Research and Practical Medicine Journal
ISSN / EISSN : 24092231 / 24101893
Current Publisher: QUASAR, LLC (10.17709)
Total articles ≅ 373
Latest articles in this journal
Research and Practical Medicine Journal, Volume 7, pp 51-62; doi:10.17709/2409-2231-2020-7-3-5
Lung cancer is one of the leading causes of death in the world. Despite improvements in diagnostic procedures, most cases of this disease are diagnosed at common and metastatic stages. In recent years, new approaches to systemic antitumor treatment have been registered, which are the main method of treatment in patients with stage IIIB-IV. The diagnosis and staging of patients with lung cancer in recent decades has increasingly relied on minimally invasive tissue sampling techniques, such as endobronchial ultrasound (EBUS) or endoscopic ultrasound (EUS) needle aspiration, transbronchial biopsy, and transthoracic image guided core needle biopsy. These modalities have been shown to have low complication rates, and provide adequate cellular material for pathologic diagnosis and necessary ancillary molecular testing. It is important to understand how a small amount of biopsy material obtained using minimally invasive techniques is processed and evaluated by pathologists. An important condition is obtaining a sufficient number of cell or tissue substrate, can reliably establish the malignant process, to determine the histologic tumor type (whether it’s adenocarcinoma or squamous cell carcinoma), carry out the immunohistochemical and molecular genetic study to determine indications for the purpose of targeted, immunotherapy and the selection of chemotherapy regimen. It is necessary to conduct a single procedure that is as gentle as possible and provides a sufficiently large amount of tissue. The method of obtaining the material should be selected individually depending on the location of the pathological formation, the patient's condition and the capabilities of the clinic.
Research and Practical Medicine Journal, Volume 7, pp 108-118; doi:10.17709/2409-2231-2020-7-3-11
Purpose of the study. The goal is to conduct a comparative analysis of the correlation of learning success with self-assessment of physical and mental status and objective health status, taking into account the influence of demographic and socio-economic variables in senior students of medical and humanitarian specialties Materials and methods. The study was conducted from 01.12. 2017 to 01.03.2019 at the Far Eastern Federal University and the Pacific State Medical University. The sample size was 410 students (207 (50.6%) female, 203 (49.4%) male, average age 21.5 (1.2) years), who at the time of the study were studying in 4–6 courses. Information on demographic parameters, social conditions of study, residence, subjective data on morbidity and appeal was collected using: a comprehensive questionnaire on student status of a university (Pozdeeva, 2008; with additions of authors). The objective state of health and the comorbidity index were investigated when studying the medical documentation of medical institutions attached: Form 025 / y; 001–1 / y; 062 / y. In the study of quality of life associated with health, we used the international questionnaire “A short form of self-assessment of quality of life related to health MOS SF-36”. Results. The total score of self-esteem of physical well-being among students of humanities was 66.1 points, among students of medical specialties 56.4 points. Academic performance was higher among students of both directions, marking their learning conditions as satisfactory and good (r = 0.034; r = 0.048 / r = 0.045; r = 0.065). Student performance was also higher for students in both areas, evaluating the quality of education as high (r = 0.032; r = 0.046 / r = 0.033; r = 0.043), but lower for students with a high comorbidity index (r = –0.038 / r = –0.036). We also found that an increase in the number of HRQoL points is accompanied by a significant increase in academic performance in students of both directions (r = 0.035; r = 0.045 / r = 0.033; r = 0.050). An analysis of the linear regression model describing the association of academic performance with variables in the pooled sample revealed that this indicator strongly correlates with the comorbidity index (r = 8.27), HRQoL (r = 7.28), quality of education, and family income (5.55 / 5.06). At the same time, academic performance had an unreliable relationship with age, individual income, and weakly correlated with the conditions of study and residence. Conclusion. Chronic morbidity among senior medical and humanitarian students is high (comorbidity index 1.5–1.7), but the total self-assessment of the quality of life associated with health is 59–62 points and falls within the normal range of values. Thus, despite the high level of chronic somatic pathology, students generally positively assess their physical and psychological status.
