CLINICAL AND EXPERIMENTAL MEDICINE
The article provides an overview of the current data on the quality of life in cancer patients, as well as the functional results of radical treatment of prostate cancer. The main goal was to evaluate the functional results in patients after radical prostatectomy, combined radiation therapy, and high dose-rate brachytherapy in 8 to 12 months after treatment. The study included 148 patients treated from 2017 to 2018. The life quality was assessed by specialized questionnaire. The obtained results indicate the better functional results and a higher level of the quality of life of patients after radiation therapy, compared with radical prostatectomy.
In the article, clinical experience of surgical treatment of 239 patients with complex segmental (segmental type C2) and complex irregular (irregular type C3 according to the AO classification) diaphysial fractures of tibia is studied. 215 (89.9 %) patients had Ilizarov’s external fixator and 24 (10.1 %) patients had blocked intramedullary nailing. The article determined the algorithm of preoperative and postoperative management, surgical treatment depending on the nature of bone tissue damage, the size and nature of wounds in open fractures, and the degree of damage to soft tissues in closed fractures.
The objective of the article was to determine the variability of meningococcal house-keeping gene alleles circulating in Belarus. House-keeping genes sequencing was made by Sanger (ABI 3500). The phylogenetic analysis was done in MEGA X. SNPs were analyzed at pubMLST.org. 60 Belarusian meningococci, collected during 8 years, contain 17 alleles of abcZ gene (5.9 % first identified in Belarus – abcZ 1016) encoding 5 variants of the ABC transporter; 16 adk gene alleles – 2 variants of adenylate cyclase; 17 alleles of aroE gene (11.8 % Belarusian – aroE 944 and aroE 972) – 14 variants of shikimat dehydrogenase; 24 alleles of fumC gene (4.2 % Belarusian – fumC 988) – 4 variants of fumarate dehydratase; 18 alleles of gdh gene (16.7 % first identified in Belarus – gdh 560, gdh 985 and gdh 1083) – 4 variants of glucose-6-phosphate dehydrogenase; 18 alleles of pdhC gene – 11 variants of pyruvate dehydrogenase subunit and 20 alleles of pgm gene – 13 variants of phosphoglucomutase (5.6 and 5 % of Belarusian alleles − pdhC 888 and pgm 1099 respectively). Dominant alleles are abcZ 8 – 25 %, adk 5 – 30, aroE 6 – 28.3, fumC 17 – 30, gdh 560 – 20, pdhC 18 – 21.7, pgm 2 – 25 %. The Belarusian meningococcal population is diverse and includes both its own house-keeping gene alleles (7.7 %) and those circulating in other countries (92.3 %). The number of SNPs is varied from 29 (adk) to 125 (aroE). Single nucleotide polymorphisms are mostly synonymous and, on average, lead to amino acid substitutions in the range from 0.6 % in adenylate cyclase and up to 26.4 % in shikimat dehydrogenase.
Choroid melanoma belongs to malignant tumors. The choice of treatment modality depends on a tumor size and site, ocular tunics conditions, clinic logistics, and the patient’s will. The aim of the study was to evaluate the effectiveness of treatment of patients with choroid melanoma. The data of the Belarusian Cancer Registry and the case histories of patients with choroid melanoma (C69.3, ICD-10) over the period of 1999–2018 were studied. The incidence rates were evaluated on the basis of the analysis of the absolute number of persons taken ill with the disease, crude intensive rates calculated per 1,000,000 of population. To calculate the survival, the disease-specific cumulative 5-year survival rate was used. Significance evaluation was made applying the chisquare test. The incidence rates varied over the 20-year period and were 0.9 ‰ on the average. Enucleation was performed in 724 patients, 13.9 % (101 patients) being registered with synchronous and metachronous cancer. Patients with a sole tumor of choroid melanoma were analyzed. The amount of enucleations performed decreased by a factor of 1.8. To evaluate the survival, the groups of patients with large tumors were formed after enucleation and combination treatment was carried out. Of 623 patients subjected to enucleation, disease progression was established in 159 (25.5 %). Of 159 patients, the onset of disease progression occurred in 25 (15.7 %) in the 1st year, in 50 (31.5 %) in the 2nd year, and in 84 (52.8 %) in the 4th year and later. In the combination treatment group, consisting of 58 patients, decease progression was ascertained in 10 (17.2 %): in the 1st year – in 1 (10.0 %), in the 2nd year – in 6 (60.0 %), and in the 4th and later – in 3 (30.0 %). The survival rate after the organ-sparing treatment is insignificantly higher and increases to the 5th year of the follow-up, although the data are statistically insignificant (p > 0.5). At present, enucleation does not play the leading role in the choice of treatment modality for patients with clinical diagnosis of choroid melanoma. The disease-specific cumulative 5-year survival rate in patients receiving organ-sparing treatment was 85.7 ± 5.1 %, and in those subjected to enucleation – 67.2 ± 2.2 %, the data being statistically insignificant (p > 0.5). The promising trend in treating choroid melanoma patients is the development of organ-sparing treatment techniques.
