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Abstract

Aim. Assessment of vascular age by volumetric sphygmography and its relationship with the main clinical and laboratory parameters in patients with arterial hypertension.

Materials and methods. 46 patients with arterial hypertension were examined, including 26 women (56.5%) and 20 men (43.5%). The mean age was 67.0 [60.0; 73.5] years. Clinical and laboratory parameters were analyzed, including body mass index, lipidogram, fibrinogen, blood creatinine levels, and glomerular filtration rate. Vascular age was assessed using the BPLab-Vasotens apparatus (LLC Petr Telegin, Russia).

Results. Vascular age in patients with arterial hypertension was 69.0 [64.0;76.0] years and did not differ statistically from the passport age (p>0.05). Positive relationships were found between vascular age and the level of pulse pressure (r=0.65, p<0.001), index of reflection (augmentation) of pulse wave growth (r=0.29, p=0.04). No relationship was found between the stage of arterial hypertension, the presence of comorbid pathology, body mass index, lipid profile, creatinine, glomerular filtration rate, fibrinogen, and vascular age. In men, vascular age was less than in women – 65.5 [59.0; 70.5] years and 72.5 [67.0; 78.0] years, respectively (p = 0.02). In the group of women, the augmentation index of pulse wave growth and the level of fibrinogen were higher than in the group of men.

Conclusions. There were no statistically significant differences in passport and vascular age, determined by volumetric sphygmography, in patients with hypertension at various stages of the disease, depending on the presence of comorbid pathology, lipid status, and renal dysfunction. When analyzing hemodynamic parameters, direct links were established between vascular age and pulse arterial pressure, the index of reflection (augmentation) of the pulse wave increase. In the group of women with a higher indicator of vascular age, an increase in the augmentation index of the increase in pulse wave and fibrinogen was revealed.

Aim. Search for a more advanced technique for installing a mesh implant during ventroplasty of the anterior abdominal wall.

Materials and methods. Modeling of prosthetic venteroplasty was carried out using laboratory animals - rabbits weighing 2000±50 g and rats weighing 400±50 g. As part of the experiment, implantation mesh material was used: "Prolene" and "REPEREN". Ventroplasty was performed using the following techniques: onlay, inlay and sublay. The implant was fixed with a continuous suture. On the 21st day of the experiment, the material was collected to study its biomechanical and morphological properties.

Assessment of the morphological properties of preparations stained with hematoxylin-eosin and picrofuchsin according to Van Gieson was performed by histological methods. Biomechanical properties were evaluated using an INSTRON-5944 bursting machine.

Results. In the course of comparing the biomechanical properties of the abdominal wall with the maximum value of load (H), stress (Mpa), and Young's modulus, the following results were obtained, a significantly significant dependence of the biomechanical and morphological properties of prosthetic ventroplasty on the mesh implant suturing technique was confirmed, and the advantages of sublay separation ventroplasty technology were scientifically substantiated.

Conclusion. The experiment made it possible to confirm the dependence of biomechanical and morphological properties of prosthetic ventroplasty on the technique of mesh implant stitching used, to substantiate the advantages of separation ventroplasty using sublay technology.

Background. Given the role of hormones in the regulation of scar formation and remodeling processes, it is advisable to study the features of the hormonal profile in conditions of pathological scars. This will improve the efficiency of diagnosing of scar type and form a pathogenetic basis for the treatment of hypertrophic and keloid scars.

Aim. To identify the features of the hormonal profile in conditions of hypertrophic and keloid scars.

Materials and methods. The clinical state of the scars and the hormonal profile (10 hormones) were studied in 90 women with hypertrophic, keloid and normotrophic scars (control). Blood was taken before treatment on the 5th–7th day of the menstrual cycle. The results were processed by non-parametric statistics (Me (Q25-Q75), U-test at p<0.05). Correlations between hormones were determined by the method of multiple regression at the coefficient of determination R²>0.7.

Results. All patients with pathological scars showed a decrease in cortisol levels. Hypertrophic scars are characterized by an increase in the concentration of follicle-stimulating hormone, a decrease in the concentration of estradiol and testosterone. In patients with keloids, the concentration of growth hormone is increased, the levels of prolactin, luteinizing hormone are reduced. Regression analysis showed that the interdependence of hormones is maximally expressed in conditions of normotrophic scars, while hormones had 1-2 correlations in conditions of pathological scars. At the same time, the qualitative composition and direction of interrelations have changed.

Conclusion. Pathological scarring is characterized by a decrease in the level of cortisol in the blood, which is expressed in patients with keloid scars in combination with reduced prolactin. A weakening of hormonal interactions and an imbalance in the system of sex hormones were revealed in conditions of hypertrophic scars. and the increased production of growth hormone in combination with a stable interaction between steroidogenesis and a weakened adaptive ability took place in conditions of keloid scars.

