National Medical Research Center Research Articles

Methodological characteristics of the academic competition for general practitioners, family doctors and internists as a type of informal education

The article analyzes the results of the All-Russian competition for general practitioners, family doctors and internists held over five years by the National Medical Research Center for Therapy and Preventive Medicine with the support of the Russian Society for the Prevention of Non communicable Diseases.Aim. To determine the methodological characteristics of managing the academic competition as a type of informal education.Material and methods. To conduct the competition, practice-oriented tasks corresponding to professional tasks of a general practitioner were developed. In addition, we developed an original questionnaire to assess the impact of participation in the academic competition on the professional development. Family doctors and general practitioners with 1-10 years of experience, as well as internists, were included.Results. The methodological characteristics of the academic competition management as a type of informal education were determined: practice-oriented goals aimed at improving the knowledge, skills and abilities, competencies of the participants; the content of tasks based on the theory-practice relationship; compliance of tasks and real situations in the practice of a general practitioner; a systematic approach to competition management. Conclusion. The effectiveness of the academic competition as a type of informal education contributes to the professional development of participants, promotes the development of long-term attitudes towards improving professional knowledge, skills, abilities and competencies necessary for solving professional problems.

Experience of use of intraoperative computed tomography and navigation systems in minimally invasive surgery for lumbosacral spondylolisthesis

This article discusses the minimally invasive surgical technique for lumbosacral spondylolisthesis. The use of intraoperative computed tomography (iCT) and a navigation system significantly enhances the accuracy of screw placement and reduces the extent of soft tissue damage. From March 2018 to February 2024, 246 patients with lumbosacral spondylolisthesis underwent minimally invasive surgery with the use of iCT and navigation systems at the N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation. Of the above-mentioned cases, spondylolisthesis was most commonly observed at the L4-L5 (126 cases) and L5-S1 (98 cases) levels. This article presents two clinical cases from this series demonstrating successful use of these technologies.

The content of soluble forms of galectins -1, -3, -4, -7, -9 in patients with renal cell cancer of various morphological types

Background: Galectins are a family of β-galactoside binding proteins that regulate the vast majority of cellular functions, including proliferation, migration, adhesion, and phagocytosis in both health and disease. More and more experimental and clinical evidence indicates that galectins are involved in many stages of carcinogenesis, including patients with renal cell carcinoma (RCC). Aim: To analyze the clinical significance of soluble forms of galectins -1, -3, -4, -7, -9 in patients with various histological RCC types. Materials and methods: We performed a retrospective analysis of the clinical significance of galectins -1, -3, -4, -7, -9 in the serum of 140 RCC patients (84 with clear cell RCC (ccRCC), 38 with papillary (papRCC), 18 with chromophobe (chrRCC)) and in 73 healthy donors (control group), who were examined and treated from 2019 to 2023 in the N. N. Blokhin National Medical Research Center of Oncology. Galectin levels were measured in serum (obtained according to standard methods before the initiation of specific treatment) with an enzyme-linked immunosorbent assay. Results: There was a significant increase in serum galectin -1, -3, -9 levels in the whole RCC patient group, compared to the healthy donor control group; no increase was found for galectins -4 and -7. Serum galectin-1 levels in the ccRCC and papRCC patients were significantly higher than those in the controls (p = 0.0003 and p = 0.0135, respectively). No association between the serum galectins -1 and -7 and the clinical and morphological characteristics of RCC was found; however, serum galectin-7 levels in the papRCC patients correlated with the grade of tumor differentiation (r = -0.592; p = 0.001). The area under the ROC curve (AUC) for galectin-1 in ccRCC was 0.721 (p 0.0001), in papRCC 0.673 (p = 0.0086), and in chrRCC 0.576 (p = 0.355). For galectin-7, the ROC AUC values were 0.527 (p = 0.634) in ccRCC, 0.513 (p = 0.845) in papRCC, and 0.566 (p = 0.425) in chrRCC. In all histological types of RCC, there was a significant increase in serum galectin-3 compared to the controls (ccRCC, p = 0.0208; papRCC, p = 0.0014; chrRCC, p = 0.0041). The ROC analysis for galectin-3 in patients with RCC of various histological types showed AUC = 0.721 (p 0.0001) for ccRCC, 0.673 (p = 0.0086) for papRCC, and 0.576 (p = 0.355) for chrRCC. Galectin-9 levels was directly and significantly associated with the tumor size, as well as with regional metastases (r = 0.251, p = 0.021; r = 0.239, p = 0.028, respectively). The AUC values for galectin-4 were 0.619 (p = 0.021) in ccRCC, 0.577 (p = 0.214) in papRCC, and 0.534 (p = 0.666) for chrRCC. For galectin-9, they were 0.649 (p = 0.0075), 0.613 (p = 0.087), and 0.539 (p = 0.637), respectively. Conclusion: The study has demonstrated a certain association between serum galectin -1, -3, -4, -7, and -9 in the patients with RCC of various histological types. Although the results of the ROC analysis indicated average quality of the model, which does not allow for the use of the obtained data for diagnostic purposes, it is necessary to continue the research for better understanding of the mechanisms of galectin functioning, before galectin-based therapeutic agents would be introduced into clinical practice for the treatment of RCC.

