Ural State Medical University

Background: the problem of treatment of diseases of the musculoskeletal system is one of the most urgent in modern science. The main focus for our regenerative medicine is the treatment of degenerative-dystrophic diseases of the musculoskeletal system in children. This study examined the effects of liquid nitrogen vapor on osteogenesis in the rabbit femur. Cryotweezers made of porous nickel titanium alloy (nitinol or NiTi) obtained by self-propagating high temperature synthesis were used in this experiment. Aims: evaluation of the effectiveness of subdestructive cryotherapy on the focus of osteonecrosis of the femoral head in an experimental model as close as possible to LeggCalve-Perthes Disease and enhance osteogenesis in rabbit bones through cryotherapy using porous NiTi cryotweezers. Materials and methods : the study was conducted on 24 rabbits. The animals underwent of a surgical interventions against the background of aseptic necrosis of the femoral head by tunneling and cryotherapy with an applicator made of porous titanium nickelide on the osteonecrosis site to optimize osteoreparative processes of bone tissue. The control group consisted of 8 animals that did not undergo surgery. Results : It was found that a 3 s exposure time stimulates osteogenesis, which was manifested in a greater number of osteoblasts in the regenerate compared to the control sample without liquid nitrogen. It was observed that increasing the exposure to 6, 9 or 12 s had a destructive effect, to varying degrees. The most severe damage was exerted by a 12 s exposure, which resulted in the formation of osteonecrosis areas. In the samples exposed to 6 and 9 s of cryotherapy, destruction of the cytoplasm of osteocytes and osteoclasts was observed. Conclusions : The NiTi alloy produced through the SHS method offers a novel approach to the manufacture and use of cryoinstruments due to its high heat capacity and ductility, which provide rapid local cooling and its ability to prevent sticking to moist mucous tissues. The experimental results obtained make it possible to apply the proposed developed cryotherapy method to pathologically altered bone tissue.

Along with outpatient and inpatient treatment, the provision of medical care in a day hospital (DH) is becoming increasingly popular. Recently, more and more patients with functional somatic disorders, such as recurrent pain syndrome (headache, abdominal pain, or back pain), have been seeking medical attention for examination and further treatment. If left untreated, these conditions can lead to chronic pain and significantly impact the quality of life. After our survey, we found that a large number of patients with dizziness and headaches had low levels of brain-derived neurotrophic factor (BDNF). Given the significant role of the BDNF in modulating neuroplastic processes, the decrease in its level that we have identified in our patients can probably be considered a metabolic marker of the presence of neurodegenerative processes in the brain tissue of patients with dizziness and headache. Significant differences in the percentage ratio were found in patients with different levels of plasma BDNF concentration, depending on the frequency of headache episodes. Approaches to the treatment and prevention of BDNF levels in the body in recurrent headache are described. The expediency of using both drug-based and non-drug-based treatment methods in a day hospital setting is substantiated, and these methods are described in detail in the recommendations for discharge from the day hospital.

Introduction . Endometriomas are one of the most common gynecological diseases. Surgical removal of endometriomas is considered the standard treatment for large endometriomas and/or those associated with pain. However, despite the clinical effectiveness of endometrioma removal, this approach is associated with a number of reproductive risks. Objective : to compare the effect of two intraoperative hemostasis methods – autologous platelet-rich fibrin glue versus standard bipolar coagulation – on ovarian function preservation after laparoscopic cystectomy of ovarian endometriomas. Materials and Methods : A prospective comparative cohort study was conducted involving 72 reproductive-aged women with ovarian endometriomas. Patients were allocated into two groups of 36 each. All patients underwent laparoscopic cystectomy. In Group 1, hemostasis was achieved using autologous platelet-rich fibrin glue; in Group 2, bipolar coagulation was applied. Ovarian reserve was assessed before and 6 months after surgery by measuring serum AMH, FSH, and CA-125 levels; ovarian volume, antral follicle count (AFC), and ovarian artery resistance index (RI) were evaluated by transvaginal ultrasound. Results : Baseline demographic, hormonal, and ultrasound characteristics were comparable between groups. At 6 months postoperatively, the fibrin glue group showed significantly higher AMH levels compared to the coagulation group: 3.85 (1.89–7.17) vs. 2.1 (1.1–4.3) ng/mL, p=0.03. FSH levels significantly increased in Group 2 (p=0.03) but remained stable in Group 1. AFC in the operated ovary increased in the fibrin glue group (p=0.03) and did not change in the coagulation group. RI significantly decreased in both groups (p<0.01). Postoperative CA-125 levels were significantly lower in Group 1 (p=0.02). Conclusion : The use of autologous platelet-rich fibrin glue for hemostasis during laparoscopic cystectomy of ovarian endometriomas provides significantly better preservation of ovarian function compared to bipolar coagulation. This technique may be recommended as a priority approach in patients desiring fertility preservation.

