Bulletin of Russian State Medical University

Preventive healthcare encompasses a broad range of medical and social interventions aimed at protecting and promoting public health, averting diseases or reducing the risk of their development. Preventive measures seek to create conducive working conditions and good resting environment, promote physical exercise, healthy nutrition, personal hygiene and sanitation, and eventually improve the well-being of the population. This article reviews a number of research works into the impact of various factors on the health of adults and children. Based on their findings, we propose measures for reducing the effects of harmful factors and incorporating positive factors in our daily life. The model of preventive healthcare adopted in Russia is aimed at preventing adult and child morbidity, increasing life expectancy, promoting positive attitude to health, and creating safe environment.

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Early detection of dorsopathies is an urgent task for primary care physicians, since such conditions can combine with other chronic noncommunicable diseases (NСD) and adversely affect the course all comorbidities, consequently disimproving the quality of life of patients and increasing the frequency of their requests for medical assistance. This study aimed to determine the value of routine checkups in the context of detection of dorsopathies, NCD, and identification of risk factors (RF). We have retrospectively analyzed the patient records database of a rural outpatient clinic in the Tver region (years 2015 to 2017). The prevalence of dorsopathies and NCD RF were the subjects investigated. Fisher's exact test and Spearman's rank correlation coefficient (SRCC) were applied for the purposes of statistical processing of the results. We discovered that dorsopathy most often was a comorbidity to arterial hypertension and gastrointestinal tract diseases; it was strongly related to the NCD (SRCC = 0.506), age (SRCC = 0.383), slightly less so - to hypodynamia (SRCC = 0.146), type of the patient's occupation (intellectual or physical labor) (SRCC = 0.07). Routine checkups improve the rate of detection of dorsopathy: the more patients undergo such examinations, the more cases of dorsopathy are diagnosed. Thus, it is necessary to increase the number of working people attending the checkups in order to detect dorsopathies early and prevent them effectively.

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Today, a dentist can make use of any of the multitude of methods to forecast treatment effectiveness, restoration lifetime, new caries lesions development risks. However, at the national level we see no studies dedicated to evaluation of clinical effectiveness of the majority of those methods. Having analyzed the available literature, we selected CAMBRA caries development risk assessment method and made it a goal of this study to evaluate its effectiveness while also seeking to develop the most effective treatment plan. We examined 126 young adults without concomitant somatic pathologies and divided them into treatment and control groups; treatment group was then further subdivided into 3 groups depending on the risk of caries development. All patients had their teeth and tissues of the oral cavity treated following the developed and the classic plans, accordingly. After 12 months, follow-up examinations of the treatment group revealed new caries lesions in 34 (43.5%) patients, while 40 (51.3%) were diagnosed with periodontal diseases. In the control group, we found new cavities on the teeth of 25 (52.1%) patients and periodontal pathologies in 28 (58.3%) study participants. This research shows that CAMBRA and the developed treatment plan can decrease the rate of caries development in young adults.

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In a number of occupations, there is a shortage of labor force that can be filled with economically active part of the population, including people with disabilities (handicapped, HC). Unfortunately, observance of hygienic requirements in the context of HP adolescents vocational training has not been studied sufficiently: most scholars have researched only the conditions of teaching healthy adolescents. This study aimed to examine the HC adolescents vocational training conditions and develop measures to improve their working conditions with pathologies factored in. We examined adaptation potential, anxiety level, mental efficiency, sick rate and personal well-being assessment in HC adolescents (n = 120) aged 16-18, not impaired intellectually, studying sewing equipment operation, shoe repairs in the boarding scool. In the context of the study, we applied Smirnov hygiene criteria, Giessen Symptom Questionnaire, Spielberger's Test Anxiety Questionnaire, Sivkov scale, correction tables, Baevsky adaptation index. For the purposes of statistical analysis, we used parametric (Student t-test) and non- parametric (Mann-Whitney) criteria. The Spearman's correlation coefficient helped determine interrelationship of the studied parameters. We identified the following key adverse hygienic factors that have a significant impact on the students' health: intense character of labor performed, insufficient artificial lighting, noise level above the norm, high content of organic solvents and dust in the workshop's air. The timetable of the boarding school was also found to be inefficient. The results of this study allowed developing and introducing a software program to automatically compile the school's timetable with the aim to improve psychosomatic health of the students and halve the number of health-related complaints.

