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Pacific Medical Journal

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No 3 (2016)
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REVIEWS

5-10 314
Abstract
Review covers the historical and practical problems of imaging of eye structures. It describes main complications related to full and correct diagnostics of vitreoretinal pathology including such diseases as rhegmatogenous retinal detachment, proliferative diabetic retinopathy, opened and closed eye injury, etc. It was conducted a detailed analysis of current method's features and diagnostics technologies in ophthalmology, and a contemporary analysis of their possibilities as well. We examined perspective elaborations having a big potential in accuracy increase and data integrity, and their further inter-pretation.
11-14 317
Abstract
This literature review describes the role of cells of innate immune system, mast cells, in the pathogenesis of autoimmune thyroid diseases. In recent years a large number of articles were about studying new immune properties of mast cells and, in particular, their effect on T-cells' functions through secretion of various cytokines. However, the articles that have been analyzed do not fully clarify an assumed ability of mast cells to directly activate T-cells through autoantigen presentation. Possible MHC class II expression by mast cells also remains disputable. This review considers a hypothesis that mast cells can control functional activity of immune cells and thyroid, provided they have appropriate effect. At present this assumption is considered to be a mechanism that triggers the pathogenesis of autoimmune thyroid diseases.

ORIGINAL RESEARCHES

15-17 381
Abstract
Objective. Comparative analysis of bacterial population content of eye surface at local and systematical antibiotic treatment with fluoroquinolones in patients with cataract surgery. methods. The study included 185 patients (246 eyes) aged from 45 to 85 after cataract surgery. 92 patients got instillation of levofloxacin (0.5 %) 4 times per day during 3 days before the surgery, 93 patients got add-on fluoroquinolones systematically: orally, 500 mg/day. During the study it was conducted four stages of microbial examinations of conjunctival sac content: before the antibacterial treatment, in several hours before the surgery, after the surgery, and in 4-5 days after the surgery. results. Analysis of changes in the microbial contamination of the conjunctiva in the background of antibiotic prophylaxis, showed a negative value of the absolute increase (decrease) in both groups. Patients who received antibiotic prophylaxis the decrease rate was significantly higher (1.8 times). Conclusions. There is every reason to use the antibiotic scheme with the use of fluoroquinolones for systemic perioperative support cataract surgery in patients with a high risk of infectious complications.
18-20 240
Abstract
Objective. Analysis of the activity of a number of parameters of the structural remodeling of nasal mucosa with chronic tobacco smoke toxicity in rats. Methods. In 25 male Wistar rats have formed a model of chronic tobacco smoking by dispensing tobacco smoke in a specialized chamber for 9 months. 20 intact animals were in the control group. Using immunoperoxidase reaction was detected on paraffin sections of matrix metalloproteinase 9 (MMP 9) and its inhibitor - tissue inhibitors of matrix metalloproteinases 2 (TIMP 2). Results. In the experiment there was a significant increase of MMP 9 and the area occupied by intracellular enzyme. The most evident changes were observed in the lamina propria. Activity Change TIMP 2 showed the opposite trend. Conclusions. Based on the data about the molecular mechanisms regulating the activity of matrix metalloproteinases, it can be assumed that the pharmacological effect on this enzyme system will ensure the prevention and treatment of gross morphological and functional disorders of the nasal mucosa, occurring in smokers.
21-24 324
Abstract
Objective. In different regions the contribution of the potential risk factors in the formation of the biological development of children has its own characteristics, determined by the the climate and geographical factors, ecological and geochemical factors, social and economic factors, biomedical factors, etc. Methods. It was conducted a comprehensive study of the criteria of biological age in 2839 children aged from 3 to 11 living in Vladivostok. Results. The girls showed significant correlation between early childhood factors, social and sanitary, medical and biological factors and parameters of length and body weight. Food quality was significantly influenced all the criteria of physiological maturity of girls. In boys established a strong relationship between early childhood factors, hygienically-normalized lifestyle factors and length, weight, head circumference, the number of permanent teeth and the level of biological development. Conclusions. Further factor analysis will be carried out. An equity contribution of each factor in the formation of physiological maturity of the child's body will allow the scientific foundation for a set of measures for the prevention of health problems among children in Vladivostok.
