Journal of Volgograd State Medical University

Acute purulent pyelonephritis (APP) is a severe infectious kidney disease characterized by purulent inflammation of the renal parenchyma and renal pelvis. A key factor in the development of acute kidney injury is reduced blood flow to the kidneys. The purulent-destructive form of acute pyelonephritis (PDE) is often accompanied by disturbances in renal hemodynamics, which play a key role in the development of acute kidney injury (AKI). The key pathogenetic factors underlying these disturbances include endothelial dysfunction, tissue hypoxia, inflammation, and bacterial invasion. The aim of the study is an analytical review of modern Russian and international scientific publications devoted to the problem of renal hemodynamic disorders in acute purulent pyelonephritis. Research methodology. A total of 65 sources on renal hemodynamic changes in acute purulent pyelonephritis were analyzed to synthesize current knowledge of the disease’s pathogenesis, clinical manifestations, and treatment approaches. The results of the research: Four types of renal hemodynamic disturbances were identified-compensatory, subcompensatory, decompensatory, and incipient nephrosclerosis-reflecting progressively diminished renal perfusion and parenchymal injury. The principal mechanisms of these disturbances involve endothelial dysfunction, hypoxia, inflammation, and bacterial invasion. Hemodynamic impairment in acute pyelonephritis contributes to the development of AKI by exacerbating ischemic and inflammatory damage to kidney tissues. Conclusion: Renal hemodynamic disturbances in APP are a complex multifactorial process that plays a central role in the pathogenesis of AKI. Early diagnosis of hemodynamic disturbances is crucial for successful treatment and prevention of irreversible renal damage. Modern imaging techniques such as CT perfusion and MRI allow early detection of changes in blood flow and oxygenation levels, which is critical to preventing irreversible damage. A comprehensive therapeutic approach focused on improving renal perfusion, correcting endothelial function, reducing hypoxia, and controlling inflammation can enhance treatment efficacy and reduce the risk of AKI progression and chronic kidney failure.

Reducing perinatal and infant mortality is one of the key challenges in modern obstetrics. Intrauterine hypoxia remains the leading cause of stillbirths, early and late neonatal mortality, and neonatal and infant morbidity worldwide. Fetal monitoring during pregnancy and childbirth, as well as its proper use, remains essential in obstetrics, despite the rapid advancement of medical and information technology. The continuous advancement of clinical medicine, accompanied by evolving approaches to diagnosis and treatment strategy, necessitates the dissemination of novel and efficacious knowledge to a broad spectrum of specialists engaged in the provision of obstetric care. Cardiotocography has been employed since 1970, and through technological refinement and innovation, it has become increasingly accessible for remote and portable application. However, the interpretation of results remains a nontrivial task due to the complexity of fetal physiology and pathophysiology, as well as the dependence of fetal cardiac activity, cerebral function, and blood gas composition on numerous factors, including the maternal condition. By means of cardiotocography, it is possible to timely identify signs of fetal ischemia, hypoxia, or acidosis, and to minimize the number of operative deliveries. This monitoring method has certain limitations, namely the absence of a clear algorithm for the application of cardiotocography depending on the gestational age, the presence or absence of labor activity, and associated risk factors. As a result, this method frequently yields contro-versial findings. The monitoring method and practical approaches undoubtedly require improvement; however, the number of clinical studies conducted is limited due to safety considerations. The aim of the study was to systematize approaches to cardiotocographic monitoring of fetal status in utero during pregnancy and labor. Research мethodology: Based on the latest literature data, the authors' extensive clinical experience accumulated over many years has been synthesized with the aim of providing obstetricians with a precise and concise algorithm of actions for daily clinical practice. A current view of the diagnostic capabilities of cardiotocographic moni-toring is presented, and the main accessible and reliable evaluation criteria are identified. The results of the research are systematized and combined into a single tactical algorithm. Conclusions: Our structured approach is likely to significantly reduce unnecessary perinatal losses. This article is intended for a variety of stakeholders, including healthcare policymakers, obstetricians and gynecologists, and neonatologists.

