Zaporozhye Medical Journal

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ISSN / EISSN : 2306-4145 / 2310-1210
Published by: Zaporozhye State Medical University (10.14739)
Total articles ≅ 1,045
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M. Yu. Kolesnik, Yа. М. Mykhailovskyi
Zaporozhye Medical Journal, Volume 23, pp 476-479; https://doi.org/10.14739/2310-1210.2021.4.227002

Abstract:
The aim of the study: to establish the frequencies of polymorphisms in VKORC1, CYP2C9 and CYP4F2 genes among residents of the Zaporizhzhia region. Materials and methods. A total of 150 persons (62 male, 88 female) with a median age of 46 years (26; 58) undergoing preventive examination at the Medical Educational and Scientific Center “University Clinic” of Zaporizhzhia State Medical University (ZSMU). The CYP2C9, CYP4F2, VKORC1 genes polymorphisms in atrial fibrillation patients were determined in the Department of Molecular Genetic Studies of the ZSMU Medical Laboratory Center. Amplification of DNA fragments containing polymorphic regions was performed using multiplex real time polymerase chain reaction with Warfarin Pharmacogenetics kits (LLC NPO DNA Technology) in a CFX-96 thermocycler (BioRad) with a fluorescence detection scheme. Results. It was determined that among Zaporizhzhia region residents, the frequencies of CYP2C9*2 genotypes were: C/C – 77.3 %, C/T – 22.7 %, T/T – 0; CYP2C9*3 genotypes: A/A – 88.7 %, A/C – 10.7 %, C/C – 0.6 %; CYP4F2 genotypes: C/C – 56.0 %, C/T – 35.3 %, T/T – 8.7 %; VKORC1 genotypes: G/G – 38.0 %, G/A – 50.0 %, A/A – 12.0 %. There were no statistically significant differences in the distribution of genotype frequencies between males and females and between different age groups. The frequencies of CYP2C9, CYP4F2, VKORC1 genotypes in different populations were compared. Their variability in different geographic regions was established. Conclusions. CYP4F2 and VKORC1 genes polymorphisms are more common in the Zaporizhzhia region, while the prevalence of CYP2C9*2 and CYP2C9*3 genes polymorphisms is much lower. It is necessary to take into account the prevalence of genes polymorphisms that affect warfarin metabolism for each individual population to select its dose by pharmacogenetic testing.
Yu. V. Marushko, N. H. Kostynska, T. V. Hyshchak
Zaporozhye Medical Journal, Volume 23, pp 509-515; https://doi.org/10.14739/2310-1210.2021.4.227348

Abstract:
Hypertension and obesity are important problems among adolescents. In clinical practice, these diseases are often combined and worsen the quality of life, so the study on indicators of tolerance to exercise is of great scientific and practical importance. The aim. To determine the state of tolerance to physical activity among school-age children with stable hypertension depending on body weight. Materials and methods. The study involved 95 children aged from 9 to 18 years who were divided into four groups: the first – 18 patients with normal blood pressure and body weight; the second – 39 with stable hypertension and normal body weight; the third – 20 with normal blood pressure and obesity; the fourth – 18 children with stable hypertension and obesity. Exercise tolerance was examined during cycling ergometry according to the PWC 170 protocol; the maximum myocardial oxygen uptake index – VO2peak (the “gold standard” for determining tolerance) was evaluated. Results. According to the study results, among children with a combination of primary hypertension and obesity, the clinical picture of the condition is characterized by significantly more frequent complaints of dizziness, heart pain, headache and loss of consciousness. The total score of complaints was 5.8 ± 1.9 points in the combined pathology of primary hypertension and obesity group, which is significantly higher (P < 0.01) than that among children with primary hypertension or obesity. In primary hypertension and obesity, there is a decrease in VO2peak, which is most pronounced in the combination of these conditions (up to 26.4 ± 6.7 ml/min/kg among boys and up to 22.7 ± 3.6 ml/min/kg among girls) indicating a significant decrease in exercise tolerance. Conclusions. It has been proven that the combined pathology of primary arterial hypertension and obesity among adolescents greatly worsens the clinical condition of children and significantly reduces exercise tolerance more pronounced than in primary arterial hypertension or obesity.
O. P. Kolesnik, A. I. Shevchenko, A. V. Kadzhoian, O. M. Levyk, D. Ye. Chernyavskyi, В. А. Кузьменко, L. S. Lytvynenko
Zaporozhye Medical Journal, Volume 23, pp 599-604; https://doi.org/10.14739/2310-1210.2021.4.211358

