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Purpose. Conduct a comparative analysis of corneal tissue–engineered constructs that have undergone cryopreservation of three different cryoprotectants. Materials and methods. After refractive surgery Relex SMILE, corneal tissue was obtained which is called a lenticule. Corneal tissue engineering constructs (RTK) have created using decellularization methods that relate to the technologies of tissue and regenerative medicine. For decellularization of the lenticules, a protocol with a 1.5 M solution of Sodium Chloride with DNase 5 U / ml and RNase 5 U / ml was used. After decellularization, RTK was cryopreserved using: 1) 10% DMSO and 90% “corneal storage solution” (Borzenok–Moroz medium), 2) «Cryoderm» cell cryopreservation medium, 3) 100% glycerin. Transparency was assessed using spectrophotometry. The thickness of collagen fibers was assessed by scanning electron microscopy (SEM). Results. When assessing the transparency of the control and experimental groups, a statistically significant decrease in transparency was revealed in the groups using cryoprotectants – Glycerin and Cryoderm (p0.05). The Glycerol–Control group was statistically different (p

Aim: to study the possibilities of diagnostic radiology methods for changes in metaphyses and epiphyses at an early stage of the inflammatory process in children aged 1 and older and adolescents. Patients and Methods: 76 emergency patients with a diagnosis of acute metaepiphysial hematogenous osteomyelitis were examined using standard radiography (SR), ultrasonography (US), magnetic resonance imaging (MRI) and computed tomography (CT). The age of the patients ranged from 1 to 18 years. All patients in the admission department underwent US and SR with a mandatory examination of the contralateral region. After analyzing the obtained data, additional examination algorithms were formed using MRI and CT. Results and Discussion: US of the targeted area was descriptive concerning the soft tissue pathological component: paraosseous soft tissues edema was determined in 75%, structural changes of the joint, in particular, synovitis — in 78.9%, joint effusion — in 57.9%. X-ray examination had a limited opportunity to detect destructive changes in bone tissue at the early stages of the pathological process (6.6%). At the same time, MRI revealed the maximum number of semiotic signs of acute hematogenous osteomyelitis, the most significant of which were: trabecular bone marrow edema (100%), periosteal changes (96.1%) and extraosseous changes (98.5%). CT was performed in 26 patients with multifocal disease, as well as in the late stage of the inflammatory process for preoperative planning. Bone destruction at an early stage occurred in 32.7% of patients, a change in the growth area — in 81.0 % of cases. Along with these semiotic signs, sequesters (55.3 %) and fistula tracts (31.3%) were visualized. Conclusion: the obtained results made it possible to systematize information on the diagnostic radiology efficacy for acute metaphyseal and epiphyseal lesions in the early stage of the inflammatory process in children aged 1 and older and adolescents. KEYWORDS: osteomyelitis, epiphysis, metaphysis, diagnostic radiology, pediatrics. FOR CITATION: Sholokhova N.A., Olkhova E.B. On the issue of complex diagnostic radiology of inflammatory bone diseases in children at an early stage. Russian Medical Inquiry. 2021;5(5):330–334 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-330-334.

The problem of comorbidity with a high risk of polypragmasia is relevant in a large group of patients with diseases in the digestive system. Currently, the problem of comorbidity in patients with gastroesophageal reflux disease (GERD) attracts the attention of specialists due to the high disease prevalence and data indicating its association with other digestive system diseases, primarily of the hepatobiliary system. The article presents the results of clinical and experimental studies revealing the pathogenetic connections of GERD and hepatobiliary pathology accompanied by biliary dyskinesia, factors leading to an impairment of the duodenal propulsive activity. It is noted that the most important components of the esophageal mucosa lesion in duodenogastroesophageal reflux are bile acids, lysolecithin and pancreatic enzymes. The relevance of prescribing drugs that can affect the course of pathogenetically related diseases, which can significantly reduce the risk of polypragmasia, is justified. Such drugs include ursodeoxycholic acid, which, in the conditions of the GERD and hepatobiliary pathology association, contributes to the functional state normalization of the liver and biliary tract, reduces biliary dyskinesia, the severity of duodenal hypertension and duodenogastroesophageal reflux. The next example is the rebamipide cytoprotector, which has a multilateral protective effect against the mucous membrane of the GIT, including the esophagus, gastroduodenal zone, small intestine, as well as liver. The expediency of prescribing rebamipide to patients who are refractory to therapy with proton pump inhibitors is justified. KEYWORDS: comorbidity, hepatobiliary pathology, gastroesophageal reflux disease, ursodeoxycholic acid, rebamipid, proton pump inhibitors. FOR CITATION: Kazyulin A.N., Goncharenko A.Yu., Kalyagin I.E. Association of hepatobiliary pathology and gastroesophageal reflux disease. Russian Medical Inquiry. 2021;5(6):404–412 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-404-412.