25-28 338
Abstract
Objective. There are numerous studies on the vaginal mucosa changes depending on the hormonal status of the woman , but the level of vagina lysozyme at different colpocytologic picture in terms of the climacteric syndrome (CS) has not been studied. Methods. 140 women aged from 42 to 52 were examined. The relation of the cytological picture of vaginal mucosa with the level of serum lysozyme and vagina was studied. We examined gonadotropin and sex hormones. The morphological structure of the cells in the vaginal smear characterized the type of numerical maturation index (NUM). Results. In women with CS vaginal epithelial cell composition depended on the ratio of luteinizing (LH) and follicle stimulating hormone (FSH) hormones. The highest level of NUM were found in menstruating women with CS at a ratio of LH/FSH less than 0.5. When the ratio of LH/FSH 0.5-2 and non-menstruating women often recorded proliferative type smear while reducing the level of vaginal lysozyme. The lowest level of the vaginal lysozyme was detected in non-menstruating women with CS at a mixed type smear. In menstruating women with CS at a ratio of LH/FSH greater than 2, and mixed type smear was a significant rise of the lysozyme level of vagina. Conclusions. Both the decrease and the increase of lysozyme level on the background of the vagina changes the vaginal epithelium proliferative activity can disrupt vaginal microbiocenosis with the subsequent development of benign and malignant diseases of the vagina and cervix.
29-31 289
Abstract
Objective. Research objective is to correlate the manifestation degree of dry eye syndrome (DES) and the severity of changes in peripheral retina parts during ophthalmological therapy. methods. The research includes 94 patients with DES of mild and medium severity. Patients got lacrimal substitute therapy and local anti-inflammatory therapy. We diagnosed the front eye surface: the assessment of personal amelioration according to OSDI questionnaire, detecting of tear breakup time, sample colored with fluorescein, Schirmer's test, ophthalmoscopic ex amination of the peripheral retina parts. Follow-up time is 6 months. Results. It was built the logit-regressive models, showing the possibility of degeneration occurrencein peripheral retina parts with the factors changes, characterizing the state of the front eye surface and lacrimal apparatus. Conclusions. The possibility of occurrence of significant and inconvertible changes in peripheral retina parts maintained while correlating with the lacrimal factors for a month after the treatment started. The therapy by the 3rd months led to the break of connectivity of these factors.
32-35 381
Abstract
Objective. The study objective is to analyze the results of ocular prosthesis after the ophthalmoplasty, a risk assessment of anophthalmic syndrome. Methods. There were 80 patients aged from 14 to 65 years with anophthalmia after enucleation, evisceration, and evisceration with neurectomy. Results. All patients had a locomotor eye stump, in the second stage in 50 % of patients was carried the fillinf of eyepit with the buccal mucosa, the third stage in 40 %o of patients was performed a reconstructive filling of orbit bone walls, in 10 %o of cases - the tissue volumization of the orbit.We systematized clinical and morphological causes of anophthalmic syndrome. The results of ocular prosthesis after ophthalmoplasty with the assessment of sympotom group according to aesthetic qualities were represented. Conclusions. Ophthalmoplasty for the ocular prosthesis should start in time andd from the filling of the fibrous capsule of eyebulb to prevent further phthisis bulbi. When combined deformations of the eye and orbit phases of reconstructive surgery it is advisable to carry out progressively the full completion of the recovery period after each stage.
36-39 375
Abstract
