Treatment Tactics Research Articles

Эндодонтическое лечение или экстракция: поиск компромисса

The article, using the example of clinical cases from dental practice, analyzes the causes, symptoms and tactics of dental treatment in case of periapical inflammation, an algorithm of instrumental and drug treatment. A tooth caused an apical granuloma or cysts often has to be removed. The aim of endodontic treatment is the prolonged preservation of the tooth as a functional unit of the chewing apparatus, the restoration of the health of periapic tissues and the prevention of autoinfection and sensitization of the body

Клинический случай лечения иглоножом компрессионной радикулопатии шейного отдела позвоночника

On the example of a specific clinical case – compression radiculopathy of the spinal cord roots of the cervical spine, the causes and prevalence of this disease, the generally accepted tactics of outpatient treatment and its results, the pathophysiological substantiation of the use of new, non-traditional methods for the treatment of this pathology, such as acupotomy have been analyzed in the article.

Endoscopic ultrasound in diagnosis and treatment of choledocholithiasis in children

Aim. To evaluate the informativeness of endoscopic ultrasound examination in children with suspected choledocholithiasis. Materials and methods. The study enrolled 20 patients with suspected choledocholithiasis. All patients underwent endoscopic ultrasound. Patient follow-up ranged from 4 to 14 months. Results. Endoscopic ultrasound proved to be informative in all patients and determined the treatment tactics in 10 patients. In 1 observation, the results of endoscopic ultrasound allowed for omitting endoscopic retrograde cholangiopancreatography as well as surgery. No complications were reported during the diagnostic examination. Conclusion. Endoscopic ultrasound is considered to be an informative and safe method in adults as well as in children. High efficiency in detecting gallstones enabled unnecessary and traumatic surgical interventions to be avoided. Assessment of anatomic features of the ductal system during endoscopic ultrasound serves as a significant factor for safer transpapillary surgeries.

Determination of the Ki-67 threshold value for predicting lymph nodes involvement in patients with gastric cancer

The search for biological markers to assess metastatic involvement of the lymph nodes in gastric cancer is one of the key steps in determining treatment tactics. The role of Ki-67 as a marker of cell proliferation in gastric cancer remains relevant. The aim of our study is to determine the Ki-67 threshold value for predicting the lymph nodes metastases. A retrospective analysis of 154 patients with gastric cancer showed an independent and statistically significant relationship between the depth of tumor invasion T (p = 0.002), the differentiation grade G (p = 0.010), the value of the Ki-67 index (p < 0.0001) and metastatic involvement of the lymph nodes. Using ROC analysis we found that Ki-67 ≥ 45 % correlates with the optimal level of sensitivity (55.9 %), specificity (84.2 %) and accuracy (73.4 %) of the method AUC 0.738 (p >< 0.043; 95 % CI 0,654–0,823). When evaluating the overall survival of patients>< 0.0001) and metastatic involvement of the lymph nodes. Using ROC analysis we found that Ki-67 ≥ 45 % correlates with the optimal level of sensitivity (55.9 %), specificity (84.2 %) and accuracy (73.4 %) of the method AUC 0.738 (p < < 0.043; 95 % CI 0,654–0,823). When evaluating the overall survival of patients >0.043; 95 % CI 0,654–0,823). When evaluating the overall survival of patients with Ki-67 > 45 %, we found that the median OS was 32 months [HR 2.2; 95 % CI 1.2–3,9; p = 0.005], while it was not reached in the group with Ki-67 < 45 %.A Ki-67 level of ≥ 45 % is the optimal threshold for determining the likelihood of lymph node metastasis in gastric cancer.

Research on the Properties of Wasteforms after Direct Involvement of Uranium-Containing Silica Gel in Glass Network Formation.

