Federal Almazov North-West Medical Research Centre

Introduction. At least ten percent of patients who temporarily require mechanical ventilation undergo tracheostomy to ensure airway patency and prolonged ventilatory support. In contemporary clinical settings, the timely supply of tracheostomy-related devices represents a significant practical challenge. The aim of this study is to develop a device designed to maintain tracheostomy stoma patency, enabling effective tracheobronchial toilet, oxygen insufflation, and rapid reinsertion of a tracheostomy tube when mechanical ventilation needs to be resumed.Materials and methods. The methodology was based on a systems approach to the analysis and synthesis of technical systems, the development and substantiation of engineering design solutions, as well as reengineering with the optimization of key parameters and the application of methods for assessing the level of technical and economic excellence of the product.Results. A Russian medical device, the “FaTrox System” T-shaped tracheostomy tube, has been developed to facilitate the adaptation of patients receiving mechanical ventilation to spontaneous breathing, provide access for bronchial hygiene, and enable decannulation. Discussion and conclusion. Preliminary technical and technological solutions for maintaining the patency of a tracheostomy in bedridden patients provide a basis for pilot manufacturing of a medical device, followed by clinical trials to confirm its effectiveness.

Background : Acute postoperative perforating ulcers of the small intestine (APPSUI) are an understudied but dangerous complication of abdominal and pelvic surgeries. The absence of national clinical guidelines for APPSUI management makes it difficult to choose the optimal surgical approach and postoperative patient management in case of this complication. Aim : To determine the optimal surgical approach for managing APPSUI following abdominal and pelvic surgeries. Methods: Analysis of medical records of patients who underwent emergency and elective surgeries on abdominal and pelvic organs at the I.I. Mechnikov North-Western State Medical University, City Hospital No. 40, and Toksovo Clinical Interdistrict Hospital between 2012 and 2025, followed by the development of APPSUI. Inclusion criteria: Age over 18 years; History of surgery on abdominal or pelvic organs; Development of acute perforating ulcers of the small intestine during the postoperative period within the current hospitalization. Exclusion criteria: Age under 18 years; Development of small intestine perforation in close proximity to anastomoses or intestinal stomas (0.5-1 cm); Inability to exclude small intestine perforation due to mechanical or thermal injury Generalized oncological process. Results: The study analyzed medical records of 98 patients with diagnosed APPSUI. The age range of the study sample was 28 to 88 years (mean 55.5±14.1). Gender distribution: female (n = 62; 63.3%) of the total number of patients. Analysis of hospitalization type: 76.5% of patients (n = 75) were admitted to the hospital as emergencies. The main finding : upon initial detection of APPSUI, suturing should be applied as it shows the lowest mortality rate (25%; p = 0.045). Resection of the affected area is recommended for repeated perforation and/or failure of previously sutured defect. Conclusion : Differences in mortality rates depending on the chosen surgical approach for APPSUI were identified. The lowest mortality rate is observed with the suturing method, while the highest rate is characteristic of ileostomy formation when used at initial APPSUI detection. In 29 (29.5%) patients, the first relaparotomy was scheduled, of which 13 (13.2%) had a favorable outcome. In other cases, relaparotomy was performed on demand (n = 69 (70.4%)), of which 8 (11.5%) were discharged. The statistically significant difference (p<0.001) between the groups confirms lower mortality in the scheduled relaparotomy group.

Purpose. To evaluate the association between the severity of hepatic steatosis, quantitatively determined by the mean whole-liver proton density fat fraction on magnetic resonance imaging (MRI), and body mass index (BMI) in the examined patients. Materials and methods. A retrospective observational study included 776 patients who underwent multiparametric abdominal magnetic resonance imaging on Magnetom Vida (Siemens) 3 T and Ingenia Ambition S (Philips) 1.5 T scanners. BMI was calculated using the standard formula and considered a systemic anthropometric indicator of obesity. Quantitative assessment of hepatic steatosis was performed using the mean whole-liver proton density fat fraction. Steatosis severity was classified as S 0-S 3. Nonparametric statistical methods were used, including Spearman correlation analysis, intergroup comparisons with Benjamini-Hochberg correction for multiple testing, and ROC analysis. Results. A statistically significant positive correlation was found between hepatic proton density fat fraction and BMI (p=0.569; p<0.001). At the same time, for identical BMI values, a wide range of proton density fat fraction values was observed, with substantial overlap between steatosis grades. Hepatic steatosis was detected in 9 % of patients with BMI <25 kg/m2, whereas 36 % of patients with BMI >30 kg/m2 had no signs of steatosis. The area under the ROC curve for BMI was 0.793 for detecting steatosis >S 1, 0.761 for >S 2, and 0.706 for >S 3, corresponding to moderate to low discriminative performance. Conclusion. BMI is statistically associated with the severity of hepatic steatosis but demonstrates high variability and pronounced overlap between steatosis grades. The presence of hepatic steatosis in 9 % of patients with normal BMI and its absence in 36 % of patients with obesity reflect the limited diagnostic value of BMI for assessing the degree of hepatic fat infiltration. Quantitative assessment of proton density fat fraction by MRI provides an objective and reproducible characterization of hepatic steatosis regardless of BMI category.

