Orenburg Regional Clinical Hospital №2

Objectives: To evaluate the effectiveness of our first experience in employing transcathether arterial embolization (TAE) of popliteal artery branches in patients with knee osteoarthritis (OA). Materials and methods: The research included 80 people with knee OA grades 1-2, resistant to standard conservative treatment and without indications for surgical intervention. The patients were divided into 2 groups of 40 people each; in group 1, intra-articular injection of sodium hyaluronate (synovial fluid prosthesis) was chosen as minimally invasive therapy; in group 2, TAE of popliteal artery branches was performed. Clinical and functional characteristics of joints were assessed using WOMAC and Lysholm scales at baseline and 3 months after intervention. Results: Before surgery, in both groups 1 and 2, high levels of WOMAC scale (150 [138-184] and 162 [140-190] points, respectively) and low levels of Lysholm scale (42 [35-54] and 40 [38- 60] points, respectively) were recorded. At 3 months after treatment, patients of both groups demonstrated significant improvement in clinical and functional results in the form of decrease in WOMAC scale to 94 [84-120] for group 1, p<0.001; and 52 [40-79] points for group 2, p< 0.001. According to Lysholm scale, satisfactory results were obtained in group 1 (68 [60-85] points, p = 0.001) and good results in group 2 (91 [85-95] points, p < 0.001). On comparison of both groups, patients with TAE achieved lower values of WOMAC (p = 0.023) and higher values of Lysholm scale (p = 0.06). No complications were recorded in both groups. Conclusion: TAE of popliteal artery branches is an effective minimally invasive intervention that significantly reduces severity of pain and improves the function of knee joints. This method requires more studies with larger number of patients, development of selection criteria in order to increase accessibility in practical healthcare.

Background. Colorectal laterally spreading tumor (LST) is a large and relatively flat neoplasm more than 10 mm in diameter, growing laterally to the intestinal wall. Endoscopy plays a major role in the diagnosis and treatment of LST. Aim. To study the efficacy of endoscopic mucosal resection of colorectal laterally spreading tumors. Materials and methods. A retrospective analysis of the results of endoscopic mucosal resection of LST performed between 2020 and 2023 at the Center of Coloproctology of Orenburg Region State Hospital No. 2 was performed. Hot-snare en bloc and piecemeal endoscopic mucosal resections (EMR) were performed. Results. In the course of the study, we have analyzed 1,762 endoscopic resections of colon neoplasms, of which LST removal was performed in 99 (5.61 %) cases in 87 patients. EMR en bloc was performed in 23 (23.2 %) cases. Piecemeal EMR was performed in 76 (76.8 %) cases. There were no mortalities. Four (4) (4.04 %) complications were recorded. In 6 (12.2 %) cases out of 49 patients studied, residual lesions were detected at the control colonoscopy after 6 months. Conclusion. Endoscopic mucosal resection is an effective and accessible method of minimally invasive resection of colorectal laterally spreading tumors.

Neuromyelitis optica spectrum disorders (NMOSD, formerly known as opticoneuromyelitis or Devic's disease) are severe chronic autoimmune inflammatory diseases of the central nervous system (CNS) associated with high disability in the absence of adequate treatment. In Russia, no assessment of the medical and social characteristics of this disease and the quality of life of patients has been conducted, which complicates the assessment of the prognosis and the development of medical and social management strategies for these patients.Objective: to analyse the medical and social characteristics and quality of life of patients diagnosed with NMOSD (opticoneuromyelitis).Material and methods. The condition of patients with a confirmed diagnosis of NMOSD or opticoneuromyelitis was assessed using a specially designed questionnaire, which also included questions about patients' attitudes towards their health. The SF-36 international quality of life questionnaire was used to score quality of life. Based on the results of the study, 280 patients diagnosed with NMOSD were surveyed in 21 regions of the Russian Federation.Results. Most patients with NMOSD who are observed by neurologists receive specialised treatment, but half of all patients with NMOSD currently experience some difficulties in obtaining drug therapy. Over the past year, 28.6% of respondents reported an improvement in their health, 39.6% reported no change, and 31.8% reported a deterioration. Self-assessment of health status declines sharply in patients over 55 years of age. The majority (74%) of patients report a decline in vision. Every second patient noted a decrease in vision at the onset of the disease. Severe movement disorders are characteristic, and for the majority (91%) of patients with NMOSD, strenuous physical activities such as running and weight training are not possible. Patients with disability groups I or II are more limited in their physical and mental resources. Patients receiving treatment significantly better assess changes in their health over the past year, both physical and psychological. Those who receive specialized drug therapy have a much better perception of their own health and its prospects. The SF-36 quality of life indices for NMOSD are significantly lower than normal, primarily in terms of physical condition, but also in terms of psychological well-being.Conclusion. In NMOSD, there are pronounced changes in the quality of life of patients, both according to the original questionnaire and according to the SF-36 scale. Receiving timely and adequate treatment significantly improves these indicators and the prognosis.

