Krokhalev Vadim Yakovlevich

Scopus Publications

Intraocular Inflammation Associated with Intravitreal Drug Injections: Current State of the Problem

Teaching intercultural communication to medical undergraduate students: a pilot study
Ksenia A. Mitrofanova, , Vadim Ya. Krokhalev, Oleg Yu. Nuzhdin, , and
Scientific and Educational Initiative
Introduction. The globalization influences the education system, and medical education is not an exception. Along with general communication skills medical undergraduate students should demonstrate their competence in intercultural communication. The aim of the study was to implement an elective course “Intercultural Communication” in the Russian medical school and validate an adapted questionnaire to evaluate the effectiveness of teaching the course for the development of cultural awareness of students as a component of the intercultural competence. Materials and Methods. The course “Intercultural Communication” developed and implemented in the medical school included four major topics: the basics of intercultural communication; the culture and communication; the language and culture; the intercultural communication in Medicine. The adapted questionnaire to evaluate the changes in cultural awareness of students was filled in by them before and after the course studying. The questionnaire included the following parts: demographics; questions to assess attitudes towards cultural diversity; Bogardus-type questions; feedback on the questionnaire. The study results were evaluated using the descriptive and statistical analysis methods. Results. Out of 149 students, 125 (83,9%) completed the questionnaire both before and after studying the course. Statistically significant changes in students’ responses were attributed to three questions devoted to attitudes towards cultural diversity. No statistically significant changes were identified in responses to Bogardus-type questions. The majority of students (84%) commented that the questionnaire had made them think about cultural diversity and intercultural differences. Conclusion. The study showed that students’ cultural awareness changed to more positive attitude towards representatives of other cultures taking into account cultural diversity in the society including the healthcare field. However, further development of objective tools to assess the intercultural competence of students and improvement of methods to teach intercultural communication to medical and pharmaceutical undergraduate students are needed.

Results of a survey of ophthalmologists on the special aspects in performing and interpreting optical coherence tomography examination of the macula
Olga V. Zaytseva, Evgeny V. Bobykin, and Vadim Ya. Krokhalev
ECO-Vector LLC
BACKGROUND: Optical coherence tomography (OCT) is the main method for in vivo examination of the morphology of ocular posterior segment structures, used in modern ophthalmological practice. AIM: Study of special aspects in performing and interpreting the results of OCT of the macula by ophthalmologists working in the healthcare system of the Russian Federation. MATERIALS AND METHODS: In the anonymous survey, conducted using an original online questionnaire of 12 questions 59 respondents took part. They confirmed being ophthalmologists with experience in performing OCT and gave their consent to took part in the survey. RESULTS: The majority of respondents (79.6%) reported that they face the need to perform OCT without obtaining the patients clinical data. 66.1% of respondents always evaluate the correct placement of segmentation boundaries. Only 56% of the respondents always or often perform frontal (en face) scans during OCT examination of the macula. At the same time, 16.9% of specialists indicated that they did not know what segmentation boundaries are, and 8.5% noted that they did not understand the term en face scan. The principle of layer-by-layer analysis is used by 94.9% of respondents when describing images. Significant discrepancies were also revealed in the interpretation by the respondents of some parameters on specific examples of OCT scans. 71.2% of respondents have experience in using templates when describing OCT images, and 13.6% use them constantly. The proportion of specialists who consider it expedient to develop and introduce into clinical practice a standard protocol (template) for describing macular OCT images was 84.7%. CONCLUSIONS: Insufficient awareness of some ophthalmologists about particular principles of interpreting the results of an OCT imaging and about certain practical aspects of its application was revealed. This indicates the need in improving the quality of informational support and training of specialists. A request was received from ophthalmologists about the need to develop a standard protocol (template) for describing OCT images of the macular area with the aim of subsequent implementation into the clinical practice of the healthcare system of the Russian Federation.

