Chronic back pain (CBP) associated with intervertebral disc degeneration (IVDD) is a leading cause of medical consultations, decreased quality of life, and temporary and permanent disability. The mechanisms of CBP development and persistence in patients with IVDD have been studied for many years, but this issue remains far from resolved. The search for predictive biomarkers that could help identify patients with IVDD at high risk for CBP continues. In recent decades, research has shown increasing interest in identifying epigenetic biomarkers for this disorder. to summarize the results of preclinical and clinical studies on the role of microRNAs (miRs) as epigenetic biomarkers of the development and progression of CBP in patients with IVDD. English-language articles; original experimental (preclinical) studies; original clinical study; assessment of changes in systemic (in the blood) and/or local (in the intervertebral disk (IVD)) levels of miR expression in IVDD, either independently or in comparison with healthy controls; and studies that were completed and the results of which were published. PubMed, Springer, Google Scholar, Scopus, Oxford Press, Cochrane, and e-Library databases. Charting for this scoping review involved developing a data extraction form to summarize extracts and organize data from included studies. This was an iterative process where the charting tables and figures may be refined as the review progresses. 126 studies were analyzed in detail, focusing on their study designs and comparing changes in miR expression in animal models of IVDD and in patients with IVDD compared to healthy controls. During the preparation of this scoping review and upon subsequent detailed review of the original publications, it turned out that the results of one study were not justified by the authors due to identified technological problems (the article was withdrawn by the editorial board of the journal). Therefore, we excluded the results of this study from the subsequent analysis. As a result, this section summarizes the results of 60 preclinical and 65 clinical studies. Some miRs (e.g., miR-21 and miR-132) are associated with the regulation of inflammatory pathways that contribute to increased degradation of IVD extracellular matrix and enhanced nociceptive signaling through various mechanisms, contributing to the progression of CBP. Other miRs (e.g., miR-145 and miR-223) exert protective effects, enhance regenerative potential, and alleviate CBP. Despite the promising results of these studies, there are limitations in the use of miRs as perspective epigenetic biomarkers of CBP in patients with IVDD because the pattern of potentially predictive and protective miRs in relation to the mechanisms of CBP formation and progression in IVDD has not yet been sufficiently studied. The results of some preclinical and clinical studies are contradictory. Further research is needed to clarify the role of miR signatures in animal models and clinical trials on IVDD-specific CBP.

The analysis was conducted of 14,578 patients vaccinated against coronavirus infection in Krasnoyarsk and Zelenogorsk. As a result of the study, the effectiveness of vaccination against the SARS-Cov-2 coronavirus was proven. It was found that of all vaccinated people, 49.5% did not get sick with COVID, and the majority of vaccinated patients had a mild course of the disease. Mortality in the study group from a new coronavirus infection was 3.9% in Krasnoyarsk, 2.9% in Zelenogorsk (p = 0.0005). The median age of patients who died from a new coronavirus infection in Krasnoyarsk was 68.0 [61.0; 72.5] years, among women 68.5 [61.5; 77.0] and in Zelenogorsk among men 72.5 [62.0; 83.0] years, among women 78.0 [71.0; 83.0] years.Among patients with severe and extremely severe severity, 24 patients were vaccinated, which accounted for 7.9% of all patients with severe and extremely severe severity. Among the deceased patients, 21 (7.8%) patients were vaccinated. In 18 (6.8%) patients who died, infection with a new coronavirus infection occurred within 10 days from the date of vaccination.

Acute myocardial infarction (AMI) remains a major public health concern worldwide. The aim of this narrative review was to identify and summarize the results of epidemiological studies on AMI incidence in Russia and abroad. Russian and international publications were searched in the databases eLibrary, PubMed, and Google Scholar. The search covered the previous 5 years. The analysis showed that the incidence rate of AMI in the Russian population during the study period remained high, reaching 140.8 cases per 100,000 population by 2022. This rate was lower compared with some CIS countries (Belarus, 174.5 cases) and European countries (Sweden, 288.0 cases; United Kingdom, 288.0 cases; France, 180.2 cases; Hungary, 177.5 cases; Spain, 169.0 cases; Cyprus, 160.0 cases), as well as New Zealand (536.0 cases), the United States (439.9 cases), Japan (389.7 cases), Australia (352.0 cases), Iran (343.0 cases), China (231.6 cases), and Tanzania (172.0 cases). These findings indicate that the incidence of AMI remains high both in Russia and globally, with an upward trend among middle-aged individuals. This highlights the need for future multicenter epidemiological studies of AMI incidence in Russia, particularly among adults aged 45–59 years, to support the development of new diagnostic and therapeutic strategies.

