Introduction . Intraoperative bleeding control remains a key challenge in laparoscopic liver surgery. The standard time-limited Pringle maneuver causes total organ ischemia. An alternative involves the targeted occlusion of blood inflow and outflow to the liver part being removed, which is anatomically justified by the segmental structure of the organ. Materials and methods . A patient was 67 years old with metastatic liver disease (segments VI and VII) due to previously treated rectal cancer. Laparoscopic S6–7 bisegmentectomy was performed using an original method of extraparenchymal selective hepatic vascular exclusion. Blood loss was less than 150 ml. The patient was discharged on day 6 after the complication-free postoperative period. Results and discussion . The proposed method is based on the segmental structure of the liver (Couinaud, 1957) and knowledge of variant anatomy (Michels, Hiatt, Nakamura). In contrast to the Pringle maneuver and extra-Glissonian approach, ischemia is limited to the affected part, which excludes total ischemic damage and reduces the operating time. The obtained results are in line with the best world data. The method is protected by a Russian patent application. Conclusion . Extraparenchymal selective hepatic vascular exclusion during laparoscopic liver resections represents a safe and effective method for minimizing blood loss and ischemic damage to the parenchyma. The method can be recommended for use in specialized centers.
Introduction . Multidrug resistance represents a major obstacle to tuberculosis control. Treatment of multidrug-resistant tuberculosis is lengthy, complex, and often ineffective. Surgical methods, such as thoracoplasty, can improve treatment effectiveness compared with conservative treatment. One contemporary minimally invasive approach to collapse surgery is endobronchial valve insertion, which can be performed as an independent procedure or in combination with other surgical interventions. Wider and more timely use of collapse surgery in patients with destructive tuberculosis and multiple or extensive drug resistance may shorten treatment duration and improve clinical outcomes. Materials and methods . A retrospective study was conducted at the Republican Clinical Center for Phthisiology and Pulmonology (Republic of Bashkortostan, Russia). Primary medical records, an archive of radiographic images (including CT scans), and sputum culture results obtained from the BAKLAB system based on data from the Republican Medical Information and Analytical System (RMIAS) were analyzed for 80 patients with destructive tuberculosis caused by drug-resistant pathogens. Statistical analysis was performed using the Microsoft Office software package. Differences were considered statistically significant at p < 0.05. Results and discussion . In the present study, three criteria were used to assess the effectiveness of complex treatment for destructive forms of tuberculosis. These include time to sputum culture conversion, cavity closure, and positive radiological dynamics (R-dynamics). Analysis of sputum culture conversion time in patients with destructive drug-resistant tuberculosis yielded the following results: χ² = 12.056, p = 0.061 (at the border of statistical significance). Analysis of R-dynamics yielded χ² = 7.86, p = 0.228. Statistical significance was not achieved, presumably due to the small sample size of 20 patients per group. In contrast, the difference in cavity closure rates was statistically significant: χ² = 20.04, p = 0.0027. Combined treatment was associated with a higher cavity closure rate than conservative treatment. Conclusion . The results of the study demonstrate that collapse surgery combined with chemotherapy regimens may result in faster recovery compared to treatment with a standard chemotherapy regimen alone.
