Introduction. Community-acquired pneumococcal pneumonia is characterized by a severe course in patients with metabolic syndrome (MetS); however, the influence of various combinations of its components remains poorly understood. This study performed stratification of patients according to the component composition of MetS with an assessment of markers of systemic inflammation and endotoxemia.Aim. To evaluate the features of the systemic inflammatory response in patients with pneumococcal pneumonia depending on the criteria of metabolic syndrome, with assessment of the leukocyte index of intoxication and markers of inflammation.Materials and methods. A prospective comparative cohort study included 38 patients with pneumococcal pneumonia, stratified into 3 groups according to the criteria for metabolic syndrome (IDF, 2005). Blood sampling was performed within the first 24 hours of hospitalization, followed by determination of endotoxin level (LAL test), markers of inflammation (interleukin-6, tumor necrosis factor-alpha, C-reactive protein, procalcitonin), immune status (CD4+/CD8, lymphocyte subpopulations), and calculation of the leukocyte index of intoxication.Results. The most pronounced disturbances in immune status and endotoxemia indicators were registered in patients of group A (abdominal obesity + type 2 diabetes + arterial hypertension + dyslipidemia), where an increase in endotoxemia level to 1.46 [1.29; 1.55] EU/ml, leukocytosis (14.8±1.3 ×10⁹/L), neutrophilia (81.8±3.1%), lymphopenia (14.8±2.5%), and an increase in the leukocyte index of intoxication to 9.4±1.4 were noted. An imbalance in the immunoregulatory index was revealed due to a decrease in CD4+ lymphocytes (33.8±2.2%) with a simultaneous increase in CD8+ cells (30.6±2.2%), indicating impaired regulation of the immune response. Indicators of patients in group B (abdominal obesity + type 2 diabetes + reduced high-density lipoprotein cholesterol (HDL-C) level) and group C (abdominal obesity + arterial hypertension + hypertriglyceridemia) demonstrated statistically significantly less pronounced changes in both immunological parameters and endotoxemia level.Conclusion. The most unfavorable profile, characterized by the maximum level of endotoxemia, hyperactivation of the cytokine cascade (interleukin-6, tumor necrosis factor-α, C-reactive protein, procalcitonin), and signs of immune dysregulation (decreased CD4+/CD8+ ratio, high leukocyte index of intoxication), was formed in patients of group A, which combines abdominal obesity, type 2 diabetes, arterial hypertension, and dyslipidemia.
Background. Hypertrophic cardiomyopathy (HCM) is a genetically determined disease characterized by left ventricular hypertrophy of various localizations, including asymmetric septal, concentric, and apical morphotypes, myocardial fibrosis, myofibrillar disorganization, and predisposition to sudden cardiac death. Feature Tracking cardiac MRI allows quantitative assessment of myocardial strain regardless of HCM morphotype; however, comprehensive analysis of synchronization parameters (time-to-peak, TTP) and strain rate in Russian patient cohorts remains limited.Purpose. To determine the characteristics of global and segmental myocardial deformation, temporal parameters, and strain rate of the left ventricle in patients with HCM using cardiac MRI with Feature Tracking technology.Materials and Methods. Analysis included 74 patients with confirmed HCM diagnosis who underwent 3.0T cardiac MRI. Using CVI 42 software, the following parameters were determined: global longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS) in percentages; time-to-peak (TTP) parameters for each deformation direction; peak systolic strain rate. Comparison was performed with published reference values for healthy volunteers at 3.0T. Patient risk stratification was performed based on GLS values.Results. GLS was significantly reduced (–7.22±4.43% vs normal –16.9±1.8%, p<0.001), GCS was moderately reduced (–16.21±3.16% vs normal –19.2±2.1%, p<0.001), and GRS was compensatorily elevated (45.52±21.60% vs normal 34.2±6.1%, p<0.001). TTP dispersion was 80.9±21.9 ms, exceeding normal values 1.6-fold, indicating pronounced mechanical dyssynchrony (88.4% of patients with SD > 50 ms). Risk stratification revealed that 60% of patients demonstrated critically reduced GLS values (> –8.35%), which is associated with poor prognosis in recent studies. Identification of such severe dysfunction suggests the need for comprehensive risk stratification for sudden cardiac death, as outlined in the 2023 ESC guidelines.Conclusions. Feature Tracking 3.0T cardiac MRI reveals a characteristic deformation pattern in HCM with pronounced GLS reduction, moderate GCS reduction, and compensatory GRS elevation. Pronounced mechanical dyssynchrony may serve as an arrhythmia risk marker. The majority of this cohort demonstrates critical GLS values requiring careful sudden cardiac death risk stratification.