The publication provides clinical and diagnostic features of congenital, intrauterine, perinatal and postnatal infections in newborns based on a review of current clinical guidelines. There are common patterns and similar clinical manifestations for all of these infections, but there are significant differences. Attention is paid to the importance of isolating the “TORCH” syndrome in newborn children in order to carry out subsequent diagnosis of the etiology of infection. Additional information about intraamniotic infection is provided. Methods of laboratory diagnosis of infection are presented. Direct methods are described: microscopy, polymerase chain reaction, bacteriological (culture) method. Among the indirect diagnostic methods, information is provided on enzyme immunoassay, determination of immunoglobulins M and G. Attention is paid to the importance of studying the avidity of immunoglobulins G. The detection of low-avidity antibodies confirms acute infection. The presence of highly specific antibodies makes it possible to establish a history of infection. The advantages and disadvantages of direct and indirect methods of diagnosing infection in children are described. First of all, patients should be examined for those infections for which etiological and pathogenetic treatment has been developed. The main goal of therapy is to reduce the replication of the infectious agent in order to prevent damage to cells and tissues. The criterion for the effectiveness of therapy is considered to be the positive dynamics of the child’s condition, as well as the negative results of the polymerase chain reaction.

The success of assisted reproductive technologies depends on many factors, the main ones being the quality and genetic status of the embryo and endometrial receptivity. Preimplantation genetic testing is a tool that aims to reduce the risk of selecting an aneuploid embryo for transfer. Disputes surrounding the use of preimplantation genetic testing are conducted in the context of older patients, with recurrent miscarriage, with genetic karyotype abnormalities in a married couple, as well as multiple unsuccessful attempts at ART in the anamnesis. This study was conducted in the period from 2020 to 2024 on the basis of the Federal State Budgetary Institution «Ural Research Institute of Maternal and Infant Care» of the Ministry of Health of the Russian Federation. The study included 127 married couples with infertility, whose embryos underwent preimplantation genetic testing. All embryos were divided into two groups: the first group included 102 embryos with a euploid set of chromosomes, the second group included 93 embryos with an aneuploid and mosaic set of chromosomes. The main evaluation criteria were embryo quality and clinical pregnancy rates. his study made it possible to study the influence of clinical and anamnestic data of married couples on the chromosome set of embryos subjected to PGT-A. During a retrospective assessment of ART programs with PGT-A, it was revealed that the morphological quality of the embryo, the factor of infertility of the couple, as well as the number of ART attempts in history do not affect its chromosomal composition. However, with an increase in FSH levels and the age of a man or woman, the frequency of formation of a euploid embryo decreases.

Background . Cervical insufficiency, often associated with genital infections, remains one of the leading causes of extremely preterm and early preterm births. Since cervicovaginal infections change the antimicrobial properties of cervical mucus, studies of local immunity can offer new insights into the pathogenesis of this pregnancy complication and help predict preterm birth. Objective . To examine a local immune response in the cervical mucus of pregnant women with cervical insufficiency that leads to preterm birth. Methods . A retrospective cohort study of 106 pregnant women with cervical insufficiency was conducted. These women were diagnosed with cervical insufficiency according to the clinical guidelines (Cervical Insufficiency, 2021). A microscopic and biomolecular analysis of vaginal and cervical material was performed for all patients. Additionally, the following parameters were estimated in the cervical mucus of 58 randomly selected women: total white blood cell count and functional activity and viability of neutrophils, as well as the levels of macrophage inflammatory protein 1β, high-mobility group protein B1, and matrix metalloproteinase-8. A statistical analysis of the results was performed retrospectively, depending on obstetric outcomes: premature and term births. The obtained data were statistically processed using the SPSS software (version 25.0, IBM, USA). Differences in parameter values between the groups were considered statistically significant at p < 0.05. Results . Cervicovaginal infections in women with cervical insufficiency were detected in 84.9% of cases in the preterm birth group and in 57.5% of cases in the term birth group (p = 0.002). In both groups, cervicitis was found to be prevalent. In the immunological study of cervical mucus, the group with cervical insufficiency leading to preterm birth differed most significantly in the number of neutrophil extracellular traps, as well as in the levels of macrophage inflammatory protein 1β and high-mobility group protein B1. Conclusion . Cervicovaginal infections constitute a risk factor for preterm birth. In patients with cervical insufficiency, changes in the local immunity markers of cervical mucus can serve as predictors of preterm birth.

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.

According to the Order of the Ministry of Health of the Russian Federation dated 04.27.2021 No 404n, as part of the medical screening of the adult population, it is mandatory to perform esophagogastroduodenoscopy at the first stage of medical examination at the age of 45 and colonoscopy for persons aged 40 years in the scope of the second stage of medical screening. The value of esophagogastroduodenoscopy and colonoscopy depends on the quality of the examination of the mucous membrane and the timely examination. There are many factors that prevent the achievement of the criteria for the quality of the study, including the lack or insufficient depth of procedural sedation and/or analgesia. The article presents guidelines for procedural sedation and/or analgesia in adult patients with esophagogastroduodenoscopy and colonoscopy. The recommendations are based on regulatory legal acts, guidelines, and the results of clinical trials and metanalyses. The evidence of the need for esophagogastroduodenoscopy and colonoscopy under conditions of procedural sedation and/or analgesia is substantiated. The recommendations describe algorithms for assessing the risk of lung aspiration and cardiopulmonary complications before performing endoscopic examinations. Based on the results of clinical studies, a technique of stepwise administration of propofol has been developed. Extended periprocedural monitoring of vital functions is proposed. The criteria for recovery and discharge of patient’s home are described. The developed recommendations are aimed at providing effective and safe procedural sedation and/or analgesia in adult patients with diagnostic esophagogastroduodenoscopy and colonoscopy.

