Saratov JOURNAL of Medical and Scientific Research

2020, volume 16

Autonomic cardiac support in young males with arterial hypertension syndrome according to the type of hemodynamic response to physical exercise

Year: 2020, volume 16 Issue: №3 Pages: 728-736
Heading: Cardiology Article type: Original article
Authors: Zayats A.N., Shyshko V.I.
Organization: Grodno State Medical University

Objective: To evaluate the clinical and instrumental signs of autonomic dysfunction in young men with arterial hypertension (AH) syndrome depending on the type of hemodynamic response (TGR) to dosed physical activity. Material and Methods. Veloergometry (VEM) and cardiovascular testing (CVT) were performed in 208 men aged 18-29 years: 22 men in the control group, 34 men with physiological TGR, 52 men with hyperreactive TGR, 53 men with hypertensive TGR, 45 men with hyperdynamicTGO (HDTGR). Results: Clinical manifestation of autonomic dysfunction was present in less than 1/3 of patients regardless of TGR. In the HDTGR group SDNN was 36 (30; 54) ms, LF —605(363; 1073) ms2/Hz, HF — 322(160; 947) ms2/Hz and were significantly less than in other groups. According to the CVTdata, there was a paradoxical SDNN 1.2 times increase, the absence of HF and %VLF dynamics. Conclusion: Autonomic support is mostly disturbed in HDTGR, and is accompanied by a significant strain of the regulatory systems, hyporeactivity of the central regulatory mechanism and vagal unresponsiveness with a paradoxical SDNN increase.

Keywords: arterial hypertension, autonomic dysfunction, young age

Polymorphic variants of the renin-angiotensin-aldosterone system genes associated with the risk of hypertension development (review)

Year: 2020, volume 16 Issue: №3 Pages: 724-728
Heading: Cardiology Article type: Review
Authors: Elkina A.Yu., Akimova N.S., Shvarts Yu.G.
Organization: Saratov State Medical University

Arterial hypertension refers to multifactorial pathology. Both environmental factors and genetic risk factors contribute to its development. One of the promising areas for the early diagnosis and prevention of hypertension may be the identification of genes whose mutations predispose to its development. The review analyzes the works published for the period 2010-2020 (38 scientific papers), devoted to the molecular genetic basis of the development of arterial hypertension and identifying the possible role of polymorphism of the renin-angiotensin-aldosterone system genes in the genesis of hypertension. The search for sources was carried out in the databases PubMed®, Scopus®, EBSCOhost, Medline, eLIBRARYRU.

Keywords: arterial hypertension, gene polymorphism of the renin-angiotensin-aldosterone system

Features of clinical and echocardiographic parameters in patients with perioperative atrial fibrillation in abdominal surgery

Year: 2020, volume 16 Issue: №3 Pages: 718-724
Heading: Cardiology Article type: Original article
Authors: Dzhioeva O.N., Drapkina О.М., Bezkorovayny P.N., Abdurozikov Е.Е., Shvartz V.A.
Organization: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow State Clinical Hospital n. a. V. V. Veresaev, Moscow State Clinical Hospital №24, National Research Center for Preventive Medicine

Aim: To examine the features of the clinical and anamnestic status and parameters of transthoracic echocardiogra-phy in patients depending on the development of perioperative AF during abdominal noncardiac surgery. Material and Methods: A cohort study. Data from 102 patients was analyzed. The median age was 66 (60; 74), for men —42.2% and 57.8% for women. Results: PeOAF was observed in 37.25% of all studied medical histories. In the group of patients with PeOAF was marked by greater body mass index (p=0.053). In the group with PeOAF it was observed a statistically significant lower value of glomerular filtration rate (p=0.001). Of the comorbidities in the PeOAF group, CHD, diabetes mellitus, and COPD were significantly more common (p<0.001). In patients who were transferred to insulin therapy in the perioperative period, PeOAF was also significantly more frequent. Obtained statistically significant differences (p=0.019) in the development PeOAF in various techniques of surgical intervention: at laparotomy PeOAF marked more often. According to Echo data revealed that in terms of research alone, intraoperatively and in the postoperative period in the group of patients with PeOAF significantly differed from patients without PeOAF all the parameters of intracardiac hemodynamics. Conclusion: In the group of patients with PeOAF at rest, a statistically significant lower LV FV was observed; increased values of linear LV dimensions, LV diastolic filling index, the diameter of the inferior Vena cava, and calculated systolic pressure in the pulmonary artery.

