Modern medical technology

Problems and achievements in the study of metabolic bone disease in young children (literature review)

L. M. Boiarska — 2024-09-30

In recent years, intensive research on bone metabolism in early childhood has led to significant progress in understanding and characterizing disorders affecting skeletal formation. The role of vitamin D₃ in improving maternal health and reducing the risk of developmental disorders in the fetus, newborn, and especially premature born infants, is an important area of research today. Therefore, understanding new pathophysiological aspects of bone formation can help optimize the diagnosis and prevention of bone metabolism disorders.

Aim. The aim of this work is to systematize and analyze scientific research data, to reveal pathophysiological mechanisms contributing to the development of metabolic bone diseases in premature infants, and to search innovative approaches to diagnosis and prevention of these disorders.

Materials and methods. The study involved reviewing and analyzing domestic and foreign literature sources using the PubMed and Scopus databases for the period 2019–2024. The literature was searched and selected using the keywords: newborns, preterm infants, neonatal osteopenia, metabolic bone disease, and ultrasound densitometry. Full-text articles from studies with evidence levels I–II were included to this review in order to systematize and summarize the findings.

Metabolic bone disease (neonatal osteopenia) presents a significant medical challenge in the care of preterm infants, especially those born with very low birth weight and sick neonates. The current requirements of the medical community are aimed to maximize bone density during growth periods, starting from the intrauterine and neonatal stages, to promote the formation and preservation of bone tissue in later life.

Conclusions. The safest and most universal screening method for assessing bone mineral density in preterm infants is quantitative ultrasound. It is expected that over the next decade, many fundamental studies will form the basis for the development of unified guidelines for the diagnosis, treatment and prevention of metabolic bone disease to improve the quality of life of children with bone metabolism disorders.

The use of a trench candle as an alternative heating and light source in wartime and possible negative consequences

O. O. Kovalyov — 2024-09-30

Aim. To examine the composition of ultrafine aerosol in the air generated by the trench candle burning and compare combustion products with proven carcinogens according to the International Agency for Research on Cancer (IARC) classification.

Materials and methods. The content of ultrafine aerosol emitted from trench candle burning was studied using a NanoScan 3910 portable scanning spectrometer. The number, area, surface volume and mass concentration of particles were measured at 0.5 and 1.5 meters above the floor level before and after the trench candle burning for 10 minutes. The chemical composition was assessed by inductively coupled plasma optical emission spectrometry (ICP-OES, PerkinElmer Optima 2100 DV, USA). The morphological characteristics of suspended particles were studied by scanning electron microscopy (TESCAN VEGA3, Czech Republic).

Results. High concentrations of suspended particulates in the ultrafine particle size range outnumbering the background content by almost 985 times (p ≤ 0.001) have been found to be emitted from the trench candle burning into the indoor air at the breathing level. The ultrafine aerosol contained carcinogenic heavy metals according to the IARC classification (chromium, cadmium, and cobalt).

Conclusions. The use of trench candles during the Russian–Ukrainian war relates military and civilian populations to a risk group, that requires wartime carcinogenic effects on the Ukrainian population to be studied and demands the development of a National Program for primary and secondary prevention of cancer as soon as today.

Intraoperative oximetry of hollow organs in case of gunshot injuries of the abdomen

I. V. Sobko — 2024-09-30

The aim of the study is to analyze the application of intraoperative oximetry for assessing the viability of hollow organ segments during the implementation of Damage Control Surgery (DCS) in patients with gunshot abdominal injuries.

Materials and methods. Intraoperative oximetry of the walls of damaged hollow organs was performed in 76 wounded combatants with penetrating gunshot wounds to the abdomen in phase I of DCS, that allowed to determine the state of microcirculation and the viability of the intestinal wall of the injured and other doubtful areas within a few minutes. In phase III of DCS, intraoperative oximetry was performed to assess the viability of questionable areas of both sutured wounds and intestinal stumps after obstructive resections.

Results. The high efficiency of intraoperative oximetry in penetrating gunshot injuries of the abdomen in phase I of DCS tactics has been proven. The oxygenation rate in the SpO₂ measurement zone of 95 % and above indicates the viability of intestinal tissue and good conditions for anastomosis formation or wound suturing. The SpO₂ level from 89 % to 95 % indicates the questionable viability of the intestinal wall, and below 89 % – the deterioration of microcirculation and a high risk of intestinal wall necrosis development. Repeated intraoperative oximetry in phase III of DCS made it possible to assess the viability of the walls of the small intestine and colon, obstructive stumps of the small intestine and colon, and to optimize surgical tactics with repeated resections of suspicious and non-viable areas of the small intestine and colon. In the main group, the formation of ileo-transverse anastomoses increased by 14.6 % (р = 0.013), and transverso-sigmoanastomoses – by 9.9 % (р = 0.030). This became possible due to the reasoned refusal to form terminal stomas. In the main group, ileostomies were not formed, and in the comparison group they were formed in 5.8 % of the wounded. At the same time, colostomies formation was also reduced by 17.7 % (р = 0.008). The consistent use of intraoperative oximetry in the phase I and III of the DCS tactics made it possible to optimize the surgical tactics, which led to a decrease in complications in the main group by 12.4 % (р = 0.007).