Objective. Research objective is a follow-up analysis of the causes of post-traumatic enecleation of eyeballs in adults of Krasnoyarsk region. Methods. A look back analysis of medical documents of the 100 inhabitants of Krasnoyarsk region, that had a post-traumatic enucleation of the eyeball in 2003-2004 and in 2013-2014. The gender, age, settlement, social status and occupation of patients were taken into account as well as injury type and post-traumatic pathology, and the enucleation waiting period. Results. Primary morbidity of post-traumatic anophthalmia was 0.095 per 10 000 inhabitants over 18 years. In comparison with the 2003-2004 in recent years primary enucleations became threefold frequent, the number of eye resection reduced 1.3 times due to pain subatrophy, and 3.4 times - as a result of post-traumatic secondary glaucoma. The time elapsed from the time of injury to the removal of the eye reduced 6 times - from 12 to 1.8 months. Conclusions. The main factor determining the reduction of the execution time of enucleation is the absence of comprehensive activities of medical and social rehabilitation at the level of medical care that existed at the first analyzed period. Another determining factor reducing the resection time of injured eyeball is transition of ophthalmologists from budgetary structures in private health care organizations.
40-41 330
Abstract
Objective. In Russia, there are some continuing negative trends in children's health such as an increased incidence rate, including chronic disease, retardation and deceleration of physical development, increased incidence of neuroticism. The study objective is to determine contemporary tendencies of children and teenagers health using longitudinal study and taking into consideration dietary habits. Methods. 1542 school children were double examined (7-17 years old) of the 1st and 2nd health groups. Physiometry was conducted according to generally accepted methods with the use of standard equipment and was complemented with questionnaire survey. Mental health was assessed by criterion 'presence/absence' Clinical and biochemical blood indexes were also assessed. Results. It was discovered that the levels of general and primary morbidity increased by a factor of 2.5, including respiratory organs diseases (40 %), traumas and intoxications (35 %), derma diseases and diseases of subcutaneous fat. 97.2 % of girls and 89.9 % of boys had burdened anamnesis and lowered resistance. Physical development indexes were characterized by a high rate of abnormalities (each 4-5th case). Conclusions. Only 48.9 % school children had a harmonious physical. It was registered a misbalance of body components. The number of children who had eaten in school cafeteria decreased. Poor daily nutrition was determined by insufficient fuel value, protein, lipid, magnesium, calcium, vitamins A and C gap along with an excessive intake of carbohydrates. By a cluster analysis we determined the risk groups of health problems and developed individual recommendations using the 'traffic light' diet, it was recommended to conduct bioimpedansometry in decreed time limits.
42-44 398
Abstract
Objective. The research objective is to determine structural features of development of idiopathic colitis. Methods. Morphological, histochemical, immunological histochemical and morphometric tests were conducted adapted from 15 autopsies and 15 biopsies of colon of patients suffering from inflammatory intestine diseases. Results. In the area of pathological changes of the colon revealed numerous cells with apoptosis and necroptosis signs, and specific perifocal inflammatory reaction in the upper third of the mucosal crypts. It was determined high levels of expression of p53, Bax and PUMA, and low level villin in epithelial cells. By increasing the production of villin, expression of proapoptotic factors drastically reduced. Conclusions. Apoptosis and necroptosis of intestinal epithelium advanced or premature as a result of the villin deficiency, cause chronic non-infectious colitis. Development of subsequent inflammation with various cell infiltration and cytokine imbalance contributes to chronic process and the creation of precancerous background.
45-48 290
Abstract
Objective. Questions of home diet during weekends of preschool children require particular consideration as the day regimen alters and causes shifts in diet nature. Methods. Weekend diet was studied with the interviewing parents in 122 families using a method of 24 hour food replication. Indicators of food and energy value of diets designed with the help of chemical composition tables and calorific value of Russian foods. Results. It was found excessive consumption of sausages (2 times), poultry (1.6 times) as compared to the recommended levels of consumption, providing rations with pasta and cereals exceeded normalized indicators by 40 and 43 %. There has been a shortage of food basket for the content of fish and fish products, milk and dairy products, cheese and cheese products, potato, fresh fruit, vegetables and herbs. The amount of animal protein is 30.14±1.57 g/day at rated value of 35.10 g/day, vitamin A - less than half the age norm, B vitamins - 75 % of the physiological norms of consumption, vitamin PP preschool children loses 27 %, Ca - 47 % Mg - 14 %. Conclusions. Feeding preschoolers at home does not meet regulatory requirements in terms of product security, the energy value and chemical composition of homemade diets are characterized by a pronounced imbalance of mineral elements.
49-53 265
Abstract
