Neymark M.I.,Altai State Medical University |
Kiselev R.V.,Clinical Hospital
Obshchaya Reanimatologiya | Year: 2017
The purpose of the study is to examine the effect of anesthesia and respiratory support parameters on central and peripheral hemodynamics in patients with morbid obesity undergoing an endoscopic gastric resection. Materials and methods. A randomized study of 43 patients with a body weight index of >40 kg/m2 who underwent an endoscopic longitudinal gastric resection (sleeve gastrectomy) was performed. Patients were divid- ed into two groups. In Group 1 (n=22), combined anesthesia based on the low-flow desflurane inhalation was applied along with the mechanical ventilation in the VC-CMV mode with a constant PEEP level. In Group 2 (n=21), combined anesthesia based on the low-flow desflurane inhalation was applied along with the prolonged epidural analgesia (PEA) with 0.2% ropivacaine solution and VC-CMV respiratory pattern, with PEEP dose esca-lation using titration, inverted respiratory cycle, and a gradual increase in the respiratory rate. The intraoperative monitoring included central and peripheral hemodynamics, blood gases, and ABB. The purpose of the study is to examine the effect of anesthesia and respiratory support parameters on central and peripheral hemodynamics in patients with morbid obesity undergoing an endoscopic gastric resection. Materials and methods. A randomized study of 43 patients with a body weight index of >40 kg/m2 who underwent an endoscopic longitudinal gastric resection (sleeve gastrectomy) was performed. Patients were divid- ed into two groups. In Group 1 (n=22), combined anesthesia based on the low-flow desflurane inhalation was applied along with the mechanical ventilation in the VC-CMV mode with a constant PEEP level. In Group 2 (n=21), combined anesthesia based on the low-flow desflurane inhalation was applied along with the prolonged epidural analgesia (PEA) with 0.2% ropivacaine solution and VC-CMV respiratory pattern, with PEEP dose esca-lation using titration, inverted respiratory cycle, and a gradual increase in the respiratory rate. The intraoperative monitoring included central and peripheral hemodynamics, blood gases, and ABB. Results. The study demonstrated that there was more stable central and peripheral hemodynamics in Group 2 during the intraoperative period as compared to Group 1, where increased systolic BP, median NMBP, diastolic BP, HR, CI, SVI, and SVRI levels were registered. In addition, in Group 2, ??O2 levels were significantly higher and ?CO2 levels were lower during pneumoperitoneum; no significant changes in ABB were recorded. Conclusion. Thoracic epidural analgesia with pneumoperitoneum, increased intraabdominal pressure, and PEEP escalation mode provide stable intraoperative central and peripheral hemodynamics during endoscopic gastric resection in patients with morbid obesity. © 2017, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
Lapii G.A.,Institute of Molecular Pathology and Pathomorphology |
Yakovleva A.Y.,Institute of Molecular Pathology and Pathomorphology |
Neimark A.I.,Altai State Medical University
Bulletin of Experimental Biology and Medicine | Year: 2017
Structural characteristics of the vaginal mucosa in stress incontinence and its correction by IncontiLase technology were studied. Studies of vaginal biopsy specimens before the exposure showed degenerative and atrophic changes in the stratified squamous epithelium, disorganization of fibrillar structures of the intercellular matrix, and microcirculatory disorders. Studies after Er:YAG laser exposure showed signs of neocollagenogenesis and elastogenesis, foci of neoangiogenesis, reduction of epithelial degeneration and atrophy, and an increase of the fibroblast population. Morphometry showed that the volume density of blood capillaries and the thickness of the epithelial layer increased by 61.1 and 64.5%, respectively. The use of IncontiLase technology in stress incontinence led to structural reorganization of the vaginal mucosa, improving its morphology and function and alleviating the symptoms of incontinence. © 2017, Springer Science+Business Media New York.
