Moscow Clinical Scientific Center

Examines injuries in hockey as one of the most pressing issues facing modern sports medicine and epidemiology. Domestic and foreign epidemiological data are presented according to the level of sports events, gender and age of athletes, localization of injury, as well as characteristics of internal and external risk factors.

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.

Pulmonary arteriovenous malformation (PAVM) is an embryonic disorder of pulmonary vessels characterized by a communication between arterial and venous vessels. It occurs in 2–3 cases per 100 thousand population. In 60–70% of cases, PAVM can be single, in 30–40% of cases they are multiple, in 75% of cases – unilateral. It is known that the effect of oncogenes, teratogens, and ionizing radiation in the 7–12th weeks of embryogenesis is a prerequisite for the formation of vascular anomalies. However, the main role belongs to genetic factors involved in angiogenesis, inflammatory cytokine genes and genes encoding factors involved in vascular wall remodeling. The article presents a clinical case of PAVM in S4, S5 of the left lung diagnosed by contrast-enhanced multislice computed tomography. The pathology was detected in a 43-year-old male patient who complained of non-productive cough, inspiratory dyspnea with minor physical exertion, headaches, severe general weakness, which appeared after left-sided pneumonia suffered a month before admission to the hospital. Left-sided video-assisted thoracic surgery was performed with segmentectomy of S4, S5 left lung segments. Histological examination revealed arteriovenous anastomoses.

Background. In Russian clinical practice, there is no systematic information on patients with follicular lymphoma (FL) relapses after first-line therapy, and only isolated data are presented regarding the frequency of early and late relapses in the domestic population, first-line therapy regimens used in these patients, the dynamics of treatment response, timing of relapse, and second-line therapy regimens. A detailed analysis of a large cohort of patients with relapsed FL, including detailed clinical, laboratory, morphoimmunohistochemical, and molecular genetic characteristics, the treatments administered at onset and during relapse, as well as the identification of factors correlating with the risk of early progression, is of great scientific and practical interest. This is the focus of this study. Our results will be aimed at optimizing treatment and improving the prognosis of FL patients in Russia who have received second-line therapy. Aim. To describe changes in the therapeutic landscape of first-line FL therapy from 2001 to 2025 for patients receiving treatment at the National Medical Research Center for Hematology; to analyze the effectiveness of the therapeutic protocols used; to study cases of treatment resistance and identify significant factors influencing the prognosis of the disease; as well as to determine outcomes for patients with the first early relapse of nodal FL. Materials and methods. A retrospective and prospective study conducted from 2001 to 2025 at the National Medical Research Center of Hematology (Moscow) included 445 patients with newly diagnosed FL of cytological types 1–2 and 3A (World Health Organization, 2017). The median follow-up was 95 (1–251) months. All patients were treated according to the criteria of the Groupe d’Etude des Lymphomes Folliculaires. All patients included in the study were divided into two groups: those who received initial treatment between 2001 and 2022 (the historical control group; n = 374) and those who received initial treatment between 2022 and 2025 according to the new FL-2022 risk-based differentiated treatment protocol for patients with nodal FL (n = 71). Data for the two groups were analyzed separately. Results. With a median follow-up of 98 (1–251) months, the 2-year, 5-year, and 10-year overall survival of 374 patients from the historical control group (2001–2022) were 93, 90, and 85 %, respectively; 2-year, 5-year, and 10-year event-free survival were 82, 71, and 55 %, respectively. With high-dose chemotherapy, compared with standard regimens, the proportion of progressions / relapses was significantly lower (26 % versus 40 %; p = 0.01), but if events occurred, they were predominantly early (72 % versus 58 %; p = 0.2). According to the results of multivariate analysis, independent prognostic risk factors for disease progression within 24 months after the start of therapy (POD24) were identified: absence of BCL2 gene rearrangement (odds ratio 3.52 (1.89–6.55); p 0.0001) and 3A cytological type (odds ratio 3.8 (1.61–0.16); p = 0.0033). During second-line therapy in the first early relapse / progression after R-B (rituximab + bendamustine), R-CHOP (rituximab + cyclophosphamide + doxorubicin + vincristine + prednisolone) and autologous hematopoietic stem cell transplantation, complete remission was achieved in only 38 % of patients, and after R-DHAP it was not achieved in any case. With therapy according to the FL-2022 protocol (2022–2025), with a median follow-up of 23 months, 2-year overall survival was 100 %, 2-year event-free survival was 97 %. Second-line therapy was required in only 6 % of patients. Conclusion. The development of early relapse / progression has a critical impact on the survival prognosis of FL patients. The use of a differentiated treatment protocol for patients with nodal FL (FL-2022), based on clinical, morphological, immunohistochemical, and genetic prognostic factors, has significantly improved treatment outcomes and reduced the risk of POD24. When FL first relapses, there is no uniform treatment standard, and the regimens used vary greatly. Treatment outcomes in the first relapse remain modest, especially for the high-risk POD24 group, necessitating a change in the treatment paradigm for this patient group.