The group of hypermethylated long noncoding RNA genes is associated with different types of metastasis in ovarian cancer

Background: Ovarian tumors are characterized by asymptomatic progression until their late stages, when at the time of diagnosis the patient already has extensive metastatic disease. In addition to lymphogenous and hematogenous metastasis in ovarian cancer, there are peritoneal dissemination and metastasis to the greater omentum with ascites; moreover, peritoneal carcinomatosis is the predominant route of metastasizing of ovarian cancer. Epigenetic factors, such as gene methylation, regulatory microRNAs and long non-coding RNAs (lncRNAs), contribute to progression of this cancer. Our previous bioinformatic and experimental studies have identified 13 genes of lncRNAs (GAS5, HOTAIR, LINC00472, LINC00886, MAFG-DT, PLUT/PDX1-AS1, SNHG1, SNHG6, SNHG12, SNHG17, TINCR, TP53TG1, TUG1) hypermethylated in the ovarian neoplasms. Aim: To evaluate the clinical significance of methylation levels of 13 lncRNA genes (GAS5, HOTAIR, LINC00472, LINC00886, MAFG-DT, PLUT/PDX1-AS1, SNHG1, SNHG6, SNHG12, SNHG17, TINCR, TP53TG1, TUG1) associated with various types of ovarian cancer metastasis, including lymphogenous, peritoneal, omental, and distant metastases. Methods: The methylation levels of lncRNA genes GAS5, HOTAIR, LINC00472, LINC00886, MAFG-DT, PLUT/PDX1-AS1, SNHG1, SNHG6, SNHG12, SNHG17, TINCR, TP53TG1, TUG1 were analyzed by quantitative real-time methylation-specific polymerase chain reaction. We tested 122 duplicate samples of ovarian neoplasms, including 104 malignancies and 18 borderline tumors, as well as 45 peritoneal macro metastases, collected in the N.N. Blokhin National Medical Research Center of Oncology in 2020 to 2023. The study included 21 samples of primary tumor from patients with lymphogenous metastases, 45 samples from patients with peritoneal dissemination, 61 from those with omental metastases, 49 from patients with ascites, and 9 with distant metastases. Results: The tumor samples from the patients with lymphatic nodes metastases showed a significant increase in the methylation level of two lncRNA genes: SNHG6 (p = 0.044) and SNHG12 (p = 0.006). Peritoneal dissemination was associated with hypermethylation of four lncRNA genes: GAS5, HOTAIR, LINC00472 (p 0.05), and most significantly TINCR (p = 0.001). GAS5, HOTAIR, LINC00886 (p 0.05) and most significantly LINC00472 (p 0.001) hypermethylation was typical for omental metastasis, and that of LINC00472 and LINC00886, with ascites (p 0.05). Peritoneal macroscopic metastases demonstrated increased methylation of MAFG-DT (p 0.001) and TP53TG1 (p 0.001) and desmethylation of LINC00886 (p = 0.003) and SNHG12 (p = 0.002), compared to their primary tumors. Conclusion: We performed the analysis of clinical significance of 13 hypermethylated lncRNA genes in ovarian cancer and were the first to show that 10 genes (GAS5, HOTAIR, LINC00472, LINC00886, MAFG-DT, SNHG6, SNHG12, TINCR, TP53TG1, TUG1) were associated with various types of ovarian tumor metastasis. Also, we were able to determine certain panels of lncRNA, which, if demonstrate abnormal methylation, were specific for lymphogenous and peritoneal metastasis of ovarian tumors.

