Modern Development Problems of Russian Healthcare: Part 2.

The second part of the article (see the beginning in No. 6-2021) analyzes the negative consequences of the so-called health care optimization. It is shown that as a result of its implementation, the availability of medical care has decreased. A possible way to improve the territorial organization of medical services is considered. The effectiveness of the Russian health care system in the fight against the coronavirus pandemic was assessed.

Evaluation of the Efficiency of Oxygen-Helium Therapy for Patients with Covid-19-Associated Pneumonia.

This article summarizes the experience of managing patients with COVID-19-associated pneumonia treated in one of the intensive care units of a multidisciplinary hospital with and without a heated oxygen-helium mixture. It has been shown that the use of a heated oxygen-helium mixture in the complex therapy of pneumonia caused by SARS-CoV-2 is effective. A comparative analysis of the clinical manifestations of the disease and the results of laboratory tests in the main and control groups of patients confirm with a high degree of reliability the improvement of blood oxygenation, the normalization of the acid-base balance and the positive dynamics of the main parameters, which ultimately increases the efficacy and reduces the time of treatment.

Modern Development Problems of Russian Healthcare (Part 1).

The paper (part 1) analyzes the dynamics of indicators characterizing the state of health of the Russian population. A comparative analysis of the development of healthcare in Russia and other countries is carried out. The conclusion is confirmed that the main problem in the development of Russian healthcare is the insufficient volume of public funding. The drawbacks and limited potential of the adopted funding model are assessed. A possible way to increase public funding is proposed. It is shown that the availability of medical care is reduced as a result of the so-called optimization of healthcare. A possible way to improve the territorial organization of medical services is considered. The effectiveness of the Russian healthcare system in the fight against the coronavirus pandemic is assessed.

Effects of prolonged isolation in a confined space on status of oxidative stress and prothrombogenesis: In preparation for possible future manned space expedition to Mars.

INTRODUCTION: Apart from inflammation and endothelial dysfunction, other key components in the development of atherogenesis include prothrombogenesis and oxidative stress. The effects of long-term confinement and isolation, exposure to radiation and different gravity forces during space travel could potentially increase the long-term risk of atherosclerosis. To the best of our knowledge, this is the first study determining the status of prothrombogenesis and oxidative stress in six cosmonauts subjected to the longest duration of confined isolation period of 520 days in preparation for prospective undetermined manned space travel to Mars. MATERIALS AND METHODS: This collaborative research between the National Space Agency (ANGKASA), Universiti Teknologi MARA, Malaysia and Institute of Biomedical Problems (IBMP), Russia was conducted at the Russian Academy of Sciences IBMP, Moscow, Russia. Six multi-national cosmonauts were assigned to live in a ground-based confined module for 520 days. Standard exercise and diet regime were instituted throughout the isolation phase. Six age, ethnic and gender-matched healthy, free-living ground controls were recruited in parallel. Serial serum and whole blood were analysed for biomarkers of prothrombogenesis [plasminogen activator inhibitor-1 (PAI-1) and homocysteine] and oxidative stress [oxidised low-density lipoprotein (ox-LDL) and malondialdehyde (MDA)]. RESULTS: There were significantly lower concentrations of PAI-1 and homocysteine in cosmonauts during confinement compared to the controls. There were no significant differences seen in the concentrations of biomarkers of oxidative stress during confinement but there was a significant percentage change increment for serum MDA in cosmonauts. CONCLUSION: Long-term confinement decreased the risk of prothrombogenesis and this could be attributed to the exercise and diet regime which includes omega-3 fatty acids supplementation given to the crew members during their confinement period. However, oxidative damage could not be excluded and may be attributed to the influence of psychological stress during this prolonged confinement.

[EXPERIMENTAL AND THEORETICAL STUDIES OF HUMAN HYPERCAPNIC VENTILATORY RESPONSE WITH THE USE OF MATHEMATICAL GAS EXCHANGE MODELING].

A mathematical model of biotechnical system integrating the human cardiorespiratory system with hard- and software was designed to investigate breathing control. The model describes dynamics of carbon dioxide and oxygen in 3 biotechnical system compartments in the course of rebreathing tests. The tests do not require tanks with compressed gas and, therefore, can be performed in space flights. Results of simulated modeling of the ventilation response in 2 breath tests, i.e. to hypercapnia due to rebreathing of a hyperoxic gas mixture and to hypercapnia combined with hypoxia due to air rebreathing, are presented. Model validity was verified by comparison of the modeling and experimental data. The mathematical model made it evident that CO2 partial pressures in tissues, lungs and the breathing circuit equalize very fast when initial carbon dioxide concentration in the respiration circuit is equal to the end-tidal CO2 concentrations in man at rest.

