Comparative assessment of mortality and lethality rates of newborns at the regional level

In order to assess the mortality and lethality rates of newborns in obstetric organizations of the North-Western Federal District in 2013–2019, a comparative analysis of official statistics data was carried out. It was found that in the North-Western Federal District in the period from 2013 to 2019, there was an almost annual decrease in newborn mortality rates. The overall decrease in mortality in maternity care organizations of the Federal District (from 2,5% to 1,9%) was mainly due to a decrease in mortality in obstetric hospitals of the first and second levels (respectively from 3,2% to 1,2% and from 1,7% to 0,7%), while most children died in perinatal centers, where the mortality rate has not changed in recent years (2013 – 4,1%; 2019 – 4,0%). The study showed a decrease in mortality rates in the subjects of the Russian Federation that are part of the federal district, except for the city of St. Petersburg. The average hospital lethality rate of newborns in maternity care organizations of the North-Western Federal District during 2013–2019 was in the range of 1,9%–2,0%, did not change significantly and corresponded to the national average. However, the level of hospital lethality significantly differed in individual subjects of the district – in more than half of them, the level of hospital lethality exceeded the average, while in others it was significantly lower. Thus, the decrease in the mortality and lethality rates of newborns in maternity care organizations indicates an increase in the quality of medical care for children in the North-Western Federal District. dicates an increase in the quality of medical care for children in the North-Western Federal District.

 

Optimization of the Algorithm for Choosing the Surgical Treatment of Anterior Recurrent Instability of the Shoulder Joint

Introduction. Chronic recurrent instability of the shoulder joint is a frequent outcome of conservative treatment oftraumatic dislocation of the shoulder (2.8–30 % of cases). Preoperative examination largely determines the outcome of surgical treatment of this pathology.

The aim of the study was to provide a clinical assessment of the developed algorithm for the surgical treatment of patients with recurrent anterior shoulder joint instability. Materials and methods. The results of treatment of 98 patients with recurrent anterior shoulder joint instability were studied. Preoperative examination included clinical tests, MRI or CT with calculation of bone loss. Fifty-six patients (57.1 %) underwent Bankart operation, 14 patients (14.3 %) – Latarjet operation. Twenty-three patients (23.5 %) underwent Bankart + Remplissage surgery, and 5 (5.1 %) – Latarjet + remplissage. The result was assessed on the ROWE scale.

Results. Bone defects significant in the formation of instability (“glenoid off track”) were found in 19.4 % of patients, and “glenoid on track” – in 80.6 %. According to the proposed algorithm for treating patients with anterior recurrent instability of the shoulder joint, the “glenoid off track” state was an indication for Latarjet surgery. When “glenoid on track” was used, indications for Bankart operation were displayed. The remplissage procedure was indicated in case of the presence of a Hill-Sachs grade 3 defect or the presence of hyperelasticity of the tissues of the shoulder joint. The mean ROWE score for the entire group of patients before surgery was 41.5 ± 12.8 points, and 15 months after sur gery – 94.9 ± 3.4 points. Two recurrent dislocations were revealed, one of which was associated with repeated trauma, and the other – with an incorrect choice of stabilization technique. One complication (axillary nerve neuropathy) was observed, which was arrested conservatively.

Conclusions. The proposed algorithm allowed us to obtain positive results in 97.9 % of cases. 