Polyneuropathy is a common disorder of the peripheral nervous system. Diabetic neuropathy is the most common and most studied variant of polyneuropathies. The duration of carbohydrate metabolism disorders and inadequate glycemic control are risk factors for nervous system damage in diabetes. Distal neuropathy is a common type of neuropathy associated with diabetes. Interconnecting pathological mechanisms initiated by high blood glucose result in the damage of peripheral nerve fibers. Clinical presentations of distal neuropathy depend on the damage of proximal or distal and sensory or motor nerve fibers and the involvement of the vegetative nervous system. Medications improving metabolic processes in nerve fibers and reducing the severity of peripheral nerve damage are beneficial in addressing the harmful effects of hyperglycemia. Neurometabolic therapy includes thiamine, pyridoxine, and cyanocobalamin (B vitamins) which provide neurotropic effects. B vitamins acting as co-factors in many enzymatic reactions significantly affect the normal functioning of nerve fibers. B vitamins are effective and safe agents used to treat peripheral nervous system diseases for many years. This paper discusses the potential use of B vitamins for diabetic neuropathy and the COVID-19 treatment and rehabilitation. KEYWORDS: polyneuropathy, hyperglycemia, diabetes, distal neuropathy, B vitamins, thiamine, pyridoxine, cyanocobalamin, COVID-19. FOR CITATION: Biryukova E.V., Shinkin M.V. Clinical aspects of B vitamin use. Russian Medical Inquiry. 2021;5(9):579–585 (in Russ.). DOI: 10.32364/2587-6821-2021-5-9-579-585.

Aim: to assess the efficacy and safety of Lactogynal® to normalize vaginal microflora after antimicrobial treatment for bacterial vaginosis (BV) and to prevent recurrences of vulvovaginal candidiasis (VVC) during pregnancy. Patients and Methods: this multicenter prospective non-interventional comparative study included 100 women in the 3rd trimester of pregnancy diagnosed with acute BV (n=50) or acute VVC (n=50). 25 women of each group received standard antimicrobial treatment only. 25 women of each group received Lactogynal® as the second step of antimicrobial treatment. Women were followed up until delivery and discharge. The rate of BV and VVC recurrences before delivery was considered the key indicator of treatment efficacy. In addition, obstetrical and perinatal outcomes, compliance, the type and duration of antimicrobial treatment for BV and VVC were evaluated. Results: in women with BV and VVC who received Lactogynal®, no recurrences during the follow-up were reported (p

Clinical observations of gastrointestinal (GIT) cancer in pregnant women are presented. It is emphasized that early warning signs, typical of the initial manifestations of gastrointestinal stromal tumors, remains underestimated against the background of pregnancy. Frequently, common stages of the disease (III–IV) are detected accidentally after the manifestation of symptoms (gastrointestinal bleeding, formations palpated through the abdominal wall) or due to the detection of metastatic ovarian tumors, which manifest themselves as an independent disease. Long-term results of treatment of patients with secondary ovarian malignancies remain unfavorable. Conclusion. Pregravid training should be at the forefront and include a complete examination of patients, especially those with untypical complaints, in level 3 institutions with appropriate laboratories and modern methods of instrumental research. Key words: pregnancy, gastrointestinal malignancies, ultrasound

Aim: to evaluate the efficacy of conservative treatment in patients with degenerative meniscal tear (DMT) in the setting of knee osteoarthritis (OA) as an alternative to combined treatment. Patients and Methods: a prospective comparative study included 236 patients aged 45–65 years with DMT in the setting of stage I–III OA according to the Kellgren-Lawrence classification (70 of them — men). Group 1 consisted of 122 patients (86 of them — women) who underwent combined treatment: arthroscopy for DMT of the knee joint and complex therapy in the postoperative period: NSAIDs (celecoxib), a combined drug from the group of symptom-modifying slow-acting drugs SYSADOA (chondroitin sulfate + glucosamine sulfate), exercise therapy, physiotherapy. Group 2 (n=114) received only complex therapy. Control tests (pain assessment on the visual analog scale (VAS), WOMAC scale, life quality assessment on the EQ-5D scale, treatment satisfaction) were performed 10 and 20 weeks after the therapy initiation. Results: there was a statistically significant (p

