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Extreme Medicine

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Vol 24, No 2 (2022)
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5-13 31
Abstract

Spermatogenesis is characterized by the significant changes of three-dimensional organization of the nucleus in spermatocytes, spermatides and spermatozoa. The functional cooperation between the nuclear envelope proteins and the acroplaxome/manchette is essential for nuclear elongation, acrosome biogenesis, formation of the flagellum. Furthermore, the nuclear envelope ensures the non-random chromosome arrangement within the nucleus. The LINC (linker of nucleoskeleton and cytoskeleton) complex proteins are involved in interaction between the cytoskeleton and the nucleoskeleton, as well as in the control of mechanotransduction. The LINC complex contains proteins of the outer and inner nuclear membranes: KASH and SUN, respectively. The LINC complex proteins are involved in formation of the sperm head and flagellum, and are, therefore, essential for male fertility. This review will consider the issues of the LINC complex protein localization in cells during the successive stages of spermatogenesis, the role in regulation of sperm maturation, and mutations of the LINC complex proteins resulting in male infertility.

14-21 19
Abstract

Organophosphates (OPs) and carbamates are a common cause of intoxication associated with convulsive disorders. These cholinergic substances form a bond with acetylcholinesterase (AChE), thus contributing to accumulation of acetylcholine in synapses and causing typical manifestations of toxicity, including seizures. Standard antidote therapy provides sufficient symptom control, reduces seizures and decreases mortality only in case of prescription at the early stage of poisoning or preventive administration. Traditionally, atropine is used, that blocks the activity of the muscarinic cholinergic receptors in the parasympathetic nervous system and reduce the smooth muscle contraction activity, along with oximes that reactivate the reversibly inhibited AChE in the nicotinic acetylcholine receptors found in skeletal muscle. If these are not sufficient, benzodiazepines that interact with γ-aminobutyric acid receptors are used to jugulate seizures, prevent organic brain desease and post-traumatic epilepsy. There are no unified guidelines for the cases of antidotes having no effect or insufficient efficacy of antidotes. Unwanted side effects of the existing drugs and progressive decrease of efficiency within 30 min after exposure to OPs necessitate the search for new agents. Combination therapy, new dosage forms, developing original molecules or modifying the existing ones are among the developed approaches discussed in our review.

22-32 30
Abstract

The COVID-19 pandemic affected every sector of society, radically altering the work of health systems throughout the world. In the situation of the mass influx of patients seeking medical care that was hard to control, the issue of the widespread adoption of the medical sorting (triage) principles became urgent within weeks. The review provides analysis of 49 publications dealing with various aspects of arranging pre-hospital triage. The dynamic changes in approaches to triage, its objectives and technologies, as well as in the contribution of various X-ray imaging methods depending on the evolving experience of working with the novel infection, are of great interest. The search for literature in Russian and English published before March 10, 2022 was performed in a number of databases (Embase, Medline/PubMed, Researchgate, medrxiv.org, RISC). The search was performed using the following keywords: COVID-19, coronavirus, коронавирус, SARS-COV-2, 2019nCOV, lung ultrasound, computed tomography, computerized tomography, компьютерная томография, СT, triage, сортировка. The strategy of establishing pre-hospital triage centers or stations in case of pandemic makes it possible to reduce both the burden on the emergency departments and the occupancy rate for inpatient services. Quick access to various imaging methods (X-ray imaging, lung ultrasound or computed tomography) greatly facilitates taking clinical decisions, and could be considered beneficial in the current extraordinary situation.

33-41 39
Abstract

Tuberculosis, caused by Mycobacterium tuberculosis, remains a global burden on our country and entire world. According to the World Health Organization, 10 million incident cases of tuberculosis were registered in 2019. A steady increase in the drug-resistant tuberculosis aggravates the situation and appears to be the major obstacle to the fight against the disease. A thorough understanding of the pathogen physiology and virulence properties is extremely important for the development of new diagnosis methods and treatment strategies. Multiomics approaches to studying the infectious agents are indispensable in understanding the nature of the disease. Despite the availability of sufficient genomic and transcriptomic data, pathogenic potential, survival rate, persistence, immunomodulation, mechanisms underlying drug resistance and host–pathogen interaction remain poorly understood. The use of proteomic approaches has been more informative, and provides more information about the true state of the cell in various conditions. Proteomic and bioinformatic approaches helped considerably in identification and characterization of target proteins that could be used for the development of new therapeutic options. Nevertheless, OMICs data integration with simultaneous use of the system approach to studying various clinically significant mycobacterial strains makes it possible to increase knowledge about the disease mechanisms and infection control methods. The review outlines various OMICs technologies and their role in the development of the M. tuberculosis diagnostic panels.

