Novosibirsk State Medical University

Objective. To evaluate structural retinal changes in patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) over time and to analyze their association with the progression of neurological impairment. Material and methods . Clinical data (EDSS, T25FW, 9-HPT, SDMT) and optical coherence tomography (OCT) results (average thickness of the ganglion cell and inner plexiform layer [avgGCL+IPL]; average thickness of the peripapillary retinal nerve fiber layer [avgRNFL]) were analyzed in patients with RRMS and SPMS (42 women, 19 men; age 46.20 ± 9.49 years) over a follow-up period of 12.87 ± 1.25 months. Comparisons were performed between groups stratified by disability level (Group 1: EDSS 0–2.0, Group 2: EDSS 2.5–3.5, Group 3: EDSS≥4.0), as well as by the presence of at least one sign of progression (increase in EDSS by 0.5–1.0, ≥20 % worsening in T25FW/9HPT, or ≥4-point/10 % decrease in SDMT). Results and discussion . EDSS did not change significantly during follow-up (p = 0.451); however, 45.2 % of patients demonstrated signs of progression according to T25FW/9HPT/sDMT. T25FW performance worsened more markedly in Groups 2 and 3 (p < 0.001), while no significant differences were observed between groups in other measures. Statistically significant differences in avgGCL+IPL and avgRNFL were found between Groups 1 and 3 (p = 0.007 and p = 0.016, respectively). Annual avgGCL+IPL change was −0.58 [−1.00; −0.17] μm in Group 1 vs. −3.00 [−3.33; −1.25] μm in Group 3; annual avgRNFL change was −0.62 [−1.75; 0.75] μm in Group 1 vs. −2.38 [−3.25; −1.88] μm in Group 3. Moreover, annual reductions in avgGCL+IPL and avgRNFL were greater in patients with progression (−1.54 [−3.00; −0.46] and −2.31 [−4.69; −1.25] μm, respectively) compared with stable patients (−0.83 [−1.50; −0.25] and −0.75 [−1.88; 0.50] μm, respectively), with statistically significant differences (p = 0.018 and p = 0.003, respectively). Progression was predicted by avgGCL+IPL loss >1.17 μm/year (sensitivity 64.3%; specificity 66.7 %) and avgRNFL loss >1.125 μm/year (78.6 and 63.6 %, respectively). Conclusions. Accumulation of neurological deficits occurs even in the absence of EDSS changes, while the neurodegenerative process is more active in patients with greater disability and longer disease duration. Annual thinning of avgGCL+IPL and avgRNFL on OCT may serve as a predictor of MS progression.

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.

Purpose of a study: to analyze the possibility results of surgical treatment of patients with mediastinal tumors. Material and methods . From 2006 to 2024, 278 patients (97 (34.89%) men and 181 (65.11%) women) with mediastinal tumors various interventions were performed. The age of the study participants ranged from 15 to 79 years, average age of patients was (49.8 ± 11,8) years old. In 96 cases, open interventions were performed, in 182 cases, mini invasive. In 219 (78.77%) patients, the tumor was localized in the anterior mediastinum, in 58 (20.86%) in the posterior mediastinum, in 1 (0.35%) in the anterior and posterior mediastinum. Results . The tumor was completely removed using sternotomy in 59 patients (21.22%), thoracoscopy in 134 (48.20%), thoracotomy in 18 (6.47%), dual-port thoracoscopy in 16 (5.75%), single-port access in 5 (1.79%), VATS intervention in 4 (1.43%), cervicotomy with partial sternotomy in 2 (0.71%), and clamshell in 1 (0.35%). Partial tumor resection was performed in 16 (5.75%). In 13 patients (4.68%), the volume of intervention was expanded due to tumor invasion or ingrowth into the vessels of the lung, pericardium, lung tissue, or chest wall. Postoperative complications occurred in 20 patients (7.19%). The mortality rate was 2.15% (6 patients). Conclusion . Surgical interventions in patients with mediastinal tumors are highly effective and have a low incidence of intra- and postoperative complications and mortality. When planning a surgical intervention, preference should be given to mini invasive interventions as low-traumatic, shorter in duration and highly radical, comparable to “open” surgeries. If mini invasive intervention is impossible, an “open” version of the operation can be considered, including with expansion of the volume when the tumor grows into the lung tissue, vessels, pericardium. Tumor debunking intervention are applicable for large tumors to reduce their volume, eliminate compression of the trachea, bronchi, vessels and carry out further treatment (chemotherapy, radiation therapy).

