Saratov JOURNAL of Medical and Scientific Research

Original article

The estimation of biocompatibility of polycaprolactone matrices mineralized by vat-erite in subcutaneous implantation tests in white rats

Year: 2018, volume 14 Issue: №3 Pages: 451-456
Heading: Physiology and Pathophysiology Article type: Original article
Authors: Ivanov A.N., Kurtukova М.О., Kozadaev M.N., Tyapkina D.A., Kustodov S.V., Saveleva M.S., Bugaeva I.O., Parakhonsky B.V., Galashina E.A., Gladkova E.V., Norkin I.A.
Organization: Saratov National Research University n.a. N. G. Chernyshevsky
Summary:

Aim: to estimate biocompatibility of matrices produced from polycaprolactone (PCL) and mineralized by vaterite (CaC03) by studying local and systemic manifestations of inflammatory reaction in subcutaneous implantation tests in white rats. Material and Methods. The experiment was conducted on 40 rats divided into four equal groups: control, comparison (rats with imitation of implantation), negative control (rats with implanted non-biocompatible matrices) and experimental group, comprised of animals with implanted PCL/CaC03-matrices. Local inflammatory manifestations were analyzed by morphological assay of implantation area tissues. Systemic inflammatory manifestations were estimated by TNF-a concentration and interleukin-lp (IL-1) in blood serum by ELISA. Results. The changes in cellular population content demonstrate that a PCL/CaC03-matriceonthe21 day after the implantation to rats is evenly colonizing by fibroblast cells and vascularizing. This type of matrices does not provoke intense inflammatory reaction seen in negative control animals and accompanied by systemic manifestations such as statistically significant rise in TNF-a and IL-1 concentrations. Conclusion. The data obtained in the study proving the biocompatibility of PLC/CaC03-scaffolds experimentally substantiate the potential for their use in tissue engineering.

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Patients interviewing — an effective method of forming social competencies of medical students

Year: 2018, volume 14 Issue: №3 Pages: 445-447
Heading: Sociology of Medicine Article type: Original article
Authors: Skryabina E.N., Aleksandrova O.L., Korneva Yu.M., Pasechnaya N.V., Kats Z.V.
Organization: Saratov State Medical University
Summary:

The professionalism of a doctor is determined not only by scientific knowledge, but also by high moral qualities. Aim is the formation of the social competencies of the students of the medical university, concerning the personal qualities of the doctor. The authors used a self-developed questionnaire, which included questions relating to patients' characteristics (gender, level of education, disease origin and its duration) and to attending physician (work experience, theoretical and practical skills, moral qualities). Material and Methods. Questioning of 100 patients of the rheumatologi-cal department of the State Regional Hospital of Saratov was performed by students of the Saratov Medical University. Results. The survey showed that most patients considered the moral qualities of a doctor to be very important and they determined the successful treatment of patients. The ineffectiveness of treatment is largely due to loss of confidence in doctor. Conclusion. Questioning of patients allowed students to be convinced of the importance of formation of high moral qualities of a doctor as they help mutual understanding of a doctor and a patient, increase treatment efficiency.

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Health care supervisors' opinion on prophylactic work in medical organizations

Year: 2018, volume 14 Issue: №3 Pages: 438-444
Heading: Health Service Organization Article type: Original article
Authors: Korshever N.G., Sidelnikov S.A., Yakhina R.R.
Organization: Saratov Regional Centre of Medical Prophylaxis, Saratov State Medical University
Summary:

 The aim: to investigate the condition of prophylactic work in medical organizations and to determine the directions for optimization of this process. Material and Methods. There has been carried out an anonymous questioning 92 of health care supervisors of the Saratov region, as well the analysis of data obtained from Saratov Regional Centre of medical prophylaxis. It was found that there were significant shortcomings in the individual items in the preventive work of medical organizations. Results. There has been determined the awareness of health care supervisors about normative-legal acts regulating prophylactic work; use of corresponding informational-methodical materials; management of registration documents and submission of reporting documents; performance of primary, secondary and tertiary prophylactic measures; realization of means and methods of hygienic upbringing and education of patients; activities of offices (departments) of medical prophylaxis. It has been established that the condition of prophylactic work in medical organizations of the Saratov region is at the satisfactory level but needs to be optimized. The directions of optimization are determined by the necessity to raise the levels of a number of characteristics analyzed. None of the considered measures of the first prophylaxis has been evaluated with the mark "good", (> 4,0 points); some measures of the secondary prophylaxis (purposeful sanitary-hygienic education of patients and members of their families in skills of care associated with a certain disease or with a group of diseases, etc.) (2 points) have been evaluated with the mark "unsatisfactory"; the state of the tertiary prophylaxis has been evaluated on the whole with the mark "satisfactory", i.e. 3,4 points. Conclusion. The obtained materials may be useful in daily practice of medical organizations.

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Methodology of advanced medical information registries design

Year: 2018, volume 14 Issue: №3 Pages: 434-437
Heading: Health Service Organization Article type: Original article
Authors: Fedonnikov A.S., Kolesnikova A.S., Rozhkova Yu.Yu., Kirillova I.V., Bessonov L.V., Ulyanov V.Yu., Kossovich L.Yu.
Organization: Saratov State Medical University
Summary:

Aim: development of information exchange methodology between the main participants of health branch in providing of medical care for traumatology and orthopedic patients at the base of specialized registers design. Material and Methods. Analysis and systematization of 31 registers of medical information in the field of traumatology and orthopedics functionality placed in Federal Institute of Industrial Property, European Patent databases, developers' web-sites were made. Search depth was designated from 1979 and was defined by the date of the earlier found information source. Results. Analysis of specialized registries has shown that most of it (70.9%) are mono-nosological and contain information about diagnostic and treatment measures provided at the level of a medical institution. It was developed a methodology of specialized registry of medical information functionality including the information of applied medical devices, pharmaceutical preparations, medical technologies, rehabilitation programs, medical care evaluation results methodology which let operate with the data forming in information systems of the main health branch participants. Conclusion. Proposed information exchange methodology determines the necessity of integrated target-oriented registry development. Its practical use let increase management decisions quality influencing the achievement of health branch participants objectives.

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Analysis of working conditions of employees of Samara medical institutions

Year: 2018, volume 14 Issue: №3 Pages: 427-433
Heading: Hygiene Article type: Original article
Authors: Tupikova D.S.
Organization: Samara State Medical University
Summary:

Objective: an analysis of the conditions and nature of the work of public health workers in the city of Samara, according to their own research and the results of a special assessment of working conditions for the development of preventive measures. Material and Methods. The study analyzed the results of assessing the factors of the production environment, such as microclimate and illumination in 70 rooms of two large medical institutions of the city of Samara. An estimation of the qualitative and quantitative microbial composition of the air medium in the analyzed rooms was carried out. The analysis of registration cards for a special assessment of the working conditions of workplaces in the same organizations was carried out between 2012 and 2017. Results. In analyzing the conditions and nature of the work of medical workers, it was revealed that the final class of working conditions for doctors and nurses of surgical departments was 3.3, therapeutic 3.2 as a result of biological factors. At the same time, the air in the working area of the study rooms of the surgical and therapeutic sections differed significantly in the structure of the conditionally pathogenic microflora. Physical and chemical factors did not exceed the level of class 3.1-3.2. Conclusion. An analysis of the results of the studies showed the need to optimize ventilation in the residents and nurses, as well as the need to improve the quality of natural and artificial lighting. The expediency of standardization of the conditionally pathogenic microflora of the air environment in class «B» premises is shown.