Uranium-containing silica gel (UCSG) is a secondary waste generated during the advanced treatment of nuclear wastewater. In order to reduce the growing storage pressure for UCSG, from the perspective of building a borosilicate glass network, UCSG was used to replace SiO2 in the glass-cured formula to directly achieve the immobilization of UCSG. SEM-EDS results showed that uranium was uniformly distributed in the matrix, and the maximum solid solubility of UCSG (two components: silica gel and uranyl ions) in the formula was as high as 55 wt %. At the same time, TG-MS proved that silica gel lost OH groups (down about 4.61 wt %) and formed Si-O-Si bond by condensation. FT-IR and XPS proved a change in the number of Si-O-Si bond, and new Si-O-B and Si-O-Al bond appeared on the spectrum. This was evidence that silica gel could self-involved participate in the construction of glass networks. EPR analysis obtained the changes in the coordination environment of U atom, the U atom decreased spin electrons number in the glass than in uranyl crystals. The glass also has good physical properties (hardness: 6.51 ± 0.23 GPa; density: 2.3977 ± 0.0056 g/cm3) and chemical durability (normalized leaching rate: LRU = 2.34 × 10-4 ± 2.05 × 10-6 g·m2·days-1 after 42 days), this research provided tactics for simple treatment of uranium-containing silica gel in one step.

Respiratory epithelial adenomatoid hamartoma in a child with nasal polyposis. Case report

Benign and malignant formations of the nose and paranasal sinuses in the early stages of development are asymptomatic or manifest minor nonspecific signs, and therefore often remain unrecognized. Hamartoma is a tumor-like formation of a dysembriological nature, consisting of excessive tissues peculiar to the affected organ. Due to the rarity of the occurrence of hamartomas of the sinonasal region, especially in pediatric practice, their diagnosis may present certain difficulties, since they can mimic other formations, such as nasal polyps or inverted papilloma, may occur as an isolated formation in the nasal cavity, or in combination with chronic rhinosinusitis, nasal polyposis, allergic rhinosinusitis. Aim – to report a rare clinical case in pediatric practice of respiratory epithelial adenomatoid hamartoma associated with allergic rhinosinusitis and polyposis, display the relationship between the occurrence of respiratory epithelial adenomatoid hamartoma and chronic inflammation of the nasal cavity and paranasal sinuses, to carry out differential diagnosis with other exophytic aggressive lesions of the nasal cavity, combine and summarize available data on sinonasal hamartomas. The article describes a clinical case of respiratory epithelial adenomatoid hamartoma in a 17-year-old child with a previous 4-year follow-up with nasal cavity polyposis and a history of repeated polypotomy. The results of endoscopy and computed tomography of the nasal cavity and paranasal sinuses, the results of surgical intervention, as well as the conclusions of a histological examination of the tumor removed from the patient are presented. The authors analyzed the domestic and foreign literature, on the basis of which they presented a differential series of sinonasal hamartomas. Respiratory epithelial adenomatoid hamartoma is a rare pathological formation of the sinonasal region, which manifests itself as an isolated polypoid mass in the nasal cavity or as an accidental surgical finding in patients with chronic sinusitis. The association with nasal polyps supports the hypothesis that inflammation may be one of the inducing factors. Respiratory epithelial adenomatoid hamartoma, although rare, should be considered in the differential diagnosis of exophytic lesions of the nasal cavity. The tactics of treatment involves endoscopic removal of the formation within healthy tissues, which provides good long-term results, relapses are extremely rare.

Explore the possibilities of the artificial intelligence program in the diagnosis of diabetic macular edema, age-related macular degeneration, central serous choriopathy and vitreomacular interface anomalies on the structural optical coherence tomography scans.

Background: macular diseases present a large group of pathological conditions leading to vision loss and poor vision. Early diagnosis of such changes plays an important role in the treatment tactics and comes one of the crucial factors in predicting results.
 Aims: study the possibilities of the artificial intelligence program in the diagnosis of the macular diseases based on the scans of structural OCT analysis.
 Materials and methods: the study included patients undergoing examination and treatment at the Federal Medico-Biological Agency Federal Research Clinical Center and the Moscow Regional Research Clinical Institute named after M.F. Vladimirsky. 200 eyes with the macular diseases and also eyes without macular pathology were examined. A comparative clinical analysis of structural OCT scans performed on an RTVue XR 110-2 tomograph was carried out. Retina AI software was used to analyze OCT scans.
 Results: during the OCT scans analysis various pathological structures of the macular were identified, and then a probable diagnosis was defined. The obtained results were compared with the diagnosis of the ophthalmologists. The sensitivity of the method was 95.16%; specificity - 97.76%; accuracy - 97.38%.
 Conclusions: Retina.AI allows ophthalmologists to successfully perform automated analysis of the OCT scans and identify various pathological conditions of the eye fundus.