Objective. The study objective is to analyze selective indexes of optical density of the cornea at early stages of keratoconus before and after cornea photopolymerization. Methods. We observed 30 patients (36 eyes) with keratoconus at the I-III stage of disease. We determined the optical density of the cornea pupil zones, and studied dynamics of selective optical density before and after cross-linking according to Scheimpflug images. Results. We revealed an increase of the optical density of the cornea on the background of disease progression. After crosslinking determined a significant increase in the optical density of the cornea in a month , the stabilization of high performance - in 3 months and a slight decrease of - 6 months. Reducing the optical density of the cornea with a clinically significant increase in corneal - compensatory intraocular pressure and corneal correction coefficient of elasticity recorded 12 months. After 18 months, the optical density of the cornea remained above baseline values, morphofunctional and biomechanical indicators have stabilized. Conclusion. Indicators optical density of the cornea are informative for estimating regeneration periods and the timing of its completion, and can serve as a criterion of pathogenic disease progression.
54-57 384
Abstract
Objective. In patients with degenerative myopia even low-impact intervention such as the phacoemulsification (PE) is accompanied by an increased risk of intraoperative and postsurgery complications. Methods. A clinical analysis of the PE results in 102 patients suffering from complicated cataract on the background of degenerative myopia. The comparison group consisted of 100 patients with uncomplicated myopic and senile cataract. Results. Despite the complete lack of intraoperative complications, the incidence of late postoperative retinal complications in the study group was 6.2 %o. Among them: macular edema, partial vitreous detachment, peripheral vitreochorioretinal dystrophy and rhegmatogenous retinal detachment. Conclusions. Taking into consideration the possibility of retinal complications in the postoperative period, the PE can be considered reasonable for a long dispensary observation. Its periodicity should be every three months during the first year (the most dangerous period). Thus it is necessary to examine in depth how the posterior pole and the equatorial and peripheral parts of the retina.
58-61 280
Abstract
Objective. Patrinia scabiosifolia Fisch. ex Link (fam. Valerianaceae) is commonly used for treatment of insomnia and anxiety. Efficiency of tincture of P. scabiosifolia for correction of psychosomatic damages induced whole-body vibration in male CD-1 mice was studied. Methods. The effect of supplementing P. scabiosifolia preparation were investigated on stress response in mice during shuttle or transportation vibration simulation. Results. Intragastric introduction of tincture P. scabiosifolia at a dose 5 ml/kg has increased duration of physical work until absolute fatigue and optimized behavior activity in the mice. Patrinia exhibited energy-saving effect in liver and skeletal muscles and normalized hormonal status of mice under whole-body vibration. Conclusions. The present research revealed that the application of P. scabiosifolia root tincture will be effective in suppressing vibration stress responses and can be recommended as vibroprotective remedy.
62-64 270
Abstract
OBJECTIVE. THE PURPOSE OF THE STUDY IS AN ASSESSMENT OF THE CLINICAL AND COST-EFFECTIVENESS OF PERIOPERATIVE ANTIBIOTIC PROPHYLAXIS SYSTEMIC FLUOROQUINOLONES CATARACT. METHODS. IT WAS CONDUCTED A RETROSPECTIVE RANDOMIZED STUDY OF THE INCIDENCE OF POSTOPERATIVE INFECTIOUS COMPLICATIONS THAT DEVELOPED AFTER THE 9314 CATARACT SURGERY CARRIED OUT BY
65-67 508
Abstract
Objective. The research objective is to determine complement diagnostic criteria of an intrauterine growth retardation (IUGR) using the data of anthropometric measures. methods. It was conducted ultrasound fetometry in 131 pregnant women with detected IUGR. The control group includes similar measures of 101 women with physiological gestation course. Results. In fetus with IUGR it was detected a fetometric gap except for some measures that differ depending on pathology and gestational age. At a dissymmetric IUGR the size of a fetal head and a femur length decreased, it was registered a significant narrowing of abdominal circumference. At a symmetric IUGR all measures fell off. Conclusions. The phase of cellular hyperplasia cells, which occurs before 32 weeks of gestation, when the pathological effects develops proportional to the reduction of cellular structure that characterizes the symmetrical form of IUGR, and formed an asymmetric form of pathology with a predominance of the processes of hypertrophy of the cells (after 32 weeks ), characterized by, first of all, the size mismatch of the abdominal cavity.

