Kazan medical journal

Medical peer-review journal for physicians and researchers.

Editor-in-Chief: Ayrat U. Ziganshin, MD, PhD, Professor.


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Published bimonthly since 1901, distributed by subscription.

About: the Kazan Medical Journal is a peer-reviewed journal for clinicians and medical scientists, practicing physicians, researchers, teachers and students of medical schools, interns, residents and PhD students interested in perspective trends in international medicine.

Missions of the Journal are to spread the achievements of Russian and international biomedical sciences, to present up-to-date clinical recommendations, to provide a platform for a scientific discussion, experience sharing and publication of original researches in clinical and fundamental medicine.






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Vol 103, No 6 (2022)

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Theoretical and clinical medicine

Features of hemodynamic and structural parameters of the heart in young people with varying stages of cardiometabolic risk
Parve S.D., Sineglazova A.V.

Background. Cardiometabolic diseases are one of the leading causes of disability and mortality worldwide, which justifies the relevance of studying their early manifestations.

Aim. To analyze the hemodynamic and structural echocardiographic parameters of the heart in relation to cardiometabolic risk factors and its staging according to the Cardiometabolic Disease Staging (CMDS) scale in young patients.

Material and methods. 109 patients were examined: 57 males (52.3%) and 52 females (47.7%) aged with a median of 36.1 [32.6–39.2] years without cardiometabolic diseases. The design of the study was a cross-sectional case-control study. The parameters of cardiometabolic risk were assessed with its calculation and assessment taking into account the stage according to the CMDS scale. Echocardiography was performed in M- and B-modes. The data were processed using the SPSS Statistics 23 program. The Mann–Whitney U test, the Kruskal–Wallis test, and the Pearson and Fisher χ2 tests were used. Correlation analysis according to Spearman was carried out.

Results. The first stage of cardiometabolic risk was established in 17 examined patients (15.6%), the rest had stage 2 (n=57; 52.3%) or stage 3 (n=35; 32.1%) of cardiometabolic risk. Deviations from the normal values of hemodynamic echocardiographic parameters were not revealed. The frequency of increase in the index of relative thickness, the thickness of the posterior wall of the left ventricle, the interventricular septum thickness, the myocardium mass of the left ventricle did not differ (p=0.198–0.983). A direct correlation between the left atrial, end-systolic and diastolic volumes, left ventricle wall thickness, and an inverse relationship between the left ventricular ejection fraction and cardiometabolic risk factors was established. At the 3rd stage of cardiometabolic risk, higher values of the left atrial volume (47 [46–49] ml; p=0.005), end-systolic (30.42 [29.23–32.04] ml; p=0.001) and diastolic (79 [78–81] ml; p=0.003) volumes of the left ventricle and lower left ventricular ejection fraction (61 [60.35–62.65] ml; p=0.004) than on the 1st and 2nd stages were diagnosed.

Conclusion. An increase in the cardiometabolic risk is associated with an increase in preload and afterload on the left heart.

Kazan medical journal. 2022;103(6):909-917
pages 909-917 views
The role of microvascular dysfunction in the pathogenesis of heart failure with preserved ­efficiency fraction
Kopeva K.V., Maltseva A.N., Mochula A.V., Grakova E.V., Zavadovsky K.V.

Background. The results of a growing number of international studies support the assumption that the prevalence of coronary microvascular dysfunction is much higher than previously thought, including in patients with heart failure with preserved ejection fraction.

Aim. To study the role of coronary microvascular dysfunction in the pathogenesis of heart failure with preserved ejection fraction in patients with non-obstructive lesions of the coronary arteries.

Material and methods. The study included 73 patients with non-obstructive lesions of the coronary arteries. Dynamic single-photon emission computed tomography was used to evaluate the parameters of coronary blood flow reserve. Coronary microvascular dysfunction was defined as the presence of reduced coronary blood flow reserve ≤2. The distribution of patients was carried out depending on the reserve of coronary blood flow: the first group (n=35) included patients with a reduced reserve ≤2, the second group — with preserved reserve >2 (n=38). Statistical processing of the study results was carried out using nonparametric methods: in the analysis of quantitative indicators, the Mann–Whitney test was used; in the analysis of qualitative features, the analysis of contingency tables using the Pearson χ2 test was performed. To search for relationships between variables, correlation analysis with the calculation of Spearman's correlation coefficients was used.

Results. In 82.9% of cases, patients in the first group had heart failure, while in patients in the second group, it was diagnosed only in 44.7% of cases (p=0.014). The values of the coronary blood flow reserve correlated with the size of the left atrium (r=–0.527; p=0.001), the E/A (r=–0.321, p=0.012) and E/e' ratio (r=–0.307; p=0.021). In patients with heart failure, the levels of coronary blood flow reserve correlated with the functional class: in patients with functional class I (n=21), the values of this indicator were 2.87 (2.52; 2.94), with class II (n=8) — 1.98 (1.65; 2.16), with functional class III (n=17) — 1.51 (1.23; 1.69).

Conclusion. The presence of coronary microvascular dysfunction is associated with a higher incidence of heart failure with preserved ejection fraction; values of coronary blood flow reserve correlate with parameters of diastolic dysfunction.

Kazan medical journal. 2022;103(6):918-927
pages 918-927 views
Clinical phenotypes of patients with ischemic heart disease and borderline coronary artery stenoses
Ostanina Y.O., Yakhontov D.A., Struts Y.D., Lyaskovskaya A.A.