КЛИНИЧЕСКИЙ СЛУЧАЙ БОЛЕЗНИ КУГЕЛЬБЕРГА-ВЕЛАНДЕРА (СПИНАЛЬНОЙ МЫШЕЧНОЙ АТРОФИИ III ТИПА)

Background. Differential diagnosis of neuromuscular diseases is one of the most difficult areas in neurology. Molecular genetic research in these patients is of particular importance. The article presents a clinical case of 5q spinal muscular atrophy type III (Kugelberg – Welander disease), confirmed by molecular genetic testing. Description of the clinical case. The article presents the clinical observation of a patient with an initial diagnosis of Erb – Roth myopathy. A genetic study was carried out. The analysis of the presence of exon 7 of the SMN1/SMN2 genes showed the absence of a signal corresponding to exon 7 of the SMN1 gene. A search for deletions in the SMN1 gene showed the homozygous deletion of exons 7–8 of the SMN1 gene in the proband. Homozygous deletion of exons 7–8 of the SMN1 gene causes 5q proximal spinal muscular atrophy. As a result of determining the num-ber of copies of the SMN1 and SMN2 genes, 0 copies of exons 7–8 of the SMN1 gene and 4 copies of exons 7–8 of the SMN2 gene were registered, which confirms the diagnosis of 5q spinal muscular atrophy type III. Conclusion. Adult patients suffering from neuromuscular diseases are recommended to undergo confirmatory DNA diagnostics to prescribe pathogenetic treatment, which increases their chances of survival. In young people with a clinical diagnosis of neuromuscular disease, genetic testing is required to clarify the diagnosis and further treatment tactics.

ОЦЕНКА РЕЗУЛЬТАТОВ РЕВИЗИОННОГО ЭНДОПРОТЕЗИРОВАНИЯ ТАЗОБЕДРЕННОГО И КОЛЕННОГО СУСТАВОВ ПРИ ПЕРИПРОТЕЗНОЙ ИНФЕКЦИИ

Background. Periprosthetic infection is a serious complication of large joint replacement surgery. To date, there is no consensus on the choice of surgical tactics for treating this category of patients. The aim of the work. To determine the effectiveness of one-stage and two-stage revision hip and knee replacement surgery in reducing periprosthetic infection. Materials and methods. We analyzed the results of revision replacement surgery in 78 patients with deep periprosthetic infection of the hip and knee joints. In 38 patients, one-stage revision replacement surgery was used, in 40 patients – two-stage. Treatment results were assessed 1 year after the surgery. Out of 78 patients, in 45 (57.7 %) choosing the type of revision replacement surgery was made according to the algorithm developed at the Irkutsk Scientific Centre of Surgery and Traumatology. Results. Using revision replacement surgery made it possible to stop the infectious process in 64.1 % of patients. The best results were obtained after two-stage revision surgery, in which relief of the infectious process was achieved in 72.5 % of cases. The choice of treatment tactics for patients according to the algorithm improved the results of two-stage revision joint replacement surgery up to 87.5 %. Using the criteria proposed in the algorithm when assessing the positive and negative results of revision surgery made it possible to confirm the effectiveness of the algorithm in 80% of patients and to identify the probable reasons for the maintenance of periprosthetic infection: incorrect choice of the type of surgery, the presence of extensive bone defects, the presence of polyallergy. Conclusion. Analysis of the results of revision arthroplasty for periprosthetic infection made it possible to confirm the effectiveness of the proposed algorithm for choosing the type of surgery, to establish the highest effectiveness of two-stage revision surgery compared to one-stage surgery, and also to determine the probable causes of negative treatment results.

