Background. In recent years erythropoietin has received particular attention due to the discovery of its important non-haematological effects. Erythropoietin is recognized as a pluripotent glycoprotein, manifesting neurotropic and neuroprotective properties as well as participating in angio-, neuro- and oligodendrogenesis, interferes with the effects of hypoxia-ischemia, oxidative stress and associated with them inflammation and apoptosis in the brain. During fetal hypoxia, the dominant production of erythropoietin switches to the placenta, starting its active synthesis to protect the brain, heart and other vital organs from harmful effects of severe hypoxia.

Objectives. The study was aimed at determining the correlation between the severity of hypoxic ischemic brain injury and erythropoietin level in the artery and vein of the umbilical cord.

Methods. A clinical observational cross-sectional study was conducted on the basis of the Maternity Hospital, Neonatal Pathology and Pediatric Departments №1 and №2 of the Research Institute of Obstetrics and Pediatrics under the auspices of Rostov State Medical University, Russian Federation. The study included 184 newborns with moderate (group II, n = 78) and severe hypoxic ischemic injury of the central nervous system (group III, n = 42). Group I consisted of 64 children without signs of central nervous system injury in the early neonatal period. Among which, following the maternal medical histories, 40 newborns were allocated to the group with the apparent development of delayed manifestation of neurological pathology. The evaluation of erythropoietin concentration in the umbilical cord blood was conducted separately in the artery and vein with Erythropoietin-EIA-BEST, a set of reagents for the enzyme-linked determination of erythropoietin concentration in the blood serum. Statistical analysis was carried out via MS Excel 2019 (Microsoft, USA), Statistica 12.5, (IBM, USA), SPSS27.001.

Results. Erythropoietin concentrations in the blood of the artery and vein of the umbilical cord in the groups of newborns were determined according to the severity of hypoxic-ischemic brain injury. The authors of the study showed the correlation between the “maternal-placental-fetal” blood flow at 36–40 weeks of gestation, which parameters are important antenatal predictors of the central nervous system injury, and the values of erythropoietin in arterial and venous umbilical cord blood as diagnostic markers.

Conclusion. The severity of cerebral abnormalities is determined by a high level of erythropoietin, while a decrease in erythropoietin level with severe cerebral deficit can mark a disabling injury.

Background. The prevalence of inflammatory-destructive periodontal diseases remains to be a global problem. Long-term topical application of chlorhexidine bigluconate and metronidazole is known to involve various side effects, thereby requiring widening the spectrum of herbal preparations used for treating chronic periodontitis.

Aim. To evaluate the efficacy of Chlorophyllipt in the treatment of chronic generalized periodontitis by studying cytokine concentration dynamics in the gingival fluid.

Methods. A randomized controlled clinical study of outcomes achieved in 50 patients with chronic generalized periodontitis treated in Dental Polyclinic No. 3, Krasnodar Кrai, was carried out. The control group included 20 clinically healthy people. Patients diagnosed with chronic generalized periodontitis were divided into the main (n = 25) and comparison (n = 25) groups. The main group received basic therapy and conventional conservative treatment with the addition of Chlorophyllipt. The comparison group received basic therapy and conventional conservative treatment. The therapy efficacy was estimated based on clinical indicators and IL-1β, IL-1Ra, IL-8, and TNF-α cytokine levels in the gingival fluid before treatment and after 14 days, three days, and six months of treatment. Statistical analysis was performed using the SPSS version 15 software (USA).

Results. All clinical parameters improved significantly in both chronic periodontitis groups after 14 days, three days, and six months of treatment in comparison with their levels before treatment (p < 0.001). At the same time, the conventional conservative treatment with the addition of Chlorophyllipt reduced inflammatory processes in periodontal tissues and gum bleeding at earlier stages. In the main group IL-1β, cytokine levels after 14 days of treatment were 19% lower than in the comparison group (p = 0.025), while IL-1Ra cytokine levels were 52% higher (p = 0.023). Six months after treatment, IL-1β and TNF-α cytokine levels were 14% and 32% lower than in the control group, respectively (p₂ = 0.021 and p₂ = 0.008), while IL-1Ra cytokine levels were 39% higher (p =0.019). All these results were statistically significant.

