Subgroup 1B Research Articles

Coagulation hemostasis disorders and elevated lipoprotein (a) levels in patients with arterial hypertension and multifocal atherosclerosis

Introduction. Hemostatic disorders may act as additional risk factors in patients with arterial hypertension (AH) and multifocal atherosclerotic lesion (MFAL). Elevated lipoprotein (a) (Lp(a)) levels may exacerbate procoagulant shifts.Aim. To identify disorders in the coagulation link of hemostasis in patients with AH and MFAL, depending on the level of Lp(a).Materials and methods. The study included 219 patients with hypertension and MFAL, median age 59 (53; 66) years, of which 110 patients with stage I–II controlled hypertension (group 1) and 109 patients with stage III controlled hypertension with a history of ischemic stroke. Depending on the level of Lp(a), patients in each group were divided into 2 subgroups with Lp(a) levels < 50 mg/dl and with Lp(a) levels above 50 mg/dl. Patients of both groups received antihypertensive, lipid-lowering, antiplatelet therapy and had comparable values of blood pressure and lipid spectrum.Results. In group 2 patients, procoagulant shifts were significantly more often recorded, despite the constant use of antiplatelet therapy. Violations of hemostasis parameters depending on the level of Lp(a) were observed in subgroups 1b and 2b. According to the results of multiple a posteriori comparisons, the most significant hypercoagulation changes were observed in patients with stroke, as well as with Lp(a) levels > 50 mg/dl.Conclusions. Thus, in some patients with hypertension and MFAL, despite taking antihypertensive, lipid-lowering and antiplatelet therapy, coagulation hemostasis disorders may occur. Elevated Lp(a) levels are combined with more pronounced hemostatic disorders, especially in the presence of a previous stroke. Intensification of antithrombotic therapy may be considered in such patients to prevent cardiovascular complications.

Dynamics of endothelial function in patients with arterial hypertension with different cardiovascular risk against the background of antihypertensive therapy

The aim of the work was to investigate the dynamics of endothelial markers in patients with arterial hypertension with different cardiovascular risk under the influence of the prescribed treatment during a year of observation. The first group (with a moderate risk of cardiovascular events) included 48 patients with arterial hypertension (AH). The second group consisted of 54 patients with hypertension and a high risk of cardiovascular events, namely type 2 diabetes. Each group of patients was randomized into two subgroups by blood pressure (BP) medication. In patients of subgroup 1a (n=29) and subgroup 2a (n=35) – the main subgroups – the therapy necessarily included the angiotensin II receptor antagonist losartan potas­sium in a dosage of 50-150 mg/day, depending on the blood pressure level. Patients of subgroup 1b (n=19) and subgroup 2b (n=19) – comparison subgroups were treated with antihypertensive drugs of other first-line groups according to the data of the unified clinical protocol for the treatment of hypertension. According to the ROC analysis, it was determined that the dynamics of endothelin-1 (ET-1) indicators after 9 and 12 months of therapy (a decrease of 12% or more from the initial level) can predict the normalization of indicators of the coagulation and anticoagulation systems with indicators of sensitivity and specificity – 85% (95% CI 62.1-96.6%) and 92.9% (95% CI 76.5-98.9%), respectively. A decrease in the level of Willebrand factor (fV) by 23% or more due to such a treatment time can be used as a prognostic sign in determining the regression of endothelial dysfunction with sensitivity – 75% (95% CI 50.9-91.2%), specificity – 100% (95% CI 87.5-100%). According to the given data, both in the group with moderate and with high cardiovascular risk, there is a relationship between endothelial dysfunction (ED) and the duration of hypertension, indicators of the lipid spectrum and abdominal obesity – factors that increase the viscous resistance of the blood circulation, as well as platelet hyperactivity in the bloodstream. We have also established that according to the dynamics of ET-1 indicators after 9 and 12 months of therapy (decrease by 27% or more from the initial level), it is possible to predict the normalization of indicators of the coagulation and anticoagulation systems with indicators of sensitivity – 81.8% (95% CI 59.7-94.7%), specificity – 90.6% (95% CI 75-97.9%). A decrease in the level of fV by 24.5% or more after a year of treatment can be used as a prognostic sign in determining the regression of endothelial dysfunction with sensitivity – 68.2% (95% CI 45.1-86.1%), specificity – 71.9% (95% CI 53.3-86.2%). The obtained results testify to the dominant role of type 2 diabetes as a factor in platelet disorders of hemostasis. Taking into account the positive dynamics of the above-mentioned markers of ED during the year of treatment, their relationship with the reduction of blood pressure, indicators of the lipid spectrum and abdominal obesity, it should be noted the positive effect of angiotensin II receptor blockers (BRA II) as endothelioprotective drugs. Considering the irrefutable literary data about the absence of thrombomodulin in the blood stream, even its insignificant appearance indicates the presence of endothelial dysfunction. Determining the state and dynamics of changes in endothelial function under the influence of prescribed therapy will make it possible to improve the diagnosis of endothelial function disorders and increase the effectiveness of treatment of patients with hypertension and various cardiovascular risks.

