Dynamic Characteristics of Medical and Demographic Indicators of Public Health in Arkhangelsk Oblast in the First Twenty Years of the XXI Century: Retrospective Analytical Descriptive Study

Background. Assessing the dynamic characteristics of basic public health indicators is essential to ensure the sustainable human development, quality of life and health care system performance in the Arctic and Subarctic regions of Russia. The study is based on the need for constant monitoring of the medical and demographic situation in order to provide timely correction of measures for improving the health care system performance.Objective — to assess the trends in basic medical and demographic indicators characterizing the population health of the Arkhangelsk Oblast. Target population: population of the Arkhangelsk Oblast, no impacts, no outcomes.Methods. Criteria for sample or group formation: the research was performed by means of a continuous method based on the study of population of medical and demographic events. The main inclusion criterion was the availability of information about a medical and demographic event in the Arkhangelsk Oblast in the Russian Fertility and Mortality database (RusFMD), the database of the Federal State Statistics Service (Rosstat). Estimated parameters: life expectancy, infant mortality, disability, morbidity, natural population growth and chronicity rates related to the population of the Arkhangelsk Oblast excluding the Nenets Autonomous Okrug. The study was conducted between 2021 and 2022. The following measurement methods were used: autoregressive and integrated moving average, Irwin method to identify abnormal values, linear regression, time series dynamics, and method of chain substitutions. The research was performed by means of a continuous method based on studying the population of medical and demographic events.Results. Natural population growth and chronicity rates showed a stable negative trend, which indicated a decrease in the reproduction potential of the population, and an increase in chronic forms of diseases. Life expectancy, primary morbidity, and primary disability demonstrated a positive trend, but with a tendency to exhaust the positive potential. Infant mortality was the only indicator that consistently showed a positive trend. No additional results of the research were reported.Conclusion. The results of the study demonstrated the deterioration in population health of the Arkhangelsk Oblast, which may be due to a decline in living standards and quality of life as well as to a decrease in health care system performance and a rise in its dysfunctionality. The study has no limitations

Pattern of morphological and neurophysiologic changes in women with the syndrome of the descending perineum

Aim of investigation. To determine morphological rating of connective tissue structures of perineum and detect neurophysiologic disorders of pelvic floor in patients with the descending perineum syndrome (DPS).Material and methods. Original study included 39 women with DPS in the age of 21 to 68 years, with clinical and instrumental signs of descending perineum syndrome. Comparative study of pattern of connective tissue structures in 14 DPS patients that constituted main group and in 10 women without clinical and instrumental DPS signs (control group) was carried out. In 27 DPS patients conductivity of genitofemoral nerve, F-wave latency and anal sphincter motor activity potential were investigated.Results. In main group changes of collagen skeleton of perineal skin, pelvic ligaments, vaginal walls with significant dissociation, disorganization and breakdown of collagen was revealed that was associated by severe hyperelastosis and lymphostasis in connective tissue structures of perineum. In 88,8% of patients with DPS statistically significant disorder of electric conductivity by genitofemoral nerves, and in 70,4% - severe denervation of reflex arch from sacral region of vertebral column to anal sphincter was revealed.Conclusions. Along with distinct changes of connective tissue structures of perineum, DPS it is characterized by neurophysiologic disorders of pelvic floor registered not only in peripheral innervation zone, but also along the whole reflex arch

Potentials of transanal endoscopic surgery at early rectal cancer

Aim of investigation. Improvement of results of organ-preserving treatment of early rectal cancer, and assessment of sensitivity and specificity of transrectal ultrasound investigation (TRUS) at these patients.Material and methods. Overall 14 patients with adenocarcinomas (uT1N0) of high or moderate degree of differentiation were selected for transanal endoscopic operation (TEO), as a basic treatment method of villous rectal tumors. Male to female ratio among investigated patients was equal (7/7). Mean tumor size was 2,6±0,8 cm (1,0–4,0 cm). The average distance from the lower pole of tumor to outer edge of anal canal and to dentate line was 7,1±1,7 cm (4,0–9,0 cm) and 4,8±1,9 cm (1,5–7,0 cm) respectively. Preoperative examination included: digital investigation of the rectum, rectoromanoscopy with biopsy, colonoscopy, TRUS, computer tomography and magnetic-resonance tomography of abdominal cavity and small pelvis.Results. The median duration of operation was 39 (25–110) minutes. Tumor-free resection edges have been obtained in all operation specimens. All tumors were removed en bloc. No postoperative morbidity was marked. Preoperative and final diagnoses coincided in all cases. At pathomorphological study adenocarcinoma at Tis stage was revealed in 3 patients (21 %), Т1 — in 10 (71%) and Т2 — in one (8%). In female patient with Т2 adenocarcinoma radical operation was executed, in the removed specimen pararectal lymph node (N1) metastasis was found out. The mean follow-up of patients was 12 (2–20) months, no signs of local tumor relapse were found.Conclusion. TEOs, having minimal morbidity level, are alternative to radical operations at early rectal cancer, however wide utilization of the method is limited by such factors, as depth of neoplasm invasion and involvement of pararectal lymph nodes. Application of TEO should be prudent. Preoperative tumor staging plays the key role