Liver transplantation is a radical treatment for end-stage liver disease. Improved transplantation outcomes have led to an increasing number of women of reproductive age with functioning grafts, making pregnancy after liver transplantation an important clinical issue. Pregnancy following liver transplantation is associated with increased risks for both mother and fetus, including complications related to immunosuppressive therapy, graft dysfunction, and comorbidities.Objective. To analyze pregnancy cases in women after liver transplantation, evaluate current research and international guidelines for patients of reproductive age following liver transplantation, and identify risk factors affecting pregnancy outcomes and maternal-fetal health.Materials and methods. A literature search was conducted in PubMed, Scopus, Web of Science, eLibrary.ru, and Google Scholar databases for the period 2014-2025 using keywords: liver transplantation, pregnancy, pregnancy outcome, immunosuppressive therapy, rejection, preeclampsia. Inclusion criteria were original studies, systematic reviews, meta-analyses, clinical cases, and professional society guidelines. Exclusion criteria included publications without full-text access and duplicate data. A total of 36 sources were analyzed.Results and discussion. According to literature data, live birth rates after liver transplantation range from seventy to eighty percent, however rates of preterm delivery (thirty to forty percent), preeclampsia (twelve to fifteen percent), and cesarean section (forty to fifty percent) significantly exceed those in the general population. Risk of graft rejection during pregnancy is three to ten percent. Major maternal complications include gestational hypertension, preeclampsia, gestational diabetes, and infectious complications. Most common fetal complications are intrauterine growth restriction, prematurity, and low birth weight. International guidelines emphasize the need for pregnancy planning no earlier than one to two years post-transplantation with stable graft function and absence of rejection episodes, as well as adjustment of immunosuppressive therapy to pregnancy-safe medications. Primary drugs of choice are tacrolimus and cyclosporine, while mycophenolate mofetil should be replaced with azathioprine at least six weeks before planned conception. Pregnancy management requires careful multidisciplinary monitoring involving a transplant surgeon, high-risk obstetrician, and neonatologist.Conclusion. Pregnancy after liver transplantation is a complex process requiring a multidisciplinary approach and careful monitoring. Despite improved prognosis, pregnancy in these cases carries increased risks. Further research is needed to optimize pregnancy management, develop strategies to reduce graft rejection risk, and minimize complications.
Introduction. Freiberg–Köhler disease is a rare form of osteochondropathy of the second metatarsal head characterized by avascular necrosis, destruction of the articular surface, and secondary osteoarthritis. The disease predominantly affects adolescent and young adult females and is accompanied by severe pain, limited mobility, and foot deformity. Even with early diagnosis, conservative treatment is often insufficient to prevent disease progression, making surgical intervention necessary.Aim: To evaluate the effectiveness of the collagen membrane Chondro-Scaffold in the surgical treatment of Freiberg–Köhler disease.Object and methods. A retrospective analysis of clinical data from 28 patients was performed to assess the effectiveness of a technique combining shortening osteotomy and implantation of the Chondro-Scaffold collagen membrane using functional (AOFAS and VAS) and radiographic parameters. Postoperative follow-up was carried out at 3, 6, and 12 months.Results. The use of the Chondro-Scaffold collagen membrane resulted in a significant improvement in foot function, as demonstrated by an increase in the AOFAS score from 46.2 to 89.5 and a decrease in pain intensity from 7.6 to 1.5 according to the VAS scale.Conclusion. The use of the Chondro-Scaffold collagen membrane is a promising approach in the surgical treatment of Freiberg–Köhler disease, leading to improved clinical and functional outcomes and enhanced patient quality of life. Further studies are required to evaluate long-term effectiveness.