Background: Excessive scarring remains a frequent complication in plastic surgery, yet standardized preventive strategies are lacking. Type I collagen-based biomaterials may support regenerative processes and improve scar outcomes. Methods: This case series includes six female patients (ages 24-52) undergoing wound management after trauma and procedures including blepharoplasty, abdominoplasty, and revision mammaplasty. Native collagen type I (7% or 15%) was injected along wound margins or into hypertrophic scars at 3-4 week intervals. Outcomes were assessed through patient-reported symptoms and Antera 3D imaging (vascularity, pigmentation, surface topography). Results: Patients reported reduced tightness, pruritus, and scar stiffness after initial sessions. Antera 3D imaging showed decreased vascular and pigment indices, and a reduction in surface elevation over follow-up (up to 14 months). No adverse effects such as atrophy or infection were observed. Conclusions: Native type I collagen was well tolerated and may be a useful adjunct for wound healing and scar modulation following plastic surgery.

Despite a large number of studies, the problem of impaired wound healing, in particular hypertrophic scars, remains relevant. Currently, there is no “gold” standard for the management of patients with hypertrophic scars. The purpose of this work was to analyze modern methods of prevention and treatment of hypertrophic scars, in terms of pathogenetic aspects, advantages and disadvantages. The review article includes systematic reviews, original research, and clinical cases describing the prevention and treatment of hypertrophic scars. The search was conducted for the key terms “hypertrophic scar”, “scar-free healing”, “therapeutic strategic”, and “wound healing” in the bibliographic databases PubMed, Scopus, and eLibrary. Articles with the highest citation index were selected from the data obtained. A total of 3,861 titles, 1,484 full articles were reviewed, and 139 articles are included in this review. An analysis of numerous scientific papers has provided a deep understanding of modern strategies for the prevention and treatment of hypertrophic scars. In this article, all the presented methods can be divided into 2 groups: methods that directly affect the blocking of extracellular matrix overproduction and methods that improve regeneration, including tissues around the wound. The latter, according to a few authors, are a promising area of wound healing, as they reduce the overall healing time, thereby contributing to a noticeable aesthetic improvement in the appearance of scars.

Background: To date, there have been no studies on the dynamics of areas of pain, paraesthesia and hypoesthesia after the use of various transcutaneous electrical nerve stimulation in the treatment of meralgia paresthetica. Methods: In this pilot study, we observed 68 patients with obesity-related bilateral meralgia paresthetica. Pain syndrome, paraesthesia symptoms, and hypoesthesia were evaluated using 10-point scores. In addition, pain drawing (PD) was used to determine the area of the spatial distribution of pain syndrome and paraesthesia symptoms, and body drawing was used to determine the area of hypoesthesia. Sham TENS was performed in the control group, and effective TENS was performed in the treatment group. The treatment group consisted of two subgroups. One subgroup underwent HF-LA TENS, and the second subgroup underwent LF-HA TENS. Results: Despite the greatest analgesic effect observed from HF-LA TENS, which was assessed using scoring methods, during and after treatment, the reduction in the area of pain and paraesthesia symptoms and the area of hypoesthesia was moderate, short-term, and reversible. In contrast, LF-HA TENS had a pronounced analgesic and sustained anti-paraesthesia effect, manifested by a noticeable decrease in pain and paraesthesia symptoms area in PD, gradually increasing during the first 2 months of follow-up and accompanied by an irreversible prolonged decrease in the area of hypoesthesia. Conclusion: The areas of paraesthesia and hypoesthesia correlate with affective reactions to long-term chronic pain, which noticeably regress under the influence of LF-HA TENS compared to HF-LA TENS.

