Modern Clinical Practice Research Articles

Диагностическая лапароскопия в современной хирургии (обзор литературы)

The research presents a review of the current state of the method of diagnostic laparoscopy in modern clinical practice. In modern medicine, there is a tendency to minimize injuries to the patient in diagnostic search to achieve a compensatory state as soon as possible, to improve the quality of life, and to maintain working capacity. All these conditions meet the requirements of the method of diagnostic laparoscopy. The purpose of this research is to assess the current state of the scope and prevalence of diagnostic laparoscopy in modern surgery. Materials and methods: the search was carried out in the open electronic scientific databases PubMed and the databases of the Russian scientific electronic library eLibrary using keywords and phrases: laparoscopy, diagnostic laparoscopy, surgical intervention, current trends, abdominal cavity. Results. In modern surgical practice, diagnostic laparoscopy is considered as a highly informative preoperative method for detecting intra-abdominal pathologies and postoperative complications. This technique is widely used in gynecological practice, oncogynecology, in acute and chronic surgical pathologies in patients of various ages in order to assess the state of the intra-abdominal space and determine the correct tactics and extent of surgical intervention in the earliest possible time. In urgent abdominal pathology, laparoscopy remains the leading minimally invasive technique that allows assessing the extent and prevalence of the process. Conclusion: the vector of development of modern clinical medical practice creates all the conditions for the regular development and active growth of the possibilities of carrying out the presented diagnostic technique in various areas of surgical profiles.

Эффективность синустрабекулэктомии в современной клинической практике

Aim: to assess the hypotensive effect of sinustrabeculectomy (STE) carried out within the "cascade" treatment algorithm for glaucoma. Patients and Methods: this open prospective interventional single-center cohort study was performed in 443 consequently included patients who underwent surgery for primary open-angle non-compensated glaucoma (POAG) and then were under follow-up for 6–24 months. The STE outcomes were evaluated using commonly accepted criteria of "complete success" and "qualified success", as well as "qualified failure" and "complete failure". The analysis of postoperative intraocular pressure (IOP) changes over time was performed using statistical methods. Results: the "complete success" of surgical operation achieved in 305 (68.9%) cases was associated with a significant and long-lasting decrease (at least for two years) in IOP values. The "qualified success", assuming that the renewal of medication therapy was an essential condition for maintaining a steady IOP was reported in 118 (26.6%) cases. Thus, the surgical treatment in combination with the postoperative hypotensive therapy helped to normalize IOP for at least two years in 423 (95.5%) patients of the study group. The "complete" STE failure due to the loss of filtration and the onset of indications for repeat surgery was reported in 20 (4.5%) cases. The triple combination treatment of glaucoma does not preclude from initiating further surgical IOP normalization and can be used safely prior to planned STE. A statistically significant IOP decrease from the baseline was achieved in all patients (even in the "complete failure" cases) at all 3 endpoints of the study (at 6, 12 and 24 months). The most pronounced and stable decrease in IOP during a two-year follow-up was associated with the "complete success" STE. Conclusion: a statistically significant IOP decrease from the baseline was achieved in all patients even after the "complete failure" of the surgical treatment at all endpoints of the study. The most pronounced and stable decrease in IOP during a two-year follow-up was associated with the "complete success" STE. The preoperative IOP level did not correlate with the results of STE and cannot be considered as a factor predicting its success or failure. Keywords: glaucoma, sinustrabeculectomy , intraocular pressure, glaucoma surgery, cascade algorithm, complete success, qualified success, complete failure. For citation: Antonova A.V., Nikolaenko V.P., Brzhesky V.V., Vuks A.Ya. The efficacy of sinustrabeculectomy in the modern clinical practice. Russian Journal of Clinical Ophthalmology. 2023;23(1):21–26 (in Russ.). DOI: 10.32364/2311-7729-2023-23-1-21-26.