Research and Practical Medicine Journal, Volume 7, pp 119-126; doi:10.17709/2409-2231-2020-7-3-12
Purpose of the study. To analyze the legal issues, related to the definition of «medical rehabilitation» established in Russian legislation. Materials and methods. A comparative review of the definitions "medical rehabilitation" formulated by World Health Organization and the Russian legislator is made. The main problems of the legal definition of "medical rehabilitation" are studied, including: the problem of distinguishing between "medical rehabilitation" and "treatment". Results. The definition of the term "medical rehabilitation" and terminology used for medical rehabilitation are not consistent in Russian law (legislation still includes such archaic definitions as "rehabilitation treatment" and "rehabilitation medicine"). There is also no unified approach to the question of whether medical rehabilitation is a part of treatment or whether it is an independent stage of medical care. The boundaries between the concepts of "medical rehabilitation" and "treatment" are blurred. Conclusion. The absence of clear boundaries between the definitions of “medical rehabilitation” and “treatment” leads to the risk of violation of licensing requirements by medical organizations, because to determine the list of works (services) to be licensed, it is necessary to correctly determine the specifics of the services provided. The correct classification of a service as medical rehabilitation or medical treatment also effects on the specialization of the involved medical specialists, as well as on the allocated structural units of medical organization. The analysis shows that the main difference between treatment and rehabilitation is the approach. The approach to rehabilitation is broader, it’s primary goal is to return the patient to his previous social status, rather than clinical recovery. At the same time, the main difficulty in distinguishing the mentioned above definitions is related to the fact that the method underlying the medical service is actually licensed, but the same tools and methods can be used both in treatment and medical rehabilitation. Due to these ambiguities, it appears that the current legislation needs to be improved.
Research and Practical Medicine Journal, Volume 7, pp 127-135; doi:10.17709/2409-2231-2020-7-3-13
Purpose of the study. To form proposals for improving the organization of the radiology diagnostics service in Oncology. Materials and methods. In 2019, the opinion of radiation diagnostics doctors (n=230) on the availability and quality of radiation studies for cancer patients was studied. The obtained empirical data were statistically processed with the calculation of intensive and extensive indicators, average values (M±δ) with a risk of error of 0.05. The student's t-test was used to assess the statistical significance of differences. The original data had a normal distribution. Individual parameters of the research results were given a score. Results. Radiologists highly rated the quality of their primary specialization for working with cancer patients (4.6 ± 0.3 points) and further postgraduate education (4.2 ± 0.8 points), but 38.6% need to deepen this knowledge. The respondents indicated that patients are not sufficiently informed about radiation studies, including: about the methods (67.3%); about contraindications (34.3%); about the procedure for obtaining a conclusion (30.8%); about the established waiting times (21.7%); about the procedure for pre-registration (15.6%). 33.9% of doctors pointed to the unreasonableness of radiological examinations in certain cases in cancer patients. According to the respondents, it will improve the quality and availability of medical care for cancer patients: additional training of radiologists (70.0%) and clinicians (42.6%); equipping medical institutions (38.2%), a separate procedure for routing cancer patients to radiological research (44.7%); increasing the staff of radiologists (36.1%) and nurses (17.4%); using telemedicine technologies (31,7%); excluding cases of unjustified referral of patients to research (27.3%); uninterrupted operation of medical equipment (27.3%). Conclusion. The results of the study revealed systemic shortcomings in the organization of the radiation diagnostics service in providing medical care to patients with cancer, the elimination of which will improve the system of organizing medical care for them, improve its quality and accessibility.
