[The results of clinical application of the mesh with anti-adhesive fluoropolymer coating in laparoscopic intraperitoneal repair of primary ventral hernia]. / Rezul'taty klinicheskogo primeneniya setchatogo endoproteza s antiadgezivnym ftorpolimernym pokrytiem pri laparoskopicheskoi intraperitoneal'noi plastike pervichnykh ventral'nykh gryzh.

OBJECTIVE: The purpose of the study was to evaluate the results of using fluoropolymer-coated mesh during intraperitoneal onlay mesh hernia repair in patients with primary ventral hernias. MATERIAL AND METHODS: The multicenter, non-randomized, controlled clinical study included 88 patients of both sexes who were operated on using a laparoscopic approach using the IPOM technique for a primary ventral hernia. The duration of observation ranged from 3 to 12 months. In the main group, 48 patients received fluoropolymer-coated meshes (Ftorex). A comparison was made with a retrospective group of 40 patients who were treated with anti-adhesive collagen-coated meshes (Parietene composite, Parietex Composite, Symbotex). RESULTS: The number of early and late postoperative complications in the groups did not have significant differences, at the same time, their number was lower in the group of patients in whom fluoropolymer-coated meshes were used. Most of the complications corresponded to Clavien-Dindo class I and II and did not pose a significant threat to health. There were no recurrences of hernias observed in patients included in the study. There were slightly more adhesions in the fluoropolymer-coated mesh group (35.4% vs. 25.0% in the collagen-coated mesh group). The quality of life of patients in the study groups did not differ. CONCLUSION: In laparoscopic IPOM hernia repair fluoropolymer-coated meshes are not inferior in effectiveness and safety to traditionally used collagen-coated meshes and can be recommended for use in patients with primary ventral hernias.

[Nocturia in Parkinson's disease]. / Nokturiya, svyazannaya s bolezn'yu Parkinsona.

OBJECTIVE: Evaluation of nocturia and its relationship with clinical characteristics of Parkinson's disease (PD) and dopaminergic therapy. MATERIAL AND METHODS: One hundred and thirteen patients with PD of I-III Hoehn and Yahr stage (H&Y) were examined using the following scales: IPSS, including nocturia domain, UPDRS, Sch&En, PDQ-39, MMSE, FAB, BDI, STAI-S and STAI-T, PFS-16, NMSQuest, GDSS, GSRS, and orthotest. RESULTS: Nocturia was detected in 93 patients. It depended on the age of the patients (rS=0.345; p<0.001) and was more spread among women (p=0.002). We obtained positive correlations of nocturia (p<0.05) with: PDQ-39 (rS=0.296), H&Y (rS=0.223), UPDRS (rS=0.265) and its items (speech, walking disorders, standing up from chair, posture and postural stability), NMSQ (rS=0.318), FAB (rS= -0.359), BDI, STAI-S and STAI-T, PFS-16, gastrointestinal parameters and blood pressure in the supine position. No significant effect of dopaminergic therapy on the severity of nocturia was found. According to regression analysis (stepwise method), predictors of nocturia are depression, higher lying blood pressure, constipation and postural instability (R2=0.474). CONCLUSIONS: Nocturia is the most common urological symptom in patients with PD and it significantly reduces the quality of life starting from the early stages of the disease. Nocturia increases as PD progresses, it is independent of dopaminergic medications, and it is directly associated with a number of parkinsonian symptoms (postural, frontal cognitive, affective and autonomic), which are partly dopamine-resistant. This indicates the common pathogenesis of nocturia and other symptoms of PD and the significant influence of polytransmitter imbalance.

[Lower gastrointestinal dysfunction in patients with Parkinson's disease]. / Disfunktsiya nizhnikh otdelov zheludochno-kishechnogo trakta u patsientov s bolezn'yu Parkinsona.