Exploring the Clinical Application of Danshen Injection Combined with Acupuncture Based on Modern Pharmacology

Danshen contains salvianolic acid, tanshinone, volatile oil and inorganic elements, which are widely used in the treatment of cardiovascular diseases in modern clinical practice. The main water-soluble component of Danshen has various pharmacological effects, including anti-inflammatory, anti-tumor, neuroprotection, myocardial protection and immunity enhancement. The purpose of this paper is to explore the current status of pharmacological research on Danshen, discuss the clinical efficacy of Danshen injection combined with acupuncture in the treatment of hypertension, coronary angina and rheumatoid arthritis, combine traditional Chinese medicine acupuncture therapy with the pharmacological mechanism of Danshen, and provide a new direction for the treatment of clinical diseases.

Fast MRI Reconstruction via Edge Attention

Fast and accurate MRI reconstruction is a key concern in modern clinical practice. Recently, numerous Deep-Learning methods have been proposed for MRI reconstruction, however, they usually fail to reconstruct sharp details from the subsampled k-space data. To solve this problem, we propose a lightweight and accurate Edge Attention MRI Reconstruction Network (EAMRI) to reconstruct images with edge guidance. Specifically, we design an efficient Edge Prediction Network to directly predict accurate edges from the blurred image. Meanwhile, we propose a novel Edge Attention Module (EAM) to guide the image reconstruction utilizing the extracted edge priors, as inspired by the popular self-attention mechanism. EAM first projects the input image and edges into Q_image, K_edge, and V_image, respectively. Then EAM pairs the Q_image with K_edge along the channel dimension, such that 1) it can search globally for the high-frequency image features that are activated by the edge priors; 2) the overall computation burdens are largely reduced compared with the traditional spatial-wise attention. With the help of EAM, the predicted edge priors can effectively guide the model to reconstruct high-quality MR images with accurate edges. Extensive experiments show that our proposed EAMRI outperforms other methods with fewer parameters and can recover more accurate edges.

Winner of the 2022 Wakley–Wu Lien Teh Prize: the dutiful son by his father's bedside

The 2022 Wakley–Wu Lien Teh Prize invited submissions sharing ideas of “a heart full of great compassion and empathy” in modern Chinese clinical practice.1 We are pleased and grateful to have received 187 submissions—twice the number of submissions in 2021—telling touching and provocative stories about all aspects of medical practice in China. Essays were shortlisted by two editors at The Lancet Group and anonymised essays were sent to external advisers in China for their reflections and thoughts.

