Torkildsen ventriculocisternostomy was historically one of the principal surgical treatments for obstructive hydrocephalus. However, nowadays it tends to be regarded mainly as a salvage procedure when standard shunting or endoscopic ventriculostomy is not feasible.Case report. A 5-year-old boy with obstructive hydrocephalus secondary to a cystic midbrain tumor underwent tumor resection combined with Torkildsen ventriculocisternostomy. Postoperatively, adjuvant radiotherapy was administered, resulting in long-term disease stabilization. At the age of 37 years, 32–33 years after surgery, he developed dysphagia, respiratory disturbances, cervico-occipital pain, and sensory impairment in the upper limbs. Magnetic resonance imaging demonstrated migration of the distal catheter tip with penetration into the upper cervical spinal cord segments and formation of a focal myelopathic lesion. A suboccipital craniotomy was performed; the migrated catheter segment was removed, the system was shortened, and the distal end was reimplanted into the cisterna magna with fixation to the dura mater. Complete regression of neurological deficits was achieved, with a favorable 10-year follow-up.Discussion. We report a rare delayed case of myelopathy caused by migration of the cisternal catheter tip more than 30 years after Torkildsen ventriculocisternostomy. This observation highlights the need for lifelong surveillance of patients who have undergone such procedures, strict adherence to surgical technique (appropriate catheter length selection and secure fixation), and timely surgical revision at the earliest signs of brainstem dysfunction or involvement of the upper cervical spinal cord.
Cerebral revascularization by superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is performed in patients with moyamoya disease, complex aneurysms, and selected extraand intracranial occlusive lesions to augment cerebral perfusion and potentially reduce the risk of ischemic complications and death.Case report. A 67-year-old patient presented with severe visual impairment (mainly on the right), gait unsteadiness, episodic subjective limb weakness, and marked fatigue. He had a significant medical history, having suffered an ischemic stroke in 2016 in the territory of the right MCA. A computed tomography angiography demonstrated occlusion of the right internal carotid artery and reduced cerebral blood flow in both occipital lobes and the left parietal lobe. An STA-MCA bypass anastomosis was performed. The postoperative course was uneventful; follow-up computed tomography angiography confirmed bypass patency without intracranial hemorrhage or new ischemic lesions, and a 10–15% increase in the cerebral blood volume index (up to 8.6 mL/100 g). No recurrent strokes were observed within 30 days and during 11 months of follow-up.Discussion. Creation of an STA-MCA anastomosis may offer prospects for improving quality of life after ischemic stroke, including potential amelioration of post-stroke depression and other associated emotional disturbances.
Aim. To evaluate whether the use of ChatGPT as a supplement to usual teaching improves medical students’ shortterm knowledge, clinical reasoning, and near-term performance.Materials and methods. We systematically searched PubMed, Scopus, ScienceDirect, SpringerLink, and Web of Science on 25 June 2025, for studies involving medical students that evaluated ChatGPT as a supplement to teaching and reported objective educational outcomes. Two independent reviewers screened records, extracted data, and assessed the risk of bias. A narrative synthesis was then conducted due to the level of heterogeneity in interventions and outcome measures across the studies.Results. Three randomized trials conducted in Germany, Turkey, and China met the inclusion criteria. ChatGPTsupported interventions improved or at least maintained short-term educational outcomes over the control groups for knowledge tests, clinical reasoning, and some of the Mini-Clinical Evaluation Exercise (Mini-CEX) domains.Structured and immediate ChatGPT feedback improved Clinical Reasoning Indicator-History Taking Inventory scores after a simulated patient encounter, and ChatGPT-generated explanations were not inferior to expert feedback in overall key-features question performance but were less effective for more complex items, where expert feedback remained superior. Overall, the risk of bias was judged to be low to some concerns, with likely unblinded Mini-CEX assessment noted as a significant limitation.Conclusion. ChatGPT used as a supervised adjunct to teaching showed value for short-term knowledge acquisition and clinical reasoning development.