Introduction. Musculoskeletal diseases and injuries are a pressing problem for millions of people. Damage to the hyaline cartilage leads to further degradation of the articular surface. Conservative treatment methods are ineffective, and at the final stage, a highly traumatic, costly procedure of joint arthroplasty is required. After it, in 3% of cases, complications occur in the form of periprosthetic infection, the treatment of which requires significant additional economic costs, reducing the quality of life and increasing the risk of disability of patients. Of particular interest is the prediction of recurrence of periprosthetic infection associated with the chronicity of the process and a significant increase in the duration of treatment and its costs.The aim of the study. Creation of a structured database for subsequent analysis of factors influencing the risk of recurrence of periprosthetic infection of the hip joint using the Python programming language based on archival data of patients with hip joint arthroplasty.Materials and methods. The work was carried out using information about patients with periprosthetic infection of the hip joint, who were treated at the Center in the period from 2010 to 2022. Discussion. The obtained data allow predicting the risk of recurrent PJI, as well as analyzing the causes leading to it, which will allow adjusting the further treatment regimen for such patients in order to avoid or minimize the development of recurrent periprosthetic infection.Results. A structured database of cleaned and prepared data for further analysis was obtained with 1611 unique patients, each of whom was described by 101 unique attributes. The possibility of predicting the risk of developing periprosthetic infection based on the information obtained using an automatic algorithm was shown.Conclusion: further analysis of the data bank will allow us to deepen our understanding of the causes of recurrent periprosthetic infection and consolidate the experience of traumatologists and orthopedists regarding the management of this cohort of patients.
The relevance of the problem of post-stress depression is explained by its high prevalence, significant socioeconomic consequences, and the low effectiveness of existing therapeutic approaches. The pathogenesis of depression, as a heterogeneous disorder, is due to multiple predisposing factors and diverse biological mechanisms; therefore, a unified concept of its origin has not yet been developed. This stimulates the intensification of research in the direction of finding new diagnostic markers and therapeutic strategies for the treatment of depression. The set of biologically active compounds of dandelion extract determines its potential effectiveness in the treatment of depressive states.The aim of the study was to investigate behavior patterns in rats under conditions of stress-induced depression after an intragastric load of dandelion extract.Materials and methods. The study was conducted on 90 six-month-old male Wistar rats. A "social" stress model was used to simulate the depressive state in animals. All animals were equally divided into 3 groups of 30 rats each, according to the randomization principle: Group 1 — intact animals, to which no effects were applied; Group 2 — control, in animals a depressive state was modeled, and they received intragastrically distilled water, in a volume of 2 ml daily for 20 days from the moment of depression modeling; Group 3 — males, which from the first day of depression modeling received intragastrically an aqueous extract of dandelion medicinal plant, produced by KorolevPharm LLC with a concentration of active substances of 3.5-4.0%, at a dose of 75 mg/100 g of animal weight, in a volume of 2 ml. Behavioral patterns were studied in animals on the 21st day of the experiment using the behavioral despair tests according to the Porsolt method, Open Field and Elevated Plus Maze. Digital data from all experiments were statistically processed using parametric and nonparametric analysis methods.Results. It was found that depressed animals exhibited decreased active swimming time and increased passive swimming and immobilization time. However, aggressive and submissive rats treated with dandelion extract for depression demonstrated less pronounced depressive symptoms compared to untreated animals. Results from the Open Field and Elevated Plus Maze tests revealed that aggressive and submissive rats exhibited increased anxiety during stress-induced depression, manifested by decreased vertical and horizontal activity, increased grooming time, and increased fecal bolus production. Biologically active substances in dandelion extract are capable of inducing inhibitory processes in the nervous system and reducing psychoemotional stress in animals in the open field, elevated plus maze, and Porsolt tests. This is due to their ability to activate protective inhibition processes in the central nervous system, resulting in a reduction in psychoemotional stress in rats. Consequently, these compounds exert stress-protective and antidepressant effects.Conclusions. Intragastric administration of dandelion extract to rats with aggressive and submissive behavior patterns in a state of social depression helps reduce the manifestations of depression.