S-11-3: CLINICAL IMPLICATION OF AORTIC STIFFNESS

Modern clinical practice stresses the importance of basing healthcare practices and health policy on the best available clinical evidence. However, it is a long journey to translate research evidence into routine clinical practice through closing fundamental translational gaps. There have been numerous studies and meta-analyses demonstrating the prognostic value of arterial stiffness beyond established CVD risk factors, including age and blood pressure. Nevertheless, clinical practice guidelines rarely recommend the routine use of arterial stiffness in daily care. To facilitate the routine use of arterial stiffness measurements, the corresponding translational gaps in the clinical application should be analyzed and addressed. To justify the routine clinical use of any biomarkers, several criteria must be met. For the many methodologies to estimate arterial stiffness, their reliability and reproducibility in a standard clinical setting should be firstly demonstrated. Moreover, in a busy clinical environment, a less complicated measurement procedure with operator independence is more welcomed. Second, these techniques must carry the ability to add additional risk discrimination beyond the conventional risk prediction systems such as Framingham risk score or SCORE and should be cost effective. Not only the independent prognostic value but also the significant reclassification ability should be shown. Lastly, clear indication of the implementation of arterial stiffness techniques should be provided including but not limited to being used for risk stratification, treatment monitoring, or as a therapeutic target. Previous studies pertaining to arterial stiffness have been endeavored to address most but not all the above requirements. The independent value of arterial stiffness in predicting cardiovascular events have been presented. Moreover, its ability to predict incident hypertension and target organ damage, including brain, heart, and kidney have also been confirmed. In an individual patient data meta-analysis of cf-PWV for subjects at intermediate risk, adding cf-PWV into standard risk factors rendered a net reclassification of 15% and 27% for coronary heart disease events and CVD death, respectively. Such analysis provide justification to apply arterial stiffness measurements in routine clinical practice. They can make risk prediction more accurate by re-classifying subjects with intermediate cardiovascular risk into a higher risk level, in which treatment is indicated or into a lower risk level, in which further therapy could be safely avoided. In subjects with intermediate risk such as whitecoat hypertension, isolated diastolic hypertension, or borderline hypertension, the uncertainty in risk prediction may be further reduced by measuring arterial stiffness. Of the techniques for estimating arterial stiffness, advantages and disadvantages of each technique are observed. Although cf-PWV has the strongest evidence base supporting clinical value, the operator independence limits its widely use in routine practice. Cuff-based devices require less training, but may be less accurate. Further research is required to address this important unmet need. Besides, recommendation of the routine use of arterial stiffness techniques could be further supported by conducting randomized controlled trials adopting arterial stiffness as a treatment target, a treatment monitoring instrument, or as a tool incorporated in the intervention strategies such as risk stratification for subjects with intermediate risk profiles. To obtain health insurance reimbursement, cost-effectiveness analysis accompanied with the prospective studies for arterial stiffness is also warranted to support its routine clinical implement. In summary, the distinctive clinical value of arterial stiffness techniques relies on the ability of a single assessment to provide important information regarding blood pressure progression and susceptibility to end organ damage. The most useful scenario seems to be the more accurate risk classification for subjects at intermediate CVD risk, in which condition the need for treatment is uncertain, such as patients with masked or white coat hypertension. Therefore, arterial stiffness can be seen as complimentary to current blood pressure, and both should be considered when risk prediction is required for making timely and relevant treatment decisions. The role of arterial stiffness as a treatment target, treatment monitoring strategy in response to therapy, or a tool in the intervention strategy should be further uncovered in prospective studies or randomized controlled trials.

SYMBIOSIS OF MEDICAL TECHNOLOGIES AND ARTIFICIAL INTELLIGENCE: NEW OPPORTUNITIES IN ONCOLOGY

SYMBIOSIS OF MEDICAL TECHNOLOGIES AND ARTIFICIAL INTELLIGENCE: NEW OPPORTUNITIES IN ONCOLOGY

Existing and Novel Biomaterials for Bone Tissue Engineering.

The treatment of bone defects remains one of the major challenges in modern clinical practice. Nowadays, with the increased incidence of bone disease in an aging population, the demand for materials to repair bone defects continues to grow. Recent advances in the development of biomaterials offer new possibilities for exploring modern bone tissue engineering strategies. Both natural and synthetic biomaterials have been used for tissue repair. A variety of porous structures that promote cell adhesion, differentiation, and proliferation enable better implant integration with increasingly better physical properties. The selection of a suitable biomaterial on which the patient's new tissue will grow is one of the key issues when designing a modern tissue scaffold and planning the entire treatment process. The purpose of this article is to present a comprehensive literature review of existing and novel biomaterials used in the surgical treatment of bone tissue defects. The materials described are divided into three groups-organic, inorganic, and synthetic polymers-taking into account current trends. This review highlights different types of existing and novel natural and synthetic materials used in bone tissue engineering and their advantages and disadvantages for bone defects regeneration.

Is there a Need to Change the Basic Principles of Histology? Educational, Functional and Embryological Perspective

Although it is not an easy task to classify cells into different types, or in turn cell types into tissue types, a clear, understandable, didactically and clinically relevant tissue classification is indispensable for undergraduate medical education, expert discussions in biomedical research as well as for clinical practice. From the earliest discovery of the light microscope on, tissue classification has been a dynamic process. Historically, it was not a rare occurrence that different textbooks offered different tissue classifications. Nowadays, classifications have almost become uniform - the most common is the histological classification into four basic tissue types (epithelial, connective, muscle, nervous), which is recognized by the majority of modern histology and pathology textbooks. The reason is that, with some exceptions, this classification seems to be the most relevant not only for educational purposes but also from an embryological perspective and clinical-histopathological practice. Recently, attempts have been made to abandon this established classification and replace it with a new one. Any new classification, which would improve the presently used is welcomed. However, if the proposed innovation does not satisfy the needs of modern education and clinical practice, it should be handled with great caution or reconsidered.

