Saratov JOURNAL of Medical and Scientific Research

Original article

Optimization of the process of creating models of human blood vessels

Year: 2019, volume 15 Issue: №2 Pages: 353-357
Heading: Human anatomy Article type: Original article
Authors: Dol A.V., Ivanov D.V., Fomkina O.A.
Organization: Saratov National Research University n.a. N. G. Chernyshevsky, Saratov State Medical University

Objective: to optimize the process of biomechanical modeling of blood vessels on the example of creating models of the arterial circle of the brain. Material and Methods. Biomechanical modeling requires the creation of a patient-oriented three-dimensional solid-state geometric model of the object under study. This problem can be solved by computer data processing (CT) or magnetic resonance (MRI) tomography. A program that implements the construction of blood vessel contours on individual sections of MRI in semi-automatic mode. These contours are exported as saved curves in a specifc format to SolidWorks, where they are used to create three-dimensional models of blood vessels. The models obtained in this way take into account the personal characteristics of the structure of the vascular bed of a particular patient and can be used in the process of biomechanical modeling. Results. The results of the program implementation of the recursive frontal growth method for processing two- dimensional slices of tomograms are presented. Conclusion. The developed software allows semi- automatic loading of DICOM images and obtaining fat sections of vessels on their basis, as well as transferring them for further processing into computer-aided design systems.

2019_02_353-357.pdf1.09 MB

Transformation of the personal identifcation system in the context of severe somatic disease

Year: 2019, volume 15 Issue: №2 Pages: 347-352
Heading: Sociology of Medicine Article type: Original article
Authors: Orlova M.M.
Organization: Saratov National Research University n.a. N. G. Chernyshevsky

Resocialization of persons in a situation of illness determines one of the most important tasks of a health care system, namely, restoration of social opportunities of a patient. Objective: psychological analysis of identity system transformation of identifcations in a situation of a severe physical disease. Material and Methods. The study included a random sample of men and women aged 18–65: patients with ischemic heart disease (IHD) (n=116), and the control group (n=181). The following methods have been used: questionnaire, personal self-conception survey by S. R. Panteleev; R. Lazarus» study coping strategies; «Life style index»; family environment scale (FES) adapted by S. Y. Kupriyanov; WHO Quality of Life Questionnaire (WHOQOL); M. Kuhn»s test «Who am I?»; J. Rotter»s subjective control level test questionnaire; V. N. Dovlatova»s questionnaire for identifying cognitive inclination to dependency. Results. Signifcant diferences (p=0.01) in expression of identity indicators were obtained, which allowed to identify features of identifcation system characteristic of patients with ischemic heart disease without disability and with disability. Diferences in identifcation predictors with social roles, physical characteristics, negative self-identifcation and total number of self-descriptions were identifed using the regression analysis data. Conclusion. Change of personality of a patient with ischemic heart disease can be interpreted as othering and leads to difculties in social interactions and loss of opportunity to rely on their own personality, which requires psychotherapy. Socialization as a basic characteristic of modern society defnes one of the most important tasks of medical and social assistance to the population, namely, the restoration of the social capabilities of the patient. An analysis of the internal picture of the disease in patients with chronic somatic diseases in a social context makes it possible to determine the tasks of re-socialization in a situation of disability.

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Assessment of behavioral risk factors for chronic non-communicable diseases among medical students

Year: 2019, volume 15 Issue: №2 Pages: 342-347
Heading: Sociology of Medicine Article type: Original article
Authors: Balashova М.Е., Shemetova G.N., Gubanova G.V.
Organization: Saratov State Medical University

Aim: assessment of risk factors for chronic non-communicable diseases in medical students to improve measures for the formation of a healthy lifestyle. Material and Methods. In order to identify risk factors for chronic non-communicable diseases, a questionnaire method was used. A survey included 80 frst- year students and 80 sixth-year students of medical school. The questionnaire included information about the sex, age, smoking and alcohol consumption, physical activity, and nutrition. Results. Respondents are characterized by a high frequency of risk factors for chronic non-communicable diseases (СNCD): low physical activity (60.0 %), poor diet (81.0 %), smoking (16.2 %). The combination of risk factors for the development of СNCD was revealed in 31.8 % of students. Conclusion. The high frequency of risk factors for CNS among students indicates the need to improve measures to increase the efectiveness of prevention, therapeutic measures and the formation of a healthy lifestyle.