Aim: to present clinical guidelines describing the clinical, laboratory, endoscopic and histological characteristics of autoimmune gastritis (AIG) and to provide information support for decision-making on diagnosis, prognosis assessment and choice of management tactics for patients with AIG. Key points. AIG is an organ-specific autoimmune disease characterized by the presence of antibodies to parietal cells and/or intrinsic factor, in which inflammation and atrophy are limited to the gastric mucosa, functionally manifesting as hypo- and achlorhydria. There is evidence of an increase in the incidence of AIG worldwide. AIG is often associated with autoimmune thyroiditis (up to 40 % of cases), type 1 diabetes mellitus, and autoimmune polyglandular syndrome. Data on laboratory diagnostic methods, esophagogastroduodenoscopy, and histological examination of biopsies are presented, with an analysis of the endoscopic and histological picture typical of AIG. When AIG is combined with H. pylori infection, eradication therapy is recommended. In addition to symptomatic treatment and treatment of anemia, long-term rebamipide therapy is recommended to potentiate the protective properties of the gastric mucosa. Endoscopic monitoring of patients with AIG is recommended at intervals of once every 3 years.

Baricitinib (BARI) is widely used in rheumatoid arthritis (RA); however, real-world data on its place in therapy and efficacy in patients with difficult-to-treat (D2T) RA are limited. Objective: to assess the clinical and demographic characteristics of patients with RA, including those in the D2T RA subgroup, the outcomes of BARI use in routine practice across different lines of therapy (LT) and switching strategies, as well as its steroid-sparing effect. Material and methods. A retrospective analysis was performed of patients included in the Moscow registry of immune-mediated inflammatory/autoimmune diseases who were followed up from 19.08.2021 to 26.12.2024 and were prescribed BARI. Data from three visits (V1–V3) with a 6-month interval were analyzed. Study endpoints were changes in DAS28-ESR/CRP, CDAI/SDAI, tender joint count (TJC) and swollen joint count (SJC), patient and physician global assessment of disease activity; the proportion of patients in remission and with low disease activity; the number of patients receiving glucocorticoids (GCs) and methotrexate (MTX), as well as GCs and MTX doses. Current therapy at the time of the study and prior therapy were analyzed; a separate analysis was performed for the D2T RA subgroup. Results and discussion. The study included 188 patients (82% women); mean age was 56.0±12.1 years; median RA duration was 11 (7–18) years. The mean follow-up duration was 12.6 (2.3–29.7) months. The intervals between visits averaged 6.5 months. The D2T RA subgroup included 17 (9%) patients. BARI was prescribed as 1st LT in 62.2% of patients, as 2nd LT in 14.9%, and as 3rd LT in 22.9%; 62.2% of patients had not previously received biologic DMARDs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs), whereas 37.8% were switched to BARI from bDMARDs or tsDMARDs. By V3, with BARI used as 1st LT, the median DAS28-ESR decreased from 3.4 to 3.1 (-8.8%; p<0.05); as 2 nd LT, from 3.3 to 2.9 (-12.1%); and as 3rd LT, from 4.1 to 2.9 (-29.3%); the median DAS28-CRP decreased by 6.9%, 6.9%, and 24.1%, respectively. The greatest reduction in activity indices was observed after switching from interleukin-6 inhibitors (IL-6i): the median DAS28-ESR decreased from 4.02 to 2.99 (-25.6%; p=0.0174) and CDAI from 14.47 to 10.88 (-24.8%). The smallest decrease in indices was recorded after prior therapy with Janus kinase inhibitors (JAKi). In such patients, DAS28-ESR decreased on average by 3.0%, while