Treatment of Periprosthetic Infection with Silver-Doped Implants Based on Two-Dimensionally Ordered Linear Chain Carbon

Relevance. Formation of pan-resistance microorganisms, microbial biofilms on implants and recurrent infection rate stimulate the search for optimal prosthesis materials for treatment of periprosthetic infection (PJI). Purpose of the study — to compare the efficiency of two stage PJI treatment with simultaneous implantation of a spacer in combination with implants with silver-doped coatings based on two-dimensionally ordered linear chain carbon (TDOLCC+Ag) during the first stage and the conventional revision with a spacer only. Materials and methods. The study included 72 patients with PJI of the knee (n = 42) and hip (n = 30) joints. Control group (conventional revision) consisted of 35 patients and the main group (TDOLCC+Ag coated implant incorporated in a spacer) — 37 patients. Mean age of the patients was 61 years. Temporary components were replaced by the final components during revision at the second stage. Evaluation methods: clinical, X-ray, laboratory, microbiological and follow up history. Results. Inflammation markers and synovial fluid cytosis in the groups at the first revision stage featured equal high base values. During the second stage leucocyte count and cytosis reached normal values, ESR decreased twofold in both groups, CRP decreased five times in the main group. Throat and nasal swabs demonstrated growth of Staphylococcus aureus at 24,3-32,4% in both groups. The leading inducer of PJI was staphylococcal flora with MRSA share of 7,1% and MRSE — from 62,5 to 66,7%. End-points of evaluating treatment outcomes were revision spacer implantation at the second stage of sanation and recurrent PJI. Control group featured implantation of more revision spacers (5) as compared to the main group (1) after the treatment. Two recurrent PJIs were reported for the control group in 11 months while no recurrent infection was reported for the main group. Conclusion. The study demonstrated statistically significant improvement in the outcomes of PJI treatment by spacers with implants coated by TDOLCC+Ag as compared to the conventional treatment option.

[Using autonomous electrostimulation device Erektron in treating female overactive bladder]

INTRODUCTION

Overactive bladder (OAB) is one of the most common syndromes of lower urinary tract dysfunction. Besides standard therapy using anticholinergic medications, comprehensive management of overactive bladder includes physiotherapy.

AIM

To test the clinical effectiveness and safety of autonomous electrostimulation device "Erektron" in treating OAB in women.

MATERIALS AND METHODS

The study was conducted at the Urology and Gynecology Clinic of the Innovative Medical Technology Center between 25.04.2014 and 30.01.2015. It included 20 women with newly diagnosed OAB both with and without urinary urgency incontinence or urinary stress incontinence. The patients were divided into 2 groups. All patients were treated with the first line anticholinergic agent solifenacin 5 mg daily. In patients of group 1, anticholinergic therapy was administered concurrently with intravaginal electrostimulation using "Erektron" device.

RESULTS

In both groups, the treatment resulted in positive results, but a more pronounced improvement was found in group 1 patients with mixed incontinence.

CONCLUSION

Autonomous electrostimulation device MT-RV "Erektron" can be used in comprehensive management of patients with OAB, including those with stress urinary incontinence.

[INDICES OF THE OXIDATIVE STATUS IN CHRONIC ADMINISTRATION OF COLLOID CARBONATE CALCIUM PRAPARATION WITH FAUCET AND LOW-MINERALIZED DRINKING WATER IN RATS]

There are discussed the changes of an array of indices of the oxidative status in chronic administration of colloidal calcium carbonate preparation with faucet and low-mineralized drinking water to rats. Slight differences between significant effects of administration of 3 and 30 mg/L of preparation permit to suggest that the process of its incoming delivery into organism of rats has a bottleneck in the nature of total capacity of macrophages of intestinal lymphoid tissue to absorption of particles.

[The morphofunctional cellular evaluation of liver and kidney in rats in dynamics of 6-month consumption of water produced with the use of noncontact activation after electrochemical treatment]

There were investigated morphofunctional indices of liver and kidney in male outbred rats in the dynamics of the 6-months consumption of water after its noncontact activation. There were studied 4 experimental groups of animals consumed waters named as "Anolyte" and in dependence on the activation time, 3 types of catholyte water ("Catholyte--5", "Catholyte--25", "Catholyte--40"). Moscow tap water settled for a week served as control. "Anolyte" water was found to increase in the kidney the number of hypertrophied gromeruli only in 6 months, while the consumption of "Catholyte--25" water and especially, "Catholyte--40" in 1 and 6 months caused the damage of liver and kidney, and for the index of alteration of renal glomeruli after 6 months of water consumption there was revealed the dependence on the activation time of "Catalytes".