Lipoprotein (a) (Lp(a)) is a genetically determined risk factor for atherosclerosis, with extremely high levels associated with very high cardiovascular risk. Despite this, in routine clinical practice these patients often remain insufficiently identified.Aim. To characterize the prevalence and severity of subclinical atherosclerosis in various vascular beds in patients with Lp(a) ≥ 180 mg/dL, including younger age groups.Materials and methods. We performed a retrospective analysis of a database comprising 101,078 outpatients, from which 1105 (1.09%) individuals with Lp(a) ≥ 180 mg/dL and available lipid profile data were selected; women accounted for 67.2%, and the mean age was 52.74 ± 14.59 years. The presence of atherosclerotic cardiovascular disease (ASCVD) was ascertained from medical records, and atherosclerosis was assessed by duplex ultrasound of the brachiocephalic arteries (BCA) and lower extremity arteries (LEA), as well as by the Agatston coronary artery calcium score (CACS). At least one vascular bed was evaluated in 69.8% of patients, and all three were evaluated in 6.2%.Results. Most patients showed elevated levels of total cholesterol and low-density lipoprotein cholesterol. From the age of 25–44 years onward, a substantial proportion of patients already showed atherosclerotic involvement of the BCA and LEA with stenosis ≥20% and pronounced coronary calcification (CACS > 100 units), with a shift toward more severe lesions in older age groups. In the subgroup that underwent imaging of all three vascular beds, 60.0% of patients aged 25–44 years had two or three beds that were affected; the proportion of patients with involvement of all three vascular beds increased to 40.0% in those aged 45–59 years, 76.9% in those aged 60–74 years, and reached 100% in patients aged ≥ 75 years (p < 0.001). The prevalence of clinically documented ASCVD increased from 10.3% in the 25–44 age group to 67.1% in patients aged ≥ 75 years. Even among patients without documented ASCVD, atherosclerotic involvement of the BCA, LEA and coronary calcification was detected in 85.9%, 82.6% and 37.1% of cases, respectively.Conclusion. Patients with Lp(a) ≥ 180 mg/dL are characterized by a high prevalence and early onset of subclinical, frequently multifocal atherosclerosis, with a pronounced age-related gradient of progression. These findings support the case for designating this cohort as a priority group for in-depth evaluation, risk re-stratification and more intensive preventive management.
Aim. To assess the association between immune-related thyroid dysfunction (irTD) and overall survival or progressionfree survival in patients with malignant neoplasms receiving immune checkpoint inhibitor therapy.Materials and methods. This multicenter prospective cohort study comprised 235 patients (156 men; mean age approximately 60 years) with histologically or cytologically confirmed malignancies of various localizations who were treated with programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors. Thyroid function was assessed before the treatment and every 4 weeks thereafter. irTD was diagnosed based on standardized biochemical and ultrasound criteria. Adverse events were graded according to CTCAE (Common Terminology Criteria for Adverse Events). Survival was analyzed using the Kaplan–Meier method, with comparisons performed using the log-rank test, and univariable Cox proportional hazards models, with hazard ratios (HRs) and 95% confidence intervals (CIs), were applied.Results. irTD occurred in 52 patients (22.1%). In all cases, destructive thyroiditis with a transient thyrotoxic phase followed by hypothyroidism (CTCAE grade 1–2) was observed and did not require discontinuation of immune checkpoint inhibitors. The median time to irTD onset was 7.9 weeks. Patients with and without irTD were comparable in terms of sex, age, disease stage, previous cancer therapy, and type of PD-1/PD-L1 inhibitors. The development of irTD was associated with better progression-free survival (median 126.2 vs 40.0 weeks; HR 0.37; 95% CI: 0.25–0.55; p < 0.001) and better overall survival (211.6 vs 147.0 weeks; HR 0.43; 95% CI: 0.25–0.73; p = 0.002).Conclusion. In this prospective multicenter cohort study, irTD occurred in approximately one-fifth of patients treated with PD-1/PD-L1 inhibitors, mainly during the first weeks of therapy, was generally mild, and was associated with improved survival. These findings suggest that irTD may be considered as a potential surrogate marker of treatment efficacy and support the need for regular monitoring of thyroid function during immunotherapy.