Keywords: noncardiac surgery, perioperative atrial fibrillation, risk stratification of noncardiac surgery, transthoracic echocardiography

A new approach to the initial assessment of hearing

Year: 2020, volume 16 Issue: №3 Pages: 714-717
Heading: Otolaryngology Article type: Original article
Authors: Vladimirova T.Yu., Aizenshtadt L.V., Davydkin-Gogel M.M.
Organization: Samara State Medical University

Purpose: To substantiate the possibility of using frequency hearing research in the web application "Automated system of primary hearing assessment". Material and Methods: The study was conducted in the Department of Otorhinolaryngology of Clinics of Samara State Medical University in October 2019. It involved 91 patients aged 17 to 73 years (mean age 48±14.6 years). All participants in the study were divided into two age groups: group I — 17-59 years old, group II — over 60 years old. Patients were asked to pass a hearing assessment in two ways: on the Interacoustics AC-40 clinical audiometer and the web application "Automated system for primary hearing assessment" developed by us (patent no. 2019664671). Results: The maximum difference in average hearing thresholds between tonal threshold audiometry and the web application in group I was 3.3 dB at 2 kHz on the right and 3.2 dB at 2 and 4 kHz on the left, in group II-4.7 and 3.5 dB at 1 and 2 kHz on the right, and 7.2 dB at 4 kHz on the left. The presented data were evaluated using the Cohen Kappa coefficient and confirm a high level of correspondence between the results obtained using the clinical audiometer and the developed web application. Conclusion: Based on the results obtained, a conclusion is made about the possibility of using a web application for primary rapid diagnostics of hearing in General medical practice in conditions of difficult accessibility of audiological care.

Keywords: audiometry, initial assessment of hearing, telemedicine

Neuroendocrine mechanisms of regulation of eating behavior (review)

Year: 2020, volume 16 Issue: №3 Pages: 707-713
Heading: Endocrinology Article type: Review
Authors: Bolotova N.V., Kurdiyan M.S., Filina N.Yu.
Organization: Saratov State Medical University

The review analyzes the published data on the role of various neurotransmitters, hormones involved in the formation and disturbance of eating behavior. To search for articles, the PubMed database was used, as well as the archives of the journals "Pediatrician", "Medicine: theory and practice" Environment and Energy Science", "Problems of Endocrinology", "Modern Technologies in Medicine", "Russian Journal of Cardiology", "Universum: Medicine and Pharmacology", "Questions of Children's Dietetics", Kursk Scientific and Practical Bulletin "Man and His Health". The literature review used 49 literature sources; articles were published in the period from 2004 to 2020.

Keywords: neurotransmitters, hormones, eating behavior

Age-related features of visual evoked potentials in the norm and at myopia

Year: 2020, volume 16 Issue: №2 Pages: 690-695
Heading: Ophtalmology Article type: Original article
Authors: Sharipov A.R., Mikhaylova G.M., Mukhamadeev R.A.
Organization: Republican Clinical Oncology Dispensary of the Ministry of Health of the Republic of Bashkortostan, Russian Eye and Plastic Surgery Center