The aim of the study is to identify the relationships between the functional state of vascular endothelium and regional cerebral blood flow in people of working age with moderate to severe obstructive sleep apnea syndrome. A transverse prospective observational study was conducted. It included 24 patients. Among them were 16 patients of working age with moderate to severe obstructive sleep apnea syndrome who were included in the main study group and 8 patients without sleep disorders in the control group according to polysomnography. The levels of biochemical markers of endothelial dysfunction, the indicators of endothelium-dependent vasodilation of the brachial artery were determined. Single-photon emission computed tomography of the brain was performed using 99mTc-hexamethylpropyleneaminoxime. In the patients of working age with moderate to severe obstructive sleep apnea syndrome, significantly lower average group values of the serum nitric oxide level of 11.7 (6.25‒18.30) μmol/l were detected versus 34.4 (25.33‒41.70) μmol/l in the control group, p < 0.01), as well as higher homocysteine concentrations of 19.4 (15.13‒23.76) μmol/l versus 11.6 (6.40‒ 14.71) μmol/l in the control group, p < 0.05, sP-selectin 176 (142.0‒189.0) ng/ml versus 122 (113.3‒168.5) ng/ml in the control group, p < 0.05, and sE β-selectin 78 (69.0‒121.0) ng/ml versus 52 (43.1‒73.3) ng/ml in the control group, p < 0.05. The data on the correlation of the level of neurohumoral markers of endothelial dysfunction of sP-selectin (p < 0.01) and sE-selectin (p < 0.05) with the degree of impaired regional cerebral blood flow were obtained. A direct relationship was found between the markers of endothelium-dependent vasodilation and regional cerebral blood flow in the frontal segments (p < 0.05), the temporal segment on the right (p < 0.05).
The effects of complex compositions, containing branched-chain amino acids (BCAA), taurine and tryptophan, on the pool of free amino acids in the liver of rats were studied under the conditions of subchronic alcohol intoxication (SHAI). It was established that SHAI led to the decreased levels of treonine, lysine, oxyproline, arginine, b-alanine, as well as the depletion of the pool of irreplaceable amino acids in the liver of rats. Administration of the composition of BCAA and taurine was found to normalize the ratio of replaceable irreplaceable amino acids, the ratio of glycogenic and ketogenic amino acids, to activate the reaction of nitrogen utilization, and to increase Fisher’s index. The effects of the composition, containing BCAA, taurine and tryptophan, were similar to those of amino acid composition that did not contain tryptophan.
The goal of the study was to analyze the upper respiratory tract condition indicators obtained by means of сone beam computed tomography (CBCT) for patients with dentition system diseases and obstructive sleep apnoea syndrome. Patients were divided into 3 study groups. The control group (the 1st study group) included the CBCT data obtained for 33 healthy patients. The 2nd study group included the CBCT data obtained for 136 patients with dentition system diseases (partial secondary edentia combined with chronic generalized periodontitis) without sleep disorder signs. The 3rd study group included the CBCT data obtained for 70 patients with partial secondary edentia combined with deep distal occlusion and obstructive sleep apnoea syndrome (OSAS). The CBCT method using the proposed diagnosis criteria made it possible to identify not only dentition system diseases, but also the dysfunction of the upper respiratory tract, in particular the OSAS causes. It was found with confidence that the reduction of the upper respiratory tract diagnostic indicators by 40 % or more, as compared to the regulatory indicators of healthy patients, led to the dysfunction of the respiratory tract and the apnoea development. Deep distal occlusion and secondary edentia conditioned the presence of the upper respiratory tract concave configuration and the localization of the minimum cross-sectional area below the occlusion plane, which increases the probability of development and progression of the obstructive sleep apnoea syndrome.
