Pharmateca

Background: Venous thromboembolism (VTE) occurs in 10–15% of patients with malignancies and is associated with a clinically significant decrease in quality of life across all key domains. Traditional low-molecular-weight heparin (LMWH) therapy requires daily subcutaneous injections, which reduces adherence and worsens quality of life. Direct oral anticoagulants (DOAC) are comparable to LMWH in terms of efficacy and safety; however, their impact on quality of life as a primary endpoint in cancer patients has been poorly studied.

Objective: Evaluation of the impact of two anticoagulant regimens (rivaroxaban vs. enoxaparin) on quality of life, treatment adherence, and anxiety/depression in patients with newly diagnosed cancer-induced VTE after 3 and 6 months of follow-up.

Methods: A prospective, open-label, randomized, controlled trial included 70 patients (35 in each group) with histologically confirmed malignancy and newly diagnosed symptomatic VTE. Patients were randomized in a 1:1 ratio with stratification by tumor location and baseline EORTC QLQ-C30 global health status score. The DOAC group received rivaroxaban (15 mg twice daily for 21 days, then 20 mg once daily for up to 6 months). The LMWH group received enoxaparin (1.5 mg/kg subcutaneously once daily). The primary endpoint was the change in quality of life at 6 months according to the EORTC QLQ-C30 global health status questionnaire. Secondary endpoints included venous disease-specific quality of life (VEINES-QOL/Sym, PEmb-QoL), treatment adherence (Morisky-Green questionnaire + diary), psychoemotional status (HADS), incidence of post-thrombotic syndrome (Villalta scale), clinical outcomes, and treatment satisfaction (TSQM – Treatment Satisfaction Questionnaire for Medication).

Results: After 6 months of follow-up, global health status (EORTC QLQ-C30) improved by 12.4 points in the rivaroxaban group compared with baseline, while in the enoxaparin group the improvement was 4.2 points (between-group difference 8.2 points; p=0.004). Adherence to therapy (≥80% of doses taken) was 91.4% in the rivaroxaban group and 71.4% in the enoxaparin group (p=0.036). The level of anxiety and depression according to the HADS scale was significantly lower in the rivaroxaban group (HADS-A: 6.2±2.4 vs 8.9±3.1, p=0.008; HADS-D: 5.4±2.1 vs 7.6±2.8, p=0.011). The incidence of post-thrombotic syndrome at 6 months was 17.1% in the rivaroxaban group versus 31.4% in the enoxaparin group (p=0.042). Clinical outcomes (recurrent VTE, major bleeding) did not differ between the groups.

Conclusion: Rivaroxaban therapy was associated with clinically significant improvements in quality of life, higher treatment adherence, and a lower incidence of post-thrombotic syndrome compared with enoxaparin in patients with cancer-induced venous thromboembolism, with comparable efficacy and safety profiles. These data support the use of rivaroxaban in cancer patients with VTE, taking into account not only the risk of thrombosis and bleeding but also the predicted impact on quality of life.

Objective: Comparative assessment of the efficacy and safety of two forms (75 mg/day gastro-soluble buffered and 100 mg/day enteric-coated) of acetylsalicylic acid (ASA) in patients with stable coronary artery disease (CAD) and determination of the impact of these forms on the incidence of cardiovascular complications (CVC), bleeding, and other gastrointestinal (GI) adverse events, as well as treatment adherence.

Materials and methods: This observational, retrospective, single-center, non-interventional study included 2,112 patients of both sexes with stable CAD. Of these, 1166 (55.21%) were in the group receiving the gastro-soluble form of ASA and 946 (44.79%) were in the group of patients taking the enteric-coated form. To reduce the risk of systematic error and increase the reliability of the results, pseudo-randomization was performed using the «nearest neighbor» pair selection method based on the PSM (Propensity Score Matching) index for 8 characteristics (gender, age, arterial hypertension (AH), history of myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), type 2 diabetes mellitus (DM2), chronic kidney disease (CKD)). Two clinically comparable groups were formed: 829 patients receiving the enteric-coated form of ASA and 829 patients taking the gastro-soluble buffered form of ASA. The primary composite efficacy endpoint included the incidence of MI, stroke, transient ischemic attack (TIA), unstable angina (UA), and cardiovascular death. Secondary efficacy endpoints included the incidence of rehospitalization and myocardial revascularization. Safety outcomes included the incidence of bleeding according to the BARC scale, hemorrhagic stroke, and erosive and ulcerative esophageal, gastric, and duodenal ulcers. Adherence to therapy was assessed using the Morisky-Green scale.