Prediction and prevention of cardiotoxic adverse reactions in neurological diseases is a pressing issue due to necessity for long-term use of antidepressant drugs. The aim of the study was to examine the quantity of antidepressant prescriptions, observation of adverse events (especially cardiovascular ones) and the caution in prescribing by practicing neurologists compared with physicians of other specialties. Materials and methods: 97 physicians of various specialties participated in the survey. After excluding physicians who did not use antidepressants in their practice, the participants were divided into two groups: neurologists and physicians of other specialties. Differences in responses between the two groups were assessed with the Pearson chi-square test (χ2) and the Kruskal-Wallis test. Results. The analysis of a survey of physicians using antidepressants in their clinical practice revealed the statistically significant differences between neurologists and physicians of other specialties who participated in the study. Neurologists tend to underestimate the cardiotoxicity of antidepressant medications (particularly SSRIs), which can lead to a potentially fatal complication—ventricular tachycardia (Torsade de Pointes). A statistically significant difference in awareness of the diagnostic criteria for long QT syndrome was found in medical practice of neurologists and physicians in other specialties. Conclusion. As a result of the analysis the obtained results, the following ways of improving the dispensary observation of patients on antidepressants were: increasing awareness and alertness of practicing physicians about the long QT syndrome; ECG monitoring before and during taking antidepressants; collection of family history and life history in patients before prescribing antidepressants. Presence of tachycardia, syncope, or anoxic seizures in a patient taking antidepressants can arise suspicion for TdP, a potentially fatal complication of QT syndrome; it requires immediate discontinuation of the drug, replacement with a less cardiotoxic one, 24-hour Holter ECG monitoring, and pharmacogenetic testing.

Phytotherapy, as a traditional medicine method, has diverse therapeutic properties that can be used for disease-modifying therapy of intervertebral disc degeneration (IDD) in humans. Of particular interest are herbal remedies for the correction of chronic inflammation (primarily cytokine imbalance). The aim of this descriptive review is to update knowledge about herbal methods that are promising or traditionally used for the correction of cytokine imbalance in IDD. The results of preclinical and clinical studies and publications of historical interest on the traditional use of herbal remedies in Eastern and Western medicine were analyzed. Most herbal remedies for the correction of cytokine imbalance in IDD have evidence classes C and D, while the number of herbal remedies with evidence classes A and B is still small, despite many years and even centuries of experience in traditional medicine. In recent decades, there has been a trend toward increased research interest in this topic, with a growing number of preclinical studies of herbal remedies in animal models of IDD and arthritis (including arthritis of the facet joints of the spine). This review has demonstrated that traditional herbal medicine has not lost its clinical significance and can be used as a component of disease-modifying therapy for IDD in humans. Planning and conducting new preclinical and clinical studies of herbal remedies for this disease are necessary to increase the level of evidence for their use in clinical practice in accordance with modern requirements.

Antiseizure medication (ASM) induced metabolic syndrome (AIMetS) is a common adverse drug reaction (ADR) of pharmacotherapy for epilepsy and psychiatric disorders. However, the sensitivity and specificity of blood biomarkers may be insufficient due to the influence of combined pathology, concomitant diseases, and the peculiarities of the metabolism of ASMs in patients with epilepsy. Methods: The presented results of experimental and clinical studies of microRNAs (miRs) as epigenetic biomarkers of MetS and AIMetS, which were entered into the different databases, were analyzed for the last decade (2014–2024). Results: A systematic review demonstrated that miRs can act as promising epigenetic biomarkers of key AIMetS domains. However, the results of the review demonstrated the variable role of various miRs and their paralogs in the pathogenesis of AIMetS. Therefore, as part of this study, an miRs signature was proposed that allows us to assess the risk of developing and the severity of AIMetS as low risk, medium risk, and high risk. Conclusions: The mechanisms of development and biomarkers of AIMetS are an actual problem of epileptology, which is still far from being resolved. The development of panels (signatures) of epigenetic biomarkers of this widespread ADR may help to increase the safety of pharmacotherapy of epilepsy. However, to increase the sensitivity and specificity of circulating miRs in the blood as biomarkers of AIMetS, it is necessary to conduct “bridge” studies in order to replicate the results of preclinical and clinical studies into real clinical practice.