Conclusions. Intraoperative oximetry for gunshot injuries of the abdominal cavity is a simple, fast and effective method that allows to determine the state of microcirculation in the wall of the hollow organ (its viability) and optimize the nature of surgical intervention in phase I of DCS tactics. Intraoperative oximetry in phase III of DCS allows to determine the state of microcirculation in the areas of sutured intestinal injuries, intestinal stumps after obstructive resections performed in favor of the formation of inter-intestinal anastomoses and prevent the development of complications.

The influence of occlusive-stenotic lesions of the arteries of the head and neck on the methods and results of surgical treatment of ruptured arterial aneurysms

V. P. Komarnytskyi — 2024-09-30

Aim: to analyze the results of surgical treatment of patients with ruptured arterial aneurysms in the presence of occlusive-stenotic lesions of cerebral arteries and to evaluate the impact of combined lesions on the choice of surgical treatment method.

Materials and methods. A retrospective study was conducted on the medical histories of patients with aneurysmal disease of cerebral arteries from 2006 to 2022. The main group consisted of 63 patients with occlusive-stenotic lesions of cerebral arteries who underwent surgery for ruptured arterial aneurysm. The comparison group included 63 patients without occlusive-stenotic lesions. The analysis included an assessment of neurological status, examination results, and statistical data processing.

Results. Occlusive-stenotic lesions of the head and neck arteries were more frequently observed in men, the maximum difference in age was found at a stenosis of 50–75 % (men – 48.30 ± 2.51 years; women – 62.00 ± 5.06 years, p < 0.01). Cerebral artery stenosis was more commonly observed in cases of ruptured middle cerebral artery aneurysms. The main group had more fatal cases (n = 5) compared to the comparison group (n = 2), p = 0.25.

Conclusions. Ruptured arterial aneurysms are more frequently diagnosed in the presence of middle cerebral artery stenosis (p < 0.05). Ruptured aneurysms in patients with occlusive-stenotic lesions of cerebral arteries are more often diagnosed in middle age (p = 0.0001). The combination of stenosis and aneurysm complicates the disease course and affects the choice of surgical method. Patients with combined lesions have a higher risk of ischemic complications (p = 0.03). The greatest life risks arise from ruptured arterial aneurysms in men with concomitant arterial stenosis. The main risk factors are occlusive-stenotic lesions of the arteries, recurrent hemorrhages, and large intracranial hemorrhages.

Changes of eye’s functions among patients with age-related macular degeneration during the use of vitamin D medications

T. M. Komarova — 2024-09-30

Aim. To increase the effectiveness of the treatment of age-related macular degeneration (AMD), dry form, in postmenopausal women by determining the level of serum vitamin D and correcting its deficiency.

Materials and methods. The study was conducted on the basis of the Department of Ophthalmology at Bogomolets National Medical University, was prospective, case-control, included 88 women (88 eyes) aged 72.0 ± 10.1 years, who were divided into 2 groups: control group – 20 patients (20 eyes) without AMD and study group – 68 patients (68 eyes) with AMD, dry form.

Results. Supplemental vitamin D did not significantly improve visual acuity, but slowed the deterioration of contrast sensitivity. Deficiency of vitamin D is associated with lower visual acuity, negatively affects contrast sensitivity, more strongly than its insufficiency. The results of the treatment in the AREDS-2 + vitamin D group after 12 months showed a probable double increase in the content of 25(OH)D in patients with AMD, dry form (p < 0.05). Visual acuity after 12 months decreased by 7.56 % (from 0.19 ± 0.06 to 0.20 ± 0.06) in women who took only AREDS-2 drugs, and by 6.78 % (from 0.18 ± 0.07 to 0.19 ± 0.08) in the group where vitamin D medications were additionally prescribed (p > 0.05). Logarithmic indicators of contrast sensitivity after treatment had a slight negative trend in both groups, decreased by 2.80 % in women in the AREDS-2 group, and by 2.25 % in women who additionally took vitamin D medications (p > 0.05).