[Dynamics of duration of tracheal forced expiratory noises during long-term isolation in the "Mars-500" experiment].

Dynamics of duration of tracheal forced expiratory noises in a group of volunteers was studied before, during and after 520-days confinement. The duration did not change in most volunteers. Two volunteers demonstrated significant changes of tracheal sounds duration and some spirometric parameters. Increase in duration of tracheal forced expiratory noises and decrease in spirometric parameters reveal ventilatory impairment of obstructive type. Analysis of duration of tracheal forced expiratory noises dynamics during prolonged confinement proves to be a sensitive technique to test ventilatory function changes.

[Vitamin D status in population of the perm territory and Komi and Udmurtia Republics].

Seasonal and geographical variability in blood serum concentration of 25-OHD3 among the residents of the Perm Territory, Komi and Udmurtia Republics (327 subjects in total) were investigated. The mean values of serum 25-OHD3 concentrations in 13-16 years old adolescents vary from 31.1 to 49.6 nmol/l, in adults from 39.7 to 47.7 nmol/l. They are within the range of variation reported in other groups in Russian Federation and North-Western Europe. Seasonal fluctuations of vitamin D content are more expressed in adolescents. The geographical distribution of the measures does not agree with the conventional notion that it has a latitudinal (South-North) variability gradient.

Use of Corynebacterium pseudodiphtheriticum for elimination of Staphylococcus aureus from the nasal cavity in volunteers exposed to abnormal microclimate and altered gaseous environment.

Effectiveness of saline suspension of Corynebacterium pseudodiphtheriticum containing spray was assessed in a 30-days chamber experiment modeling the effects of hyperthermia and polluted air on humans. Spray was targeted at eliminating Staphylococcus aureus from the nasal cavity of human subjects. Three of four volunteers became S. aureus carriers in the course of the experiment, and one was a chronic carrier of methicillin-resistant S. aureus (MRSA). Spray application eradicated S. aureus in three subjects and reduced its presence in the MRSA carrier. Results of the study suggest that C. pseudodiphtheriticum can be used for control of S. aureus in the nasal environment. However, further investigations are required.

[Assessment of thromboplastins according to the WHO guidelines and the results of external quality control].

The study was undertaken to assess commercial thromboplastins for compliance to the WHO guidelines and to substantiate the validity of the results of a prothrombin test carried out using these thromboplastins. The test thromboplastins were shown to meet the WHO guidelines for assessment of thromboplastins. Over 5-8 years of the authors'participation in two external quality control programs (Federal External Quality Control System, Russia; 72 trials; NEQAS, United Kingdom; 60 trials), the international normalized ratio derived through the use of assessed thromboplastins did not differ from that established due to the interlaboratory consensus value of both external quality control systems. It is concluded that correct thromboplastin assessment provide accurate results of determination of prothrombin time.

[Epileptic leukoencephalopathy and its significance in the pathogenesis of epilepsy].

A role of the white matter pathology in the pathogenesis of epilepsy is discussed. Results of the neurohistological study of the removed material of patients who were operated for pharmacoresistant temporal epilepsy are presented. The experimental study of animals that allowed to follow-up morphological changes in the cortex and underlying white matter during the formation of an epileptic focus has been conducted. The attempt has been made to evaluate in-vivo noninvasively the white matter in patients with local cryptogenic epilepsy using different functional neuroimaging methods.

[Characteristics of negative pressure inspiration effect on the cardiorespiratory system of humans in the conditions of 5-day dry immersion].

Changes in external respiration and central hemodynamics induced by negative (relative to atmospheric) inspiration pressure were studied in supine subjects before and on day-4 of a dry immersion (DI) experiment. Changes in the cardiorespiratory system as a result of negative inspiration pressure included rise of the amplitude of breathing motions and reduction of their frequency, and distinct breathing-related HR fluctuations. Combination of immersion and altered pressure in the mask caused breathing-related variations of systolic pressure and plethysmogram signal, and improved arterial blood oxygenation. These results can be useful for developing pressure-gradient methods of counteracting the adverse effects of blood redistribution toward the cranial-end.

[Biomechanics and regulation of the external respiration in the conditions of 5-day dry immersion].