Pharmacological correction of the activity of bone remodelling markers in the oral fluid of patients with generalised periodontitis depending on blood type

This article presents the data on the effectiveness of the treatment complex we developed on the activity of bone remodelling markers in the oral fluid during the treatment of generalized periodontitis, depending on the blood group. The use of our proposed drugs of general and local action in patients with generalized periodontitis of different blood groups allowed to reduce the average content of TRACP in the oral fluid by 18.25%, while increasing the level of BSALP by 27.64% in comparison with the corresponding data before treatment, p, р1<0.05, 0.01, which indicates the predominance of bone remodelling processes over osteoresorption processes in patients of the main group. The tactics of treatment of patients with generalized periodontitis of different blood groups, which we propose, is more effective than the conventional therapy and contributes to a faster achievement of remission of generalized periodontitis.

Results of ultrasonic examination of patients with internal bleeding and multiple injury at the prehospital stage: a literature review

Purpose: review and systematisation of publications in scientific medical literature devoted to ultrasound examination of trauma patients at the prehospital stage. Materials and methods: a search in scientific databases SCOPUS, Cochrane, PubMed, Russian Science Citation Index (RSCI) by key words: polytrauma, haemorrhage, evacuation of victims, ultrasound examination (US) was carried out. We analysed 46 literature sources — 2 domestic and 44 foreign, including data of meta ‑ analyses and systematic reviews; 23 studied articles were published in the last 5 years. Results: according to a number of scientific studies, ultrasound examination can be successfully used in patients with polytrauma at the prehospital stage, including during air ambulance evacuation on board a helicopter. Ultrasound examination according to the FAST protocol reduces the time to surgical intervention by 64–76%, reduces the need for radiation exposure, the incidence of complications after injury and the duration of the patient’s hospital stay. According to some authors, the sensitivity, specificity, positive and negative predictive value of the method in detecting intra–abdominal injuries and haemorrhage are 28–76%, 83–97%, 87–96% and 37–94%, respectively, which makes it an important tool for examination of an urgent patient, especially with unstable haemodynamics, influencing the treatment tactics. For the paediatric population in the diagnosis of haemoperitoneum, according to a meta‑analysis, the specificity of US leaves 95%, sensitivity — 66%. The method can be successfully applied in the work of aeromedical teams on board an air ambulance helicopter: according to a systematic review and meta‑analysis, the overall sensitivity of ultrasound in the diagnosis of pneumothorax during air ambulance evacuation is 61%, specificity — 99%. Conclusion: considering the analysed data from large randomised trials, meta‑analyses and systematic reviews, the use of ultrasound allows to make the right decisions regarding the tactics of treatment of the urgent patient, its transportation and choice of hospital, reduces the number of examinations, shortens the time to get the patient to the operating room and the duration of hospital stay, positively affects the outcome of the disease.

Efficient chemo-immunotherapy leveraging minimalist electrostatic complex nanoparticle as “in situ” vaccine integrated tumor ICD and immunoagonist

IntroductionImmunotherapy has unprecedentedly opened up a series of neoteric tactics for cancer treatment. As a burgeoning approach, chemo-immunotherapy has innovatively expanded the accomplishments of conventional chemotherapeutic agents for cancer governing. ObjectivesAn efficacious chemo-immunotherapy leveraging minimalist electrostatic complex nanoparticle (NP) integrated tumor immunogenic cell death (ICD) and immunoagonist was developed as a watertight “in situ” vaccine for cancer therapy through convenient intratumoral administration with minimized systemic toxicity. MethodsChemical-modified pH-sensitive cis-aconityl-doxorubicin (CAD) and immunoadjuvant unmethylated cytosine-phosphate-guanine (CpG) were co-packaged by polycationic polyethylenimine (PEI) though electrostatic-interaction to construct PEI/CpG/CAD NP. By intratumoral injection, this positively charged NP could be detained at tumor site and endocytosed by tumor cells effortlessly. Then, doxorubicin was released through cis-aconityl cleavage induced by endosomal-acidity and further triggered tumor ICD, the moribund tumor cells could release damage-associated molecular patterns (DAMPs) to recruit dendritic cells (DCs). Meanwhile, the entire tumor debris derived into diversified antigens and cooperated with immunostimulatory CpG to excite DC maturation and activated comprehensive antitumor immunity. ResultsProminent tumor suppression was achieved in aggressive mouse melanoma tumor model, which verified the feasibility and effectiveness of this minimalist CAD/CpG-codelivered NP. ConclusionThis study has provided a convenient and promising paradigm for potent cancer chemo-immunotherapy.

