Tula Regional Clinical Hospital

Introduction. In the Russian Federation, there is insufficient data on approaches to the treatment of polycythemia vera (PV) and myelofibrosis (MF). There is also a lack of information on the assessment of treatment effectiveness in routine clinical practice. Aim : to study treatment approaches for patients with MF (primary myelofibrosis (PMF), post-polycythemic myelofibrosis (PPMF), post-thrombocythemic myelofibrosis (PTMF)) and PV in routine clinical practice. Materials and methods. A multicenter, non-interventional, prospective observational study included 2005 patients from 49 centers: PV — 1019 (50.8 %), MF — 986 (49.2 %) patients. Gender, age, diagnosis, disease duration, mutation status of the JAK2 V617F gene, risk groups, and quality of life were analyzed. Results. The median age of patients with PV was 57 years, MF — 55 years. In one third of PV patients, a histological examination of the bone marrow trepan biopsy was not performed; in MF, trepanobiopsy was not conducted in less than 10 % of cases. When assessing the risk of thrombotic complications in PV, only 9.0 % of patients were classified as high-risk, yet thrombotic events were reported in 13.7 % of cases. According to the IPSS index, 39.8 % of MF patients were classified as intermediate-2 and high-risk, while 27.0 % were classified by the DIPSS index. In more than 80 % of cases, patients received hydroxycarabamide. 76.9 % of MF patients responded to ruxolitinib therapy for a period of 60 months, but only 30 MF patients received it as first-line therapy. Ruxolitinib was used as second-line therapy in 183 (18.6 %) MF patients and 54 (5.3 %) PV patients in the entire study group. Analysis of survival in over 2,000 patients allowed for the evaluation of overall survival (OS) and event-free survival (EFS), which are close to epidemiological estimates, indicating the persistent complexity of treating these patients. The proportion of MF patients with progressive disease was comparable to the proportion of patients who responded to therapy for all drugs except ruxolitinib. The use of ruxolitinib made it possible to achieve remission in most patients. Conclusion. The study characterized treatment outcomes and clinical-demographic features of patients with MPN. Discrepancies exist between real-world clinical practice and the diagnostic and therapeutic algorithms presented in the clinical guidelines.

Acute suppurative pyelonephritis is a severe kidney infection characterized by areas of ischemia and necrosis, making accurate assessment of renal perfusion crucial for diagnosis and treatment. In recent years, modern functional imaging techniques, including perfusion computed tomography (CT perfusion), have been increasingly used to evaluate renal blood flow. This review presents current data on the capabilities of renal CT perfusion in diagnosing and monitoring acute suppurative pyelonephritis, describing the principles of the technique and data post-processing for quantitative hemodynamic measurements. The CT perfusion method helps identify ischemic areas in the affected kidney and provides an objective assessment of perfusion impairment. Clinical studies show that perfusion abnormalities correlate with disease severity and the occurrence of suppurative complications, supporting the use of CT perfusion as an important prognostic tool for selecting optimal conservative or surgical treatment. Several advantages of CT perfusion are highlighted, such as high diagnostic value due to combined morphological and functional assessment, short examination time, and the ability to simultaneously assess both kidneys for comparison. However, the method also has significant limitations: high radiation exposure and the need for intravenous contrast increase the risk of complications (e.g., contrast-induced nephropathy) and restrict its use in patients with renal insufficiency. To mitigate these risks, careful patient selection, minimal necessary doses of radiation and contrast, and adequate hydration are recommended. Thus, renal CT perfusion is a promising adjunct in the diagnosis of acute pyelonephritis, capable of improving the assessment of pathological changes and patient outcomes when used judiciously.

We present a clinical observation of successful staged intraoperative stop bleeding and organ-preserving surgery in a patient with placenta ingrowth in multiple pregnancy. The use of a sequential algorithm: ligation of uterine vessels, application of assembling hemostatic sutures, resection of the uterine wall with the area of placenta ingrowth, suturing of the wound with assembling sutures followed by its reinforcement with additional two rows of separate sutures allowed to stop bleeding and perform organ-preserving operation.