Degenerative spine diseases (DSD) are a leading cause of chronic low back pain and disability. Existing conservative and surgical methods often fail to address the root cause of pain and are associated with risks. This study aimed to evaluate the clinical efficacy and safety of a minimally invasive method of laser autoplasty of the nucleus pulposus in patients with chronic pain syndrome.Materials and methods. A prospective single-center study was conducted with 20 patients. Inclusion criteria: chronic non-radicular pain or radiculopathy in the irritation phase due to disc degeneration of stages I-III according to a classification (Pfirrmann). Under X-ray control, laser exposure (diode laser, 1061 nm) wasapplied to three zones of the nucleus pulposus. Outcomes were assessed before surgery, after, and at 3- and 12-months using VAS, ODI, DN4, PainDetect, SF-36, HADS scales, and MRI of spine. Results. A significant reduction in low back pain intensity (VAS: from 4.8±1.2 to 1.25±1.11 at 12 months, p<0.001) and improvement in functional status (ODI: from 15.15±4.87 to 5.88±4.28, p=0.0056) were observed. The proportion of patients with neuropathic pain decreased from 30% to 10%. Quality of life (SF-36) scores significantly improved, and levels of anxiety and depression (HADS) decreased. No complications were recorded. Conclusion. Laser autoplasty of the nucleus pulposus is a highly effective and safe method for treating chronic pain syndrome in patients with stages I-III DSD, providing significant and sustained clinical improvement despite the lack of confirmed long-term structural disc restoration. The method can be considered a promising alternative to more invasive interventions.
This review analyzes the fundamental mechanisms of neurovascular unit (NVU) degradation and restoration under conditions of acute cerebral blood flow deficiency and subsequent reperfusion. The physiological basis of cellular disorganization is examined, with lipid peroxidation acting as the leading factor in neuronal membrane destruction. Particular attention is paid to the role of the mitochondrial network as a central regulator of NVU cell survival. The paper describes in detail current understanding of the structural and functional integrity of the NVU and the molecular mechanisms of its damage. Central to this is the analysis of the PGC-1α regulatory axis as a key factor in mitochondrial biogenesis and antioxidant defense. The authors systematize data on mitochondrial dynamics (fusion), selective autophagy (mitophagy), and the role of the mitochondrial proliferator-activated pore (mPTP) in determining cell fate in the post-perfusion period. The final section of the review discusses promising strategies for pharmacological correction: from the reduction of oxidative stress and neuroinflammation to the induction of organelle biogenesis. The therapeutic potential of mitochondrial modulation as an effective method for restoring the neurovascular unit after ischemic injury is substantiated.
Gestational diabetes mellitus (GDM) is a serious problem in obstetrics, especially in combination with polymorbid pathology. The introduction of an interdisciplinary approach to pregnancy management makes it possible to minimize risks and improve the quality of medical care.The purpose of this work is to evaluate the features of pregnancy management in a patient with diagnosed GDM and concomitant diseases, to analyze the effectiveness of modern clinical recommendations and interdisciplinary interaction in reducing obstetric and perinatal complications.Materials and methods. The study examined a clinical case of a patient with GDM on the background of polymorbid pathology. To assess the patient's condition, laboratory and instrumental research methods were carried out as part of prolongation of the present pregnancy, treatment of the detected pathology and preparation for the upcoming birth through the natural birth canal under CTG control, as well as prevention of bleeding from the end of the second period of labor.Results. Positive dynamics was observed against the background of the therapy.Conclusions. An interdisciplinary approach to pregnancy management in a patient with GDM and polymorbid pathology allowed minimizing the risk of obstetric and perinatal complications. The use of modern clinical recommendations, including personalized nutrition, glycemic control and timely medication correction, ensured a favorable pregnancy outcome for both mother and child.
Background. Burnout among higher education faculty represents a significant occupational health concern with direct implications for teaching quality and institutional performance. The convergence of increased administrative burden, digital transformation, and the COVID-19 pandemic has intensified emotional exhaustion across academic settings worldwide. Objective. To systematize the psychological, social, and organizational determinants of professional burnout among university faculty and to substantiate evidence-based principles for its prevention.Main Content. Key risk factors examined include chronic work overload, role ambiguity, limited professional autonomy, insufficient institutional support, and interpersonal workplace conflict. Burnout manifestations are analyzed comparatively across technical, humanities, and medical universities. The rationale for multimodal diagnostic approaches — combining standardized instruments (MBI, OLBI) with clinical assessment methods — is discussed. Digital transformation is identified as an independent contributor to emotional exhaustion. Organizational and psychological prevention strategies are proposed, tailored to the characteristics of different academic environments. Conclusion. Effective burnout prevention in higher education requires the integration of validated diagnostic tools, targeted institutional interventions, and sustained psychological support adapted to the specific profile of each educational organization.