Aim. To demonstrate the possibility of the influence of metabolic disorders on the formation of type 2 myocardial infarction in a young woman using a clinical example. Key points. Acute myocardial infarction in young women may not be diagnosed due to low alertness of doctors and patients themselves, since this pathology is rare at this age. However, over the past decade, the prevalence of myocardial infarction in young women has increased. The presented clinical case demonstrates the development of atherosclerotic coronary lesion with critical stenosis of the coronary artery in a 31-year-old woman, which required its endoprosthetics. The lesion manifested itself with a typical clinical picture of newly developed angina, but the patient herself assessed these symptoms incorrectly, which led to late hospitalization and the development of myocardial infarction. Acute myocardial infarction was briefly preceded by an unfavorable metabolic background: impaired carbohydrate metabolism, abdominal obesity, hypothyroidism. Conclusion. Despite the low incidence of ischemic heart disease in young women, it is necessary to be alert in the presence of myocardial ischemia symptoms in this group of patients, especially in the presence of metabolic disorders. The most important are carbohydrate metabolism disorders, abdominal obesity, and hypothyroidism. Abdominal obesity, accompanied by metabolic disorders, may be one of the possible potentially controllable risk factors for myocardial infarction in young women. Keywords: myocardial infarction, young women, abdominal obesity.

INTRODUCTION: Specialized scales developed to assess survival and mortality of patients after liver transplantation have not been validated when applied to liver failure in the setting of obstructive jaundice. OBJECTIVE: To determine the prognostic value of multiparametric scoring scales and to identify predictors of unfavorable outcome in liver failure due to obstructive jaundice. MATERIALS AND METHODS: 53 patients with confirmed liver failure due to obstructive jaundice of benign etiology who underwent biliary decompression were included in this prospective, observational, single-center study. Depending on the outcome two groups were distinguished: with favorable (n = 27, 51 %) and with unfavorable outcome (n = 26, 49 %). The following time points were defined for the dynamic evaluation of the course of the disease: day 1, day 3, day 7, and day 11 after decompression. Statistical processing of the data was performed using IBM SPSS Statistics 22 software for social science data analysis. RESULTS: The sensitivity and specificity of the studied scales in predicting liver failure due to obstructive jaundice were calculated on the basis of receiver operating characteristic (ROC) analysis. The AUROC for the SOFA was 0.862, for the MELD — 0.882, for the APACHE II — 0.864, for the Child-Turcotte-Pugh — 0.813. The sensitivity and specificity values for the SOFA were 78.9 and 77.8 %, for the MELD — 80.8 and 79.7 %, for the APACHE II — 57.7 and 81.9 %, and for the Child-Turcotte-Pugh — 75.1 and 70.9 %, respectively. Albumin was an independent predictor of unfavorable outcome (AUC ROC 0.909, p = 0.01), sensitivity 88.6 %, specificity 85.2 %. CONCLUSIONS: The scales presented in the study and the biomarker candidate “albumin” showed significant prognostic ability, but low values of sensitivity and specificity (less than 80 %) in some points of the study require the search for additional predictors of unfavorable outcome of liver failure due to obstructive jaundice.

The functional responsibilities of general practitioners (family doctors) (GPs) have changed significantly over the past decade. The number of GP functions has expanded. Despite the increasingly complex professional activities of GPs, there is no scientific evidence for the qualification characteristics of GPs expressed in knowledge, skills, abilities, and competencies in the theory and practice in training. In this regard, a study was conducted to determine the priority of GP competencies that make up the qualification characteristics of a specialist. Aim. To analyze, generalize and rationale the research results, as well as to develop preliminary guidelines for GP training. Material and methods. The information base for the study was the results of ranking competencies according to their importance in the professional activities of GPs in Russia. It was obtained during the ascertaining experiment, implemented using the Delphi method as a method of expert assessment and strategic planning of training specialists. Conclusion. The analysis of competencies developed and agreed upon by experts showed its compliance with the job functions of GPs, the requirements of the Federal State Educational Standard for the General Medical Practice (Family Medicine) and the WONCA guidelines. A summary of the study results to determine the priority of competence in GP activities showed the following: — all competencies (25) were defined as necessary and constitutive of GP qualification; — 21 competencies were considered significant and highly significant for GPs; — 4 competencies were considered as of moderate significance and below moderate significance. The analysis of the priority of competences revealed insufficient methodological support for GP training in accordance with the social order. The results obtained showed the need to continue the study within the project "Quality Management of Training of General Practitioners (Family Doctors)".