Long-term results (60 months) of anti-VEGF therapy of macular diseases in real clinical practice. Part 2
E. V. Bobykin, R. V. Buslaev, V. Y. Krokhalev, O. V. Morozova, and N. S. Beresneva
Real Time, Ltd.
Purpose: to study long-term results of anti-VEGF therapy for macular diseases of patients followed up for 60 months in real clinical practice. Materials and methods. The research group included 57 patients (43 women, 14 men; median age 62 years) who received antiVEGF therapy (ranibizumab, aflibercept) and remained under regular observation for 60 months. Of these, 24 patients had “wet” agerelated macular degeneration (wAMD), 20 had myopic choroidal neovascularization (mCNV), 10 had macular edema due to retinal vein occlusions (MERVO), and 3 patients had diabetic macular edema (DME). Statistical analysis of demographic indicators and treatment results was carried out using STATISTICA 13.3 software: conditions of normality for variables, nonparametric and parametric criteria were determined, and rank analysis of variance was carried out. The characteristics of the study group are given in the first part of this article [ROJ, 2022; 15 (3): 11–17]. Results. Over the research period, the best corrected visual acuity (BCVA) increased from 0.29 0.35 0.42 to 0.47 0.54 0.61 (p < 0.00001); 91.2 % of patients maintained the indicator or improved it with regard to the baseline. The proportion of subjects with BCVA ≥ 0.5 ranged from 61.4 to 73.7 % during the research period. The average number of intravitreal injections (IVI) received by the patients was 8.93 10.84 12.75. We revealed a tendency towards a gradual decrease in the intensity of treatment and confirmed it (p < 0.00001). The proportion of patients who received 4 IVI or more over 12 months of treatment decreased from 57.9 % in the first year to 12.3 % in the fifth year, and the proportion of cases where anti-VEGF therapy did not need to be resumed before the end of the year of treatment increased from 28.1 % (in the second year of research) to 49.1 % (in the fifth year). The need for IVI anti-VEGF drugs in wAMD and DME was significantly greater than in MERVO and mCNV. Conclusion. The results confirm high efficiency of anti-VEGF therapy. To solve the issue of ill-timed or insufficient treatment, it is necessary to start the therapy as early as possible, use the most effective (proactive) regimens, apply individualized approach to the treatment, take organizational measures aimed at facilitation of access to specialized care, and, generally, to change the attitude of the professional community.

Long-term results (60 months) of anti-VEGF therapy of macular diseases in real clinical practice. Part 1
E. V. Bobykin, R. V. Buslaev, V. Y. Krokhalev, O. V. Morozova, and N. S. Beresneva
Real Time, Ltd.
Purpose: to study long-term (over a 60 months’ follow-up period) results of anti-VEGF therapy for macular diseases in real clinical practice.Materials and methods. We undertook a single-center retrospective uncontrolled cohort study of 169 patients (109 women, 60 men) who received anti-VEGF therapy for eye diseases (ranibizumab, aflibercept). The treatment started between May 2010 and August 2015. The study group included 57 patients who remained under regular observation for 60 months. Of these, 24 cases had “wet” age-related macular degeneration (wAMD), 20 cases had myopic choroidal neovascularization, 10 had macular edema due to retinal vein occlusions and 3 had diabetic macular edema. The remaining 112 patients whose follow-up was discontinued made up the comparison group. We analyzed the dynamic results of clinical and instrumental examination in both groups, as well as data from a phone survey among the comparison group about the reasons for the termination of clinical observation. Statistical analysis of demographic data and treatment results was carried out using the Statistica 13.3 software. Conditions of normality for variables, nonparametric and parametric criteria were determined, and rank analysis of variance was carried out.Results. The patients in the study group were significantly younger (p = 0.0029), had a higher initial (p = 0.0019) and final (p = 0.00027) best corrected visual acuity, and received a significantly greater number of intravitreal injections (p < 0.000001). In contrast, they had a significantly lower rate of therapy intensity factor (the ratio of injections number to the duration of observation in months) over the treatment period (p < 0.000001). In addition, the study group had a significantly lower proportion of men (p = 0.041) and patients with wAMD (p = 0.0010). The reasons for the termination of observation in the comparison group given in the phone survey, were as follows: stopped regular observation / treatment — 57 people (50.9 %), continue treatment in a different clinic — 3 (2.7 %), died — 13 (11.6 %), status unknown — 39 (34.8 %).Conclusion. The data of the main morphological and functional results of treatment of the study group patients, discussion and conclusions will be presented in the second part of this article.