Dental Care for Cancer Patients in the Prevention of Complications of Chemotherapy and Head and Neck Radiation Therapy

Oncological diseases occupy one of the first places in the structure of disability and mortality of the population. The main methods of treating patients with malignant tumors in the maxillofacial area are surgical method, radiation therapy and chemotherapy. Treatment with only one of the listed methods It is rarely performed, mainly at the stage of cancer in situ or stage I of the disease. The treatment depends on the clinical and morphological characteristics of the tumor and requires the use of all methods simultaneously or in a certain sequence. Radiation and chemotherapy treatments not only have systemic side effects, but also side effects in the treatment area. Against the background of antitumor treatment, there is an exacerbation of concomitant chronic diseases, including odontogenic ones. Pathological changes appear on the mucous membrane oral cavity, on the skin, in the subcutaneous tissue, in the salivary glands and in the bone marrow of the jaw bones. The degree of damage to these structures during tumor treatment depends on their initial condition. At the same time, the initial condition of the oral cavity affects the quality of antitumor treatment. Poor oral hygiene and chronic odontogenic lesions can cause the development of episodic fevers and other general complications. All this requires stopping or changes in the tactics of antitumor treatment, which reduces its radicalism. It becomes obvious that sanitation of the oral cavity, carried out before treatment by an oncologist, will avoid or reduce the frequency complications in the maxillofacial area, improve the quality of life of an oncology patient. Dental care for such a patient has features and requires an individual approach. The purpose of this study was to review the literature on the main oral tissue complications arising from chemotherapy and radiation therapy in the head and neck region. In Google Scholar, Medline, Scopus, Web of Sciences, PubMed a systematic review was conducted. Search keywords terms included head and neck cancer, dental care, prevention of complications of cancer, oral tissue lesions manifestationin, chemotherapy, head and neck radiation therapy. Conducted a preliminary search and reviewed 132 titles and abstracts in this literary review included 48 article. This article analyzes the main complications of oral tissues resulting from chemotherapy and radiation therapy in the head and neck area and provides practical recommendations for the management and prevention of complications in this category of patients.

Drug Interactions in the Treatment of Chronic Heart Failure: Analysis of Clinical Guidelines