Comparative evaluation of the effect of three different obturation techniques on push-out bond strength of AH Plus Bioceramic and EndoCeramic sealers: An in vitro study

Abstract Context: Effect of three different obturation techniques on bond strength of bioceramic sealers. Aim: This study aimed to investigate the effect of cold lateral compaction, thermafil, and thermoplasticized obturation techniques on the push-out bond strength of AH Plus Bioceramic and EndoCeramic sealers. Settings and Design: The design of the study was an in vitro study. Materials and Methods: Forty-two extracted teeth that were single-rooted and had fully developed apices were chosen, decoronated, and biomechanically prepared using rotary nickel–titanium (NiTi) instruments. Samples were divided into two groups of n = 21. Group 1: AH Plus Bioceramic sealer, Group 2: EndoCeramic sealer. Then, based on the obturation technique employed, each group was divided into three subgroups (n = 7): subgroups 1a, 2a: Cold lateral compaction; Subgroups 1b, 2b: Thermafil; and Subgroups 1c, 2c: Thermoplasticized (obtura). Using universal testing machine, slices from the middle third of the sample’s root were analyzed to determine the push-out bond strength values. Results: Compared to other groups push-out bond strength was noticeably higher for the cold lateral compaction technique with EndoCeramic sealer (Subgroup 2a), followed by the Thermafil technique with EndoCeramic sealer (Subgroup 2b). Conclusions: In the present study, compared to heat-based obturation techniques, cold lateral compaction showed better push-out bond strength values for both sealers. EndoCeramic sealer resulted in greater push-out bond strength values than AH Plus Bioceramic sealer.

Analysis of the course and outcomes of COVID-19 at different stages of the pandemic in hemodialysis patients

The purpose of this study was a comparative analysis of the characteristics of the course and outcomes of COVID-19 in HD patients at different stages of the pandemic, focusing on the of the use of immunomodulatory therapy.Materials and methods. The retrospective study included 897 HD patients with COVID-19 (mean age 60.7 years, M 58.5%) who were hospitalized at Moscow City Hospital № 52. Group 1 (n=720) consisted of patients infected between the end of March 2020 and April 2021, group 2 (n=177) included patients hospitalized in May-December 2021. Each of group was divided into 2 subgroups based on treatment approaches. Subgroup 1a (n=231) included patients of the initial period of the pandemic who did not receive adequate immunomodulatory therapy, while Subgroup 1b (n=489) included patients of the late stage, were treated with IL-6 receptor blockers and corticosteroids. In group 2, 108 patients in Subgroup 2a received similar therapy, while 69 patients in Subgroup 2b were treated with neutralizing monoclonal antibodies in the early stages of the disease.Results. Mortality rates in Group 1 and Group 2 was 20.1% and 14.7%, respectively (p<0.09). The incidence of unfavorable outcome was highest in Subgroup 1a and lowest in Subgroup 2b (31.2% vs 5.8%, p<0.01). Mortality in Subgroups 1b and 2a was comparable (14.9% and 20.4%), despite more severe initial lung damage according to CT data in Subgroup 2a. In these patients, immunomodulators was more frequently combined with therapeutic plasma exchange (TPE). Independent risk factors for an unfavorable outcome were the progression of pulmonary pathology, with the transformation of stages CT 1-2 to CT 3-4, and a high comorbidity index.Conclusions. The use of immunomodulatory drugs imprtoved the effectiveness of COVID-19 treatment in patients with CKD5D. In severe cases, the most favorable outcomes were achieved with a combination of immunobiological drugs, corticosteroids, and TPE. An even more significant reduction in mortality was observed following the introduction of neutralizing monoclonal antibodies into clinical practice. Independent predictors of unfavorable outcome of COVID-19 in HD patients were a high comorbidity index and the progression of CT 1-2 into CT 3-4.

Bradysystole in permanent atrial fibrillation: clinical importance and modeling in experiment

Aim – to determine additional risks of developing arterial thrombotic and thromboembolic complications in bradysystolic AF and substantiate the results using modeling of intra-arterial hemodynamics. Material and methods. A single-center prospective study involving 252 patients: 146 in the main group, 106 in the control group. The main group was divided into 2 subgroups: 1A subgroup RR ECG interval 1.5 seconds; 2B subgroup RR≥1.5 seconds. A comprehensive examination of the patients was carried out. The second stage is prospective comprising an analysis of the development of arterial thrombotic and thromboembolic complications over 1 year. Experimental modeling was carried out using the “Device for simulating intra-arterial circulation”. Results. Thrombotic and thromboembolic complications were more common in subgroup 1B (OR=8.287 (2.287; 30.040); z=3.219; p=0.001). When analyzing the main parameters of the hemodynamics of the main arteries, the first pulse wave, coming after a long pause of 1.5 seconds or more in AF, was accompanied by a statistically significant increase in all of analyzed parameters. In the experiment, when simulating AF, the intensity of the mechanical impact of the free end of the thread on the wall of the rotameter was maximum when the pause between pulse waves was 1.5 seconds or more (9.70 ± 2.52 mm). At this moment, the piezocrystalline pressure sensor recorded the maximum increase in pressure inside the rotameter tube by an average of 56%. Conclusions. Bradysystole in AF is associated with a significantly higher likelihood of developing long-term thromboembolic events. The first pulse wave, coming after a long pause between ventricular contractions during AF, leads to a significant increase in the main parameters of the hemodynamics of the main arteries (linear velocity of blood flow, volumetric blood flow). When monitoring heart rate in AF, it is necessary to avoid bradysystole with pauses between ventricular contractions of 1.5 seconds or more, due to a higher risk of stroke, myocardial infarction, and distal arterial embolism in other vascular regions.