Russian-language resources for medical natural language processing (NLP) are expanding rapidly; however, their fragmentation, uneven curation, and limited clinical reliability hinder the development of safe machine learning systems for prognosis, prevention, and precision medicine. We provide the first systematic survey of Russian medical NLP datasets and analyze their suitability for clinically meaningful tasks as defined by the MedHELM taxonomy. We additionally perform expert clinical validation of three representative public corpora—RuMedPrimeData (real outpatient notes), MedSyn (synthetic clinical notes), and RuMedNLI (translated natural language inference)—assessing clinical plausibility, diagnosis accuracy, and logical consistency. Experts identified substantial reliability issues: across randomly sampled subsets of each corpus, only approximately 20% of RuMedPrimeData records, fewer than 15% of MedSyn records, and approximately 55% of RuMedNLI pairs met essential quality criteria, which can hinder downstream ML systems built on these data. To support robust applications—ranging from medical chatbots and triage assistants to predictive and preventive models—we outline practical requirements for high-quality datasets: coordinated, expert-validated, machine-readable corpora aligned with clinical guidelines and insurance logic, standardized de-identification, and transparent provenance. Strengthening these data foundations will enable the development of reliable, reproducible, and clinically relevant AI systems suitable for real-world healthcare applications.

This article presents a rare clinical case of nodular adenomyosis located in the isthmic region of the uterus in a pregnant patient. The peculiarity of this form is that the adenomyosis node can prevent the fetus from passing through the birth canal, which required a change in clinical management. Elective delivery via a classical cesarean section was selected as a lower segment incision was technically infeasible due to the location of the adenomyosis node in the lower uterine segment. Magnetic resonance imaging enabled accurate localization of the adenomyosis node during pregnancy. This case highlights the importance of raising awareness in the diagnosis of this condition in order to choose appropriate delivery tactics and prevent obstetric risks.

Today, thanks to recent advances in stroke treatment, mortality rates are declining and life expectancy is increasing for patients who have suffered a cerebrovascular accident. However, hemorrhagic stroke remains a leading cause of disability. The occurrence of adverse outcomes such as post-stroke seizures and epilepsy undoubtedly impairs patients’ quality of life. One approach to addressing the important clinical and research challenge of preventing post-stroke seizures is the administration of antiepileptic drugs in the early stages of hemorrhagic cerebrovascular accidents.

Myocardial repolarization disturbances resulting in an increased value of dispersion of ventricular repolarization (DR) are associated with the development of life-threatening ventricular arrhythmias. The main tool for detection of repolarization disorders is electrocardiography (ECG). This review is devoted to the new knowledge regarding the physiological and clinical significance of DR and its ECG-reflection. The search for scientific literature was performed using e-LIBRARY, CyberLeninka and Pubmed data bases and the keywords (dispersion of repolarization, QT interval dispersion, Tpe interval, Tpe interval dispersion, Tpe/QT ratio) in different Russian and English spellings. The analysis of experimental, clinical and in silico studies demonstrated that the interval between the peak and the end of T-wave (Tpe) and its derivatives (relatively new ECG-indices, not yet widely used in clinical practice — Tpe interval dispersion and Tpe/QT ratio) provide information of both global and local dispersion of ventricular repolarization, being the proven useful predictors of life-threatening arrhythmias associated with the increased repolarization heterogeneity and the total mortality, while the dispersion of QT interval (the most “traditional” index of DR) is the least accurate measure of DR and arrhythmic risk. The threshold values of the considered ECG-indices of DR are given, and the age- and sex-dependence of them is discussed. The peculiarities of T-wave parameters measuring as well as the problems and the prospects of searching for the new arrhythmogenic ECG-indices are discussed.

Polymyalgia rheumatica (PMR) is a prevalent immune-mediated inflammatory rheumatic disease that typically affects individuals over the age of 50. Despite significant advances in the diagnosis and treatment of PMR, challenges remain in the objective assessment of disease activity, which hinders the development and implementation of the treat-to-target (T2T) strategy. Diagnosis is primarily based on clinical symptoms and laboratory markers of inflammation—most notably, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). However, the diagnostic value of these markers is reduced in patients receiving interleukin-6 inhibitors, emphasizing the need for alternative biomarkers. The Polymyalgia Rheumatica Activity Score (PMR-AS) and its modifications (CRP-PMR-AS, ESR-PMR-AS, and clin-PMR-AS) are among the most thoroughly studied tools for the quantitative assessment of disease activity. The potential of imaging modalities such as ultrasound and magnetic resonance imaging (MRI) is also being actively explored for visualizing structural changes and assessing inflammatory activity in PMR. These techniques have demonstrated high sensitivity and specificity but require further standardization and validation of their clinical relevance. The development of a comprehensive monitoring strategy based on validated indices and objective biomarkers may serve as a foundation for the creation of national clinical guidelines and facilitate the successful implementation of the T2T approach in routine rheumatologic practice.

For patients with glioblastoma, the LMR serves as a diagnostically significant inflammatory biomarker independent of glucocorticoid administration. In patients with metastatic brain lesions, the most significant diagnostic value was demonstrated by monocyte counts, PIV and LMR.