Background. According to Russian epidemiological studies, the prevalence of chronic heart failure (CHF) in the general population is high and amounts to 7–10%. Therapy of any disease, and especially chronic disease, is associated with the prescription of drugs. With the development of evidence-based medicine and implementation of its achievements in real clinical practice all over the world there is an increase in the number of prescribed drugs. This explains the high relevance of the problem of drug-drug interactions. Aims — analysis of interactions of drugs recommended for prescription to patients suffering from CHF. Methods. Based on the Clinical Guidelines (CG), all possible interdrug interactions of recommended medicinal products were analysed. Information on potential drug-drug interactions was obtained from the specialised website Drugs.com. Know more. Be sure (https://www.drugs.com/interactions/list/). Results. ACE inhibitors / ARA II / valsartan+sacubitril, beta-adrenoblockers and aldosterone antagonists are recommended as part of combination therapy for treatment according to CG for all patients with symptomatic heart failure (class II–IV) and reduced LV ejection fraction 40%. Amiodarone, verapamil and diltiazem are among the drugs not recommended for use in patients with the diagnosis of CHF. Also, according to clinical guidelines, HMG-CoA reductase inhibitors (atorvastatin, lovastatin, pitavastatin, rosuvastatin, simvastatin, fluvastatin), direct renin inhibitors (heparin), COX-2 inhibitors (parecoxib, polmacoxib, celecoxib, etoricoxib) are among the unrecommended drugs in chronic heart failure.For ACE inhibitors, no adverse effects from interaction with beta-blockers have been identified. This combination is widely used and recommended by the CG. According to the “Major” type for ACE inhibitors with drugs indicated for use in CHF according to CG, 4 potential interactions were identified: with valsartan-sacubitril; angiotensin II receptor antagonists; with aldosterone antagonist (spironolactone); with loop and thiazide diuretics. Therefore, the appointment of angiotensin II receptor antagonists is carried out in case of ineffectiveness of initial therapy with ACE inhibitors, when changing the treatment tactics. These drugs are not used in combination with each other due to the risk of hyperkalemia. The prescription and use of diuretics while taking ACE inhibitors should be controlled by a physician also due to the risk of hyperglycaemia. In Moderate type, potential interactions with dapagliflozin, eplerenone, cardiac glycosides and heparin have been identified for ACE inhibitors. For beta-blockers, no potential Major-type interactions were identified with drugs from CG. Combinations with dapagliflozin, loop and thiazide diuretics, cardiac glycosides, spironolactone and ivabradine require special attention. It is recommended to avoid the combination of beta-blockers with valsartan. Of the recommended angiotensin II receptor antagonists, no risk of potential interactions with beta-blockers has been identified for candesartan and losartan.

Features of the Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction According to the Russian Registry of Acute Myocardial Infarction - REGION-IM

Based on data from the Russian REGION-IM registry, to study the features of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) in real-life clinical practice. REGION-IM is a multicenter prospective observational study. The observational period is divided into 3 stages: during the stay in the hospital and at 6 and 12 months after inclusion in the registry. The patient's records contain demographic and history data; information about the present case of MI, including the time of the first symptom onset, first contact with medical personnel, and admission to the hospital; coronary angiography (CAG) data, percutaneous coronary intervention (PCI) data, and information about the thrombolytic therapy (TLT). Reperfusion therapy was performed in 88.9 % of patients with STEMI. Primary PCI (pPCI) was performed in 60.6 % of patients. The median time from the onset of symptoms to pPCI was 315 minutes [195; 720]. The median time from ECG to pPCI was 110 minutes [84;150]. Isolated TLT was performed in 7.4 %, pharmaco-invasive treatment tactics were used only in 20.9 % of cases. The median time from ECG to TLT (prehospital and in-hospital) was 30 minutes [10; 59], whereas the median time from ECG to prehospital TLT was 18 minutes [10; 39], and in 63 % of patients, TLT was performed more than 10 minutes after diagnosis. PCI followed TLT in 73 % of patients. The frequency of reperfusion therapy for STEMI in the Russian Federation has increased considerably in recent years. The high frequency of pPCI is noteworthy, but the timing of pPCI does not always comply with clinical guidelines. The results of this registry confirm the high demand for pharmaco-invasive strategies in real-life clinical practice. Taking into account geographical and logistical features, implementing timely myocardial reperfusion requires prehospital TLT. However, the TLT frequency in the Russian Federation is still insufficient despite its proven maximum effectiveness in the shortest possible time from the detection of acute MI.

«Назначить нельзя не назначить»: роль β-блокаторов в современном лечении пациента с артериальной гипертонией и сопутствующими заболеваниями