42-49 35
Abstract

Establishing a link between the objective research data and the thought process is one of the major issues of modern neurophysiology. The study was aimed to find an opportunity to perform objective analysis of the causes of cognitive impairment in individuals having a history of mild novel coronavirus infection by solving the inverse EEG problem. A total of 38 COVID-19 survivors were assessed, who had returned to work. The control group included 33 healthy individuals. EEG was recorded using a 128-channel system with an average reference. The data obtained were subjected to the EEG microstate segmentation and converted using the algorithm for solving the inverse EEG problem implemented in the sLORETA software package. In individuals with no history of COVID-19 being in a state of relaxed wakefulness, the component of rhythmic activity within Brodmann area 47, responsible for perception and realization of music, was found in all classes of EEG microstates (0.01 < p < 0.05; χ2-test). Auditory-speech load was characterized by rhythmic activity within areas 22, 23, 37, 39, 40, 44, 45, and 47. In individuals having a history of novel coronavirus infection being in a state of relaxed wakefulness, rhythmic activity within areas 22, 37, 39, 40 was detected. Under auditory-speech load, there was rhythmic activity within areas 37, 39, and 41 (p < 0.05; 2-test). Thus, alterations in realization of speech function in the form of he disordered sequence of switching on the main language centers were revealed in COVID-19 survivors.

50-55 17
Abstract

Psychophysiological assessment of employees of 10 Russian nuclear power plants revealed a low degree of psychophysiological adaptation (PPA) in 30% of subjects. Studying the fuctional activity (FA) of the brain by EEG revealed the decline in FA in individuals with the low degree of PPA. The impaired cerebral energy exchange could be one of the factors contributing to the decline in the brain functional state. The study was aimed to assess the features of the cerebral energy exchange in the employees of the hazardous nuclear facilities and productions with the low degree of PPA. A total of 159 EEG recordings acquired from individuals with the low degree of PPA (50.8 ± 4.6), and 152 EEG recordings acquired from individuals with the high degree of PPA (48.8 ± 1.5) were studied. Energy exchange was assessed in individuals with the low FA of both brain as a whole and the following conditionally distinguished structural and functional units (SFUs) of the CNS: mainly cerebral cortex (SFU-1), cortical-subcortical interactions (SFU-2), central control of the cardiovascular system (SFU-3). EEG was recorded by standard method using the electroencephalography unit. The magnitude of the hemispheric differences (HD) in the power of biopotentials (BP) between the homologous EEG leads was used to assess the cerebral energy exchange. There is evidence of the cerebral energy exchange increase in the anterior cortical areas of individuals with the low degree of PPA. The increased cerebral energy exchange has been also revealed in SFU-1 and SFU-2 responsible for the mental and psychophysiological functions of the CNS. However, cerebral energy exchange remains unchanged in the SFU-3 reflecting the central control of the CVS.

56-64 27
Abstract

It is important to control the levels of specific IgG against SARS-CoV-2 to ensure the timely monitoring of immunity in patients with COVID-19. Yet it is unclear what antibody levels protect against new infection and how long the protection is maintained. The study was aimed to assess the dynamic changes in the levels of IgG against SARS-CoV-2 by the two-year controlled observation. Healthy individuals (n = 70), COVID-19 survivors (n = 42), and people vaccinated with Sputnik V (n = 43) were enrolled. They were followed-up from April 2020 to April 2022. Serum IgG levels were defined (n = 312) using immunochip and the commercially available test system. Significance of differences was estimated using the Mann–Whitney U test for р ≤ 0.05. IgG levels in the disease survivors (median 97.1; 95% CI: 80–162 BAU/mL) and vaccinated individuals (103.1; 78–139 BAU/mL) were significantly higher than in healthy people (4.3; 4.1–4.5 BAU/mL). Intensity of immune response significantly increased after vaccination of the disease survivors (up to 1023; 657–1191 BAU/mL) or administration of booster dose to vaccinated individuals (413; 213–545 BAU/mL). In elderly convalescents (60+), IgG levels were significantly higher, and in vaccinated people these were significantly lower, than in people under the age of 60. IgG levels decreased faster in vaccinated individuals (after 3–4 months), than in the disease survivors, and stabilized at <100 BAU/mL in 60% of subjects within 5–9 months. Thus, intensity and duration of immune response in COVID-19 survivors and vaccinated people vary significantly depending on age, observation period, and additional vaccinations/revaccinations. Three cases of infection after full vaccination were reported over the entire follow-up period, including infection in a patient having a history of the disease and subsequent vaccination.