Long-term results of rectocele surgical treatment

Aim of investigation. Evaluation of quality of life and studying of long-term results of treatment in patients after rectocele surgery.Material and methods. Original study included patients (n=41), operated in State Scientific Center of Coloproctology for rectocele in 2007 to 2011. Age of patients was 24 to 64 years (mean —48,95±9,09). The plasty of rectovaginal septum was executed by an implant in 23 patients (56,1%), in 18 (43,9%) Longo's procedure, including combination to plasty of rectovaginal septum by polypropylene implant in 9 cases (21,6%). Results of surgery were estimated in terms of 6 to 60 months after operation. The median follow-up period was 36 months.Results. Good and satisfactory results of treatment were achieved in 28 (70,7%) patients. improvement rectum function was marked in comparison to preoperative period. Unsatisfactory results were registered in 12 (29,3%) patients which postsurgical state did not improve.Conclusion. Analysis of results indicated, that evacuatory function of the rectum in the first 2 years after operation improved at 85,4% of patients, however eventually in 46,3% it worsened. It was found also, that results of operation did not depend on the method of rectocele surgery. During the study statistically significant factors influencing results of rectocele treatment were revealed: age of patients, duration of constipation and number of deliveries in past history, as well as the presence of internal rectal intussusception

Large Rearrangements in Genes Responsible for Familial Adenomatous Polyposis, <i>MUTYH</i>-Associated Polyposis and Peutz–Jeghers Syndrome in Russian Patients

Аim: to reveal the rate of large rearrangements in the genes responsible for familial adenomatous polyposis, MUTYH-associated polyposis and Peutz–Jeghers syndrome.Materials and methods. The MLPA method was used for identification of large rearrangements. A total number of 135 patients was included in the study: 83 patients with a clinical diagnosis of “familial adenomatous polyposis”, 18 — with suspected MUTYH-associated polyposis, and 34 — with a clinical diagnosis of “Peutz–Jeghers syndrome”.Results. Seven large deletions and one large duplication in the APC gene were identified in 83 patients with classic familial adenomatous polyposis, with rate of large rearrangements 9.6 % (8/83). In 18 patients with suspected MUTYH-associated polyposis, no large rearrangements were found in the MUTYH gene. Four large deletions in the STK11 gene (12 %, 4/34) were detected in 34 patients with Peutz–Jeghers syndrome.Conclusion. For the first time, the expediency of including the method of detecting large rearrangements in routine DNA test list for Russian patients with various hereditary polyposis syndromes is demonstrated. Routine use of MLPA method makes it possible to increase the total frequency of detection of pathogenic variants in the APC and STK11 genes above 90 %. At the same time, the need for searching of large rearrangements in the MUTYH gene were not justified

Нормативные показатели функционального состояния мышц запирательного аппарата прямой кишки по данным нейрофизиологического исследования