Any antipsychotics provoke more or less ocular complications. Some of them are relatively harmless (i.e., dark eyelids, conjunctival and corneal pigmentation, mydriasis, nystagmus, dry eye etc.). These adverse effects are resolved spontaneously after treatment discontinuation, drug switching, or prescribing additional therapy. However, the intake of both typical and atypical neuroleptics, lithium salts, some anticonvulsants (e.g., topiramate) is associated with high risks of vision loss. Moreover, in some patients these medications may result in blindness. The use of psychotropic drugs (e.g., tricyclic antidepressants or serotonin reuptake inhibitors) in patients with higher risk of acute angle closure is of particular concern. The association between phenothiazines and anticonvulsants and retinopathy, chlorpromazine and cataract, anticonvulsants and poor color vision and reduced contrast sensitivity is also important. Psychiatrists and ophthalmologists should consider potential ocular side effects in patients receiving psychotropic drugs. Knowing management algorithm for these conditions is also important. The number of recent publications on this issue is limited. Therefore, articles older than 10 years are sometimes used. Keywords: eye, visual organ, adverse effects, psychotropic drugs, neuroleptics, tricyclic antidepressants, selective serotonin reuptake inhibitors, glaucoma, retinopathy, cataract. For citation: Petukhova A.A., Panov A.A., Malygin Ya.V., Kazanfarova M.A. Side effects of psychotropic drugs on eye. Russian Journal of Clinical Ophthalmology. 2021;21(1):29–33. DOI: 10.32364/2311-7729-2021-21-1-29-33.

The review considers the role of intestinal endotoxin in the pathogenesis of a number of obstetric and gynecological diseases, as well as the results of their treatment with the use of enterosorption in order to correct endotoxin aggression. The well-known methods for determining anti-endotoxin immunity and modern classification of enterosorbents were presented. The analysis of the main results of more than 30 years experience in the use of enterosorbent polymethylsiloxane polyhydrate was conducted, taking into account the mechanisms of its medical and prophylactic effects in the treatment of pre-eclampsia, arterial hypertension of pregnant women, miscarriage, endometriosis, chronic pelvic inflammatory disease, urogenital disorders, vulvar lichen sclerosus. The evaluation of therapeutic properties of the drug polymethylsiloxane polyhydrate was carried out, and prospective directions for its further use in obstetric and gynecological practice were planned. Key words: pregnancy loss, pre-eclampsia, vulvar lichen sclerosus, endometriosis, endotoxin, endotoxin aggression, enterosgel

The article presents current data on the clinical features of vulvar lichen sclerosus at both early and late stages, the need for timely diagnosis, the possibilities of local and systemic therapy, dosage regimens and its duration. Key words: kraurosis, vulvar lichen sclerosus, lichen sclerosus, topical glucocorticoids, moisturizers

This article discusses the role of various respiratory viruses in the development of bronchial asthma and in triggering its exacerbation. It covers the pathogenetic mechanisms underlying virus-induced bronchial asthma and the importance of interferons for disease control. We summarized the results of international and Russian studies analyzing the utility of type 1 interferons for children and adults with virus-induced asthma exacerbations. Combination drugs containing recombinant α2b interferon plus α-tocopheryl acetate plus ascorbic acid have demonstrated their efficacy in the prevention and treatment of virus-induced asthma exacerbations in routine clinical practice. Moreover, these drugs were safe and well tolerated by patients, which opens new prospects for patients with virus-induced asthma. Key words: virus-induced bronchial asthma, respiratory viruses, children, interferons, therapy, recombinant α2b-interferon + α-tocopheryl acetate + ascorbic acid

Modern research indicates the presence of living bacteria in atherosclerotic plaques. However, the potential of microbes in the formation of biofilms in arterial plaques has not been studied. Purpose of the study. Identification of biofilms on fragments of arterial vessels with atherosclerotic plaques. Materials and methods. Fragments of atherosclerotic plaques isolated during coronary artery bypass grafting in patients with coronary artery disease were cultured in an exhaustive fluid system under anaerobic conditions in vitro for 1 or 14 days. The presence of biofilms was evaluated using scanning electron microscopy. Results. Mixed biofilms, represented by rod-shaped bacteria and cocci, were identified after in vitro cultivation in all fragments of atherosclerotic plaques. The characteristic ultrastructure revealed the main stages of the biofilm life cycle. Conclusions. Modeling biofilms on biotic surfaces in a system of exhausted fluids under anaerobic conditions will allow us to study in detail the phenotype of biofilms and provide a significant understanding of the pathophysiology of infectious processes in blood vessels and atherosclerotic plaques. Key words: atherosclerotic plaque, chronic periodontitis, biofilm-forming microbes, periodontal pathogens, causative agents of nosocomial infections, fluid technology