Aim. To develop a multimodal environmental modification protocol for the intensive care unit (ICU) and evaluate its feasibility and preliminary associations with sleep quality and pain intensity in patients.Materials and methods. A quasi-experimental, single-arm study involving 152 adult patients was conducted from June to August 2025 in the ICU of a Type B hospital in Central Java, Indonesia. Environmental modifications included six interventions: earplugs, eye masks, music therapy, lavender aromatherapy, lighting adjustments, and noise reduction measures, which were applied daily for three consecutive nights (content validity = 0.94). Sleep quality was measured using the Richards-Campbell Sleep Questionnaire (RCSQ), and pain intensity was measured using the numeric rating scale (NRS). Paired t-tests, 95% confidence intervals (CI), and Cohen's d were used to describe intervention effectiveness. Normality of distribution was tested using the Shapiro–Wilk test.Results. All 152 ICU participants completed the three-day protocol, with overall adherence being 94%. Mean RCSQ scores improved from 34.6 with 11.3 to 51.8 with 10.6 (95% CI: 15.46–18.94; paired t-test, p < 0.001; Cohen's d = 1.57). Mean NRS scores decreased from 4.7 with 1.8 to 2.8 with 1.3 (95% CI: −2.15 to −1.65; paired t-test, p < 0.001; Cohen's d = 1.21). No adverse events were noted. Objective environmental monitoring (subsample n = 40) showed a mean reduction in noise and lighting levels at the patient's bedside during the intervention.Conclusion. The protocol for creating a positive environment in the ICU was feasible, acceptable, and resulted in subjective improvements in sleep quality and pain intensity in patients.
Aim. To develop and validate a test setup for measuring the load under compression elements (CE) of multilayer bandages composed of materials with different stiffness.Materials and methods. Prototypes of multilayer bandages were fabricated in the laboratory by combining three types of CEs (foam polymer and dense nonwoven viscose material) with three types of fixing fabrics (FF) based on polyester and viscose/polyester. The test setup consisted of an upper-limb model made of rigid plastic covered with artificial skin and a block with two strain‑gauge sensors that recorded the load in gram-force (gf) under the CE area and in a control zone without a CE at an external pressure of 40 mmHg. For each CE–FF combination, 10 repeated measurements were performed in two regions of the sample (60 values per sensor per group), and the data were analysed using nonparametric statistical tests.Results. The load under the CE differed significantly between groups (p < 0.001) and depended on the type and stiffness of the material: the median load under type 3 CE with the highest stiffness was 259.4 (252.6; 263.3) gf, whereas under type 1 CE with the lowest stiffness it was 149.9 (145.1; 171.9) gf. Type 2 CE produced intermediate values of 241.7 (206.4; 259.3) gf. Testing of the FFs also showed statistically significant differences in pressure in the absence of a CE (p < 0.001): the highest load was recorded under type 2 FF (viscose/polyester) at 141.0 (140.2; 142.1) gf, and the lowest under type 1 FF made of polyester with higher surface density at 14.5 (14.3; 15.6) gf; type 3 FF provided an intermediate level of 65.7 (64.9; 69.3) gf.Conclusion. The developed in vitro setup shows high sensitivity to differences in CE stiffness and FF properties and can be used as a screening tool for quantitative comparative assessment of multilayer bandage prototypes with locally differentiated compression areas prior to in vivo studies.