Background. Ischemic heart disease, despite ongoing therapeutic and preventive measures, remains the leading cause of disability and mortality in people of working age.

Aim. Study of cardiovascular risk factors and assessment of the clinical and angiographic picture in patients with stable coronary heart disease and borderline coronary artery stenoses of various clinical phenotypes.

Material and methods. 236 patients with functional class I–III stable angina pectoris aged 49–59 years with borderline (40–70%) coronary artery stenoses were examined. All patients underwent a general clinical examination, cardiac ultrasound and coronary angiography. The nonparametric Mann–Whitney U-test was used to compare indicators between groups. To compare binary and categorical indicators, Fisher's exact two-tailed test was used. Differences in the compared parameters were considered statistically significant at p <0.05.

Results. The predominance of the following clinical phenotypes, which determined the further distribution into groups, was revealed: coronary heart disease without myocardial infarction — the first group; coronary heart disease with myocardial infarction more than 6 months old — the second group; coronary heart disease with a metabolically unhealthy phenotype of obesity without diabetes mellitus — the third group, coronary heart disease with diabetes mellitus — the fourth group. In the third and fourth groups, there was no significant difference in the frequency of myocardial infarction in the past, and patients in the third group with a history of myocardial infarction suffered it at the earliest age (44.3 [41; 50] years, p <0.01). Despite the presence of arterial hypertension in 97.5% of groups of patients with different phenotypes, the fourth group showed the highest values of the left ventricular myocardium mass index (240.6 [146.3; 286.3], p <0.01). In the same group, multivessel coronary artery lesions were more frequently recorded during angiographic examination — in 25 patients (47.2 [33.4; 52.3]%, p <0.01).

Conclusion. Despite the absence of obstructive coronary artery disease, patients with stable coronary heart disease and borderline coronary artery stenoses are at risk of cardiovascular complications due to the presence of arterial hypertension in the vast majority, a significant incidence of obesity, dyslipidemia, and carbohydrate metabolism disorders.

Kazan medical journal. 2022;103(6):928-936
pages 928-936 views
The effect of hydrochloric, malic and succinic salts of 2-ethyl-6-methyl-3-oxypyridine on ­self-­assessment of depression manifestations in women receiving radiotherapy after surgical ­treatment of uterine cancer
Volchegorskii I.A., Vazhenin A.V., Alekseeva A.P.

Background. The detection of cancer and its subsequent treatment contribute to the development of depression. This circumstance illustrates the need for proactive prevention of affective status disorders in cancer patients, its dynamic control and timely correction.

Aim. Comparative analysis of the effect of hydrochloric, malic and succinic salts of 2-ethyl-6-methyl-3-oxypyridine (methylethylpyridinol, ethylmethylhydroxypyridine malate, ethylmethylhydroxypyridine succinate) on the dynamics of self-assessment of depression manifestations in women recieving radiation therapy after surgical treatment of uterine cancer.

Material and methods. A short-term, prospective, simple “blind”, placebo-controlled, randomized study of the effect of methylethylpyridinol, ethylmethylhydroxypyridine malate and ethylmethylhydroxypyridine succinate on the severity of depression symptoms in patients receiving radiation therapy after extended extirpation of the uterus with appendages was performed. The study was completed by 96 patients. Course two-week administration of drugs in almost equimolar single doses (0.83–0.88 mmol) was started simultaneously with radiation therapy. The treatment effectiveness was assessed using the Beck Depression Inventory 2 and 4 weeks after the start of the study. Statistical comparison of related samples was carried out using the Friedman test and post hoc analysis using the paired Wilcoxon test with the Bonferroni correction. Independent samples were compared using the Kruskal–Wallis test with a post hoc analysis using the Dan–Bonferroni test.

Results. Radiation therapy was found to cause a clinically significant increase in the severity of depressive symptoms in 14 and 28 days after the start of the study (p ≤0.010). Two-week administration of methylethylpyridinol, ethylmethylhydroxypyridine malate, and ethylmethylhydroxypyridine succinate reduced the severity of depressive symptoms to the normal level (p <0.001), mainly due to a decrease in the severity of symptoms of the cognitive-affective cluster (p <0.001). The studied drugs with equal severity prevented the escalation of depression symptoms according to the Beck Depression Inventory (p ˃0.05).

Conclusion. Hydrochloric, malic and succinic salts of 2-ethyl-6-methyl-3-oxypyridine are equally effective in preventing the development of depression during postoperative radiation treatment of patients with ute-rine cancer.

Kazan medical journal. 2022;103(6):937-946
pages 937-946 views
The content of cytokines in the blood of patients with various stages of breast cancer
Saptarova L.M., Imelbaeva E.A., Tukhbatova A.V., Galimov S.N., Mufazalova N.A.

Background. Cytokine homeostasis is an important factor characterizing the general condition and adaptive capabilities of the body of patients with malignant neoplasms. However, the role of various growth factors and their significance in the development and enhancement of malignant growth in breast cancer remain poorly understood.

Aim. To evaluate the levels of cytokines - tumor necrosis factor α, interleukins-4, -6, -8 and -10 — in the blood serum of patients with different stages of breast cancer in comparison with healthy volunteers.

