BACKGROUND: Combat-related limb injury requiring amputation is a severe, disabling injury. Effective prosthetic fitting is key to the quality of life of such patients. One of the main obstacles to prosthetic fitting is chronic pain syndrome. AIM: To evaluate the efficacy of various surgical treatment methods for pain syndrome in patients with amputated limb defects resulting from combat trauma, and to identify factors influencing the treatment outcome. METHODS: Pain was assessed using a visual analog scale and a neuropathic pain diagnostic questionnaire. To identify independent predictors of failure in pain control, unsuccessful prosthetic fitting, and recurrence, a multivariable logistic regression analysis was performed. RESULTS: Neurosurgical operations using microsurgical techniques and the addition of alcohol neurolysis (chemical neurolysis with alcohol) were superior to similar operations without alcoholization. Thus, the median visual analog scale score after treatment was 0.5 points versus 1 point (p = 0.018), and the success rate of prosthetic fitting was 76% versus 53% (p = 0.022). In 66.7% of patients who underwent repeated surgeries, switching to neurosurgical interventions using microsurgical techniques and nerve alcoholization ensured successful prosthetic fitting. A correlation was identified between the time from injury to admission and the duration of treatment (r = 0.42; p = 0.004). Operations without nerve alcoholization were the strongest independent risk factor for failure in pain relief, unsuccessful prosthetic fitting, and recurrence (odds ratio = 5.05; p = 0.009; 5.81; p = 0.011; and 5.21; p = 0.015, respectively). Therapeutic blocks were associated with a lower risk of failure in pain relief and prosthetic fitting (odds ratio = 0.1; p = 0.040 and 0.06; p = 0.046, respectively). Amputation at the thigh level was a predictor of unsuccessful prosthetic fitting and recurrence (odds ratio = 4.18; p = 0.025 and 3.82; p = 0.036, respectively); each additional neuroma increased the risk of unsuccessful prosthetic fitting by 2.1-fold (p = 0.025) and the risk of recurrence by 2.41-fold (p = 0.012). CONCLUSION: Adding nerve alcoholization to microsurgical interventions significantly improves the outcomes of neuroma treatment and reduces the risk of recurrence; surgeries without nerve alcoholization are not recommended as a standalone method for this population. The identified predictors can be used for risk stratification, but they require confirmation in larger samples.
BACKGROUND: Arctic living conditions are associated with exposure to a complex of adverse environmental factors, among which photoperiodic disruption (the polar day phenomenon), physical inactivity, chronic psychoemotional stress, pronounced solar radiation deficiency, and nutritional imbalance play a leading role. The combination of these factors can initiate early pathological changes in the vascular wall long before the clinical manifestations of atherosclerosis. AIM: To assess the state of vascular stiffness, endothelial function, and metabolic profile in men under special habitability conditions on the Franz Josef Land archipelago during the polar day. METHODS: We examined 120 men aged 30.5 ± 6.9 years working on the Franz Josef Land archipelago during the polar day (May–June). We assessed cardio-ankle vascular index, pulse wave velocity, augmentation index, anthropometric and biochemical parameters, hormonal status, and markers of inflammation and endothelial dysfunction. RESULTS: In the examined men, the following subclinical signs of vascular remodeling were revealed: 62% had an increased level of asymmetric dimethylarginine (0.81 ± 0.15 µmol/L); 88% had high-sensitivity C-reactive protein (3.89 ± 2.31 mg/L); 76% had tumor necrosis factor alpha (10.31 ± 3.27 pg/mL); 78% had oxidized low-density lipoproteins (94.33 ± 20.12 U/L). 25-Hydroxyvitamin D was less than 30 ng/mL in 100% of the examined individuals. The cardio-ankle vascular index correlated with asymmetric dimethylarginine and high-sensitivity C-reactive protein (r = +0.56 and r = +0.57, respectively; p 0.001); the correlation of the cardio-ankle vascular index with leptin and adiponectin (r = +0.07 and r = −0.19, respectively) did not reach statistical significance. The duration of stay on the island correlated with high-sensitivity C-reactive protein (r = +0.30; p = 0.003) and interleukin-6 (r = +0.24; p = 0.019). CONCLUSION: In individuals working in Arctic conditions during the polar day, a cluster of early markers of vascular remodeling has been identified: endothelial dysfunction, low-intensity systemic inflammation, dyslipidemia, adipokine imbalance, and chronobiological dysregulation, increasing with the duration of stay on the island. These data justify the advisability of systematic cardiometabolic monitoring in individuals staying under special habitability conditions.