OBJECTIVE: To assess the lower gastrointestinal tract dysfunction in patients with Parkinson's disease (PD) and to reveal its relationships with motor and non-motor symptoms. MATERIAL AND METHODS: One hundred and eighteen patients with PD of I-III Hoehn and Yahr (H&Y) stages were studied using UPDRSI-IV, Sch&En, PDQ-39, MMSE, BDI, STAI-S and STAI-T, PFS-16, NMSQ, GSRS, BSFS, AUA. Body mass index and saliva amount and lacrimation (Schirmer's test) were assessed. RESULTS: Constipation from mild to moderate intensity was present in 71.2% of the patients; predominantly mild diarrhea occurred in 27.9%; alternations of diarrhea with the difficulty in intestine emptying were observed in 25.4%. We found significant correlations of constipation with the following parameters: Sch&En scales (rS=-0.291) and PDQ-39 (rS=0.478), patient's age (rS=0.275), H&Y stage (rS=0.2604), UPDRS (rS=0.254), axial motor symptoms of parkinsonism, and a number of affective and autonomic disorders, most of which were partly dopamine-resistant. Diarrhea did not affect the quality of patient's life, or depend on age, PD stage, main digital and non-motor symptoms, but directly correlated with the severity of constipation (rS=0.263) and other gastrointestinal disorders. There were no effects of dopaminergic therapy, including levodopa, dopamine-receptor-agonists, and amantadine, on the lower gastrointestinal tract dysfunction. CONCLUSION: Dysfunction of the lower gastrointestinal tract (predominantly from mild to moderate intensity) was detected in most PD patients of I-III stages. Our data indicate a complex pathogenesis of the PD impaired bowel emptying, involving degeneration of non-dopaminergic structures, and the predominant influence of concomitant diseases and inadequate laxative therapy on the formation of diarrhea syndrome in PD.

Gastrointestinal Dysfunction Impact on Life Quality in a Cohort of Russian Patients with Parkinson's Disease I-III H&Y Stage.

Background: There are still no clearly proven methods to slow down or stop the progression of Parkinson's disease (PD). Thus, improving the quality of life (QoL) of patients with PD becomes of primary importance. Autonomic dysfunction and its symptoms are known to worsen the quality of life in PD, but the degree of this influence is underinvestigated. Particularly, impacts of the separate significant gastrointestinal symptoms, such as dyspepsia, constipation, and abdominal pain, in PD should be more precisely evaluated with the help of specific scales. Objective: To assess the impacts of gastrointestinal dysfunction and its symptoms on PD patient's QoL using PDQ-39. Methods: 111 PD patients in the I-III Hoehn and Yahr (H&Y) stage were enrolled in the study. The following scales were applied: UPDRS III, PDQ-39, GSRS, GDSS, MMSE, BDI, STAI-S, and STAI-T. Results: The linear regression model showed that the PDQ-39 SI depended on summary assessments GSRS-SI (ß = 0.333, p < 0.001), BDI (ß = 0.463, p < 0.001), and UPDRS III (ß = 0.163, p < 0.05). The use of the stepwise method, adding GSRS-SI and UPDRS III scores to the BDI predictor, improved the model (R2 increased from 0.454 to 0.574). The investigation of GSRS domain's influence revealed that PDQ-39 SI had a significant correlation with almost all of them, but the regression analysis showed significant QoL impacts of only two factors: constipation and abdominal pain (ß = 0.288, p < 0.01 and ß = 0.243, p < 0.05 accordingly). Conclusions: Our results suggest a considerable negative influence of depression and gastrointestinal dysfunction (especially constipation and abdominal pain) on QoL of patients with PD. Their impact on QoL in patients with I-III H&Y stages of PD is more significant than that of motor symptoms. Therefore, the correction of depression and gastrointestinal dysfunction should be prioritized in PD therapy.

[Clinical features of BPPV and their influence on the choice of the doctor's tactics]. / Dobrokachestvennoe paroksizmal'noe pozitsionnoe golovokruzhenie: osobennosti klinicheskoi kartiny i ikh vliyanie na vybor taktiki vracha.