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In their daily life teachers go through a lot of stress ensuing from abrasive relationships with the administrative staff, colleagues or students, and family conflicts. Long-term exposure to stressors leads to the syndrome of emotional burnout, which can be avoided is preventive care is taken. The aim of this study was to identify burnout symptoms in the humanities teachers working for higher educational institutions and to propose adequate preventive measure. We recruited 1,489 teachers who were offered to anonymously fill out a questionnaire and also collected information about their health from sickness leaves. Statistical analysis included calculation of means, their errors, intensive and extensive variables, and confidence intervals. Two in three teachers reported fatigue, regular back/chest pain, and headache. The use of a scoring scale allowed us to conclude that a lot of respondents (43.2%) had severe burnout symptoms. Every second teacher demonstrated poor health awareness. To prevent staff burnout, measures should be taken aimed at stimulating a positive attitude to medical care, improving health literacy and motivating teachers to lead a healthy lifestyle.

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The growing incidence of nutrient-related diseases is a global challenge. The aim of this work was to study consumption of staple food products and to estimate the incidence of nutrient-related diseases in Voronezh region. Food consumption was analyzed from the reports of the local branch of the Federal State Statistics collected over two 5-year periods (1995-1999 and 2012-2016). The incidence of nutrient-related diseases was estimated based on the reports providing information about patients’ visits to healthcare facilities. The districts of Voronezh region were assigned to 5 ranks. Over the studied periods, the population of Voronezh region considerably changed its diet: consumption of fish and seafood, fresh fruits, meat, vegetables, gourds and melons, eggs, vegetable oil, milk and dairy products per person increased significantly. At the same time, consumption of sugar, breads and potatoes still exceeds the recommended intake 1.42-2.04-fold, which means that the main component of the diet is carbohydrates. We observed a significant 4.5-fold increase in obesity incidence, a 1.8-2.0-fold increase in the incidence of anemia and endocrine disorders and a 1.2 increase in the incidence of gastrointestinal diseases. In terms of prevention measures, the priority should be given to areas at a high risk of nutrient-related diseases.

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Among the factors that have a strong impact on public health the environment, living conditions, food and water quality are just as important as socio-economic forces. Providing the population with access to safe potable water has become a socio- economic priority in Russia. The aim of this work was to characterize the aquifers supplying the population of Ryazan region with water for personal and domestic needs and to compare their chemical composition. Sample collection was performed in cooperation with the Center for Hygiene and Epidemiology (Ryazan region). The obtained data were processed using ANOVA. The Kashirsky and Ozersko-Khovansky aquifers turn to be the most commonly used ones supplying water to 30.7% and 27.3% of the total artesian wells. The Oksko-Tarussky and Podolsko-Myachkovsky aquifers rank second, feeding 21% and 18.9% of the wells, respectively. The share of the Kasimovsky aquifer in the total water supply is only 2.1%. Although the recommended lifespan of an artesian well is 25 years, two-thirds of the wells in Ryazan region have been in service for 26 to 50 years, and one in every 4 wells is over 50 years old. The chemical composition of the groundwater drawn from different aquifers is different. High concentrations (0.7 mg/l) of iron (Fe2+) are present in the water from the Ozersko-Khovansky aquifer (р ≥ 0.05). Sulfates are found in abundance in the Podolsko-Myachkovsky and Ozersko-Khovansky aquifer. The water from the Oksko-Tarussky aquifer contains high concentrations of ionized ammonia.

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Present day education routines subject schoolchildren to considerable loads associated with studying. This research effort aimed to study the effect attention switching physical exercises (the type peculiar to the mental arithmetic curricula) have on heart rate, adaptation abilities, stress resistance, higher mental functions and conditioned reflex activity of children. Examining 124 schoolchildren aged 7-9 and 10-12 years, we applied the pedagogical experiment method that includes benchmarking, formation and control stages, as well as a number of psychological methods: short-term, associative and image memory diagnostics; Bourdon-Wiersma test; search for logical solutions; evaluation of motor skills. Varicard 2.51 was used to assess functions of the cardiovascular system and other physiological state indicators. At the benchmarking stage, we discovered the differences in higher mental functions conditioned by age and gender. Girls aged 7-9 had their memory, attention, ideation indicators 20-40% higher than boys of the same age. Boys aged 10-12 had their higher mental functions developed 10-30% better than girls of the same age. At the formation stage, we registered the optimizing effect attention switching physical exercises have on information processing speed and memorizing effectiveness: corresponding indicators increased 1.5-2 times (7-9 y.o., both genders) and 1.2-1.5 times (10-12 y.o., both genders), accordingly. It was concluded that adding the attention switching physical exercises to mental arithmetic curricula makes training sessions more effective.