Plasmablastic lymphoma (PBL) is a rare and aggressive B-cell lymphoma associated with immunodeficiency states, primarily with HIV infection, and Epstein–Barr virus (EBV). The coexistence of PBL and pregnancy represents an exceptional rarity. This article presents a clinical case of a 31-year-old patient with stage IV HIV infection (WHO clinical stage) without antiretroviral therapy (ART). At 25–26 weeks of gestation, the patient was diagnosed with generalized PBL involving the skin, lymph nodes, mammary glands, lungs, liver, and brain. The disease was complicated by disseminated pulmonary tuberculosis and cytomegalovirus infection, and ended with an unfavorable obstetric outcome – maternal death following cesarean section. This case illustrates the aggressiveness of PBL during pregnancy in the setting of profound immunodeficiency, emphasizing the importance of early HIV detection, initiation of ART in women of reproductive age, and a multidisciplinary approach to the management of such patients.
Background. Bezoars, as a cause of high gastrointestinal obstruction, occur in 0.4–4% of cases, with phytobezoars being the most common type. In an intact stomach, phytobezoar formation is practically impossible due to hydrolytic breakdown of plant fibers by hydrochloric acid and pepsin. After gastric resection, a complex of pathophysiological changes develops (hypochlorhydria, impaired motility, loss of the pyloric barrier) that predisposes to bezoar formation.Aim. To present a clinical case of diospyrobezoar in a patient with a history of gastric resection and to analyze the pathogenetic mechanisms underlying its formation.Materials and Methods. A 71-year-old female patient with a history of two-thirds gastric resection with a Billroth-I gastroduodenal anastomosis was admitted emergently with signs of high gastrointestinal obstruction (nausea, vomiting after food and water intake, absence of stool). Historytaking revealed persimmon consumption 3 days before symptom onset. Esophagogastroduodenoscopy (EGD) with an attempted endoscopic removal of the bezoar was performed, followed by surgical intervention after the endoscopic approach failed.Results. EGD revealed a dense, stone-hard phytobezoar occupying the gastric stump lumen with extension into the duodenum; endoscopic removal attempts were unsuccessful. A midline laparotomy and gastrotomy were performed, with evacuation of a foreign body measuring 10.0×5.0 cm. The postoperative course was uneventful, and the patient was discharged in satisfactory condition on postoperative day 14.Conclusion. Patients with a history of gastric resection constitute a high-risk group for bezoar formation due to impaired hydrolysis and mechanical processing of dietary fiber. Endoscopic removal of large, dense bezoars is not always effective, necessitating timely conversion to surgical treatment.
Pathological processes of the endometrium represent an extensive group of diseases that require special vigilance. In practice, unjustified invasive interventions are often observed in elderly patients, which leads to a search for an approach to routing and treating postmenopausal women undergoing intrauterine interventions.The purpose of this article is to study the management tactics of postmenopausal patients with endometrial pathology.Materials and methods. The analysis of data from domestic and foreign literature and guidelines, as well as the medical history of 1 patient, was carried out on the basis of the gynecological department of the CHUZ KB RZD-Medicine Samara.Results. A patient with a comorbid background and a long postmenopausal period (>15 years) underwent hysteroscopy with suspected uterine polyp, which revealed intrauterine synechiae. After 3 days, according to transvaginal ultrasound, hematometer complications with a suspected fibrin clot were detected.Conclusions. This clinical case highlights the limited possibilities of ultrasound diagnostics in detecting focal changes in conditions of atrophic endometrium. Management tactics for postmenopausal patients with endometrial pathology should be based on the clinical picture, individual risk, and expediency of intervention. In the absence of symptoms and the presence of small formations, it is possible to choose a wait-and-see approach with regular ultrasound and pipel biopsy, avoiding unnecessary invasive procedures.
