Saratov JOURNAL of Medical and Scientific Research

2020, volume 16

Clinical significance of cystatin С and TGF-01 in the assessment of renal function in the surgical treatment of renal cell carcinoma

Year: 2020, volume 16 Issue: №3 Pages: 786-792
Heading: Urology Article type: Original article
Authors: Tarasenko A.I., Rossolovsky A.N., Berezinets O.L., Durnov D.A., Chekhonatskaya M.L., Loiko V.S., Bobylev D.A., Maslyakova G.N.
Organization: First Moscow State Medical University n.a. I.M. Sechenov, Saratov State Medical University

Objective: to evaluate the possibility of using cystatin С and TGF-p as prognostic markers of renal impairment and unfavorable oncological results of surgical treatment of renal cell carcinoma (RCC). Material and Methods. We examined 60 patients with RCC. Patients were divided into 3 groups: with RCC after nephrectomy (group 1); after laparo-scopic nephrectomy (group 2); after laparoscopic resection of the tumor (group 3). All patients before the operation on the 7th-10th day, after 1-3 years of postoperative follow-up, the concentrations of cystatin С and TGF-p in the blood serum were studied by solid-phase ELISA. Results. The majority of patients in the groups showed a significant decrease in glomerular filtration rate (GFR) compared to the control, and 3 years after nephrectomy, most patients had stage C3A chronic kidney disease (CKD). The Cystatin С content in all groups of patients with RCC had a statistically significant increase compared to the control (2664, 3103, and 2709 ng/ml in groups 1.2 and 3 versus 143 ng/ml, respectively) (p<0.05). Conclusion. In the majority of patients with RCC, postoperative initiation and progression of "surgical" CKD occurs, which persists 3 years after surgical treatment. Cystatin С can be considered as a predictor of high antitumor activity in patients with RCC, and requires monitoring in the long-term postoperative period.

Keywords: biomolecular markers, cystatin C, renal cell carcinoma, renal function

Morphological changes of the bladder wall of fetuses with antenatally detected syndrome "megacystis"

Year: 2020, volume 16 Issue: №3 Pages: 779-785
Heading: Urology Article type: Original article
Authors: Deryugina L.A., Napsheva A.M., Medvedeva A.V., Rozhkova D.V., Maslyakova G.N.
Organization: Saratov State Medical University

Objective: To determine the morphological features of the structure of the wall of the urinary bladder of the fetus with antenatally identified syndrome "megacystis". Material and Methods: Morphological investigations of the bladder wall of 11 fetuses of 12-21 weeks of gestation with diagnosed "megacystis" syndrome, obtained as a result of the termination of pregnancies, were carried out. The study was carried out using survey method, histochemical and immunohisto-chemical staining methods. Results: In all cases, the structure of the bladder wall with diagnosed syndrome "megacystis" sharply differed from the norm. The changes affected all layers, but the most pronounced pathological processes developed in the muscle layer, which did not differentiate into layers, the process was accompanied by a violation of the course of muscle fibers. Detrusor hypotrophy was observed in fetuses up to 18 weeks of gestation, the thickness of which decreased on average by 1,8 times. In fetuses with a gestational age of 21 weeks, the hypertrophic variant of the detrusor prevailed with an increase in its thickness by 2,6 times. In all cases, there was a significant depletion of the muscle wall with blood vessels up to 6% of the norm and a decrease in the number of nerve fibers to 24%. Conclusion. The study allowed to distinguish two variants of changes in the bladder at the syndrome "megacystis": "hypertrophic variant", characterized by an increase in the thickness of the muscle layer, and "hypotrophic variant", characterized by a decrease in the thickness of the muscle layer, which fits into the diagnostic concept of "detrusor dysplasia".