Central pontine myelinolysis is a disease characterized by acute death of myelin sheaths cells in the central part of the pontine pons while maintaining the structural composition of neurons. The word "pontine" indicates the region of the bridge of the brain (pons - pons, region of the brain), and "myelinolysis" refers to the process of destruction of the myelin of the nerve cells of the bridge. The death of brain cells in this pathology is facilitated by an electrolyte imbalance and a sharp change in oncotic pressure. Central pontine myelinolysis often develops in patients suffering from alcoholism, malnutrition, cancer, infections, and other conditions that dramatically disrupt the electrolyte balance of the body. The purpose of this work is to describe a clinical case provoked by a new coronovirus infection COVID-19, which aggravated the course of the disease. The untimely neuroimaging and late seeking medical help also contributed to the poor outcome. As a result of the analysis of this case, a conclusion was made about the need for clinical alertness of pontine myelinolysis and the use of the necessary diagnostic measures, such as neuroimaging methods and the study of metabolic markers. Previously, this rare disease with a poor outcome has not been described in a correlation with coronavirus infection. In connection with the diagnosis established in the early stages and the therapy prescribed in accordance with it, it is possible to limit or prevent the complications of the disease.

The paper describes a clinical case of methylmalonic acidemia in a newborn premature baby with a aggravated genealogical and obstetric history. The problems of diagnosing aminoacidopathy as a large heterogeneous group of hereditary diseases, which, as a rule, manifest in early childhood and are accompanied by life-threatening or disabling consequences, are considered. The paper presents clinical and laboratory data on methylmalonic acidemia, and analyzes the mechanisms of pathogenesis. It is noted that the difficulty in diagnosing methylmalonic acidemia, as well as other aminoacidopathy, is associated with the polymorphism of the clinical picture, the absence of specific clinical manifestations at the onset of the disease manifestation, and the use of special research methods in the diagnosis. It has been shown that the presence of aggravated factors often does not allow correct interpretation of clinical and laboratory data, making timely diagnosis and treatment difficult.
Conclusion. Diagnosis of methylmalonic adiduria should take into account the unfolding of metabolic changes in the blood and urine over time. It is necessary to simultaneously analyze changes in the levels of metabolites in the blood and urine. The gold standard and the most reliable method of delivering a diagnosis is DNA diagnostics.

Nebulizer therapy is widely used in modern respiratory medicine. Nebulizers are devices that convert a liquid into a suitable for inhalation by a patient aerosol, which meets the requirements of the European standard for nebulizer therapy prEN 13544-1. The fundamental differences between nebulizers and other inhalation devices (metered aerosol inhalers, powder inhalers) are the possibility to perform maneuvers on spontaneous breathing, the use of drugs, which do not involve the use of other inhalers, and the possibility to select drug doses depending on patients need.

Although this delivery method is effective for many respiratory diseases, and it is preferred for special groups (children, the elderly, as well as severe exacerbations, etc.), there are some peculiarities and limitations of its use, which should be taken into account by clinicians. According to the principle of operation, nebulizers are divided into compressor, ultrasonic and electronic-mesh, which differ in technical characteristics and indications for use. Compressor nebulizers are most widely used in medical institutions (intensive care units, hospitals, offices) and at home, relatively inexpensive, simple and easy to maintain, have additional components (chambers with inhalation-exhalation valves, masks for children and children) adults, nasal aspirator, etc.). Modern jet nebulizers are equipped with spray mode switches, so that the aerosol feed rate and the aerodynamic diameter of particles of an average mass from 2-3 to 10 microns can be adjusted. Depending on the selection of the switch mode and the corresponding medication, the nebulizer can be used in the treatment of rhinitis, laryngitis, bronchitis, asthma and other diseases of both upper and lower respiratory tract.

Modern genetics uses a number of methods that are its tools in understanding the essence of human hereditary pathology. Genetic methods are usually used together. Understanding the possibilities of methods for studying human genetics is the key to successful diagnosis of hereditary diseases. The lecture presents methods for studying modern genetics. It is shown that clinical genetics operates with a number of methods that allow successfully solving the tasks assigned to it. The methods of modern genetics include: genealogical, clinical, cytogenetic, molecular cytogenetic, molecular genetic, population, twin, dermatoglyphic, bioinformatic, biochemical, paraclinical, bioengineering methods and modeling method. All methods are of practical importance and help to make a diagnosis and predict the development of the disease. Methods in genetics are used in diagnostic schemes when making a diagnosis of a hereditary disease. In clinical practice, as a rule, methods with the lowest cost are used first, and then more accurate, modern, but also expensive methods are resorted to. This allows you to establish the diagnosis of even the rarest hereditary disease.

Filippov Evgeny Semenovich was born on February 22, 1948 in Irkutsk. In 1972 he graduated from the medical and preventive faculty of the Irkutsk State Medical Institute. After graduating from the institute in 1972-1974. worked as the head of the department of the Children's Infectious Diseases Hospital in Irkutsk. From 1976 to 1978, he studied at the clinical internship of the Leningrad State Institute for the Improvement of Doctors at the Department of Pediatrics No. 2. He continued his studies as a postgraduate student at the Department of Hospital Pediatrics of the Leningrad Pediatric Medical Institute from 1978 to 1981, where he defended his Ph.D.