Privolzhsky Research Medical University

The study is devoted to the analysis of the motivational and emotional profile of students of the last year of study in specialty 33.02.01 Pharmacy (secondary vocational education) as a novice pharmaceutical cadre. The diagnosis was carried out using the methodology of V. E. Milman, it allows us to assess the structure of motivation, the ratio of motives for maintenance and development, as well as the types of emotional profile. The results of the study showed that the motives of professional activity are dominated by a creative approach to work and a desire for contact with people, at the same time, the desire to be useful to society is expressed moderately. Emotionally, emotional fatigue is most pronounced, but at the same time, novice employees react energetically to obstacles and try to overcome them. However, this indicates a high level of stress during professional adaptation. In general, regressive tendencies predominate in the motivational profile (87.50% of respondents) — that is, an orientation towards stability, compliance with norms in the absence of a desire for self-development, as well as a mixed sthenic emotional profile (56.25% of respondents), meaning the presence of internal tension. The typological analysis and comparison of the types of motivational and emotional profiles have shown that the most common is a combination of a regressive motivational profile with a mixed sthenic emotional profile, which can be considered as a potential risk factor for emotional maladaptation during primary professional adaptation in the absence of systemic support. The data obtained demonstrate the desirability of introducing mentoring programs for novice pharmaceutical workers, which, through support, reduce the emotional stress that occurs at the beginning of professional activity; the expediency of directing mentors efforts to develop the internal motivation of novice pharmaceutical personnel and their emotional stability for successful professional development and improving the quality of their professional results. Taken together, the results obtained emphasize the importance of taking into account the motivational and emotional characteristics of novice pharmaceutical personnel in the development and implementation of professional support and mentoring programs.

Intraoperative assessment of the condition of pancreatic tissue, including identification of “soft” pancreatic parenchyma and areas of pancreatic ductal adenocarcinoma (PDAC) are important for the prevention of postoperative pancreatic fistulas (POPFs), a predictor of the likely success of pancreatic islet isolation for transplantation, and for determining accurate resection margins in case of PDAC. The aim of this study was to analyze pancreatic stiffness using compression optical coherence elastography (C-OCE) to differentiate intact from fibrotic parenchyma and to determine the resection margins of PDAC. A total of 35 freshly excised human pancreatic specimens containing PDACs together with some of the surrounding non-tumorous pancreatic tissue derived from pancreatectomies were studied. In our investigation, calculation of the stiffness (Young’s modulus, kPa) and its color-coded 2D distribution were performed for different pancreatic tissues using C-OCE. The accuracy of the resulting data was confirmed by histological studies. The palpation stiffness of the pancreatic parenchyma was also qualitatively evaluated intraoperatively by the surgeon. Stiffness values were compared between POPF positive and negative groups. It has been shown that C-OCE can be used to differentiate various tissue types in pancreatic specimens (such as adipose tissue, acinar tissue, connective tissue, pancreatic cancer, and islets of Langerhans) and to objectively distinguish intact pancreatic parenchyma from fibrotic tissue based on quantitative stiffness assessment (p < 0.0001). A high negative correlation was observed between the percentage of acinar tissue present, determined using histological examination, and the average stiffness of the specimens, based on C-OCE data (r = -0.86; p < 0.0001). It was found that, when using a C-OCE value of < 84 kPa as the cutoff for pancreatic parenchymal stiffness to predict POPF, the sensitivity and specificity were 85% and 95%, respectively. Furthermore, our study is the first time that C-OCE technology has been demonstrated accurately to visualize the transition zone between PDAC and the surrounding non-tumorous tissues both after neoadjuvant chemotherapy and without. Therefore, the present study provides a new approach to the further rapid and objective in-traoperative assessment of the status of pancreatic parenchyma in patients, based on calculation of its stiffness using real time C-OCE data enabling improved differentiation of ‘soft’ pancreatic parenchyma from ‘hard’, as well as areas of PDAC.