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Biomarkers of renal damage and immunohistochemical detection of oncogenesis in the surgical treatment of renal cell carcinoma

Year: 2018, volume 14 Issue: №3 Pages: 420-426
Heading: Urology Article type: Original article
Authors: Tarasenko A.l., Rossolovsky A.N., Berezinets O.L., Ponukalin A.N., Medvedeva A.M., Zakharova N.B., Popkov V.M., Maslyakova G.N.
Organization: Saratov State Medical University, I.M. Sechenov First Moscow State Medical University
Summary:

Objective: to assess the possibility of using markers of renal injury and carcinogenesis as additional criteria for the choice of the method of surgical treatment of RCC and to minimize the risk of development and progression of kidney injury. Material and Methods. 60 patients with morphologically confirmed RCC T1-3M0N0 operated on in the volume of open nephrectomy or laparoscopic nephrectomy or laparoscopic resection and the kidney were examined. Patients were divided into 3 groups: group 1: patients after nephrectomy performed for kidney cancer using traditional surgical technique, group 2: patients after laparoscopic nephrectomy and group 3: after laparoscopic resection of kidney tumor. Before surgical operation, on the 5-7 day and after 1 month, all patients were examined by concentrations of urinary excreted lipocalin 2 (NGAL), and serum concentrations of IL-18, MMP-9 and IGF-1. Renal function was estimated using the calculated GFR equation (CKD-EPI 2009) based on serum creatinine level. Immunohistochemical study of histological preparations of distant tumors on proliferation antibodies (Ki-67, PCNA), apoptosis (BAX, Bcl-2) was performed. Differences in clinical data and clinical variables were compared using Spearman rank correlations and t-test. Results. The studied indices of renal damage of IL-18, NGAL, MMP-9 and IGF-1 both in the early (5-7 days) and later (1 month) postoperative period showed a correlation between the surgical intervention method and the degree of tumor cell differentiation. Conclusion. The levels of biomolecular markers of renal damage (IL-18, NGAL, MMP-9 and IGF-1) correlate with the degree of differentiation in thetumoral cells and functional activity of the remaining renal parenchyma in the postoperative period, but also depend on the individual characteristics of the patient's body. A certain level of expression of MMP-9 and IL-18 with a small tumor size can be a guide to determine the indications for the choice of organ-preserving surgery in patients.

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Comparative analysis of the quality of life before and after various methods of invasive treatment of esophageal cancer

Year: 2018, volume 14 Issue: №3 Pages: 408-411
Heading: Surgery Article type: Original article
Authors: Tolstokorov A.S., Ramazanov E.N., Dergunova S.A.
Organization: Saratov State Medical University
Summary:

The aim of the work is to assess the quality of life before and after multistage and one-stage operations, palliative interventions performed with malignant neoplasms of the esophagus. Material and Methods. The quality of life was evaluated in 565 patients with esophageal cancer at various stages of surgical treatment by means of questionnaires for assessing the quality of life of GIQLI, GSRS, MOS SF-36 questionnaire. Results. When performing multi-stage operations before the end of treatment, the quality of life changes insignificantly, and is comparable with the quality of life after palliative operations. The study of the quality of life after the end of treatment with the use of endoscopic minimally invasive technologies in these questionnaires convincingly showed the advantage of this category of surgical interventions due to less trauma, better cosmetic effect, quick activation and rehabilitation in the postoperative period. Conclusion. Taking into account the results of the research, preference is given to one-stage operations with the use of minimally invasive endoscopic techniques, which in a short time can save the patient from cancer and significantly improve the quality of life.

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Evaluation results of arthroscopic reconstruction of rotator cuff using single-row anchor fixation

Year: 2018, volume 14 Issue: №3 Pages: 401-407
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Chirkov А.А., Spiridonova O.V., Yakovlev V.N.
Organization:
Summary:

The purpose was to evaluate the results of arthroscopic reconstruction of the rotator cuff of a shoulder using the single-row anchor fixation method, to evaluate the dependence of the results of treatment on the size of the rupture of the rotator cuff of the shoulder. Material and Methods. This report provides an analysis of results of surgical treatment of 84 patients with the damage of the rotator cuff of a shoulder, who underwent arthroscopic reconstruction of the rotational cuff of a shoulder using single-row anchor fixation. The size of rupture of the rotator cuff of the shoulder was measured with the use of MRI and during surgery itself. All ruptures were subdivided into small (less than 1 cm), medium (1-3 cm) and large (3-5 cm). The exclusion criteria were patients with a massive rupture of the rotator cuff of a shoulder, with retraction of the tendon to the level of the articular process of the scapula or fatty degeneration of the muscles of the short shoulder rotators. The paper presents the features of operative technique and original algorithm for postoperative rehabilitation at different stages of treatment. Evaluation of the results of treatment was performed according to the rating scale of the Constant score, ASES, UCLA. Results. The average age of the patients was 56.0±7.4 (36-71 years). Of these, 22.6% patients had a small degree of rupture of the rotator cuff of a shoulder, 50% middle and 27.4% patients had a large degree of rupture. The nearest results (up to one year) were evaluated in 5 patients, long-term results in 79 patients (more than a year). The average rating score according to the Constant score was 89,8±9,2; the average value according to the ASES scale was 83,7±17,6; the average value according to the UCLA scale was 29.3±5.9. In all other patients complete recovery was observed in the period from 6 months to a year after the operation, there was a decrease in the pain syndrome, an increase in the volume of movements, an improvement in the quality of life. Conclusion. Arthroscopic reconstruction of the rotator cuff of a shoulder using the method of single-row anchor fixation, if necessary, with the help of seams which reapproximate the edges of the rupture, and with the help of the accompanying procedures, provides good results. Reduction in pain, increase in movement and in muscle strength in the arm were noted in all patients, regardless of the size of the damage to the rotator cuff of the shoulder. The rehabilitative protocol used ensures the creation of favorable conditions for engraftment of the restored tendon and, at the same time, provides prevention of the development of the stiffness of the shoulder joint.

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Anatomic and functional disorders in children with flatfoot

Year: 2018, volume 14 Issue: №3 Pages: 396-401
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Sertakova.A.V., Dokhov M.M., Rubashkin S.A., Timaev M.Kh.
Organization:
Summary:

Aim: to analyze anatomic and functional changes in children with flatfoot. Material and Methods. We analyzed foot state in 40 children (34 boys and 6 girls, aged 5-14, mean age: 9.6±2.3 yrs), comparison group consisted of 30 healthy children aged 5-14 (mean age 8.5±2.5 yrs) without foot pathology. Patients were diagnosed on the basis of clinical examination: complaints, functional stress tests, QL questionnaire Oxford Ankle Foot, instrumental methods (X-ray, biomechanical investigation). Results. Right from early age (5 yrs) children start experiencing discomfort in feet in the course of various physical exercises, in our experiment 77% of patients have discomfort complaints. Mean indexes of OAFQ were 30.8±12.5. All children had signs of astragalus erection with respect to calcaneum which stipulates disturbance of longitudinal arch of foot joints and of normal function in talocalcaneal coalition. The disturbance of gait time indexes results in its decreased function. Conclusion. At present the problem of flatfoot in children did not get proper attention. The surgeons should focus on the features of pathology development in children 7-14 yrs applying all modern diagnostic methods.

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Anatomic and functional disorders in children with flatfoot

Year: 2018, volume 14 Issue: №3 Pages: 396-401
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Sertakova.A.V., Dokhov M.M., Rubashkin S.A., Timaev M.Kh.
Organization:
Summary:

Aim: to analyze anatomic and functional changes in children with flatfoot. Material and Methods. We analyzed foot state in 40 children (34 boys and 6 girls, aged 5-14, mean age: 9.6±2.3 yrs), comparison group consisted of 30 healthy children aged 5-14 (mean age 8.5±2.5 yrs) without foot pathology. Patients were diagnosed on the basis of clinical examination: complaints, functional stress tests, QL questionnaire Oxford Ankle Foot, instrumental methods (X-ray, biomechanical investigation). Results. Right from early age (5 yrs) children start experiencing discomfort in feet in the course of various physical exercises, in our experiment 77% of patients have discomfort complaints. Mean indexes of OAFQ were 30.8±12.5. All children had signs of astragalus erection with respect to calcaneum which stipulates disturbance of longitudinal arch of foot joints and of normal function in talocalcaneal coalition. The disturbance of gait time indexes results in its decreased function. Conclusion. At present the problem of flatfoot in children did not get proper attention. The surgeons should focus on the features of pathology development in children 7-14 yrs applying all modern diagnostic methods.

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