METHODS

68-69 272
Abstract
The results of the correction of postsurgery ametropia by implantation of additional intraocular lens (IOL) were presented. The study included two patients (2 eyes) with postsurgery ametropia of spherocylindrical nature. IOL implantation of additional Add-On Torica-sPB (HumanOptics AG/Dr. Schmidt Intraocularlinsen GmbH, Germany) was performed. During the period of patient management it was not registered any features of gadget dislocation or any other complications. Visual acuity improved in both cases.
70-71 317
Abstract
Objective. It was developed an original modification of musculoplasty of an extraocular eye muscle to treat strabismus. Methods. We observed 32 patients with the conjugate monolateral entropy. In all cases, in order to reduce the deviation angle was performed a modified musculoplasty of internal rectus of a squinting eye. Results. Evaluation of treatment results showed a statistically significant decrease in the mean angle of deviation in the total population of patients with a 24,5±2,7 to 6,3±4,1° (p<0.05). Conclusions. The use of the modified musculoplasty in the correction of strabismus with deviation 15-17° enables to eliminate the defect and to reduce the number of operated muscles. At angles of deviation of more than 17° musculoplasty must be combined with one-stage 'amplification' of the antagonist muscles, thus reducing the number of stages of the surgical correction of strabismus.
72-73 352
Abstract
Objective. To determine the severity and treatment of the syndrome of "dry eye" patients after adenoviral keratoconjunctivitis. Methods. In 21 patients with syndrome of "dry eye" after adenoviral keratoconjunctivitis were treated tear replacing (kationorm, hiloparin-dresser) and tear incentiving therapy (Restasis). Results. Syndrome of "dry eye" severe and moderate after adenoviral keratoconjunctivitis occurs in 76.2 % of patients of the main group. Appointment therapy syndrome of "dry eye" elevating tear production. Conclusions. Tear replacing (kationorm, hiloparin-comod) are effective in mild to moderate syndrome of "dry eye", while severe syndrome of "dry eye" in addition to the necessary treatment tear replacing and tear incentiving (Restasis).
74-75 270
Abstract
Bjective. Research objective is to assess the excimer laser photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) in ametropia correction in patients with pseudophakia. Methods. It was conducted the analysis of refractive surgery after lens extraction and intraocular lens implantation in 38 patients 20-81 years with secondary ametropia on pseudophakic eyes: PRK performed on 10, LASIK - 44 eyes. Analysis of visual acuity and corneal parameters was carried out after 1, 2 and 3 months after surgery. Results. By the end of the observation period in patients after PRK and LASIK has stabilized performance in visual acuity without correction and with correction. Stable refractive effect was observed after LASIK arrived after a month, and after PRK after 2 months. Conclusions. The use of excimer laser technology in the secondary ametropia after lens extraction with intraocular lens implantation is safe and fairly predictable method for correcting visual acuity.
76-78 337
Abstract
Two groups of patients with myopia were compared. The first one included 38 patients who had a surgery by the extraction of a lenticula through the small section (SMILE method), the second group consisted of 30 patients, they had the myopia correction by laser stromal keratomileusis (LASIK method) according to standard technology. The improvement of visual acuity was registered in both groups. Femtosecond laser enabled creating the superficial flap with the presice accuracy. Keratoprogramm after the femtosecond actions were more regular feature and was noted for the obvious homogeneity. Personal satisfaction with the sense of vision after surgeries by SMILE method were higher than of those after excimerlaser surgeries.
79-83 294
Abstract
Objective. The research objective is to improve the treatment of the unstable shaft fractures of a lower leg. Methods. We treated 39 patients aged from 18 to 49. Localization of tibia fractures corresponded to the level of the middle and lower thirds of the fractures of the fibula were placed on the same level and were splintered or fragmented. We used a standard blocking intramedullary osteosynthesis of the tibia with additional intramedullary fixation of the fibula TEN (titanium elastic nail). Results. We tracked results in a period of 6 to 12 months after surgery in 32 patients. Infectious complications were not registered. Fracture healing in 3-5 months recorded in the 31 cases. Conclusions. These results demonstrate greater stability in the osteosynthesis of fractures of both bones of the lower leg, below istmalnoy localized area of the tibial shaft.