Objective. To compare the methods of oligohydramnios (OHA) diagnosis using 2D- and 3D-ultrasound and to determine clinical significance of OHA in women with intrauterine infection. Patients and methods. We evaluated the amount of amniotic fluid in 130 pregnant women (at weeks 13–21) aged between 17 and 45 years by measuring the largest vertical pocket and calculating the volume of the largest pocket. Seventy patients were found to have reduced amount of amniotic fluid (Group 1). Sixty women comprised the control group (Group 2). Results. The method for measuring the largest vertical diameter of a fluid pocket demonstrated the following performance characteristics: 84% sensitivity, 94% specificity, 87.9% accuracy, and 0.5 AUC. The performance of measurement of the largest pocket volume was as follows: 92.5% sensitivity, 97.3% specificity, 96.1% accuracy, and 0.8 AUC. Perinatal losses were observed only in Group 1 (n = 2; 28.6%). Women in Group 1 were more likely to have fetal hypotrophy than women in Group 2 (54 (77.1%) vs 5 (8.3%)). Hypoxic-ischemic brain injury and intrauterine infections were also more common among patients with OH than in controls (65 (92.8%) vs 4 (6.6%) and 59 (84.3%) vs 7 (11.6%), respectively) (p < 0.001). Conclusion. Early OH is a marker of severe obstetric and perinatal complications in patients with signs of intrauterine infections. Measurement of the largest pocket volume demonstrated better performance characteristics for the detection of early OH than calculation of the largest vertical diameter of a fluid pocket. Key words: intrauterine infection, oligohydramnios, amniotic fluid, three-dimensional ultrasound

Objective. To perform comparative analysis of parameters and structure of maternal mortality (MM) in the Far Eastern Federal District (FEFD) and Siberian Federal District (SFD) in 2014–2019. Materials and methods. The database for analysis was generated using map-based emergency notifications of maternal deaths (69 in FEFD and 180 in SFD). We used methods of descriptive statistics, Pearson's χ2-test, and calculated odds ratios (ORs) with 95% confidence intervals (95% CIs). Results. Between 2014 and 2018, the dynamics of MM in the FEFD and SFD had a one-way trend: it decreased in 2014–2017, but dramatically increased in 2018 primarily due to social factors. In 2019, we observed a significant growth of MM in the FEFD, while the SFD demonstrated a reduction of MM. The most common cause of maternal death in both districts was extragenital diseases. However, there were some differences in the structure of obstetric causes: in FEFD, preeclampsia and obstetric hemorrhage were the most frequent obstetric causes of death, while in SFD, women primarily developed embolism and placental abruption. Conclusion. The dynamics and structure of MM in the FEFD and SFD require management decisions aimed at improving medical care with the consideration of clinical guidelines, organization of continuous audit, systematic development of practical teamwork skills both in simulation training centers and healthcare institutions. Key words: Far Eastern Federal District, maternal mortality, Siberian Federal District

The review analyses the available literature on the main principles of breastfeeding support in cases of confirmed/suspected novel coronavirus infection in breastfeeding mothers. Various approaches to management of mother and baby in the conditions of the COVID-19 pandemic have been studied that found reflection in the protocols of the World Health Organization, Chinese, American and European medical communities. The evolution of Russian recommendations is analysed. A rationale is offered for the current guidelines on temporary mother-child separation in the healthcare settings when maternal COVID-19 is suspected/confirmed and on the organization of infant feeding with expressed maternal milk. The literature on the nutritional and biological value and the safety of expressed breast milk stored in various conditions is reviewed. Practical advice is given on organization of an individual breast milk bank at home. Key words: breastfeeding, breast milk, individual milk bank, coronavirus infection, newborns, COVID-19 pandemic, breast milk expression

Recurrent episodes of bronchial obstruction are most common in young children. Various phenotypes of wheezing/bronchial obstruction in preschool children have been described. Large cohort studies demonstrated that it is possible to estimate the risk of chronic bronchopulmonary diseases (developing in adolescence or adulthood) among children with recurrent episodes of bronchial obstruction. All children with recurrent bronchial obstruction should be carefully followed-up and receive timely rational therapy. In children with mild bronchial obstruction, the combination of bromhexine, guaifenesin, and salbutamol in fixed doses has demonstrated high efficacy. Key words: bronchial asthma, bronchial obstruction, children, bromhexine + guaifenesin-salbutamol, prognosis, wheezing phenotypes, COPD