Biosensor technologies in medicine, as in many other areas, are replacing labor-intensive methods of monitoring human health. This paper presents the results of experimental studies on label-free sensors based on a hollow core microstructured optical waveguide (HC-MOW) for human blood serum analysis. The MOWs with a hollow core of 247.5 µm in diameter were manufactured and used in our work. These parameters allow the hollow core to be filled with high-viscosity solutions due to the capillary properties of the fiber. Calculations of the spectral properties of the HC-MOW fiber were carried out and experimentally confirmed. Twenty-one blood serum samples from volunteers were analyzed using standard photometry (commercial kits) and an experimental biosensor. The obtained transmission spectra were processed by the principal component analysis method and conclusions were drawn about the possibility of using this biosensor in point-of-care medicine. A significant difference was shown between the blood serum of healthy patients and patients with confirmed diagnoses and a long history of cardiovascular system abnormalities. Algorithms for spectra processing using the Origin program are presented.

Distal humerus fractures (DHF) are a very common injury in the elbow joint area in adults, accounting for about 0.5-5% of all musculoskeletal injuries. In addition, DHF fractures damage soft tissues, including tendons and muscles, which is typical for injuries to these structures. With forced long-term immobilization due to fractures of the distal humerus, persistent combined contractures of the elbow joint develop, which requires early open reposition of bone fragments and stable functional osteosynthesis. However, despite the development of surgical methods for treating fractures of the extremity bones, the percentage of disability remains high in fractures of the distal humerus, including among patients of working age. When performing osteosynthesis of this type of fractures, the choice of the optimal surgical approach is of great importance, which allows both to reduce trauma to soft tissues and to provide a sufficient visual overview of bone fragments. Despite many years of experience in treating this type of fractures, the world traumatology and orthopedic community still lacks a single algorithm for choosing a surgical approach when performing osteosynthesis. Thus, the aim of this review is to summarize the data of the world literature on various aspects of the treatment of fractures of the pelvic bone, the implementation of surgical approaches and approaches to choosing the optimal treatment method.

The aim of the study — to find the features of the history, symptoms, laboratory and ultrasound data in patients with different stages and localization of endometriosis.Materials and methods. This retrospective controlled study included 99 patients with different stages according to the rASRM and localization of endometriosis who were divided into 3 groups: A1 (n = 34) — women with deep infiltrating endometriosis (DIE); A2 (n = 17) — with stages III–IV endometriosis without infiltration; B (n = 48) — with stages I–II ovarian endometriosis (OMA).Results. The severity of pain according to the visual analogue scale was 4 [3; 6]: A1 — 5.00 [4.00; 6.75]; A2 — 6.00 [4.00; 7.00]; B — 4.00 [2.00; 5.50] (p = 0.050). The duration of the symptoms of endometriosis was 8 [3; 36] months: A1–12 [6; 36]; A2 — 24 [7; 60]; B — 6 [1;24] (p = 0.010). According to the transvaginal ultrasound enlargement of the adnexa was found in 86/99 patients: A1 — 27/34; A2 — 11/17; B — 48/48 patients (p = 0.009). Intraoperatively adhesions were found in 86/99 patients: A1 & A2 — 48/51; B — 38/48 patients (p = 0.028).Conclusion. Women with DIE and stages III–IV endometriosis have a more severe chronic pelvic pain than women with stages I–II OMA. The severity of pain has no connection with the presence of intrapelvic adhesions. Adhesions of the pelvic organs are more often found in women with stages III–IV endometriosis. Transvaginal ultrasound is an effective imaging method for diagnosing OMA and DIE.