The objective was to evaluate standard neurophysiological characteristics of the external anal sphincter and pelvic floor muscles using electromyography interference pattern analysis.Materials and methods. Electromyography was performed in 33 volunteers without complaints of bowel incontinence or bowel evacuation disorders: 20 (60.6 %) men (mean age 57.3 ± 9.4  years) and 13 (39.4 %) women (mean age 55.3 ± 12.8 years).  Intra-anal electrode registered cumulative values of contractile force  of sphincter ani externum: background and voluntary bioelectrical  activity (BEA). Integral values of mean and maximal BEA amplitude  for the rectal obturator muscles at rest, for voluntary contraction,  during straining, and with increased intra-abdominal pressure were calculated.Results. Standard values of BEA of the rectal obturator muscles were obtained. These values can be used for qualitative and quantitative evaluation of pelvic floor muscles function and in  additional multicenter studies aimed at development of a unified  algorithm of rectal obturator and pelvic floor muscles evaluation.Цель работы – оценка нормативных величин нейрофизиологических показателей наружного анального сфинктера и мышц тазового дна при использовании метода интерференционной электромиографии.Материалы и методы. Анализ электромиографии проведен у 33 добровольцев, не имеющих жалоб на нарушение функции держания кишечного содержимого и опорожнения  прямой кишки, – 20 (60,6 %) мужчин (средний возраст 57,3 ± 9,4 года) и 13 (39,4 %) женщин (средний возраст 55,3 ± 12,8 года). Внутрианальным электродом  регистрировались суммарные показатели сократительной способности анального жома –  фоновая и произвольная биоэлектрическая активность (БЭА). Получены интегральные показатели средней и максимальной амплитуды БЭА для мышц  запирательного аппарата прямой кишки (ЗАПК) в покое, при произвольном сокращении, пробах с натуживанием и при повышении внутрибрюшного давления.Результаты. Получены нормативные величины БЭА мышц ЗАПК, позволяющие качественно и количественно оценивать функцию мышц тазового дна, которые можно использовать при  проведении дополнительных мультицентровых исследований для создания унифицированного алгоритма оценки ЗАПК и мышц тазового дна

СУБТОТАЛЬНАЯ РЕЗЕКЦИЯ МОЧЕВОГО ПУЗЫРЯ КАК АЛЬТЕРНАТИВА ЦИСТЭКТОМИИ ПРИ ОБШИРНОМ ЕГО ВОВЛЕЧЕНИИ В ОПУХОЛЕВЫЙ ПРОЦЕСС У БОЛЬНЫХ С МЕСТНО-РАСПРОСТРАНЕННЫМ КОЛОРЕКТАЛЬНЫМ РАКОМ

The volume of an operation on the urinary bladder (UB) in case of its extensive involvement due to locally advanced colorectal can-cer varies from partial cystectomy to cystectomy. The results of a morphological examination of 18 patients after pelvic exenterationdemonstrated true invasion into the urinary bladder wall only in 7 (38.9%) cases. This created preconditions for organ-preservingtreatment. Combined operations with partial cystectomy were performed in 37 patients. Pathology showed true tumor invasion intothe urinary bladder wall in 13 (35.1%) cases. The bladder volume was 55.2±17.1 ml after surgery and 175 to 360 (230±31.2) mlfollowing autohydrotraining with pharmacological support made 3 months after surgery. No patient had recurrent urinary bladderdisease. The surgical results suggest that organ-preserving treatment does not violate the oncological radicalism principles and is aserious alternative to cystectomy: Firstly, there is no need for the technically complex stage of an operation - to create a urinaryreservoir. Secondly, urination is preserved by its natural way; there are no signs of urinary incontinence, which ensures the betterquality of life.  Субтотальная резекция мочевого пузыря как альтернатива цистэктомии при обширном его вовлечении в опухолевый процесс у больных с местно-распространенным колоректальным рако

Диагностическая ценность применения номограмм в прогнозировании возникновения несостоятельности колоректального анастомоза (обзор литературы)

The anastomosis leakage is one of the most terrible complications of rectal cancer surgery. The anastomosis leakage rate after low anterior resection may exceed 20 %. The anastomosis leakage increases postoperative mortality, length of hospitalization, requires the formation of a temporary or permanent colostomy, which impairs the quality of life of patients. In recent years, some authors have suggested using a nomogram, a prognostic algorithm in the form of a graphic image showing the probability of a certain outcome individually for each patient. This review presents literature data on the use of nomograms in predicting the occurrence of colorectal anastomosis leakage after rectal cancer surgery.Несостоятельность анастомоза — одно из самых грозных осложнений в хирургии рака прямой кишки, частота которого при выполнении низких передних резекций может превышать 20 %. Возникновение несостоятельности анастомоза приводит к увеличению послеоперационной летальности, длительности госпитализации, требует формирования временной или постоянной колостомы, что значительно ухудшает качество жизни пациентов. В последние годы некоторые авторы предлагают использовать номограмму — прогностический алгоритм в виде графического изображения, показывающего вероятность определенного исхода индивидуально для каждого пациента. В данном обзоре литературы представлен мировой опыт применения номограмм в прогнозировании возникновения несостоятельности колоректального анастомоза у больных раком прямой кишки