Objective. To evaluate the effect of combined spinal-epidural anesthesia and additional immune enteral nutrition on pain syndrome and surgical stress response in redo hip replacement for periprosthetic infection. Material and methods. An open prospective randomized simple blind trial included 100 patients who underwent redo hip replacement for periprosthetic infection: group 1 (n=28) — general anesthesia with sevoflurane, no additional nutrition; group 2 (n=36) — combined spinal-epidural anesthesia, no additional nutrition; group 3 (n=36) — combined spinal-epidural anesthesia with additional enteral nutrition (500 ml) 3 days before surgery for 10 days. VAS scores of pain syndrome were assessed in 1, 3, 5 and 7 days after surgery. In all groups, serum cortisol was assessed before anesthesia, after removal of all components of prosthesis, in the morning on the 1st, 3rd, 5th and 7th days after surgery. Results. There was significantly more severe pain in group 1 compared to groups 2 and 3. Serum cortisol was lower in groups 2 and 3 during surgery (p=0.001), 1 (p=0.028), 3 (p=0.001) and 5 (p=0.016) day after surgery. In group 3, serum cortisol was lower in 3 (p=0.001) days after surgery. Conclusion. Combined spinal-epidural anesthesia and immune enteral nutrition in redo hip replacement for periprosthetic infection reduce endocrine and metabolic components of surgical stress response. Epidural analgesia in postoperative period contributes to less severe pain and lower cortisol concentrations during and after epidural anesthesia.

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.

NAFLD is an urgent multidisciplinary problem, given its high prevalence worldwide, as well as its role in the development and progression of cardiometabolic disorders and cancer. The review analyzed current data regarding epidemiology, mechanisms of development of non-alcoholic fatty liver disease and current possibilities of its therapy. The problem of NAFLD is well understood. At the same time, new data are published regarding the mechanisms of its development, the impact on other metabolically associated diseases. This proves that a further search for new treatment regimens for such patients is necessary in order to improve the prognosis and reduce cardiometabolic risks. Particular attention in the review was paid to the possibilities of hepatoprotective therapy for hepatic steatosis.

Intraoperative assessment of pancreatic quality, followed by sampling for the potential isolation of Langerhans islets for subsequent autotransplantation, is currently a key component of post-total pancreatectomy diabetes mellitus treatment. The aim of this study was to quantitatively evaluate pancreatic parenchymal stiffness using optical coherence elastography (OCE) imaging, and to investigate the utility of the OCE method as a potential indicator of islet yield after pancreatectomy. A total of 41 freshly excised human pancreatic specimens, containing pancreatic ductal adenocarcinoma (PDAC) and surrounding non-tumorous tissues post-pancreatectomy, were studied. In this research, the stiffness (Young’s modulus, kPa) and its color-coded 2D distribution were calculated for various pancreatic samples using compression OCE. Stiffness values were compared between intact pancreatic parenchyma (islet-poor and islet-rich) and pancreatic lesion groups (parenchymal fibrosis and/or PDAC invasion). The data were confirmed by histological analysis. In addition, the measured stiffness values for various morphological groups of the pancreatic samples were compared with the number of isolated islets obtained from pancreatic samples after collagenase treatment. The study demonstrated that OCE can effectively distinguish areas of pancreatic lesions and identify intact pancreatic parenchyma containing Langerhans islets. A highly significant increase in mean stiffness (p < 0.0001) was observed in postoperative pancreatic samples exhibiting signs of parenchymal fibrosis or PDAC invasion compared to unaffected, intact pancreatic parenchyma. For the first time, a relationship between stiffness values and the number of isolated pancreatic islets was demonstrated; in particular, the number of isolated islets significantly decreased (≤110 pcs/g) in samples exhibiting stiffness values above 150 kPa and below 75 kPa. The optimal stiffness range for the efficient isolation of islets (≥120 pcs/g) from pancreatic tissue was identified as 75–150 kPa. The study introduces a novel approach for rapid and objective intraoperative assessment of pancreatic tissue quality using real-time OCE data. This technique facilitates the identification of regions affected by pancreatic lesions and supports the selection of intact pancreatic parenchyma, potentially enhancing the accuracy of Langerhans islet yield predictions during surgical resection.