Conclusions. Irreversible vision loss is a global problem with both medical and socioeconomic consequences. Age-related macular degeneration is one of the main diseases that lead to blindness, especially in people over 50 years old. Additional prescription of vitamin D to AREDS-2 may be beneficial in slowing the progression of AMD. Further studies are needed to confirm these results.

Disorders of menstrual function during puberty and the risk of nonalcoholic fatty liver disease with comorbid diseases of the gastrointestinal tract

V. O. Dynnik — 2024-09-30

The aim of the study was to determine the relationship between disorders of menstrual function in adolescence and the risk of nonalcoholic fatty liver disease (NAFLD) with comorbid gastrointestinal pathology.

Materials and methods. We examined 129 adolescent girls aged 12–17 years with menstrual disorders (61 with abnormal uterine bleeding (AUB) and 68 with oligomenorrhea (OM)) and measured anthropometrics, indices of lipid and carbohydrate metabolism and liver enzymes. Data are presented in the form of mean (M), standard deviation (SD) and median (Me), a factorial model was developed.

Results. The study shows the peculiarities of the clinical course of menstrual function disorders in girls of puberty age. Patients with AUB were characterized by significantly lower average body mass indices, they were younger compared to patients with OM. The nature of metabolic changes that depended on the type of menstrual disorders in teenage girls was clarified. Adolescents with AUB had statistically significantly higher average levels of immunoreactive insulin, HOMA index, triglycerides, very low-density lipoprotein cholesterol, aspartate aminotransferase. This creates conditions for the formation of nonalcoholic fatty liver disease. A model was created regarding the participation of dyslipoproteinemia, changes in the carbohydrate spectrum and levels of liver enzymes in the formation of nonalcoholic fatty liver disease in girls with menstrual cycle disorders.

Conclusions. Disorders of menstrual function are associated with an increased risk of NAFLD formation. Adolescent girls with menstrual disorders need metabolic screening. The atherogenic profile of lipoproteinemia, marked changes in the carbohydrate spectrum and increased serum levels of liver enzymes in girls with menstrual cycle disorders are the basis for the formation of nonalcoholic fatty liver disease.

Evaluation of anti-inflammatory properties on the surface of dental implants depending on the type of processing

S. D. Varzhapetian — 2024-09-30

The aim. Study of the anti-inflammatory properties of the surface of commercial dental implants made of zirconium and titanium with different processing methods using the example of the course of the first stage of implantation.

Materials and methods. The structural (microstructure of the surface, biocompatibility, surface corrosion, elemental surface structures) and clinical (severity of peri-implantitis and mucositis, coefficient of implant stability) characteristics of dental implants made of zirconium with surface treatment by the PEO method and implants made of titanium with DAE surface treatment were studied. Median test (χ²), Kruskal–Wallis test (H), univariate variance analysis (F) were used. The difference in parameters was considered statistically significant at the p ≤ 0.05 level.

Results. The PEO surface had a monolithic surface layer with rounded pores averaging 4.51 μm². The DAE surface had a polyhedral irregular shape, about 7–12 μm². On the DAE surface: carbon – 4.59 wt%, oxygen – 6.16 wt% and traces of zinc were found. A significant difference in the elemental composition of PEO implants was the presence of chlorine (0.93 wt%), silicium (0.14 wt%), aluminum (0.23 wt%), potassium (0.47 wt%) and magnesium (0.07 wt%). The results of comparing the contact angle of the B&B Dental 29.2 ± 5.9° and Zircon-Prior 21.5 ± 3.3° samples had no statistically significant difference (р > 0.05). After 7 days of exposure in the SBF solution, zirconium implants with a PEO surface increased calcium by 21.87 wt%, phosphorus by 35.68 wt%, sodium by 72.89 wt%, and chlorine by 76.21 wt%. Aluminum, silicium, and zinc were no longer detected. The peculiarity of the titanium implant sample with the DAE surface was only the background level of calcium – 0.06 wt% and the complete absence of phosphorus; the most significant components were oxygen – 16.71 wt%, carbon – 12.37 wt%, sodium – 6.47 wt%, and chlorine – 5.90 wt%. Assessment of cell adhesion to the surface of Zircon-Prior and B&B Dental samples neither on the first nor on the seventh day of incubation did not demonstrate a statistically significant difference. Clinical signs of bone tissue resorption were identified around 30.8 % of implants with a PEO surface and 27.3 % of implants with a DAE surface (p = 0.8); inflammation of the mucous membrane – in the areas of installation of 34.6 % of PEO implants and 72.7 % of DAE (p = 0.009). 3.8 % of PEO implants and 9.1 % of DAE implants were lost (p = 0.44). The average ISQ were significantly different: 59.2 ± 4.1 DAE implants versus 64.4 ± 4.9 PEO implants, p = 0.003.