[Study of cytogenetic and cytotoxic effect of non-contact electrochemically-activated waters in the five organs of rats]

For the first time the multiorgan karyological analysis of five organs of rats was applied for the study of the cytogenetic and cytotoxic action of the four types of non-contact electrochemically activated water in the 30-days in vivo experiment. The effects of investigated waters were not detected in bone marrow polychromatic erythrocytes. "Anolyte" (ORP = -362 mV) did not have a negative effect on rats. "Catholyte-5" (ORP = +22 mV) and "Catholyte-25" (ORP = -60 mV) induced cytogenetic abnormalities in the bladder and fore stomach. The same catholytes and "Catholyte-40" (ORP = -10 mV) changed the proliferation indices: increased the mitotic index in the fore stomach epithelium and reduced the frequency of binucleated cells in the fore stomach, bladder and lungs. The increase in the rate of cells with cytogenetic abnormalities on the background of the promotion of mitotic activity can be considered as a manifestation of the negative effect, typical for catolytes, but the effect of each out of them has its own features.

[Biochemical effects of chronic peroral administration of carbon nanotubes and activated charcoal in drinking water in rats]

Chronic 6-month experiment was carried out in rats, which received drinking water with multi-walled carbon nanotubes (MWCNTs), diameter of 15-40 nm, length ≥ 2 mkm) or activated charcoal (AC, diameter of 10-100 mkm), blood samples of the animals were used for assessment of biochemical markers. Both coal compounds induced the appearance of signs of oxidative stress 2 weeks after the beginning of the experiment and alteration of serum markers of liver and renal damage, as well as changes of cortisol and protein serum concentrations later Thus, despite of known high (asbest-like) inhalation toxicity of carbon nanotubes in comparison with other carbon allotrops (fullerenes and black carbon), we have found similar effects of MWCNTs and carbon microparticles in orally treated rats.

[Morphofunctional cell assessment of dynamics of silver nanoparticles exposure on the rat liver]

There was investigated the dynamics of 1-, 3- and 6-month exposure to 4 doses of silver nanoparticles of size 14.3 +/- 0.05 nm stabilized with gum arabic, and 4 doses of silver sulfate on the liver of male outbred rats by 13 cell morphofunctional indices. As the solvent to obtain a working solution there was used distilled water solutions of different conccentrations were obtained on the base of Moscow tap water cleaned out by a charcoal filter. The animals had free acccess to the drinkers with the studied water. For silver sulfate as a control intact rats served, for silver nanoparticles--acacia gum. The increase in the number of polyploid hepatocytes, micronekroses and discomplexation of hepatic beams and the decreasing the number of reticular endothelial system cells in the liver were shown to permit to evaluate the effect of 6-month nanosilver exposure to the liver at a dose of 0.3 mg/kg as pronounced harmful (Fel), 0.023 mg/ kg--as LOAEL, and 0.0028 and 0.0006 mg/kg--as NOEL. The effect of silver sulfate in doses of 0.28 and 0.03 mg/ kg is assessed as pronounced harmful (Fel), 0,0028 mg/kg--as LAOEL and 0.0005 mg/kg--as NOEL. More earlier detection of toxicity of silver sulfate as Fel (at 3 months) and in smaller doses indicates its greater toxicity to the liver than silver nanoparticles.