ABSTRACT The ability of tumor cells to migrate and invade adjacent tissue is a key property underlying the metastatic process. To ensure greater deformability and to facilitate movement, migratory cells undergo multiple changes in biophysical parameters, including those of stiffness and membrane viscosity. However, reports on correlations between cell motility and stiffness, or between cell motility and membrane microviscosity are rather limited and conflicting. Here, using atomic force microscopy (AFM) and fluorescence lifetime imaging (FLIM), we have investigated alterations in the mechanical properties of cancer cells and in the microviscosity of their plasma membranes that are associated with the migration process. It was found that upon activation of migration either through a “wound healing” test or by inducing epithelial-mesenchymal transition, human colorectal cancer cells undergo profound biomechanical remodeling characterized by simultaneous decreases in cell stiffness and in plasma membrane microviscosity. Our findings, therefore, support the results of previous studies that have shown cell softening and membrane fluidization to be critical adaptive responses enabling cell movement and that these can be regarded as potential biomarkers of tumor cell motility, offering scope for identifying new therapeutic targets.

Aim. To demonstrate the advantages of ultrasound examination of the heart with bubble contrast in the diagnosis of patent foramen ovale using clinical examples. Key points. A total of 121 transesophageal echocardiographic examinations were performed in the clinic from November 2023 to December 2024 to clarify the diagnosis of patent foramen ovale, including 51 cases where bubble contrast was used. Two clinical cases are presented as examples. In the first case, a 30-year-old patient with a history of lacunar stroke was found to have a patent foramen ovale with a diameter of 3 mm with a shortened valve and a positive bubble test. The patient was referred for surgical treatment, after which the complaints disappeared (dyspnea during physical exertion, aching pain in the heart area radiating to the left shoulder, resolving on its own, headaches, episodes of rare heartbeat at night, increased fatigue and weakness) and a significant increase in tolerance to physical exertion. In the second case, the patient was diagnosed with a small open oval window with a positive bubble test (without a permanent right-to-left shunt). Given the small size of the anomaly, dynamic observation is indicated for the patient. Conclusion. The use of bubble contrast echocardiography allows for a timely accurate diagnosis, the selection of the right approaches to patient treatment, including surgical treatment, and the prevention of complications. The advantage of this method is its availability: no additional expensive equipment or special training is required, and it can be used in routine ultrasound diagnostic rooms. Keywords: patent foramen ovale, echocardiography, bubble test, cryptogenic stroke.

BACKGROUND: Impaired blood supply to the bladder is considered a risk factor for urinary dysfunction, including in patients with benign prostatic hyperplasia. One of the possible causes of pelvic hemodynamic disturbances is hypertension. AIM: This study aimed to evaluate the impact of hypertension on the severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia. METHODS: This retrospective and prospective observational study included 6117 men aged 48 to 83 years (mean age: 59.57 ± 10.1 years) who underwent surgical treatment for benign prostatic hyperplasia; 5960 patients were included in the final analysis. Medical records were reviewed with assessment of International Prostate Symptom Score, ultrasonographic findings of the prostate and bladder, and the presence and characteristics of comorbid conditions. RESULTS: Hypertension was identified in 3052 (51.2%) patients, of whom only 1385 (45.4%) were aware of the diagnosis. Patients with benign prostatic hyperplasia and concomitant hypertension demonstrated greater severity of lower urinary tract symptoms, with significant differences observed not only in overall International Prostate Symptom Score but also separately for storage and voiding symptoms. The severity of urinary dysfunction, primarily storage symptoms, depended on the stage and duration of hypertension, as well as on pharmacological blood pressure control. The presence of hypertension influenced the likelihood of persistent urinary dysfunction after surgical treatment of benign prostatic hyperplasia. In the postoperative period, lower urinary tract symptoms were observed in 2078 (68.1%) of 3052 patients with hypertension, compared with only 577 (19.8%) of 2908 patients without hypertension. CONCLUSION: Hypertension is associated with increased severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia; the duration and stage of hypertension, as well as antihypertensive therapy, are of significance. Hypertension may be considered a risk factor for persistent lower urinary tract symptoms in the long-term postoperative period. Prior to deciding on surgical intervention for benign prostatic hyperplasia in patients with hypertension, adequate blood pressure control followed by reassessment of lower urinary tract symptom severity appears to be necessary.