Evaluation of the prevalence of silicone oil droplets in the vitreous in patients treated with multiple intravitreal drug injections
E. V. Bobykin, I. A. Kulakova, O. V. Morozova, and V. Ya. Krokhalev
FSPSI SCFHHRP
Background. At present, intraocular drops of silicone oil, which is a lubricant for disposable syringes used for intravitreal injections, are being actively studied. Among the undesirable effects of their presence are patient’s complaints of visual discomfort associated with floating opacities, as well as a potential connection with episodes of intraocular inflammation and increased intraocular pressure.The aim: to assess the prevalence of silicone oil droplets in the vitreous in patients treated with multiple intravitreal injections.Materials and methods. A single-center retrospective cohort study was carried out. Inclusion criterion: treatment with multiple (at least 5) intravitreal injections of drug solutions performed according to registered indications. The study group consisted of 86 eyes of 85 patients (56 women, 29 men; age – from 36 to 89 y.o., average – 71.7 y.o.), who received an average of 13.2 injections of solutions of various drugs.Results. Drops of silicone oil were detected by biomicroscopy in 57 eyes (66.28 %) and by ultrasonography in 76 (88.37 %). The coincidence of the results of applying the methods was recorded in 73.26 % of observations. Seven (8.1 %) patients had characteristic complaints. Four patients (4.7 %) had a history of aseptic vitreitis. The hypothesis was confirmed that the possibility of silicone oil droplets getting into the vitreous increases with the number of intravitreal injections. A similar relationship was established in relation to the possibility of the appearance of characteristic complaints in patients due to the presence of drops and episodes of aseptic vitreitis.Conclusion. The release of drops of silicone oil from syringes during intravitreal injections is an urgent problem that requires further study. In the Russian Federation, the situation is aggravated by the lack of prefilled syringes with drugs approved for administration into the eye cavity, as well as the lack of syringe models designed for use in ophthalmology.

Results of clinical approbation of information leaflet for patients treated with intravitreal injections of drugs
V. V. Neroev, O. V. Zaytseva, E. V. Bobykin, A. Zh. Fursova, P. A. Nechiporenko, V. Y. Krokhalev, O. V. Morozova, and R. M. Sutyushev
Real Time, Ltd.
Intravitreal injection (IVI) is a drug delivery method, widely used in modern ophthalmology. To increase the awareness of patients receiving treatment in the healthcare system of the Russian Federation, the Expert Council on Retinal and Optic Nerve Diseases of the Association of Ophthalmologists, an All-Russian Public Organization in 2020 proposed a leaflet “Intravitreal injections (information for patients)”.Purpose: to conduct a clinical assessment of the leaflet by multicenter anonymous surveying of patients.Material and methods. Patients who had experienced IVI treatment were asked to read the leaflet for 20 minutes and then answer 12 questions of the specially designed questionnaire. 93 patients were interviewed in clinics in Moscow, St. Petersburg, Yekaterinburg and Novosibirsk: of these, 57 (61.3%), the average age of all patients was 63.9 years, the most common diagnosis was neovascular age-related macular degeneration (52 cases, 55.9%), the experience of previous treatment ranged from 1 to 104 months.Results. The leaflet had a positive response from the patients (91.4% of the questionnaires received “excellent” and “good” ratings), 90.3% patients reported that the information contained was fully or largely consistent with their experience of IVI treatment. The overwhelming majority of respondents (88.2%) did not experience any difficulties in reading the leaflet. At the same time, the patients revealed insufficient awareness on issues related to the treatment. Also, the patients showed insufficient awareness of issues concerning their health: only 20 (21.5%) respondents could answer all five questions of the questionnaire about the understanding of the relevant information, and 31 patients (33.3%) could answer four questions. This fact emphasizes the importance of information support for the patient.Conclusion. The clinical assessment of the leaflet “Intravitreal injections (information for patients)”, which contains brief information about what the procedure is, contraindications, preparation details, symptoms of the postoperative period that require urgent assistance, allows us to recommend the leaflet for use in the clinical healthcare practice of the Russian Federation.