Conclusion. Due to the established clinical and immunological efficacy, Chlorophyllipt can   be included in the conventional conservative therapy of chronic generalized periodontitis. The determined levels of IL-1β, IL-1Ra, and TNF-α cytokines in chronic periodontitis patients can be used when assessing the response of periodontal tissues towards therapeutic interventions.

Background. Early prognosis for the outcome of a coma-induced critical condition is central to selecting an optimal tactic for patient management. This question remains insufficiently studied, thus justifying the task of identifying significant criteria for differences in terminal coma patients (stage III, irreversible) who died and those recovered to different levels of consciousness.

Objectives. To analyze the intensive care outcomes for patients in a terminal coma and to establish differences between the initial state of patients who have died and those who have recovered to different levels of consciousness.

Methods. A retrospective observational study was conducted on 210 patients aged 21 to 65 hospitalized in the Anesthesiology and Resuscitation Unit of Ochapovsky Regional Clinical Hospital No. 1 (Krasnodarsky Krai) with a diagnosis of terminal coma in the period from 2010 to 2015. The study did not include patients with pregnancy, histologically-confirmed malignancies, cardiovascular diseases (NYHA classes III-IV, according to the New York Heart Association Functional Classification), terminal liver cirrhosis and chronic kidney disease at the stage of hemodialysis. Depending on the critical condition outcome, the admitted patients were divided into groups: group 1 (n = 101) — patients with adverse outcomes; group 2 (n = 109) — patients with relatively favorable outcomes (recovery to a level of consciousness at score 4 and higher, according to The Glasgow Coma Scale). The condition was assessed with referring to available clinical data. Statistical processing of the obtained study results was carried out via nonparametric techniques using Microsoft Excel 10 (Microsoft, USA) and Statistica 6.0 (StatSoft, USA).

Results. The mortality structure against the background of a terminal coma in the following diagnosis: polytrauma — 54%, hemorrhagic stroke — 56%, isolated traumatic brain injury — 37%, acute cerebrovascular accidents (ischemic type) — 33% and acute posthypoxic dyscirculatory encephalopathy — 11%. Intergroup differences between the deceased and survivors were obtained in the following parameters: age (older with unfavorable outcome); base deficit — by 52%; glucose — by 47.6%; troponin — by 47.1%; potassium — by 13.7% and daily diuresis — by 27.5%.

Conclusion. The obtained results are likely to be used in a combination of clinical, instrumental and laboratory examinations in order to provide early detection of the risk group with an adverse outcome.

Background. The healing of skin wounds having various etiologies is known to involve a multistep process characterized by certain intercellular interactions affecting dermal cells, their attachment, migration, and differentiation. Here, recovery is interpreted as the return of dermis to its original state. The fact is, however, that the dermal extracellular matrix (ECM) is structurally impaired, which suppresses the regulatory and repository functions of the dermis, leading to the formation of a scar that inhibits several biological functions in the affected area and causes aesthetic problems associated with mobility.

Objectives. To evaluate the structural features of dermis during wound healing using a calcium-containing biodegradable implant.

Methods. The study used 60 rats that were inflicted with a third-degree burn injury (partially damaged dermis). The selected animals were divided into two groups: experimental and control. On post-burn day 14, a calcium-containing biodegradable implant was administered to rats from the experimental group, while a sterile saline solution was used in the control group. Material was sampled at two months (74 days) and four months (134 days). In order to assess the morphological state of the burn area, its sections were stained with hematoxylin and eosin, according to Mallory and Van-Gieson. For the selective detection of collagens, immunohistochemical tests using antibodies to collagen types I and III (Abcam, England) were employed. To characterize dermal cells, the authors used antibodies to vimentin (LabVision, USA), as well as to СD-68 (cluster of differentiation 68), α-SMA (alpha-smooth muscle actin), CD-105 (cluster of differentiation 105), and VEGF (vascular endothelial growth factor) receptors (Abcam, England). The obtained results were processed using the Statistica 6 software (StatSoft, USA).