BACKGROUND: Osteoarthritis is a pressing concern due to its widespread prevalence. Annually, the disease results in disability, reducing quality of life and necessitating joint replacement. Excess weight plays a significant role in the development of the disease. AIM: To study the levels of CD95 and p53 as markers of apoptosis in rat chondrocytes in the context of experimentally simulated arthrosis and obesity, and to evaluate their correction with dexamethasone in vitro. METHODS: The study was conducted on 180 white male Wistar laboratory rats, divided into five groups of 36 animals each. Group 1 was the control group; groups 2–5 were experimental groups in which arthrosis was simulated by damaging the articular cartilage and obesity was induced in cell cultures. After decapitation under general anesthesia, cartilage tissue samples were collected. Chondrocytes were cultured in vitro, where the effects of obesity were simulated, with correction by dexamethasone solution at doses of 1, 10, and 100 ng/mL in groups 3, 4, and 5, respectively. Cell cultures of groups 1 and 2 remained intact. Expression levels of CD95 and p53 were assessed on days 3, 5, and 10. RESULTS: An increase in the levels of apoptosis markers CD95 and p53 was observed in group 2 throughout the entire experimental period, with a maximum on day 10. With the addition of 1 ng/mL dexamethasone to the cell culture, CD95 levels decreased by 34.1% on day 3 and by 38.3% on day 5, and increased by 186.5% on day 10. p53 protein expression decreased by 33.1% on day 3, by 29.5% on day 5, and by 23.9% on day 10. Dexamethasone at a dose of 10 ng/mL reduced CD95 levels by 27.6% on day 3 and by 29.6% on day 5, but on day 10, an increase of 178.2% was observed. p53 levels increased by 107.2% on day 3 and by 112% on day 5, and decreased by 57% on day 10. Dexamethasone at a dose of 100 ng/mL reduced CD95 expression by 66.8% on day 3 and by 53.1% on day 5, and an increase of 129% was observed on day 10. p53 levels decreased by 75.1% on day 3, by 52.9% on day 5, and by 4.3% on day 10. CONCLUSION: Obesity in the presence of gonarthrosis activates chondrocyte apoptosis and promotes increases in CD95 and p53. Dexamethasone at a dose of 1 ng/mL reduces apoptosis markers on day 3, with a further decrease in effectiveness; at a dose of 10 ng/mL, it has a positive effect lasting up to 5 days for CD95, while p53 expression increases for 5 days and decreases by day 10. Dexamethasone at a dose of 100 ng/mL reduces CD95 and p53 expression throughout the entire experimental period.
BACKGROUND: In the context of a steadily aging population and a progressive increase in the incidence of cardiovascular diseases, coronary heart disease with coronary artery calcification is a critical issue in modern cardiology. The progressive calcification of the vascular bed with age not only serves as an independent predictor of cardiovascular complications but also poses significant challenges in selecting the optimal strategy for endovascular revascularization in patients in older age groups. AIM: To conduct a retrospective analysis of the effectiveness of treatment in patients with coronary heart disease and coronary artery calcification in elderly and senile age. METHODS: We analyzed clinical data and quality-of-life indicators in two groups of patients: group 1 (main) with endovascular intervention and group 2 (comparison) with drug therapy alone. The level of calcified vascular lesions was determined using coronary angiography and a method for selecting treatment tactics (Patent RU2831567C1). RESULTS: The groups were comparable by functional class of angina: functional class III, 97 (83.6%) and 114 (83.2%) patients in groups 1 and 2, respectively; functional class IV, 19 (16.4%) and 23 (16.8%) patients; by sex: men, 82 (70.7%) and 96 (70.1%) patients; women, 34 (29.3%) and 41 (29.9%) patients; by age: 72 ± 8.9 and 73 ± 8.1 years. Both groups were comparable in terms of the main selection criteria but differed in terms of the presence of obesity: the body mass index was 27.9 ± 1.8 and 29.1 ± 1.6 kg/m², respectively, in groups 1 and 2. The groups were comparable by the presence of concomitant diseases: arterial hypertension, 61 (52.6%) and 95 (69.3%) patients; diabetes mellitus, 41 (35.3%) and 84 (61.3%) patients; smoking, 44 (37.9%) and 77 (56.2%) patients in groups 1 and 2, respectively. In the long-term follow-up, the mortality rate of patients in both groups did not differ significantly. In the main group, there was a decrease in the angina class (φemp = 2.329; p = 0.05). The probability of adverse cardiovascular complications and the risk of restenosis had a small but statistically significant intergroup difference (φemp = 2.049 and φemp = 2.088, respectively; p = 0.05). CONCLUSION: The degree of coronary calcification in the conservative therapy group was associated with a significantly higher incidence of diabetes, hypertension, and smoking in these patients compared with the main group. Despite the lack of impact on overall survival, endovascular treatment allows for significant improvement in physical activity and psychoemotional status, which is critically important for prolonging active longevity and improving the quality of life of patients of elderly and senile age.
BACKGROUND: Tuberculosis of peripheral lymph nodes remains a pressing problem of extrapulmonary tuberculosis in the Republic of Kazakhstan, ranking second in the morbidity structure. The search for ways to optimize treatment, including the timing of surgical intervention and the use of pathogenetic therapy, is an important task of clinical phthisiology. AIM: To evaluate the efficacy of comprehensive treatment of patients with tuberculosis of peripheral lymph nodes, including early lymphadenectomy and the use of the immunomodulator betaleukin, compared with the standard approach of delayed surgical treatment. METHODS: We retrospectively analyzed treatment outcomes of 69 patients with tuberculosis of peripheral lymph nodes. The main group (n = 35) consisted of patients treated in 2023–2024 who received comprehensive treatment: standard chemotherapy, early lymphadenectomy (within 1–1.5 months from the start of chemotherapy), and the immunomodulator betaleukin. The comparison group (n = 34) consisted of patients treated in 2018–2019 who received standard chemotherapy with delayed surgical treatment (at 4–4.5 months) without immunomodulators. RESULTS: In the main group, relief of intoxication symptoms was significantly more frequent in the first 3 months (85.7% vs 61.7% in the comparison group, p 0.05) and disappearance of periadenitis was faster (80% vs 44.1%, p 0.05). In patients with fistulas in the main group, closure occurred earlier: by 2 months after curettage, fistulas had closed in 61.5% of patients, while in the comparison group, closure took longer (only 33.3% of patients had fistula closure by 3 months). CONCLUSION: The use of the developed approach, which includes early surgical intervention and immunomodulation with betaleukin, made it possible to accelerate the regression of local manifestations of the disease and shorten the duration of treatment for patients with tuberculosis of peripheral lymph nodes. Further studies are required to clarify the contribution of each component of treatment.