Keywords: detrusor dysplasia, megacystis syndrome

Urolithiasis: modern concepts of etiology of disease (review)

Year: 2020, volume 16 Issue: №3 Pages: 773-779
Heading: Urology Article type: Review
Authors: Galkina N.G., Kaliniva Е.А., Galkin A.V.
Organization: Penza Institute for Further Training of Physicians — Branch Campus of the Russian Medical Academy of Continuous Professional Education, Penza Regional Clinical Hospital n. a. N.N. Burdenko, Penza State University

Urolithiasis is a polyetiological disease that occupies an important place in the practice of urologist. In the treatment of urolithiasis, the main approach is a search for the cause of disease and competent correction of existing disorders. It is especially important to know the etiology and risk factors of urolithiasis, which is the subject of this literature review. In this article, we look at inhibitors of stone formation, genetic aspects of the disease, risk factors in detail (bariatric surgery, inflammatory bowel disease, colonization of the intestine by Oxalobacter formigenes, renal SLC26A6 expression), relationship between urolithiasis and vitamin D. To review the literature, a search was performed in electronic databases, such as eLIBRARY, Embase, MEDLINE, Scopus, Web of Science, from January 1, 2000 to April 1, 2020, which considered the etiology and risk factors of urolithiasis. For the search, we used keywords and their combinations: "urolithiasis", "risk factors", "etiology". A total of 49 literature sources were analyzed.

Keywords: etiology of urolithiasis, risk factors of urolithiasis, urolithiasis

Modern principles of treatment of recurrences of hernias of intervertebral disc of lumbar spine (review)

Year: 2020, volume 16 Issue: №3 Pages: 769-772
Heading: neurosurgery Article type: Review
Authors: Chekhonatsky V.A., Dreval O.N., Kuznetsov A.V., Chekhonatsky A.A., Gorozhanin A.V., Shestakov A.A., Sidorenko V.V.
Organization: Clinical Hospital n. a. S. P. Botkin, KSMA — branch of the Russian Medical Academy of Continuous Professional Education, Saratov State Medical University

The review of data on the study of the effectiveness of modern methods of treatment of recurrent intervertebral hernias of the lumbar spine according to research by specialists involved in the treatment of degenerative diseases of the spine. The search for medical literature was carried out from 2010-2019 using available databases: PubMed, eLibrary, Cochrane in the number of 31 sources. This publication presents the main methods of surgical treatment of recurrent herniated disc, describing both positive and negative aspects of each method.

Keywords: recurrence, treatment

The choice of performing tactics of dorsal decompressive-stabilizing interventions on the lumbar spine for the prevention of degenerative disease of an adjacent segment

Year: 2020, volume 16 Issue: №3 Pages: 762-768
Heading: neurosurgery Article type: Original article
Authors: Byvaltsev V.A., Kalinin А.А., Pestryakov Yu.Ya., Spiridonov A.V.
Organization: Clinical Hospital "Russian Railways Medicine", Irkutsk State Medical University, Krasnoyarsk Regional Clinical Hospital, Russian Railways

Purpose: Comparative analysis of the results of dorsal decompressive-stabilizing interventions (DDSI) on the lumbar spine for substantiating the method of prevention of adjacent segment degenerative disease (ASDd). Material and Methods: 79 patients were included in the retrospective research, 2 groups were identified: in group I (n=41) single-level research, in group II (n=38) two-level DDSI, with rigid stabilization of the spinal motion segment, in the presence of signs of its degeneration was made. Clinical outcomes, instrumental data and surgical complications were evaluated. Results: It was a decrease of pain syndrome in the postoperative period, an improvement in the quality of life in two groups (p<0.001). In the inter-group comparison of the visual analog scale (VAS) — back, legs, ODI, SF-36 in group II, the results at discharge were lower than in group I (p<0.001), after 3.6.12 months there is a comparable improvement in a quality of life and a decrease in pain by VAS in both groups (p>0.05). In the distant period (24, 36 months), clinical results are better in-group II (p<0.05). The number of late surgical complications and revision interventions is higher in a group II (17.1 and 4.0%) (p<0.05). Conclusion: Preventive rigid stabilization of adjacent segment with signs of initial degeneration improves long-term results, reduces the number of repeated operations, despite the larger volume of primary medical intervention.

