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Vol 78, No 3 (2023)

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Surgical Treatment of Congenital Heart Diseases Associated with Pulmonary Hypertension in Adults

Gorbachevsky S.V., Chazova I.E., Martynyuk T.V., Shmalts A.A.


The outcome of treatment of adult patients with congenital heart disease (CHD) and pulmonary hypertension (PH) depends on the adequacy of diagnosis with a thorough assessment of hemodynamics and the correctness of the chosen tactics. Enormous success has been achieved, various classifications and algorithms for managing children and adults with this nosology have been created and are widely used. Thanks to the creation and widespread introduction into clinical practice of various types of drugs, the results of surgical treatment of CHD with PH have improved significantly. A new cluster of patients has emerged who can undergo palliative surgery against the background of irreversible pulmonary hypertension, leading to a significant improvement in the quality and life expectancy. At the same time, to this day, it is far from always possible to evaluate each specific case with full confidence in the possibility of performing surgical treatment. Modern advances in CHD cardiac surgery have significantly expanded the indications for the correction of defects with high PH in adults. Operability (implying normalization of pulmonary artery pressure) and indications for palliative surgery (without regression of PH, but with an improvement in the quality and life expectancy of patients) are still the main debatable issues.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):165-175
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Prognosis of Early Outcomes after Isolated Coronary Bypass Surgery: Results of a Single-Center Cohort Study

Golukhova E.Z., Keren M.A., Zavalikhina T.V., Bulaeva N.I., Marapov D.I., Sigaev I.Y., Merzlyakov V.Y., Alsibaya M.D., Volkovskaya I.V., Yakhiaeva K.B., Sheikina N.A.


Background. The importance of predictors of adverse outcomes after coronary bypass surgery needs to be regularly review in view of changing standards of practice. Predicting complications will help reduce current mortality and morbidity among patients who have undergone coronary bypass surgery (CABG). Aims — prediction and determination of independent predictors of in-hospital mortality after CABG based on the results of preoperative examination. Methods. In a retrospective cohort single-center study, we analyzed the results of 2239 patients who underwent isolated CABG for the period from September 2018 to August 2021. The primary endpoint of the study was hospital death after CABG. Also, the frequency of: non-fatal myocardial infarction, non-fatal stroke, acute heart failure, postoperative rhythm and conduction disorders, acute renal failure, multiple organ failure, infectious complications was analyzed. Next, we searched for independent predictors and built a prognostic model for assessing the risk of death after CABG. Results. Results. Hospital mortality among patients was 1.34% (n = 30). Independent predictors of death after CABG were: ejection fraction (OR — 0.91; 95% CI: 0.88–0.93; p < 0.001), body mass index (OR — 0.90; 95% CI: 0.82–0.99; p = 0.035), glomerular filtration rate (OR — 0.97; 95% CI: 0.96–0.99; p = 0.005), repeated CABG (OR — 9.3; 95% CI: 2.74–31.24; p < 0.001), critical atherosclerotic lesion of the arteries of the lower extremities (OR — 4.5; 95% CI: 1.933–10.268; p < 0.001). The model for predicting the probability of death after CABG had high quality metrics: ROC-AUC — 0.838 (95% CI: 0.747–0.929; p < 0.001), sensitivity — 72.4%, specificity — 84%. The threshold value of the logistic function P at the cut-off point, which corresponded to the highest value of the Yuden index, was 0.015. The outcome was predicted when the value of the logistic function P was higher than or equal to this value. Conclusion. We have developed a model for predicting in-hospital mortality after CABG based on independent linear predictors: left ventricular ejection fraction, body mass index, glomerular filtration rate, repeated CABG, critical atherosclerotic lesion of the main arteries of the lower extremities.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):176-184
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Development and Validation of the One-Factor Questionnaire “Patient Satisfaction with Medical Care”

Сhargaziya L.D., Shelegova D.A., Vyskochkov V.S., Tyufilin D.S., Shibalkov I.P., Deev I.A., Kobyakova O.S.