Aim. To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.Material and methods. The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%).Results. A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.Conclusion. IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the “aggressiveness” of therapy.

This brief review presents Russian and foreign models of acute myocardial infarction (AMI), which are used to gain new knowledge about the pathophysiology of the development of this disease, as well as to search for sensitive and specific biomarkers of AMI and associated pathologies, including vascular cognitive disorders. However, modeling vascular cognitive disorders associated with AMI is a challenging task. Re-searchers need to take into account the additive effect of ischemia of striated muscles (myocardium or skeletal muscles) and central anesthetics during the simulation of AMI in experimental animals.

Background/Objectives: The anxiolytic effect of transcutaneous electrical nerve stimulation (TENS) is associated with the activation of endogenous inhibitory mechanisms in the central nervous system. Both low-frequency, high-amplitude TENS (LF-TENS) and high-frequency, low-amplitude TENS (HF-TENS) are capable of activating opioid, GABA, serotonin, muscarinic, and cannabinoid receptors. However, there has been no comparative analysis of the effectiveness of HF-TENS and LF-TENS in the treatment of GAD. The purpose of our research was to study the effectiveness of direct HF-TENS and LF-TENS of the right median nerve in the treatment of patients with GAD compared with sham TENS. Methods: The effectiveness of direct HF-TENS and LF-TENS of the right median nerve in the treatment of GAD was studied using Generalized Anxiety Disorder 7-item scale (GAD-7) and the Hamilton Anxiety Rating Scale (HAM-A). 40 patients underwent sham TENS, 40 patients passed HF-TENS (50 Hz—50 μs—sensory response) and 41 patients completed LF –TENS (1 Hz—200 μs—motor response) for 30 days daily. After completion of treatment, half of the patients received weekly maintenance therapy for 6 months. Electroencephalography was performed before and after treatment. Results: Our study showed that a significant reduction in the clinical symptoms of GAD as assessed by GAD-7 and HAM-A was observed after HF-TENS and LF-TENS by an average of 42.4%, and after sham stimulation only by 13.5% for at least 2 months after the end of treatment. However, LF-TENS turned out to be superior in effectiveness to HF-TENS by 51% and only on electroencephalography leads to an increase in PSD for the alpha rhythm in the occipital regions by 24% and a decrease in PSD for the beta I rhythm in the temporal and frontal regions by 28%. The prolonged effect of HF-TENS and LF-TENS was maintained without negative dynamics when TENS treatment was continued weekly throughout the entire six-month observation period. Conclusions: A prolonged anxiolytic effect of direct TENS of the right median nerve has been proven with greater regression of clinical and neurophysiological manifestations of GAD after LF-TENS compared to HF-TENS. Minimal side effects, low cost, safety, and simplicity of TENS procedures are appropriate as a home treatment modality.