2019_02_342-347.pdf783.66 KB

Modern practical-oriented approach to professional selection for medical professions among school graduates

Year: 2019, volume 15 Issue: №2 Pages: 338-341
Heading: Health Service Organization Article type: Original article
Authors: Kasimovskaya N.A.
Organization: I.M. Sechenov First Moscow State Medical University

Objective: to study efciency of introduction of new instrument of vocational guidance in the feld of medicine — «Pre-Professional Examination» (Practical part), to estimate the current state of readiness for choice of medical profession among school leavers. Material and Methods. In 2017, for the frst time, an organizational experiment on the technology «Objective Structured Clinical Examination» (OSKE) for students of 11 grades of schools in Moscow (n=2703) was conducted and a comparative analysis with the results of obligatory «Pre-Professional Examination» (Practical part) (n=3100 respectively) to assess the practical skills of frst aid, also applied a sociological method to assess the readiness of graduates of secondary general educational organizations to the choice of the medical profession (n=300). Results. As a result of research it is established that at voluntary choice of participation in the practical-oriented examination (organizational experiment) the results are higher (60 points — 35.1±1.4 %), than at obligatory passage of «Pre-Professional Examination» (Practical part) (60 points — 2.1±0.3 %) which determines its importance as a motivational factor in the choice of professions in the feld of medicine. The sociological survey showed that 49±3.1 % of students-graduates of schools have not yet decided on the choice of profession. Conclusion. The efectiveness and signifcance of introducing the «Pre- professional exam» (practical part) as a promising method of strategic planning in government regulation of the formation of human resources for the health care system from school graduates and challengers for medical specialties has been scientifcally proven.

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Actual nutrition and food status of children with alimentary-dependent pathology

Year: 2019, volume 15 Issue: №2 Pages: 333-337
Heading: Hygiene Article type: Original article
Authors: Setko A.G., Mryasova Zh.K., Terekhova E.A., Tyurin A.V.
Organization: Orenburg State Medical University

Purpose: to study the actual nutrition and nutritional status of children with nutritional-dependent pathology. Material and Methods. The object of the study was 100 children aged 3–11 years, with a clinical diagnosis of alimentary-dependent pathology (functional dyspepsia (K30) and chronic gastritis (K29.3-K29.5)). Evaluation of the actual nutrition of children was carried out in organized children»s groups questionnaire based on 24-day reproduction of food. Nutritional status was assessed by the Quetelet index, physical development was assessed by somatometric indicators (height, body weight, chest circumference) using centile tables with and harmonious physical development. Results. Child nutrition is characterized by excessive energy value, increased content and imbalance of macro- and micronutrients. At the same time, 12 % of children have excessive nutritional status, 14.8 % have disharmonious physical development due to very low body weight (7.4 %). Conclusion. As a result of the study, data were obtained characterizing the nutrition of children as irrational and inadequate, leading to changes in nutritional status and physical development.

2019_02_333-337.pdf321.7 KB

Control of safety of products intended for children: chemical and analytical support

Year: 2019, volume 15 Issue: №2 Pages: 328-333
Heading: Hygiene Article type: Original article
Authors: Larkina M.V., Goryacheva L.V., Egorchenkova O.E., Feiskhanov M.R.
Organization: Federal Scientifc Center of Hygiene n. a. F. F. Erisman

Objective: to develop a method for measuring the concentrations of zinc dimethyldithiocarbamate (cimate) and zinc diethyldithiocarbamate (ethylcymate) in aqueous extracts, which provides control of the level of migration of these substances into the aquatic environment and meets the requirements of TR CU 008 / 2011 «On the safety of toys», based on the gas chromatographic analysis method. Material and Methods. The object of the study included samples of the aqueous extract of rubber latex compositions that form the basis of children»s toys, standard samples of cymate, of ethylcymate, of carbon disulphide. Experimental studies have been carried out to develop a gas chromatographic method using a fame photometric detector, a capillary column and an analysis of the equilibrium vapor- gas phase. Results. It was found out that the quantitative determination of cymate and ethylcymate in aqueous extracts is possible with the combination of chromatography of solutions of carbon disulfde in benzene and automatic dosing of the vapor phase (carbon disulfde released as a result of acid hydrolysis in the presence of tin chloride (II)). The efciency of the selected conditions of gas chromatographic analysis is shown. The conversion factor K, which characterizes the correction of the values obtained by analyzing the direct input of carbon disulfde in benzene and vapor phase analysis, is calculated. Conclusion. To control the safety of products intended for children, developed a method of measuring concentrations of cymate and ethylcymate the aqueous extracts of rubber latex products. The method is designed in the determination: 0,1 mg / dm3.

Prognostic significance of the assessment of the expression of immunohistochemical markers and the degree of pathomorphism before and after treatment of patients with prostate cancer at high risk of progression

Year: 2019, volume 15 Issue: №2 Pages: 318-324
Heading: Urology Article type: Original article
Authors: Voronina E.S. , Fomkin R.N. , Bucharskaya A.B. , Palatova T.V. , Popkov V.M., Maslyakova G.N.
Organization: Saratov State Medical University