Background. MELAS syndrome is a maternally inherited mitochondrial disorder whose cardinal triad — lactic acidosis, seizures, and stroke-like episodes — frequently mimics acute ischaemic stroke. Late, adult-onset presentations are easily missed, delaying disease-specific therapy.Aim. Through a single clinical case, to outline the diagnostic pathway from a presumptive ischaemic stroke to confirmed mitochondrial encephalomyopathy in a 44-year-old woman, and to map the neuroimaging, neurophysiological, and morphological steps that anchor the diagnosis of MELAS.Case presentation. A 44-year-old woman was admitted with a working diagnosis of ischaemic stroke after presenting with an upper-left quadrantanopia, blurred near-vision, impaired attention and memory, and a sense of head heaviness. Brain MRI showed cortical laminar necrosis in the right occipital lobe with the subcortical white matter spared — a pattern uncharacteristic of arterial-territory infarction. Lactate dehydrogenase was elevated (450.83 U/L); blood lactate sat at the upper reference limit. Needle EMG documented a reduction in mean motor-unit potential duration. Biopsy of the vastus lateralis muscle revealed fragmentary atrophy, coagulation necrosis of individual fibres, and the ragged-red-fibre pattern of mitochondrial myopathy. Disease-modifying therapy was started — L-arginine, coenzyme Q10, succinic acid, and riboflavin.Conclusion. Adult-onset MELAS demands deliberate vigilance from the neurologist. Sparing of the subcortical white matter beneath a zone of cortical laminar necrosis, a lesion that ignores arterial territories, a myopathic EMG, and ragged-red fibres on biopsy form a self-reinforcing constellation that supports the diagnosis ahead of molecular confirmation and lets disease-specific treatment begin without delay.
Background. Anaphylactic shock in obstetrics is a rare but potentially life-threatening cause of maternal and perinatal morbidity and mortality, largely determined by the specific immunological alterations occurring during pregnancy.Case presentation. We report a case of anaphylactic shock developing after administration of cefotaxime as preoperative antibiotic prophylaxis, resulting in a fatal maternal outcome. The causative agent was a cephalosporin capable of inducing cross-allergic reactions with penicillins.Conclusion. Thorough allergological history-taking and careful assessment of comorbidities in pregnant patients may not entirely prevent anaphylaxis, but can substantially reduce its severity and consequences.
Relevance. Treatment of chylothorax in patients depends largely on the underlying cause. In some cases, it is associated with disruption of the intact lymphatic duct (due to trauma or surgery), while in others, it is due to venous and lymphatic hypertension (in cases of congenital heart disease, lymphatic duct malformations, heart disease, and cancer). The main goal of conservative treatment is to reduce the flow of chyle through the thoracic duct to ensure spontaneous resorption, reduce systemic lymph production through diet (dry food, fasting, somatostatin/octreotide, midodrine, and sirolimus, parenteral nutrition), replenish nutrient losses, drain the pleural cavity, and use pleurodesis (talc, bleomycin, tetracycline, povidone, hypertonic glucose solution). This treatment is aimed at eliminating the underlying cause of chylothorax. If conservative therapy is ineffective and the chylothorax persists at 1000 ml or more, surgical treatment is performed (video-assisted thoracoscopy, clipping, or ligation of the thoracic duct). Goal: to develop a step-by-step plan for the comprehensive treatment of patients with chylothorax of various etiologies. Material and Methods. The study included 21 patients with chylothorax of various etiologies (emergency admissions (17) and transfers (4) from other hospitals) admitted to the thoracic department. Results. Treatment of chylothorax depends on the underlying cause, individual manifestations, and the intensity of chyle production. In some cases of non-traumatic chylothorax, pulmonary bypass grafting and biopsy were used to identify the cause. Conservative treatment was based on pleural drainage and included a low-fat diet, transfusion therapy, somatostatin/octreotide, and sirolimus. The primary goal was to reduce chyle production by decreasing fat absorption and preventing malnutrition. Nutritional interventions included total parenteral nutrition or enteral diets. In cases of ineffective non-traumatic chemotherapy and postoperative traumatic chemotherapy, VTS + CLP were performed (pleurodesis and pleurectomy were performed if necessary, regardless of the etiology, as it is not always possible to completely relieve chylorrhea). Reducing chyle leakage ensures spontaneous resorption, and in cases of venous and lymphatic hypertension due to heart failure or oncologic pathology, additional specific treatment is required. Conclusion. The treatment strategy for chemotherapy is determined based on the etiopathogenesis and intensity of lymph leakage, using a step-by-step treatment plan, from the least invasive to the most invasive methods. Malignant neoplasms, chronic chylous effusion complicated by pulmonary embolism, and cardiac disease, despite the complex treatment aimed at reducing chylothorax volume, including VTS and CLP, require additional specific therapy. Traumatic chemotherapy (postoperative). In most cases, along with conservative management, chylothorax requires vascular thoracic surgery and duct clipping, and in some cases, pleurodesis is also needed. Conversely, with typical mechanical trauma and normal lymphatic duct pressure, conservative management is sufficient.
