Imaging and diagnostic accuracy of outpatient and inpatient hysteroscopy

Aim. To compare the results of visualisation and diagnostic accuracy during outpatient and inpatient hysteroscopy in women with endometrial disease.Materials and Methods. We performed a retrospective analysis of patients with uterine diseases who underwent outpatient hysteroscopy at Kemerovo City Clinical Hospital №4 (n = 300) or inpatient hysteroscopy within the hospitals (n = 300) in Kemerovo from 2018 to 2020. Confirmation of endometrial disease was carried out by manual vacuum aspiration.Results. Indications, imaging, and diagnostic accuracy did not differ for most endometrial diseases in outpatient and inpatient hysteroscopy, yet inpatient hysteroscopy was the option of choice in women with infertility (p = 0.035). Diagnostic accuracy of outpatient and inpatient hysteroscopy was highly concordant, albeit outpatient hysteroscopy more often revealed adenomyosis and uterine malformation and less often identified endometrial polyps.Conclusion. Outpatient and inpatient hysteroscopy are equally efficient, although outpatient hysteroscopy has its benefits in detecting adenomyosis and uterine malformation and be less informative in diagnosing endometrial polyps.

Risk factors for death in patients with severe COVID-19 admitted to an intensive care unit

Aim. Severe COVID-19 is accompanied by reduced blood oxygen saturation, systemic inflammatory response syndrome and multiple organ failure, all causing a significant deterioration of homeostasis associated with death. Here we aimed to study the risk factors for death in patients with severe COVID-19 who have been admitted to an intensive care unit.Materials and Methods. The study included 144 consecutive patients with severe COVID-19 who have been admitted to an intensive care unit of Kuzbass Clinical Hospital from August to December 2020. Groups of survivors and non-survivors were equal in number (n = 72) and matched by gender (36 men and women) and age (median age 64 years, interquartile range 56-70 years in survivors and 58-69 years in non-survivors). Complete blood count, urinalysis, biochemical analysis, coagulation testing, and measurement of anti-SARS-CoV-2 IgM/IgG were carried out in all patients immediately upon the admission to intensive care unit.Results. Risk factors for death in severe COVID-19 at the admission to intensive care unit were arterial hypertension, chronic heart failure, peripheral atherosclerosis, impaired renal homeostasis (reduced glomerular filtration rate, elevated serum creatinine and urea, proteinuria, hematuria), augmented fasting blood glucose and lactate, neutrophilia (in men), lymphopenia and increased neutrophil-to-lymphocyte ratio (in women), and decreased IgM/IgG to SARS-CoV-2 (in women).Conclusion. We found both independent and gender-specific risk factors for death due to COVID-19.

Epidemiology of Streptococcus pneumoniae serotypes in children before and after pneumococcal vaccination

Aim. To investigate how the pneumococcal vaccination affects the distribution of Streptococcus pneumoniae serotypes.Materials and Methods. In 2011-2019, 1,852 healthy children (1,354 aged ≤ 5 years and 480 aged from 6 to 17 years) were examined for the nasopharyngeal pneumococcal carriage. Of them, 539 children were tested before the start of pneumococcal vaccination (2011-2014), while 1,313 were tested during the vaccine campaign (2015-2019). Pneumococcal strains were serotyped using multiplex polymerase chain reaction.Results. Streptococcus pneumoniae serotype distribution considerably differed between children ≤ 5 and 6-17 years of age. Serotypes 23F, 19F, 19A, 6AB, and 15BC were prevalent in children ≤ 5 years of age while the older children were characterised by a high prevalence of capsular serotypes (3 and 33AF/37), serogroup 9 (9AV and 9LN), non-typeable streptococci, as well as 19F, 6AB and 6CD serotypes. Vaccination was associated with a significantly decreased prevalence of Streptococcus pneumoniae carriage (from 41.5% to 19.2%) among children ≤ 5 years of age, while this reduction was less pronounced (from 13.5 to 9.0%) in older children. Vaccination led to the shift in the distribution of pneumococcal serotypes towards an increased prevalence of non-vaccine serotypes that was particularly prominent in children ≤ 5 years of age. In particular, vaccination reduced the prevalence of 23F and 19A pneumococcal serotypes but heightened prevalence of 11AD serotype and to the appearance of previously undetected serotypes such as 8, 10A, 17F, 22F, 24ABF, 34, and 39.Conclusion. Pneumococcal vaccination decreased prevalence of pneumococcal carriage, yet causing a serotype replacement effect requiring improved microbiological monitoring in children of all age groups.