Conclusions. Resorption of bone tissue around zirconium implants with a PEO surface (30.8 %) was more common than around titanium implants with DAE surface treatment (27.3 %), p = 0.8. Clinical signs of bacterial damage were more frequent and more severe around DAE-coated implants (72.7 %) than in the areas of PEO implants (34.6 %), p = 0.009. In zirconium implants with surface treatment by the PEO method (64.4 ± 4.9 units), the index of stability (ISQ) was significantly higher than in titanium implants with surface treatment by the DAE method (59.2 ± 4.1 units, p = 0.003). The probability of “loss” of titanium implants with DAE surface treatment (9.1 %) at the surgical stages of implantation is higher than that of zirconium implants with PEO surface treatment (3.8 %, p = 0.44).

The effect of dental gel with IL-1β antagonist on indicators of nitrosative stress and antioxidant system in rats with experimental chronic generalized periodontitis

O. O. Dmytriieva — 2024-09-30

The aim of the study was to evaluate the action of dental gel with IL-1β receptor antagonist on the indicators of nitrosative stress and antioxidant system in rats with experimental chronic generalized periodontitis.

Materials and methods. Experimental chronic generalized periodontitis (CGP) was modeled using a calcium-deficient peroxide diet with reduced masticatory function in Wistar rats weighing 190–220 g for 8 weeks. The studied pharmacological agents were administered within 30 days after the development of CGP: 1 % dental gel with IL-1β receptor antagonist (1 mg/kg, locally using a dispenser); and antioxidant Mexidol (250 mg/kg, intragastrically). To assess the condition of periodontal tissues, the levels of nitrotyrosine, iNOS, Cu/ZnSOD, and glutathione peroxidase-4 were determined by immunoenzymatic quantitative analysis; levels of stable metabolites of NO, reduced and oxidized glutathione were determined using biochemical methods.

Results. Course administration of dental gel with IL-1β antagonist in a therapeutic regimen to rats with CGP resulted in a decrease in the depth of periodontal pockets, almost complete elimination of bleeding and swelling of the gums, as well as to a decrease in iNOS expression by 37.8 % (p < 0.05), nitrotyrosine concentration – by 55.2 %, and NO metabolites – by 30 % (p < 0.05) in the blood of animals. Dental gel with IL-1β antagonist application resulted in an increase in concentration of reduced glutathione by 63 % (p < 0.05), glutathione peroxidase-4 expression – by 60.4 % (p < 0.05), and Cu/ZnSOD – by 31.2 % (p < 0.05) in the blood of animals with CGP. Mexidol, when administered to rats with CGP, affected only two studied indices – the level of nitrotyrosine and reduced glutathione (p < 0.05). However, it was inferior to the gel with the IL-1β receptor antagonist in terms of the degree of influence on these parameters (р < 0.05).

Conclusions. The obtained results provide experimental justification for further study of IL-1β antagonist as a promising agent for the treatment of CGP.

Disorders of the central nervous system cognitive and mnestic functions in genetic arterial hypertension and with the use of beta-blockers of different generations

A. O. Svitlytskyi — 2024-09-30

Arterial hypertension is currently one of the most common diseases in the world. A long-term increase in pressure results in changes in the target organs, the healthy functioning of which depends on a stable blood supply (kidneys, eyes, brain), which is primarily caused by damage to small vessels. β-blockers are among the drugs with proven effectiveness in the treatment of hypertension, but their long-term use has different effects on the cognitive sphere, which is determined by the coordination of neurotrophic and neurotransmitter processes in the corresponding brain structures.

Aim. To comparatively analyze the effect of β-blockers from different generations on cognitive and memory functional parameters of the central nervous system in rats with genetically determined hypertension.

Materials and methods. The study used 40 male rats weighing 280–300 g with spontaneous arterial hypertension (SHR) aged 8 months and 10 normotensive control normotensive Wistar–Kyoto rats (WKR) weighing 200–220 g. The animals were divided into 5 experimental groups of 10 rats each. In the experimental study, massometric, instrumental, functional and statistical methods were used with triple measurement of blood pressure by non-invasive Blood Pressure Analysis Systems TM BP-2000 Series II (Visitech Systems, USA). SHR of the 3^rd, 4^th, and 5^th groups were orally administered drugs daily for 30 days, propranolol – 50 mg/kg, carvedilol – 50 mg/kg, and hypertril – 20 mg/kg, respectively. The ability of animals to learn and remember an aversive stimulus was assessed through the conditioned passive avoidance reaction. test Statistical data processing was performed by the package of applied and statistical programs Excel 7.0 (Microsoft Corp., USA) and Statistica (license No. JPZ804I382130ARCN10-J). The significance of differences in study results was determined by pSt ≤ 0.05.