Results: In the group taking the gastro-soluble form of ASA (Cardiomagnyl 75 mg/day), the incidence of vascular events was 44% lower than among patients taking enteric-coated forms (4.34% vs. 7.70%; odds ratio (OR) = 0.56; 95% confidence interval (CI): 0.38–0.82; p=0.004). Duodenal erosion was more common among those taking enteric-coated forms (3.3% vs. 0.5%; 95% CI: 1.87–4.34 and 0.16–1.12, p< 0.001). The same was true for minor bleeding grades 1–2 according to BARC (0.1% vs. 1.1%; 95% CI: 0.04–0.73 and 0.53–2.10, p=0.011). The readmission rate was also higher in the enteric-coated ASA group (18.8% vs. 26.4%; 95% CI: 15.97–21.08 and 21.12–27.39, p< 0.001). No significant differences were found in the adherence assessment.

Conclusion: In real-world clinical practice, administration of the gastro-soluble, buffered ASA (Cardiomagnyl) is associated with significant advantages in terms of efficacy and safety compared to the enteric-coated form.

Dysfunctional biliary tract disorders represent a complex of clinical symptoms resulting from motor-tonic dysfunction of the gallbladder, bile ducts, and sphincters. Primary biliary tract dysfunction accounts for approximately 4%. The incidence of secondary biliary tract dysfunction is significantly higher and can reach 100% in cases of organic diseases of the gallbladder and biliary tract. This article discusses clinical and diagnostic criteria for biliary tract dysfunction in accordance with Rome V criteria (2026). Changes in section E - “Disorders of the gallbladder and sphincter of Oddi” of the new edition of the consensus “Rome V criteria” (2026) are aimed at a clearer definition of biliary pain, improving the diagnostic criteria for dysfunctional disorders of the gallbladder and disorders of the sphincter of Oddi.

When considering the treatment of functional biliary tract disorders in the Rome IV and Rome V consensus criteria, special attention is given to trimebutine. We searched the Pubmed, Scopus, and Elibrary.ru databases for articles published before May 1, 2026, that examined the properties and effects of trimebutine, with a focus on its effects on the hepatobiliary system. The sources identified suggest that trimebutine (Trimedat^®) is a multitarget drug, as it promotes normal motility, reduces visceral hypersensitivity, and exhibits anti-inflammatory and neuromodulatory effects, which enhances the effectiveness of treating functional biliary tract disorders.

The presented results of studies of the efficacy and safety of trimebutine (Trimedat^®) in patients with dysfunction of the gallbladder and sphincter of Oddi, which demonstrated a significant improvement in clinical symptoms and laboratory parameters, indicate the effectiveness of the use of trimebutine in the standard therapy of biliary tract dysfunctions.

Bronchial asthma (BA) remains a common chronic disease with poor control in a significant proportion of patients, associated with a high risk of exacerbations and mortality. The excessive use of short-acting β₂-agonists (SABA) is one of the modifiable factors for poor asthma control. The use of SABA without an anti-inflammatory component creates an illusion of well-being, contributing to the progression of airway inflammation, which is accompanied by decreased control, increased asthma exacerbation frequency, and the risk of death. Recognition of these risks has led to a fundamental revision of asthma management strategies, abandoning SABA monotherapy and requiring the use of inhaled glucocorticosteroids for symptom relief. The logical conclusion of this evolution was the development of a new fixed-dose combination of budesonide and salbutamol, which combines rapid symptom relief with anti-inflammatory action. A systematic search was conducted in the PubMed, Web of Science, and Medline electronic databases. The efficacy of budesonide/salbutamol was confirmed in the MANDALA and BATURA studies, which demonstrated a significant reduction in the risk of severe exacerbations and systemic steroid load in patients with varying asthma severity. Data from the TYREE study confirm the protective effect of the combination against exercise-induced bronchoconstriction. Thus, the fixed-dose combination of budesonide/salbutamol represents a new standard of symptom-oriented therapy, providing a comprehensive approach to disease control and reducing the risk of exacerbations.