The purpose of the study is to compare age-related features of the visual analyzer formation using the method of visual evoked potentials (VEP) in patients with myopia and with "normal" vision. Material and Methods. A total of 42 people (84 eyes) were examined using the following methods: the study of visual acuity, determination of clinical refraction and registration of visual evoked potentials. The age of the patients ranged from 6 years to 31 years of age. In the group of volunteers, there were 3 age groups and 1 group with myopia. Results. The average values for the first group with monocular stimulation and lead from the ipsilateral hemisphere were obtained: 79.7±0.8, 111.8±1.2 and 157.5±1.8 ms for N75, P100 and N145 respectively (M±SE). For the second group: 77.5±1.9, 104.1±1.2 and 142.7±1.3 ms. For the third group: 78.7±0.7, 103.9±1.1 and 136.8±2.3 ms. For the fourth group: 71.4±3.9, 111.6±3.7 and 158.3±3.6 ms. Significant differences were shown in the configuration, component composition and characteristics of the pattern-VEP during stimulation of the central and peripheral fields of vision. Significant differences were found in the degree of maturity of macular region of subjects with normal vision and with myopia. Conclusion. The detected differences in visual analyzer formation indicate that primary sensory mechanisms and mechanisms of their cognitive analysis matured at different times in healthy subjects and patients with myopia.

Keywords: formation of the visual system, visual cortex of the brain

A standardized approach to the choice of basic surgical treatment for large macular holes

Year: 2020, volume 16 Issue: №2 Pages: 687-690
Heading: Ophtalmology Article type: Short message
Authors: Chuprov A.D., Kazennov A.N., Mambetova Е.М.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution

The purpose of the study is to optimize the choice of tactics for surgical treatment of large macular holes. Material and Methods. Analysis of the surgical treatment of macular holes in 18 patients (18 eyes) was performed. Patients were divided into 3 groups. Group 1 (8 eyes) included patients with a hole diameter of up to 500±22 urn, group 2 (6 eyes) — with a diameter of up to 800±20 urn, and group 3 (4 eyes) — over 800 urn. In group 1 vitrectomy was performed with peeling of the inner border membrane (IBM), application of platelet rich plasma (PRP) mass and tamponade with air; in the group 2 vitrectomy was performed with IBM peeling, application of PRP mass or closed with a free inverted IBM flap and tamponade with SF6 gas; in group 3 vitrectomy was performed with IBM peeling and closing of the macular holes was performed using a free inverted IBM flap with silicone oil tamponade. Results. There was complete closure of the macular holes with the formation of a normal fovea profile and improvement of visual acuity in all cases of group 1. In group 2 (PRP application) in 2 cases of 6, a second intervention was required with the"plasty" of the macular hole using an inverted IBM flap. In group 3, in 1 case, the gap did not close and in 1 more case it closed with a defect at the level of the ellipsoid zone of the photoreceptors. Conclusion. The preliminary results' analysis showed the effectiveness of the developed algorithm for surgical treatment of macular holes, depending on their diameter, which is optimal and allows obtaining the required anatomical and functional result.

Keywords: inverted flap IBM, macular hole, platelet-rich plasma, tamponade

Tactical approaches to management of patients with macular pathology

Year: 2020, volume 16 Issue: №2 Pages: 683-687
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Borshchuk E.L., Voronina A.E., Lositskiy А.О.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution

The purpose is to evaluate the effectiveness of tactical approaches to macular pathology treatment based on retrospective data analysis. Material and Methods. Between 2014 and 2019, 12007 courses of treatment of patients with macular pathology (1372 patients) were conducted at the S. Fyodorov Eye Microsurgery Federal State Institution, Orenburg branch. 69.5% of patients were diagnosed with "Macular and posterior pole degeneration" (H35.3), "Retinal angiomatosis" (H35.0) was diagnosed in 11.3%, cases with "Other specified retinal disorders" (H35.8) 9.4%. Results. Comparison of the best corrected visual acuity (BCVA) was made and 2 groups were distinguished: group 1 consisted of patients with negative dynamics, group 2 included patients with positive dynamics. Among all patients, the best values of BCVA were in patients diagnosed with "Other specified retinal disorders", while BCVA improved by 0.13 in most patients with this nosology, in case of macular edema (1.8% of the sample), an improvement in BCVA by 0.13 was also noted. Tactical approaches were analyzed in patients with the best BCVA values, and it was found that intravitreal injection of drugs (IVID) more often led to an increase or stabilization of BCVA in patients with various pathologies of the macular zone. In the sample the majority of patients with macular pathology were diagnosed with "Macular and posterior pole degeneration", 65.35% of patients in this nosological group had positive dynamics in BCVA in the course of 3 years. Conclusion. The most effective method of treating patients with the diagnosis "Macular and posterior pole degeneration" was intravitreal injection of angiogenesis inhibitors (Aflibercept and Ranibizumab) according to the regimen described in the instructions for these drugs.