Alport syndrome (AS) is a hereditary nephropathy caused by mutations in the COL4A3, COL4A4, and COL4A5 genes. Rare contiguous COL4A5–COL4A6 alterations cause AS with diffuse leiomyomatosis (AS-DL).Case report. A 16-year-old male had mild proteinuria, hematuria, hearing loss and myopia since childhood. Estimated glomerular filtration rate was 82.8 mL/min/1.73 m². Kidney biopsy showed segmental mesangial sclerosis; immunofluorescence was negative. Electron microscopy demonstrated diffuse glomerular basement membrane thinning and podocyte foot-process effacement. Two deceased brothers had end stage kidney disease; the mother had hematuria, uterine myoma, and a benign bladder tumor. A diagnosis of X-linked AS was established according to the Flinter criteria and nephroprotective treatment was initiated. Since 2024, the patient had complained of epigastric symptoms. An endoscopy revealed a 2-cm gastric submucosal lesion. A whole-exome sequencing identified a hemizygous missense variant in COL4A5 and a COL4A6 exon 1–2 deletion, confirming AS-DL.Discussion. This case demonstrates the co-occurrence of AS-DL and shows that early pedigree assessment, combined with integrated clinicopathologic-genetic evaluation in a multidisciplinary framework, enables a timely diagnosis of atypical familial AS-DL and improves clinical management.
Adenomatous goiter is a common benign thyroid condition that can become surgically challenging when it extends into the mediastinum, including in patients with a history of partial thyroid surgery. Retrosternal goiter is often diagnosed at a late stage, and its management is frequently complex due to distorted mediastinal anatomy.Case report. A 58-year-old woman with a history of left isthmolobectomy performed in 2006 presented with a rapidly enlarging right-sided neck mass accompanied by dysphagia. Although the cervical findings initially suggested right thyroid lobe involvement, contrast-enhanced computed tomography revealed a massive retrosternal goiter originating from residual left thyroid tissue. The lesion extended retrosternally into the anterior mediastinum, resulting in significant tracheal narrowing, displacement of the esophagus, and close anatomical relationships with major mediastinal vessels. Management was undertaken by a multidisciplinary team, and the patient underwent complete thyroidectomy using a combined transcervical approach and median sternotomy, achieving complete resection of the retrosternal component.Discussion. This case highlights delayed retrosternal progression of adenomatous goiter after partial thyroid surgery. Cross-sectional imaging guided surgical planning, and median sternotomy enabled safe complete resection, underscoring the importance of long-term follow-up and multidisciplinary management.
Aim. Evaluation of the diagnostic and clinical effectiveness of the HepatoScan AI system, integrating neural network– based computed tomography (CT) analysis and interactive three-dimensional (3D) preoperative modeling in realworld clinical practice.Materials and methods. A single-center comparative study was conducted, including a prospective cohort with artificial intelligence-assisted (AI) preoperative planning (n = 104) and a purposefully matched retrospective cohort undergoing standard preoperative planning (n = 100). In the AI-assisted group, automated liver and lesion segmentation, 3D volumetry, and stratification of anatomical complexity using the TROPH-L (Tumor – Regional capsule – Outflow veins – Portal vein – Hepatic bile – Localization) classification were applied. Diagnostic performance was assessed at the patient level using sensitivity, specificity, and AUROC (area under the receiver operating characteristic curve), with histopathological confirmation for malignant tumors and expert interpretation of multiphasic CT for benign lesions. Clinical effectiveness was analyzed in patients classified as TROPH-L II–III.Results. The compared groups were well balanced in terms of demographic and clinical characteristics, lesion parameters, and distribution of TROPH-L categories. In the overall cohort, the use of HepatoScan AI was associated with a higher sensitivity of preoperative diagnosis compared with the standard approach (93.3% vs. 84.2%; p = 0.008), while maintaining high specificity. The AUROC was higher in the AI group (0.954 vs. 0.892), although the difference was not statistically significant; a similar trend was observed across nosological subgroups. Among patients classified as TROPH-L II–III (n = 54 in the AI group and n = 55 in the standard planning group), AI-assisted planning was associated with a shorter operative time (160 vs. 180 minutes; p = 0.01) and reduced intraoperative blood loss (280 vs. 400 mL; p = 0.004). In addition, a higher rate of R0 resections (100% vs. 91.3%) and lower rates of postoperative complications and in-hospital mortality were observed in the AI group, although these differences were not statistically significant.Conclusion. Integration of the HepatoScan AI system with interactive 3D preoperative planning is associated with improved diagnostic performance and favorable intraoperative metrics in patients with liver tumors, particularly in anatomically complex cases (TROPH-L II–III). These findings highlight the strong potential of the proposed digital technologies to optimize preoperative planning and warrant further prospective multicenter validation.