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Pediatric urinary disorders manifested as urinary incontinence, compelling urges to urinate, etc. remain an important problem of contemporary healthcare. In spite of being extensively covered in the literature, urinary disorders, including enuresis, still present a diagnostic challenge to the physicians of primary healthcare facilities. Based on the findings of our retrospective study that revealed discrepancies between referral and final diagnoses of pediatric urinary disorders, we give recommendations to both physicians of primary healthcare facilities and their inpatient care colleagues that will help them to arrive at the correct diagnosis of a urinary disorder or concomitant bladder-bowel dysfunction using the proposed diagnostic algorithm.

Contrast-enhanced radiotherapy (CERT) is a binary treatment modality in which the absorbed radiation dose is not only determined by the parameters of the external radiation source but also affected by the concentration of a dose-enhancing agent (DEA) in the studied object. In this work we assessed the distribution of the absorbed dose in a murine B16F10 melanoma injected with a single dose of an aqueous Bi-DTPA solution. The mice were exposed to a single fraction of X-ray irradiation for 28.5 min. In vivo measurements of DEA concentrations were done on a micro-CT scanner using the radiopacity values of malignant tissues from the obtained CT images. We found that the presence of DEA enhanced the absorbed dose more than twofold in 6% of the tumor volume; in 29% of the tumor volume the absorbed dose increased more than onefold. The tumor growth delay time calculated for our model was 0.76 days (we only accounted for the damage caused directly by radiation), whereas in our previous research study tumor growth delay was 10 days. This discrepancy may indicate that in the tumors exposed to contrast-enhanced radiotherapy growth delay results from both the damage directly caused by radiation and other antitumor mechanisms.

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Research into the effects of radiation delivered at ultrahigh dose rates > 1 × 107 Gy/min to biological objects is a new promising area of radiobiology. The unique characteristics of the high-current nanosecond electron accelerator Mir-M enable its use in medical and biological research, specifically in the experiments aimed at investigating the effect of therapeutic doses at a dose rate up to 100 MGy/s. In this work we study the effects of ultrahigh dose rate photon radiation on human lung carcinoma (A549) and melanoma (MelMtp-x) cells lines and compare them with those of the therapeutic gamma unit Rokus-AM. We show that ultrahigh dose rates induce more significant damage in the studied cell lines at doses between 2 and 7 Gy, radioresistant melanoma being more sensitive to photon radiation delivered at ultrahigh dose rates.

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In the last decade there has been a tendency to move away from the symptomatic treatment and embrace targeted therapies. This process is underpinned by the accumulated knowledge of the mechanisms underlying the pathogenesis of diseases and driven by the advances in biotechnologies. T-cell receptors with variable TRBV9 β-chain regions have been recently associated with spondyloarthritis including its subtype, ankylosing spondylitis. The aim of this work was to engineer a chimeric monoclonal antibody targeting the variable region of the T-cell receptor β-chain encoded by the TRBV9 gene segment and assess its specificity and cytotoxicity. Using flow cytometry and next generation sequencing, we demonstrate that the engineered chimeric antibody is highly specific and exhibits cytotoxic activity against its target. Approaches based on the use of therapeutic chimeric antibodies against pathogenic T-clones may hold great promise for the therapy of autoimmune disorders in general and AS in particular.

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The actual prevalence of genetic variants causing familial hypercholesterolemia (FH) in every population remains unknown. The aim of this work was to determine the spectrum of pathogenic variants in patients with acute coronary syndrome (ACS) and clinically diagnosed FH using targeted sequencing. We selected 38 patients with ACS from the sample of 2,081 participants of two multicenter observational studies (2004-2007; 2014-2016) who had a clinical diagnosis of FH based on the Dutch Lipid Clinic Network score and Simon Broome criteria. The men and women included in the study were ≤ 55 and ≤ 60 years of age, respectively. Molecular genetic screening was done by targeted next-generation sequencing. We started by sequencing 3 genes associated with FH, including LDLR, APOB, and PCSK9. If no relevant variants were detected, the panel was expanded. Of 38 patients, 24 (63.2%) were shown to have mutations that could cause clinical manifestations of FH and premature coronary artery disease. All patients were heterozygous carriers. Mutations were detected in three “classic” genes LDLR, APOB, and PCSK9 associated with FH, as well as in other genes involved in lipid metabolism, such as APOE, ABCA1, ABCG5, ABCG8, LPL, ANGPTL3, and MTTP. Five variants detected in our study sample had not been described previously: the pathogenic p.Val273_Cys313del variant of the LDLR gene, the likely pathogenic p.Arg160His variant in the APOE gene, two variants of uncertain significance p.Glu612Lys and c.*415G>A in the PCSK9 gene, and the mutant variant p.Ala776Ser in the LDLR gene. We conclude that the use of clinical diagnostic criteria in patients with ACS and FH enables identification of carriers of both “classic” mutations associated with FH and rare genetic variants that can be phenotypically expressed as FH.