Abstract:
Breast cancer is one of the most widespread malignant neoplasm in Ukraine (20.6 % of all malignant neoplasms). The usual incidence of breast cancer (BC) in women, as of 2019, is 70.3 cases per 100 thousand population. At the moment, BC during pregnancy is rare (only in 0.4 % of all BC cases in women aged 16 to 49 years), the decision on treatment remains difficult for a patient as well as an oncologists. Despite the fact that the treatment of malignant breast disease is usually carried out in non-pregnant women, the problem of tactics for managing patients with different gestation lengths remains unresolved. Thus, the treatment of pregnant women with BC should be guided a multidisciplinary integrated approach to maximize the benefits and minimize the risk to both a mother and a fetus, including the optimal tactics of surgical treatment and chemotherapy. Therapeutic decisions should be based on the stage of disease, tumor morphology, gestational age at diagnosis, and possible pregnancy risks. A promising way of addressing this problem is to conduct more studies to determine the most effective and safest treatment strategies for BC in pregnant women.
B. I. Slonetskyi, М. I. Tutchenko, I. V. Verbytskyi, V. O. Kotsiubenko
Zaporozhye Medical Journal, Volume 23, pp 583-589; https://doi.org/10.14739/2310-1210.2021.4.232565

Abstract:
The aim of the work. To analyze the world achievements in modern diagnostic and treatment tactics in patients with strangulated ventral hernias, as well as to outline promising and pragmatic directions for further research. The literature review presents current trends and views on the choice of individual components of the integrated diagnostic approach in patients with strangulated ventral hernias, and focuses on various principles of therapeutic tactics. The need to further improve the examination methods of abdominal organs, anterior abdominal wall, hernia contents (polypositional roentgenoscopy or roentgenography, ultrasound, CT, MRI) is emphasized and prospects of allohernioplasty and videolaparoscopic technologies with an integrated approach in choosing the method for correction or reconstruction of abdominal wall depending on the prognostic risk factors of postoperative complications are substantiated. Comparison of individual priorities of planned hernia surgery provided the opportunity to define the main directions in terms of urgent medical treatment features for patients with strangulated ventral hernias, taking into account a phasal nature of the pathological process and the availability and applicability of various synthetic implants. The literature analysis allowed for enough critical evaluation of the current state of tension-free allohernioplasty – the main fundamental principle of modern urgent surgery for ventral hernias and determining the main pragmatic directions of a selective approach in choosing the therapeutic tactics for patients with infected surgical wound. Conclusions. Urgent surgery of strangulated ventral hernias requires adequate and timely provision of individual and differentiated approaches in choosing the volume and method of surgery. Improvement of methods for predicting and preventing complications in patients with strangulated ventral hernias will expand the indications for the use of advanced types of tension-free hernioplasty.
V. А. Lysenko, V. V. Syvolap
Zaporozhye Medical Journal, Volume 23, pp 462-468; https://doi.org/10.14739/2310-1210.2021.4.229002