Significant heterogeneity in stromal vascular fraction (SVF) isolation protocols and interspecies differences limit the standardization of cell therapy for bone defects. The aim of the study: To systematize data from experimental in vivo studies by evaluating the influence of adipose tissue sources, isolation methods, and dosing on regeneration efficacy. Research мethodology: Following PRISMA 2020 guidelines, a PubMed search was conducted (2014–2024). Original studies containing quantitative SVF composition parameters and verified osteogenesis outcomes were analyzed. The results of the research: Thirty-eight studies were included in the review. Native SVF demonstrates a favorable safety profile, stimulating reparative osteogenesis and neoangiogenesis following both local and systemic administration. The "point-of-care" approach minimizes regulatory barriers. Adipose tissue harvest volume was found to be species-specific: 4–5 g (rats), 2–6 g (rabbits), 5–50 g (dogs), ~15 g (sheeps), ~100 g (goats), and 20 g (horses) with a mean cell yield of 0.5–3.15 × 10⁶ cells/g of tissue. Reference single dose per defect were established: 1.5–12 × 10⁶ cells/mL (rodents), 6–16 × 10⁶ cells/mL (rabbits) and 5–60×10⁶ cells/mL (large animals). Optimal seeding density on scaffolds was 18–40 × 10⁶ cells/cm³. Combining SVF with blood-derived products (PRP, tPRP, WP) accelerated osteogenesis 3.7-fold and increased M2 macrophage density 6.9-fold, enabling a xenogeneic-free strategy. For critical-sized defects, monotherapy was inferior to combinatorial approaches: integration of SVF with bioceramics and polymeric matrices (β-TCP, BCP, chitosan, 3D-printed constructs) enhanced mechanical integration by 150 % and accelerated mineralization up to 8-fold. Conclusion: SVF is an effective tool for bone repair when cell loading is adjusted for species-specific requirements. Interspecies variability necessitates the development of differentiated dosing protocols to support successful clinical translation.

The aim of the study: To evaluate the clinical outcomes of implanting a high-add intraocular lens (IOL) Lentis MAX LS-313 MF80 in patients with late-stage age-related macular degeneration (AMD) and comorbid cataract. Research мethodology: Two clinical cases were presented: patients with fibrovascular scar and geographic atrophy in macular zone who were undergone implantation of the Lentis MAX LS-313 MF80 IOL as part of a rehabilitation strategy for the better-seeing eye. A distinctive feature of this IOL is the presence of an additional near-vision segment on both anterior and posterior lens surfaces, providing an addition of +8,0 D. IOL power calculation was performed targeting emmetropia, with the addition segment oriented inferiorly during implantation. The main selection criterion for patients with fibrovascular scar in macular zone was the absence of intra- and subretinal fluid for at least 3 months. Preoperative diagnostics included standard clinical and functional examinations. In addition to standard clinical and functional examination, all patients were undergone optical coherence tomography (OCT) of the posterior segment and fundus photography to assess macular involvement. Postoperative evaluation of distance and near (33 cm) visual acuity was performed. The results of the research: No intra- or postoperative complications were observed. Both patients demonstrated improved visual function on the first postoperative day: uncorrected distance visual acuity was 0,1 and 0,2 in the first and second cases, respectively, and near visual acuity was 0,3 in both cases. Patients reported subjective improvement in near vision quality, the ability to read large print and perform daily tasks without additional correction. Conclusion: Implantation of the Lentis MAX LS-313 MF80 IOL is an effective and safe method for visual rehabilitation of patients with late-stage AMD. The absence of complications and functionally significant improvement in near vision confirm the feasibility of using this lens in patients with combined macular pathology and cataract. These results justify the need for further studies with a larger number of observations and long-term follow-up.