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Modern biomedical research technologies actively use bioimaging for studying cells, tissues and whole organisms. Multicolor bioimaging is applied when simultaneous observation of different events at the molecular and cellular level is needed. Bioluminescent imaging methods are the most sensitive, however, their use for multicolor labeling is complicated due to the insufficient number of available uciferin-luciferase pairs. Having a number of advantages compared to previously studied bioluminescent systems, the new bioluminescence systems of higher fungi and marine polychaete Odontosyllis could become a useful expansion of the bioimaging toolbox.

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Palpation is one of the classic examination methods in open surgeries. In minimally invasive surgery, intra-operational manual palpation is impossible to use for assessing tactile characteristics of tissues. In Russia, the only available instrument for intra- operational assessment and objective registration of tissue visco-elastic properties is the Medical Tactile Endosurgical Complex (MTEC). The aim of this work was to study the performance of MTEC in renal surgery. The study was performed during nine elective laparoscopic surgeries for clear cell renal carcinoma and simple renal cysts. We have found several differences in the use of MTEC in renal surgery, as compared to its use in gastrointestinal or lung surgeries. The key factor determining these differences was the inverse relations between tissue visco-elastic properties: the studied tumors were softer than the surrounding tissue. Detection of intraparenchymal tumors by tactile methods was impossible. For surface tumors, in one case out of nine it was possible to strictly locate the border of the tumor by tactile examination. We were able to quantitatively assess and determine the difference in hardness of tumors and intact tissue using MTEC. This allows studying the prognostic value of objectively registered tactile characteristics of renal tumors.

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Aurumacryl is an incomplete metal salt of poly(acrylic acid) that exhibits hemostatic activity and inhibits the growth of transplantable carcinomas in vivo. The samples of aurumacryl synthesized following the original technique are insufficiently soluble, which complicates the study of the mechanisms involved in their synthesis and underlying their cytotoxic effect. The aim of this work was to study the impact of the following factors on aurumacryl properties: the molecular weight of the polyacrylate polymer in a range between 2 and 1,000 kDa, the presence of a counterion H+ or Na+, the molar ratio of AuCl- to the polyacrylate polymer (1 : 5 and 1 : 10), the total concentration of the polyacrylate polymer during synthesis (0.1 and 3%), and the type of drying (lyophilization). By comparing the cytotoxicity of aurumacryl samples with significantly different molar ratio of gold ions to the polyacrylate polymer against human breast carcinoma cells (MCF-7), we established that the proportion of the polymer and its molecular weight in the sample do not affect the biological properties of the synthesized substance. Using UV spectroscopy, we revealed that the concentration of Au (III) ions in aurumacryl determines its cytotoxicity.

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Rivaroxaban is a safer and more effective alternative to warfarin. However, there are reports of some cases of major hemorrhagic complications associated with rivaroxaban that significantly impair the patients' quality of life and can lead to a fatality. Personalized therapy, including pharmacogenetic testing, may help prevent such adverse events. This study aimed to investigate how ABCB1 3435C>T (rs1045642) and CYP3A5 6986A>G (rs776746) gene polymorphisms, when carried by a patient taking rivaroxaban to prevent thrombosis after total hip or knee replacement surgery, affect prothrombin time (PT). Sixty-five patients participated in the study. Their genotypes were identified by PCR in real time. To learn PT peculiar to each patient, we collected venous blood on the 5th day of their anticoagulation therapy, 1 hour before they took rivaroxaban and 3 hours after. Having calculated %∆PT, we divided the patients into 2 groups: 1) %∆PT ≤ 0 (n = 7; 10.8%); 2) %∆PT > 0 (n = 58; 89.2%). Regarding the distribution of rs1045642 polymorphism, we determined the difference between the groups to be statistically significant (χ2 = 6.64; p = 0.027). As for rs776746 polymorphism, the difference was insignificant (χ2 = 0.101; p = 1.0). We discovered that rs1045642 polymorphism has a significant effect on PT variance in patients taking rivaroxaban to prevent thrombosis after total hip or knee replacement surgery.

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