The value and accuracy of intracoronary electrocardiogram in the diagnosis of myocardial ischemia in coronary heart disease.

Although intracoronary electrocardiography (IC-ECG) offers direct electrophysiological insights into myocardial ischemia caused by insufficient coronary blood supply, compared to common diagnostic methods like electrocardiography (ECG), it lacks widespread adoption and robust clinical research. To analyze the value and accuracy of intracoronary electrocardiogram in myocardial ischemia diagnosis in coronary heart disease patients. Three hundred patients treated at our hospital were included in the study. Patients were categorized into non-ischemic group A (Fraction Flow Reserve [FFR] > 0.8) and ischemic group B (FFR < 0.75) based on FFR examination results. Both groups underwent IC-ECG examination. The ischemic group received percutaneous coronary intervention (PCI) treatment followed by another FFR examination, dividing them into non-ischemic subgroup B1 (FFR > 0.8) and ischemic subgroup B2 (FFR < 0.75). Both subgroups underwent IC-ECG examination. Receiver operating curves were constructed using FFR to assess the clinical utility of different IC-ECG parameters. Group A patients showed a significant decrease in ST-segment shift at J-point, ST-segment integral, T-peak, T-wave integral, and T-peak to end-time, while the Corrected Q-T interval (QTc-time) was significantly higher in the B group (p< 0.05). The parameters, including ST-segment shift at J-point, ST-segment integral, T-wave integral, T-peak, T-peak to end-time, and QTc-time, were found to have clinical significance in predicting the occurrence of myocardial ischemia (p< 0.05). Intracoronary electrocardiogram QT interval dispersion and Q-T peak (QTp) interval dispersion have a high diagnostic accuracy for myocardial ischemia in coronary heart disease.

Dissemination of Urinary Escherichia coli Phylogroup B2 in Provincial and Community Hospitals in Uthai Thani, Central Thailand.

Escherichia coli is a Gram-negative bacterium that causes a variety of clinical infections in humans, including diarrhea, sepsis, and urinary tract infection. This bacterium is a common multidrug-resistant threat in community and hospital settings worldwide. This study examined the antimicrobial susceptibility and genetic relationship based on Clermont phylotyping and enterobacterial repetitive intergenic consensus (ERIC)-PCR of 84 E. coli urinary isolates from provincial and community hospitals in Thailand. All isolates were susceptible to nitrofurantoin, and almost all isolates were susceptible to carbapenem, fosfomycin, and amikacin. High resistance rates to fluoroquinolone, ampicillin, and trimethoprim/sulfamethoxazole were observed. Clermont phylogroup B2 was predominant (n = 58). Subtyping of the B2 phylogroup revealed diverse subgroups, of which subgroup V (n = 11), VII (n = 9), III (n = 6), and II (n = 6) were most prevalent. ERIC-PCR showed that the strains of the B2 subgroups III and V were spread between provincial and community hospitals and between hospital wards. This evidence suggests the need for comprehensive infection control monitoring, with strong active surveillance at all hospital levels.

Postoperative complications and hernia recurrence after the use of various ventral hernia repair techniques

Prosthetic hernioplasty (HP) for ventral hernias (VH) has a complication rate of up to 27% and a hernia recurrence rate up of to 37%, depending on the chosen technique. The use of laparoscopic HP techniques allows for a shorter hospital stay and a lower risk of wound infection. There is a wide range of data on the superiority of laparoscopy over the open technique in terms of recurrence rates and various types of complications. The results of comparing HP with and without suturing of the hernia defect are controversial. Objective — to study the structure and incidence of postoperative complications, as well as the frequency of hernia recurrences after the use of open and laparoscopic HP for VH. Materials and methods. A multicenter prospective study, which included 482 patients diagnosed with VH, was conducted at the clinical base of the Department of General Surgery No. 2 at Bogomolets National Medical University. A total of 279 (57.9%) patients had primary VH, while 203 (42.1%) had incisional VH. The patients were divided into two groups, comparable in terms of age, sex, and hernia size distribution. Group 1 included 250 (51.9%) patients who underwent open HP with suturing of the hernia defect: subgroup 1a — open sublay (n=243; 50.4%), and subgroup 1b — open intraperitoneal onlay mesh technique (IPOM) (n=7; 1.5%). Group 2 included 232 (48.1%) patients who underwent laparoscopic HP using the IPOM technique: subgroup 2a — IPOM without suturing of the aponeurosis defect (n=81; 16.8%), subgroup 2b — IPOM with suturing of the aponeurosis defect (n=108; 22.4%), and subgroup 2c — IPOM+ with open aponeurosis defect suturing (n=43; 8.9%). Follow‑up evaluations were carried out at intervals of 2 weeks, 1 month, 6 months, and 1 year to assess the presence of complications, recurrence, and satisfaction with the cosmetic effect of the operation. Results. The overall frequency of complications after HP was 15.6%, while after open sublay it was 21.2%, and after laparoscopic IPOM it was 9.9%. All cases of complications belonged to Grades I—IIIb according to the Clavien‑Dindo classification. In both groups, there were no fatalities. In group 1, the frequency of seroma was 11.6% and hematoma was 5.6%, and in group 2, it was 7.3% and 0.9%, respectively. A statistically significant increase in the frequency of hematoma development was observed after open HP techniques compared to laparoscopic ones (p=0.004), while the frequency of seroma detection was comparable (p=0.148). Non‑suturing of the aponeurosis defect after laparoscopic IPOM in patients with VH did not result in an increase in the total number of complications or the percentage of recurrence (p &gt;0.05). Laparoscopic IPOM with hernia suturing demonstrated significantly higher patient satisfaction with the appearance of the anterior abdominal wall compared to other HP techniques (р &lt;0.05). Conclusions. The open sublay and laparoscopic IPOM HP procedures have a comparable recurrence rate of VH (p &gt;0.05). The incidence of infectious complications and hematomas is significantly higher after open operations compared to laparoscopic ones (p=0.041 and p=0.004, respectively).