Keywords: adjacent level syndrome, degenerative diseases of the lumbar spine, dorsal decompressive-stabilizing interventions

Comparative analysis of surgical outcomes for achondroplasic children receiving PRP-therapy (a case-control study)

Year: 2020, volume 16 Issue: №3 Pages: 757-761
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Timaev M.Kh., Sertakova A.V., Alieva A.V.
Organization: Saratov State Medical University

Objective: To assess surgical outcomes in achondroplasic pediatric patients receiving PRP-therapy (Platelet-Rich Plasma therapy) for lengthening long bones. Material and Methods: 27 achondroplasic patients had been examined and operated in the pediatric trauma orthopedic department of the Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University n. a. V.I. Rasumovsky in 2014-2018, their mean age 4.7±2.1 у. o. (4-11 у. o. range). The examination involved conventional clinical examination as well as X-ray examination. All patients were divided into 2 groups, the division criteria being intraoperative application of PRP-therapy (autoplasma therapy or plasmolifting). Group 1 (n=14) was made up of patients who had underwent transosseous compression distraction osteosynthesis with no PRP employed while all patients of Group 2 (n=13) had received PRP injections. Results: The distraction consolidation index (DCI) in Group 1 (n=14) was 72±7 days/cm (good and satisfactory results) and the average length of the grown distraction was 4.5±2.5 cm. In PRP-therapy employed Group 2 DCI was 65±10 days/cm (good results) and the distraction length was 6.5±2.5 cm. In patients of Group 1 sectioned, lateral and central forms of the distraction prevailed while in patients who had received PRP-therapy spindle and cylinder forms of the distraction were observed. Conclusion: PRP-therapy employed in all stages of the elective distraction at limb osteotomy allows significant DCI improvement as well as activation of bone tissue remodeling in the osteotomy area, the geometric type of trabeculae formation being more beneficial.

Keywords: transosseous distraction osteosynthesis, PRP-therapy, achondroplasy

Methods of tendomus-cular plasty for the management of upper extremity deformities in children with infantile cerebral palsy (review)

Year: 2020, volume 16 Issue: №3 Pages: 752-756
Heading: Traumatology and Orthopedics Article type: Review
Authors: Dokhov M.M., Zvereva К.Р., Ehdalov Kh.R., Timaev M.Kh., Rubashkin S.A., Sertakova A.M., Norkin I.A.
Organization: Saratov State Medical University

The review covers the published studies on the management of upper extremity deformities in children with infantile cerebral palsy distributed in PubMed, PubMed Central, eLibrary resources. The concept of 'spastic arm' includes 'inward rotation' contracture of the shoulder joint, flexion contracture of the elbow joint, ulnar contracture of the wrist joint as well as finger joints. The pathology pattern of the upper extremity impedes grasping, gripping, manipulating, and lowering the objects, inhibits the development of individual skills for daily routine and full participation in social life, education, and leisure. The methods of tendomuscular plasty are a part of the comprehensive treatment of children with this diagnosis. However, the choice of the patients and the type of the surgery as well as the assessment of the outcomes remain unsettled issues. The contemporary researches on the subject are retrospective and descriptive. Designing the detailed algorithms for the management of the patients with spastic upper extremity is a promising trend aimed at facilitating the practice for orthopedic surgeons and enhancing the outcomes in this cohort of patients.

