Tajik State Medical University

Periodontal disease leads to progressive destruction of tooth-supporting tissues. Conventional therapies, such as open flap debridement, control inflammation but provide limited regeneration. Bioactive glass (BG), a bioactive and osteoconductive material, has emerged as a promising regenerative agent in periodontal therapy. This meta-analysis evaluated the clinical efficacy of BG in reducing probing depth (PD) and improving clinical attachment level (CAL) in periodontal lesions. A systematic search of Embase, PubMed, and Cochrane Library up to April 2025 identified randomized controlled trials (RCTs) assessing BG as a standalone intervention for periodontal regeneration. Studies reporting PD and/or CAL outcomes were included. Following Cochrane Collaboration standards, two reviewers independently extracted data and assessed bias risk. Meta-analysis using a random-effects model in RevMan (v5.4) addressed study heterogeneity. Twelve RCTs involving 234 patients and 406 periodontal defects were included. BG significantly improved PD reduction (MD = 1.27 mm; p = 0.0006) and CAL gain (MD = 1.49 mm; p = 0.0005), with moderate-to-high heterogeneity and no significant publication bias. These findings confirm that BG significantly enhances clinical outcomes in periodontal regeneration. Despite variability among studies, BG demonstrates strong potential as an effective regenerative material, warranting further high-quality trials.

Background. The evolution of surgical treatment for urolithiasis has shifted from open surgery to minimally invasive methods, among which retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are the current standard of care. Purpose. To conduct a comparative analysis of the efficacy, safety, and clinical outcomes of RIRS and PCNL. Materials and methods. A review of the literature was performed, analyzing data on indications, techniques, postoperative outcomes, and complications of RIRS and PCNL. Special attention was paid to comparing the Stone-Free Rate (SFR), complication rates, and intra- and postoperative parameters. Results. PCNL demonstrates a statistically significantly higher primary SFR compared to RIRS (up to 94% vs. 73–82%) for stones 1–2 cm, particularly those located in the lower pole. However, RIRS is associated with significantly less invasiveness: reduced blood loss (decrease in hemoglobin, p<0.05), lower transfusion rates, shorter hospital stay (1–1.3 days vs. 2–3 days for PCNL), and less postoperative pain. For stones >2 cm, PCNL remains the "gold standard," while for stones <2 cm, RIRS is the treatment of choice due to its optimal balance of efficacy and safety. Conclusion. Modern surgical management of urolithiasis is based on risk stratification and an individualized approach. PCNL remains the most effective method for large and complex stones, whereas RIRS is a preferred minimally invasive alternative for smaller stones, providing a comparable final SFR with a better safety profile and faster patient recovery.

Abstract Background Acute respiratory failure (ARF) is a frequent complication of acute decompensation of chronic heart failure (ADCHF) and significantly worsens prognosis. High-flow oxygen therapy (HFOT) and non-invasive ventilation (NIV) are commonly used to correct hypoxemia; however, comparative data on their effects on gas exchange, respiratory rate, oxygenation index, and patient tolerance in this population remain limited. Aim To compare the effects of HFOT and NIV on gas exchange parameters, respiratory rate, oxygenation index, and therapy tolerance in patients with ADCHF complicated by ARF. Methods This single-center randomized study was conducted from September 2022 to September 2023 in the cardiac intensive care units of our University Clinical Hospital. Among 270 hospitalized patients with ARF, 108 met the inclusion criteria, and 68 completed the full treatment protocol. Patients were randomized into two groups: HFOT (n=34) and NIV (n=34). Key physiological parameters were monitored at admission and at 1, 6, and 24 hours after therapy initiation. Primary outcomes included PaO₂, PaCO₂, respiratory rate (RR), SpO₂, and oxygenation index (OI). Therapy tolerance was assessed using a 10-point visual analog scale (VAS). Statistical significance was set at p0.05). PaCO₂ decreased by 1–3% and 4–5%, RR decreased by 15–16% and 12–15%, SpO₂ increased by 15–18% and 15–17%, and OI increased by 14–33% and 8–17%, respectively (p>0.05). At 6 hours, further improvement was observed: PaO₂ increased by 52% in both groups (HFOT 101–127 mmHg, NIV 103–131 mmHg), PaCO₂ decreased by 5–10%, RR decreased by 23–29%, SpO₂ reached 97–99%, and OI was 308–362 and 303–337 units, respectively. At 24 hours, parameters stabilized: PaO₂ 94–97 and 92–97 mmHg, PaCO₂ 37–45 and 37–52 mmHg, RR 18–18 and 18–19 breaths/min, SpO₂ 98–99% in both groups, OI 313–327 and 312–329 units. Differences between groups were not statistically significant (p>0.05). Therapy tolerance was better in the HFOT group: moderate-to-severe discomfort (VAS>3) was reported in 36.7% of patients versus 63.3% in the NIV group (p=0.042). No serious adverse events were observed in either group. Conclusions Both HFOT and NIV effectively improve gas exchange and reduce respiratory rate in patients with ADCHF complicated by ARF. HFOT is associated with higher therapy tolerance and fewer reports of discomfort. Both methods are safe and can be applied early in the course of acute decompensated heart failure to optimize patient outcomes.