Two new species of Perinereis Kinberg, 1865 (Annelida: Nereididae) from the rocky shore of Maharashtra, India, including notes and an identification key to Group 1

Two new species of Perinereis with single bar-shaped paragnaths on area VI (Group 1) from the rocky shores of Mumbai, Maharashtra, India, are described with barely (Subgroup 1A) or largely (Subgroup 1B) expanded proximal region of dorsal ligule in posterior parapodia. Perinereis malabarensis sp. nov. can be distinguished from the morphologically similar 1B species P. euiini Park &amp; Kim, 2017 by the paragnath count in area I, the laterally isolated paragnaths in area III, and the length of the dorsal cirrus and dorsal ligule. Additionally, P. misrai sp. nov. is more similar to 1A species P. falsovariegata Monro, 1933 and P. villalobosi Rioja, 1947, but differs by the paragnath count in areas III–V and VII–VIII, the isolated paragnaths in area III, and the number of rows in the anterior band of areas VII–VIII. The morphological characters of the current 44 species within Perinereis G1 are compared, and an identification key to the species belonging to this group is also provided.

Effectiveness of broadband pulsed light and anti-inflammatory doses of minocycline in patients with papulopustular acne

Аbstract. Relevance. Over the past decades, laser devices have been regarded as the method of choice in the treatment of a wide range of skin conditions, including acne. This is the reason for the active search for new methods of therapy, adherence to which in patients with acne would be higher. From this point of view, the increase in the efficiency of broadband pulsed light (IPL) in combination with low doses of minocycline has all the prerequisites for inclusion in the therapeutic complex in the treatment of patients with acne. Purpose of the study. To study the efficacy and safety of using a combined method of therapy with broadband pulsed light and low doses of minocycline in patients with papulopustular acne, taking into account the concentration of MMP-1, MMP-2, MMP-3, MMP-9 in blood serum and the DISS index. Material and methods. Under observation were 100 patients (76 women) and (24 men) aged 18 to 45 years with a diagnosis of papulopustular form of acne, moderate severity. All patients, depending on the initial violation of the skin microbiota, were divided into two groups: group 1–50 patients, group 2–50 patients, each group was divided into subgroups depending on the type of therapy: subgroup A — 25 patients, subgroup B — 25 patients. All patients underwent a study of the concentration of MMP-1, MMP-2, MMP-3, MMP-9 in the blood serum. Research results. The results of comparing the levels of MMP-1, 2, 3, 9 and the DISHS index before and after various methods of therapy in patients with papulopustular acne, of moderate severity in subgroups 1B and 2B showed a more significant trend towards a decrease in MMP-1, 2, 3, 9 and the DISHS index relative to subgroups 1A and 2A. Conclusions. Analyzing the results of the study, we can conclude that the use of a combined method of treatment in patients with papulopustular form of acne, of moderate severity, demonstrated greater efficiency in the dynamics of reducing the levels of MMP-1, 2, 3, 9 concentrations, as well as reducing the total index DISH compared with low-dse minocycline and a topical retinoid.

Identification of Dof transcription factors in Dendrobium huoshanense and expression pattern under abiotic stresses.

Introduction: DNA-binding with one finger (Dof) transcription factors (TFs) are a unique family of TFs found in higher plants that regulate plant responses to light, hormones, and abiotic stresses. The specific involvement of Dof genes in the response to environmental stresses remains unknown in D. huoshanense. Methods: A total of 22 Dof family genes were identified from the D. huoshanense genome. Results: Chromosome location analysis showed that DhDof genes were distributed on 12 chromosomes, with the largest number of Dof genes located on chromosome 8. The phylogenetic tree revealed that DhDofs could be categorized into 11 distinct subgroups. In addition to the common groups, DhDof4, DhDof5, DhDof17, and the AtDof1.4 ortholog were clustered into the B3 subgroup. Group E was a newly identified branch, among which DhDof6, DhDof7, DhDof8, and DhDof9 were in an independent branch. The conserved motifs and gene structure revealed the differences in motif number and composition of DhDofs. The dof domain near the N-terminus was highly conserved and contained a C2-C2-type zinc finger structure linked with four cysteines. Microsynteny and interspecies collinearity revealed gene duplication events and phylogenetic tree among DhDofs. Large-scale gene duplication had not occurred among the DhDofs genes and only in one pair of genes on chromosome 13. Synteny blocks were found more often between D. huoshanense and its relatives and less often between Oryza sativa and Arabidopsis thaliana. Selection pressure analysis indicated that DhDof genes were subject to purifying selection. Expression profiles and correlation analyses revealed that the Dof gene under hormone treatments showed several different expression patterns. DhDof20 and DhDof21 had the highest expression levels and were co-expressed under MeJA induction. The cis-acting element analysis revealed that each DhDof had several regulatory elements involved in plant growth as well as abiotic stresses. qRT-PCR analysis demonstrated that DhDof2 was the main ABA-responsive gene and DhDof7 was the main cold stress-related gene. IAA suppressed the expression of some Dof candidates, and SA inhibited most of the candidate genes. Discussion: Our results may provide new insights for the further investigation of the Dof genes and the screening of the core stress-resistance genes.