The paper is focused on clarifying the role of using β-blockers in modern treatment of arterial hypertension (AH) in patients with comorbidities. Despite the fact that the majority of clinical guidelines on the treatment tactics for AH consider β-blockers as the drugs prescribed when there are certain additional indications, nowadays an attempt is made to return to the distant past of cardiology, when β-blockers played a role of first line antihypertensive drugs. The paper provides evidence-based arguments in favor of the balanced approach to prescription of β-blockers to patients with AH. At the same time, the paper presents the results of the recent analysis involving the data on the participants of the large randomized trial focused on assessing the effects of dapagliflozin in patients with heart failure and preserved left ventricular ejection fraction suggesting frequent use of β-blockers in clinical practice for patients with AH and concomitant disorders, as well as the β-blockers’ safety and probable efficacy. The paper provides the meta-analysis results allowing one to estimate antihypertensive effect of β-blockers, the use of which makes it possible to reduce systolic blood pressure by almost 8—10 mm Hg. Furthermore, the paper discusses an opportunity to quickly obtain information about the role of certain drugs for treatment of AH using ChatGPT that is considered to be a promising information technology. The paper also provides data on the use of the doses of β-blockers that are not high enough and does not allow to achieve optimal heart rate in clinical practice.

Scales for assessing neurological disorders and degenerative changes in the cervical spine. Literature review

More than sixty scales have been developed for the diagnosis and treatment of degenerative pathology of the cervical spine from the perspective of neurological syndromes. The use of most of these in clinical practice is limited. The purpose of this study is to highlight the most popular scales for assessing degenerative changes of the cervical spine from the perspective of neurological syndromes in the diagnosis and determination of treatment tactics for single-segment stenosis of the spinal canal at the cervical level. The current clinical guidelines “Degenerative Spine Diseases” 2021 use the Neck Disability Index, the Visual Analog Scale, and the Frankel Grade among all scales. MEDLINE (PubMed) and Google Scholar were searched from 1972 to 2023 using the key words “cervical spine degeneration”. The initial search identified more than 13,000 articles. This review included 52 studies in which the analysis of clinical and neurological data was carried out using scoring scales for assessing neurological syndromes and functional status in degenerative spinal stenoses at the cervical level. The validity, reliability, and applicability of the scales in clinical practice were analyzed and compared. Based on the analysis of literature data, the most rational scales to use from the standpoint of validity, reliability, and time consumption are the Visual Analog Scale for pain assessment, the Neck Disability Index for assessing cervical radiculopathy, the European Myelopathy Score to assess cervical myelopathy, the Neck Pain and Disability Scale to assess functional outcomes, and the Hospital Anxiet y and Depression Scale for mental status assessment.

Evaluation of the effectiveness of various surgical techniques for early stabilization of the rib cage in comparison with conservative treatment tactics and predictors of an unfavorable outcome in patients with severe combined trauma

The objective was to evaluate the clinical effectiveness of various surgical techniques for early stabilization of the rib cage in comparison with conservative treatment tactics. The authors attached great importance to the search for predictors of an unfavorable outcome in patients with severe combined trauma.Materials and methods. This multicenter, non-randomized, open, retro- and prospective cohort study included 65 patients with chest trauma. Pa tients were categorized into three groups depending on the technique of restoration of the disturbed thoracic skeleton. Group 1 included 19 patients with the age of 39.9 ± 2.4 years and severity of MODS-II scale 4.0 ± 0.6, ISS 24.1 ± 1.8 points. In this group, submersible constructs were used to restore sternal reconstruction. Group 2 included 24 patients aged 30.9 ± 2.4 years with MODS-II severity score of 4.3 ± 0.5, ISS 27.1 ± 1.0 points. The stabilization of the frame was carried out using the technique of fixation of the bones of the ribs and sternum with an external fixation device (AVF). Frame stabilization was performed according to the technique of fixation of rib and sternum bones with external fixation apparatus (EFA). Group 3 contained 22 patients aged 48.6 ± 2.9 years with severity of MODS-II scale 3.9 ± 0.3, ISS 24.3 ± 1.3 points and conservative treatment tactics.Results. The respiratory biomechanics parameters in groups 1 and 2 had no statistically significant differences after 24 hours of the surgical interven tion and stabilized the rib cage. The exception concerned increased CO2 accumulation and a distinct tendency to decrease lung tissue extensibility (Slang) in the group 1, which could indicate restriction of chest excursion. The analysis of correlation between clinical and laboratory parameters and lethal outcome indicated that unfavorable outcome was most closely related to prolonged prehospital time, initial severity of the condition according to SOFA and APACHE II integral scales, as well as to the development of acute kidney injury and uncompensated tissue hypoxia.Conclusion. The comparison of the three treatment methods showed that each of them has its own advantages: the technique of surgical treatment using submersible structures is characterized by the greatest aggressiveness for the victim, limits the excursion of the chest in accordance with the biomechanics of respiration, which contributes to the aggravation of tissue hypoxia, but reduces the duration of treatment and financial costs. The least expensive, but comparable in aggressiveness, is the method of hardware fixation. The most sparing for the patient, although lengthening the time of treatment and, accordingly, its cost, is the conservative method of management. Thus, the choice of surgical tactics is left to the attending physician and the patient.