Resume: The first quarter of the 21st century is nearly complete, and the medical community increasingly faces the challenges of global population aging and the steady rise in chronic disease prevalence. It is evident that the complete or partial loss of function in one organ affects the status of others. The kidneys and lungs jointly regulate fluid homeostasis, acidbase balance, immune response, and the production of biologically active molecules. For instance, renal insufficiency leads to fluid overload and hypertension, thereby exacerbating disease severity and increasing mortality in patients with chronic lung diseases, such as interstitial lung diseases and COPD. At the same time, chronic lung diseases significantly affect kidney health, both through hypoxia and nephrotoxic effects of treatments. Rheumatic diseases, such as systemic sclerosis, should be specifically highlighted, as fibrosis develops in both organs. Understanding inter-organ interactions is crucial for preventing complications and improving survival. These factors underscore the necessity of recognizing these interrelations when selecting treatment strategies. Ideally, a multidisciplinary approach should be employed, involving specialists in pulmonology, nephrology, and rheumatology. Collaborative efforts will enable proper treatment, timely detection, and prevention of complications. Applying knowledge of inter-organ relationships will not only improve the quality of medical care but also reduce the financial burden on the healthcare system. This review attempts to describe the mechanisms linking kidney damage and pulmonary dysfunction, with a focus on chronic kidney disease (CKD) and its impact on lung health. It emphasizes the importance of early detection of CKD and outlines potential biomarkers for assessing damage to both organs, as well as therapeutic targets. The search was conducted in electronic databases such as Scopus, Web of Science, PubMed, and Google Scholar, using relevant keywords: «COPD and CKD,» «ILD and CKD», «Kidney function and lung function,» «Renal dysfunction and respiratory failure.» The search span was 15 years, from 2009 to 2024, and included only open-access articles in English, encompassing all types of studies, focusing solely on adults and animal studies. Pediatric studies were excluded from consideration.

In Russian Federation in 2022, the Expert Council adopted the main definitions and terms for neuromyelitis optica spectrum disorders (NMOSD) and proposed a treatment algorithm for patients with NMOSD with antibodies to aquaporin-4 (AQP4-IgG). The publication is intended to present the results of the work of the Russian Expert Council in September 2024. The experts agreed on clarifications of previously published terminology, new definitions, current issues in the therapy of NMOSD, proposed profiles of patients with NMOSD for ravulizumab and a monitoring plan during treatment with this drug, and agreed on an updated algorithm for prescribing medications that prevent exacerbations in patients with NMOSD with AQP4-IgG aged 18 years and older.

Objective: The aim of the NiSaXPA study is to evaluate the quality of diagnosing, socio-demographic characteristics and treatment tactics of patients with axial psoriatic arthritis (axPsA) in real-world clinical practice in the Russian Federation.Material and methods. The study involved 600 patients from 21 clinical centers in the Russian Federation.Results and discussion. The diagnosis of axPsA was confirmed in 357 (59.5%) of 600 patients according to the centralized expert assessment. All 357 patients with axial lesions met criteria of the clinical guidelines for the treatment of patients with PsA. Of these, 201 (69%) patients had radiologically significant sacroiliitis (SI) according to Kellgren and 103 (59.2%) had active SI according to magnetic resonance imaging. The presence of syndesmophytes was confirmed in 119 (43.9%) patients. Inflammatory back pain was observed in approximately 80% of patients, most commonly in the lumbar and cervical spine. "Silent" sacroiliitis were found in 1.1–3.5 % of cases. 26.8% of patients were positive for HLA-B27. In the 6 months prior to the study, high PsA activity was present in 21.6% of patients according to the rheumatologist's assessment, while high activity according to the BASDAI index was found in 71.9 % of patients, and moderate and high activity according to the DAPSA index – in 82.7%. On the 24th week of observation, the number of patients with low activity according to BASDAI doubled and reached 66.3 %, while low activity and remission according to the DAPSA index amounted to 52.5% and 8.1% of patients, respectively. In most cases (about 27%), patients with axial manifestations were prescribed interleukin (IL) 17A inhibitors, about 14% of patients received tumor necrosis factor-α inhibitors, and about 4% received IL23 inhibitors.Conclusion. In 40.5% of patients, axial skeletal involvement in PsA was over-diagnosed due to misinterpretation of clinical and imaging data. The vast majority of patients (77%) were treated with synthetic disease-modifying antirheumatic drugs, mainly methotrexate, which do not affect the activity of spondylitis. Biologic disease-modifying antirheumatic drugs (bDMARDs) were taken by 46.5% of patients. Switching therapy to bDMARDs led to a significant reduction in disease activity.In order to improve the quality of medical care, the Russian clinical guidelines for the treatment of patients with PsA and the algorithms for the diagnosis of axial involvement need to be comprehensively implemented.