Abstract:
Atrial fibrillation (AF) and chronic heart failure (CHF) often coexist due to common pathophysiological mechanisms and risk factors. However, the effect of CHF on heart remodeling in patients with permanent AF has been insufficiently studied. The aim: to study the influence of CHF on changes in structural and geometric parameters and diastolic function of the heart in patients with permanent AF. Materials and methods. The study included 100 patients (men – 60 % (n = 60); women – 40 % (n = 40)) with CHF of ischemic origin and AF, stage II AB, NYHA II-IV FC, and 16 coronary heart disease patients (men – 62.5 % (n = 10), women – 37.5 % (n = 6)) with AF without signs of CHF. Patients were comparable in age (P = 0.267), height (p = 0.406), weight (P = 0.518), body surface area (P = 0.388). Doppler echocardiography was performed on the device Esaote MyLab Eight (Italy) according to standard methods. Results. Patients with AF and signs of CHF were dominated by individuals with eccentric hypertrophy (49 % vs. 19 %; P = 0.0270), and patients with AF without signs of CHF – with eccentric remodeling (0 % vs. 25 %; P = 0.0001). Patients with AF and signs of CHF had significantly higher systolic pressure in the pulmonary artery (54.85 ± 14.23 mm Hg vs. 42.99 ± 11.94 mm Hg; P = 0.028) and pulmonary capillary wedge pressure (PCWP) (12.18 (9.80; 15.33) mm Hg vs. 8.92 (7.62; 10.50) mm Hg; P = 0.005) than patients with AF without signs of CHF, indicating more pronounced pulmonary hypertension and a more significant increase in left atrium pressure. AF patients with signs of CHF demonstrated significantly higher left ventricle end-diastolic pressure (LVEDP), as evidenced by the parameters: E\E’ medial (9.87 ± 5.24 vs. 6.15 ± 1.39; P = 0.001), E/E’ mean (8.38 ± 4.21 vs. 6.06 ± 1.97; P = 0.005), e’ medial (9.96 ± 3.79 cm/s vs. 12.81 ± 3.60 cm/s; P = 0.004). AF patients with signs of CHF had decreased LV EF (55.58 ± 14.65 % vs. 65.44 ± 10.87 %; P = 0.006), systolic velocity of the medial fibrous ring of the mitral valve S (6.92 ± 2.41 cm/s vs. 8.40 ± 2.03 cm/s; P = 0.015), and significantly higher values of TEI RV (0.58 ± 0.16 c. u. vs. 0.48 ± 0.11 c. u.; P = 0.011), but decreased TAPSE values (16.22 ± 4.60 mm vs. 19.54 ± 5.00 mm; P = 0.067), indicating more pronounced systolic dysfunction of both ventricles. Conclusions. Comorbidity of CHF and AF in patients is accompanied by the increased percentage of eccentric hypertrophy (49 %; P = 0.027), more pronounced systolic dysfunction of the left and right ventricles, increased LVEDP, PCWP, systolic pressure in the pulmonary artery, dilation of the inferior vena cava.
O. O. Vorovskyi
Zaporozhye Medical Journal, Volume 23, pp 590-598; https://doi.org/10.14739/2310-1210.2021.4.209522

Abstract:
The aim. Based on the data of the publications of herniologists for the last 5 years to examine the effectiveness and safety of prosthetic materials used in hernioplasty of postoperative ventral hernias. According to surgeons, the incidence of postoperative ventral hernia is up to 20 % of performed laparotomies, and if risk factors are present – up to 70 %. This problem was considered solved by the use of prosthetic mesh that became the standard of surgical approach in hernia repair since a recurrence rate was reduced to 20 %. However, the results of histological examination and body biological responses to an implant showed chronic inflammatory processes due to use of prosthetic material, especially polypropylene, causing purulent-inflammatory complications and intraperitoneal adhesion in 20.0–45.8 %. To prevent adhesion, a special barrier layer was applied on the polypropylene mesh, a process of mesothelial epithelialization (formation of the neoperitoneum) was supposed to occur, thereby reducing the risk of adhesions. A temporary nature of the barrier coating, where adhesion may develop at any time after implantation resulting in complications, has proven to be a potential problem of composite prostheses. There has been an attempt to address the challenge by using biological meshes made of decellularised pig and bovine dermis. However, recurrence rates after repair of hernia using the biological meshes was 6.3–61.0 %, wound infection – 16.0 %. Conclusions. Thus, world publications have proved today that it is impossible to perform adequate hernioplasty of postoperative hernias without the use of prosthetic material. However, complications and recurrences of the disease remain quite high. In order to improve these indicators, a sufficient number of studies were conducted, the effect of various prosthetic meshes on the patient body and on the postoperative wound itself was examined. Nevertheless, all the results are often contradictory, without specific conclusions about the indications for the use of method and type of prosthetic material.
Zaporozhye Medical Journal, Volume 23, pp 485-491; https://doi.org/10.14739/2310-1210.2021.4.233643