[Comparative analysis of the influence of nano- and ionic forms of silver on biochemical indices in laboratory animals]

A comparative analysis of the effect of silver nanoparticles (SNP) with a diameter of 14 nm and silver sulfate (SS) on biochemical indices of the state of the organism under the administration of preparations with drinking water to mice F1 CBAxC57Bl (from 0.1 to 500 mg Ag/l for 2 weeks) and nonlinear rats (from 0.01 to 5 mg Ag/l within 6 months) has been performed In the experiment on mice there was found an increase in activity of glutathione reductase (GR) in erythrocytes under the administration of both drugs and reduction of antiradical activity of serum--under the introduction of SNP only. The administration of low doses of SNP in the experiment on rats caused much less pronounced changes in serum markers of the state of the liver; kidneys, protein and lipids metabolism in comparison with equivalent doses of the SS, that as a whole with the qualitative differences on GR activity in erythrocytes satisfactorily was explained by activation of phagocytic cells with nanoparticles. Thus, for the first time the SNP biological effects in animals were shown to be caused both by the exposure to solubilized Ag+ ions and by the response of cells to the surface of the nanoparticles themselves.

[Biophysical aspects of biological activity structure--strain calcium carbonat in micellar form]

Results of the study of electrochemical and structural state of phase of associated water in the solutions of structurally stressed calcium carbonate in the micellar form are reported. On the base on the comparison of structural--physical changes of activated water with the data on the activity of bioluminiscentic "Ecolyum" microorganisms in their noncontact activation the electronic mechanism of the effect of activated water on cellular metabolism is substantiated The use of "Micellate of calcium" possessing non-contact electron-donor action on cellular structures was shown to permit to compensate the deficit of electrons and thereby to restore the activities of reductases and iron-containing peptides required for the production of regulatory ROS and alteration in redox state of the intracellular environment.

[Effect of multi-walled carbon nanotubes on the morphofunctional state of the small intestine cells of mice]

The experiment was conducted in male mice SBAchS57Vl/6 and Balb/c, which consumed water, obtained from the use of carbon nanotubes. in a free drinking regimen for 2 weeks (mice SBAchS57Vl/6) and 2 months (mice Balb/c) Control group consisted of three groups of animals: intact and mice received fine coal in the same concentrations as under the impact of the nanotubes. Under exposure to the maximal of the studied concentration of carbon nanotubes a significant change in the fine structure of the villi of the small intestine was found in the form of increasing the number of unstructured villi and proliferation of epithelial cells, most pronounced in duration of exposure until 2 months.

[Changes in the electrochemical parameters and structural state of water exposed to ultra-high frequency radiation]

This investigation of the impact of microwave radiation on the state of water has indicated that concurrently with thermal exposure, there are cooperative processes that affect the structural and energetic state of its metastable phase.

[Impact of the structuredness of water on the formation of its biological activity against leukocyte phagocytic activity and cell-mediated immunity]

The effects of waters of varying structuredness on the body's immunological responsiveness were investigated. Long-term intake of highly-structured waters was shown to lead to the stimulation of delayed hypersensitivity reaction and the activation of leukocyte phagocytic activity.

[Approaches to prediction of gastropathy development risk due to non-steroidal antiinflammatory drugs]

AIM

Examination of gastric secretion in rheumatoid arthritis (RA) patients and its response to sodium diclophenak and indomethacine.

MATERIALS AND METHODS

46 RA patients entered the study. All of them have been long on nonsteroid antiinflammatory drugs (NAID). Two groups of patients were analysed: group 1--free of NAID gastropathy, group 2--with NAID gastropathy. pH was followed by Gastroscan system.

RESULTS

The analysis of 24-h pH-grams in both groups when NAID were not taken showed that in NAID gastropathy acid-forming gastric function is not affected while the alkalizing function markedly declines. Indomethacine is more aggressive to upper gastrointestinal tract mucosa than sodium diclophenak.

CONCLUSION

Dynamic intragastric pH-metry can prognosticate the risk of NAID gastropathy.

[Current problems in improving the postgraduate training of public health management personnel]

Improvement of advanced training of heads of dentistry institutions is one of the pressing problems in the days of transferring public health service into a new economic system. Curricula, forms and methods of training should be revised to become more practically directed. Purposeful training should be carried out on an agreement basis.