65-73 23
Abstract

Earlier, it has been convincingly established that exposure to ionizing radiation (IR) alters the T cell-mediated immunity in the long term. However, a search for papers describing the effect chronic exposure to radiation has on various subpopulations of T-helpers yielded no results. Therefore, we designed this study seeking to investigate the quantitative characteristics of various subpopulations of T-helpers in the peripheral blood of individuals chronically exposed to low-level radiation for a long period of time. The study involved 102 chronically exposed Techa Riverside residents (Russia) aged 60–87 years. The participants were divided into two groups, one comprised of exposed individuals with the average red bone marrow (RBM) irradiation dose of 567 ± 73 mGy, another, the control group, comprised of people with the irradiation dose below 70 mGy. With the help of flow cytometry, we identified the quantitative characteristics of T-helper subpopulations in the peripheral blood at various stages of their differentiation, as well as various T-helper subpopulations of central and effector memory. The study revealed no significant differences in the composition of T-helper subpopulations in the compared groups. We discovered a significant growth of the double positive follicular T-helper 17 subpopulation in the population of central memory T-helpers, which is associated with the increase of RBM (p = 0.04; S = 0.19), thymus and peripheral lymphoid organs (p = 0.03; S = 0.22) irradiation dose. In the group of exposed individuals, the number of naive T-helpers (p = 0.009) and double positive follicular T-helpers 17 in the TEM subpopulation (p = 0.04) was decreasing as the age of participants increased, and the number of effector memory T-helpers, on the contrary, increased with age (p = 0.04). We have not registered similar phenomena in the comparison group.

74-80 26
Abstract

COVID-19 pandemic announced by World Health Organization in March 2020 raised concern on potential demographic losses. This retrospective study was aimed to analyze the pandemic-related changes in the demographic status of the Ozyorsk urban district located close to the nuclear industry facility — the “Mayak” Production Association. Population changes in the Ozyorsk urban district over the last decade were analyzed based on the open-access demographic data. The impact of the COVID-19 pandemic on the demographic status of the Ozyorsk urban district was assessed using the crude overall mortality rates. Comparison of the overall mortality rates has been performed between 2020 and each previous year to assess the deviation of mortality from the forecasted value. The overall mortality rate in 2020 has been found increased significantly by 19%. Excess mortality attributed to the impact of the pandemic was 13.4%. The expected absolute number of excess deaths from COVID-19 being the main cause of death was 60 (4.2%). The COVID-19 pandemic had a significant negative impact on the demographic status of the Ozyorsk urban district; however, the role of COVID-19-associated deaths in overall mortality was not predominant.

81-86 14
Abstract

Studying the features of radiological situation in the workplace and assessing the individual effective doses in employees of research organizations working with open radiation sources (RS) are an urgent scientific task due to additional risks resulting from variability in the conditions and regimes of the technological operations. The study was aimed to assess the working conditions and intake of radionuclides by the employees of the V. G. Khlopin Radium Institute working with open RS. The data on exposure to work-related radiation factors were obtained by dosimetry, radiometry, and spectrometry. It was found that radiological situation in the employees' workplaces was characterized by the broad range of the gamma ambient dose equivalent rate values (0.10–122 µSv/h), alpha and beta working surface contamination, radioactive pollution of air in the working areas. In some individuals, spectrometry revealed the following: 125I in the thyroid gland (up to 9,850 Bq), 90Sr in the skeleton (up to 16,500 Bq), 137Сs in the whole body (up to 1,100 Bq), etc. The findings can provide the basis for developing the measures to improve the quality of individual internal dose control and the efficiency of medical care provision to the research organization employees dealing with open RS.