Total Shoulder Arthroplasty Versus Reverse Shoulder Arthroplasty in Primary Glenohumeral Osteoarthritis With Intact Rotator Cuffs: A Meta-Analyses.

Traditional practice favors total shoulder arthroplasty (TSA) for the treatment of primary glenohumeral osteoarthritis (PGHO) with an intact rotator cuff; however, the indications for reverse shoulder arthroplasty (RSA) have expanded to include PGHO. The purpose of this systematic review is to compare the mean differences in the range of motion and patient-reported outcomes between the TSA and RSA with an intact rotator cuff and to analyze the subgroup of the Walch type B2 glenoid. This IRB-exempt, PROSPERO-registered systematic review strictly followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines. A literature search of five databases revealed 493 articles, of which 10 were included for quantitative synthesis. Level III evidence studies with the diagnosis of PGHO and ≥2 years of follow-up were included. Studies without preoperative and postoperative data were excluded. The Newcastle-Ottawa scale was used to evaluate the methodologic quality of the included studies. Preoperative and postoperative range of motion and patient-reported outcomes were collected. The random-effects model was employed, and p < 0.05 was considered statistically significant. There were a total of 544 and 329 studies in the TSA group and RSA group, respectively. The mean age in the TSA group and RSA groups were 65.36 ± 7.06 and 73.12 ± 2.40, respectively (p = 0.008). The percentages of males in the TSA and RSA groups were 73.2% and 51.1%, respectively (p = 0.02). The mean differences in forward elevation, external rotation in adduction, internal rotation scale, visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Single AssessmentNumericEvaluation (SANE) scores were improved for both groups with no significant differences between the two. There were 9.6 times the revisions in the TSA group (8.8% vs. 0.91%; p = 0.014) and 1.5 times the complications in the TSA group (3.68% vs. 2.4%; p = 0.0096). Two hundred and forty-two glenoids were identified as Walch type B2 (126 in the TSA groupand 116 in the RSA group). The mean ages in the B2 subgroup were 68.20 ± 3.25 and 73.03 ± 1.49 for the TSA and RSA, respectively (p = 0.25). The percentages of males in the B2 subgroup were 74.6% and 46.5% for the TSA and RSA groups, respectively (p = 0.0003). The ASES, SANE, forward elevation, and external rotation in the adduction results were descriptively summarized for this subgroup, with average mean differences of 49.0 and 51.2, 45.7 and 66.1, 77.6° and 58.6°, and 38.6° and 34.1° for the TSA and RSA groups, respectively. In the setting of primary glenohumeral osteoarthritis with an intact rotator cuff, the RSA has a similar range of motion and clinical outcomesbut lower complication and revision rates as compared to the TSA. This may hold true in the setting of the B2 glenoid, although a high-powered study on this subgroup is required. Anatomic shoulder arthroplasty maintains an important role in select patients. Further studies are required to better elucidate the role of glenoid bone loss and posterior humeral head subluxation with regard to implant choice.

An In Vitro Study to Compare the Shear Bond Strength of Metal and Ceramic Brackets Using Conventional Acid Etch and Self-Etch Primer.

In this, in vitro study's objective is to assess the shear bond strength (SBS) of metal and ceramic orthodontic brackets that have been adhered to enamel using a conventional acid etch/primer and self-etching primer (SEP) adhesive method. One hundred excised human premolars were bonded on brackets and were divided into group 1 -Metal brackets were bonded on teeth and group 2 -Ceramic brackets were bonded on teeth. These two groups were further subdivided: subgroup 1a - 25 metal brackets bonded using conventional acid etch/primer adhesive system, subgroup 1b - 25 metal brackets bonded using SEP, subgroup 2a - 25 ceramic brackets bonded using conventional acid etch/primer adhesive system, and subgroup 2b - 25 ceramic brackets bonded using SEP; brackets were debonded using a computerized Instron universal testing machine. The mean value of SBS of metal and ceramic brackets bonded using conventional acid etch/primer adhesive systems had higher SBS than those bonded using SEP. SBS ranged from 7.95 to 12.24 MPa which was in the acceptable clinical range. SBS values of all four subgroups exceeded the range of 6-8 MPa observed to be acceptable for routine clinical use.

In-Vitro Evaluation of Dental Adhesive Bond Strength With Diode Laser Irradiation Before Photopolymerization.