The aim of the study: To compare the results of different methods of additional correction of ametropia after previously performed laser correction of myopia and myopic astigmatism. Research methodology: A retrospective randomized study was conducted. The study included 144 patients (230 eyes) who were undergone additional correction of ametropia at different times after previous laser correction of myopia and myopic astigmatism (LASIK, FemtoLASIK, CLEAR). The average age of the patients was (34.2 ± 6.58) years. The refractions values before correction of ametropia were as follows: spherical component (-1.1 ± 0.9) diopters; cylindrical component (-0.5 ± 0.5) diopters, and spheroequivalent (-1.4 ± 0.89) diopters. The pachymetry values were (472.9 ± 39.5) micrometers. The average time between primary and repeated surgery was (5.85 ± 6.0) years. Five options were used for re-intervention: lifting the corneal flap formed during the primary surgery; forming a new corneal flap thinner than the primary flap (flap in flap); forming a new edge of the primary corneal flap using a femtosecond laser and lifting it (side-cut-only); transepithelial photorefractive keratectomy (trans-PRK); and forming the corneal flap edge mechanically using a dissecting knife after CLEAR-technique. The results of the research: Uncorrected distance visual acuity (UDVA) on the first day after additional correction was (1.07 ± 0.2); spherical component was (-0.0 ± 0.38) diopters; cylindrical component was (-0.25 ± 0.5) diopters, sphere equivalent was (-0.14 ± 0.5) diopters. Keratometry indicators were K min (38.6 ± 1.8) diopters; K max was (39.2 ± 1.9) diopters. Root mean square (RMS) wave-front indicators in the 5 mm zone were (0.51 ± 0.2). Contrast sensitivity values were (43.3 ± 14.79) at 4 mm, (44.86 ± 14.5) at 5 mm and (44.1 ± 14.1) at 6 mm. Conclusion: Post-laser correction of ametropia can be achieved in various ways, depending on the presence or absence of a corneal flap, its thickness, and the residual corneal stroma.

Nowadays the use of laser technologies in clinical dentistry is developing quite rapidly, which expand the preventive possibilities. At the same time, the clinical effectiveness of medical and preventive measures is increased, which leads to a complex rehabilitation. Despite a deep study of the therapeutic laser effect on various pathological processes of organs and tissues of the oral cavity, it remains a relatively new way of professional competencies of a dentist. This situation requires further research studying additional spectra of the laser technologies use in dentistry. The aim of the study of the research is to increase the efficiency of surgical treatment of gingival volume enlargement by development of method of free gingival graft laser de-epithelization from the palate. Research methodology: The paper presents the results of the practical application of the developed method for laser de-epithelialization of a free gingival graft from the palate (patent application No. 2026102568 dated 03.02.2026). At the same time, a dynamic assessment of the effectiveness of using the 2 year developed method was carried out in 103 clinical cases in a group from 22 years to 45 years old. Patients were divided into 2 groups: 1 – gingival augmentation was carried out using a free gingival graft (CCT) from the palate de-epithelialized with an erbium laser (main group n = 75); 2 – de-epithelialization was performed using a scalpel (control group n = 28). Statistical evaluation of the obtained results was carried out in the MS Office Excel program using standard methods. The results of the research: The method of de-epithelialization of a free gingival graft from the palate with a laser allows them to be more efficiently used in operations to restore gingival volume, reducing the length of rehabilitation of patients, improving functional efficiency and stability of the surgical treatment result and reducing the risk of recurrences of soft tissue recession due to careful removal of the epithelial layer with a laser and obtaining a complete connective tissue graft of uniform and greater thickness compared to traditional methods using a scalpel. Conclusion: The obtained clinical results of the practical application of the developed method characterize its effectiveness, safety and convenience. In this regard, the method of de-epithelializing a free gingival transplant from the palate with a laser can be effectively used in dentistry.