Yurchenko Yu.N.,Bryansk Regional Hospital One |
Yurchenko A.N.,Bryansk Regional Hospital One |
Smagina I.V.,Altai State Medical University
Nevrologiya, Neiropsikhiatriya, Psikhosomatika | Year: 2016
Objective: to study the clinical and epidemiological features of multiple sclerosis (MS) in the Bryansk Region. Patients and methods. Information about 180 (31.0%) of 590 MS patients registered in the Bryansk Region with a valid diagnosis of MS according to the 2005 McDonald criteria was analyzed. All the patients are followed up at the Demyelinating Disease Office, Neurology Department, Bryansk Regional Hospital One. The Expanded Disability Status Scale (EDSS) was used to evaluate the severity of the disease and the degree of disability. The rate of MS progression was calculated from the ratio of EDSS scores at the time of examination to disease duration. Results: The Bryansk Region is shown to belong to a moderate MS risk area: the prevalence of the disease is 48.1 cases per 100,000; its incidence in the individual districts of the region is 5.0 to 211.4 cases per 100,000. There has been an approximately 1.2-fold increase in the prevalence of MS in the past 7 years. The mean age of MS patients in the Bryansk Region is 39.9±10.1 years; about 70% of the patients are in the age range of 29-49 years. The mean age at the onset of MS is 28.0±9.1 years. Early-onset MS before the age of 18 years is recorded in 20 (11.1%) patients; late-onset MS (after the age of 45 years) is in 7 (3.9%). There is a preponderance of its multifocal onset. Sensitive and motor disorders and optic neuritis more frequently occur as the first symptom at monofocal onset. The duration of MS averages 11.0±5.5 years (1 to 32 years). The mean duration of the first remission is as long as 33.1±26.1 (0-144) months and that of the second one is 19.2±17.7 (0-132) months. The mean EDSS score was 3.3±2.4 (0-9.0). The rate of MS progression in the region averages 0.38±0.28 per year. About 60% of the patients have Groups I, II, and III disability. Remitting MS is more common (69.4% of cases), its secondary and primary progressive course is noted in 28.9% and in nearly 2% of the patients, respectively. Conclusion: The findings may be useful in planning sociomedical care for patients with MS in some areas of the Bryansk Region.
El'chaninova E.Yu.,Altai State Medical University |
Smagina I.V.,Altai State Medical University
Nevrologicheskii Zhurnal | Year: 2017
A review of epidemiology, clinical manifestations, diagnosis and treatment of pediatric multiple sclerosis of the databases Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, RISC. Pediatric MS is defined as debuted MS before 16 years of age or before 18 years of age in some countries. Patients with pediatric MS make up about 4-5% of MS patients. Relapsing-remitting type of the disease is observed in 97-99% of children with MS. The risk of pediatric MS associated with HLADRB1∗1501, and increased blood levels of antibodies to the Epstein-Barr virus in the studied populations. Clinical manifestations of MS in children and adults is similar, although acute disseminated encephalomyelitis is more common in children, which greatly complicates the differential diagnosis. The McDonald 2010 criteria are highly sensitive and specific criteria in the diagnosis of MS in children. Associated with MS cognitive disorders may complicate the learning process of children and adolescents with MS. Evidence-based conclusions about the effectiveness and safety of drugs for the treatment of MS in children and adolescents is insuficient, although evidence suggests that modern disease modifying treatment of MS is well tolerated and can be effective.
Avdalyan A.,Altai Branch of Blokhin Russian Cancer Research Center |
Bobrov I.,Altai State Medical University |
Klimachev V.,Altai State Medical University |
Lazarev A.,Altai Branch of Blokhin Russian Cancer Research Center
Sarcoma | Year: 2012
The objective of this study was to investigate the prognostic value of microvessel density (MVD) in uterine leiomyosarcoma (LMS) and peritumoral area (PA) as evaluated by CD31 expression and argyrophilic nucleolar organizer region (AgNOR) count in endothelial cells. Tissue specimens from 66 patients with uterine LMS were examined. There were no significant differences in the mean MVD between tumor itself and the PA (P = 0.9); moreover, the MVD in the PA often exceeded that in the tumor. No correlation or significant differences were also found in the MVD between different grades of malignancy of LMS (r = 0.1; P = 0.07). The number of AgNORs in tumor endothelial cells was significantly higher in tumor vessels than in the peritumoral area (P < 0.005) and increased with the tumor grade. Analysis of the prognostic value of MVD in uterine LMS and PA showed that the density of tumor vessels was not an independent criterion, while the MVD in the PA affected 10-year survival to a significantly greater extent ( ρ2 = 27.5; P = 0.0003). The number of AgNORs also had an important effect on survival of LMS patients: when the threshold of 11.6 granules was exceeded, prognosis was significantly more unfavorable than that prior to exceeding the threshold. Copyright © 2012 Ashot Avdalyan et al.