Purpose: to analyze the expression of immunohistochemical markers in patients with prostate adenocarcinoma at high risk of progression before and after combined and combined treatment of patients with prostate specific antigen (PSA) level of blood below discriminatory. Material and methods. Examined patients (n = 80) with a diagnosis of “High-risk progression prostate cancer,” with clinical stage T3a, total score for Gleason scale from 8 to 10, the level of total PSA more than 20 ng / ml. Patients of the 1st group (n = 42) only combined surgical treatment in the scope of TUR and HIFU ablation the prostate; The 2nd group of patients (n = 38) additionally applied androgen deprivation in adjuvant mode. Results. Blood PSA, determined in patients after various methods of treatment is not always an objective indicator of its effectiveness. Immunohistochemical studies of tumor tissue for proliferative activity tumor cells, the activation of apoptosis in them, as well as the assessment of specific tumor markers and tumor suppressor genes showed that a decrease in the expression of these markers in patients with PSA values ​​of blood lower than discriminatory observed in all patients independently on the type of treatment. However, after treatment in the 1st group of patients, despite the achievement PSA level of nadir, there is a decrease in the expression of an intercellular adhesion marker E-cadherin, which indicates an increased risk of tumor metastasis, as well as increased expression of markers of the apoptosis inhibitor Bcl-2 and androgens, which indicates about the possibility of progression of tumor growth. Conclusion For a more accurate assessment therapeutic pathomorphism in patients with prostate cancer at high risk of progression, which HIFU ablation monotherapy was carried out, along with the determination of blood PSA level, it is necessary during the control biopsy of the prostate immunohistochemical studies of tumor tissue to determine the prognosis and risk of relapse.

2019_02_318-324.pdf1.45 MB

Possibility of frameless biopsy of deep and remote brain tumors and impact of its results on treatment strategy

Year: 2019, volume 15 Issue: №2 Pages: 312-317
Heading: neurosurgery Article type: Original article
Authors: Shabunin A.V., Gorozhanin A.V., Vakatov D.V., Shestakov A.A., Chekhonatsky V.A.
Organization: Clinical Hospital n. a. S. P. Botkin

Purpose: to assess the possibilities of frameless biopsy of brain tumors with deep and hard-to-reach localization and its impact on the treatment strategy. Material and Methods. 56 patients with supratentorial brain tumors of deep and hard-to-reach localization who underwent biopsy using frameless neuronavigation according to accepted standards. Results. In 9 (16.1 %) cases there was a discrepancy between the data of the preliminary MRI examination and the histological conclusion of the punctate after the biopsy, which changed the tactics of treatment. Conclusion. Biopsy of brain tumors of deep and hard-to-reach localization allows you to accurately and least invasive to establish the correct diagnosis. Conducting a frameless biopsy with subsequent immunohistochemical verifcation of the biopsy allows planning adequate further treatment, increasing the duration and quality of life of patients with brain tumors of deep and hard-to-reach localization.

Keywords: treatment
2019_02_312-317.pdf835.66 KB

The study of surgical activity dynamics at patients with hypertensive intracerebral haematoma using simulation analysis in the Chuvash Republic


Objective: improving the efciency of treatment for patients with hypertensive intracranial hematomas by means of planning optimization, epidemiological evidences simulation analysis and dynamics of surgical treatment indices. Material and Methods. 225 patient charts with hypertensive intracerebral hematomas have been analyzed. All patients were examined and treated in Cheboksary Republican Clinical Hospital January 2008 to December 2017 Results. The retrospective analysis revealed decrease in the number of surgeries for hypertensive intracerebral hematomas from 35 to 19 From 2011 to 2017 mortality in the group of patients with 30 to 60 ml hematomas decreased as well. Surgeries in the group of patients aged 50–70 who had strokes most frequently in 2010–2017 got fewer. Conclusion. Introduction of decision-making system at diagnosis stage enables applying diferentiated approach for choosing surgical treatment approach.

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Experience of endovideosurgical hemithyroidectomy use for patients with benign thyroid diseases

Year: 2019, volume 15 Issue: №2 Pages: 290-295
Heading: Surgery Article type: Original article
Authors: Vertyankin S.V., Turlykova I.A., Meshcheryakov V.L., Grekov V.V., Chupakhin N.V., Vanzha Ya.E., Ivanova V.A., Zhurkin K.I..
Organization: Saratov State Medical University

Objective: development and assessment of the way of an endoscopic hemithyroidectomy improving visualization of anatomical structures and excluding «the confict of tools». Material and Methods. Results of treatment of 103 patients who transferred hemithyroidectomy from endoscopic and traditional approaches to the period from 2014 to 2018 on the basis of the Hospital of S. R. Mirotvortsev (Saratov) are analyzed. According to access option patients were divided into 2 groups. The compression syndrome, functional autonomy of a thyroid gland and results of a puncture biopsy were indications to operation. Results. Unilateral paresis of a throat is diagnosed for 1 patient after traditional intervention, stopped within 1.5 months, after an endovideosurgical hemithyroidectomy — for 3 patients, and was stopped in terms from 7 days up to 1.5 months. Signs of hypoparathyrosis were not found in the groups of patients. The complications connected with administration of carbon dioxide did not arise. Conversionwas not required in any case. Conclusion. Development and assessment of a new way of an endoscopic hemithyroidectomy which is feasible, safe and provides high degree of esthetic result.

2019_02_290-295.pdf467.52 KB