Extreme Medicine

ISSN Print 2713-2757 ISSN Online 2713-2765

Extreme Medicine

SCIENTIFIC AND PRACTICAL REVIEWED JOURNAL OF FMBA OF RUSSIA

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Glazanova TV, Shilova ER, Bessmeltsev SS

The treatment of multiple myeloma is inextricably linked to the need for assessment and monitoring of the minimal residual disease (MRD). Assessment of the MRD allows evaluating the efficacy of therapy and obtaining significant prognostic information; it is an indicator of the degree of eradication of the tumor clone. The methods for detecting residual tumor cells evolve constantly, which translates into updates of the criteria reflecting the scale of response to therapy. There is no single MRD detection technique; common recommendations suggest seeking for pathological cells both intramedullary and extramedullary. This review describes current MDR determination methods, including imaging, next generation multiparametric flow cytometry, and methods based on DNA analysis — allele-specific oligonucleotide polymerase chain reaction and next generation sequencing. We compare their advantages, limitations, disadvantages, clinical significance, and show the necessary sensitivity thresholds of the described methods and the conditions that make this or that approach ideal in the context of detection of MRD.

Received: 2023-11-16

Published online: 2023-12-31

DOI: 10.47183/mes.2023.062

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VIEWS 310

Solonin SA, Belova MV, Tereshkina NE, Kasholkina EA, Tyurin IA, Godkov MA, Potskhveriya MM

The spread of COVID-19 in Russia has led to restrictive measures. The stress associated therewith had a noticeable psychoemotional effect on the population, which could not but affect the numbers and patterns of acute chemical poisonings (ACP). This study aimed to investigate the patterns of ACP in Moscow in the context of the COVID-19 pandemic. We analyzed data describing cases admitted with ACP to N.V. Sklifosovsky Research Institute for Emergency Medicine in 2019–2021, factoring in the dynamics COVID-19 prevalence as diagnosed with RT-PCR tests. The results of the analysis were processed using nonparametric methods and GraphPad Prism 9 software. Within the considered period, 2020 was the peak year. The number of acute poisonings (AP) with ethanol and its surrogates in 2020 was 109.7% greater than in 2019 (both sexes; the figure for women alone was 286.2%). Male patients suffered AP with drugs and corrosive substances more often than female (p < 0.0001). The number of drug abuse cases in 2019–2021 varied slightly, increasing by 2.4 and 6.7% annually. Synthetic narcotic substances were most common: methadone, cathinones, psychostimulants, and mixtures of substances. We discovered parallel trends in dynamics of ethanol intoxication and COVID-19 cases, and no such between drug poisonings and the said morbidity. Thus, the identified specifics of ACP patterns in the capital of Russia associated with the COVID-19 pandemic are a spike in alcohol abuse (especially among women), and lack of noticeable effect of the disease on use of drugs.

Received: 2023-10-06

Published online: 2023-12-29

DOI: 10.47183/mes.2023.052

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VIEWS 341

Bobrov MP, Voitenkov VB, Ekusheva EV, Kiparisova ES

Encephalitis is a group of acute infectious diseases affecting the substance of the brain. They often lead to disability or death, and, therefore, require urgent medical attention. The article discusses the etiology, pathogenesis, and clinical picture of encephalitis, with special attention to the course of this disease after the COVID-19 pandemic. We note the growing number of encephalitis cases, especially of autoimmune variety and those caused by herpes. The possible reason behind this trend is the disruption of operation of the immune system brought by COVID-19, which manifests as a cytokine storm, neuroinflammation, and autoimmune reactions. There are cases of COVID-19-dependent encephalitis described. The pathways taken by SARS-CoV-2 to penetrate into the cells of the central nervous system have not yet been fully studied, although there are hypotheses that this happens both trans-synaptically through mechanoreceptors and chemoreceptors of the respiratory system into the medulla oblongata, and through receptors of the angiotensin converting enzyme 2.