Circular RNAs, Noncoding RNAs, and N6-methyladenosine Involved in the Development of MAFLD.

Noncoding RNAs (ncRNAs), including circular RNAs (circRNAs) and N6-methyladenosine (m6A), have been shown to play a critical role in the development of various diseases including obesity and metabolic disorder-associated fatty liver disease (MAFLD). Obesity is a chronic disease caused by excessive fat accumulation in the body, which has recently become more prevalent and is the foremost risk factor for MAFLD. Causes of obesity may involve the interaction of genetic, behavioral, and social factors. m6A RNA methylation might add a novel inspiration for understanding the development of obesity and MAFLD with post-transcriptional regulation of gene expression. In particular, circRNAs, microRNAs (miRNAs), and m6A might be implicated in the progression of MAFLD. Interestingly, m6A modification can modulate the translation, degradation, and other functions of ncRNAs. miRNAs/circRNAs can also modulate m6A modifications by affecting writers, erasers, and readers. In turn, ncRNAs could modulate the expression of m6A regulators in different ways. However, there is limited evidence on how these ncRNAs and m6A interact to affect the promotion of liver diseases. It seems that m6A can occur in DNA, RNA, and proteins that may be associated with several biological properties. This study provides a mechanistic understanding of the association of m6A modification and ncRNAs with liver diseases, especially for MAFLD. Comprehension of the association between m6A modification and ncRNAs may contribute to the development of treatment tactics for MAFLD.

Prediction of perioperative complications and mortality in patients with complicated forms of colon cancer

Complicated forms of colon cancer occupy a significant share of emergency operations in general surgical departments with high rates of mortality and complications. Assessment of possible complications and mortality before surgery is an important aspect in choosing treatment tactics for this group of patients. The aim of the study. To analyze the risks of complications and mortality in the perioperative period in patients with complicated forms of colorectal cancer using the prognostic CR-POSSUM scoring system and to determine the critical levels of the CR-POSSUM score using ROC analysis. Materials and methods. The data of 71 (100 %) patients who were treated for complicated forms of colorectal cancer were analyzed. The studied group included 36 (50.71 %) men and 35 (49.29 %) women aged 67.97 ± 12.71 years. In the postoperative period, complications were found in 32 (45.07 %) patients, there were 8 (11.27 %) deaths. Results. The mortality risk at the time of hospitalization was 6.40 (3.50; 19.10) %. The actual mortality rate in the studied group was 8 (11.27 %) patients, which corresponded to the CR-POSSUM theoretically calculated mortality risk, U = 234.0, p = 0.739. Conclusions. Increased level of complications was noted at the critical score ˃20 points, AUC = 0.744, p ˂ 0.001 (sensitivity – 71.0 %, specificity – 67.5 %) and the critical score of increasing the mortality rate was ˃22 points, AUC = 0.781, p = 0.005 (sensitivity – 75.0 %, specificity – 74.6 %) as defined by CR-POSSUM. According to the ROC analysis, the increase in mortality in the studied group did not depend on the character and complexity of surgical interventions (p = 0.159), but on the general patient condition at the time of hospital admission (р ˂ 0.001). At the same time, the increased level of complications in the group depended on both the character and complexity of the surgical intervention (p = 0.028) and on the general patient health at the time of hospitalization to the general surgical department (р ˂ 0.001).