COMING INTO BEING AN EMPATHIC DOCTOR: MODERN VIEWS AND CHALLENGES

Medical reformation process based on a human-centered approach requires universities to train healthcare professionals who are able to update knowledge and skills quickly, to adapt to new conditions, and be highly qualified and competitive specialists. The development of qualities that ensure communication with patients such as empathy is still of great importance.
 Empathy is an essential component in the professional activity of doctors of all specialties, therefore the fostering of empathy in students must be considered as inseparable component of future doctors’ training, a precondition for the successful independent practice.
 The article describes the concept of empathy, its types and components, considers the methods of forming empathy and analyzes some of them. Special attention is focused on the importance of developing empathy in the professional activity of doctors of all specialties.
 Empathy in a clinical context is the doctor's ability to understand the emotions of patients that can contribute to more thorough history taking and making more accurate diagnosis and as a consequence an effective personalized treatment plan. Clinical empathy includes the following components: 1 – the ability to understand the patients’ condition, their feelings (emotions); 2 – the ability to make a rapport with patients in order to understand their mental state, emotions, and check the accuracy of this understanding; 3 – the ability to act in a certain therapeutic way (taking into account the understanding of the patient's mental state).
 According to many researchers, empathy is a genetically determined property, strengthened or weakened by an individual's life experience that depends on certain individual personality traits, but scientists have proven that empathy can be fostered.
 According to the literature, a decline in the level of empathy is usually observed in the third year of medical training, when students begin clinical classes that require contact with patients. The researchers associate this decline with the deflation of the ideal image of a doctor and his / her professional role, which young people had when beginning their medical studies. The decrease in empathy after passing their first clinical classes can also be understood as a kind of protection mechanism in case of getting into various difficult and serious life-threatening situations. Other authors claim that there is no noticeable change in the level of empathy. Such ambiguous results arise can be explained by the fact that researchers use various evaluation methods and once again emphasize the relevance of these processes in modern clinical practice.
 Involvement of students in coming in contact with patients, and namely, during survey, examination and treatment; discussion of clinical cases with analysis of applied examination methods, treatment plan and prognosis helps to form and develop empathy, teaches communication with patients, which are quite important qualities of a doctor.
 When fostering empathy in students, one should not forget that during work the doctor encounters some stressful situations that are associated with the suffering of patients, and therefore, along with empathy, the doctor must possess stress resistance in order not to succumb to psychological deformation, emotional exhaustion and professional burnout, which in turn can negatively affect the quality of diagnosis and the effectiveness of patient treatment. It is worth noting that the achievements of modern medicine in the field of anesthesiological support, surgical intervention technologies, and patient care enable to harmonize this border between empathy and psychological deformation.
 Thus, during the professional training of doctors, educators and clinicians should pay special attention not only to the students’ acquisition of practical skills, but also to the development of empathy, the formation of stress resistance, the improvement of interpersonal communication both with colleagues and patients, and the development of skills, related to empathy in a broad sense as these aspects are one of the paramount tasks of medical education programs based on the biopsychosocial model of health.