Kuznetsova D.V.,Altai State Medical University |
Kulikov V.P.,Altai State Medical University
Blood Pressure Monitoring | Year: 2014
BACKGROUND: Arterial partial pressure alteration of CO2 (P aCO2) affects not only the cerebral blood flow velocity but also the systemic arterial blood pressure (BP). At the same time, BP can affect the cerebral blood flow. The objective of the present research is to study the impact of the PaCO2 level on cerebrovascular CO2 reactivity (CVRCO2) and BP as well as the impact of BP upon CVR CO2 alteration by hypercapnia and hypocapnia. MATERIALS AND METHODS: Cerebral blood flow velocity was recorded by means of transcranial Doppler in both middle cerebral arteries (MCAv left and right). The mean arterial pressure (MAP) was studied using the finger photoplethysmography method, arterial blood oxygen saturation was estimated by the pulse oximetry method, and end-tidal PCO2 (PETCO2) was measured with an infrared capnograph. After a recording of the reference values of all the parameters, all the volunteers underwent a rebreathing as well as a hyperventilation. RESULTS: At rest,PETCO2 was 33.6 (SD 3.1) mmHg. At rebreathing, MCAv increased at 38 mmHg PETCO2, MAP-at 43 mmHg PETCO2. By hyperventilation, MCAv decreased at 28 mmHg PETCO2, MAP-at 26 mmHg PETCO2. When PETCO2 reached 43 mmHg, CVRCO2 increased from 2.3 (SD 1.4) to 3.3 (SD 1.2)%/mmHg (P<0.01). When P ETCO2 decreased to 26 mmHg, CVRCO2 increased from-3.6 (SD 2.5) to-5.9 (SD 3.9)%/mmHg (P<0.01). CONCLUSION: Within the alteration of PETCO2 above 43 and under 26 mmHg, BP increased and decreased, respectively, leading to a change in CVRCO2. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Dudareva Yu.A.,Altai State Medical University |
Gurieva V.A.,Altai State Medical University
Human Ecology | Year: 2015
A prospective study of thyroid function in 112 women of the second generation descendants, ancestors of whom were in the area of radiation effects of the Semipalatinsk test site 29 August 1949. In retrospect, thyroid disease was studied in progenitors (233 women exposed to radiation) and parents - the descendants of the first generation (247 women). The control group included women not exposed to radiation and radiation lived outside the track. Retrospective analysis phase included archival documents and conducted with historical controls. Prospective phase included a study of the type "case - control". The state of the thyroid gland and its hormone profile, gorrmony pituitary. It was found that women who were in the area of radiation exposure, thyroid disease is more common, in contrast to the control group (8,2 ± 0,2) and (2,1 ± 0,3) %; p = 0.046, they are characterized by the presence of hyperthyroidism, hypothyroidism, postoperative (not excluded surgery for thyroid cancer), autoimmune thyroiditis, thyroid cancer. Among women, the first generation descendants of thyroid disease met by 68.3 % more than in the control group (p = 0.014), but as women of the second generation offspring. In women, the second-generation descendants greatly increased in the structure of the thyroid gland pathology share of autoimmune thyroiditis (11.6 %; p = 0.039), which was not observed in their parents and grandparents. Thus, the high incidence of thyroid disease is characterized by both women exposed to radiation, and their descendants in the first and second generation. © Northern State Medical University.