In-vitro evaluation of shear bond strength, mode of failure, and adaptation of fifth-generation (etch-and-rinse), seventh-generation,and eighth-generation self-etch dental adhesives to human dentin with or without diode-laser irradiation before photopolymerization. Seventy-two extracted human maxillary premolar teeth were collected. The buccal and lingual surfaces of teeth were grounded until dentin was exposed. Test areas of 4 mm diameter were created on both surfaces of teeth to standardize the area of treatment. The samples were then randomly allocated into three groups (n = 24): Group 1 Adper Single Bond 2 Etch-and-Rinse; Group 2Tetric-N-Bond Universal Self-Etch; Group 3 Prime and Bond Universal Self-Etch dental adhesives were used. Buccal surfaces (sub-groups 'a') of all specimens were irradiated with diode laser before photopolymerization of the adhesive material, and palatal surfaces (sub-groups 'b') were directly photopolymerized without prior diode laser irradiation and restored with composite resin. All specimens were thermocycled. Four specimens from each group were then subjected to scanning electron microscopy (SEM) analysis to examine the adaptation of adhesive to dentin, and the remaining 60 specimens were evaluated for shear bond strength tests, modes of failure at the adhesive-dentin interface, and values were recorded, tabulated, and used for data analysis. A one-way ANOVA test and the Student's t-test were used for statistical analysis. A P value ≤ 0.05 was considered statistically significant. The mean shear bond strength for the groups was: Group 1a (13.96 MPa), 1b (14.95 MPa); Group 2a (10.06 MPa), 2b (10.30 MPa); Group 3a (12.03 MPa), and 3b (10.44 MPa). No statistically significant difference was seen among sub-groups 1a and 3a, 2a and 3a, 2b and 3b as P > 0.05. A significant difference was seen among sub-groups 1b and 3b (P<0.05), 1a and 2a, and 1b and 2b (P<0.01). Adper Single Bond 2 without diode-laser irradiation before photopolymerization showed the highest shear bond strength, followed by Adper Single Bond 2 irradiated with diode laser before photopolymerization, with the maximum adaptation of dental adhesive to dentin compared to other adhesives used either with or without diode-laser irradiation.

Features of the course of irritable bowel syndrome in overweight and obese people

The aim of the study: to study the characteristics of the course of irritable bowel syndrome (IBS), associated with overweight and obesity, to optimize the management of this group of patients. Material and methods. An open-label cross-sectional study was performed including 175 participants aged 18 to 44 years (mean age 30.06 ± 6.15 years). Group 1 included 100 patients with IBS aged 18 to 44 years (mean age 30.63 ± 6.37 years, BMI 25.88 ± 6.28 kg/m2). In group 1, subgroup 1A included 50 people with IBS associated with overweight or obesity. Subgroup 1B included 50 IBS patients with normal weight. Group 2 included 75 people who did not suffer from IBS, aged from 19 to 43 years (mean age 29.31 ± 5.81 years, BMI 27.80 ± 6.20 kg/m2). Subgroup 2A included 50 participants who did not suffer from IBS and were overweight or obese. Subgroup 2B included 25 apparently healthy participants. The presence and severity of IBS symptoms were assessed using a 10-point scale. The severity of gastrointestinal symptoms, the presence of anxiety and depression, the level of specific anxiety, quality of life and eating habits were assessed using verified questionnaires. All participants underwent a study of the levels of leptin and adiponectin in the blood serum and zonulin in the feces. Results. The characteristic clinical stigmas in patients suffering from IBS associated with overweight and obesity are described: IBS with a predominance of constipation, severe course of the disease, high incidence of signs of depressive and anxiety disorders, special eating habits characterized by the predominance of flour, sweet, fatty and salty foods in the diet food, severe disturbances in the permeability of the intestinal epithelial barrier. High concentrations of leptin and low levels of adiponectin in the blood serum of such patients may play a significant role in the formation of IBS symptoms. Conclusion. The results obtained open up opportunities for research into the pathogenetic mechanisms of the formation of IBS in people with overweight and obesity, as well as modification of existing treatment regimens for patients with IBS.

Clinical significance of endocrine disorders in the development of early vascular aging in males with abdominal obesity and concomitant arterial hypertension: An observational cohort study