Anti-vegf therapy of wet age-related macular degeneration: Analysis of patients lost to follow-up
E.V. Bobykin, S.A. Korotkih, V.Ya. Krokhalev, R.V. Buslaev, N.S. Beresneva, and O.V. Morozova
Media Sphere Publishing Group
Patients lost to follow-up (LTFU) are a well-recognized challenge, both in clinical trials and in real clinical practice. PURPOSE To study the reasons for patients receiving anti-VEGF therapy for «wet» age-related macular degeneration (wAMD) in clinical environment to cease monitoring in the clinic. MATERIAL AND METHODS This retrospective cohort study included patients with wAMD which received anti-VEGF therapy (ranibizumab, aflibercept) in the Ural State Medical University clinic from 2011 to 2019 (n=241). A subgroup of patients continuing treatment (n=90) was compared with a subgroup of lost to follow up patients (LTFU, n=151, 62.7%). Observation lasting less than 12 months was an exclusion criterion. Statistical analysis included a comparison of demographic and clinical data. The reasons for treatment discontinuation were determined using a phone survey. RESULTS Characteristic for the LTFU subgroup were shorter duration of the follow-up (p<0.0001), lower number of intravitreal injections (p<0.0001), lower baseline (p<0.0001) and final best corrected visual acuity (p<0.0053) as well as higher values of therapy intensity coefficient (the ratio of the number of intravitreal injections to the duration of the follow-up, p<0.0001). According to the results of the phone survey, the following categories of LTFU were identified: ceased regular monitoring/treatment - 83 (55.0% of the LTFU subgroup), continued treatment in another clinic - 14 (9.3%), deceased - 18 (11.9%), status unknown - 36 (23.8%). The most common causes of LTFU were dissatisfaction with treatment results, financial burden and general comorbidities, which were named by 50, 27 and 17 respondents, respectively. CONCLUSION In accordance with identified reasons for LTFU, we determined the directions for increasing the effectiveness of wAMD treatment: early diagnosis and start of treatment; using the most effective drugs and therapeutic regimens; increasing the availability of anti-VEGF therapy.

Factors determining the compliance of patients receiving anti-VEGF therapy for macular diseases with long-term follow-up in real-life practice
E. V. Bobykin, V. Y. Krokhalev, R. V. Buslaev, and O. V. Morozova
Real Time, Ltd.
Purpose: to identify statistically significant factors that determine adherence to long-term follow-up on the part of patients receiving anti-VEGF therapy for macular diseases.Material and methods. A retrospective analysis was performed on 247 patients (153 women, 94 men) aged 24 to 92 years treated with anti-VEGF for “wet” age-related macular degeneration (n = 164), diabetic macular edema (n = 18), macular edema due to retinal vein occlusion (n = 35) and myopic choroidal neovascularization (n = 30). Demographic data and treatment results were statistically analyzed with the STATISTICA 13.3 program (normal conditions for variables, non-parametric and parametric criteria were determined).Results. Follow-up duration was shown to depend on gender (women are more committed to long-term treatment, p < 0.05), diagnosis (the longest follow-up related to myopic choroidal neovascularization patients), initial and final visual acuity. The comparison of subgroups of patients with the longest (over 30 months, n = 56) and shortest (till 12 months, n = 92) follow-up showed that prolonged monitoring corresponds to higher values of the initial (p < 0.01) and final (p < 0.05) visual acuity, as well as a lower average number of injections over the entire follow-up (p < 0.001) and a younger age of patients (p = 0.02).Conclusion. The follow-up duration depends on gender and age, the intensity of treatment, as well as on the initial and final visual acuity at a significance level of ˂ 0.05. Also, the follow-up duration depends on the particular diagnosis. An indicator clearly reflecting the severity of the burden of treatment is proposed: the coefficient of therapy intensity which is inversely related to the patient’s adherence to therapy.