Abstract Background Acute respiratory failure (ARF) is a common complication of cardiogenic pulmonary edema and worsens prognosis in acute heart failure (AHF) patients. High-flow oxygen therapy (HFOT) and non-invasive ventilation (NIV) are commonly used to correct hypoxemia, but comparative data on their effects on respiratory function and patient comfort are limited. Aim To compare the effects of HFOT and NIV on respiratory rate, blood gas parameters, patient comfort, and clinical outcomes in patients with cardiogenic pulmonary edema and acute respiratory failure. Methods This single-centre randomized study was conducted in the cardiac intensive care unit of our University Clinical Hospital from September 2022 to September 2024. A total of 120 patients with ARF were randomized to receive HFOT (n=60) or NIV (n=60). Randomization was computer-generated. The primary endpoint was the change in respiratory rate (RR) over 60 minutes. Secondary endpoints included PaO₂, PaCO₂, SpO₂, hemodynamic parameters, patient discomfort (10-point visual analog scale), and safety outcomes (premature discontinuation and clinical deterioration). Statistical analysis included t-test or Mann–Whitney U test for independent samples; significance was set at p0.05 for all). SpO₂ increased by 11.2%, 10.8%, and 10.5% in HFOT, and 10.5%, 10.9%, and 10.7% in NIV (p>0.05). Patient discomfort after 60 minutes was lower in HFOT (median 3, IQR 2–4) than in NIV (median 5, IQR 3–7; p=0.038). Moderate-to-severe discomfort (EVA>3) was reported in 36.7% (22/60) in HFOT and 63.3% (38/60) in NIV. PaO₂ and PaCO₂ changes at 60 minutes were not significantly different between groups (PaO₂ +63.5% HFOT vs +62.8% NIV, p=0.274; PaCO₂ −13.6% HFOT vs −15.2% NIV, p=0.312). Premature discontinuation due to discomfort occurred in 3.3% (2/60) in HFOT vs 8.3% (5/60) in NIV; clinical deterioration requiring conversion to invasive ventilation occurred in 6.7% (4/60) and 3.3% (2/60), respectively. Conclusions HFOT and NIV effectively reduce RR and improve oxygenation in patients with cardiogenic pulmonary edema. HFOT provides better patient comfort and fewer therapy interruptions. Blood gas improvements are similar between methods. Early initiation and optimal selection of respiratory support are critical to enhance tolerance and clinical outcomes in acute heart failure patients.

Soil methanogens and methanotrophs jointly regulate methane (CH4) cycling, yet how they maintain stability under environmental changes and thereby affect CH4 emissions remains poorly understood. Integrating a large-scale survey of 31 Qinghai-Tibet Plateau alpine wetlands with amplicon sequencing and microcosm incubation, we quantify the multidimensional stability architecture of these CH4-cycling guilds, spanning taxonomic diversity, community structure, and component abundance. While diversity stability is comparable between guilds, methanogens exhibit significantly lower structural and component stability than methanotrophs. Underpinning this divergence, methanogens show a flexible insurance strategy shaped by compensatory dynamics and deterministic assembly, while methanotrophs display a strategy of rigid tolerance via robust networks, broad niche widths, and weak environmental filtering. Furthermore, the environmental drivers of stability architecture are decoupled between the two guilds. Critically, component stability shows stronger associations with CH4 fluxes than the traditional Shannon diversity for both guilds, while the direction and strength of the diversity-CH4 flux relationship vary across stability architectures. These findings highlight the importance of integrating microbial stability architecture to predict ecosystem functioning under global change.