Successful surgical treatment of metachronous carcinoma of the appulla of Vater and ductal carcinoma of the distal parts of the pancreas

Background. Currently, there is a steady trend towards an increase in the incidence of both synchronous and metachronous multiple primary malignant tumors (MPMT). However, metachronous polyneoplasia of the pancreatobiliary tract is relatively rare, and there have been very few reports on successful treatment of this malignancy. Case presentation. In September 2014, the patient K. was diagnosed with adenocarcinoma of the ampulla of Vater (T2N0M0, stage Ib) and underwent gastropancreatoduodenal resection with the creation of pancreatic-gastric anastomosis at the Abdominal Department of Cancer Research Institute of Tomsk National Research Medical Center. There were no complications in the postoperative period. At a 6.5-year followup, no evidence of disease progression was found. In April 2021, a follow-up examination conducted at the Cancer Research Institute revealed a large lesion on the distal part of the pancreatic stump with no clinically significant manifestations. Diagnosis of MPMT was confirmed by transgastric endoscopic ultrasound-guided biopsy. Histological and immunohistochemical examinations revealed undifferentiated ductal carcinoma of the pancreas. Considering the metachronous tumor localization, pancreatic stump extirpation with resection of the posterior wall of the stomach and splenectomy was performed. No complications occurred in the postoperative period. The patient received replacement therapy for exocrine pancreatic insufficiency and individual correction of carbohydrate metabolism. At a 15-month follow-up, liver metastases were detected, and palliative chemotherapy was administered. The patient died 6 months later due to disease progression. The survival time was 99 months after the first surgery and 21 months after the second surgery. Conclusion. We report a rare case of metachronous cancers of the ampulla of Vater and pancreatic stump developed with an interval of 6.5 years. The patient underwent successful curative resections consecutively. The overall survival time from the date of diagnosis was 99 months.

The <i>LGALS1</i> gene polymorphism is not associated with galectin-1 levels in tumor tissue and blood of colon cancer patients

Background: Galectin-1 plays an important role in the pathogenesis of colorectal cancer (CRC). The blood and tumoral levels of galectin-1 could be dependent on the polymorphism of the promotor region of LGALS1 gene. Aim: To analyze an association between galectin-1 levels in tumor tissue and plasma and the genotype of the rs4820293 and rs4820294 polymorphisms of the LGALS1 gene in CRC patients. Materials and methods: The study included a total of 70 inpatients with pathologically verified CRC (International Classification of Diseases 10th Revision codes C18-C20, 39 men and 31 women, mean age 65.4 ± 5.7 years), who were receiving treatment in the Tomsk Regional Oncology Center and Cancer Research Institute of the Tomsk National Research Medical Center from 2020 to 2022. The control group consisted of 70 healthy volunteers (34 men and 36 women, mean age 62.3 ± 7.2 years). Venous blood samples were taken from all study participants and tumor tissue samples were obtained from the CRC patients. Galectin-1 expression in the tumor tissue was assessed by immunohistochemistry and plasma galectin-1 levels by enzyme-linked immunosorbent assay. The LGALS1 gene polymorphisms rs4820293 and rs4820294 were identified by restriction fragment length polymorphism analysis. Results: The distributions of genotype and allele frequencies of polymorphic variants rs4820293 and rs4820294 of the LGALS1 gene in the CRC patients and in the healthy donors were comparable (p 0.05). Calculation of odds ratios did not confirm any association between LGALS1 gene polymorphisms and CRC. However, the rs4820294 polymorphism had a strong association with regional metastasis and tumor differentiation grade (Cramer's V above 0.4, p 0.001). The plasma galectin-1 levels in the CRC patients with the AA genotype of the rs4820294 polymorphism were higher than in the healthy carriers (17.42 versus 12.92 ng/ml, p = 0.040). However, there were no significant differences in the content of galectin-1+ cells in the tumor and galectin-1 in plasma of the CRC patients depending on the genotype of the LGALS1 gene polymorphisms (p 0.05). Conclusion: The LGALS1 gene polymorphism is not associated with CRC, but in the carriers of the rs4820294 variant is related to clinical and morphological parameters of the tumor process. The intratumoral expression and blood levels of galectin-1 in CRC patients are not dependent on the genotype of rs4820293 and rs4820294 polymorphisms of the LGALS1 gene.

Correlates of Nucleocapsid Antibodies and a Combination of Spike and Nucleocapsid Antibodies Against Protection of SARS-CoV-2 Infection During the Omicron XBB.1.16/EG.5-Predominant Wave.

We aimed to examine the association among nucleocapsid (N) antibodies, a combination of N and spike (S) antibodies, and protection against SARS-CoV-2 reinfection. We conducted a prospective cohort study among staff at a national medical research center in Tokyo and followed them for the incidence of SARS-CoV-2 infection between June and September 2023 (Omicron XBB.1.16/EG.5 wave). At baseline, participants donated blood samples to measure N- and S-specific antibodies. Cox regression was used to estimate the hazard ratio and protection ([1 - hazard ratio] × 100) against subsequent SARS-CoV-2 infection across these antibody levels. Among participants with previous infection, higher pre-reinfection N antibodies were associated with a lower risk of reinfection, even after adjusting S antibody levels (P < .01 for trend). Estimation of the protection matrix for N and S antibodies revealed that high levels in N and S antibodies conferred robust protection (>90%) against subsequent infection. In addition, a pattern of low pre-reinfection N antibodies but high vaccine-enhanced S antibodies showed high protection (>80%). Pre-reinfection N antibody levels correlated with protection against reinfection, independent of S antibodies. If the N antibodies were low, vaccine-boosted S antibodies might enhance the reinfection protection.