Microsurgical treatment of ocular artery aneurysms is classified as high-risk surgery. It is anatomically impossible to prevent and stop bleeding from ophthalmic aneurysms by applying a standard clip proximal to the aneurysm. Case report. A 46-year-old man was admitted complaining of periodic headaches for 6 months. Outpatient magnetic resonance imaging revealed an aneurysm of the right internal carotid artery (ICA). According to computed tomography and cerebral angiography, an aneurysm of the ocular artery was verified. The patient chose an open surgery from the proposed treatment methods. Clipping of the aneurysm of the ocular artery mouth was performed by pterion access with an extradural extraction of the petrosal segment of the ICA to prevent intraoperative bleeding. The course of the postoperative period was smooth, without neurological symptoms, and the stitches were removed on the 9th day. The patient was discharged under outpatient supervision with a recommendation to control the radicality of clipping after 6 months. Discussion. Temporary clipping of the ICA in the carotid canal during microsurgical operations for ocular artery aneurysms allows controlling the risk of bleeding from the main surgical access without isolating the neurovascular bundle of the neck, which reduces the traumatic nature of the operation and is preferable from a cosmetic point of view.
One of the rare forms of anemia in patients with liver cirrhosis (LC) is acanthocytosis (spur cell anemia) – a non‑immune hemolytic anemia caused by alterations in the lipid composition of the red blood cells membrane because of severe liver failure. Case report. A 37‑year‑old patient with decompensated alcoholic LC (Child‑Pugh class C, the MELD‑Na (Model for End‑Stage Liver Disease – Na) score was 34 points) presented with severe weakness and dyspnea. Acute‑on‑chronic liver failure was diagnosed: CLIF‑C ACLF (Chronic Liver Failure Consortium Acute‑on‑Chronic Liver Failure Score) score was 46. Severe macrocytic anemia with reticulocytosis was detected: hemoglobin – 50 g/L, red blood cells – 1.26×10¹²/L, reticulocytes – 77.9 ‰. Other causes of anemia, such as blood loss, iron deficiency, vitamin B 12 and folate deficiencies were excluded. The Coombs test was negative, and bone marrow examination ruled out myelodysplasia. Blood smear analysis revealed that 20% of red blood cells had the shape of spur cells, with approximately half of them being acanthocytes. Orthotopic liver transplantation was performed. Follow-up examination after three months showed normalization of liver function tests and absence of anemia and acanthocytosis. Discussion. This case report highlights the need for blood smear examination to detect acanthocytes – a rare but prognostically unfavorable cause of anemia in patients with LC. Liver transplantation remains the only effective treatment option.