The purpose of the study is to identify the personal determinants of constructive and destructive strategies of ethnocultural adaptation among adolescents in a multicultural educational environment. Research methods and organization. The study involved adolescents aged 15–18 years, representing Russian, Tatar, and Uzbek ethnocultural groups. As personality determinants, indicators of voluntary behavioral self-regulation, emotional intelligence, coping strategies, and character accentuations were considered. To analyze the relationships between personality traits and adaptation strategies, correlation analysis and multiple regression analysis were used. Research results and conclusions. The obtained data demonstrated that constructive strategies of ethnocultural adaptation are determined by a well-developed system of behavioral self-regulation, the ability to manage emotional states, and a predominance of cognitive coping strategies. Destructive strategies are associated with emotional reactivity, impulsivity, avoidance, and the prominence of certain types of character accentuations. The findings expand our understanding of the psychological mechanisms of ethnocultural adaptation in adolescents and confirm the significance of personal resources as factors in the formation of adaptive behavior in a multicultural educational environment.

Aim . To optimize the risk assessment of hemodynamically significant coronary artery (CA) stenosis in COVID-19 survivors with chronic coronary syndrome (CCS) based on a comprehensive analysis of anamnestic, clinical and paraclinical parameters. Material and methods. The study included 431 patients with CCS and positive SARS-CoV-2 serological tests for >12 weeks prior to enrollment (203 with mild and 228 with moderate COVID-19). The examination included clinical and laboratory parameters (including apolipoprotein A1 and B, lipoprotein(a)), systemic inflammation biomarkers, echocardiography, coronary angiography, and residual risk assessment. Multivariate logistic regression analysis was performed to identify independent predictors of hemodynamically significant coronary artery stenosis. Statistical processing was performed using RStudio 2025.05.0 (R 4.4.2), with p<0,05 considered statistically significant. R e sults . Patients with moderate COVID-19 were more likely to have class II obesity (p=0,004), type 2 diabetes (p=0,007), C3-C4 chronic kidney disease (p<0,001), functional class III angina (p<0,001), heart failure with mildly reduced ejection fraction (p=0,003), as well as more pronounced metabolic disorders and inflammatory shifts. In this group, GZSCA (86,4% vs, 68,0%; p<0,001), multivessel disease (p=0,046), and coronary artery restenosis (p=0,042) were diagnosed significantly more often. Multivariate logistic regression analysis identified the following predictors for hemodynamically significant CA stenosis: moderate COVID-19 (odds ratio (OR) 1,84 [1,02; 3,39], p=0,047), aortic diameter >3,28 cm (OR 2,52 [1,42; 4,55], p=0,002), segmental myocardial contractility disorders (OR 3,72 [1,71; 9,06], p=0,002), extracranial artery atherosclerosis (OR 2,56 [1,37; 4,78], p=0,003), hyperuricemia >308,5 μmol/L (OR 2,22 [1,25; 3,95], p=0,006), high-density lipoprotein <1,27 mmol/L (OR 1,99 [1,11; 3,62], p=0,021), high residual risk for low density lipoprotein (OR 2,48 [1,31; 4,7], p=0,005), triglyceride-glucose index >9,46 (OR 1,89 [0,91; 4,22], p=0,102), fibrinogen >3,25 g/L (OR 1,62 [0,83; 3,12], p=0,149), history of hypertension >16 years (OR 1,85 [0,98; 3,6], p=0,064) and age >56 years (OR 1,65 [0,88; 3,09], p=0,116). Based on the resulting multifactorial model, an online risk prediction calculator for hemodynamically significant CA stenosis in COVID-19 survivors with CCS. Conclusion . Previous COVID-19, especially with moderate course, is associated with a more unfavorable clinical and angiographic phenotype of CCS. The developed risk prediction algorithm for hemodynamically significant CA stenosis can serve as a practical tool for early risk stratification and optimization of patient management in the post-COVID period.