Material and methods. The study was conducted in 65 patients aged 25 to 67 years (mean age 44.5 [40.0–56.5] years). Two groups were distinguished: the first — with stage 1–2, the second — with stage 3–4 of breast cancer. The comparison group consisted of 15 apparently healthy women without cancer, aged 29 to 66 years (mean age 51.0 [39.0–61.0] years). Blood levels of tumor necrosis factor α, interleukins-4, -6, -8 and -10 were studied by enzyme immunoassay. The obtained data were processed using the methods of variation statistics, the Statistica 10.0 software package. The significance of differences was assessed by calculating the median and interquartile interval, analysis of variance was performed using the Kruskal–Wallis H-test, and Dan's Q-test was used for multiple comparisons. The critical significance level p for statistical tests was taken equal to 0.05.

Results. In the group of patients with stage 1–2 breast cancer, an increase in the blood levels of all studied cytokines was revealed in comparison with the group of healthy women: interleukin-6 (p=0.00719), interleukin-8 (p=0.00259), tumor necrosis factor α (p=0.00014), interleukin-4 (p1=0.0133), interleukin-10 (p1 <0.00001). In the group of patients with stage 3–4 breast cancer, an increase in blood levels was characteristic of all studied cytokines: interleukin-8 (p=0.00009), tumor necrosis factor α (p=0.000004), interleukin-4 (p <0.00001), interleukin-10 (p <0.00001), except for interleukin-6 (p=0.15608). The established patterns in changes in the content of cytokines in the blood of patients with breast cancer at different stages of development can serve as the basis for developing approaches to the diagnosis and treatment of the disease.

Conclusion. In patients with breast cancer, the levels of tumor necrosis factor α, interleukins-4, -6, -8, -10 (p <0.05) are higher than in healthy women.

Kazan medical journal. 2022;103(6):947-954
pages 947-954 views
Comparative assessment of the quality of life and the effectiveness of treatment in patients after early and delayed anterior cruciate ligament reconstruction
Radysh I.I.

Background. In modern medical practice, a significant interest in the study of quality of life is manifested in the biopsychosocial approach, which indicates the concept of a holistic view of the course of the disease and the effectiveness of treatment.

Aim. To give a comparative assessment of the quality of life and the effectiveness of treatment of patients after early and delayed reconstruction of an isolated injury of the anterior cruciate ligament.

Material and methods. The results of a survey of 782 patients aged 18–54 years according to the international standardized questionnaire of the quality of life (SF-36 — Short Form-36 Health Survey Questionnaire) before and after arthroscopic reconstruction of an isolated injury of the anterior cruciate ligament using a free autograft from the tendons of the semitendinosus and tender muscles are presented. All patients were divided into two groups. The first group included 403 patients (232 males and 171 females), anterior cruciate ligament plasty was performed at an early stage, from the 1st to the 6th week after the injury. The second group included 379 patients (211 males and 168 females) who were operated on late, from the 7th week to 1 year after the injury. Statistical analysis was performed using the Statistica 12.0 program (Stat Soft, Inc.). The significance of differences between independent samples was determined using nonparametric tests: the Mann–Whitney U test and the Wilcoxon T test.

Results. It was found that 1 year after the operation, in patients of the first group, the values of the treatment effectiveness indicator in terms of the total indicator of physical and mental components of health are significantly higher compared to the second group (p <0.0001, Mann–Whitney U-test). A high correlation between the indicators of treatment effectiveness according to the assessment scales of the physical component of health and the mental component of health in groups depending on the timing of the reconstruction of the anterior cruciate ligament was found. Thus, the Spearman's rank correlation coefficient in the first group between the indicators of treatment effectiveness in terms of the total indicator of the physical and mental components of health was r=0.79 (p=0.001), and in the second group — r=0.71 (p=0.001).

Conclusion. The long-term results of assessing the quality of life of patients indicate the predominant effectiveness of the treatment of patients operated on in the early stages after injury, compared with delayed surgery.

Kazan medical journal. 2022;103(6):955-961
pages 955-961 views
Resistance of Klebsiella pneumoniae isolated from patients with chronic osteomyelitis to ­antibacterial drugs
Shipitsyna I.V., Osipova E.V.

Background. The spread of highly resistant strains of Klebsiella pneumoniae in the departments of purulent orthopedics determines the need for constant monitoring of the sensitivity of bacteria to antibacterial drugs.

Aim. To monitor the resistance of K. pneumoniae bacteria isolated from patients with chronic osteomyelitis to antibacterial drugs.

Material and methods. The resistance profiles of 663 clinical strains of K. pneumoniae isolated from wounds and fistulas of 294 patients with chronic osteomyelitis who were treated in the purulent department of the Federal State Budgetary Institution “National Medical Research Center for Traumatology and Orthopedics named after G.A. Ilizarov” in the period 2016–2021 to eight drugs: cefazolin, cefotaxime, cefepime, imipenem, meropenem, amikacin, gentamicin, piperacillin + tazobactam were analyzed. The analysis of the results was statistically proces¬sed using the software AtteStat, version 13.0. Data are presented as a percentage (%) of the total number of strains isolated during the study period.