This article focuses on the most important issues of perioperative antimicrobial prophylaxis (PAP) in pediatric colorectal surgery. We have analyzed currently available Russian and foreign documents on PAP and its specific characteristics in pediatric practice and colorectal surgery. We have provided the most up-to-date recommendations on perioperative prevention of enterocolitis and strictures in children with Hirschsprung's disease. Key words: antibacterial preventive therapy, colorectal surgery, pediatric surgery, surgical wound infection

Inflammatory diseases of the nasal cavity and paranasal sinuses are identified as the leading cause of upper respiratory disorders. Nose breathing is of crucial importance to provide the entry for air to get into the respiratory system. In addition to oxygen saturation, nose breathing provides the exchange of air in the paranasal sinuses. This process is required to maintain normal microflora of the nasal cavity. In contrast, mouth breathing occurring during the inflammatory diseases of the nasal cavity is associated with discomfort and poor health-related quality of life and results in inflammation. Viral inflammatory disorders often exacerbate a patient’s condition and provoke bacterial inflammation. Recent widespread occurrence of antimicrobial resistance forced to change the paradigm in the treatment of inflammatory disorders and to refocus on time-proved topical therapies. Systemic antibiotics are now used only for strict indications. Other treatment options are widely applied. Thus, silver preparations characterized by antiseptic and bactericidal properties allow to avoid complications and to aid the recovery. They are the best choice of topical agents for treating acute rhinosinusitis. KEYWORDS: acute rhinitis, acute rhinosinusitis, acute respiratory viral infections, antibacterial drugs, topical treatment, argentum proteinate. FOR CITATION: Ovchinnikov A.Yu., Miroshnichenko N.A., Nikolaeva Yu.O. Effective and safe treatment for the inflammatory diseases of the nose and nasopharynx. Russian Medical Inquiry. 2020;4(4):238–242. DOI: 10.32364/2587-6821-2020-4-4-238-242.

A round table on the topic “Urinary tract infections in women: what a gynecologist needs to know?” was organized within the framework of the 21st All-Russian Science Education Forum “Mother & Child” that was held on September 28–30, 2020, in Moscow. The speakers reported on an increasing incidence of urinary tract infections (UTIs), in particular, cystitis. This is accounted for by the lack of a common diagnostic and treatment approach to this disease among various medical specialties and self-medicating with randomly chosen or low-dose antibiotics. Current recommendations for the prescribing of medications to reduce the symptoms of acute cystitis are addressed. The increase in the prevalence of antibiotic resistance is highlighted. The development and more active implementation of the approaches avoiding the use of antibiotics to prevent UTI recurrences are required. KEYWORDS: cystitis, urinary tract infections, recommendations, immune prophylaxis, cranberry, D-mannose, vitamin D. FOR CITATION: 21st All-Russian Science Education Forum “Mother & Child”. Urinary tract infections in women: what a gynecologist needs to know? (Post-release). Russian Journal of Woman and Child Health. 2020;3(4):282–288. DOI: 10.32364/2618-8430-2020-3-4-282-289.

Purpose To improve technique of cortical fixation of quadrupled semitendinosus autograft in anterior cruciate ligament (ACL) reconstruction providing a tight contact of the tendon and bone inside the tunnels. Material and methods Application of the technique offered earlier for preparation and placement of quadrupled semitendinosus autograft in ACL reconstruction for a maximal tendon-bone contact is reviewed. The technique uses cortical buttons for semitendinosus graft fixation. Proximal and distal ends of the graft are corrugated at placement, thus increasing the diameter and providing additional fixation inside the bone tunnels. The modified technique employs same corrugated sutures with an easier placement practice. Potential fixation tightness in the tunnels is assessed by an increase in the diameter at both ends of the prepared graft while tightening corrugated sutures. Six semitendinosus tendons of 3 cadavers were used for testing. Results Diameters of the proximal and distal ends of the graft prepared with modified technique increased by 1.33 ± 0.52 mm and 1.5 ± 0.55 mm, respectively, at tightening the corrugated sutures. The ends of the corrugated sutures were tightened with a force of 50 N with a tension of 80 N applied to the graft. Elastic deformation was observed at 364.83 ± 69.16 N during the tensile test for the graft prepared with earlier technique and cortical fixation thread with the focus on the strength of transverse threads. The modified technique ensured a reliable construct being comparable with that provided by all-inside technique (760 N) by removing the weak link. Tendon graft preparation time reduced by 30 %. Conclusion Modification of the earlier described technique for preparation and placement of quadrupled semitendinosus autograft facilitated tight contact of the tendon and bone inside the tunnels, easier placement practice and improved strength characteristics of the prepared graft.