Aim. To compare the cervical volume of patients who underwent successful and failed induction of labor (IOL) procedures.Materials and methods. This systematic review and meta-analysis were conducted according to PRISMA guidelines. A comprehensive literature search was performed in PubMed, EMBASE, Scopus, and Google Scholar to identify cohort studies published between January 01, 2005 and December 31, 2024, that compared cervical volume in pregnant women who underwent IOL. A random-effects meta-analysis was performed.Results. Seven studies involving 534 pregnant women were included. Four studies were considered low risk of bias and two studies were regarded as high risk of bias. Risk of bias assessment could not be performed in one study because the full-text of the article was not available. The pooled analysis of two studies involving 168 pregnant women demonstrated a positive association between the lower cervical volume and successful vaginal delivery within 24 hours (odds ratio 7.19; 95% confidence interval: 3.31 to 15.64; I² = 0%). The pooled analysis of five studies involving 422 pregnant women showed no statistically significant difference between successful and failed IOL, with a mean difference –1.32 cm3; 95% confidence interval: –8.37 to 5.72; I² = 89.8%). Subgroup analyses showed no statistically significant association between cervical volume and successful IOL when defined as vaginal delivery without time restriction or within 24 hours. However, a significantly lower cervical volume was observed in women who achieved the active phase of labor within 12 hours. The Egger’s regression test confirmed the absence of small‑study effects (coefficient = 0.50, standard error = 1.75, p = 0.78).Conclusion. Cervical volume has significant potential as a parameter for predicting successful IOL, with a smaller cervical volume being associated with better outcomes, although subgroup findings remain inconsistent.
Aim. To design, develop and validate a 3D head simulation model for foramen ovale puncture, incorporating computer vision-based artificial intelligence (AI) technologies. Materials and methods. A 3D simulation model with AI integration was developed in the prototyping laboratory. Its effectiveness for surgical training was evaluated by two groups: neurosurgeons with five or more years of experience ( n = 10) and residents ( n = 28). Training outcomes were assessed using the following parameters: intervention time, number of puncture attempts until they achieved the first one without any complications, number of complications involving critical anatomical structures. The validity was assessed using a Likert scale. Results. Before the training session, the groups differed in terms of the time spent on the procedure, the number of puncture attempts and the number of complications involving critical anatomical structures. Post-training intervention time decreased by 50% in both groups, the number of puncture attempts reduced by 50.0% in physicians and by 60.3% in residents. The cumulative number of complications declined by 57.8% in physicians and by 59% in residents. Likert scale analysis revealed no statistically significant differences between groups across all parameters. The feasibility and educational effectiveness of the model were rated as 4 or 5 by 90% of participants in both groups. Anatomical realism received a score of 4 or 5 from 90% of physicians and 100% of residents. Radiographic realism received a score of 4 or 5 from all participants. The cost of creating a simulator, excluding the cost of a 3D printer, was 22,685 rubles. Conclusion. The developed 3D simulation model with AI integration significantly improved training outcomes both in physicians’ and residents’ groups. The use of standard prototyping equipment provides a cost-effective, radiation-free alternative for widespread implementation in neurosurgical education.
Common surgical approaches to the dorsal midbrain include: the occipital transtentorial, supracerebellar infratentorial, posterior subtemporal, and the tonsilloveal transaqueductal approaches. Case report. A 38-year-old man presented with mild right-sided weakness and diplopia following an episode of headache and vomiting two weeks prior to admission. A neurological examination revealed mild right-sided weakness, a downward and outward strabismus, a mild left ocular mydriasis and accommodation paralysis alongside alternating syndrome. Magnetic resonance imaging revealed a 20×30×25 mm rupture of the cavernous malformation of the left midbrain peduncle as well as hematomas within the cavernoma. Using the supracerebellar infratentorial approach in a sitting position with minimal incision of dorsal midbrain, the cavernoma was completely resected together with surrounding subacute hematoma. In the early postoperative period, a regression of neurological symptoms was observed. Discussion. The choice of median suboccipital craniotomy and contralateral supracerebellar infratentorial approach is the preferred route for complete resection of cavernoma of dorsal midbrain surface in order to avoid any postoperative neurological deficit.