OBJECTIVES: BPPV is the most common cause of recurrent vertigo. Except vertigo attacks main clinical symptoms of BPPV can include autonomic symptoms and imbalance, which sometimes complicate the diagnosis of BPPV.Purpose To evaluate clinical symptoms and management of patients with BPPV before the setting of correct diagnose. MATERIAL AND METHODS: A total of 640 patients (504 (78.8%) women) aged from 20 to 86 years old, mean age 56.43±0.54 years with BPPV were included and diagnosed by roll and Dix-Hallpike tests. Among them 144 (22.5%) patients were inpatient and 496 (77.5%) patients were outpatient. The detailed patient intake comprised the disease onset, the type of dizziness, vertigo triggers, autonomic symptoms, similar attacks in the past and previously made definite diagnosis of BPPV. The period from the appearance of the first symptoms to the correct diagnosis was assessed. RESULTS: The majority of patients (75.3%) consult a neurologist at the initial visit. Only 30.6% of patients had a correct diagnosis within a week of the onset of the disease. Initial BPPV symptoms included persistent dizziness that increased with head turns (38.8%), nausea and vomiting (21.6%), significant increase in blood pressure (13.4%), persistent imbalance while walking (73.4%). Inpatients more frequently had constant continuous dizziness, high blood pressure, severe nausea and vomiting, and the onset of symptoms in the morning when getting out of bed (p<0.05). CONCLUSION: Initial BPPV symptoms may be similar to other diseases. Focusing on medical history and complaints leads to frequent diagnostic errors, unnecessary hospitalization and prolonged treatment of patients. Positional tests are necessary for the correct diagnosis of BPPV.

Registry of Acute Myocardial Infarction. REGION-MI - Russian Registry of Acute Myocardial Infarction.

Aim      To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods  The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion      REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.

[A method for prediction functional dizziness after benign paroxysmal positional vertigo]. / Sposob prognozirovaniya razvitiya funktsional'nogo golovokruzheniya posle pristupa dobrokachestvennogo paroksizmal'nogo pozitsionnogo golovokruzheniya.

OBJECTIVE: To identify risk factors for functional vertigo (FV) in patients with benign paroxysmal positional vertigo (BPPV) based on the analysis of emotional and personality disorders at the time of the occurrence of BPPV and to develop a method for predicting its development. MATERIAL AND METHODS: The study included 93 people, 81 women (87.1%), with benign paroxysmal positional vertigo (BPPV), aged 18 to 65 years, mean age 50 [41.5; 59]). After successful treatment with repositioning maneuvers, patients were re-examined 1 month later. Fifty-three patients underwent a semi-structured interview to identify a history of panic attacks (PA) using DSM-5 diagnostic criteria. After successful BPPV treatment, patients completed the following scales and questionnaires: Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale Short form (VSS-SF), Numeric analog scale of fear (from 0 to 10), Depersonalization-Derealization Inventory (DDI), PHQ-9, GAD-7, PHQ-15, Holmes-Rahe Stress Inventory, Anxiety Sensitivity Index (ASI). RESULTS: The cohort was divided into two groups according to the presence (group 1, n=17) or absence (group 2, n=76) of complaints for dizziness 1 month after BPPV. The frequency of PA history in group 1 was higher than in group 2 (80 vs 29.3%). Patients from group 1 had higher rates in all scales: DHI (57 vs 49, p=0.048), subscale DHI-E (18 vs 12, p=0.006), and subscale A VSS-SF (9 vs 5, p=0.03); DDI (18 vs 11, p=0.01), GAD-7 (13 vs 4), p=0.0002), Numeric analog scale of fear (10 vs 5, p<0.00005), ASI (55.5 vs 36.5, p<0.005). We developed a predictive method for diagnosis FD after BPPV, which sensitivity is 78.9% (95% CI 67.80-86.94) and specificity 94.12% (95% CI 71.31-99.85). CONCLUSION: The likelihood of developing FV after BPPV can be predicted using the proposed predictive method. Early screening for FV can be used to prevent persistent postural-perceptual dizziness.