Results. The administration of a calcium-containing biodegradable filler during the burn healing process was found to ensure local fibroblast activation with the formation of collagen types I and III. When the implant residence time was prolonged up to four months, an increase in the number of macrophages expressing CD-68 receptors was observed. Of note is that these cells retained their localization, while α-SMA-expressing cells were localized in both the superficial and deep dermal compartments. The number of cells expressing CD-105 and VEGF rose as well.

Conclusion. The use of the biodegradable filler is found to be promising in terms of post-burn dermal regeneration, as well as providing a dermal ECM, whose collagen network composition and assembly are similar to the original. Here, macrophages act as the primary synthesis regulators of the dermal ECM and stimulate fibroblasts, which ensures re-epithelialization and angiogenesis of the inflicted area.

Background. Biliary cystadenomas and cystadenocarcinomas are rare cystic tumors of the liver. Complicated differential diagnostics for simple cysts often leads to errors in surveillance of patients with these tumors. Cystadenoma and cystadenocarcinoma should be suspected upon detection of single or multilocular cystic neoplasms of the liver with septa and blood flow loci  in the cyst wall, especially in middle-aged women. The localization of the tumor is critical. The most common localization is segment IV of the liver. Urgent intraoperative biopsy is required to determine the extent of surgery.

Case description. Clinical observations with analysis of the examination and treatment data of two female patients aged 38 and 56 were presented. Both clinical observations illustrate the underestimation of the preoperative examination data that served as a ground for diagnosis of liver cysts with inadequate extent of surgery. In the first case, the resection was incomplete, and, as such, the biliary cystadenoma recurred in the resection area, the capsule of the neoplasm was ruptured and an encysted fluid collection was formed. In the second case, lack of histological examination of the excised neoplasm, due to confidence in its morphological verification as a cyst, resulted in cystadenoma recurrence in the resection zone with metastasis to the contralateral lobe of the liver.

Conclusion. Hepatic cystadenomas and cystadenocarcinomas are often misdiagnosed as simple cysts. These tumors should be suspected in central localization of the tumor in the liver, especially in young women. The clinical and instrumental symptomatology and radiological semiotics of the disease require careful evaluation. The recurrence of a cystic lesion in the resection zone in a patient previously operated for a hepatic cyst serves as an additional signal for detecting biliary cystadenoma. Rational strategy for surgical management of cystic liver lesions should include hepatectomy within healthy tissues (both anatomical and atypical) with mandatory intraoperative ultrasound and urgent histological examinations.

Background. Polymorphism of clinical manifestations of mental pathology in dermatology often leads to diagnostic errors and severe social exclusion of patients.

Clinical case description. The presented clinical case demonstrated the similarity of the clinical picture of self-destructive dermatosis with the symptoms of pyoderma gangrenosum, which determined our differential diagnostic search. Ulcerous defects in the patient were localized in places accessible for self-destruction and did not cause severe pain characteristic of pyoderma gangrenosum. In addition, lack of association with systemic diseases, unsuccessful long-term dermatological treatment, uniformity of skin lesions, and rapid healing of skin manifestations resulting in a scar were more characteristic of self-destructive dermatosis. A pathomorphological examination of the skin revealed morphological data typical of artificial dermatitis in combination with sclerotic changes, and excluded the presence of granulomatous diseases, vasculitis, and deep purulent inflammation of the dermis (neutrophilic dermal abscesses). Thus, histological changes in the biopsy material did not correspond to the clinical skin manifestations. The constant self-destructive actions of the patient resulted in excoriations, ulcerations, with the subsequent secondary infection and conspicuous cicatricial skin changes.