The article presents an experimental study characterizing the effects of a single oral administration of an aqueous solution of depleted uranium oxides on the tracheal mucosa of rats one month after exposure. Its chemical and radiological toxicity may pose health risks, taking into account the synergistic effects of the radionuclide during accumulation after incorporation. It is important to determine the organotropism of structural components of the tracheal mucosa following oral administration, excluding the inhalation route. Currently, this issue is one of the leading concerns in radiobiology and medicine for predicting pathological conditions and developing decorporation agents. The aim of the study was to assess the morphofunctional state of the tracheal mucosa components with evaluation of topographical features of different surfaces (anterior, lateral, and posterior walls) one month after a single oral administration. Research methodology: The experiment involved 55 outbred adult male rats weighing 200–220 g: a control group (n = 10) and an experimental group (n = 45) that received a single dose of an aqueous solution of depleted uranium oxides (0.1 mg per 100 g body weight). Tracheal fragments were collected one month later, followed by fixation and preparation of paraffin sections stained with hematoxylin and eosin. Combined histochemical staining (PAS reaction and Alcian blue) was performed to detect neutral and acidic mucopolysaccharides. The results of the research: Combined statistical and cluster analysis revealed individual heterogeneity and variability of ciliated cells in the pseudostratified epithelium with distinct topographical features. Changes in the total number of goblet cells, their proportion, and transformation of the mucin secretion profile were observed. Conclusion: The comprehensive analysis demonstrated that diagnostic criteria of the tracheal mucosa and their topographical features are informative indicators, reflecting individual response patterns after incorporation of an aqueous solution of depleted uranium oxides one-month post-exposure.

The aim of the study: assess the features of heart and kidney damage in patients with AH and LEAD. Research methodology: The study included 100 patients with AH, of whom 50 had concomitant LEAD. No differences were found between the groups in terms of gender and age. The patients were examined using echocardiography, ultrasound of the lower extremities, blood creatinine measurement, albumin-creatinine ratio, GFR calculation, and renal angiography. Statistical analysis was performed using IBM SPSS Statistics. The results of the research: In patients with AH and LEAD, compared to patients with AH without LEAD, there was a significant increase in LVDD by 9.5 %, LVSD by 12.1 %, LAVI by 24.7 %, and LVMMI by 26 %. Concentric and eccentric LVH, type 1 and 2 LVDD, and a decrease in E by 29.6 %, A by 10.1 %, e` by 32.8 %, and E/A by 22.1 % were significantly more common. In the experimental group, compared to the control group, there was a significantly higher level of blood creatinine by 25.5 % and a lower GFR by 11.6 %, as well as a twofold higher value of AKR. In 68 % of patients with AH and LEAD, atherosclerosis of the renal arteries was detected during renal angiography. Binary logistic regression analysis revealed that a decrease in LAVI by 1 ml/m<sup>2</sup> increases the probability of maintaining GFR above 60 ml/min/1.73 m<sup>2</sup> by 21 %, while the presence of atherosclerosis of the renal arteries reduces it by 7.1 %. ROC analysis showed that a decrease in e` and an increase in LAVI significantly increased the probability of developing C3 CKD. Conclusion: In patients with AH and LEAD, compared to patients with isolated AH, concentric and eccentric LVH, type 1 and 2 LVDD, and deterioration of renal function and markers of renal damage were significantly more common. An increase in LAVI >25.5 ml/m² significantly increases the likelihood of developing CKD stage 3, and an increase in LAVI by 1 ml/m² increases the likelihood of developing CKD stage 3 by 21 %. The risk of developing CKD stage 3 significantly increases when e` is less than 5.5 m/s and when renal artery stenosis is present.