Background. Visceral obesity is a risk factor in the development of metabolic and endocrine disorders leading to arterial hypertension and cardiovascular complications. Their early predictors include increased vascular stiffness and early vascular aging. The current literature lacks studies into the effects of changes in testosterone, cortisol, and aldosterone levels in serum on vascular stiffness and the development of early vascular aging in patients with visceral obesity. Objective. To determine the relationship between hypercortisolemia, hyperaldosteronemia, and hypotestosteronemia and vascular stiffness and the presence of early vascular aging in male patients with visceral obesity. Methods. An observational cohort study of 78 males aged 35–45 years (mean age 38.1 ± 6.5 years) diagnosed with abdominal obesity and grade 1 arterial hypertension was conducted. The mean waist circumference ranged 105.5 ± 6.9 cm; systolic and diastolic blood pressure ranged 152.5 ± 5.0 and 92.5 ± 5.0 mm Hg, respectively. The vascular age of the studied patients (n = 78) comprised 44.1 ± 6.2 years, which was statistically higher than their passport age (р &lt; 0.001). The studied patients were divided into subgroups according to both total testosterone (&lt; 12.1 nmol/l in subgroup 1A (n = 49) and ≥ 12.1 nmol/L in subgroup 1B (n = 29)) and cortisol in the evening saliva portion (&gt; 4.5 nmol/L in subgroup 2A (n = 24) and ≤ 4.5 nmol/L in subgroup 2B (n = 24)). All the patients completed the study. To assess the hormonal status, the total testosterone sex steroid-binding globulin (SSBP) and insulin in morning serum samples were investigated. Insulin resistance was assessed based on the NOMA-IR index. The concentration of total testosterone was determined by enhanced chemiluminescence (Ortho-Clinical Diagnostics, J&amp;J); the SSBP and insulin levels were determined by delayed fluorescence. Aldosterone content was determined by radioimmunoassay; free cortisol and testosterone were measured by luminescent LIA. Free and bioavailable testosterone concentrations in serum were calculated using an online calculator (issam.ch/freetesto.htm). The cardio-ankle vascular index (CAVI) was determined using a VaSera VS-15000N device, which automatically calculated the vascular age. Statistical analysis was performed using the Statistica 10.0 Windows package (StatSoft, Inc., USA). Results. The vascular age of patients with hypogonadism was statistically significantly ( р &lt; 0.001) higher than their passport age and the vascular age in males without hypogonadism. The CAVI and vascular age were also statistically significantly higher in males with functional hypercorticism (р &lt; 0.001) compared with a subgroup of patients without hypercorticism. The vascular age and CAVI increased with an increase in the salivary cortisol concentration 2200 (r = 0.5; р &lt; 0.05) and decreased with an increase in the salivary cortisol level 900 (r = –0.5; р &lt; 0.05). These parameters decreased with an increase in serum aldosterone obtained in the morning (r = –0.4; p &lt; 0.05) and increased with an increase in serum aldosterone in the evening (r = 0.4; p &lt; 0.05). In 23% (n = 18), an inversion of the daily rhythm of cortisol production was observed; in these patients, salivary cortisol levels of 2200 exceeded salivary cortisol levels of 900. The vascular age of patients with the inversion of cortisol production (49.4 ± 4.4 years) was statistically significantly ( р &lt; 0.001) different from that of patients with normal changes in salivary cortisol concentrations (41.9 ± 4.9 years). CAVI was also higher (р &lt; 0.001) in males with inverted fluctuations in salivary cortisol levels (7.51 ± 0.62) compared to those with normal diurnal rhythm (6.45 ± 0.69). The results of aldosterone evaluation revealed that 17% of the patients (n = 13) had higher aldosterone levels in the evening serum portion compared to the morning serum portion. In these patients, the vascular age (45.8 ± 5.1 years) was higher ( р &lt; 0.001) than that in males with normal physiologic changes in aldosterone levels (41.6 ± 5.7 years). A similar pattern was observed when comparing vascular stiffness indices. Thus, the CAVI in men with inverted changes in aldosterone concentration (6.9 ± 0.8) was significantly higher ( р &lt; 0.001), compared to that in men with physiological changes in blood aldosterone levels (6.4 ± 0.8). Conclusion. Endocrinologic disorders in male patients with visceral obesity and concomitant arterial hypertension (functional hypogonadism, functional hypercorticism, inverted daily rhythms of cortisol and aldosterone production) contribute to the development of early vascular aging by increasing vascular stiffness.

Tactics of combined/complex treatment of patients with breast cancer with isolated metastatic lesions of supraclavicular or parasternal lymph nodes

Purpose. To evaluate the treatment tactics for patients with breast cancer (BC) with isolated metastatic lesions of the supraclavicular or parasternal lymph nodes (LNs). Material and methods. We analyzed the data of 134 patients with breast cancer, who were divided into 2 groups: 1st (n=83) – patients with lesions of the supraclavicular and parasternal lymph nodes, both isolated and in combination with lesions of any other groups of lymph nodes; 2nd (n=51) – patients with isolated or combined lesions of only subclavian or axillary lymph nodes. In group 1, lymphadenectomy was performed in 27 patients (subgroup 1A), radiation therapy of the affected lymph nodes was performed in 56 (subgroup 1B). In group 2, patients received chemotherapy for the affected lymph nodes. Results. Survival after 1 year of observation was almost the same in subgroups 1A (surgical treatment of lymph nodes) and 1B (radiation therapy of lymph nodes) – 96.3 and 96.4%, respectively; after 3 years of observation – 77.8 and 80.4%, respectively; 5-year survival rate – 33.3 and 44.6%, respectively. However, the data obtained were statistically unreliable. Conclusion. When comparing 5-year overall survival, surgical removal of metastatic supraclavicular and parasternal lymph nodes is inferior to radiation therapy. Thus, it can be assumed that excluding the surgical stage of LN treatment does not worsen the results of therapy in the group of patients with breast cancer and metastatic lesions of supraclavicular or parasternal LNs.