Introduction . Cystic neoplasms of the pancreas (PC) represent a group of heterogeneous neoplasms that differ in the principles of clinical management and require morphological verification. A promising method of differential diagnosis involves Raman spectroscopy providing information about the substance composition based on the spectral lines obtained by irradiating the substance with a laser. Materials and methods . A prospective single-center study was performed in patients with morphologically verified cystic neoplasms of the pancreas. The analysis included 13 observations: 4 pseudocysts and 9 mucinous cysts. The cyst composition was analyzed using a portable OPTEC-785LRam spectrometer with an excitation wavelength of 785 nm. Statistical analysis was performed after digital preprocessing using the principal component analysis (PCA) supplemented by nonparametric tests. Results . The first two principal components (PC1 and PC2) explained 37.77 and 15.98% of the variability, respectively. The division of the sample into mucinous cysts and pseudocysts was performed according to PC1. After comparison by the Mann–Whitney test and assessment of the effect size, wave numbers with the most characteristic peaks for mucinous cysts (1102, 1228, and 1422 cm- ¹) and pseudocysts (644, 610, and 966 cm- ¹) were identified. These wave numbers correspond to vibrations of amide and lipid bonds. The Leave-one-out analysis confirmed the stability of key features. Discussion . This study represents the first application of Raman spectroscopy in the determination of the cyst composition for the differential diagnosis of pancreatic mucinous cysts. Despite high values of sensitivity and specificity, the obtained data should be considered preliminary: external validation is required due to the small sample size. Conclusion . The performed Raman spectroscopic analysis of native cystic fluid revealed spectral differences between mucinous cysts and pseudocysts, which can reflect differences in protein-lipid composition and inflammatory changes. The method eliminates complex sample preparation and can potentially be used as an additional tool for the differential diagnosis of pancreatic cystic neoplasms.
Introduction . Diffuse adult-type gliomas are characterized by significant molecular heterogeneity, highlighting the need for reliable biomarkers for diagnosis, disease characterization, and therapeutic stratification. The aim of this study is to evaluate the role of ERBB3, REST, DDR1, ACSS2, and DHODH proteins as potential biomarkers using integrated transcriptomics and protein imaging data. Materials and methods . Transcriptome validation was performed using RNA-seq data from The Cancer Genome Atlas (TCGA), including samples of IDH-wild-type Grade 4 glioblastoma (n = 153), IDH-mutant Grade 2 (n = 249) and Grade 3 (n = 263) diffuse astrocytoma, and normal brain tissue (n = 270). Protein expression, tissue distribution, and subcellular localization were assessed using immunohistochemistry (IHC) and immunofluorescence (IFA) images from the Human Protein Atlas (HPA) database. Results . The ERBB3 and REST genes showed the highest expression in glioblastoma, with progressively decreased levels in lower-grade gliomas and normal brain tissue. DDR1 gene expression was significantly elevated in all glioma groups compared to normal brain tissue, with less pronounced differences between tumor grades. ACSS2 gene expression was elevated in glioma tissue, while DHODH showed particularly high expression in highgrade Grade 3–4 gliomas. IHC analysis demonstrated increased protein expression and a predominantly cytoplasmic/membrane localization in tumor tissue. ELISA analysis revealed distinct subcellular patterns: ERBB3 and DDR1 proteins were predominantly membrane-associated, REST was primarily nuclear, while ACSS2 and DHODH proteins showed predominantly cytoplasmic localization. Discussion . ERBB3, REST, DDR1, ACSS2, and DHODH proteins represent promising candidates for biomarkers of adult-type gliomas. Their differential expression and distinct subcellular localization suggest involvement in complementary mechanisms of tumor progression. Integrated HPA imaging and TCGA transcriptome analysis provides a useful framework for biomarker prioritization and subsequent experimental and clinical validation. Conclusion . These results confirm the potential of the molecular markers investigated for the study and characterization of adult-type diffuse gliomas.
Four currently known main molecular subtypes of endometrial cancer include tumors with POLE and p53 protein mutations, with a defective mismatch repair system, as well as without a specific molecular profile. The molecular classification of malignant tumors can be used to predict the course of the disease and determine the need for adjuvant treatment. Patients with POLE mutations often require no adjuvant treatment and have a favorable prognosis for overall and disease-free survival, while patients with p53 protein mutations require aggressive adjuvant treatment due to high rates of disease progression. Women with p53 protein mutations benefit most from adding chemotherapy to adjuvant treatment. Tumors with microsatellite instability and without a specific molecular subtype have an intermediate prognosis: the need for adjuvant treatment is determined by the extent of the disease. Moreover, the addition of immune therapy for metastatic cancer in patients with microsatellite instability brings benefits to survival rates. Knowing the molecular subtype of endometrial cancer can make treatment more personalized and improve targeting of radiation, immune, and drug therapy after surgery.