Barbaeva S.N.,Altai State Medical University |
Kulishova T.V.,Altai State Medical University
Voprosy kurortologii, fizioterapii, i lechebnoĭ fizicheskoĭ kultury | Year: 2016
We have studied stabilographic characteristics and their dynamics in the healthy children (n=30) and the patients suffering from juvenile cerebral palsy (JCP) in the form of spastic diplegia (n=99) after they had undergone the combined rehabilitation treatment with the use of various methods of electrical stimulation. The mean age of the children was 7.0±1.7 years. The patients with JCP included in the main group (n=45) received therapy with the application of electrical stimulation based on the AKorD apparatus while the patients with JCP comprising the group of comparison were treated with the use of the Mioritm 040 apparatus. Vertical stability of the schoolchildren was evaluated using the Stabilan-01-2 hardware system, once in the healthy children and twice (before and after the termination of rehabilitation) in the patients with JCP. A course of the rehabilitative treatment of the patients with JCP included in the main group resulted in a 24.6% and 15.8% reduction (p<0.05) of the statokinesiogram area in the tests with the open and closed eyes respectively. The visual control coefficient increased significantly. The patients of the comparison group experienced a marked reduction of the area of statokinesiogram in the tests with the open eyes (by 15,5% (р<0,05)) while the remaining characteristics of interest remained unaltered. It is concluded that the treatment of the children presenting with juvenile cerebral palsy with the use of the AKorD apparatus for electrical stimulation is more efficient for the maintenance of the vertical posture in comparison with the treatment based on the use of the Mioritm 040 apparatus.Abstract available from the publisher.
Tregub P.,Altai State Medical University |
Kulikov V.,Altai State Medical University |
Bespalov A.,Altai State Medical University
Pathophysiology | Year: 2013
Introduction: We studied the comparative efficacy of independent and combined effects of normobaric hypoxia (90. mmHg) and permissive hypercapnia (50. mmHg) in increasing the tolerance of rats to acute hypobaric hypoxia. Methods: We determined the time to loss of pose and life duration as a measure to assess the degree of tolerance of animals to hypobaric hypoxia by exposing them to an altitude of 11,500. m (barometric = 180. mmHg). Results: Exposure to hypercapnic hypoxia increased the tolerance to acute hypobaric hypoxia compared to exposure to normobaric hypoxia or permissive hypercapnia alone. Discussion: The positive effects of hypercapnia and hypercapnic hypoxia occurred after one exposure, and increasing the number of exposures proportionally increased the tolerance to acute hypobaric hypoxia. The effect of permissive hypercapnia on increasing the tolerance to acute hypobaric hypoxia was found to be significantly greater than that of exposure to normobaric hypoxia. Therefore, we propose that hypercapnia is the dominant factor in increasing tolerance to acute hypobaric hypoxia. Conclusion: Tolerance to acute hypoxia maximally increases in case of joint effect of normobaric hypoxia and permissive hypercapnia. © 2013 Elsevier Ireland Ltd.
Shoikhet Ya.N.,Altai State Medical University |
Markin A.V.,Altai State Medical University
Terapevticheskii Arkhiv | Year: 2010
Aim. To determine the specific features of respiratory support in patients with obstructive sleep apnoea syndrome (OSAS) concurrent with chronic obstructive pulmonary disease (COPD). Subjects and methods. Thirty-six patients with OSAS concurrent with COPD were examined. External respiration function, apnoea/hypopnoea index, and arterial gas composition were determined in all the patients. The efficiency of continuous positive airway pressure (CPAP) therapy was evaluated in all the patients with the crossing-syndrome (CS). Results. The prevalence of CS among the patients with OSAS was 18.8%. The CS patients'need for bilevel positive airway pressure (BiPAP) therapy was 27.8%. These patients and those treated with CPAP had at baseline a daytime hypercapnia level of 50.7 ± 1.8 and 42.0 ±1.2 mm Hg (p = 0.005) and a nocturnal blood oxygen saturation level of 83.6 ± 1.3 and 88.8 ±0.9% (p -0.004), respectively. BiPAP therapy resulted in a 1.8-fold reduction in the desaturation index than did CPAP therapy-Conclusion. On choosing a respiratory support method in patients with OSAS, one should assess the presence of chronic lower airway obstruction, the degree and type of chronic respiratory failure, and the presence and magnitude of clinical, functional, and laboratory signs of alveolar hypoventilation. Bilevel lung ventilation is more effective in patients who have CS, daytime hypercapnia, and nocturnal hypoxemia uncorrected by CPAP therapy and who need high therapeutic pressure.