Results. K. pneumoniae strains showed the greatest resistance to cephalosporin antibiotics and inhibitor-protected penicillins. The number of strains resistant to aminoglycosides decreased from 2016 to 2021. Imipenem had the highest activity against Klebsiella, the proportion of resistant strains did not exceed 48% over 6 years. Meropenem was active against Klebsiella over a 3-year period from 2016–2018 (the proportion of resistant isolates did not exceed 28.5%). Starting from 2019, the number of resistant strains increased, in 2021 their number was 63.9%. Among all the isolated strains of K. pneumoniae, the largest share fell on polydrug-resistant strains (89.6%).

Conclusion. The monitoring of the resistance of K. pneumoniae strains to eight antibacterial drugs revealed a high incidence of multidrug-resistant strains, low efficacy of cephalosporin antibiotics and inhibitor-protected β-lactam drugs, and an increase in resistance to carbapenems.

Kazan medical journal. 2022;103(6):962-967
pages 962-967 views

Experimental medicine

Variant anatomy of the colonic and aberrant branches of the superior mesenteric artery
Gaivoronsky I.V., Bykov P.M., Gaivoronskaya M.G., Sinenchenko G.I., Nichiporuk G.I.

Background. The rapid development of abdominal, endovascular surgery and transplantology necessitate a detailed study of the structural features of the abdominal cavity vessels.

Aim. To study the variant anatomy of the colonic branches of the superior mesenteric artery in men and women.

Material and methods. The study was conducted based on the analysis of the results of multislice spiral computed tomography, a total of 2300 computed tomograms of adults aged 25 to 75 years (913 males and 1387 females) were studied. To assess the statistical significance of the aorta branches architectonics variants frequency dependence on gender, the method of analyzing four-field tables (Pearson's chi-square test) was used. The correlation strength was assessed using the normalized value of the Pearson coefficient.

Results. It has been established that the branches of the superior mesenteric artery, which vascularize the large intestine, have a wide range of variant anatomy. According to their number and the presence of aberrant branches, these variants can be classified into mono-, bi-, tri-, quadri- and penta-arterial. The most common variant of the architectonics of these branches of the superior mesenteric artery is biarterial. Mono- and pentaarterial branching variants of the colonic branches of the superior mesenteric artery are extremely rare in both sexes. The iliocolic and middle colic arteries are permanent branches of the superior mesenteric artery, and the right colic artery may be absent (in 7% of cases in males and 19% in females). Among the aberrant branches of the superior mesenteric artery, we noted the arteries involved in the blood supply to the liver: the right accessory, right replacement, and common hepatic arteries. In men in 25% of cases, in women in 16% of cases, a deviation from the superior mesenteric artery of the aberrant hepatic branch was noted.

Conclusion. The architecture of the colonic branches of the superior mesenteric artery is characterized by a wide range of variant anatomy and a high incidence of aberrant hepatic arteries.

Kazan medical journal. 2022;103(6):968-975
pages 968-975 views
Analysis of oxidative modification of rat epididymal mitochondrial proteins under normobaric chronic hypoxia and modulation of nitric oxide (II) synthesis
Marsyanova Y.A., Zvyagina V.I., Petrov A.V.

Background. The molecular mechanism of NO effects in adaptation to hypoxia is of interest as a potential point of application in the therapy of fertility disorders.

Aim. To assess the degree of oxidative modification of epididymal mitochondrial proteins during hypoxia under conditions of experimentally modified NO synthesis.

Material and methods. Sexually mature rats were divided into four groups of 8 individuals: (1) control (animals without hypoxia); (2) chronic normobaric hypoxia, the animals were kept in a sealed chamber with oxygen reduced to 10% once a day for 14 days; (3) animals with hypoxia were injected with an inhibitor of the synthesis of nitric oxide (II) L-nitroarginine methyl ester at a dose of 25 mg/kg intraperitoneally once a day for 7 days; (4) animals with hypoxia were injected with the substrate for NO synthesis L-arginine at a dose of 500 mg/kg intraperitoneally once a day for 10 days. In the mitochondrial fraction of the head and tail of the epididymis, the activity of superoxide dismutase, the amount of NO metabolites, and the degree of oxidative modification of proteins were evaluated. Statistical analysis was performed using the Shapiro–Wilk, Mann–Whitney, and Spearman tests; differences were considered significant at p <0.05.

Results. Hypoxia led to an increase in the oxidative modification of proteins in the mitochondria of the head of the epididymis — 319.12 [240.98; 363.63] c.u./mg protein relative to control — 17.89 [15.31; 27.62] c.u./mg protein, p=0.0009. In the mitochondria of the tail of the epididymis, the oxidation of proteins under the studied conditions was less pronounced. The use of L-nitroarginine methyl ester, as well as L-arginine, led to a decrease in the level of oxidative modification of proteins in the head of the epididymis relative to the hypoxia model — 39.89 [29.25; 43.17] and 37.25 [34.91; 40.96] c.u./mg of protein, respectively, p=0.0009.

Conclusion. Mitochondrial proteins in the head of the epididymis are more susceptible to oxidative damage during hypoxia; a decrease in the level of NO metabolites under conditions of oxygen deficiency is associated with a decrease in the oxidative modification of mitochondrial proteins.

Kazan medical journal. 2022;103(6):976-985
pages 976-985 views


Prospects for the study of transposons in the pathogenesis of autoimmune diseases
Mustafin R.N.