Received: 2023-11-03

Published online: 2023-12-29

DOI: 10.47183/mes.2023.059

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VIEWS 293

Grishina GV, Krobinets II, Kasyanov AD, Sidorkevich SV

The problem of iron deficiency among donors is relevant and directly affects the provision of hemocomponents to the blood service. Donors, being a risk group for the development of iron deficiency, are examined before donation, including a study of hemoglobin levels. However, there is no information about the state of iron stores, when depleted, iron deficiency anemia develops. In turn, anemia is a contraindication to donation and, therefore, leads to medical exemptions from donation. The purpose of the study was to evaluate the main indicators of iron metabolism in donors of blood and (or) blood components at risk of developing latent iron deficiency. The examination of 174 donors included a hemogram, assessment of the level of hemoglobin, serum ferritin (SF), transferrin, and soluble transferrin receptors. When assessing the intensity of changes in reserve and transport iron indicators, 228 deviations from the reference range were analyzed. The criterion for the risk of developing iron deficiency was hemoglobin values at the lower limit of normal (130–135 g/l in men and 120–125 g/l in women) and the threshold level of ferritin (30 μg/l in male donors and 20 μg/l in women). The risk group included 58.3% of young donors — women who donate blood 1–2 times during the year (p < 0.01) and 66.6% (p < 0.01) of donors — men who donate blood regularly throughout 4 and > years. The average ferritin level in male donors was 27.37 μg/l (p < 0.02) and lower than the reference values. It is concluded that it is advisable to assess the indicators of iron metabolism in donors in the case of borderline hemoglobin levels, in women of reproductive age after 2 blood donations and in men with the number of donations ≥ 10. To replenish the iron depot in the body, when iron deficiency is detected in donors, it is necessary to consider the issue of prevention.

Received: 2023-11-09

Published online: 2023-12-28

DOI: 10.47183/mes.2023.055

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VIEWS 283

Zemlyakov IYu, Zhdanov DS, Bureev ASh, Golobokova EV, Kosteley YV

Stroke prevalence is one of the most acute problems in the medical and social aspects of society: strokes are the second most common in the mortality statistics of the population. In the Russian Federation, stroke occurs annually in almost 500,000 people and is the first among the causes of death from neurological diseases and the second most common cause of death after heart disease. The most common consequences of stroke are motor disorders of varying severity, manifested as changes in muscle tone, paresis and paralysis, and impaired walking function. This paper is an overview of the current state of robotic rehabilitation devices used for post-stroke limb paresis and of expected trends of their development. The existing variants of their construction, conditions of kinesiotherapy sessions for obtaining the greatest effect are considered. The authors are of the opinion that the nearest prospect for the development of high-tech devices of this type is not only complex stationary universal complexes for clinics, but also simple mobile specialized simulators with remote medical control for outpatient use.

Received: 2023-11-01

Published online: 2023-12-28

DOI: 10.47183/mes.2023.054

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VIEWS 313

Baranova TI, Rybyakova TV, Dmitrieva MO, Anisimov DA, Tarasova MS, Ogannisyan MG

Winter swimming implies extreme cold stress, which can cause respiratory disorders, arrhythmias, and elevated blood pressure even in generally healthy people. Pre-training examinations for athletes practicing winter swimming should include additional criteria evaluating reaction of the cardiovascular system (CVS) to cold water. This study aimed to determine the risk of pathological abnormalities in the examined individuals exhibiting different CVS reactions to immersion in cold water. We assessed reactivity of CVS with the help of a cold-hypoxic test (CHT), following a previously developed algorithm. The subjects of the analysis were CVS reactions to CHT and physical data collected after swimming in cold water. The study involved 255 female and 205 male participants, all of them almost healthy, aged 18–25 years. They participated in testing in a laboratory setting. Poly-Spektr-8/E cardiograph was used to record ECGs, and GraphPad Prism 8 package for Windows 10 for statistical analysis. Findings: in highly reactive and reactive participants, CHT causes lengthening of the PQ interval, with its value in the initial state (IS) equal to 158 ± 7.2, and with CHT — 178 ± 9.1 (p < 0.01); in subjects of he paradoxical type, CHT, against the background of higher pulse, triggered increase of QTc, which in the IS was 405 ± 7.1, with CHT — 420 ± 7.5 (p < 0.05). As for blood pressure, on average, CHT made it grow, SBD by 17.4 ± 4.3 mmHg, DBP by 12.9 ± 3.1 mmHg (p < 0.05). Swimmers adapted to cold, when swimming in cold water, had QTc above normal in 50% of cases: e.g., if IS of QTc was 434 ± 24 s, after swimming it increased to 492 ± 25 s. After a 200 m swim at t = 1.5–2 °C, the average blood pressure in the group, compared to IS, increased, with SBD growing by 16.9 ± 3.1 mmHg, and DBP — by 12.3 ± 2.3 mmHg (p < 0.05). Having analyzed the data, we conclude that CHT can be the basis of additional criteria extending examinations for athletes seeking admittance to cold water swimming.