Keywords: cerebral palsy, tendomuscular plasty, upper extremity

Comparative analysis of efficacy of concomitant strabismus orthoptic treatment in children using the computer program "Robin Hood" for binocular vision training

Year: 2020, volume 16 Issue: №3 Pages: 748-751
Heading: Ophtalmology Article type: Original article
Authors: Balabaeva Е.А., Matrosova Yu.V., Fabrikantov O.L.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin

Purpose. To perform the comparative analysis of the efficacy of orthoptic treatment in combination with binocular vision training using the computer program "Ribin Hood" in children with concomitant strabismus. Material and Methods. The examination included 89 patients who were divided into two groups: group I included children who underwent orthoptic treatment once in three months regularly, group II included patients undergoing orthoptic treatment unregularly but who regularly trained at home according to the developed program. Results. It was noted that there was a statistically significant decrease in the objective and subjective strabismus angle, including with spectacles and without them, before and after treatment in both groups. Also, there was a statistically significant decrease in the number of patients with monocular vision and the number of patients with binocular vision at different distances increased significantly. Conclusion: Orthoptic treatment in combination with home training has a more pronounced positive effect and can be used as the addition to the complex treatment of concomitant strabismus.

Keywords: binocular vision, computer programs, concomitant strabismus, orthoptic treatment

Left ventricular remodeling in patients with ankylosing spondylitis

Year: 2020, volume 16 Issue: №3 Pages: 743-747
Heading: Cardiology Article type: Original article
Authors: Makhina V.I, Rebrov А.Р.
Organization: Saratov State Medical University

The goal is to study the features of heart remodeling in patients with ankylosing spondylitis (AS) who do not have cardiovascular diseases. Material and Methods: The study included 90 patients (aged 18 and older) with AS. The assessment of disease activity was determined using BASDAI (Bath AS Disease Activity Index) and ASDAS (The Anky- losing Spondylitis Disease Activity Score) indices. All patients underwent transthoracic echocardiography (EchoCG) was performed to assess the state of the heart. Depending on the values of the left ventricular (LV) mass index and the relative LV wall thickness index, various types of LV hypertrophy and remodeling were identified. Results: The median age of patients was 38 [33; 46], the average duration of AS was 15.7±7.3 years; 61 of the patients (68%) were male. According to the echocardiographic study, 72 (80%) patients showed normal LV geometry and 18 (20%) showed signs of LV myocardium remodeling. Concentric remodeling of the left ventricular myocardium was observed for 9 (50%) patients, concentric hypertrophy was observed in 4 cases (22.2%), eccentric hypertrophy — in 5 cases (27.8%). Conclusion: Structural and functional changes of the heart were detected in 20% of young patients with AS without a history of cardiovascular diseases. EchoCG can serve as a method of early diagnosis of cardiovascular system pathology in young patients with ankylosing spondylitis who do not have cardiovascular diseases.

Keywords: ankylosing spondylitis

Medication cardiotoxicity: potential of prevention and correction (review)

Year: 2020, volume 16 Issue: №3 Pages: 736-743
Heading: Cardiology Article type: Review
Authors: Kalyuta T.Yu., Kiselev A.R., Bazarbaeva A.Kh.
Organization: Medical University "Reaviz" in Saratov, Saratov State Medical University

The cardiotoxicity of various drugs has become an increasingly actual problem in recent years due to the growth of number of patients exposed to drugs with a high frequency of cardiotoxic side effects. Most often, heart damage is associated with chemotherapy in cancer patients and with the use of immune checkpoint inhibitors (ICI) in patients with rheumatologic diseases and oncology. This review comprises recent data from various clinical studies on the mechanisms of cardiotoxic effects of drugs in such patients, the prognosis of their course, the possibilities of prevention of heart damage and correction for already developed cardiac damage. Information obtained from publicly available databases (State register of medicines of the Russian Federation, Register of medicines of Russia, VigiBase, ClinicalTrials. gov) and databases of scientific medical publications (, PubMed®) was analyzed. The search was performed using the keywords "chemotherapy" and "cardiotoxicity". We analyzed 24 scientific publications over the past 5 years, 5 databases and 21 publications issued in the period since 2000 to 2015 year, devoted to the cardiotoxic effect of drugs. Publications related to cardiotoxicity studies in humans were analyzed, but animal studies were not analyzed.

Keywords: cardiotoxicity, chemotherapy