Background. Ischemia-reperfusion injury (IRI) remains a significant complication following liver transplantation, associated with early allograft dysfunction and worse outcomes. Predicting the risk of IRI could guide the selection of organ preservation strategies and posttransplant management.Objective. To develop and validate a clinical risk scoring system for predicting severe IRI in liver transplantation. Materials and Methods. A retrospective analysis of 1,238 liver transplantations performed at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2000 to 2025 was conducted. Severe IRI was defined as peak transaminase levels >1,000 IU/L within the first 7 postoperative days. Donor, procedural, and recipient factors were evaluated using multivariable logistic regression to construct a simplified risk scoring system.Results. Complete data were available for 827 patients, among whom 312 cases of severe IRI were recorded, accounting for 37.7% of the cohort. Independent predictors included donor age with an odds ratio of 1.04 per year, cold ischemia time with an odds ratio of 1.17 per hour, and portal vein thrombosis with an odds ratio of 1.52. The developed IRI Risk Index (IRI Score), ranging from 0 to 9 points, stratified patients into low-risk (0–2 points) with an IRI rate of 35.6%, intermediate-risk (3–5 points) with a rate of 42.1%, and high-risk (≥6 points) with a rate of 52.2%. The area under the ROC curve was 0.555 (p<0.001). High-risk patients comprised 2.8% of the cohort.Conclusion. The IRI Score enables early identification of patients at elevated risk for severe IRI and provides a specific algorithm for decision-making regarding the use of machine perfusion. The simplicity of the index and its reliance on pre-transplant variables make it practical for clinical application.
Relevance. Clinical studies show that women with low vitamin D levels are more likely to experience early menopause. The combination of early menopause and vitamin D deficiency increases the risks of cardiovascular disease, osteoporosis, and metabolic syndrome.The aim of the study was to study the effect of vitamin D deficiency on the development of cardiovascular pathology in postmenopausal women.Materials and methods. The study involved 43 women with a decrease in estradiol levels below 73 pmol/l and an increase in FSH levels above 30 IU/l and the absence of a menstrual cycle for at least 12 months. The first group (n-20) included patients with vitamin D deficiency. The second group (n-23) consisted of patients of the same age with adequate vitamin D levels. The levels of IL-6, brain natriuretic peptide, D–dimer, lipidogram, fasting glycemia and glycated hemoglobin were studied in patients of both groups. All patients underwent EchoCG and daily blood pressure monitoring.Results. Postmenopausal women with vitamin D deficiency have higher levels of proatherogenic plasma lipid profile fractions, IL-6 levels, brain natriuretic peptide, and D-dimer. Obesity, type 2 diabetes mellitus, and hypertension are more common.Conclusions. The study demonstrated the negative impact of vitamin D deficiency on cardiovascular risks in postmenopausal women. This highlights the need for regular laboratory monitoring of vitamin D levels in clinical practice as part of an integrated approach to the prevention and management of cardiovascular health in peri- and postmenopausal women.
Relevance. Hypertensive disorders complicate up to 10% of pregnancies, making a significant contribution to the statistics of maternal and perinatal morbidity and mortality. Placental dysfunction is a key factor in the pathogenesis of these complications. Ultrasound examination (US) with Dopplerometry, although it is considered the standard for assessing blood flow in the mother-placenta-fetus system, is limited in its ability to visualize structural changes in the placenta. Magnetic resonance imaging (MRI), due to its high tissue contrast and spatial resolution, is considered as a promising non-invasive method that can complement existing approaches to assessing the placental condition in hypertensive disorders.Objective. To describe placental structural changes in pregnancies complicated by hypertensive disorders based on MRI data and to compare the results with those of ultrasound and histopathological examination.Materials and methods. A prospective case-control pilot study was conducted involving 13 pregnant women with hypertensive disorders in the second and third trimesters. Each placenta was studied using 3T MRI (standard sequences), ultrasound with Dopplerometry, and subsequent histopathological examination after delivery.Results. In 13 patients (mean age 33.7±6.1 years), MRI revealed characteristic structural changes: diffuse areas of reduced MR signal on T2-weighted images (in 100% of cases), high lobularity (54%) and granularity (54%), as well as circulatory disorders: infarcts (69%) and hematomas (38%). Histopathological changes were detected in 85% of cases. In 38% of cases, MRI detected alterations when the Dopplerometry results were within normal ranges. The severity of the changes correlated with the severity of hypertensive disorder and adverse pregnancy outcomes.Conclusion. MRI enables the detection of characteristic structural changes in the placenta in hypertensive disorders, which directly reflect vascular, immune-inflammatory, and other microscopic lesions. These changes can be pronounced even with normal Doppler measurements and are associated with adverse pregnancy outcomes. MRI provides additional information about the condition of the placenta in hypertensive disorders, opening up prospects for improving the management of such pregnancies.