Results. In groups of rats that received β-blockers with different properties (groups 3, 4 and 5), blood pressure was quickly stabilized to target values. A comparative analysis of the cognitive parameters after correction by β-blockers of different generations has shown a significant difference in their effects with proven high effectiveness of hypertril. The drug increased the latency to enter the dark chamber 24 hours after training compared to animals treated with propranolol (group 3) by almost 3-fold, with a 4-fold increase in the percentage of trained animals. The advantages of carvedilol were a 54 % longer latent period and a 2-fold greater number of rats that successfully developed the reflex. Correction with propranolol and carvedilol has proven to be poorly effective in terms of the ability to learn and develop the conditioned-reflex skill with the worst effect of propranolol.

Conclusions. Rats with spontaneous arterial hypertension (SHR) demonstrate a significant decrease in cognitive performance compared to normotensive rats. Drug correction of arterial hypertension with hypertril (a β-blocker of the latest generation with NO-mimetic action) has a highly effective effect on the development of conditioned-reflex skills and the ability to learn that indicates a reduction in cognitive deficits in SHR with essential arterial hypertension.

Isolated “on-pump” tricuspid valve repair through right-sided anterolateral thoracotomy by modified femoral-monocaval cannulation in patients with repeated heart intervention – a safe and effective surgical alternative

V. V. Osaulenko — 2024-09-30

Tricuspid valve dysfunction has always been considered less clinically important than left heart valve disease. Disruption of the tricuspid valve can lead to cardiac dysfunction, causing severe and irreversible complications in patients if not treated in time. Reoperations for tricuspid valve insufficiency are surgical procedures associated with particularly high peri- and postoperative risk. The optimal timing and strategies for surgical intervention in isolated tricuspid valve insufficiency remain controversial.

Aim. Improving the immediate and long-term outcomes of patients with a cardiac surgical profile by evaluating the efficacy and safety of isolated tricuspid valve repair on the working heart by right anterolateral thoracotomy with reintervention.

Materials and methods. A single-center retrospective observational study of the clinical data of 12 patients who underwent tricuspid valve monosurgery between January 2022 and March 2024 was conducted. We evaluated the results of surgery in patients with isolated tricuspid valve annuloplasty on a working heart through a right anterolateral thoracotomy. Planned surgery was performed in 100 % (n = 12) of patients. The average age of the patients was 68.8 ± 2.2 years. Patients were divided by sex as follows: women – 75 % (n = 9), men – 25 % (n = 3). We collected demographic data of the patients, results of echocardiography, surgical intervention, hospitalization, and EuroSCORE was calculated based on patient medical records.

Results. The degree of postoperative regurgitation of the tricuspid valve according to the results of control echocardiography significantly decreased compared to the degree of insufficiency before surgery. The level of in-hospital mortality in the first 30 days after surgery in the studied group was 8.33 % (n = 1) of cases. The average duration of parallel artificial circulation was 63.3 ± 8.6 min, surgical intervention lasted 271.67 ± 22.20 min, the average duration of postoperative inotropic support was 0.8 ± 0.2 days, transfusion of blood components was required in 8.33 % (n = 1) of cases, stay in the intensive care unit after surgery was 1.0 ± 0.9 days, the total duration of hospitalization was 4.30 ± 1.72 days. Indicators of renal failure, EuroSCORE, episodes of cardiac arrhythmias, and other postoperative complications were significantly lower than with standard surgical techniques described in the current scientific literature.

Conclusions. Isolated tricuspid valve repair on the working heart through right anterolateral thoracotomy is a safe and effective surgical alternative in patients with reoperation. The use of right-sided anterolateral thoracotomy during repeated cardiac surgery allows preserving the integrity of the bone frame, avoiding technically difficult cardioplegia and aortic clamping, preventing damage to the main vessels and coronary arteries when mobilizing certain parts of the heart, and heart failure. Carrying out tricuspid valve plastic surgery on a working heart allows to achieve a good clinical result in patients with isolated tricuspid insufficiency at careful selection of the responders for the proposed technique with satisfactory terms of stay in the intensive care unit and in the hospital, the absence of ischemic and/or reperfusion damage to the heart, and a quick return to normal life activities. Indications for isolated surgery on the tricuspid valve should be based on reliable echocardiographic parameters of the right heart function.