[Modern minimally invasive technologies in spine surgery]. / Sovremennye maloinvazivnye tekhnologii v khirurgii pozvonochnika.

The number of spine surgeries has been annually increasing all over the world. It is associated with high incidence of spinal degenerative diseases, vertebral traumas and different tumors. Minimally invasive surgical techniques are being developed in spine surgery considering extended surgical procedures, long hospital-stay and disability period. These techniques minimize surgical trauma, shorten hospital-stay and disability period.

[Efficiency of the Decision-Making Module in the Personalized Choice of an Anticoagulant].

Aim        To evaluate the effectiveness of the decision-making module in selecting an oral anticoagulant for patients with atrial fibrillation.Material and methods        638 patients with atrial fibrillation aged 68.2±4.5 years were evaluated. The CHA2DS2-VASc, HAS-BLED, and 2MАСЕ scales, the creatinine clearance calculator, and the Morisky-Green questionnaire were used.Results   311 (48.75 %) patients had paroxysmal atrial fibrillation, 138 (21.6%) had persistent atrial fibrillation, 44 (22.7%) had long-standing persistent atrial fibrillation, and 145 (22.7 %) had permanent atrial fibrillation. Mean CHADS2­VASc scale score was 4.82; НAS-BLED scale score was 2.9; 2MACE score was 2.28; and compliance score was 3.52. 172 (26.9 %) patients were treated with rivaroxaban; 166 (26 %), with apixaban; 84 (13.2 %), with dabigatran; 210 (32.9 %), with warfarin; and 6 (1 %), with acetylsalicylic acid.Conclusion            The developed decision-making module is based on scientific justification of personalized selection of the oral anticoagulant and updates the knowledge on major issues of prescription.

[Clinical and psychological features in patients with incident and recurrent cases of benign paroxysmal positional vertigo]. / Kliniko-psikhologicheskie osobennosti patsientov pri vpervye voznikshikh i retsidiviruyushchikh pristupakh dobrokachestvennogo paroksizmal'nogo pozitsionnogo golovokruzheniya.

OBJECTIVE: To assess the clinical and psychological features in patients with incident and recurrent posterior canal BPPV. PATIENTS AND METHODS: The study included 47 patients (mean age 49.1±10.9 years; 12.8% of men and 87.2% of women) with idiopathic BPPV, posterior canal. According to the anamnesis, the patients were divided into two groups: 27 (57.4%) patients with incident BPPV (iBPPV) and 20 (42.6%) patients with recurrent BPPV (rBPPV). All patients were treated with repositioning Epley and/or Semont maneuvers until resolution of canalolithiasis. After that, clinical and psychological testing was immediately carried out, including short version of Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Visual analogue scale (VAS) for fear of vertigo spells, Depersonalization-Derealization Inventory (DDI), Social Readjustment Rating Scale (SRRS) of Holmes and Rahe, Anxiety Sensitivity Index (ASI), Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ). RESULTS: Patients with rBPPV compared with iBPPV had more severe symptoms of dizziness according to DHI (p=0.02) due to a functional and emotional subscales, as well as a more pronounced feeling of fear according to VAS (p=0.01). The data obtained on the remaining scales and questionnaires did not show statistically significant differences between the groups. The revealed results may indicate a greater predisposition of patients with rBPPV to the development of a special kind of mental disorders - functional dizziness or persistent postural-perceptual dizziness, which requires additional study and development of preventive measures.

[Minimally invasive ventral hernia repair: apply or save?] / Maloinvazivnye tekhnologii v gerniologii: primenyat' nel'zya ekonomit'.