Predictors of intrahepatic cholangiocarcinoma recurrence after surgical treatment

Purpose of the study. To study the CT semiotics of intrahepatic cholangiocarcinoma (ICC) to determine the prognostic markers of recurrence. To analyze the association between CT characteristics of ICC and mutations in IDH1/2, MET, KRAS, BRAF, ERBB2, EGFR, FGFR genes. Materials and methods. We analyzed databases and diagnostic images of Vishnevsky National Medical Research Center of Surgery and Loginov Moscow Clinical Research Center for the period from April 2016 to January 2022 using the key queries «intrahepatic cholangiocarcinoma», «liver», «hepatocellular carcinoma», «metastases», «radio genomics». 142 patients with liver neoplasms were identified, including 90 cases of ICC, 31 cases of hepatocellular carcinoma and 21 cases of metastatic liver lesions, all morphologically verified (histologic and immunohistochemical analysis of biopsy material). Results. Associations between CT features and mutations of MET and IDH1/2 genes were determined. According to the results of statistical analysis all four CT-signs, such as bile duct dilatation, capsule retraction, presence of dropout foci and tissue volume changes, are correlated with the probability of recurrence (death) in patients with ICC. Conclusion. In a retrospective study, our results emphasize the potential prognostic significance of CT signs of ICC. We identified CT signs that allow differential diagnosis of ICC with hepatocellular carcinoma and colorectal cancer metastases. We also identified associations between CT signs of ICC and mutations of IDH1/2 and MET genes, which may allow us to non-invasively obtain data on clinically significant molecular markers of tumors to apply a personalized approach to patient treatment.

Computational vectorelectrocardiography: comparison of representations according to McPhee-Parungao and Frank

Aim: to compare amplitude-temporal and vectorcardiographic (VCG) parameters calculated through most commonly used matrix transformations.Materials and methods. Preliminary literature search revealed Kors and inverse Dower transformation to be the most commonly used matrices for converting ECG‑12 into Frank VCG. Trunov-Aidu matrix appeared to be the only one for deriving VCG in the McFee-Parungao lead system.The study included 1250 ECGs of patients at the National Medical Research Center of Cardiology with various cardiovascular diseases: arterial hypertension, coronary heart disease, post-infarction cardiosclerosis, aortic stenosis. For each patient, using the above transformations, three VCGs with an intact and three VCGs with an inverted direction of the Z axis (according to Ozol) were obtained. The comparison was carried out based on the main amplitude-temporal indicators of P-QRS-T, as well as on VCG parameters: spatial QRS-T angle, QRS loop area, QRS integral vector, fractional integrals P and QRS. A total of 9 pairwise comparisons of 134 indicators were carried out for each synthesized VCGResults. The strongest (r &gt; 0.9 or r &lt; -0.9) significant (p &lt; 0.001) linear correlation was found between the spatial metrics: P, QRS, T wave loop lengths, QRS loop area, QRS-T angle, ventricular gradient, and QRS shared integrals. Significant relationship between projection parameters and P-QRS-T amplitude and duration was observed in some cases. The largest number of correlations was noted between parameters calculated in McFee-Parungao and Frank lead system derived by Kors.Conclusions. Strong linear relationship was found between the VCG parameters determined through Kors, Dower and Trunov-Aidu matrix transformations, which indicates the equivalence of the results obtained through these matrices.

The Role of the Simulation Center in Conducting and Preparing for the Olympiads in Surgical Specialties Among Residents

The simulation center plays an important role in training medical personnel. The All-Russian Interdisciplinary Olympiad among residents has been held for two years at the A.V. Vishnevsky National Medical Research Center of Surgery. Pros: immersion in the specialty, working through surgical interventions, improving hand motor skills, communication between educational institutions. Cons: high workload for students, high costs for preparing competitions. Organizing and holding Olympiads in a simulation center is a progressive stage in training medical personnel in surgical specialties.