Radiation therapy is one of the most common cancer treatment methods, with approximately 50–60% of cancer patients receiving it. Despite the outstanding advances in the field of its application, especially once technology is concerned, significant obstacles still need to be overcome. The main problems of radiation therapy include tumor resistance and damage to healthy tissues, which leads to negative consequences and inadequate tumor control. Manipulations with the microRNA family is considered to be a promising approach for overcoming these limitations. The purpose of the review is to analyze the literature data on the role of microRNAs in the regulation of resistance to radiation therapy in human tumors, as well as to evaluate the possibility of manipulations with microRNAs to overcome radioresistance. The evaluation of the articles was carried out in accordance with PRISMA guidelines. The search retrieved 2153 publications. The search queries included the following keywords and their combinations: “microRNA”, “cancer”, “oncological diseases”, “malignant neoplasms”, “radiation therapy”, “radioresistance”. The analysis of the literature data shows that microRNAs will play an important role in radiation oncology in the future. The use of microRNAs is likely to be the basis for the development of specialized therapies that will increase radiosensitivity, as well as for predicting the response to radiation therapy. Early studies have shown that microRNAs can be used as biomarkers for predicting and monitoring therapy, providing a more accurate and personalized approach to patient management.

The purpose of the study was to substantiate the effectiveness of local combined use of miliacil and EHF-therapy in the complex treatment of purulent wounds of the lower extremities in patients with diabetes mellitus and its effect on morphological and functional changes in tissue defects. Our studies included 96 patients with purulent wounds of the lower extremities, localized on the thigh or lower leg against the background of diabetes mellitus. In 48 patients of the main group, miliacil and EHF-therapy were used in the local treatment of wounds, 48 patients in the control group used only miliacil. Of the 96 patients, 56 patients received complex treatment of purulent wounds, 40 received conservative treatment and plastic surgery. In all patients receiving complex conservative treatment, morphological studies of wound tissues were performed at admission, on the 7th day of conservative treatment, with the consent of the patients. When miliacil and EHF-therapy were used, the wounds healed by 13 days in most patients. Most patients in the control group showed complete wound healing by the 18th day of treatment. The positive effect of miliacil and EHF-therapy on the course of purulent wounds in patients with diabetes mellitus was also confirmed by histological research methods. An increase in leukocyte and macrophage reactions, a more active formation of poorly differentiated granulation connective tissue due to the intensification of vasculogenesis. The new method of therapeutic correction contributed to better and adequate epithelialization of the wound defect, traced after 7 days of clinical observation. Thus, with the complex use of miliacil and EHF-therapy, its high efficiency was established in the treatment of purulent wounds against the background of diabetes mellitus.