Objective. To study bone turnover markers in biological fluids (urine, blood serum, oral fluid (OF) and gingival crevicular fluid (GCF)) at the stage of planning an orthodontic strategy in children with end-stage chronic kidney disease (ESKD).Materials and methods. Pilot, cross-sectional, multicenter study was conducted. A total of 48 children aged 7 to 17 years were examined and divided into three groups: 14 children with ESCKD, 14 children with renal transplant dysfunction (RTD), 20 almost healthy children. Bone turnover markers were assessed by changes in osteocalcin (OC) in the OF, GCF and blood serum, urinary deoxypyridinoline (DPD), levels of total, ionized calcium and phosphorus in blood and pH of OF. Bone tissue mineral density was assessed by cone-beam computerized tomography according to the C. Mish classification.Results. All groups of children were comparable by gender and age. All patients had no significant mineral and bone disorders. Total and ionized calcium did not demonstrate statistically significant differences between the study groups. Serum phosphorus level was higher in ESCKD children compared to RTD children and control group. Urinary DPD, OC in GCF and OF pH were higher in children with CKD compared to healthy children. However, there were no statistically significant changes between the ESCKD group and the RTD group. In the posterior maxilla, the Hounsfield index was higher in the group with RTD compared to the ESCKD group (p < 0.01), and similar to the control group. In the anterior maxilla, as well as in the anterior and posterior mandibular regions, the Hounsfield index was higher in the control group than in the ESCKD and RTD groups.Conclusion. The most prominent changes of bone turnover markers were found in children with ESCKD. Urinary DPD and OC in GCF were associated with the decrease in kidney function and jawbone mineral density.
Aim. To evaluate the effect of etamsylate on the activation of signaling pathways involved in the regulation of platelet aggregation in the setting of macrohematuria following ureteral lithotripsy (ULT).Material and methods. A total of 192 patients undergoing ULT followed by ethamsylate administration were assessed for inclusion in the study. All patients received nonsteroidal anti-inflammatory drugs. The study included 42 patients (20 men and 22 women; mean age 54.2 ± 15.1 years) who developed macrohematuria following administration of three doses of etamsylate (125 mg I.V. the first dose was administered 6 hours after ULT, followed by further doses every 6 hours). Platelet receptor activity was assessed before and after administration of the fourth dose of ethamsylate (125 mg I.V.) using standard (EC50) and subthreshold (EC10) concentrations of agonists: epinephrine, adenosine triphosphate, adenosine diphosphate (ADP), adenosine, platelet-activating factor (PAF), soluble type IV collagen, and a stable thromboxane A2 analog.Results. After administration of the fourth dose of etamsylate, macrohematuria significantly decreased compared to baseline values: 46.6 ± 8.9 vs. 76.7 ± 7.0 red blood cells per field of view (p < 0.001). After administration of the fourth dose of etamsylate, upon stimulation with standard agonist concentrations (EC50), there was a significant increase in the activity of the PAF receptor by 9.1% (p = 0.007), the thromboxane prostanoid receptor by 7.9% (p = 0.006), the glycoprotein VI receptor by 22.8% (p < 0.001), and ethamsylate-induced platelet aggregation by 10.4% (p < 0.05). The maximal aggregatory response using subthreshold agonist concentrations (EC10) was observed when platelets were incubated simultaneously with ethamsylate and ADP: amplitude, slope, and AUC (area under the curve) increased by 16.9%, 60.0%, and 54.7%, respectively, compared to isolated stimulation of P2Y receptors (p < 0.05), and by 26.2%, 77.2%, and 65.6%, respectively, compared to incubation with ethamsylate alone (p < 0.05).Conclusion. The maximal proaggregatory effect of ethamsylate was mediated through P2Y receptors, along with modulation of thromboxane prostanoid and PAF receptors, which promote intracellular Ca²+ elevation