Electroneuromyographic examination of pelvic floor muscle dysfunction in patients with descending perineum syndrome

Aim: to assess the functional state of the pelvic floor muscles and their innervation in patients with descending perineum syndrome, manifested simultaneously by obstructive defecation and chronic neurogenic pelvic pain.Materials and methods: in 2022–2023, 51 patients (40 (78.4 %) women, 11 (21.6 %) men; age 50.9 ± 14.5 years) with pelvic organ prolapse, manifested by obstructive defecation and chronic neurogenic pelvic pain were examined at the Ryzhikh National Medical Research Centre for Coloproctology. All patients underwent high-resolution anorectal manometry and stimulation electroneuromyography according to a comprehensive neurophysiological protocol using a St. Mark’s electrode.Results: manometric patterns of functional defecation disorders were detected in 40 (78.4 %) patients, in the rest they were confirmed by defecography data and a negative evacuation test according to the Rome criteria IV. With stimulation electroneuromyography, neuropathy was detected in 68.6 % of cases by increasing the latency of the M-response of the pudendal nerve on the right or left. Complex neurophysiological diagnostics made it possible to additionally identify neuropathy in another 25.5 % of patients: according to changes in the mixed reciprocating reflex response (mixed feedback-reflex response) (efferent pathway) — in 17.7 % of cases; according to changes in the bulbocavernous reflex (efferent and afferent pathways) — in 7.8 % of cases. That is, neuropathy was determined in 94.1 % of patients in total.Conclusions:Functional diagnostic methods are an effective tool for studying the state of the pelvic floor muscle structures and their innervation and make it possible to identify pathogenetic links of disorders, the clinical manifestations of which are anal incontinence, neurogenic pelvic pain and proctogenic constipation in the form of obstructive defecation.Stimulation electroneuromyography makes it possible to detect disturbed innervation of the pelvic floor muscles and anal sphincter in the standard study of the M-response in 68.6 % of cases with perineal prolapse syndrome with a combination of proctogenic disorders and neurogenic pelvic pain. The use of a comprehensive neurophysiological protocol makes it possible to detect innervation disorders in 94.1 % of cases.

Клинические и гистологические особенности быстропрогрессирующего гломерулонефрита у детей

Rapidly progressive glomerulonephritis (RPGN) associated with antineutrophil cytoplasmic antibodies (ANCA) is complicated in children due to the severity of the disease and the lack of clear consensus on treatment. The purpose of this research was to analyze the course of RPGN and its outcomes in children depending on the morphological basis after the results of nephrobiopsy. Materials and methods used: a single-center cohort retrospective study had been carried out as medical records’ analysis of patients diagnosed with RPGN aged 1 to 18 y/o who were observed at the Nephrology Department of the Scientific Research Institute of Pediatric Nephrology and Urology with the National Medical Research Center for Children’s Health (Moscow, Russia) in 2015-2024. Renal survival was assessed for different clinical and morphological options, the Renal Risk Score was assessed then. Results: 18 (7 m/11 f) were identified of Me age of diagnosis 14.1 [9.9; 15.5] y/o. ANCA was detected in all patients: pANCA in 12 (66.7%, 95% CI 40.9-86.7) and cANCA in 6 (33.3%, 95% CI 13.3-59.0) plus a single patient had a rare combination of dual positivity for anti-GBM and MPO-ANCA. Extrarenal manifestations were described in 10 (55.6%, 95% CI 30.8-78.5). Morphological subclassification of focal segmental glomerulosclerosis was detected in 5 (31.3%, 95% CI 11-58.7), extracapillary proliferation in 8 (50%, 95% CI 24.7-75.4), sclerosing in a single patient (6.3%, 95% CI 0.2-30.2) and the mixed one in 2 cases (12.5%, 95% CI 1.6-38.4). The median follow-up period was 21.6 [12.6-35.3] months, the outcome of stage 5 chronic kidney disease (CKD) was observed in 4, overall renal survival after 12 months was 94.4% (95% CI 84.4-100.0) and 86.6% (95% CI 70.6-100.0) after 36 months. An increase in the relative risk of achieving stage 5 CKD in patients with extrarenal (general) manifestations was detected as 1.67 times (95% CI 1.01-2.77) and 10.5 times (95% CI 1.46-75.42) in those receiving dialysis. Differences in the median glomerular filtration rate at onset were revealed in patients with extrarenal manifestations and isolated glomerulonephritis (p=0.004). Conclusion: when choosing treatment tactics for RPGN in children and assessing renal prognosis, it is necessary to take into consideration the results of a morphological study and the degree of damage to the renal tissue.