Treatment of patients with ventral hernias remains one of the most pressing problems of abdominal surgery. Surgeons are trying to find a «gold standard¼ for the treatment of this pathology. Great hopes are placed on minimally invasive techniques, however, due to their high cost, they do not yet find mass distribution in everyday practice. In our opinion, this is short-sighted. We tried to analyze the feasibility of using minimally invasive techniques in the treatment of patients with ventral hernias of various locations, from the position of clinical and economic efficiency.

[The experience of development of partnership between science and health care institutions in resolving issues of circulatory system diseases].

In Russia, the process of clustering institutions at the regional level is evolved. The analysis of scientific publications revealed only several examples of efficiently functioning medical clusters. As a rule, the publications present problems or projects and perspectives of development of medical clusters. At that, no information is available concerning organizational mechanisms integration of institutions. Purpose of the study is to evaluate the results of partnership between institutions of science and practice in resolving strategic health problems related to diseases of blood circulatory system. Materials and methods. The study applied such methods as monographic approach, data derivation, statistical technique, logical and system analysis. Results. The partnership between scientific and educational institutions and practical health care organizations was analyzed on the example of the system of medical care of circulatory system diseases organized in the Kemerovo region. The effective functioning of such a partnership is based on seven integration principles. Thus, the number of treated patients increased by 7.1% from 2011 to 2018. At the same time, the number of beds decreased by 9.2%. As a result, bed turnover increased by 18.1% over this period. The work of X-ray surgery service almost doubled the rate of percutaneous coronary interventions in case of acute coronary syndrome (from 22.0% in 2011 to 42.7% in 2018). The main organizational basics of successful cooperation of institutions are succession and interdependency in work of physians and departments, joint environments of quality management, knowledge management and personnel training, shared management of research and medical activity, common production and information environment, corporate culture and traditions.

[Surgical treatment of spine injuries]. / Khirurgicheskoe lechenie povrezhdenii pozvonochnika.

The history of spinal fixation started in the 19th century and had an intensive development in subsequent years. Special progress in surgery for spinal traumatic injuries was noted in the Second World War. Last decades minimally invasive spinal surgical techniques are developed and introduced in everyday practice.

[Functional (psychogenic) vertigo]. / Funktsional'noe (psikhogennoe) golovokruzhenie.

Psychogenic (functional) vertigo is in second place by frequency after benign positional paroxysmal vertigo. It is often difficult to make the diagnosis, diagnostic program is expensive and traditional treatment often is not effective. This literature review covers current concepts on the terminology, clinical signs, pathogenesis and treatment approaches with regard to functional vertigo. Special attention is given to cerebral mechanisms of the pathogenesis including cognitive aspects.

[Factors affecting effective patient management for preventing recurrent coronary events].

AIM: To identify factors affecting effective management of patients with myocardial infarction for preventing recurrent coronary events in the outpatient setting. MATERIALS AND METHODS: The study group consisted of patients (n=111) with recurrent myocardial infarction. The control group consisted of patients with primary myocardial infarction (n=89) after percutaneous coronary intervention. Social and demographic, clinical and behavioral factors (weight loss, smoking cessation, adherence to therapy, physical and psychological rehabilitation) were evaluated. RESULTS: Risk factors contributing to the development of repeated MI were as follows: patients' age, concomitant polyvascular and multivessel disease, arterial hypertension, hypercholesterolemia, excess weight and smoking, poor adherence to the recommendations of cardiologists and general physicians. CONCLUSION: The analysis of the effectiveness of the management of patients with myocardial infarction demonstrated the importance of the outpatient rehabilitation in preventing repeated acute coronary events.

[Organizational aspects of managing patients with atherosclerosis obliterans of lower-limb vessels at an ambulatory stage].