Aim. To study morphological and developmental changes in the structure of mice’s limbic system, which overexpress 70 kDa heat shock proteins (HSP70) and co-express mutant fused-in-sarcoma (FUS) protein with amyotrophic lateral sclerosis (ALS).Materials and methods. The study was based on mice (n = 36; six for each group) of six lines either without FUS mislocalization: C57Bl/6 (wild-type); extracellular (HSP70out) or intracellular (HSP70in) overexpression of HSP70 family 1A protein; or with FUS mislocalization: transgenic mice with ALS-FUS (FUS[1-359]); and double transgenic animals (FUS[1-359]/HSP70out and FUS[1-359]/HSP70in). All FUS expressing mice were symptomatic with myasthenia up to limb paralysis in some animals. When the mice were 20 weeks old, they were killed by staining histological slides of their brain using hematoxylin and eosin, toluidine blue by Nissl, immunofluorescent antibodies for the neuronal nuclear marker (NeuN) of the caudoputamen, septal nuclei, and hippocampus, as well as glial fibrillar acid protein (GFAP), S100β protein, and synaptophysin for the hippocampus. The number of neurons and the number of cells with a positive reaction to antibodies were counted. The statistical processing included ANOVA and were compared with the results from the Tukey test for.Results. Statistically significant differences were observed for the FUS-expressing groups compared to FUS-negative groups: (1) a reduction in the number of neurons and NeuN+-cells in the caudoputamen and amygdala, especially for FUS[1-359]/HSP70out group; (2) an increase in the number of hyperchromic neurons in the subiculum, cornu Ammonis (CA1), and dentate gyrus, with a significantly greater increase for FUS[1-359] and FUS[1-359]/HSP70out groups compared to FUS[1-359]/HSP70in group; (3) an increase in the number of GFAP+and S100β+-cells in the hippocampus, with the most pronounced change for the FUS[1-359] and FUS[1-359]/HSP70out groups compared to с FUS[1-359]/HSP70in group.Conclusion. An overexpression of HSP70 family 1A protein and co-expression of mutant FUS protein in the cytoplasm is accompanied by mitigated neurodegeneration in the structure of the limbic system compared with the expression of mutant FUS protein alone.
Aim. To evaluate the diagnostic capabilities of combined positron emission tomography (PET) with accumulation of 18-fluorodeoxyglucose and computed tomography (CT) data, with additional 3D-visualization of CT DICOM files using the 3D Slicer software, in detecting tumor invasion of the paragastric tissue in locally advanced gastric cancer.Materials and methods. A prospective open-label study was conducted as part of the research project “SmartGastro”. Four women and four men aged 51 to 81 years with a histologically confirmed diagnosis of gastric cancer underwent combined PET/CT following the “Whole Body” protocol at 60–80 minutes after the administration of the radiopharmaceutical agent (RPA). The obtained results were analyzed through visual assessment of CT and PET images separately, as well as through fused scans, followed by 3D reconstruction based on CT DICOM data. All patients underwent surgery. The resected macroscopic specimen was stepwise excised along its perimeter, followed by a histological examination of the resection margins (paragastric fat tissue). In all cases, R0 resection was confirmed, indicating radical tumor removal. The initial delineation of tumor boundaries based on PET-CT and CT imaging was compared voxel-by-voxel with the secondary delineation performed through a visual assessment of the excised macroscopic specimen.Results. In 5 out of 8 cases, compromised peritumoral paracardial tissue detected on CT corresponded to regions of radiopharmaceutical agent uptake on PET. Areas demonstrating increased RPA accumulation in the peritumoral tissue, along with a corresponding rise in densitometric values on CT, were indicative of true invasion. This was confirmed by a histological examination of the resected specimen, in 6 out of 8 cases. The sensitivity of combined PET/CT, assessed on a voxel-by-voxel basis against postoperative pathological findings, was 0.88 (95% confidence interval (CI): 0.76–0.97), while specificity reached 0.91 (95% CI: 0.80–0.99). The discrepancy in tumor boundaries between these modalities, determined using the Hausdorff distance, was 5.2 mm, with a mean tumor size of 38×30×39 mm. Conclusion. Combined PET/CT enables the surgeon to identify precisely a compromised mesolayer adipose tissue.The construction of 3D-models of perigastric tissues affected by the tumor process, combined with the visualization of the gastric tumor and associated vasculature, facilitates comprehensive preoperative planning for oncological surgery.