The work was concerned with evaluation of the external respiration function and regulation in healthy human subjects participating in simulation of the microgravity effects by dry immersion (DI). In the baseline data collection period, in DI (days 2 and 4) and after DI completion pulmonary volumes were registered, the ratio of thoracic and abdominal components of quiet breathing and respiratory maneuvers calculated, and parameters of respiration regulation, i.e. length of breath-holding and ability to voluntary control breathing motions, were determined. It was shown that breathing pattern did not undergo gross changes in immersion as compared with pre-DI test data; however, inspiratory reserve volume grew (p < 0.05) and expiratory RV reduced (p < 0.01). DI did not alter the ventilation function of lungs; yet, most of the subjects trended to increase the abdominal component of quiet breathing and displayed a statistically significant increase of the parameter during the maneuver made to determine the vital capacity of lungs. Maximum breath-holding, equally in the course of inspiration and expiration in DI, did not differ from baseline values. Accuracy of voluntary breathing control was better in immersion. We believe that similar to microgravity, exposure in DI produces regular alterations of pulmonary RV (partly because of changed body position), thoracic-abdominal ratio in breathing motions, and shifts in voluntary respiration regulation.

[Monitoring the efficiency of heparin anticoagulation in patients on programmed hemodialysis].

The activated partial thromboplastin time (APTT) test is widely used to monitor heparin anticoagulation. The relationship of the APTT to the activity of administered unfractionated heparin was defined in 23 patients on programmed hemodialysis, by using six APTT reagents. A calibration curve was plotted for each reagent. The heparinized and nonheparinized plasma values of APTT depended on the reagent being used. During clinical heparin therapy, an APTT-heparin concentration relationship was also defined by the used reagent. The reagents showed varying heparin sensitivity both in vitro and in vivo studies. APTT was estimated for the therapeutic application of heparin for all the reagents in the examinees. The authors consider it necessary to define an APTT-heparin concentration relationship for each reagent being used.

[Approbation of a new test system determining the activity of a plasmin inhibitor in patients with sepsis].

Plasmin inhibitor (PI) determination is an essential diagnostic method. The purpose of the study was to develop an amidolytic assay for estimating PI activity, by applying the test system made by RENAM (Moscow). The new system is based on purified plasmin (human plasma) with the activity attested by the international standards. The developed method shows precision and accuracy with low and normal PI activity. The pilot clinical trial in patients with sepsis had demonstrated that the PI activity determined by this method is associated with some hemostatic parameters (prothrombin index, thrombin generation) and a patient's status (septic shock, hepatic dysfunction).

[Fibrinogen determination by the Clauss method. Reagents and analyzers].

The Clauss method was recommended by the WHO to measure plasma fibrinogen levels. The purpose of this study was to assess the application of test systems made by the RENAM Research-and-Production Association (Moscow) on different types of clinical laboratory analyzers to measure fibrinogen by the Clauss method. The calibration line is shown to be of major value in obtaining correct results on each coagulometer. The findings suggest the accuracy and reproducibility of the determination of fibrinogen concentrations by the Clauss when the REHAM test systems are used to measure fibrinogen concentrations on various analyzers if accurate calibration lines are obtained.

[Analysis of lupus anticoagulant. International external quality control].

The paper describes a reagent kit and standardized methods for lupus anticoagulant (LA) laboratory diagnosis. LA could be determined on the basis of screen/confirm assays and the reagents produced by RENAM, Moscow. The external quality control by ECAT Foundation proved the correctness of the authors' LA determining procedure. A pilot clinical study has shown that the developed approach has a high LA specificity for differential approach in thrombophilic patients.

[Choice of surgery in the treatment of recurrent varicocele].

The article presents the results of examination and surgical treatment of 48 patients with varicocele recurrence after Ivanisevich operations. Ultrasound dopplerography revealed principal causes of the recurrences: unperformed ligation of vein-satellites, undetected renospermatic reflux with hypertension in the renal vein, undetected ileospermatic or mixed reflux. Depending on the detected hemodynamic disorders, we made microsurgical ligation of veins-satellites, created proximal vein-veinous testiculosafic or distal testiculosafic anastomoses with good clinical results and correction of pathospermia. Ultrasound dopplerographic control of anastomoses after 1 year of their creation showed satisfactory function of anastomoses in 80.1% cases. Thus, choice of surgical method in varicocele recurrence must be based on assessment of hemodynamic disorders in the territory of genital veins.

[Standardization of coagulologic technique for antithrombin III estimation and its clinical application].

A standard assay procedure for estimating antithrombin III activity was derived from the Abildgaard technique as follows: 1) to decrease errors at the preanalytical stage, by using preliminarily defibrinated lyophilized plasma-calibrator and 2) to increase measurement accuracy, by using the concentration of a fibrinogen preparation and simplifying the analytical procedure. The estimation of plasma antithrombin activity in patients with pulmonary thromboembolism or sepsis points to the changes in antithrombin III activity.