Background. Traditional dental prosthetic methods are characterized by marginal fit errors of 100–200 μm, fabrication times of 2–6 weeks, and postoperative complication rates of 15–40%. Digital technologies — CAD/CAM systems, intraoral scanning, and additive manufacturing — represent a paradigm shift in prosthetic dentistry; however, systematized data on their clinical effectiveness and economic feasibility remain fragmented.Aim. To conduct a systematic analysis of the accuracy, clinical effectiveness, and economic indicators of digital technologies in prosthetic dentistry compared to traditional methods.Materials and methods. A systematic review was performed according to the PRISMA protocol. Searches were conducted in PubMed, Scopus, Web of Science, and Cochrane Library (2013–2023). Forty-seven studies were included: 23 randomized controlled trials, 18 prospective cohort studies, and 6 systematic reviews with meta-analysis. Cumulative sample: 6,284 patients, 8,917 prostheses. Primary endpoints: marginal fit accuracy (μm), fabrication time (days), complication rate (%). Secondary endpoints: patient satisfaction (OHIP-14), prosthesis cost (euros), corrective visits. Study quality was assessed using Cochrane Risk of Bias Tool 2.0 and NewcastleOttawa scales. Statistical analysis: weighted mean differences with 95% confidence intervals, meta-regression (RevMan 5.4, Stata 17.0).Results. Digital technologies reduced marginal fit errors from 127.5 μm to 34.2 μm (weighted mean difference –93.3 μm; 95% CI: –102.1 to –84.5; p<0.001), representing a 73.2% relative improvement. Best results were achieved with monolithic zirconia crowns fabricated by CAD/CAM milling: 23.1 μm versus 134.2 μm (p><0.001). Median fabrication time for fixed prostheses decreased from 14 to 2 days (p><0.001). Chairside CAD/CAM technology enabled single-visit completion in 78% of cases (mean time 87 ± 23 minutes). The incidence of inflammatory complications at 12 months decreased from 14.8% to 6.2% (relative risk 0.42; 95% CI: 0.31–0.57; p >< 0.001). Temporomandibular joint dysfunction frequency decreased from 8.9% to 3.4% (relative risk 0.38; p = 0.001). Secondary caries developed in 2.8% versus 9.4% with traditional prosthodontics (relative risk 0.30; p<0.001). Cumulative survival of fixed prostheses at 24 months was 96.8% for digital versus 92.3% for traditional constructions (p=0.002). Mean OHIP-14 score: 41.2±6.3 versus 35.7±8.1 points (difference 5.5; 95% CI: 4.2–6.8; p><0.001). Adaptation time to removable prostheses decreased from 16.8 to 4.2 days (p><0.001). Cost per single crown decreased from €280 to €195 (30.4% savings). Economic efficiency is achieved with monthly volumes ≥12 prostheses, reaching break-even at 18–24 months. Implementation barriers: equipment cost €109,500–128,400, learning curve with optimal accuracy achieved after >100 procedures, post-processing of 3D-printed constructions required in 11.3% of cases, scanning artifacts in subgingival preparations in 8.4% of cases. Meta-regression revealed accuracy improvement of 0.142 μm per additional procedure (p=0.003).Conclusions. Digital technologies demonstrate statistically and clinically significant superiority over traditional methods in marginal fit accuracy (73.2% improvement), fabrication time (7-fold reduction), complication rates (58–70% decrease), patient quality of life, and under certain conditions — economic indicators. Optimal cost-effectiveness is achieved in clinics with volumes ≥12 prostheses/month. Structured educational programs to overcome the learning curve, protocol standardization, and ensuring equitable access to technologies are critically important.