The significance of the risk factor for mortality in patients with blunt abdominal trauma (BAT) complicated by generalized peritonitis (GP) has not been reliably confirmed, which complicates an objective, integrated assessment of the risk factor as a whole. The aim of the study: to determine the significance of age as a risk factor for adverse treatment outcomes in patients with BAT and GP who underwent laparotomy (LT) and relaparotomy (RLT). Hypothesis tested: Age is a risk factor for BAT and GP. Research methodology: Study design: retrospective cohort. 63 patients with RT and RP were included in 4 groups: I – single laparotomy (16), II – relaparotomy (RLT) "on demand" (T) (17), III – RLTT with transition to programmed RLT (13), IV – initially programmed RLT (17). All patients were operated on in Volgograd City Clinical Hospital No. 25, a level 3 trauma center, in the period 2005–2025. Statistical processing and analysis of the results by nonparametric statistics methods using Microsoft Excel 2019 and SPSS Statistics 26. The results of the research: Patients in older age groups were more likely to die. Age is a strong risk factor: mortality increases significantly with age (p = 0.003, Pearson chi-square). Age has a statistically significant effect on mortality (Fisher's exact test (3×2) p = 0.0005). The strength of the association between age and mortality is moderate (Cramer's V ≈ 0.5). OR 3.33 (95 % CI 1.03–10.8). The risk of death in the 45–59-year-old group is 3.3 times higher than in the 18–44-year-old group. Conclusions: Age is a strong risk factor for BAT and GP – mortality increases significantly with age, especially over 60 years (p < 0.001), regardless of gender (p = 0.56). Integrating this parameter into clinical decision-making can enhance risk stratification and improve patient management.

Mortality among recipients - patients with liver cirrhosis who are on the transplant waiting list, is 15–25 % per year. This circumstance determines the high importance of minimally invasive surgical interventions, which are not only a technically convenient bridge on the way to liver transplantation, but often the only feasible life-saving option for the patient. The aim of the study: Search for ways to predict non-transplant and recurrence-free survival of patients with liver cirrhosis with respect to portal bleeding after its staged minimally invasive surgical treatment and prevention. Research methodology: A controlled comparative study of the outcomes of minimally invasive surgical treatment and prevention of portal bleeding in 295 patients with liver cirrhosis over the period 2006–2025 was conducted. All patients with liver cirrhosis were divided into three groups depending on the management strategy for liver lesions: main group (group 1) – 109 patients who received minimally invasive combined surgical treatment; comparison group (group 2) – 84 people who underwent various types of endoscopic correction; and control group (group 3), which included the results of conservative treatment in 102 patients. Short-term outcomes were assessed up to 6 months, medium-term outcomes up to 5 years, and long-term outcomes over 5 years among 142/295 patients (48.1 %). The results of the research: The application of combined minimally invasive surgical treatment and prophylaxis demonstrates the best survival outcomes compared to the use of only endoscopic or conservative therapy. Two models were obtained for predicting transplant-free and recurrence-free (regarding portal bleeding) survival in patients with liver cirrhosis after undergone minimally invasive surgical treatment and portal bleeding prophylaxis. Conclusions: The obtained methods for calculating the survival times of patients with liver cirrhosis after surgical correction of portal hypertension can be applied in the form of a mobile application for the most accurate determination of transplant-free and recurrence-free (in relation to portal bleeding) survival time while being on the liver transplant 'waiting list'.

Plantar footprint analysis is an important method for diagnosing foot deformities in children; however, manual annotation of anatomical landmarks is time consuming and subject to inter observer variability. Deep learning methods can automate this process. The aim of the study: To develop and train a lightweight convolutional neural network (CNN) for automatic detection of 13 foot keypoints on plantar footprint images, suitable for clinical use on standard computing hardware. Research methodology: The initial dataset comprised 651 annotated foot images with manual landmark files (.ffp). Data augmentation (rotations, brightness/contrast adjustments, noise addition, horizontal reflections) was applied. A lightweight U Net based architecture with heatmap output was developed. Training was performed on an NVIDIA RTX 3050 GPU using the AdamW optimizer, MSE loss, batch size of 4, and gradient accumulation every 2 steps over 100 epochs. The results of the research: Stable convergence was achieved: training loss decreased from 0.05 to 0.0003, and validation loss decreased from 0.05 to 0.0006, indicating no overfitting. On the test set (400 images), the mean Euclidean distance was (2.8 ± 1.2) pixels, PCK@10 (Percentage of Correct Keypoints within 10 pixels) reached 96.2 %, and the mean confidence score was (0.94 ± 0.05). Keypoints of the first and fifth metatarsal heads were localized most accurately, while medial arch points presented the greatest challenge. The developed Python script provides automatic keypoint placement with confidence scores. Conclusion: The proposed lightweight neural network (1.2 million parameters) achieves accuracy comparable to manual annotation while requiring significantly fewer computational resources. The system automates plantar footprint annotation, reduces physician time, minimizes inter observer variability, and can be integrated into routine clinical practice using standard equipment. Future work includes multicenter validation, dataset expansion, and web application integration.

