肌收缩功能的神经运动调控动力学Тh11Тh12。方法。实验对象为体重140180g的实验室大鼠。实验动物分为对照组(8只)和脊髓休克组(6只)。在不破坏与人体循环系统的连接的情况下，部分分离分离小腿肌肉比目鱼肌和指长伸肌(EDL)。单次电脉冲(10 V, 0.5 ms)刺激坐骨神经。记录两组动物在股动脉注射管碱(1 mM)或去甲肾上腺素(10 mM)前后坐骨神经电刺激引起的两侧肌肉收缩情况。脊柱化后，分别在股动脉注射相同浓度的管曲碱或去甲肾上腺素前和后10分钟电刺激坐骨神经时，重新记录肌肉收缩情况。结果。动物棘化后，肌纤维m. EDL的收缩力增加到0.430.03 g (p=0.040)，但时间参数不变。与此相反，比目鱼的收缩时间缩短至0.0530.005 s (p=0.045)，而收缩力没有变化。对照组动脉内给药去甲肾上腺素导致比目鱼肌收缩增加1.210.17 g (p=0.048)， EDL增加0.570.07 g (p=0.043)。去甲肾上腺素可使比目鱼肌收缩增加1.210.09 g (p=0.047)， EDL增加0.660.05 g (p=0.043)。突触后胆碱能受体阻滞剂管碱给药可降低两种对照中两种肌肉类型的收缩力[m]。比目鱼肌可达0.390.03 g (p=0.039)， m. EDL可达0.110.02 g (p=0.042)]。比目鱼可达0.340.05 g (p=0.039)， m. EDL可达0.150.04 g (p=0.040)]动物。结论。所获得的数据表明，温血动物快慢骨骼肌收缩活动的控制机制存在显著差异;基本调节剂对两种肌肉收缩的相似作用的持续存在，以及对脊柱化的显著反应，突出了神经营养控制对快、慢运动单元功能的贡献。
{"title":"Contractions dynamic of “fast” and “slow” rat muscle under spinal shock and modulators of contraction","authors":"V. Valiullin, A. E. Khairullin, A. Eremeev, A. Teplov, A. Shaĭkhutdinova, N. M. Kashtanov, S. N. Grishin","doi":"10.17816/KMJ2021-329","DOIUrl":"https://doi.org/10.17816/KMJ2021-329","url":null,"abstract":"Aim. To study the dynamics of neuromotor regulation of the contractile function of fast and slow muscles in rodents during spinal shock by spinal cord transection at the level Тh11Тh12. \u0000Methods. The experiments were carried out on laboratory rats weighing 140180 g. The animals were divided into two groups: Control (8 rats) and Spinal shock (6 rats). The lower leg muscles, m. soleus and m. extensor digitorum longus (m. EDL), were dissected by partially isolating without disrupting the connection with the body's circulatory system. The sciatic nerve was stimulated with single electrical impulses (10 V, 0.5 ms). Contractions of both muscles caused by electrical stimulation of the sciatic nerve before and after the injection of the substances into the femoral artery tubocurarine (1 mM) or norepinephrine (10 mM) were recorded in animals of both groups. After spinalization, muscle contractions were re-recorded during electrical stimulation of the sciatic nerve before and 10 minutes after the injection of tubocurarine or noradrenaline into the femoral artery in the same concentrations. \u0000Results. After spinalization of the animal, the contraction force of the muscle m. EDL fibers increased to 0.430.03 g (p=0.040), but the temporal parameters remained unchanged. M. soleus, on the contrary, showed a decrease in the contraction time to 0.0530.005 s (p=0.045), and no change in the contraction force was observed under these conditions. Intra-arterial administration of norepinephrine in the control group resulted in an increase of m. soleus contractions up to 1.210.17 g (p=0.048), and m. EDL up to 0.570.07 g (p=0.043). The administration of norepinephrine in spinalized animals caused an increase in the contraction of m. soleus up to 1.210.09 g (p=0.047), and m. EDL up to 0.660.05 g (p=0.043). The blocker of postsynaptic cholinergic receptors tubocurarine administration reduced the force of contraction of both muscle types in both control [m. soleus up to 0.390.03 g (p=0.039), m. EDL up to 0.110.02 g (p=0.042)] and spinalized [m. soleus up to 0.340.05 g (p=0.039), m. EDL up to 0.150.04 g (p=0.040)] animals. \u0000Conclusion. The data obtained demonstrate the presence of significant differences in the mechanisms of control of contractile activity in the fast and slow skeletal muscles of warm-blooded animals; the persistence of the similar effect of the basic modulators on the contraction of both muscles with such a striking reaction to spinalization highlights the contribution of neurotrophic control to the functioning of fast and slow motor units.","PeriodicalId":17798,"journal":{"name":"Kazanskiy meditsinskiy zhurnal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90494758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Yakovleva, Яковлева Ольга Владимировна, I. Rogozhina, Рогожина Ирина Евгеньевна, T. N. Glukhova, Глухова Татьяна Николаевна