Background. One of the most viral principles in the development of modern healthcare is patient-oriented approach — providing a medical care considering citizens’ expectations; ensuring individual approach in solving their personal problems. One of the most important markers for assessing patient-oriented health care provision is patient satisfaction with medical care. Aims — the aim of our study was to develop and validate a tool to assess this indicator in the Russian Federation. Methods. A total of 3012 people between the ages of 18 and 83 took part in the study. The ratio of males to females in the sample was approximately 1:1 (1501 females to 1511 males). Quantitative methods were used to conduct the analysis. Construct validity was assessed using exploratory and confirmatory factor analyses (EFA and CFA, respectively) with appropriate assessment of goodness-of-fit. Reliability and internal consistency of the instrument measuring patient satisfaction with medical care was assessed using Cronbach’s alpha. Results. The study involved 3012 people aged 18 to 83 years. The ratio of men to women in the sample was approximately 1:1 (1501 women and 1511 men). The proportion of urban residents who took part in the study was 67.2%, rural — 32.8%. Less than a month ago, 22.0% of respondents received medical care for the last time; from one to three months — 22.7%; four to six — 29.1%; from seven to twelve — 16.7%; more than a year ago — 9.5%. The services of private medical organizations were used by 12.3% of the study participants, state — 87.7%. The use of confirmatory factor analysis demonstrated the acceptability of a one-factor solution and confirmed the structural validity of the developed tool. The reliability and internal consistency of the patient satisfaction measurement tool was assessed using Cronbach’s alpha. Cronbach’s alpha showed “excellent” internal domain consistency (> 0.9). Bartlett’s sphericity criterion was met (p-value < 0.001). Conclusion. The conducted statistical analysis allows us to assert the acceptability of the one-factor model and the construct validity of the proposed tool.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):185-193
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Socio-Psychological Aspects of Introducing Mobile Technologies into Clinical Trials

Khokhlov A.L., Andreenkova A.V., Dmitrieva E.V., Ilyin M.V., Lileeva E.G., Chizhov P.A., Miroshnikov A.E., Pozdnyakov N.O.


Background: High political and economic turbulence, changes in the international relations and cross-national economic ties enhance the demand for developing and launching new pharmacological treatments as a part of nationally independent health care program and import substitution policy. The number of clinical trials is growing rapidly, increasing the need for more effective solutions in organizing these trials — optimizing the time, financial resources and efforts of medical personnel. The global trend of creating a new digital ecosystem in health care also raises the issues of higher patient involvement, taking into account the patient's psychological and physical barriers including the issues of personal data security. Aims: Evaluating the motivation and readiness of current clinical trials participants to switch to mobile technologies and identifying the barriers for these shifts. Method: The survey among 75 participants of clinical trials using offline self-completed questionnaire, data processing using statistical tools for data analysis.

Results: Currently, 56% of respondents who are current participants of traditional medical trials would definitely agree to participate in mobile clinical trials. Compared to the consistency rate between traditional clinical trials estimated as 73%, the shift to a new format will result in 17% additional losses. The serious barrier for participation is the concerns about the security of personal information – it is highly relevant for 37% of respondents and moderately relevant for 44%. The important motivating factor for the participation is the open access to personal medical data - 44% of respondents were highly interested in obtaining this data and 31% are somewhat interested. Conclusion. The results of the pilot study confirmed relatively high readiness of current participants to join mobile clinical trials and use mobile devices and solutions in future trials. However the level of readiness is unequal between different socio-demographic groups. Differentiating parameters are age, former experience of clinical trials and the skills in using digital technologies. Training programs for managers and researchers of clinical trials, provision of devices for non-users, timely technical support during the data collection and transparency in data usages can help to address key issues which slow down the people’s participation in mobile trials.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):194-207
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Contemporary Interpretations of Ophthalmological Manifestations of Chronic Myeloproliferative Neoplasms

Moshetova L.K., Egoryan L.B., Vinogradova O.J., Turkina K.I., Shikhbabaeva D.I.