Abstract:
The aim: to determine the comorbidity index before cardiac surgery in high-risk patients with coronary artery disease (CAD). Materials and methods. A retrospective analysis of data from 354 random high-risk patients who underwent a surgery and were discharged from National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine during the period 2009–2019. The mean age of patients was 61.9 ± 9.6 years. All the patients were examined: ECG, ECHO CG, coronary angiography before the surgery as well as Charlson comorbidity index was calculated and a risk on the scales EuroSCORE I, EuroSCORE II and STS was stratified. Results. I–III degree obesity was revealed in 133 (37.5 %) patients, patients with type 2 diabetes mellitus (DM) were more likely to have BMI >30 kg/m2 (P = 0.017). Patients with normal weight had a carotid artery stenosis >50 % (P = 0.014) and history of stroke (P = 0.043) significantly more frequently. No differences in comorbidity of overweight and normal weight patients were detected (5.73 ± 1.70 vs. 5.9 ± 1.8, P = 0.4638). Type 2 DM was diagnosed in 90 (25.4 %) patients. In the case of normoglycemia, the comorbidity index was significantly lower than in type 2 DM (4.88 ± 1.38 vs. 6.60 ± 2.03, P = 0.0001) and glucose intolerance 5.8 ± 1.5 (P < 0.0001). Chronic kidney disease (CKD) G3a–G4 stages was diagnosed in 132 (37.2 %) patients. Significant higher comorbidity was found in patients with G3a–G4 stages CKD in comparison to those with G1–G2 stages CKD – 6.33 ± 1.78 vs. 5.46 ± 1.60 (P < 0.0001). Among comorbidities in patients with gouty arthritis, type 2 DM (P < 0.0001), obesity (P = 0.0080), CKD G3a–G4 (P = 0.0020) and varicose veins of the lower extremities (P = 0.0214) were significantly more common. Preoperative risk stratification according to the EuroSCORE II scale averaged 8.8 %. Conclusions. Preoperative analysis of baseline status in CAD patients showed the high Charlson comorbidity index, which averaged 5.7 ± 1.7. The weak direct correlation between the comorbidity index and the high predicted cardiac risk on the ES II scale (r = 0.2356, P = 0.00001), length of stay in the intensive care unit (r = 0.1182, P = 0.0262) and discharge after the surgery (r = 0.1134, P = 0.0330) was found.
O. V. Hrechana, A. H. Serbin, A. M. Rudnik, I. M. Shevchenko,
Zaporozhye Medical Journal, Volume 23, pp 541-546; https://doi.org/10.14739/2310-1210.2021.4.228765

Abstract:
The data on the composition and amount of amino acids have been analyzed in the raw materials of five legume species. All of them grow in Southern Ukrainian flora (Securigera varia (L.) Lassen, Vicia cracca L., Lupinus luteus L., Melilotus officinalis (L.) Pall., Melilotus albus Medic.) and may be used as a source of amino acids, especially essential, whose resource has to be replenished from the outside. Aim. We have studied and compared the amino acid profile of some species of the Ukrainian South Legumes, and used the multidimensional statistical cluster analysis to construction of histograms based on the amino acids content and composition of such plants as: Securigera varia (L.) Lassen, Vicia cracca L., Lupinus luteus L., Melilotus officinalis (L.) Pall., Melilotus albus Medic. Materials and methods. The raw materials were harvested at the South of Ukraine and were investigated by gas-liquid chromatography. The amino acid analyzer has been used after hydrochloric acid hydrolysis at elevated temperature. Results. 19 amino acids have been identified, of which nine are essential or partially interchangeable. The non-polar amino acid proline is in the lead in terms of quantity among the essential amino acids. Its amount was 6932 mg/100 g and the ability to accumulate it was noted in Melilotus officinalis (2276 mg/100 g). The smallest proline amount was found in Lupinus luteus (388 mg/100 g). The sulfur-containing non-polar amino acid methionine is in the smallest amount in the selected plants (506 mg/100 g). Our attention was drawn to the absence of the polar amino acid glutamine among the non-essential amino acids in some plants. Securigera varia, Vicia cracca, and Melilotus officinalis did not contain glutamine. In this subgroup, the polar aspartic acid was found in the highest amount (6824 mg/100 g) with the highest content in Vicia cracca and the lowest – in Melilotus albus (2660 mg/100 g and 385 mg/100 g, respectively). Conclusions. The analysis of the presence and number of amino acids was the basis for our multidimensional statistical cluster analysis and histograms of the presentation of the amino acid profile of the studied plant members of the family Fabaceae L. In constructing the dendrogram, three clusters were identified, and representatives of one genus (Melilotus L.) were attributed to different clusters which is significant for further chemosystematic studies.
, V. H. Kadzharian
Zaporozhye Medical Journal, Volume 23, pp 469-475; https://doi.org/10.14739/2310-1210.2021.4.232568