The aim of this work is to study the state of the problem of the development of small-for-gestational-age fetus and fetal growth restriction over the past 5 years. A review of randomized trials of the PubMed database for the period of 2015 to 2020 was carried out. Experts reached an agreement on the definition of diagnostic criteria for small-for-gestational-age fetus and fetal growth restriction, a clinically valid classification was created, and the main monitoring strategies were developed. Due to the different pathogenesis, fetal growth restriction is divided into early and late. The observation algorithm includes tests that have shown higher sensitivity and specificity. There is no single standard for the median weight and abdominal circumference of a fetus, indicators of the reference range for fetal Doppler. Smoking cessation and taking acetylsalicylic acid at a dose of 150 mg at high risk of preeclampsia is recommended to prevent the small-for-gestational-age fetus and fetal growth restriction. The pregnancy management algorithm includes Doppler ultrasound examination of the umbilical artery, cardiotocography. If this pathology occurs before 32 weeks of pregnancy, the blood flow in ductus venosus is additionally examined, and after 32 weeks of pregnancy, the middle cerebral artery blood velocities and cerebroplacental ratio are assessed. Indicators of Doppler velocimetry and cardiotocography, which serve as criteria for early termination of pregnancy, are developed, measures are proposed to improve neonatal outcomes — prevention of respiratory distress syndrome at 24–34 weeks of gestation, as well as magnesium therapy for fetal neuroprotection. The problems of preventing fetal growth restriction and the algorithm for monitoring pregnant women who do not have risk factors for small-for-gestational-age fetus, management tactics and indications for delivery while slowing fetal weight gain remain unresolved.
{"title":"Modern concepts of low birth weight and fetal growth restriction","authors":"O. Yakovleva, Яковлева Ольга Владимировна, I. Rogozhina, Рогожина Ирина Евгеньевна, T. N. Glukhova, Глухова Татьяна Николаевна","doi":"10.17816/KMJ2021-347","DOIUrl":"https://doi.org/10.17816/KMJ2021-347","url":null,"abstract":"The aim of this work is to study the state of the problem of the development of small-for-gestational-age fetus and fetal growth restriction over the past 5 years. A review of randomized trials of the PubMed database for the period of 2015 to 2020 was carried out. Experts reached an agreement on the definition of diagnostic criteria for small-for-gestational-age fetus and fetal growth restriction, a clinically valid classification was created, and the main monitoring strategies were developed. Due to the different pathogenesis, fetal growth restriction is divided into early and late. The observation algorithm includes tests that have shown higher sensitivity and specificity. There is no single standard for the median weight and abdominal circumference of a fetus, indicators of the reference range for fetal Doppler. Smoking cessation and taking acetylsalicylic acid at a dose of 150 mg at high risk of preeclampsia is recommended to prevent the small-for-gestational-age fetus and fetal growth restriction. The pregnancy management algorithm includes Doppler ultrasound examination of the umbilical artery, cardiotocography. If this pathology occurs before 32 weeks of pregnancy, the blood flow in ductus venosus is additionally examined, and after 32 weeks of pregnancy, the middle cerebral artery blood velocities and cerebroplacental ratio are assessed. Indicators of Doppler velocimetry and cardiotocography, which serve as criteria for early termination of pregnancy, are developed, measures are proposed to improve neonatal outcomes — prevention of respiratory distress syndrome at 24–34 weeks of gestation, as well as magnesium therapy for fetal neuroprotection. The problems of preventing fetal growth restriction and the algorithm for monitoring pregnant women who do not have risk factors for small-for-gestational-age fetus, management tactics and indications for delivery while slowing fetal weight gain remain unresolved.","PeriodicalId":17798,"journal":{"name":"Kazanskiy meditsinskiy zhurnal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90084317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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