The authors describe their first experience of a new approach in dispensary follow up of patients presenting with atherosclerosis obliterans of lower-extremities vessels. The work was based on the municipal system of rendering outpatient medical care in the city of Kemerovo. The patients were subdivided into two groups: one group remained under supervision of the surgeon, the other one was referred to the cardiologist. The mean duration of follow up amounted to 12 ± 1.5 months. The scope of carried out diagnostic, therapeutic and preventive procedures was assessed. The new approach to outpatient follow up, i. e., participation of the cardiologist in the therapeutic process made it possible to improve quality of medical care, also revealing positive alterations in diagnosis, treatment, and prevention of atherosclerosis obliterans of lower-limb vessels.

[Joint Prosthetic Infection: UpDate Approaches to Diagnosis and Treatment].

At present endoprosthetics of the joints is considered as a progressive and ever developing method in the surgical treatment of patients with affection of the locomotor system of any genesis. Hence, increasing of the number of endoprosthetic results in increasing of the number of patients with periprosthetic infection. Polymorphism of the clinical picture and inspecificity of the diagnostic tests often cause a delay in the diagnosis of the joint prosthetic infection (JPI) and consequently the late treatment. The contemporary data on the etiology, epidemiology, clinical picture and diagnosis of JPI are presented. The importance of cooperated treatment of JPI, i.e. combination of the surgical management and etiotropic antibacterial therapy is indicated. The choice of the concrete treatment method is defined by the patient state, comorbid pathology, the infection severity and duration.

[Impact of a learning program on the psychological aspects of quality of life in patients with prosthetic heart valves].

AIM: To evaluate the impact of a learning program on quality of life indicators in patients with prosthetic heart valves (PHV). SUBJECTS AND METHODS: One hundred and twenty-two patients with PHV were examined. A study group consisted of 72 patients who were trained at PHV school; a control group comprised 50 untrained patients. The comparison groups were matched for age, gender, education level, the underlying disease that had been a cause of heart disease, and the type of PHV. The SF-36 questionnaire assessing quality of life was used to evaluate the effectiveness of the learning program. RESULTS: At baseline, before cardiac surgery, the patients with PHV showed low physical and mental health indicators in both groups. At 6-month follow-up, the physical health component was increased by 23.8% in the control group and by 27.4% in the study group trained by the learning program (p < 0.05). Analysis of the scores of each scale of the questionnaire yielded significant results in both groups after 6 months of cardiac surgery (p < 0.05), which showed better quality of life. The comparison groups had significant differences only in the scores of the mental health component. Thus, following 6 months the mental health component was 24.1% higher in the learning program group than in the control one (p < 0.05). CONCLUSION: The learning program for patients with PHV, which is based on the principle of continuity of the in- and outpatient management, contributes to better quality of life mainly due to an improvement in the mental health component.

[Work intensity and arterial hypertension].

The authors presented dependence of arterial hypertension on work intensity, exemplified by two occupational groups--teachers and electricians, and demonstrated modifying influence of occupation on prevalence of traditional cardiovascular risk factors.

[Efficacy of the education program in the improvement of treatment compliance in patients with artificial heart valves].

The study included 94 patients with artificial heart valves aged 55.5 +/- 68 years including 47 (50%) with rheumatic heart diseases, 26 (27.7%) with infectious endocarditis, 21 (22.3%) with connective tissue dysplasia. Compliance with the treatment was estimated by the method of S.V. Davydov before and after education. The leading causes of poor compliance was insufficient socio-medical knowledge and dissatisfaction with the prescribed therapeutic regimen. The education program permitted to achieve a 3-fold decrease in the incidence of negative factors affecting compliance and 1.5-fold increase in the frequency of positive factors; socio-medical awareness and satisfaction with the prescribed treatment increased by 45.8% and 37.1% respectively (p < 0.05). The integral index of compliance before education +4.39 +/- 0.09 characterized it as a moderately positive one. It increased to +8.11 +/- 1.23 after education (p < 0.01). It is concluded that the education program based on the principle of continuity of in- and out-patient treatment improved compliance and socio-medical awareness of the patients, promoted their medico-social adaptation, increased satisfaction with the prescribed treatment and its outcome.