Prototyping neural networks to evaluate the risk of adverse cardiovascular outcomes in the population

Aim. To develop a neural network basis for the design of artificial intelligence software to predict adverse cardiovascular outcomes in the population.Materials and Methods. Neural networks were designed using the database of 1,525 participants of PURE (Prospective Urban Rural Epidemiology Study), an international, multi-center, prospective study investigating disease risk factors in the urban and rural areas. As this study is still ongoing, we analysed only baseline data, therefore switching prognosis and diagnosis task. Because of its leading prevalence among other cardiovascular diseases, arterial hypertension was selected as an adverse outcome. Neural networks were designed employing STATISTICA Automated Neural Networks (SANN) software, manually selected, cross-validated, and transferred to the original graphical user interface software.Results. Input risk factors were gender, age, place of residence, concomitant diseases (i.e., coronary artery disease, chronic heart failure, diabetes mellitus, chronic obstructive pulmonary disease, and asthma), active or passive smoking, regular use of medications, family history of arterial hypertension, coronary artery disease or stroke, heart rate, body mass index, fasting blood glucose and cholesterol, high- and low-density lipoprotein cholesterol, and serum creatinine levels. Our neural networks showed a moderate efficacy in the virtual diagnostics of arterial hypertension (84.5%, or 1,289 successfully predicted outcomes out of 1,525, area under the ROC curve = 0.88), with almost equal sensitivity (83.6%) and specificity (85.3%), and were successfully integrated into graphical user interface that is necessary for the development of the commercial prognostication software. Cross-validation of this neural network on bootstrapped samples of virtual patients demonstrated sensitivity of 82.7 – 84.7%, specificity of 84.5 – 87.3%, and area under the ROC curve of 0.88 – 0.89.Conclusion. The artificial intelligence prognostication software to predict adverse cardiovascular outcomes in the population can be developed by a combination of automated neural network generation and analysis followed by manual selection, cross-validation, and integration into graphical user interface.

Сytogenetic techniques in current biomedical research. part i: history and theoretical basis of human cytogenetics

Cytogenetics is an essential part of human genetics which studies the structure of chromosomes and their collection which is called karyotype. Cytogenetic techniques are employed while interrogating DNA organisation and compaction. Analysis of the chromosomal structure contributes to uncovering the molecular basis of various cellular processes in normal and pathological conditions. Furthermore, spectrum and frequency of chromosome abnormalities serves as an indicator of mutagenic effects. Cytogenetic techniques became indispensable for discovering the genetic causes of human diseases at different stages of ontogenesis. Genetic abnormalities are a common cause of impaired reproductive function, abnormal pregnancy, and neonatal malformations. Genetic screening for chromosomal abnormalities and congenital anomalies is a powerful tool for reducing the genetic load in human populations as well as disease, psychological and social burden on families and societies. This paper begins the cycle of lectures on molecular basis of human cytogenetics, cytogenetic techniques, and the corresponding research and clinical applications. The lecture is primarily aimed at biomedical students and physicians who often have an unmet need to analyse and interpret the results of cytogenetic analyses.

Galectin-1 and Galectin-3 expression in colon cancer and its correlation with tumor invasion, differentiation, and metastatic spread

Aim. To study the expression of galectin-1 and galectin-3 in colon cancer and the levels of these proteins in the peripheral blood in relation to the differentiation, invasion, and metastatic dissemination.Materials and Methods. We examined primary tumors and the corresponding peripheral blood samples from 81 patients with colon cancer. Control group consisted of 49 patients with colon adenoma and 17 healthy volunteers. Expression of galectin-1 and galectin-3 in colon tissue was determined by immunohistochemical staining, while their plasma level was measured by enzyme-linked immunosorbent assay. Tumor staging was performed in accordance with the TNM system (AJCC, 2009). Cell differentiation was defined according to the respective clinical guidelines (Russian Cancer Association, 2018).Results. We detected an elevated expression of galectin-1 and galectin-3 in primary colon cancer as compared with colon adenoma and higher plasma levels of these proteins in colon cancer patients in comparison with healthy volunteers. High expression of tumor and plasma galectin-1 was associated with higher tumor stage (T3/T4) and the presence of local and distant metastases. Overexpression of galectin-3 in the primary tumor correlated with lower differentiation and lymph node metastasis.Conclusion. Galectin-1 and galectin-3 are involved in colon cancer progression and might be used as predictors of an adverse outcome.