87-93 28
Abstract

Increased workloads among heads of clinical departments that result from working as both clinicists and managers may lead to the significant decline in their psychological well-being. The study was aimed to assess psychological well-being of the clinical department heads. The online survey of 216 department heads aged 32–70 having a 8–51-year experience in heathcare was conducted using the Ryff's scales of psychological well-being adopted by Shevelenkova–Fesenko, sent by e-mail or posted on the distance learning portal. The survey involved 123 men (56.9%) and 93 women (43.1%%): among them 117 people (54.2%) worked in inpatient settings, 114 people (52.8%) worked in the red zone, 138 people (63.89%) were assigned a qualification category, 63 people (29.1%) had an academic degree. Mean values, percentage, Pearson correlation coefficient, Student's t-test were calculated with the IBM SPSS Statistics 23 software. Correlations and mean differences were considered significant at р < 0.05. The average psychological well-being score was 378.67 ± 78.33; in 26 men (26%) and 28 women (43.1%) aged 36–55, the score was below standard values. Psychological well-being correlated with age (r = 0.2; p = 0.019) and years of service (r = 0.2; p = 0.008). No correlations were revealed between psychological well-being and gender (р = 0.798), type of organization (р = 0.642), the fact of having second higher education (р = 0.854), qualification category (р = 0.645), academic degree (р = 0.204), and the experience of working in the red zone (р = 0.926).Thus, more than a third of individuals aged 36–55 have psychological well-being scores below standard values. Psychological well-being of women is lower than that of men. Psychological well-being of men over the age of 35 decreases to a greater extent than standard values.

94-100 37
Abstract

The professional activity of high performance, or elite sportsmen involves loads approaching extreme exertion, which often leads to injuries of the lower limbs. Anterior cruciate ligament (ACL) injury is one of the most common types of knee injuries. This study aimed to evaluate the effectiveness of a comprehensive rehabilitation program for athletes that underwent arthroscopic ACL reconstruction. The study involved 64 athletes aged from 17 to 31 years. Treatment group participants were offered a comprehensive medical rehabilitation program that included isokinetic training sessions on the TECNOBODY IsoMove biomechanical exercising machine; the sessions followed a purpose-designed method. The results of medical rehabilitation of the athletes were assessed through gait analysis done with a DIERS Motion 4D complex. The assessments took place 8 and 15 weeks after the reconstruction. At 8 weeks after the surgery, gait analysis parameters revealed no significant differences between the groups. Fifteen weeks after the reconstruction, when treatment group (TG) members were through all the isokinetic training sessions, the results were as follows: for the Stand Time parameter, the operated limb (OL) support deficit was 0.04% compared to the healthy limb (HL) support, and for the Single Limb Support parameter it was 3.71%, while in the control group (CG) that had no isokinetic training sessions the values were 12.44% and 18.55%, respectively. As for the Swing Time parameter, TG participants showed the deficit of HL transfer symmetry (relative to OL) of 3.99%, while the value of this parameter in the CG was 20.54%. The difference is significant, which proves the effectiveness of the developed isokinetic training method as part of the comprehensive medical rehabilitation program, the application of which resulted in faster recovery of muscle strength and compromised walking-associated support and locomotor functions in TG athletes.

101-105 37
Abstract

Postoperative paresis and paralysis of the larynx, associated with breathing, voice and swallowing disorders, are actual problem of surgical treatment of the thyroid and mediastinal diseases. Traditionally, more attention is paid to phonation disorders treatment. Swallowing recovery methods are not described sufficiently. The paper reports a clinical case of early speech therapy intervention aimed at alleviating postoperative dysphagia caused by the limited flexibility of the larynx. Detailed swallowing disorder diagnosis in patient was carried out before and after the logopaedic correction of dysphagia. The main directions and results of the correctional and pedagogical work with psychological support within comprehensive rehabilitation are described. The findings confirm the need for correctional impact during the early stages of rehabilitation in case of dysphagia in surgical patients with the paresis or paralysis of the larynx.



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ISSN 2713-2757 (Print)
ISSN 2713-2765 (Online)