Detection of Magnetic Nanoparticles in Blood Vessels
F. A. Blyakhman, S. O. Volchkov, E. V. Golubeva, V. Ya. Krokhalev, E. B. Makarova, K. R. Mekhdieva, A. P. Safronov, S. Yu. Sokolov, F. A. Fadeyev, and V. V. Chestukhin
Pleiades Publishing Ltd

REASONS FOR ANTI-VEGF TREATMENT DISCONTINUATION IN REAL CLINICAL PRACTICE: RESULTS OF A PHONE SURVEY OF PATIENTS WITH MACULAR DISEASES
Evgeny V. Bobykin, Vadim Ya. Krokhalev, Nadezhda S. Beresneva, Ruslan V. Buslaev, and Olga V. Morozova
ECO-Vector LLC
Background.Anti-VEGF therapy is currently regarded as the gold standard for the treatment of many macular diseases, while the results of its application in real clinical practice are often inferior to those from randomized clinical trials. Materials and methods.A study group was formed on the basis of a retrospective analysis of the medical data of patients who received anti-VEGF therapy with ranibizumab and/or aflibercept according to registered indications, and who discontinued their follow-up in the clinic (n= 214). A phone survey of patients concerning the reasons for loss to follow-up with a statistical analysis of the obtained data was carried out. Results.The majority of patients (81.3%) discontinued observation in the clinic within two years from the start of therapy (the median duration of treatment was 7 (3; 18) months). Patients with all considered diseases had an increase in best corrected visual acuity during treatment (p 0.000001), which confirms the high efficiency of the method. According to the results of the phone survey, the following categories of respondents were identified: complete cessation of treatment 120 (56.1%) patients, change of clinic 20 (9.3%), death 23 (10.7%), status not established 51 (23.8%). The most frequent reasons for stopping treatment were dissatisfaction with its results (59 cases; 49.2%), financial burden (49; 40.8%), and systemic comorbidities (24; 20.0%). Conclusion.Searching approaches to increase patients treatment adherence is one of the priorities for improving anti-VEGF therapy.

Homing of Multipotent Mesenchymal Stromal Cells with Different Administration Routes in Old Laboratory Animals after Liver Resection
I. Yu. Maklakova, D. Yu. Grebnev, V. Ch. Yusupova, and V. Ya. Krohalev
Pleiades Publishing Ltd

Homing multipotent mesenchymal stromal cells in different ways of introduction of old laboratory animals after liver resection

Possibility to extract information on an acoustic speech signal from reflected laser radiation
Larisa A. Glushchenko, Alexander M. Korzun, Victor I. Tupota, and Vadim Ya. Krohalev
IEEE
Theoretical relations have been obtained that define signal-to-noise ratio at the input of a photodetector of a laser acoustic system. These relations allow one to determine verbal legibility of speech when recording information in a laser channel.

Human body surface oscillations remote measurements by means of laser Doppler interferometer
Larisa A. Glushchenko, Fedor A. Zapryagaev, Vladimir S. Makin, and Vadim Ya. Krokhalev
IEEE
Experimental results of remote laser measurement of a time structure of pulse wave are resulted. The executed measurements confirm the assumption that characteristics of pulse wave can be registered on the basis of Doppler's effect.

Definition of vibrations spectrum of engineering construction details via dynamic speckle-structures registration
A. V. Glushchenko, L. A. Glushchenko, and V. Ya. Krohalev
Allerton Press

ESR and luminescence of Siberian kimberlite zircon and apatite

Zircon recombination luminescence
S. L. Votyakov, V. Ya. Krokhalev, and A. A. Krasnobaev
Springer Science and Business Media LLC

INSTALLATION FOR STUDYING THE LUMINESCENCE OF MICROSPECIMENS.

Krokhalev Vadim Yakovlevich

EDUCATION

RESEARCH INTERESTS

Scopus Publications