Aim. To assess awareness of blood pressure (BP) level, adherence to therapy and achievement of target BP in residents of Russian regions as part of the 2023 hypertension (HTN) screening campaign. Material and methods. During May 2023, 4613 participants from 23 cities of Russia took part in the screening. Participation was voluntary without restrictions on sex. All patients aged over 18 years. During screening, BP and pulse were measured three times using automatic or mechanical BP monitors, and a questionnaire about behavioral risk factors, concomitant diseases and therapy was filled out. HTN was diagnosed with systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or taking antihypertensive therapy (AHT). Results. The analysis included data from 4585 respondents aged 18 to 95 years with an average age of 45 [28;59] years, of which 1729 were men (37,7%). The proportion of hypertensive patients was 49,6%. Among them, 62,8% took AHT and achieved target BP in 76,6% and 45,7% with the target BP criterion <140/90 mm Hg and <130/80 mm Hg, respectively. Most patients took dual AHT (37,4%), while monotherapy and triple therapy was registered in 27,5% and 23,4%, respectively. Initiation of therapy was performed with combination AHT in 43,7% of patients with HTN and 41,4% are currently using fixed-dose combination therapy. On-demand therapy was the most common reason for skipping medications and was more common in women, while men more often cited the high drug cost and a history of adverse reactions. Among patients with HTN, home BP measurement was associated with a higher prevalence of achieving target BP as follows: 1000 (60%) vs 100 (17%), p<0,001. Conclusion. The data obtained indicate, on the one hand, a continuing insufficient level of awareness about high BP and the use of antihypertensive drugs among the population, but there is a tendency to improve the effectiveness of the treatment of hypertension, including the use of fixed-dose combinations of antihypertensive drugs.

On June 24, 2023, a meeting of the Council of Experts was held in videoconference mode with the support of Merck LLC, dedicated to the choice of antihypertensive therapy in patients with arterial hypertension and obstructive sleep apnea syndrome.

АКТУАЛЬНОСТЬ: Специализированные оценочные шкалы, разработанные для оценки выживаемости и летальности пациентов после трансплантации печени, не валидизированы применительно к печеночной недостаточности (ПН) на фоне механической желтухи (МЖ). ЦЕЛЬ ИССЛЕДОВАНИЯ: Определить прогностическую ценность многопараметрических оценочных шкал и выявить предикторы неблагоприятного исхода при ПН на фоне МЖ. МАТЕРИАЛЫ И МЕТОДЫ: В проспективное наблюдательное одноцентровое исследование включены 53 пациента с верифицированным диагнозом ПН на фоне МЖ доброкачественного генеза, подвергшиеся декомпрессии желчевыводящих путей. В зависимости от исхода заболевания выделено две группы: с благоприятным (n = 27, 51 %) и неблагоприятным (n = 26, 49 %) исходами. Для динамической оценки течения заболевания определены временные точки исследования: 1, 3, 7, 11-е сутки после декомпрессионного вмешательства. Статистическую обработку данных проводили с использованием пакета статистических программ анализа данных общественных наук IBM SPSS Statistics 22. РЕЗУЛЬТАТЫ: На основании логистического регрессионного анализа рассчитаны чувствительность и специфичность шкал в прогнозировании ПН на фоне МЖ. Площадь под кривой ошибок (area under the curve receiver operating characteristic, AUC ROC) для шкалы Sequential Organ Failure Assessment (SOFA) составила 0,862, для шкалы Model for End-stage Liver Disease (MELD) — 0,882, для шкалы Acute Physiology and Chronic Health Evaluation (APACHE II) — 0,864, для шкалы Child—Turcotte—Pugh — 0,813. Значения чувствительности и специфичности для шкалы SOFA составили 78,9 и 77,8 %, для шкалы MELD — 80,8 и 79,7 %, для шкалы APACHE II — 57,7 и 81,9 %, для шкалы Child—Turcotte—Pugh — 75,1 и 70,9 % соответственно. Независимым предиктором неблагоприятного исхода является альбумин (AUC ROC 0,909, р = 0,01), чувствительность — 88,6 %, специфичность — 85,2 %. ВЫВОДЫ: Представленные в исследовании шкалы (SOFA, MELD, APACHE II, Child—Turcotte—Pugh) и кандидатный биомаркер «альбумин» показали значимую прогностическую способность, но невысокие значения чувствительности и специфичности (менее 80 %), в некоторых точках исследования требуется поиск дополнительных предикторов неблагоприятного исхода ПН на фоне МЖ.