Research and Practical Medicine Journal, Volume 7, pp 21-32; doi:10.17709/2409-2231-2020-7-3-2
Purpose of the study. To evaluate the dynamics of deformation of spongy application hemostatic materials in an in vitro experiment. Materials and methods. As materials of the study the following samples of hemostatic materials were used: Tachocomb (No. 1), Gelita-Spon Standard (No. 2), Reggicel Fibrillar (No. 3), samples of hemostatic sponges developed jointly with Lintex (St.Petersburg, Russia) on the basis of sodium-Carboxymethyl Cellulose (No. 3): Samples were placed on a glass substrate which was mounted on the rising REM cross-arm 0.2–1 to estimate 50% compression residual strain. A glass substrate rigidly attached to the indenter was mounted so that its lower surface would touch the upper surface of the sample. The crossarm was then lifted at 30 mm/min, compressing the sample until the force reached 50 N, after which the sample was allowed to stand under pressure for 10 seconds. After the load was removed, the sample was removed from the substrate and the compression thickness measured (immediately after compression, after 5, 10 and 30 minutes). Results. The values of the compression residual deformation on the thickness 50% (immediately after the load removal) of the samples of group No. 1 differ statistically significantly from the values of groups No. 2 and No. 3 on 5.92 and 3.51, respectively. The difference between groups No. 1 and No. 4 is 5.61. The ODP values 50% 5 minutes after the load of Group No. 1 samples was removed differ from Groups No. 2 and No. 3 on 5.93 and 3.85, respectively. The difference between groups No. 1 and No. 4 is 6.57. After 30 minutes after compression, the values of the residual deformation of the samples of group No. 1 differ from those of groups No. 2 and No. 3 on 6.9 and 4.3. The difference between groups No. 1 and No. 4 is 6.9. Also, the values of the residual deformation of the samples of group No. 2 exceed the values of the samples of group No. 3 by 1.6 times, and in comparison with group No. 4 is less by 0.03. There are fewer statistical differences with other groups in pilot groups 5–7. Conclusion. The highest values of the indicator "residual deformation at compression by thickness 50%" are noted in group No. 7 (samples based on Na-CMC unpressurized) — 32.34, which causes high mechanical properties of jaws made from this material.
Research and Practical Medicine Journal, Volume 7, pp 99-107; doi:10.17709/2409-2231-2020-7-3-10
One of the elements of the quality of medical care is its accessibility, which depends on the material and technical base of the institution, as well as on the availability of stuff and work management. Implementation of the new clinical guidelines of the Association of Oncologists of Russia (AOR) for the treatment of non-melanoma skin cancer (NRC), revealed the problem of increasing the load on stuff and equipment. Purpose of the study. To investigate and forecast the load of the kilovoltage X-ray therapy unit taking into account the updated clinical guidelines for the treatment of patients with non-melanoma skin cancer using radiotherapy. Determine the clinical and organizational changes in the technology of x-ray therapy for non-melanoma skin cancer within the day-hospital department for the skin cancer size more than 2 cm after implementation of new clinical guidelines and fraction regimes in compare with previously used schemes; derive a mathematical model of the work of the kilovoltage x-ray therapy room. Materials and methods. Data from the kilovoltage X-ray therapy office of radiotherapy unit No. 2 of the Sverdlovsk Regional Oncology Dispensary (SROD) were used. The average duration of radiotherapy sessions per patient was estimated and calculated using timekeeping. The results were evaluated using correlation analysis. In order to forecast the use of material and human resources, an economic method of mathematical modeling was used. Results. The analysis of the kilovoltage X-ray therapy unit of radiotherapy department No. 2 of the SROD for 3 years showed an increase from 10.4 to 17.3 in the average number of therapeutic fractions per patient after the implementation of the updated clinical guidelines. An increase in the average number of radiotherapy sessions leads to a doubling of the average bed-day of the patient's stay in the day-hospital. The formula was proposed for predicting the work of the unit. There is a clear correlation between the duration of treatment, the dynamics of hospitalization and the number of treated patients. The calculated results obtained using a mathematical model fully correspond to the actual performance of the radiotherapy room. Conclusion. To ensure optimal availability of medical care, it is necessary to match treatment technologies with available resources of the organization. The introduction of new treatment programs may require both the expansion of staff (medical, nursing), and an increase in the number of units of medical equipment. The obtained mathematical model of the kilovoltage X-ray therapy room allows to predict the optimal mode of work of employees while maintaining the quality and accessability of medical care.