Aim. To study the effectiveness of monafram during percutaneous coronary intervention in patients with acute coronary syndrome in critical state. Material and methods. The results of emergency intervention were analyzed in 1794 patients with acute occlusion of the culprit artery, multifocal lesions of the coronary arteries. There were 2 equal groups of 794 patients each. In the 1st (main) group, Monafram was used before percutaneous coronary intervention; in the 2nd (control) group, the drug was not used. The efficiency of coronary blood flow reestablishment was evaluated according to the method of assessing the number of coronarography frames, when the revascularized artery was filled with a contrast agent: complete reestablishment of coronary blood flow was noted up to 20 frames, from 20 to 40 it was partial, and over 40 the coronary flow was not reestablished. The number of thrombotic complications after the intervention was recorded. Results. In group 1, coronary blood flow was completely reestablished in 56.7% of patients, partially — in 43.6%, and it was not reestablished in 0.7%; in group 2, in 46.4%, 51.9% and 1.7% of patients respectively. Thrombotic complications developed in 1.3% of patients in the 1st group, and in 4.5% of patients in the 2nd. Thrombosis did not develop when coronary blood flow was reestablished completely; it occurred in 0.2% when reestablished partially and in 61.9% of patients — when it was not reestablished. Conclusion. Monafram is highly effective in the prevention of the thrombotic complications development in critically ill patients.

Purpose. To analyze the incidence of neoplasms of the eye and its appendages among residents of the Orenburg region, and determine its structure and dynamics within a 5-year period (2013 to 2017).Material and methods. A retrospective analysis of morbidity of patients of the polyclinic and the 2nd ophthalmological department of Orenburg Regional Clinical Hospital No. 1 was performed for the patients aged 4 months to 90 years.Results. Over the analyzed period (2013-2017) the incidence of oncological diseases of the eye and adnexa fell by 42 %. On the other hand, the share of malignant neoplasms increased by 40.3 %. On the whole, out-patients with neoplasms showed 68.6 % of basal cell carcinomas and 31.4 % of other malignancies, while hospitalized patients showed 58 % of basal cell carcinomas, 23.7 % of uveal melanomas and 18.3 % of other malignancies. Oncopathology of the eye and adnexa was found to affect women twice as often as men.Conclusion. The obtained results may be used to assess the changes of the morbidity for Orenburg region in prospective and retrospective aspects, as well as assess, by extrapolation, the incidence of the pathology under study in other Russian areas.

This article describes the results of experimental studies using optical methods for in vitro estimation of the composition of bile obtained from patients with different etiologies of obstructive jaundice. Experimental studies were carried out using spectrophotometry and Raman spectroscopy methods to study and compare optical properties of bile from patients with obstructive jaundice caused either by choledocholithiasis or malignant tumors. The results show that the selected methods are suitable for studying the composition and optical properties of bile and can provide additional diagnostic information. Averaged Raman spectra, as well as absorption spectra of bile, corresponding to different etiologies of jaundice origin were demonstrated.

The purpose of the study. Obtaining a set of new data, identifying patterns in the endoscopic anatomy of the ileocecal intestine and, on this basis, improving the diagnosis of its pathology.Materials and methods. The present study was conducted in 182 patients (men — 84, women — 98) who were examined and treated in the polyclinic and in the hospital of the Orenburg Regional Clinical Hospital. The age of all the examined patients is from 18 to 75 years. A set of methods was used: endoscopic (videocolonoscopy, videoileoscopy, examination of the mucous membrane in white light and in the NBI mode, the method of taking material for morphological examination), morphometric, morphological examination of biopsies, X-ray (irrigoscopy, irrigography), variational and statistical data processing.Results. In this work, a set of new data was obtained and patterns of the in vivo anatomy of the ileocecal department were revealed based on the results of colonoscopies. It was found that the endoscopic anatomy of the ileocecal region consists of individually variable parameters determined during intravital endoscopy: the shape, external structure and direction of the ileocecal valve, the internal relief and shape of the cecum, the projection and width of the tapes, the intraluminal morphometric parameters of the elements of the ileocecal valve and the cecum. Changes in the endoscopic anatomy of the ileocecal region in ulcerative colitis and Crohn’s disease were quantifi ed and presented. A rational set of studies based on endoscopic and X-ray anatomy is presented, which is necessary for improving the methods of colonoscopy, diagnosis of ulcerative colitis and Crohn’s disease, and various types of surgical treatment of pathology of this department.Conclusion. The new set of data obtained and the revealed regularities of the endoscopic anatomy of the ileocecal region expand the understanding of its clinical anatomy and the possibilities of in vivo study.