Conclusion. The presented clinical case demonstrated the complexity of the diagnostic search for a psychodermatological disorder due to the similarity of the clinical picture of self-destructive dermatosis with the symptoms of pyoderma gangrenosum, which led to a delayed diagnosis.

Background. Comorbid patients with a new coronavirus disease (COVID-19) often have thrombosis or bleeding in different periods of the disease. Early diagnosis of these complications and adequate therapy of these patients are complicated due to the peculiarities of the disease in comorbidity. Anticoagulation regimens in patients with COVID-19 are still unclear. The protocol of efficacy and safety the intermediate or therapeutic dose of low-molecular-weight heparins  is not clear and complete. It is very important to organize an individual approach for correction of the anticoagulants doses, taking into account the coagulation tests and the activity of inflammatory markers.

Clinical case description. We report a 71-year-old white male with COVID-19 pneumonia. Acute respiratory distress syndrome and atrial fibrillation were diagnosed in ten days of the disease. Therapeutic anticoagulation was started upon the admission. As early as in the 20th day of the disease a gluteal hematoma developed. Hence, prophylactic regimen of anticoagulation was started, but the worsening of dyspnea at rest, decreasing in SpO2 values to 82% according to pulse oximetry, and thrombelastographic hypercoagulability were observed after two days of such anticoagulation treatment. The patient has been receiving daily low-molecular-weight heparins injections in therapeutic doses for the following two weeks, and then the doctors have switched him to new oral anticoagulants. Patient was discharged to continue ambulatory anticoagulant’s treatment.

Conclusion. It is clear that the optimal choice of anticoagulation strategy in comorbid patients with concomitant COVID-19 remains challenging and requires randomized trials. Until the guidelines develop the effective anticoagulation strategy for various phenotypes of COVID-19 patients, the clinicians’ knowledge, experience and creative thinking will be apply to choose effective anticoagulant’s treatment on individual basis.

Background. There is currently no gold standard for functional assessment of nerve regeneration. Different researchers use various methods to assess the functionality of the regenerated nerve directly and indirectly. Indirect methods have the advantage of being minimally invasive, and the benefit of direct methods is recording the signal directly in the nerve.

Objectives. To identify significant parameters of neurogram changes in the sciatic nerve in an anaesthetized rat when the anode block is applied and to evaluate neurography as a method for functional assessment of nerve regeneration.

Methods. A series of experiments was performed on 10 anaesthetized rats. A DC anode was placed on the exposed sciatic nerve, more proximal and more distal to the recording electrodes, and a common cathode in the form of a needle was introduced into one of the forelimbs. Needle nichrome electrodes were introduced into the nerve using a manipulator. An original neurogram and a neurogram against anode activation were recorded by closing the DC circuit of different voltages to block the afferent signal, efferent signal and afferent and efferent signals simultaneously.

Results. When the anodal block of different voltages was applied to the afferent signal, efferent signal, and afferent and efferent signals simultaneously in all 10 experiments, the frequency-amplitude characteristics of the neurogram changed significantly as compared to the original neurogram. The amplitude of the neurogram increased considerably, while the frequency decreased, though not so dramatically. The changes in amplitude and frequency parameters were revealed to depend on the voltage value. In most cases, this relationship was directly proportional to the amplitude and inversely proportional to the frequency.

Conclusion. Considering the nature of the dynamics of the neurogram when exposed to the anodal block, the most significant parameter of its change is the amplitude. Changes in nerve fibre composition during its regeneration after damage cause changes in afferent and efferent signals, which is likely to be displayed in the neurogram as compared to the initial state. Thus, the anodal block can be used as a model of nerve damage, and the analysis of the dynamics of neurogram parameters — as a method for functional assessment of nerve regeneration.