Surgical risk assessment in Hiv-infected patients treated within the penitentiary system of Kemerovo region

Aim. To assess the surgical risk in HIV-infected patients who received the surgical treatment within the penitentiary system of Kemerovo Region.Materials and Methods. We retrospectively analysed the physical status and the extent of surgical risk in 296 HIV-infected patients who underwent elective (n = 201) or emergency (n = 95) surgery in Hospital №1 (Kemerovo) from 2015 to 2018. Physical status was assessed according to American Society of Anesthesiologists (ASA) Physical Status Classification System. Surgical risk was scored according to Moscow Scientific Society of Anesthesiologists and Critical Care.Results. The majority of patients had 3 (48.4 and 36.3% in emergency and elective patients, respectively) or 4a (30.5 and 45.8% in emergency and elective patients, respectively) stages of HIV infection. Opportunistic infections were diagnosed in 49.3% of patients and were always accompanied by superficial mycoses. Physical status of most patients (47.4% and 63.7% in emergency and elective patients, respectively) corresponded to ASA physical status class 3. Emergency patients mainly had surgical risk class 3 (n = 50, 52.6%) while elective patients often had surgical risk class 2 (n = 106, 52.7%). The prevalence of postoperative complications, most often impaired wound healing, was 9.8%.Conclusion. More than 80% of HIV-infected patients who underwent surgical interventions within the penitentiary system of Kuzbass were at III or IV stages of HIV infection, entailing a high frequency of opportunistic diseases such as superficial mycoses and dictating the need to include antifungal treatment into the surgical treatment. Impaired wound healing was the most frequent postoperative complication.

Insulin gene expression and functional activity of insulin signaling pathway in Alzheimer's disease

Aim. To study the insulin (INS) gene expression, insulin and lactate levels, expression of Fe65 adapter protein, and level of oxidative DNA damage marker γH2AX in different brain areas in the experimental model of Alzheimer's disease.Materials and Methods. Male, 4-month-old C57BL/6 mice received either intrahippocampal injection of β-amyloid (C57BL/6 + Aβ 1-42) or phosphate-buffered saline (C57BL/6 + PBS). Insulin (INS) gene expression in the hippocampus and amygdala was assessed by means of reverse transcription-polymerase chain reaction. Levels of lactate and insulin in different brain areas were measured by enzyme-linked immunosorbent assay. Expression of Fe65 adapter protein and γH2AX in the hippocampus was studied by immunofluorescence staining followed by confocal microscopy.Results. We found an overexpression of the INS gene in the hippocampus and amygdala, an increase in lactate level in the hippocampus, and slightly increased insulin level in the amygdala of mice with Alzheimer's disease as compared with the control group. Neurodegeneration was accompanied by an elevated endothelial expression of Fe65 adapter protein (p= 0.04) and γH2AX in hippocampal neurons (p = 0.04).Conclusion. Alzheimer's disease neurodegeneration is accompanied by a disrupted insulin signaling and impaired glucose metabolism in the hippocampus and amygdala. This further leads to a neuronal accumulation of γH2AX and impaired amyloid precursor protein proteolysis because of insulin inability to inhibit its interaction with the Fe65 adapter protein and to prevent formation and deposition of β-amyloid.

The impact of legionellosis into fatal outcomes of pneumonia in Irkutsk

Aim. To study the diagnosis of legionellosis in patients who died because of pneumonia in Irkutsk (2016-2018).Materials and Methods. We performed 65 autopsies of patients who died from pneumonia in Irkutsk (2016-2018), studied their case histories, and interrogated 510 tap water samples for Legionella pneumophila by means of inoculation and polymerase chain reaction.Results. Among 65 fatal pneumonia outcomes registered in Irkutsk during 2016-2018, legionellosis has been confirmed in three cases (4.6%). Two of these patients were at the late stages of HIV infection while the third, 74-yearold, patient had multiple comorbid conditions. Nosocomial infection was suspected in one of these cases. None of these three patients left Irkutsk during the last month of their life. The assumed transmission factor was tap water, as Legionella pneumophila was found in tap water samples collected in 2013 and 2015.Conclusion. Patients with severe pneumonia need screening for legionellosis to perform the correct treatment, particularly during COVID-19 pandemic.

Оpen globe injury in children: epidemiology and predictors of an adverse outcome

Here we aimed to analyse the prevalence, clinical course, and current approaches to the prevention and treatment of open globe injury in children as well as its complications: hyphema, retinal detachment, traumatic uveitis, and endophthalmitis. Currently, children are responsible for the 10-15% of open globe injuries. In developed countries, open globe injury is the leading cause of monocular blindness in children. Open globe injury mainly affects boys (60−70% cases), yet severe injuries are rare, and closed globe injury is the most common type of eye injury. Most injuries are accidental and occur at home in daily life (50−60%), outdoors (20−35%), at school (1−5%), or while playing sports (1−3%). Open globe injury most often affects cornea and is associated with a high risk of early and late complications and poor outcomes. Wearing of protective glasses during sports and active recreation is recognised as an efficient tool for primary prevention of open globe injury in children. The main problems in prevention of complications of open globe injury are the lack of specialised care in low-income countries and the limited awareness of parents.