PUBLIC HEALTH ORGANIZATION

84-88 302
Abstract
Objective. The study objective is to assess the impact of human resources of healthcare system on public health of Primorsky Krai and the relationship between them. Methods. The analyzed database of Primorsky Krai for the 20042014 contains about 2 mln records, describing the information of state and municipal medical organizations (MO), the medical staff, and diseased and treated patients in the context of the different classes of diseases, age groups, etc. Results. The number of physicians in state MO reduced 15 %. At the same time over 3 past years the staffing position increases which is associated with the need to increase salaries to physicians but this is done only by increasing the load on the specialist. The indicator of providing population with physicians working at state organizations decreased from 21 to 19 per 10 000 people. The deficiency of physicians in the state healthcare system was expressed in decrease of availability from 64.1 % in 2006 to 51.7 % in 2014. The absolute growth of number of staff positions amid annual population decline was not provided with physicians: staff positions increased by 34.25 on average per year, and the number of individuals decreased by 103.9. The number of physicians in state MO depended more on the number of population than on the number of staff positions. This allocation rate of physicians was not determined by population, but the need to improve the wages of specialists. Conclusions. The results indicate that the wages increase by the extension the number of positions is not an effective method of motivation and in actual practice leads to an outflow of professionals from the public health sector. It can be concluded about the protracted crisis in human resources management in the public health sector, the Primorsky Territory and the absence of significant results from ongoing activities.
89-92 446
Abstract
It was conducted the analyses of the problem of definition 'non-medical personnel of healthcare organizations' and the number control. Using the data of foreign and national resources it is shown the conceptual polysemanticism of non-medical personnel names: 'related healthcare specialists', 'supportive personnel', and 'extra personnel'. It was analysed current approaches to the separation of non-medical personnel structure. It is shown the necessity to divide this structure into two groups: workers and administrative personnel, including managers, specialists, and maintenance performers. Taking into account the suggested approach to personnel structure to determine a demand for non-medical personnel, it is recommended to control the number of administrative personnel and standards of management, services, time, etc. that can be developed during the personnel audit of healthcare organizations.
93-95 285
Abstract
In 60-80th of the 20th centuey in Kamchatka region it was created an effective mechanism of medicinal service. Based on the analysis of archival documents the author describes the types and forms of work of public authorities and medical institutions of the region, aimed at improving the quality of medical care.

PEDAGOGY

96-98 537
Abstract
Objective. The developing of the professional competence of the future medical worker, the developing of effective psychological accompanying of educational process, the improving of professional education are the most relevant during the realization of competence-based approach in the system of continuing professional education. Methods. The research was held on the base of the Pacific state medical university of the Ministry of Health of the Russian Federation with one hundred students of the medical faculty at the age of 21-45 years. The questionnaires on working career motives and the drawing projective technique "Draw the profession" reveal the causes of choosing this career, reflection of knowledge, feelings and emotions about the future of the profession. Results. A study conducted with graduates of medical faculty , shows the image formed by the profession, evaluative attitude towards it , the dominant external positive motivation and feeling a sense of indecision and timidity in their own knowledge and abilities. Conclusions. For the successful professionalization of possible psychological training to relieve tension and increase self-confidence and their professional activity.

ANNIVERSARIES



ISSN 1609-1175 (Print)