The aim of the research was to study the frequency of occurrence of anxiety and depression in first-year medical university students in the post-holiday period.Materials and methods. The study involved 70 first-year medical university students (average age 17,9 ± 1,31 years). The study was conducted as part of a periodic medical examination of participants during the first semester (in the early post-holiday period). The Hospital Anxiety and Depression Scale (HADS) was used.Results. The analysis of the answers to the questions of the HADS anxiety subscale showed that more than a third of the survey participants (38,6%) had anxiety disorders, of which more than half of the participants (51,9%) needed the advice of a clinical psychologist or psychotherapist. 21,4% of participants had a feeling of tension, 27,2% - fear, 24,3% - restless thoughts, 17,1% - inability to relax, 22,8% - internal tension or trembling, 40% - restlessness, 31,4% - panic. Analysis of answers to questions on the HADS depression subscale indicated that 22,9% of students had depressive disorders, of which more than a third (37,5%) needed the advice of a clinical psychologist or psychotherapist. 27,1% of participants had a decrease/lack of pleasure from something that used to bring positive emotions, 10% - inability to laugh, 15,7% - lack of a sense of cheerfulness, 20% - slowness, 15,7% - unwillingness to monitor their appearance, 18,6% - decreased sense of satisfaction from hobbies, 20% - decreased feelings of pleasure from a good book, radio or TV program.Conclusion. The expansion of the standard scope of periodic medical examination made it possible to screen the psycho-emotional state of students in the post-holiday period of the autumn semester and identify a risk group for the development and increase of existing anxiety-depressive disorders during the educational process, which can have an adverse effect on both the quality of life of students and the effectiveness and success of training.

Introduction: Despite the long-term use of intramuscular and intraosseous lidocaine trigger point injections (LTPI) in the treatment of patients with low back pain, there have been no studies examining their efficiency in treatment of residual pain after degenerative lumbar spinal stenosis (DLSS) decompression surgery. The purpose of our research is to examine the LTPI efficiency in the treatment of residual lumbar pain after DLSS decompression surgery and to compare the analgesic and recovery effects of intramuscular and intraosseous LTPI administered in the L4–S1 region and in the posterior superior iliac spine (PSIS) after treatment and during four months of follow-up. Materials and Methods: We observed 99 patients (F:50, M:49) aged 42 to 59 years with residual neurological disorders after DLSS decompression surgery. In all patients, the pain syndrome exceeded 6 points on the VAS and averaged 7.2 ± 0.11 points. The control group (n = 21) underwent only pharmacotherapy. In addition to pharmacotherapy, the LTPI group underwent intramuscular LTPI in L4–S1 (n = 20), intramuscular LTPI in the PSIS (n = 19), intraosseous LTPI in L5, S1 (n = 20), and intraosseous LTPI in the PSIS (n = 19). A neurological examination was carried out before treatment, 7 days after completion of treatment, and at the end of the second and fourth months of the follow-up period. Results: In the control group, intramuscular LTPI in L4–S1 subgroup, intramuscular LTPI in PSIS subgroup, intraosseous LTPI in L5, S1 subgroup, and intraosseous LTPI in PSIS subgroup, the severity of pain decreased after treatment by 27.1% (p ≤ 0.05), 41.7% (p ≤ 0.01), 50.7% (p ≤ 0.01), 69% (p ≤ 0.01), and 84.7% (p ≤ 0.01), respectively, and at the end of the second month of follow-up, by 14.3% (p > 1), 29.2% (p ≤ 0.05), 38% (p ≤ 0.01), 53.5% (p ≤ 0.01), and 72.2% (p ≤ 0.01), respectively. Reduction of neurogenic claudication, regression of sensory deficit, increase of daily step activity, and improvement of quality of life after treatment were noted in intramuscular LTPI subgroups by 19.6% (p ≤ 0.05), 36.4 (p ≤ 0.05), 40.3% (p ≤ 0.01), and 21.0% (p ≤ 0.05), respectively, and in interosseous LTPI subgroups by 48.6% (p ≤ 0.01), 67.4% (p ≤ 0.01), 68.3% (p ≤ 0.01), and 46% (p ≤ 0.01), respectively. Conclusions: LTPI is highly effective in the treatment of patients with residual pain after DLSS decompression surgery. High analgesic effect, significant regression of sensory deficits and gait disorders, and remarkable improvement of daily step activity and quality of life are noted not only after the end of LTPI treatment but also continue for at least 2 months after treatment. Intraosseous LTPI is more effective than intramuscular LTPI by 92%, and LTPI in PSIS is more effective than LTPI in L4–S1 by 28.6%.