Keywords: age-related macular pathology, angiogenesis inhibitors, macular pathology, retinal pathology

Comparative evaluation of the efficiency of astigmatism correction methods in cataract surgery

Year: 2020, volume 16 Issue: №2 Pages: 678-683
Heading: Ophtalmology Article type: Original article
Authors: Chuprov A.D., Begun D.N., Lositskiy А.О., Kazakova T.N., Voronina A.E.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution

The purpose of the study was to compare the effectiveness of methods of astigmatism correction in the surgical treatment of cataract. Material and Methods. Analysis of 157 cases (eyes) of surgical treatment of cataract with concomitant astigmatism was carried out, of which 131 eyes were operated using the ARKUATA method and 26 were operated using the TORIKA method. The age of patients ranged from 40 to 72 years. Results. As a result of the study we obtained statistically substantiated data, which showed that there were no objective differences in the compared methods for correcting corneal astigmatism: the formation of arcuate relaxing incisions and the use oftoric lOLs. Using the classification tree method, a model for predicting positive effect of the outcome of an operation with a value of un-corrected visual acuity of 1.0 was built. Conclusion. Both methods, in the absence of complications, can correct corneal astigmatism with the same statistical probability, allowing to achieve an uncorrected visual acuity of 1.0. However, from an economic point of view, the cataract surgery is most optimally performed using toric lOLs, as the cost of this treatment is 29.83% lower than when using femtosecond technologies.

Keywords: arcuate relaxing incisions, astigmatism, cataract surgery, toric IOLs

Comparative characteristics of melatonin content in lacrimal fluid and blood serum depending on the stage of senile cataract with age-related macular degeneration

Year: 2020, volume 16 Issue: №2 Pages: 673-678
Heading: Ophtalmology Article type: Original article
Authors: Khodzhaev N.S., Chuprov A.D., Smolyagin A.I., Kim S.M., Filippova Yu.V.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution

The purpose of the study is to evaluate factors affecting concentration of melatonin in the tear and blood serum in patients with a non-exudative form of age-related macular degeneration (AMD). Material and Methods. 140 patients (140 eyes) were examined, of which 52% were women, 48% were men. The following groups of patients were formed: 1) patients with non-exudative AMD and senile cataract who took melatonin; 2) patients with non-exudative AMD and senile cataract who did not take melatonin; 3) without AMD and cataract; 4) patients with non-exudative AMD, not requiring surgical treatment of cataract; 5) patients with neovascular (exudative) form of AMD (nAMD). The melatonin content was determined using immunosorbent assay. Results. The content of melatonin in all examined patients' serum ranged from 0.001 to 0.161 ng/ml, the highest median of melatonin values was observed in healthy individuals (0.125 ng/ml), and the lowest in patients with nAMD (0.021 ng/ml). The level of melatonin in the tear varies from 0.067 to 0.477 ng/ml, while its highest median was found in group 1 patients: 0.324 ng/ml. In group 2 and reference groups (without cataract with AMD and with nAMD), the melatonin content in the tear was significantly reduced (p <0.05) compared with the level in the group of healthy individuals. Conclusion. The content of melatonin in the blood serum and lacrimal fluid depends on the following factors: age, arterial hypertension, body mass index (BMI), insomnia, smoking, hair and eye color, night shifts. Using melatonin in the treatment of patients with AMD helps to increase the concentration of melatonin in tear.

Keywords: age-related macular degeneration, cataract, melatonin