Abstract:
The aim. To examine the features of structural and functional changes of the heart in patients with chronic heart failure with preserved left ventricular ejection fraction (CHF pr EF) with excess body weight depending on the presence and form of atrial fibrillation (AF). Materials and methods. The study involved 248 patients with CHF pr EF and excess body weight, the mean age was 65.0 ± 11.0 years, 146 females (58.9 %) and 102 males (41.1 %). The first group included 181 patients without concomitant AF, the mean age was 64.0 ± 11.0 years, 110 females (60.8 %) and 71 males (39.2 %); the second group included 67 patients with AF, the mean age was 67.9 ± 11.3 years, 36 females (53.7 %) and 31 males (46.3 %). Subjects with AF were further divided into subgroups: 7 patients with paroxysmal AF, the mean age – 6.7 ± 10.4 years, 3 females (42.9 %) and 4 males (57.1 %), 12 patients with persistent AF, the mean age – 70.8 ± 10.3 years, 10 females (83.3 %) and 2 males (16.7 %); 48 patients with permanent AF, the mean age – 67.3 ± 11.7 years, 23 females (47.9 %) and 25 males (52.1 %). Results. Patients with concomitant AF had a significantly larger aorta diameter (by 3.0 %), systolic left atrium size (LAs) (by 14.5 %), right atrium size (RA) (by 8.3 %), left ventricle end-diastolic size (LVEDS) (by 7.1 %), left ventricle end-systolic size (LVESS) (by 10.6 %), right ventricle size (RV) (by 13,1 %), mean pulmonary artery pressure (by 20.0 %) and the prevalence of LV eccentric hypertrophy (by 21.0 %; P ˂ 0.001). At the same time, LV wall relative thickness (LV RT) was lower by 6.3 %, LV EF – by 3.4 % and the frequency of LV concentric hypertrophy – by 19.1 % (P ˂ 0.001). In permanent form of AF compared to paroxysmal one, significantly larger LAs (by 10.6 %), RA (by 10.9 %), LV myocardial mass (LV MM) (by 18.1 %) and LV MM index (by 21.1 %) were determined and in contrast to persistent AF, LAs (by 9.8 %), RA (by 11.4 %), LVEDS (by 15.6 %), LVESS (by 15.8 %), RV (by 27, 9 %), LV MM (by 29.8 %), LV MMI (by 14.9 %) were predominant, at the same, LVRT was 12.8 % less. Conclusions. In patients with CHF pr EF and excess body weight, concomitant AF is associated with greater dilatation of the heart cavities, eccentric hypertrophy predominance, decreased LV contractility and pulmonary hypertension. Compared to other forms, permanent AF is characterized by severe structural and functional changes in the heart, maximal manifestations of LV dilatation and hypertrophy.
P. F. Muzychenko, Zh. M. Minchenko, T. I. Havrylenko, , S. V. Demidov, N. O. Ryzhkova, O. A. Pidhaina
Zaporozhye Medical Journal, Volume 23, pp 566-574; https://doi.org/10.14739/2310-1210.2021.4.204886

Abstract:
The aim – based on the analysis of the scientific literature focused on understanding the role of exosomes in the mechanisms of inflammation development and application of stem cells for cellular therapy in different pathological conditions, to identify and substantiate the prospects of using the exosomes as prognostic markers of a disease progression and application of their therapeutic potential in cardiovascular pathology. Global trends in the study of stem cells of different origins from the perspective of morphofunctional, molecular-genetic, cytogenetic, immunogenetic and cytological characteristics contribute significantly the development of regenerative medicine in the context of developing new methodological solutions for the use of stem cells and their components, particularly exosomes, for cell therapy of various pathological conditions. Studies show the indirect effect of exosomes on the immune response activation, coordination of cellular senescence processes and antigen presentation. There are also evidence of their impact on the structural and functional restoration of affected organs and blood vessels. The application potential of exosomes in practical medicine, particularly in the area of new approaches development to synthesize the newer biopharmaceuticals and as markers of multifactorial pathology course in conjunction with studies on the mechanisms of exosome involvement into immune processes is discussed. The study on the exosome-mediated mechanisms of inflammation in atherosclerosis is relevant, given the fact that their main physiological role is to implement the link between immunocompetent cells. Conclusions. Improving knowledge of the molecular biological mechanisms of the exosome influence on immunological processes in patients with cardiovascular pathology allows to expand the range of diagnostic and prognostic criteria for the formation of immuno-inflammatory reactions and endothelial dysfunction and to outline ways to personify the choice of therapeutic programs, which, in turn, can open approaches to develop fundamentally newer pharmaceuticals.
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