One of the mechanisms for the development of autoimmune diseases is changes in epigenetic regulation, the root causes of which have not yet been established. At the same time, data on the role of transposons as sources of long noncoding ribonucleic acids (RNA) and microRNAs involved in the development of immune pathology have been accumulated. In evolution, transposable elements have become the basis for the emergence of V(D)J recombination and regulation of HLA genes. Pathological transposon activation has been revealed in type 1 diabetes mellitus, rheumatoid arthritis, systemic lupus erythematosus, Aicardi–Goutieres and Sjögren’s syndromes. The influence of exogenous viruses on the development of autoimmune diseases may be due to their interactions with transposons. Transposable elements themselves are able to activate the antiviral immune response, stimulating the hyperproduction of interferon. An assumption about changes in the activation of transposons as drivers of autoimmune pathology was made, which is reflected in the expression of non-coding RNAs, which are key epigenetic factors. The analysis of the transposon-derived microRNA database (MDTE DB) made it possible to identify 13 microRNAs associated with autoimmune diseases: systemic scleroderma (miR-31, miR-609, miR-3162), juvenile rheumatoid arthritis (miR-151), systemic lupus erythematosus (miR-198, miR-342), psoriasis (miR-224, miR-378) and myasthenia gravis (miR-421, miR-551a, miR-612, miR-891b), multiple sclerosis (miR-584 ), which serves as a proof of the proposed hypothesis. Since changes in epigenetic factors under the influence of transposons are reversible and are reflected in the expression of certain non-coding RNAs, targeted therapy using microRNAs and their analogues as tools is a promising direction in the development of specific treatment for autoimmune diseases.

Kazan medical journal. 2022;103(6):986-995
pages 986-995 views

Social hygiene and healthcare management

Possibilities of the Health Utilities Index questionnaire in assessing the quality of life of children with disabilities
Vinyarskaya I.V., Terletskaya R.N., Chernikov V.V., Antonova E.V., Fisenko A.P.

Background. Currently, in the Russian Federation, the criteria for establishing disability do not take into account the assessment of the quality of life, while in developed countries this indicator is a mandatory component of examination programs and evaluation of the effectiveness of treatment and rehabilitation. In Russian pediatrics, research on the development of indicators of the quality of life in children with chronic disabling diseases has begun, this work is a continuation of this direction.

Aim. To assess the quality of life of disabled children with various somatic diseases using all the possibilities of the Health Utilities Index questionnaire.

Material and methods. A survey of 213 patients aged 5 to 18 years with chronic diseases with the status of a “disabled child” and their legal representatives was conducted using the Russian version of the international general questionnaire Health Utilities Index. Statistical analysis was performed using the SPSS software package version 26.0. The Kruskal–Wallis test and Dunn's posterior test were used.

Results. During the study, multi-attribute utilitarian indices were developed for each group of children, which ranged from 0.67±0.3 (95% confidence interval 0.55–0.78) in patients with rheumatological diseases to 0.85±0.21 (95% confidence interval 0.79–0.91) in children with heart disease and statistically significantly (p <0.001) were lower than in healthy children (0.9±0.17; 95% confidence interval 0.87–0.92). The features of one-attribute utilitarian indices depending on the class of the disease have been established. An analysis of the level and degree of functioning disorders showed that the most common and frequent for children with disabilities in the studied groups were emotional disorders; problems associated with the presence of pain; disability caused by a sense of cognitive deficit. For the first time, to determine the “categories” of the severity of violations an approach according to a multi-attribute utilitarian index was used.

Conclusion. The quality of life in children with disabilities, reduced compared to healthy peers, has nosological features; the most pronounced decrease in the quality of life was noted in children with skin diseases and rheumatological diseases.

Kazan medical journal. 2022;103(6):996-1004
pages 996-1004 views
Comparative analysis of the associations between solar activity and trends in the incidence of haemoblastoses in Russia, the USA and Canada
Pinaev S.K., Chizhov A.Y., Grjibovski A.M., Pinaeva O.G.

Background. Identification of the links between hemoblastoses and environmental factors is necessary for the development of preventive measures.

Aim. Comparative analysis of the link between hemoblastosis trends in Russia, the USA and Canada and solar activity.

Material and methods. The open data on the incidence of hemoblastoses in Canada (1983–2012), the USA (1998–2012) and Russia (1993–2018) was used. To estimate solar activity, the average annual number of sunspots (Wolff numbers) was taken. The relationship between the frequency of hemoblastoses and solar activity was studied using the Pearson correlation analysis in 11 iterations (lag 0–10 years). The results obtained are compared with the data of an earlier study on Russia.

Results. In Canada, an association with Wolf numbers was found in the frequency of Hodgkin's lymphoma in men (r=0.431, p=0.017, lag 2 years), multiple myeloma in women (r=0.542, p=0.037, lag 1 year), non-Hodgkin's lymphomas in men (r =0.538, p=0.038, lag 5 years) and women (r=0.750, p=0.001, lag 5 years), leukemia in men (r=0.707, p=0022, lag 7 years) and women (r=0.817, p=0.004, lag 7 years). In the United States, a relationship with solar activity was established for fluctuations in the incidence of Hodgkin's lymphoma in men (r=0.577, p=0.050, lag 5 years) and women (r=0.641, p=0.025, lag 5 years), non-Hodgkin's lymphomas in men (r=0.809, p <0.001, lag 3 years) and women (r=0.844, p <0.001, lag 2 years), leukemia in men (r=0.619, p=0.032, lag 1 year). In the Russian population, a relationship between solar activity and the frequency of all forms of hemoblastoses, was previously revealed. Fluctuations in the frequency of leukemia and non-Hodgkin's lymphomas in the populations of Russia, the USA and Canada have a strong positive relationship with solar activity. The strength of this association in Hodgkin's lymphoma and multiple myeloma ranges from moderate to significant. In all the countries studied, an increase in the incidence of multiple myeloma and leukemia was found, and an increase in the incidence of non-Hodgkin's lymphomas was found in Russia and Canada. The trend in the incidence of Hodgkin's lymphoma in Russia and Canada has a significant downward trend.