Research and Practical Medicine Journal, Volume 7, pp 74-82; doi:10.17709/2409-2231-2020-7-3-7
At the turn of 2019–2020, humanity was struck by a new viral infection SARS-CoV-2 (COVID-19), which quickly spread in many countries and reached the scale of a pandemic. A feature of the SARS-CoV-2 virus (COVID-19) is it’s high contagiousness, virulence and tropism to many cells of human organs. Human infection primarily occurs through the respiratory tract. Then, getting into the respiratory divisions, SARS-CoV-2 (COVID-19) can enter the blood and interact with cells of other organs. It is already known that COVID-19 uses the angiotensin converting enzyme type 2 (ACE2) receptor to enter the cell, and ACE2 is highly expressed in the kidneys. Therefore, kidney disease is a risk factor for COVID-19 infection, exacerbating the clinical course of the disease. This article discusses the main aspects of the etiology and pathogenesis of kidney diseases in the context of the COVID-19 pandemic. Since there is currently no specific vaccine against the SARS-CoV-2 virus, and there is no effective drug for the treatment of COVID-19, the identification of risk factors and early medical correction of kidney diseases can help reduce the overall incidence and mortality. Conclusion. Early detection and correction of violations of filtration and excretory function of the kidneys, including adequate hemodynamic support and restriction of nephrotoxic drugs, can improve the prognosis of recovery of a patient with COVID-19.
Research and Practical Medicine Journal, Volume 7, pp 136-145; doi:10.17709/2409-2231-2020-7-3-14
Most of cancer patients are faced with various nutritional disorders at the process of anticancer treatment. Cancer-induced metabolic abnormalities are impeded muscle recovery even with normal nutritional support. As a result, malnutrition can develop into the cancer anorexia-cachexia syndrome, aggravate the disease and adversely affect the outcome of treatment. Purpose of the study. Evaluate the effectiveness of oral nutritional support in cancer patients at different stages of antitumor treatment. Materials and methods. The literature research was conducted with keywords «quality of life», «nutritional support», «oral nutrition», «cancer» in such databases as eLIBRARY and MEDLINE in Russian and English. There was performed an analytical review of various methods of quality of life assessing, methods for assessing nutritional status and measures of choice for the necessary nutritional therapy in cancer patients. Results. Nutritional support at all stages of treatment for cancer patients may have an impact on treatment outcomes and the incidence of complications. In case of palliative care, nutritional support can be aimed at improving patient's quality of life and reducing the severity of a number of clinical symptoms, in particular, such as nausea and vomiting. Conclusion. It has been shown, that individual and intensive elimination of nutritional defects improves the quality of life of patients, especially if this occurs at an early stage of the disease. Further study of the effect from nutrition-oriented interventions in cancer patients undergoing treatment, is needed.