In clinical practice, the effectiveness of the methods employed in clinical interventions remains an important issue for every specialist. This applies not only to the selection of treatment protocols, but also to the choice of diagnostic approaches for pathological conditions. Objective assessment of treatment outcomes and diagnostic value makes it possible to improve the quality of medical care and predict long-term therapeutic results. In this regard, comparative evaluation of the methods used, taking into account their clinical effectiveness and their influence on the course of healing processes, is of particular relevance. The aim of the study: To compare surgical techniques for gingival recession coverage and to assess their effect on microcirculation in the surgical area using ultrasound Doppler flowmetry. Research methodology: The study included 60 patients aged 20 to 40 years, who were divided into three equal groups according to the technique used: free gingival graft, tunnel technique, and the authors’ proprietary technique patented as RU 2 840 748 C1. Regional blood flow was assessed by ultrasound Doppler examination of the marginal gingiva before surgery and 2 months after the intervention. One of the key parameters analyzed was the Gosling pulsatility index. The results of the research: Comparative analysis revealed the most favorable dynamics in the group treated with the authors’ proprietary technique, in which the greatest increase in the studied parameters was observed. Vas/Qas increased by approximately 0.37, and PI by 0.35. The tunnel technique also demonstrated positive results, although the magnitude of these changes was less pronounced, with Vas/Qas increasing by approximately 0.31 and PI by 0.27. In contrast, the free gingival graft group showed negative dynamics manifested by a decrease in the main parameters of local blood flow, with Vas/Qas decreasing by approximately 0.25 and PI by 0.33. Conclusion: The findings highlight the significant advantages of the authors’ proprietary technique, which demonstrated the most pronounced improvement in microcirculatory parameters and, consequently, more favorable conditions for tissue healing. The tunnel technique also proved effective, although to a lesser extent. In contrast, the use of a free gingival graft was associated with a decline in hemodynamic parameters, which may limit the clinical effectiveness of this approach.

The aim of the study was to improve the effectiveness of orthodontic treatment for congenital cleft lip and palate during the initial mixed dentition in preparation for early bone grafting by developing a special device. Research methodology: The developed device (patent application No. 2025137877 dated 12/24/2025) was used in children aged 6–7 years after lip and palate plastic surgery before bone grafting. The study was conducted on the basis of the Consultative and Diagnostic Center of the GAU RS(Ya) Republican Hospital No. 1 – M.E. Nikolaev National Center of Medicine, Yakutsk. The device was used in the initial mixed bite of children with congenital cleft lip and palate after the stages of primary lip and palate plastic surgery, the eruption of the medial incisors, and the formation and eruption of the permanent canine on the side of the cleft. The results of the research: The developed utility model created a normal position for all permanent and deciduous teeth in a fixed state on the upper jaw, including those located on the border with the cleft of the alveolar process. At the same time, the best conditions were created for bone grafting of the alveolar process of the upper jaw before the eruption of the canine tooth on the side of the non-union. The orthodontic device ensured a fixed normal position of all the teeth in the upper jaw and was an important step before bone grafting to promote favorable physiological development and optimal formation of the dentition. Conclusions: The use of this device for orthodontic treatment of children with congenital cleft lip and palate during the initial mixed dentition period is a key factor in normalizing the anatomical shape of the jaw, which determines the timely eruption of permanent teeth and the formation of a correct dental arch, and has a positive effect on the restoration of the functional activity of the dentition-maxilla system. In addition, the prompt implementation of medical rehabilitation increases the clinical effectiveness of medical and preventive measures and the social adaptation of children.