INTRODUCTION: Patients with disorders of consciousness (DoC) represent a complex patient cohort requiring a multidisciplinary approach. Despite the availability of modern national clinical guidelines (2023), real-world clinical practice in Russia continues to be challenged by the use of outdated terminology, insufficient implementation of validated diagnostic scales, and a lack of standardized management approaches, including pain assessment and management. This study was prompted by the need to assess the current situation and identify key issues to improve the quality of care for patients with DoC in Russia. OBJECTIVE: To assess the current practices, awareness, and key challenges faced by Russian healthcare professionals in the diagnosis, treatment, and management of patients with chronic DoC. MATERIALS AND METHODS: In 2024, an anonymous online survey of 204 medical and paramedical professionals (anesthesiologists, neurologists, rehabilitation specialists, psychologists, nursing staff) from various regions of Russia was conducted. The 47-item questionnaire covered demographic data, terminology used, diagnostic scales, treatment and rehabilitation methods, as well as approaches to pain assessment and management. RESULTS: Despite modern clinical guidelines, outdated terminology persists in practice: apallic syndrome (13.3 %), vegetative state. Only 62.9 % of respondents use the validated Coma Recovery Scale-Revised (CRS-R) for DoC diagnosis, while 77.1 % still use non-relevant scales (Glasgow Coma Scale, Full Outline of UnResponsiveness — FOUR). 30 % of respondents, including physicians responsible for diagnosis, use exclusively these non-relevant tools. Significant differences in approaches were identified among specialists of different profiles (intensivists, neurologists, rehabilitation specialists). The majority of respondents (83 %) acknowledge that DoC patients experience pain; however, the assessment methods (autonomic signs, grimacing) are not standardized and can be non-specific. CONCLUSIONS: The study results indicate insufficient awareness and fragmented implementation of modern standards for the diagnosis and management of patients with DoC in Russia. The findings highlight the necessity of developing and implementing educational programs for healthcare professionals aimed at standardizing terminology, promoting the use of validated diagnostic scales (CRS-R), and harmonizing approaches to pain management.

Introduction. Identifying the causes of allergic diseases and allergen sensitization patterns in young children remains a challen­ ging task of significant interest to the medical community. Objective. This study aimed to determine risk factors, sensitization profiles, and major allergens in children aged 2–4 years with allergic rhinitis (AR) residing in Beloretsk (Republic of Bashkortostan). Materials and methods. In this open-label, single-center, prospective study, 113 children with persistent rhinitis were enrolled and divided into two groups: AR (n = 68, mean age 3.19±0.78 years) and non-AR (n = 45, 3.00±0.80 years). Evaluations included medical history, eosinophilic cationic protein levels, total and specific IgE (ImmunoCAP), and nasal cytology. Polysensitized children (n = 11) underwent further testing using the ISAC-112 molecular panel. Statistical analysis employed median (Me) with 95% confidence intervals (95% CI), Mann — Whitney U-test, Yates-corrected χ ² test, Spearman’s correlation coefficient, and Chaddock’s scale. Results. AR developed by the age of three, with 54.41% of patients exhibiting mild persistent perennial symptoms (p = 0.019), predominantly sneezing (p < 0.001). Significant risk factors included family history of asthma (OR 11.9; 95% CI [2.8; 50.9]), seasonal AR (OR 2.5; 95% CI [1.1; 5.7]), maternal anemia (OR 2.3; 95% CI [1.1; 5.0]), cesarean delivery (OR 2.8; 95% CI [1.2; 6.8]), atopic dermatitis (OR 3.9; 95% CI [1.4; 10.3]), adenoid hypertrophy grade 2—3 (OR 3.2; 95% CI [1.3; 8.1]), animal exposure (OR 3.6; 95% CI [1.8; 7.3]), and passive smoking (OR 2.8; 95% CI [1.4; 5.8]). Sensitization was detected to cat dander (75.00%), dog dander (66.18%), birch (47.06%), timothy grass (20.59%), mugwort (36.76%), and house dust mites (D. p., D. f.) (41.18%). Molecular analysis (ISAC-112) confirmed sensitization to Fel d 1 (90.91%) and Bet v 1 (73.72%). Conclusion. These findings highlight the importance of regional studies in understanding the clinical and risk factors of pediatric allergic diseases, contributing to improved diagnosis and prevention strategies.