The course of chronic myeloproliferative neoplasms (CMPN), a group of systemic hematological diseases, can be accompanied by various complications and changes in tissues and organs of the whole organism. The eye is the only organ where damage of nerve fibers and blood vessels can be directly observed and examined, and ocular symptoms can be the initial, manifest of systemic pathology, the toxic effects of modern targeted therapy, or the first manifestation of a relapse of the disease after treatment. The most frequently described manifestations are caused by hematological anomalies that cause microvascular disorders. Such changes today remain insufficiently studied in terms of the using new research methods and contemporary targeted therapy. In addition, ocular symptoms may precede more serious extraocular complications. Combined ophthalmological and hematological examination of patients with CMPN can become a preventive approach for early diagnosis and timely treatment.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):208-212
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Significance of Tissue Inhibitors of Matrix Metalloproteinases Expression in Pathogenesis and Differential Diagnosis of Periodontal Pathology

Kazeko L.A., Zakharava V.A., Benesh J.D., Cherstvoy E.D.


Background. The balance of metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) is crucial for the manifestation and progression of periodontal diseases and is one of the promising areas of scientific research in terms of developing methods for selective inhibition of MMPs. Aims — to determine the significance of TIMP1 and TIMP2 expression parameters in gingival biopsies to identify the type of periodontitis at the stage of disease manifestation. Methods. A prospective study with parallel inclusion of patients with different forms of periodontitis in the compared groups was performed. The object of this study were patients with various forms of periodontitis. Pathological examination with morphometric analysis of TIMPs expression and subsequent statistical data analysis was performed using AperioImageScope v12.4.0.5043, Statistica 10.0, MedCalc19.6. Results. The study included 67 patients with aggressive (AgP, Grade C, n = 19), chronic simplex (CSP, Grade В, n = 10) and chronic complex (CCP, in the presence of occlusal trauma, Grade В, n = 38) periodontitis and 15 conditionally healthy patients (control group). The expression of TIMP1 and TIMP2 was detected with variable intensity both in the epithelium and in the stroma of the gingiva, and was significantly higher in periodontitis groups compared with the control group (MeTIMP1/2 = 32%/70%). Parameters of TIMP1 and TIMP2 expression had no significant differences in the groups with AgP (MeTIMP1/2 = 84%/98%) and CCP (MeTIMP1/2 = 83%/94%), except for higher parameters of the positivity of epithelial expression of TIMP2 (U = 61 372; p < 0.05) and lower levels of intensity of its expression in AgP (MeAgP/CCP=180/171; U = 56 491; p < 0.001). Correlation analysis revealed an inverse relationship of TIMPs expression parameters with those MMPs, including those most significant for the development of AgP — MMP1 (ρ = –0.40), MMP8 (ρ = –0.34), and MMP14 (ρ = –0.24). ROC analysis established acceptable informativeness of all studied parameters of total expression and positivity of epithelial expression of TIMP1, as well as positivity of total expression and intensity of epithelial expression of TIMP2 to distinguish between aggressive and chronic forms of periodontitis at the stage of disease manifestation. Conclusion. Our results show an increase in the expression of TIMP1 and TIMP2 in various forms of periodontitis and an inverse relationship with the MMPs inhibited by them. This complements both the fundamental knowledge of the development and progression of periodontal pathology and may have applied significance in terms of using the studied TIMP1 and TIMP2 expression criteria to establish the aggressive course of periodontitis already at the stage of disease manifestation, which will allow to individualize treatment, prevent or slow down tooth loss in order to preserve and/or improve the quality of life of this patient group.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):213-226
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Experience in a Standardized Algorithm for Surgical Treatment of Patients with Mandibular Fractures

Pankratov A.S., Gotsiridze Z.P., Kurshina S.I., Karalkin A.V., Grinin V.M., Valieva L.U.


Background. In recent decades, new surgical technologies for the treatment of patients with mandibular fractures have been introduced into clinical practice. However, the incidence of complications still remains high, practically not differing from the values 30 years ago. According to the Russian Dental Association, the incidence of complications is 15–19%. Probably, the introduction of rules governing the use of new methods of treatment can change the current situation for general clinical practice. Aims — to evaluate the effectiveness of the algorithm for the surgical treatment of patients with mandibular fractures, developed on the basis of clinical observations and biomechanical studies, based on significant clinical material. Methods. A retrospective study over a 3-year period of medical records of inpatients with mandibular fractures and their complications was carried out, in the surgical treatment of which, in the conditions of the basic clinic, the surgical algorithm developed by the authors was used. Results. Case histories of 442 patients who met the search criteria were examined. In terms of the composition of the patients included in the study group, it reflects a typical picture for this type of injury, which is typical for domestic clinical practice. The incidence of postoperative complications was 4.1% (of which accompanied by a prolongation of treatment — 2% of cases). Conclusion. The results of this work showed that the real percentage of complications in patients with injuries of the lower jaw can be significantly reduced due to strict compliance with the requirements of the algorithm, which was shown by a retrospective analysis of medical records of inpatients over a three-year period, reflecting the results of treatment of a significant number of patients. The data obtained can serve as the basis for appropriate multicenter clinical trials.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):227-233
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Comprehensive Assessment of Technological Readiness of an Innovative Project during the Development of a Pharmaceutical Product