Clinical and pharmacoeconomic aspects of the use of prolonged colony-stimulating factors

Febrile neutropenia is one of the frequent complications of systemic antitumor therapy, characterized by high rates of patient mortality, mortality is particularly high in patients with pre-existing cardiovascular disease, renal disease, as well as in the presence of anemia. In addition, the development of febrile neutropenia is associated with a decrease in the dose intensity of chemotherapy, which also has an adverse effect on the long-term results of treatment of patients with a number of malignant tumors. This dictates the need for widespread use of preventive measures aimed at minimizing the risk of FN in cancer patients receiving cytotoxic chemotherapy. Numerous studies have shown that prophylactic use of granulocyte colony-stimulating factors can significantly reduce the duration of profound neutropenia, the incidence of FN and - most importantly - related mortality. This article is devoted to a review of modern approaches to the use of granulocyte colony-stimulating factors (G-CSF) in the context of the current system of cancer care financing - clinical and statistical groups (CSGs) on the territory of the Russian Federation. Various aspects of the use of drugs of this class to prevent febrile neutropenia in the context of its primary and secondary prevention, the rules of G-CSF use, current data on the effectiveness and feasibility of use in different clinical scenarios are considered in detail. The advantages of modern long-acting dosage forms of G-CSF and their place in modern clinical practice are considered.

Polypharmacy problems in geriatric practice of Kyrgyz Republic

World statistics shows increasing numbers of aging population and increasing number of patients with multiple comorbidities, i. e. polymorbidity, which today is an urgent problem of modern clinical geriatric practice. During clinical examination of elderly and senile patients, at least 4-5 diseases and manifestations of pathological processes are diagnosed on the average. Because of this many medicines are prescribed to elderly patients at the same time, unfortunately, often unreasonably, which becomes a widespread phenomenon and is called polypharmacy. Polypharmacy is associated with an increased risk of adverse reactions that can lead to hospitalization or even death, as well as a significant increase in health care costs.In this regard, an analysis of medication prescribing in elderly inpatients with cardiovascular disease using the Medication Rationality Index (MAI) was conducted. As a result, it was found that professionals who provide care to patients are not sufficiently aware of the peculiarities of the use of drugs in elderly patients and in our health care sector there are no regulatory documents on the care of elderly patients.

Robust prognostic prediction model developed with integrated biological markers for acute myocardial infarction

Commonly used prediction methods for acute myocardial infarction (AMI) were created before contemporary percutaneous coronary intervention was recognized as the primary therapy. Although several studies have used machine learning techniques for prognostic prediction of patients with AMI, its clinical application has not been achieved. Here, we developed an online application tool using a machine learning model to predict in-hospital mortality in patients with AMI. A total of 2,553 cases of ST-elevation AMI were assigned to 80% training subset for cross validation and 20% test subset for model performance evaluation. We implemented random forest classifier for the binary classification of in-hospital mortality. The selected best feature set consisted of ten clinical and biological markers including max creatine phosphokinase, hemoglobin, heart rate, creatinine, systolic blood pressure, blood sugar, age, Killip class, white blood cells, and c-reactive protein. Our model achieved high performance: the area under the curve of the receiver operating characteristic curve for the test subset, 0.95: sensitivity, 0.89: specificity, 0.91: precision, 0.43: accuracy, 0.91 respectively, which outperformed common scoring methods. The freely available application tool for prognostic prediction can contribute to risk triage and decision-making in patient-centered modern clinical practice for AMI.

Combined hepatoprotective pharmacotherapy for liver disease

Fixed-dose drug products as well as non-fixed hepatoprotective drug combinations are commonly used in modern clinical practice. Combined and concurrent drug use makes it possible to augment the pharmacological effects of individual agents, or extend the range of their potential indications. The drugs most commonly considered for combination therapy include essential phospholipids, glycyrrhizinic acid, ursodeoxycholic acid, silibinin, and S-adenosylmethionine. This paper discusses the rationale for combined use of liver-targeting drugs from a pathogenetic viewpoint, and provides a review of the evidence from clinical trials on combined pharmacotherapy for liver disease.