BACKGROUND: Stress urinary incontinence is the most common lower urinary tract disorder in women. Obesity notably increases the risk of this condition. Surgical correction using a free synthetic sling is considered the gold standard of treatment; however, long-term outcomes in patients with morbid obesity remain controversial. AIM: This work aimed to evaluate the long-term outcomes of urethropexy using a free synthetic sling in patients with urinary incontinence and morbid obesity. METHODS: A comparative analysis of treatment outcomes was performed in 81 women with urinary incontinence and morbid obesity, divided into two groups according to the surgical approach: transobturator (n = 40) and retropubic (n = 41). Treatment outcomes were assessed at 1, 3, and 6 months postoperatively. Long-term results were evaluated after 12 months or longer. Follow-up examinations included vaginal examination with cough stress test, uroflowmetry, bladder ultrasonography with assessment of postvoid residual urine volume, and completion of the UDI-6, ICIQ-SF, and I-QOL questionnaires. RESULTS: The median age was 57.5 years [51.5; 63.5] in the transobturator group and 61 years [54; 65] in the retropubic group. The median body mass index was 38.9 kg/m2 [36.9; 40.1] in the transobturator group and 39.1 kg/m2 [37.2; 40.5] in the retropubic group. The mean postoperative follow-up period was 12 ± 2.4 months. Patients in both groups reported improved quality of life. The rate of recurrent urinary incontinence based on the cough stress test was 6 cases (14.6%) in the transobturator group and 4 cases (10%) in the retropubic group. CONCLUSION: A free synthetic sling is an effective method for the correction of stress urinary incontinence in patients with morbid obesity. A lower recurrence rate in the long-term period was observed in the retropubic approach group.

This study evaluated the effectiveness of Vabysmo (faricimab) in the treatment of patients with nAMD and DME in real-world clinical practice in Russia. A multicenter retrospective analysis was conducted based on the medical records of 328 patients (370 eyes) with nAMD and 87 patients (112 eyes) with DME (both treatment-naïve and previously treated with anti-VEGF agents) who received faricimab from July 2023 to February 2025. The following primary effectiveness indicators were assessed: changes in visual acuity (VA) and central retinal thickness (CRT) after the first four faricimab injections. Secondary outcome indicators included changes in VA, CRT, and selected disease biomarkers at 6, 12, and 18 months of treatment, as well as injection intervals during the maintenance phase. After the first four consecutive faricimab injections, VA improved by 8.1 ETDRS letters (p<0.05) in the nAMD group and by 12.8 ETDRS letters (p<0.05) in the DME group. CRT decreased by 103.3 μm (p<0.05) and 177.4 μm (p<0.05), respectively. These improvements remained stable during further follow-up (8.78±4.51 months in the nAMD group and 10.48±5.24 months in the DME group, up to a maximum of 19 months in both groups). The proportion of patients who achieved injection intervals of ≥12 weeks was 27.9% in the nAMD group and 38.5% in the DME group. Faricimab demonstrated high clinical effectiveness in real-world settings in patients with nAMD and DME, with the potential to reduce the treatment burden for patients and the healthcare system.

INTRODUCTION. Plants of Boraginaceae family (Pulmonaria mollis, Nonea rossica, Onosma simplicissima, and Cynoglossum officinale) are widespread over the Russian Federation and are promising sources of phytomedicines with important pharmacological properties, such as antimicrobial, antianaemic, anticoagulant etc. Currently, Boraginaceae are not classified as officinal plants, presumably due to pyrrolizidine alkaloids (PA) that can cause hepatotoxic effect. AIM. This study aimed to assess safety using Boraginaceae plants based on acute toxicity and content of pyrrolizidine alkaloids. MATERIALS AND METHODS. The research objects were dried herbs of Pulmonaria mollis, Nonea rossica, Onosma simplicissima, and Cynoglossum officinale , collected from flowering plants in Novosibirsk region over 2023–2024. The composition and amount of alkaloids in alcohol extracts were determined by high-performance liq­uid chromatography with diode array and mass-spectrometry detection with electrospray ionisation. Acute toxicity was tested in vivo in 102 mature male and female CD-1 mice weighing 24.0±2.0 g, aged 12 weeks, taken from Conventional Animal Vivarium of Scientific Center of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences. The animals received a single dose of dried study extracts diluted in distilled water at 5 g/kg. RESULTS. The absence of PA in P. mollis herb was established, alongside with its trace amounts (0.01 μg/g) in P. mollis leaves. In other studied plant species, PA, such as enantiomers of intermedine, lycopsamine and their deriva­tives were found: O. simplicissima herb — 1.07±0.03 μg/g, N. rossica herb — 8.25±0.08 μg/g; in C. officinale herb — 676.3±7.4 μg/g. Assessed acute toxicity made it possible to classify dry extracts from P. mollis herbs and leaves , N. rossica herb and O. simplicissima herb as toxicity class 5, and C. officinale herb as toxicity class 4. CONCLUSIONS. Study doses of extracts taken from herbs and leaves of P. mollis are non-toxic. For extracts from O. simplicissima and N. rossica herb, further research is relevant to determine toxicity in prolonged use. Extracts from C. officinale herb are toxic and cannot be used per os .