Objective. The aim of the study was to improve treatment outcomes for patients with “complex” choledocholithiasis through the combined use of modern minimally invasive methods and to develop an algorithm for their clinical application. Material and methods. A retrospective analysis of minimally invasive treatment in 245 patients with “complex” choledocholithiasis was performed. The study group consisted of 187 patients: 150 underwent endoscopic papillary large balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) with subsequent stone extraction; 20 underwent intraductal lithotripsy; 17 underwent extracorporeal shock wave lithotripsy (ESWL). The control group consisted of 58 patients treated solely with standard endoscopic mechanical lithotripsy (ML). Results. The success rate of the combined approach in the study group was 91.5%. The use of new technical approaches significantly reduced postoperative complications to 3.2%. The rate of surgical interventions required due to the failure of minimally invasive methods was 8.0%, which was statistically significantly (p<0.05) lower than in the control group treated with mechanical lithotripsy alone (8.6% and 13.8%, respectively). Based on these results, a modern algorithm for the combined use of minimally invasive approaches in treating “complex” choledocholithiasis was developed. Conclusion. The proposed integrated approach, based on a sequence of EPLBD with limited EST, intraductal lithotripsy, ESWL, and ML, improves the efficacy of minimally invasive interventions, decreases postoperative complications, and reduces the need for open surgery in patients with “complex” choledocholithiasis.
Introduction . Low testosterone levels are common in men with rheumatoid arthritis (RA). Patients with RA and hypogonadism have higher levels, reflecting systemic inflammation. Both RA and hypogonadism can negatively impact quality of life. Aim. To assess the impact of low testosterone levels on quality of life in men with RA. Materials and methods . A cross-sectional study of 73 men diagnosed with RA was conducted. All patients had their total blood testosterone levels measured and were administered the HAQ, EQ-5D, and HADS questionnaires. A cross-sectional comparison of quantitative and qualitative parameters was performed between normal and low (≤12.0 nmol/L) total blood testosterone levels. Results . Patients with hypogonadism and RA were characterized by lower quality of life indicators, which was reflected in the results of the HAQ questionnaires (1.59 ± 0.88 vs. 1.09 ± 0.87; p = 0.036), EQ-5D (0.52 [-0.01; 0.64] vs. 0.62 [0.52; 0.69]; p = 0.048), as well as the patient’s assessment of the general condition using VAS (70.0 [60.0; 80.0] vs. 60.0 [55.0; 70.0]; p = 0.039). The results of the HADS questionnaire were comparable in the studied subgroups. In the correlation analysis, the HAQ score correlated with RA activity according to DAS28CRP (r = 0.58; p < 0.001), ESR (ρ = 0.51; p < 0.001) and CRP (ρ = 0.55; p < 0.001), as well as the class of functional impairment (ρ = 0.26; p = 0.025), total testosterone (ρ = -0.3; p = 0.009) and hemoglobin (ρ = -0.48; p < 0.001). High RA activity (DAS28CRP ≥ 5.1), but not the presence of hypogonadism, as well as factors related to age and body weight, significantly increased the likelihood of having more negative results according to the HAQ questionnaire: OR 17.5; 95% CI 4.5–68.1 (p < 0.001) for HAQ ≥ 1.0 and OR 18.12; 95% CI 1.03–319.23 (p = 0.048) for HAQ ≥ 2.0. Conclusion. Patients with RA and hypogonadism have a lower quality of life, which is due to the influence of inflammatory activity.
Introduction . The development of artificial intelligence (AI) and machine learning methods opens up new opportunities for optimizing clinical and laboratory stages of assisted reproductive technology (ART) programs. Aim : to evaluate the current level of efficiency, methodological quality, and implementation prospects of AI algorithms in the clinical and laboratory stages of ART programs. Materials and Methods . A narrative literature review was conducted using PubMed/MEDLINE, eLibrary, and ScienceDirect databases covering the years 2016–2024 (additionally including fundamental 1996–2015 studies). The search was carried out by using Boolean operators: ("artificial intelligence" OR "machine learning" OR "deep learning") AND ("IVF" OR "assisted reproductive technology" OR "embryo selection"). A total of 60 publications containing verifiable quantitative algorithm performance metrics were included in the final analysis. Results . AI use shows high accuracy in blastocyst segmentation and quality assessment (AUC = 0.86–0.91), as well as in predicting controlled ovarian hyperstimulation outcomes. However, most analyzed models are limited by single-center training datasets and a lack of external validation. Conclusion. AI algorithms demonstrate high potential as decision support systems, but widespread implementation in ART practice requires prospective multicenter randomized controlled trials.