Effect of SLCO1B1 genotypes on statin intolerance and response to statins

Abstract Background Statins are a cornerstone therapy for management of hypercholesterolaemia in primary and secondary prevention of cardiovascular disease, however there is individual variation regarding efficacy of therapy and adverse side-effects experienced. Purpose Polymorphisms of the SLCO1B1 gene have shown correlation with the risk of statin side-effects and efficacy of treatment, however in real-world clinical practice, their utility remains to be established. Methods We carried out retrospective multiple linear regression analysis using robust standard errors of 129 individuals undergoing genetic testing for the SLCO1B1 polymorphisms rs4149056 and rs2306283 to investigate for an association to statin side effects and efficacy respectively. In addition, logistic regressions which account for the binary nature of the outcomes were performed. The rs4149056 gene has 3 outcomes: T/T (considered least associated with statin intolerance), C/C (considered most associated with statin intolerance) and T/C (considered intermediately associated with statin intolerance). The rs2306283 gene has 3 outcomes: A/A (considered least associated with statin response), G/G (considered most associated with statin response) and A/G (considered intermediately associated with statin response). Results According to multiple regression and logistic regression analyses SLCO1B1 rs4149056 genotypes (C/C and T/C relative to the base type T/T) do not predict the incidence of myalgia, myopathy, creatine kinase rise, liver function derangement or gastrointestinal side effects at 5% significance. SLCO1B1 rs2306283 (G/G and A/G relative to the base type A/A) do not predict LDL response to statins (p-values 0.33 and 0.52 respectively). Conclusions The presence of rs4149056 C/C and T/C genotypes was not associated with an increased risk of statin side-effects. Similarly rs2306283 genotypes did not correlate with the efficacy of statin treatment. These genotype predictors were primarily based on Simvastatin – an earlier generation statin, whereas the majority of the patients in this cohort were treated with more contemporary and widely used statins such as Atorvastatin and Rosuvastatin. We therefore conclude that these genotypic markers may have limited application in modern day clinical practice and that substantial investment of limited resources towards them may not be justified. Funding Acknowledgement Type of funding sources: None.

Research progress of Shenling Baizhu San and predictive analysis on its quality markers

Shenling Baizhu San is a classic prescription for replenishing Qi to invigorate the spleen and dispelling dampness to check diarrhea, which mainly treats the syndrome of spleen deficiency and heavy dampness. With the pharmacological effects of regulating immune system, improving lung function and gastrointestinal function, and resisting oxygen, tumor, and inflammation, Shenling Baizhu San is commonly used in modern clinical practice to treat chronic obstructive pulmonary disease, pulmonary fibrosis, bronchial asthma, irritable bowel syndrome, ulcerative colitis, chronic diarrhea, and diabetic, etc. This paper summarized the chemical constituents, pharmacological effects, and clinical application of Shenling Baizhu San in recent years, and predictively analyzed the quality markers of Shenling Baizhu San according to the "five principles" of Q-marker. The Q-markers of Shenling Baizhu San involved ginsenoside Rg_1, ginsenoside Re, ginsenoside Rb_1, pachymic acid, dehydrotumulosic acid, batatasin Ⅰ, batatasin Ⅲ, diosgenin, liensinine, neferine, luteolin, quercetin, glycerol trioleate, β-sitosterol, platycodin D, glycyrrhizic acid, glycyrrhetinic acid, liquiritin, pipecolinic acid, atractylenolide Ⅰ, atractylenolide Ⅲ, and bornyl acetate, which provided references for the quality control and follow-up research of Shenling Baizhu San.

Evaluate the practice of preoperative informed consent for elective surgical patients at the university hospital, Ethiopia, in 2022

BackgroundObtaining preoperative informed consent is considered an integral part of modern clinical practice. It works as a safeguard of the patient's rights and minimizes the chances of legal action against the surgical team members. This study was to evaluate the practice of informed consent in patients undergoing elective surgery. MethodsThe study was approved by the ethical committee of the school of medicine. The patients were reassured about the anonymity of their information. A study was conducted at different surgical departments of a teaching university hospital for one month. Participants were selected based on consecutive sampling from patients over the age of 18 years who had undergone elective surgery. ResultsThe overall adherence of our study to standard guidelines was 48.5%. During informed consent, 51% of patients were informed about their current condition; 49% of patients were informed about the nature and purpose of the proposed surgery; and 25% of patients were informed about the estimated duration of surgery and anesthesia. Conclusion and recommendationThe overall adherence of our study to standard guidelines was 48.5%. The quality of the makeshift informed consent process in this study is less than the standards. There is a great need to educate the surgical team members regarding the importance of patients' autonomy and their right to information about the proposed surgical procedure and anesthesia.