Received: 2023-10-17

Published online: 2023-12-26

DOI: 10.47183/mes.2023.053

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VIEWS 308

Blinova EA, Korechenkova AV, Nikiforov VS, Akleyev AV

DNA methylation plays an important role in carcinogenesis; there are many studies that investigate the degree of methylation of the entire genome, gene promoters, and non-coding elements in cancer cells, but much less information about changes of the methylation patterns in blood cells and links with the development of malignant neoplasms (MN). This study aimed to investigate the degree of methylation of promoter regions of cell cycle control and apoptosis genes (BAX, MDM2, TP53, NFkB1) in peripheral blood cells of persons chronically exposed to radiation with MN developing latently. The study included 200 persons chronically exposed to radiation from the Techa River, contaminated with nuclear wastes dumped into it. The level of methylation was assessed by real-time PCR. The participants were divided into exposed and control groups; comparing them, we found that in the former, the distribution of exposed individuals with latent MN by the degree of methylation of promoter regions of BAX, MDM2 and NFkB1 genes was significantly different from that in the latter (p < 0.001; p < 0.001; p = 0.004, respectively). It was established that, compared to the control group, the share of the test group participants with subsequent MN who had up to 10% of the BAX gene promoter regions methylated was significantly higher, and amounted to 98%, while in the control group this figure did not exceed 73% (p < 0.00001).

Received: 2023-10-03

Published online: 2023-12-25

DOI: 10.47183/mes.2023.051

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VIEWS 297

Vakunenkova OA, Ivnitsky JuJu, Danilova OA, Schäfer TV, Rejniuk VL

Radiation exposure of recipients before hematopoietic stem cell transplantation can cause gastrointestinal (GI) stasis. It is associated with complications of myeloablative radiation therapy: delayed vomiting, excess bacterial growth, endotoxicosis, systemic inflammation, and sepsis. The study was aimed to assess the possibility of GI stasis prevention by intragastric administration of cystamine dihydrochloride when using radiation-induced myeloablation. The severity of GI stasis, levels of enterocyte markers in the small intestinal tissues and the indicator of intestinal endotoxicosis, urinary indican excretion, were assessed in rats 72 h after the single total-body X-ray exposure to the dose of 9.64 Gy (1.1 LD99/30); the animals’ whole body oxygen consumption was recorded daily. Irradiation caused GI stasis with predominant gastric stasis, the 1.5–4.8-fold decrease in the cholinesterase and alkaline phosphatase activity in the small intestinal tissues, doubled the urinary indican excretion, the whole body oxygen consumption reduction by 17–32%. Cystamine administration generally prevented gastric stasis, but had no significant effect on the characteristics of radiation-induced enterocytopenia and did not prevent accumulation of chyme in the caecum, hyperindicanuria, radiation-induced spleen hypotrophy, and decrease in gas exchange rate. Cystamine is promising for testing in large animals as a selective agent for emergency prevention of gastric stasis during myeloablative radiation therapy.

Received: 2023-09-29

Published online: 2023-12-07

DOI: 10.47183/mes.2023.050

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VIEWS 346