Influence of significant difference in diameters of ureters on the possibility and effectiveness of ureteroureterostomy in the treatment of obstructive uropathies of the duplicated kidney

BACKGROUND: Laparoscopic ureteroureterostomy is increasingly used as a surgical correction method for obstructive uropathies of the duplicated kidney. A complicating factor for this technique may be a significant difference between the diameters of the ureters. AIM: This study aimed to analyze the effectiveness and safety of laparoscopic ureteroureterostomy in patients with obstructive uropathies of the duplicated kidney with a twofold or more difference in ureter diameters. MATERIALS AND METHODS: Among 14 children who underwent laparoscopic ureteroureterostomy for obstructive uropathies of the duplicated kidney at Almazov National Medical Research Centre between 2021 and 2023, in 10 patients (71.4%), the diameter of the “donor” ureter exceeded the diameter of the “recipient” ureter two times or more. RESULTS: In most patients, the indication for surgery was obstructive megaureter of the segment. All patients underwent laparoscopic ureteroureterostomy, proximal in 90% of cases and distal in one child. One of five patients underwent transurethral resection of the ureterocele as the first stage of operative treatment. The only complication observed in the postoperative period in the presented patients was a stent-associated urinary tract infection, which was treated conservatively. One child (10%) required ureter reimplantation with stump resection after ureteroureterostomy. CONCLUSIONS: Laparoscopic ureteroureterostomy is a safe and effective method for surgical correction of obstructive uropathies of the duplicated kidney although a significant difference is noted between the diameters of the “donor” and “recipient” ureters. This factor does not reduce the effectiveness of ureteroureterostomy and does not lead to an increased risk of postoperative complications and reoperations. Thus, laparoscopic ureteroureterostomy can be used in patients with obstructive uropathies of the duplicated kidney.

Deep Machine Learning for Automatic Segmentation of the Pancreatic Parenchyma and its hypo- and hypervascular lesions on CT Images

Objective of the study. To develop and evaluate the effectiveness of a technology for segmenting the pancreatic parenchyma and its hyper- and hypovascular lesions on abdominal computed tomography (CT) scans using deep machine learning.Materials and methods. CT scans from the database of the A.V. Vishnevsky National Medical Research Center of Surgery were used for training and testing the algorithms – a total number of approximately 150 studies (arterial and venous phases). A test dataset of 46 anonymized CT scans (arterial and venous phases) was prepared for validation of the obtained algorithms, independently assessed by expert physicians. The primary segmentation neural network used is nn-UNet (M. Antonelli et al., 2022).Results. The average accuracy of the test dataset for the model determining segmentation masks of the pancreas on CT images had an AUC of 0.8 for the venous phase and 0.85 for the arterial phase. The segmentation masks of pancreatic formations had an AUC of 0.6.Conclusion. Automated segmentation of the pancreatic parenchyma structure using deep machine learning technologies demonstrated high accuracy. However, the segmentation of hypo- and hypervascular pancreatic lesions requires improvement. The overlap of the masks showed a rather low result, but in all cases, the location of the pathological formation was correctly identified by the algorithm. Enhancing the training dataset and the algorithm used could increase the accuracy of the algorithm.No false negative results were obtained when detecting pancreatic formations; in all cases, the INS detected “suspicious” areas of the pancreatic parenchyma. This can help reduce the omission of pancreatic pathologies in CT scans, and their further assessment can be carried out by the radiologist himself.

The effect of surgical access on functional and oncological results of resections in laryngeal cancer T2N0M0

Introduction. Laryngeal cancer is the most common malignant neoplasm of the ENT organs. The preferred and primary therapy for this pathology is surgical intervention. The search for highly effective organ-saving methods of surgical treatment aimed at minimization of resection volume and preservation of functioning of the larynx continues. Current endolaryngeal surgery allows to improve functional results and is the most modern and advanced method.Aim. To compare functional and oncological results of surgical treatment of patients with laryngeal squamous cell carcinoma Т2N0M0 performed through transcervical and endolaryngeal accesses.Materials and methods. The results of surgical treatment of patients with squamous cell carcinoma of the vocal folds part of the larynx T2N0M0 performed between 2015 and 2020 at the Oncological Division of Head and Neck Tumors of the The National Medical Research Center for Otorhinolaryngology of the Federal Medico-Biological Agency of Russia were analyzed. The study included 49 men aged 52–72 years; the diagnosis was confirmed by histological examination. All patients underwent standard exams which led to diagnosis per the Tumor, Nodus and Metastasis international system.Results. Three-year recurrence-free survival after endolaryngeal resection of cancer of the vocal folds part of the larynx Т2N0M0 was 88.47 %, after transcervical resections it was 91.31 %. Analysis of functional and surgical results showed that compared to patients who underwent surgery through external access, in patients who underwent surgery with endolaryngeal access the rate of complications associated with the surgical wound in the early postoperative period was 13.04 % lower, frequency of cicatricial stenoses of the larynx was 20.06 % lower, and abnormalities of separating function of the larynx were 49.33 % rarer.Conclusion. In patients who underwent endolaryngeal resection of the larynx, better functional and surgical results were achieved compared to patients who underwent surgery through external access. Moreover, there was no statistically significant difference in oncological results between the study groups. This allows to conclude that minimally invasive endolaryngeal approaches are highly effective and functional in organ-saving surgeries for patients with squamous cell carcinoma of the vocal fold part of the larynx T2N0M0.