Conclusion. Trends in hemoblastoses in Russia, the USA and Canada are strongly related to solar activity.

Kazan medical journal. 2022;103(6):1005-1012
pages 1005-1012 views

Clinical experiences

The use of antegrade venous thrombectomy with stenting for acute iliofemoral phlebothrombosis in a patient with post-thrombophlebitis disease
Khuziakhmedov A.N., Khalilov I.G., Komarov R.N., Khalilov I.I.

Deep vein thrombosis is one of the most formidable conditions, which can subsequently cause pulmonary embolism and trigger the development of post-thrombophlebitic disease. The aim of our work was to evaluate the result of antegrade venous thrombectomy with stenting for acute iliofemoral phlebothrombosis in a patient with post-thrombophlebitic disease. Patient G., 33 years old, was admitted to the Department of Vascular Surgery of the City Clinical Hospital No. 7 of Kazan on January 1, 2021 on an emergency basis with complaints of severe swelling and pain in the right lower limb. Upon admission, the patient underwent ultrasound Doppler scanning of the veins of both lower extremities and X-ray tomography of the chest and abdominal cavities with contrast, according to which the diagnosis of acute iliofemoral phlebothrombosis on the right with thrombus flotation in the common iliac vein for 7 cm was made. According to vital indications, the surgery — transjugular thrombectomy from the iliofemoral segment using a proximal venous trap and subsequent implantation of a venous stent into the right common iliac vein — was performed. In the postoperative period, the patient received anticoagulant therapy. A day after the operation, a control ultrasound of the veins of the lower extremities and the inferior vena cava, X-ray tomography of the organs of the chest and abdominal cavity were performed. On the 5th day, the patient was discharged in a satisfactory condition under the supervision of a surgeon at the place of residence. Analysis of the results of surgical treatment of a patient with post-thrombophlebitic disease complicated by acute iliofemoral phlebothrombosis using antegrade venous thrombectomy with stenting showed that the patency of the stented iliac-femoral segment was maintained for up to 12 months. Thus, the proposed method of surgical treatment allows us to safely remove floating and occlusive thrombi from the iliocaval and femoral segments, implant stents, and thereby restore the patency of the segment, reducing the risk of possible repeated thrombosis, embolic and post-thrombophlebitic complications.

Kazan medical journal. 2022;103(6):1013-1018
pages 1013-1018 views
Correction of atrophic post-acne scars with ablative erbium laser, taking into account the predominant type of scar
Ufimtseva M.A., Simonova N.V., Sorokina K.N.

Background. The choice of an effective method of laser correction of atrophic post-acne scars, suitable for a particular type of scar, remains a difficult task, despite the variety of interventions.

Aim. To study the effectiveness of a combination of planar and fractional laser ablation in patients with atrophic post-acne scars, taking into account the predominant type of scar.

Material and methods. An open clinical intervention study included 60 patients with II–IV scar severity grade, 36 females and 24 males, with a mean age of 28.87±4.81 years. The predominance of V-shaped scars was observed in 11 (18.3%) patients, U-shaped — in 29 (48.3%), M-shaped — in 12 (20.0%), macular — in 8 (13.3%) patients. An erbium laser with a wavelength of 2940 nm was used to resurface the edge of the scars, followed by fractional ablation of the affected area. The change in the severity and quantitative index of the severity of post-acne scars after treatment, as well as the results on the international scale of aesthetic improvement, were evaluated. The safety of the method was assessed during a clinical examination on the 7th day after each procedure and 3 months after the last one, any adverse events and complications were recorded. The significance of differences was calculated using the Wilcoxon, Mann–Whitney, Kruskal–Wallis and the χ2 tests. Differences were considered statistically significant at p <0.05.

Results. Reduction of scar severity was registered, the quantitative index after treatment decreased from 11.4±3.25 to 6.2±3.1 points (p=0.000, Wilcoxon criterion). Regression of quantitative indices was established in patients with U-shaped and macular scars compared with patients with a predominance of M- and V-shaped scars (p ≤0.05, Mann–Whitney test). The average effectiveness of treatment on a scale of aesthetic improvement was 2.42±0.72 points, in 33 (55.0%) people the result corresponded to a significant improvement, in 19 (31.7%) — moderately pronounced improvement, a noticeable improvement in appearance compared to baseline was noted in 8 (13.3%) patients (χ2=23.55, p <0.000). Complications of procedures were not registered.

Conclusion. Correction of atrophic scars with an erbium laser, which combines planar and fractional ablation, is effective and safe for various types of atrophic scars; the optimal result is achieved in patients with U-shaped and macular scars.

Kazan medical journal. 2022;103(6):1019-1028
pages 1019-1028 views
Histopathology of patchy skin atrophy
Nefedov V.P., Abdrakhmanov R.M., Davidov V.P.