Quality of Life and Cognitive Function Evaluations and Interventions for Patients with Brain Metastases in the Radiation Oncology Clinic.

Simple SummaryBrain metastases (BMs) are the most common brain malignancy and are projected to increase in incidence over the coming decades. Historically, brain metastasis studies have focused on improving survival outcomes, but recently, the importance of evaluating health-related quality of life (HRQOL) and cognitive function has gained recognition. Although there is a myriad of validated HRQOL and cognitive assessments available in the radiation oncology clinic, there is an urgent need to identify tools tailored to patients with BMs and to adopt a uniform set of tests that measure HRQOL and cognition. This review presents various assessments for measuring HRQOL and cognitive function, current recommendations to improve standardization, and treatments known to preserve HRQOL and cognitive function.Brain metastases (BMs) account for a disproportionately high percentage of cancer morbidity and mortality. Historically, studies have focused on improving survival outcomes, and recent radiation oncology clinical trials have incorporated HRQOL and cognitive assessments. We are now equipped with a battery of assessments in the radiation oncology clinic, but there is a lack of consensus regarding how to incorporate them in modern clinical practice. Herein, we present validated assessments for BM patients, current recommendations for future clinical studies, and treatment advances that have improved HRQOL and cognitive outcomes for BM patients.

All-inside vs. conventional method in anterior cruciate ligament (ACL) reconstruction: systematic review and meta-analysis

Introduction: Injury to the anterior cruciate ligament (ACL) was prevalent among sports, with a female predominance. If not treated properly, ACL deficiency knee can cause significant morbidity and long-term impairment. The most often utilized reconstructive methods in modern clinical practice were conventional and all-inside treatments. This study compared all-inside and conventional ACL reconstruction methods through systematic review and meta-analysis. Method: The searching protocol was carried out using several databases, such as PubMed, ScienceDirect, and Google Scholar, to identify relevant topics in May 2022. This study used the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 (PRISMA) guidelines. Result: There were 17 studies included in this systematic review and meta-analysis. All of the reviewed studies were written in English. Most of the included studies were carried out in Europe. Theafollowaup duration range from 3amonthsato 4ayears. The total participants were 2329 patients with ACL reconstructions. There was a significant difference between groups in the overall analysis, with the all-inside technique having higher Lysholm score outcomes than the conventional technique (MD = 1.87; 95% CI = 0.41–3.33; p < 0.05) Conclusion: All-inside technique has higher Lysohlm score outcome than the conventional technique. There is no significant difference in pain and IKDC score between both groups.

Management of arterial hypertension in patients with chronic kidney disease on hemodialysis

The article is a review of information about the management of arterial hypertension (AH) on hemodialysis. This problem is relevant due to poor elaboration. At the same time, the prevalence of AH on hemodialysis is 91,4 %. The article discusses surveys concerning criteria for determining AH on hemodialysis and methodological approaches to its registration, target values of blood pressure during therapy. The concept of intradialysis hypertension, issues of the pathogenesis of AH on hemodialysis are also considered. The author presents approaches to nondrug therapy and drug treatment of patients with AH on hemodialysis. In particular, approaches to the control of sodium and volemic status within the framework of patient-dependent and apparatus-dependent technologies are considered. Data on the effectiveness of the use of certain classes of antihypertensive drugs are presented, in particular, diuretics, blockers of the renin-angiotensin-aldosterone system, beta-blockers, calcium channel antagonists, mineralocorticoid receptors are considered. The article reflects the needs of modern clinical practice in conducting evidence-based medicine research and identifies the critical points of orientation of such research.