Desmin degradation in the skeletal muscle of patients with chronic critical illness

Critical illness myopathy (CIM) is a primary myopathy that develops in critically ill patients. Histologic features of CIM include a general decrease in muscle fiber cross-sectional area and a predominant loss of the motor protein myosin. These features are observed in the absence of inflammatory infiltrates but with detectable cytokine activation. The purpose of this study was to examine the state of the extracellular matrix of the human soleus muscle under conditions of CIM caused by chronic impairment of consciousness. Incisional muscle biopsies were taken from the soleus muscle of 6 patients who were in a chronic critical condition and were treated in the Department of Anesthesiology and Reanimation at the A.L. Polenov Russian Research Institute - branch of the Almazov National Medical Research Center. The study included patients with a chronic impairment of consciousness lasting at least 2 months. Muscle biopsies taken from healthy men were used as controls. The biopsies were obtained using needle biopsy under local anesthesia. Using histological staining of tissue sections, it was determined that patients with CIM exhibited a significant increase in collagen area, surpassing the control value by 82%. An increased mRNA content of collagens I, III, and VIa was also observed, along with an increase in the protein content of collagen I and III. At the same time, we did not observe any changes in the content of fibronectin and extracellular tissue growth factor mRNA. However, we did observe an increase in the mRNA of the integrin A7 subunit. The results obtained indicate significant skeletal muscle fibrosis under CIM conditions. Further studies on the signaling pathways that regulate this process are needed.

Potential and limitations of secondary prevention of noncommunicable diseases: data from a survey of Russian outpatient physicians

Aim. To identify potential and limitations of secondary prevention of noncommunicable diseases in outpatient clinics of various Russian cities.Material and methods. Outpatient physicians from 16 Russian cities took part in the cross-sectional study. A total of 545 general practitioners took part in the survey. The survey was carried out using a previously prepared questionnaire at the National Medical Research Center for Therapy and Preventive Medicine. It consisted of 11 blocks of questions, including sex and age characteristics, the prevalence of various diseases, adherence to therapy, preferential provision of medications, consultation assistance by hospital-based physicians and coverage of doctors and nursing staff. Answers were offered in several gradations to each question. Depending on the population, cities were divided into 4 following subgroups: population &gt;2 million people (Moscow and St. Petersburg), population of 1-2 million people (Samara, Rostov-onDon, Krasnodar, Krasnoyarsk, Omsk), population of 0,4-1 million people (Vladivostok, Ulyanovsk, Penza, Kursk, Kirov, Tomsk) and population &lt;400 thousand people (Nalchik, Saransk, Ivanovo).Results. In all Russian cities, among men visited a clinic, 37% were people in the age range of 50-60 years. Second place was taken by men aged 60-65 years (30%). Most often, patients present with chronic coronary artery disease (39%), followed by type 2 diabetes (22,6%). Patients present with symptoms of heart failure in 17,7% of cases. Cancer account for 11,5% in the structure of visits. A similar frequency was found for chronic obstructive pulmonary diseases (9,2%). Every third patient is partially adherent to drug correction; partial non-adherence is detected 2 times less, while complete nonadherence is &lt;3%. On average, 67% of doctors from different cities declare 75% achievement of target levels of risk factors, while one in five declare 50% achievement of recommended indicators. In most cases, physicians report minor problems during hospitalization. Every fifth doctor reported no problems, while every tenth respondent noted difficulties in hospitalizing patients. In every second case, partial staffing is noted. Moreover, a comparable trend is observed among doctors and nursing staff. In megacities and small towns the situation is somewhat better compared to cities with a population of 0,4 to 2 million.Conclusion. To optimize the secondary prevention of noncommunicable diseases, a number of measures at the outpatient healthcare level should be taken. This includes educational work on adherence to drug and non-drug treatment correction, expanding coverage of preferential medication provision, improving interaction with hospitalbased doctors and coverage of doctors and nursing staff.

Dynamics of residual shunt closure within one year after endovascular patent foramen ovale closure: a clinical study

Aim. To study 12-month dynamics of residual shunt (RS) closure after endovascular patent foramen ovale (PFO) closure.Material and methods. We analyzed the data of 80 patients who underwent endovascular PFO closure at the Chazov National Medical Research Center for Cardiovascular Diseases in the period 2018-2023. All patients underwent a full range of examinations in accordance with current clinical guidelines. The severity of RS immediately after occluder implantation, as well as after 1, 6 and 12 months post-intervention assessment was based on transesophageal echocardiogram bubble study at the control visit.Results. In the postoperative period, RS was visualized in 17,5% (n=14) of patients. Discharge was significant in 7,5% (n=6) of patients. One month after the intervention, residual significant discharge persisted in 10,0% (n=8) of patients. After 6 months, RS was visualized in 2,5% (n=2) of patients, and after 12 months, only in one patient (1,3%). The proportion of patients with RS 1 month after the intervention decreased to 42,9%, after 6 months to 85,7%, and after 12 months to 92,9% (p&lt;0,05).Conclusion. Most patients with RS after endovascular intervention for PFO are characterized by complete endocardialization of the occluder and PFO closure within the first year.