Background. Description of the pathomorphology of patchy atrophy of the skin is found in rare publications on dermatology. At the same time, we noted a surge in the number of such cases over the past 3 years.

Aim. To study the detectability of patchy skin atrophy based on the materials of histological examination of skin biopsy specimens in the Republican Dermatovenerological Dispensary for 2016–2021, find out the most frequent localization of the process and determine the most characteristic pathomorphological signs of patchy skin atrophy.

Material and methods. The biopsy material of the skin from 816 patients, in which red spots on the skin of the trunk, arms and legs were clinically determined (clinical diagnoses were diverse) was studied. Histological preparations of the skin of patients were stained according to the standard method with hematoxylin and eosin.

Results. For 6 years (2016–2021) of studying and diagnosing 194 cases of patchy skin atrophy, the same frequency of the disease in men and women was noted (ratio 1:1). In men, patchy skin atrophy was more often detected in the young age group (up to 30 years), and in women, in the older age group (after 60 years). The most common localization of patchy skin atrophy is the trunk, extensor surface of the arms and lower leg. Histological examination of the skin in patients with patchy atrophy revealed two variants: with perivasculitis in the papillary dermis and without perivasculitis. We suggested two stages in the development of the disease: the first is the erythematous stage, the second is the sclerotic stage. The most characteristic pathomorphological signs of patchy skin atrophy are described.

Conclusion. An increase in the number of diagnosed cases of patchy skin atrophy was noted, the histological signs of which are a decrease in the number of rows of cells in the Malpighian layer, the disappearance of the basal and granular layers of the epidermis.

Kazan medical journal. 2022;103(6):1029-1033
pages 1029-1033 views
Secretory function of the contralateral parotid glands
Shchipskiy A.V., Kalimatova M.M., Mukhin P.N.

Background. The study was a reaction to an article about the “physiological asymmetry” of the salivary glands in right-handed and left-handed people.

Aim. To determine the impact of the side of the study on the function of the parotid glands as a possible factor that must be taken into account when evaluating the results of sialometry.

Material and methods. In 22 patients with xerostomia, controlled dynamic sialometry was performed in two stages. The second stage was a week after the first one. At the first stage, Lashley's capsule was on the right, the catheter was on the left, at the second stage, the catheter was on the right, the capsule was on the left. Sialometry was performed in the morning, 20 minutes after taking 8 drops of a 1% aqueous solution of pilocarpine, for 20 minutes. The results with the Lashley capsule outside the duct were considered control, the results with the catheter in the duct were controlled. This eliminated the technological measurement error. The significance of differences in sialometry parameters was assessed using statistical analysis with Student's t-test. The results were considered significant at p ≤0.05.

Results. In the sample with use of the Lashley's capsule, higher sialometry values on the right were found in 7 out of 22 cases (31.8%), on the left — in 13 out of 22 cases (59.1%) (p >0.05). In the group with the use of a catheter, in 15 out of 22 cases (68.2%) and in 5 out of 22 cases (22.7%), respectively (t=3.4028; p <0.001). In a single sample (capsules and catheter), in 22 out of 44 cases (50.0%) and in 18 out of 44 cases (40.9%), respectively (p >0.05). The results of comparing the average values on the right, obtained in 22 cases with a capsule (1.2±0.6 ml), with those on the left (1.3±0.7 ml) showed no significant difference (t=0.5254). Differences in catheter sialometry (1.0±0.7 ml on the right and 0.8±0.7 ml on the left) were also not significant (p >0.05).

Conclusion. The secretory function of the contralateral parotid glands under comparable individual conditions is the same. Objectively determined functional symmetry simplifies the analysis of the salivary glands secretory function study results.

Kazan medical journal. 2022;103(6):1034-1039
pages 1034-1039 views
Capillaroscopic diagnostics of diabetic microangiopathy using artificial neural networks in patients with diabetes mellitus
Krutikov E.S., Zhitova V.A., Rudenko M.A., Akaev R.O., Burdin D.V.

Background. The widespread prevalence of diabetes and the progressive deterioration of health against the background of this disease substantiate the need for the use of new methods for the early diagnosis of diabetic microangiopathies. The combined use of digital capillaroscopy and deep learning technologies will significantly improve the quality and speed of microvascular disorders diagnostics.

Aim. Development of a system for assessing capillary images based on artificial neural networks, as well as its testing for the early diagnosis of microangiopathy in patients with diabetes mellitus.

Material and methods. 136 patients (59 females and 77 males) with type 1 diabetes mellitus aged 25.82±6.05 years were examined and divided into two groups: the first group included 65 (47.8%) patients who had no symptoms of diabetic microangiopathies, the second group — 71 (52.2%) patients who were diagnosed with one or more diabetic microangiopathies. The control group consisted of 30 practically healthy volunteers. All patients with diabetes melitus, as well as individuals from the control group, underwent сapillaroscopic examination. The resulting images were analyzed using the developed evaluation system based on artificial neural networks. Statistical data processing was performed using the Student and Mann–Whitney tests (U-test), logistic regression analysis, and ROC analysis.

Results. In patients with diabetes mellitus, there was a decrease in the capillary network density in both groups and the diameter of the arterial sections in the second group. Capillaroscopy using the developed system showed a sufficient level of significance (χ2=21, p=0.000), high sensitivity (71.43%) and specificity (85.71%). This method can be used in the diagnosis of microangiopathy in diabetic patients.