Pyatigorsky A.M., Brkich G.E., Beregovykh V.V., Pyatigorskaya N.V.


Most of R&D, technological and experimental works carried out in Russia result in the development of technologies with low-level readiness for possible integration into the production cycles of industrial enterprises, which, on the one hand, demonstrates a lack of understanding by developers of the requirements for the product life cycle, and on the other hand, it is the possible reason for the low share of Russia in the total world exports of high-technology goods. In order to create a scientific and technical reserve in a target time, the world practice uses the Technology Readiness Levels (TRL) scale. This approach is used in various industries and has shown the possibility to develop technologies and launch production of innovative product by a target time. However, the Ministry of Education and Science notes that this approach has not yet been used to determine the readiness levels of chemical-technological processes and pharmaceutical technologies. The article discusses main scientific problems associated with conducting a comprehensive assessment of technological readiness levels of an innovative project during the development of a pharmaceutical product, using the TRL scale and the QbD concept for a systematic and early approach to development, based on a scientific understanding of the drug life cycle processes.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):234-241
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Biochemical and Signaling Functions of Plasmalogens in the Norm and in Various Diseases

Kytikova O.Y., Novgorodceva T.P., Denisenko Y.K.


Plasmalogens (PL) are alkenyl ether glycerophospholipids that perform many physiologically important functions in the body and have a variety of properties. The role of PLs as endogenous antioxidants is well studied, as well as PLs that determine the physicochemical properties of biomembranes, deposit polyunsaturated fatty acids, participate in cholesterol biosynthesis, the process of ferroptosis and adaptation of cells to hypoxia, are sources for the synthesis of platelet activating factor and act as its antagonists. At the same time, LPs are involved in the pathogenesis of neurodegenerative, inflammatory, oncological diseases and a number of other pathologies. These conditions are united by the development of chronic inflammation and oxidative stress, accompanied by a change in the activity of synthesis and the content of PL in cells. Despite the fact that PL replacement therapy inhibits inflammation, the molecular mechanisms of the association of PL with inflammation have not been fully elucidated. The purpose of this review is to summarize the latest literature data on the structure, biosynthesis, and functions of PL, their relationship with signaling cascades involved in the pathogenesis of chronic inflammatory and neuroinflammatory diseases, as well as to show current achievements and future prospects for the use of PL in the treatment of certain diseases.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):242-255
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To the 75th anniversary Academician of the Russian Academy of Sciences of Yuri Konstantinovich Yanov

Reshetov I.V., Sergeeva N.V., Serikov A.A.


On December 18, Lieutenant General of the medical service Yuri Konstantinovich Yanov turned 75 years old.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):256-257
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To the 80th Anniversary of Academician of the Russian Academy of Sciences Alexey Mikhailovich Egorov

Dygai A.M.


February 19, 2023 marked the 80th anniversary of the birth of Doctor of Biological Sciences, Professor, Academician of the Russian Academy of Sciences Alexey Mikhailovich Egorov, a leading Russian specialist in the field of medical biotechnology.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):258-259
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To the 95th Anniversary of Academician of the Russian Academy of Sciences Leonid Andreevich Ilyin


March 15, 2023 marks the 95th anniversary of Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences Ilyin Leonid Andreevich, Hero of Socialist Labor, laureate of the State Prizes of the USSR and the Russian Federation, twice laureate of the Prize of the Government of the Russian Federation, honorary president of the Federal State Budgetary Institution State Research Center of the Federal Medical and Biological Center named after A.I. Burnazyan FMBA of Russia.

Annals of the Russian Academy of Medical Sciences. 2023;78(3):260-261
pages 260-261 views

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