Research and Practical Medicine Journal, Volume 7, pp 33-42; doi:10.17709/2409-2231-2020-7-3-3
Purpose of the study. Comparison of hospital and long-term results of autoarterial reconstruction of carotid artery bifurcation and the formation of a new bifurcation with an extended atherosclerotic lesion of the internal carotid artery (ICA). Materials and methods. In the period from January 2018 to May 2020, this cohort, comparative, prospective, open-label study included 279 patients with an extended atherosclerotic lesion of the ICA operated on in the Alexandr Hospital. Depending on the implemented strategy of surgical correction, all patients were divided into two groups: group 1 (n=132) — autoarterial reconstruction of bifurcation of the carotid arteries; Group 2 (n=147) — the formation of a new bifurcation. Complications were recorded in the hospital and long-term postoperative periods. The total follow-up period was 16.4±9.3 months. The endpoints of the study were such adverse cardiovascular events as death, myocardial infarction (MI), stroke, thrombosis / restenosis of the anastomosis zone, combined endpoint (death from stroke / IM + IM + stroke). Results. The ICA clamping time in group 1 was 32.6±3.3 minutes, in group 2 – 31.7±3.5 minutes, which did not receive statistically significant differences (р=0.81). In the hospital postoperative period, adverse cardiovascular events were not recorded. In the long-term follow-up, the groups were comparable in the frequency of all complications. Identified lethal outcomes developed as a result of the formation of MI in patients with multiple lesions of the coronary arteries and a history of myocardial revascularization. The likely cause was shunt / stent thrombosis with subsequent coronary insufficiency and an increase in ischemic heart damage. The causes of stroke, recorded in each group in isolated cases, were the presence of atrial fibrillation. Patients did not comply with the recommended regimen of anticoagulant therapy, which provoked the development of cerebral catastrophe. In turn, the identified restenoses of the reconstruction zone were asymptomatic and were also observed in isolated cases in each group in the period 12 months after CEE. Conclusion. Autoarterial reconstruction of carotid bifurcation and the formation of a new bifurcation are comparable in safety and effectiveness methods of surgical treatment of an extended atherosclerotic lesion of the ICA. Operation techniques differ in the choice of an artery that is cut off from bifurcation — the external carotid artery or ICA. Further, the reconstruction progress is absolutely identical. Hospital and long-term follow-up results showed minimal indicators of the development of cardiovascular and hemodynamic changes due to the type of operation. Thus, both reconstruction techniques can be the operation of choice for an extended ICA lesion.
Research and Practical Medicine Journal, Volume 7, pp 10-20; doi:10.17709/2409-2231-2020-7-3-1
Purpose of the study. Direct evaluation of the antitumor effectiveness of neoadjuvant chemoradiotherapy for rectal cancer using local electromagnetic hyperthermia. Materials and methods. The analysis of the direct results of treatment of patients with locally advanced rectal cancer in the clinic of the MRRC them. A.F.Tsyba is a branch of the Federal State Budgetary Institution Scientific Research Center for Radiology of the Ministry of Health of Russia from 2015 to 2018. The study included 2 groups of patients: the study group of 54 patients and the control group of 56 people. All patients underwent a comprehensive examination with the aim of staging and morphological verification of the tumor. Patients of the study group in the neoadjuvant mode received conventional radiation therapy with classical dose fractionation in ROD 2 Gy, up to SOD 50 Gy, for 5 weeks with CAPOX chemotherapy, and local electromagnetic hyperthermia on the Yacht 4 unit, in the amount of 6 sessions. Patients in the control group received neoadjuvant treatment in an absolutely identical manner, with the exception of local hyperthermia. After the end of neoadjuvant therapy after 8–10 weeks, a comprehensive examination was again performed to assess the response of the tumor and a decision was made to conduct surgical treatment. During the follow-up examination, the following parameters were evaluated: tumor regression according to clinical and radiological examination. After surgical treatment, a comprehensive evaluation of the removed drug was carried out, including an assessment of the degree of therapeutic tumor pathomorphism according to Lavnikova G. P. Results. When conducting a comparative analysis of the frequency of complete clinical regressions of the tumor in the thermo-chemoradiotherapy group, we more often recorded the full clinical response, 12 patients (22%), compared with the chemoradiotherapy group, 8 patients (14%). In terms of partial response and stabilization in the chemoradiotherapy group, partial regression was observed in 75% of patients, while in the thermochemioradiation group only in 52% of cases. Stabilization in the study and control groups was 14% and 6%, respectively. All patients of the study and control groups with partial tumor regression and stabilization underwent surgical treatment. As a result, the frequency of surgical operations in the control group was slightly higher than 48 (85.7%) versus 42 (77.7%) from the main group (p>0.05). When analyzing the frequency of a complete pathomorphological response, we noted that in the thermochemo-radiation therapy group it was 34% versus 4% in the chemo-radiation therapy group. On the contrary, pathomorphism of the 1st degree was much more common in patients of the control group — 21% versus 2% in the study group. The differences in both cases are statistically highly significant (p2 15, χ27). Conclusion. The use of thermochemoradiotherapy with high statistical significance (p