Conclusion. The combined use of capillaroscopy and neural networks allows to increase the speed and quality of the examination, as well as simplify the interpretation of the resulting images.

Kazan medical journal. 2022;103(6):1040-1049
pages 1040-1049 views

History of medicine

Reform of domestic dental education in the first years of Soviet power
Maksimov E.S., Pashkov K.A.

The reform of dental education began in the RSFSR in 1918, when the People's Commissariat adopted a regulation according to which dental schools (secondary educational institutions that trained dentists in pre-revolutionary Russia) were to be closed, and odontological units and departments for pathology and therapy of dental diseases, prosthetic technology, surgery of the jaws and oral cavity were opened at the medical faculties of universities. The establishment of odontological departments did not allow a significant increase in the ranks of odontologists, since students had to spend as much time on studying dentistry as future doctors, and received only the right to practice dentistry and an incomplete medical education. The proposal to revive dental schools to meet the needs of the population in dental care by specialized professionals met with fierce resistance from the head of the dental subsection of the RSFSR People's Commissariat of Health P.G. Dauge, who considered secondary education unacceptable. The article describes the discussion that unfolded on this issue, as a result of which odontological departments were created at the medical faculties of universities, the number of dentists decreased, and the preventive direction proposed by P.G. Dauge, as a method of reducing the country's need for dental specialists, became one of the main ones in Soviet dentistry.

Kazan medical journal. 2022;103(6):1050-1057
pages 1050-1057 views
Treatment of narcological patients in the territory of Tatarstan (to the 45th anniversary of the ­Republican Clinical Narcological Dispensary of the Ministry of Health of Tatarstan)
Shaydukova L.K., Utkelbaev R.I., Khaeva R.F.

The treatment of patients with alcoholism has a long history in Kazan and refers to the experience of conducting hypnotherapy sessions by the great Russian scientist Vladimir Mikhailovich Bekhterev, which served as the basis for the creation of stress psychotherapy in modern narcology. The provision of narcological assistance in Tatarstan during the Soviet period is associated with the opening of the Republican Narcological Dispensary, which celebrated its 45th anniversary this year. There are three stages in the provision of drug abuse treatment: in the Soviet period (1975–1991), in the “post-Soviet space” (from 1991–2000), and in modern times (after 2000). Each stage is characterized by its own characteristics. The Republican Narcological Dispensary, which received the status of “clinical”, adequately copes with the task of treating patients with alcoholism and drug addiction, continuing the traditions of Russian narcology.

Kazan medical journal. 2022;103(6):1058-1064
pages 1058-1064 views
History of the Kazan School of Dermatovenereology
Faizullina E.V., Fedorova N.A., Khismatulina I.M., Shamov B.A., Gusarova E.S.

The Department of Skin and Venereal Diseases is one of the oldest departments of Kazan State Medical University. It originates in the bowels of the medical faculty of the Kazan Imperial University. The founder and first head of the Department of “Skin and Syphilitic Diseases” was Professor A.G. Ge. There are three periods in the development of the scientific school, which differ in research issues and teaching methods. The first period — from the birth of the school of A.G. Ge until the end of the 1920s, it is characterized by the fight against syphilis, which is reflected in the name of the department of “skin and syphilitic diseases”. The starting point of the second period in the history of the Kazan school of Dermatovenereology can be considered 1930, when the medical faculty of the university formed an independent institute — the Kazan State Medical Institute. At this stage, it is difficult to identify the main scientific direction, the research was carried out based on the urgent tasks of the time. The third stage (from the 1970s to the present) is characterized by research into issues of allergy and its skin manifestations. Employees of the Department of Dermatovenerology of the Kazan State Medical University are currently continuing the main traditions of the Kazan dermatovenerological school.

Kazan medical journal. 2022;103(6):1065-1071
pages 1065-1071 views

Cochrane Review Summaries

Topical corticosteroids for dry eye (Russian Translation of Cochrane Plain Language Summary)

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Liu S-H, Saldanha IJ, Abraham AG, Rittiphairoj T, Hauswirth S, Gregory D, Ifantides C, Li T. Topical corticosteroids for dry eye. Cochrane Database of Systematic Reviews. 2022. Issue 10. Art. No.: CD015070. DOI: 10.1002/14651858.CD015070.pub2.

Kazan medical journal. 2022;103(6):1072-1073
pages 1072-1073 views

Through the pages of the “Kazan Medical Journal”

A case of female false hermaphroditism

This publication is a reprint of an article by Assistant I.F. Kozlov “A case of female false hermaphroditism”, published in the Kazan Medical Journal in 1923. Reprinting is carried out in preparation for the celebration of the 150th anniversary of the first issue of the Kazan Doctors’ Society Diaries, the assignee of which is the Kazan Medical Journal. Original publication: Kozlov IF. A case of female false hermaphroditism. Kazan Medical Journal. 1921;17(2):224–232. DOI: 10.17816/kazmj79462.

Kazan medical journal. 2022;103(6):1074-1083
pages 1074-1083 views
Index of authors
Kazan medical journal. 2022;103(6):1084-1086
pages 1084-1086 views
Acknowledgements to reviewers
Kazan medical journal. 2022;103(6):1087-1088
pages 1087-1088 views

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