В работе обоснован значительный медицинский и биотехнологический потенциал муравьев, обитающих на территории Хабаровского края. Данные насекомые представляют интерес для современной фармацевтики благодаря уникальному биохимическому составу, сформировавшемуся в экстремальных климатических условиях. В отличие от тропических видов, дальневосточные муравьи вынуждены выживать в суровом климате с продолжительной холодной зимой и резкими перепадами температур. Для защиты от замерзания их организм вырабатывает особые криопротекторные соединения — глицерин, пролин и трегалозу. Эти вещества не только предотвращают повреждение клеток при низких температурах, но и обладают рядом ценных свойств, полезных для организма человека.Проведенное исследование подтверждает, что выделенные из муравьиной биомассы соединения могут быть эффективно использованы в медицине: они способствуют ускоренному заживлению ран и регенерации тканей, обладают увлажняющим действием (что актуально для офтальмологических препаратов), а также проявляют антимикробную активность. Таким образом, муравьи Хабаровского края представляют собой не просто элемент народной медицины, а перспективный биотехнологический ресурс, заслуживающий детального изучения и последующей разработки новых лекарственных средств. Полученные результаты открывают возможности для создания препаратов на основе природных адаптогенов и криопротекторов, адаптированных для нужд клинической практики.
статья посвящена анализу научно-методических подходов к проектированию современных образовательных программ в аспекте модернизации российской системы образования. Рассматриваются ключевые вызовы и тренды, обусловленные обновлением нормативно-правовой базы, внедрением Федеральных государственных образовательных стандартов нового поколения и современными санкционными ограничениями, международной изоляцией. В условиях быстрых социально-экономических, технологических и культурных изменений традиционные модели разработки образовательных программ устарели. Требуется переход от «программы как документа» к «программе как динамической модели образовательного процесса», основанной на научных данных и современных методических подходах. Цель исследования заключается в систематизации и разработке комплексных подходов к созданию образовательных программ, обеспечивающих их гибкость, практикоориентированность и соответствие актуальным требованиям рынка труда и общества. В задачи входит изучение и анализ литературы по теме работы, вопросов проектирования содержания образования, выбора педагогических технологий, организации оценочных процедур и обеспечения необходимых ресурсов, анализ проблемы согласования требований стандартов с запросами региональных рынков труда и индивидуальными потребностями обучающихся. В заключении формулируются практические рекомендации по созданию эффективных образовательных программ, которые носят адаптивный характер, ориентированы на результат и способствуют достижению стратегических целей модернизации российского образования. this article analyzes scientific and methodological approaches to the design of modern educational programs in the context of modernization of the Russian education system. It examines key challenges and trends arising from the updating of the regulatory framework, the implementation of the new generation of Federal State Educational Standards, current sanctions restrictions, and international isolation. In the context of rapid socioeconomic, technological, and cultural changes, traditional models of educational program development are outdated. A shift is required from "program as a document" to "program as a dynamic model of the educational process," based on scientific data and modern methodological approaches. The goal of this study is to systematize and develop comprehensive approaches to the creation of educational programs that ensure their flexibility, practice-oriented nature, and compliance with the current demands of the labor market and society. The objectives include studying and analyzing the literature on the topic, addressing issues of educational content design, selecting pedagogical technologies, organizing assessment procedures, and providing the necessary resources, as well as analyzing the problem of aligning standard requirements with regional labor market demands and the individual needs of students. The conclusion provides practical recommendations for creating effective educational programs that are adaptive, results-oriented, and contribute to achieving the strategic goals of modernizing Russian education.