Modern medicine faces the problem of a steady growth of cardiovascular pathology. Given the high medical and social significance of the problem of treating patients with coronary heart disease and acute myocardial infarction, the search for new effective methods to prevent or mitigate ischemic myocardial damage and mechanisms for their implementation is an urgent task of modern experimental and clinical medicine. The aim of the study was to determine the significance of nitric monoxide in realizing the infarction-limiting effect of remote ischemic postconditioning (RIPostC) in myocardial ischemia-reperfusion in young and old rats. The study revealed that RIPostC has a heart attack-limiting effect in myocardial ischemia-reperfusion in both young and old rats; however, under the conditions of the systemic action of the NG-nitro-L-arginine methyl ester inhibitor at a dose of 25 mg/kg (intravenous administration 5 min before the start of reperfusion and 15 min before RIPostC), the effect remains, although not completely, in old rats but not in young rats. Apparently, the NO synthase activity and the blood level of nitric monoxide play a more significant role in the mechanisms of the cardioprotective effects of RIPostC in young rats than in old rats.
The aim of the present research was to assess the expression of melatonin receptors (MTNR1B) in the esophageal mucosa in the gastroesophageal reflux disease associated with obstructive sleep apnea/hypopnea syndrome and to study the relationship between the detected changes and the sleep apnea severity. 84 patients aged 30–60 years, including those with gastroesophageal reflux disease (group 1, n = 25), those with gastroesophageal reflux disease associated with sleep apnea/hypopnea (group 2, n = 23), those with obstructive sleep apnoe/ hypopnoe syndrome (group 3, n = 18), and almost healthy people (group 4, n = 18), were studied. Diagnoses were based on endoscopic imaging and respiratory monitoring. The MTNR1B expression in the esophageal mucosa was determined by the immunohistochemical method using specific antibodies. The MTNR1 B expression was evaluated quantitatively using the computer program Aperio ImageScope _v9.1.19.1567. The obtained material was analyzed statistically using the software Statistica 10.0. The group 2 patients were shown to have a higher MTNR1B expression compared to the group 1 patients (0.122 [0.064; 0.266] versus 0.620 [0.332; 0.983]; p = 0.00001) and the group 3 patients (0.620 [0.332; 0.983] versus 0.232 [0.120; 0.418]; р = 0.0098). The MTNR1 B expression increased with growing sleep apnea severity: it is 0.295 [0.198; 0.403] in patients with mild apnea versus 0.941 [0.345; 0.992] in patients with moderate and severe apnea (p = 0.0021). A direct correlation between the MTNR1B expression and the sleep apnea severity degree (r = 0.50; р = 0.0016) was revealed. Patients with gastroesophageal reflux disease combined with sleep apnea revealed an increase in the MTNR1 B expression associated with the apnea severity. The revealed features of the MTNR1 B expression secondary to esophageal mucosal damage indicate the MTNR1 B inactivation secondary to accompanying apnea of hypoxia.
REVIEWS
Untreated damage to the anterolateral ligament of the knee is one of the residual rotational instability causes in patients with the ruptures of the anterior cruciate ligament after its perfect surgical reconstruction. The contribution of anterolateral ligament damage to rotational instability of the knee, its anatomical features, diagnostics and treatment have been widely discussed in the literature in recent decades. However, the insights in the fundamental issues of its anatomy and functional anatomy, and therefore the reconstruction methods and expediency are diametrically positive. Differences in the anatomy data lead to the uncertainty in diagnostic criteria and optimal treatment options. Anterolateral ligament in its nature is beyond the current-day diagnostic capabilities of magnetic resonance imaging. We have identified the reasons for disagreement among the researchers in the anatomy of an anterolateral ligament, the best ways to diagnose and treat its damage. We have suggested the ways to address these issues in this article.
SCIENTISTS OF BELARUS
ISSN 2524-2350 (Online)