The possibilities of predicting the individual risk of cervical cancer in women of reproductive age using mathematical modeling

Background. Cervical cancer (CC) refers to cancer of visual localization and in women of reproductive age remains one of the most common oncological diseases. The carcinogenesis of CC is caused by the persistence of highly oncogenic types of human papillomavirus (HPV), the level of carcinogenicity of which is the highest based on the criteria of the International Agency for Research on Cancer. However, cervical carcinogenesis does not occur in all cases of persistence of highly oncogenic types of HPV. This, in turn, determines the need for a thorough search, study and analysis of possible cofactors that can lead to neoplastic changes in the cervix.Aim. To develop a model for predicting the individual risk of CC in women of reproductive age, taking into account clinical, anamnestic, laboratory and histological data.Materials and methods. The material for the study was retrospective examination data from 251 patients of reproductive age who were treated at the Center for Gynecology and Reproductive Technologies of the National Medical Research Center “Medical and Rehabilitation Center”, Ministry of Health of Russia in the period 2015–2022. Results. Highly oncogenic HPV types were significantly more common in the group of patients with verified СС who took combined oral contraceptives (COC), compared with patients who did not take COC (p = 0.035). Multifactorial analysis allowed us to determine that long-term use of СОС for a total of more than 7 years is associated with a tendency to increase the risk of developing СС (hazard ratio 1.68; 95 % confidence interval 1.1–2.5; p = 0.010). According to the results of statistical calculation, the values of regression coefficients were obtained and the tendency to increase the risk of developing CC was predicted in the presence of such factors as: HPV type 16 persistence, body mass index, and the duration of COC intake in years.Conclusion. Thus, taking into account all possible risk factors for CC, the negative effect of cofactors, namely increased body mass index and prolonged intake of COC, on the course of HPV as the leading etiological factor of breast cancer, will allow us to identify groups at increased risk of developing CC, form an individual algorithm for monitoring and examination throughout the entire period of taking COC, as well as conduct individual cancer prevention by limiting the duration of taking COC.

The impact of adjuvant radiotherapy for cosmetic results after immediate breast reconstruction based on the tissue expander and permanent implant

Background. One of the causes of complications in breast cancer patients after immediate breast reconstruction (IBR) is postmastectomy radiation therapy (PMRT).Aim. Retrospective analysis of the results of IBR, and evaluating the effect of PMRT on the frequency and type of complications.Materials and methods. Between 2015 and 2021, 798 patients underwent IBR with tissue expander or implant in N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia. PMRT was performed in 375 patients (group 1). The remaining 423 patients did not receive PMRT (group 2). Complications, including reconstructive failure (RF), Baker grade III/IV capsular contracture (CC), were recorded and analyzed.Results. Finally, cosmetic result analyzed in 521 patients. In 281 patients of PMRT group (group 1) IBR with expander or implant were performed in 144 and 137 cases, respectively. In the 240 patients without PMRT (group 2), IBR with expander was performed in 81 patients, with implant – in 159 cases. Pooled analysis revealed that overall rate of complications in the PMRT group was 33.8 % (in 95 of 281 patients), in non-irradiation patients – 22.9 % (in 55 of 240 patients), p &lt;0.01. In group 1, RF were recorded in 67 (23.8 %) patients, in group 2 – in 44 (18.3 %) patients, p &gt;0.05. CC in group 1 were detected in 28 (10 %) patients, in group 2 in 11 (4.6 %) patients, p &lt;0.05. In patients with permanent implants RF were detected in 21 (14.6 %) of irradiation patients and in 22 (13.8 %) non-irradiation patients (p &gt;0.2). On the contrary, CC were mentioned in 22 (16.1 %) of irradiated patient and in 8 (5 %) patients that didn’t receive PMRT, p &lt;0.005. After reconstruction with expander RF were diagnosed in 46 (31.9 %) patients after PMRT and in 22 (27.2 %) non-irradiation patients, p &gt;0.2. CC were observed in 6 (4.2 %) patients from PMRT group and in 3 (3.7 %) patients treated without PMRT, p &gt;0.2.Conclusion. PMRT in patients after IBR with simultaneous installation of a permanent implant is characterized by a decrease in the incidence of RF, but an increase in the incidence of CC.