CDAI increased by 9.1%. In the D2T RA group, a significant reduction in SJC (-74.1%) and TJC (-59.6%) was noted (p<0.05), with a clinically noticeable but statistically non-significant decrease in DAS28-ESR (-18.3%), DAS28-CRP (-23.8%), CDAI (-34.6%), and SDAI (-39.4%). By V3, in 52.1% of patients (p<0.05) it was possible to reduce the GCs dose (21.7%) or discontinue GCs completely (30.4%); the MTX dose and the proportion of patients receiving it also decreased. Conclusion. In real-world practice, BARI therapy provided a reduction in RA activity across different LT and demonstrated a steroid-sparing effect. Even in patients with D2T RA, a clinically meaningful decrease in arthritis activity was observed. The most favorable switching outcomes were noted in patients previously treated with IL-6i, whereas in patients who had used JAKi, the effect of BARI was limited, which is associated with a change in the mechanism of action when another drug is prescribed. These findings require confirmation in prospective studies.

In recent years, reconstructive surgery strategies have been supplemented with innovative approaches aimed at developing tissue-engineered structures using autologous tissues and biodegradable scaffolds and matrices, the purpose of which is to reduce the risk of postoperative complications, on the one hand, while ensuring accelerated restoration of the structure and functions of organs, on the other hand. The review systematizes modern scientific trends in the field of tissue engineering of the urethra, focused on creation of biocompatible and functionally active tissue-engineered structures using achievements of cellular technologies and materials science. Particular attention is paid to describing the mechanisms and ways of forming a complete and functional three-dimensional structure of the urethra, including the use oforganoids. It is expected that this strategy will contribute to the development of personalized therapeutic approaches and improved clinical outcomes in the patients with urological diseases.

Aim. To present clinical experience with combined management of severe pseudomembranous colitis using the ATLAS scale for risk stratification and therapeutic optimization. For patients scoring 4-6 points on the ATLAS scale, a diverting loop ileostomy is created with intraoperative catheter placement through the efferent limb into the colonic lumen. In the postoperative period, sequential antegrade colonic lavage is administered via the catheter according to the following protocol: vancomycin 125-250 mg, metronidazole 500-1000 mg, and fidaxomicin 200-220 mg in 500 mL of normal saline, followed by rebamipide 100-120 mg in 500 mL of normal saline - administered twice daily with a 6-hour interval for 10 days. Conclusion. The reported case demonstrates the effectiveness of this combined strategy for managing severe Clostridioides difficile-associated pseudomembranous colitis refractory to standard medical treatment.

Modern regenerative surgery is a promising interdisciplinary field based on the use of stem cells and fully functional tissue equivalents created through cellular engineering techniques. These cells can differentiate into specialized cell types and modulate inflammatory processes, offering broad potential for the repair of damaged tissues. Of particular interest are multipotent mesenchymal stromal cells (MSCs), which exhibit high plasticity. They can differentiate into various cell lineages, including adipogenic, chondrogenic, osteogenic, and myogenic, as well as pancreatic cells, hepatocytes, and neural cells. Another key tool in regenerative medicine is platelet-rich plasma (PRP). Its advantages include ease of preparation and a minimal risk of immune reactions.