Differentiation of Lynch syndrome from other forms of non-polyposis colorectal cancer among Russian patients

Aim of investigation. Lynch's syndrome is hereditary syndrome caused by germline mutation in one of reparation genes not coupled bases and causing high risk of colorectal cancer development. At present there are no criteria, allowing to reveal all mutation carriers, and development of new guidelines is still going on, that became a task for original study. Material and methods. Search of microsatellite instability (MSI), characteristic for Lynch's syndrome, was carried out in tumor samples of 73 patients by fragment analysis method. At its detection search of germline mutations by polymerase chain reaction methods, electrophoresis and direct sequencing was carried out.Results. Microsatellite instability was found out in 17 neoplastic samples (23%, 17 of 73). At 9 person germline mutations that has allowed to attribute this group to patients to Lynch's syndrome were revealed. Three of 9 mutations were described for the first time in the world.Conclusions. According to neoplastic MSI, age and family history two new criteria for Lynch's syndrome search in the Russian patients have been offered. Efficacy of the first criterion was 60%, that of the second — 85,7%

Влияние несостоятельности анастомоза на онкологические результаты лечения больных раком прямой кишки

Background. The effect of anastomotic leakage (AL) on oncological outcomes after total mesorectumectomy is controversial.Objective: to investigate the influence of AL and other factors on oncological outcome.Materials and methods. Data of 67 patients underwent total mesorectumectomy with normal healing were compared with those for 16 patients who experienced AL. Long-term oncological outcomes were analysed.Results. Median follow-up was 43 months. AL rate was 19.4 % (16 cases out of 83). Following factors had negative influence on lower 4-year disease-free survival rate and reached statistical significance in univariant analysis: tumor invasion (hazard ratio (HR) 8.8; 95 % сonfidence interval (CI) 1.4–13.7; р = 0.01), metastases in regional lymph nodes (HR 3.5; 95 % CI 1.2–12.3; р = 0.03), tumor stage (р = 0.048), level of tumor differentiation (HR 0.1; 95 % CI 0–0.6; р &lt;0.0001), tumor stenosis (HR 8.8; 95 % CI 1.4–13.7; р = 0.002), AL (HR 3.9; 95 % CI 1.6–37.1; р = 0.01). In the logistic regression analysis independent risk factors for the development of recurrence were not revealed.Conclusion. AL was not proved to be a risk factor of worse oncological outcome. Hence, additional adjuvant treatment or extended follow-up on the basis of the occurrence of AL after low anterior resection of rectal cancer might not be justified.Цель исследования – оценить влияние НА и других факторов риска на онкологический результат лечения.Материалы и методы. Данные 67 пациентов, перенесших тотальную мезоректумэктомию, с целостным анастомозом сравнивали с данными 16 пациентов с диагностированной НА. Проанализированы долгосрочные онкологические результаты.Результаты. Медиана наблюдения составила 43 мес. Частота НА составила 19,3 % (16 случаев из 83). В однофакторном анализе статистически значимыми факторами, снижающими уровень 4-летней выживаемости, стали степень инвазии опухоли (отношение рисков (OР) 8,8; 95 % доверительный интервал (ДИ) 1,4–13,7; р = 0,01), наличие метастазов в регионарных лимфатических узлах (OР 3,5; 95 % ДИ 1,2–12,3; р = 0,03), стадия болезни (р = 0,048), уровень дифференцировки опухоли (ОР 0,1; 95 % ДИ 0–0,6; р &lt;0,0001), стенозирующий характер опухоли (OР 8,8; 95 % ДИ 1,4–13,7; р = 0,002), НА (OР 3,9; 95 % ДИ 1,6–37,1; р = 0,01). В логистическом регрессионном анализе независимых факторов риска развития рецидива не выявлено.Заключение. НА не является фактором риска плохого онкологического исхода. Таким образом, дополнительное лечение адъювантом или сокращение интервала динамического наблюдения за пациентами, имевшими в анамнезе НА после низких передних резекций прямой кишки, не оправдано