Tactics of combined/complex treatment of breast cancer patients with isolated metastatic lesion of supraclavicular or parasternal lymph nodes

The article presents data on 134 breast cancer patients who were diagnosed with lesions of the parasternal, supraclavicular, subclavian and axillary lymph nodes. The effectiveness of surgical or radiation exposure to the supraclavicular/parasternal lymph nodes in their metastatic lesion was analyzed. The survival assessment showed that after 1 year of follow-up, the values of the indicator were almost the same, amounting to 96.3 and 96.4 %, respectively, in groups 1A (surgical treatment) and 1B (radiation therapy). After 3 years, the indicator value was slightly higher in subgroup 1B – 80.4 %, while in group 1A it was 77.8 %, 5-year survival in group 1A was at the level of 33.3 %, in group 1B the indicator value was higher and amounted to 44.6 %, in group 2–78.4 %. At the same time, there were no statistically significant differences in all the terms of the study. We believe that the results of our study are fully consistent with the current trend in the treatment of breast cancer, which can be defined by the phrase ‘the less surgery, the better’. According to our data, surgical removal of metastatically altered supraclavicular and parasternal lymph nodes is inferior to radiation therapy when comparing 5-year overall survival.

Risk factors for development of type 2 diabetes mellitus in patients with obesity in late post-COVID period

Objective. To study the risk factors for developing type 2 diabetes mellitus in patients with obesity after COVID-19. Materials and methods. 61 case histories and outpatient card abstracts of patients with obesity, who suffered from moderate and severe forms of COVID-19 from 02.2021–04.2022 were analyzed. Demographic, laboratory and clinical parameters were studied during hospitalization and 12 months after discharge from the hospital. All patients initially were divided into 2 groups according to the glycated hemoglobin level. Group 1 consisted of 46 patients with prediabetes and group 2 included 15 patients without carbohydrate disorders. Results. The median age of all patients was 64 (59–66) years. Median of HbAlc was 6,0 (5,6–6,2) %, BMI –34 (33–35) kg/m2. 24 patients from group 1, who took DPP-4-inhibitors in early post-COVID-19 period constituted subgroup 1A and 22 patients, who refused treatment with these drugs, constituted subgroup 1B. Currently, 2 patients from subgroup 1A and 10 patients from subgroup 1B (χ2=8,2 р=0,004) have been diagnosed with DM2. In patients who developed DM2 in late post-COVID period the levels of HbAlc, fasting plasms glucose and BMI at the time of admission to the hospital were significantly higher (n=12) than in patients with persistent prediabetes (n=34), (p0,05). Positive correlation between these parameters and the risk of developing DM2 (R=0,5, p0,05; R=0,74, p0,05; R=0,54, p0,05, respectively) was determined. In group 2, DM2 is currently diagnosed in 2 male patients with BMI over 40 kg/m2. When comparing subgroup 1B and group 2, it was found out that DM2 in the post-COVID period occurs in every second patient with the previous initial carbohydrate disorders: in 10 people of 22 – in subgroup 1B (every 2nd patient) versus 2 patients from group 2 (every 7th patient), (χ2=4,2, p=0,04). Online calculator from medstatistic. ru was used to determine relative risk (RR). Conclusions. Thus, presence of impaired glucose tolerance increases the risk of development of DM2 in late post-COVID period. In patients with hyperlycemia on hospitalization for COVID-19, who did not receive incretin therapy (subgroup 1B) risk of DM2 was 3,4 times higher (CI 95 %=0,87–13,40). Patients, who received incretin (subgroup 1A) had risk of DM2 = 0,6 (CI 95 %=0,09–3,97). It should be assumed that incretin therapy prevents development of DM2 in patients with hyperglycemia/impaired glucose tolerance after COVID-19.

Перименопаузальные расстройства у женщин после COVID-19

Aim: to assess the health-related quality of life (HRQOL) of women with perimenopause after COVID-19 and to determine the possibilities of hormone replacement therapy (HRT) in the postcovid period. Patients and Methods: 96 female patients aged 45 to 54 years were examined. Group 1 consisted of 52 female patients who were being treated in a hospital for COVID-19 12–16 weeks before study. Group 2 (comparison group) consisted of 44 female patients without COVID-19. Further, HRT was performed in 21 female patients of group 1 without contraindications (subgroup 1A). HRT regimen: estradiol hemihydrate, 1.58 mg, transdermally sequestered and dydrogesterone, 10 mg, per os. In subgroup 1B, 31 female patients did not undergo HRT. All patients were examined, which included the following: survey, follow-up, hormone blood test and hemostasiogram. HRT efficacy was evaluated after 3 months. Results: group 1 had more significant neurovegetative, psychoemotional and metabolic disorders, as well as an increase in the frequency of menstrual disorders versus group 2. In group 1, 43/52 (82,7%) of the respondents experienced hot flashes, where 23/52 (44,2%) of female patients noted the first occurrence of hot flashes after suffering COVID-19. In group 2, 16/44 (36,3%) of patients were concerned about this symptom. In group 1, 42.3% (22/52) of patients reported menstrual disorders. In patients of subgroup 1A, the severity of neurovegetative, metabolic and psychoemotional disorders decreased after HRT versus those in subgroup 1B. Conclusion: in female patients who suffered moderate to severe COVID-19, perimenopausal disorders include more significant neurovegetative, psychoemotional and metabolic symptoms. Cyclic HRT using transdermal estrogens significantly improves the life quality of women, however, the unfavorable comorbid background observed may reduce the effect of hormone therapy KEYWORDS: perimenopause, menopausal syndrome, COVID-19, postcovid syndrome, modified Kuperman Index, hormone replacement therapy FOR CITATION: Irgasheva S.U., Nadirkhanova N.S., Azamkulova N.O. Perimenopausal disorders in women after COVID-19. Russian Journal of Woman and Child Health. 2024;7(2):110–115 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-4.