Background: Chronic obstructive pulmonary disease (COPD), primarily caused by smoking, is the third leading cause of death worldwide. Inhaled glucocorticosteroids (IGCS) are part of the recommended triple therapy for COPD exacerbations. However, in patients who continue to smoke, the effectiveness of corticosteroids is significantly reduced: they do not slow disease progression or suppress mediator production in alveolar macrophages due to oxidative stress, which blocks HDAC2 activity. One of solutions to this problem is the use of carbocysteine (CC). It maintains HDAC2 activity by reducing reactive oxygen species (ROS) levels and increasing glutathione (GSH) and superoxide dismutase (SOD) activity. This enhances the anti-inflammatory effect of GCS, reduces airway remodeling, and the frequency of exacerbations.

An alternative strategy is switching to electronic heated tobacco systems (EHTS). EHTS aerosol contains 90–95% fewer toxic substances (aldehydes, acrolein, and benzene) than cigarette smoke.

Objective: Comparative analysis of the effects of switching to EHTS and carbocysteine use on lung function recovery during combination therapy and rehabilitation for exacerbations of spirometric stage II (moderate) COPD in male smokers.

Materials and methods: The study included 37 men with stage II COPD during a bacterial exacerbation. All participants were active smokers with a smoking history of more than 20 years. Three groups were formed: group 1 – standard therapy + rehabilitation + carbocysteine; group 2 – standard therapy + rehabilitation + full transition to EHTS; control group: standard therapy only without smoking modification.

Standard therapy included triple inhalation therapy (long-acting beta-2-adrenergic agonist + long-acting M-anticholinergic + inhaled glucocorticosteroid), as well as appropriate antibacterial therapy based on the etiologic agent. Rehabilitation included bovhyaluronidase, azoximer, and Buteyko breathing exercises.

Results: By day 180 of follow-up, patients in groups 1 and 2 showed significant improvements in all spirometric parameters compared to baseline values. Both groups showed comparable increases in FEV1 (+17.3±2.39%), reflecting a reduction in inflammation and improved lung elasticity. In the control group, FVC, MEF 25-75, and FEV1 remained virtually unchanged. Particularly significant was the lack of increase in MEF 50 and MEF 75 flow rates — markers of distal bronchiole health. This indicates persistent exposure to tobacco combustion products and reduced HDAC2 activity, which limits the effectiveness of inhalation therapy.

Conclusion: Timely therapy adjustments (addition of carbocysteine or switching to EHTS) significantly improve clinical status and respiratory function in COPD patients who are not ready to quit smoking. Integrating harm reduction strategies into a personalized approach is an important component of secondary prevention. Further randomized prospective studies are needed to clarify the long-term benefits of fully switching to EHTS.

This article examines current understanding of the pathogenesis of osteoarthritis and the mechanisms underlying pain syndrome development under conditions of mechanical joint overload, inflammation, and progression of degenerative changes. The mechanisms of action of hyaluronic acid, which provide mechanical joint relief and have anti-inflammatory, chondroprotective, and analgesic effects, are analyzed. Clinical trial data and international guidelines confirming the efficacy and safety of intra-articular hyaluronic acid administration for osteoarthritis in various locations are presented. The importance of the physicochemical characteristics of hyaluronic acid, which determine its rheological properties, duration of action, and clinical efficacy, is examined.

A comparative analysis of the high-molecular intra-articular implants Flexotron^® Plus and Flexotron^® Magnum is conducted. It is shown that the products differ in sodium hyaluronate concentrations, which may determine the specifics of their clinical use. Flexotron^® Plus may be a rational choice for patients with severe pain and functional impairment, while Flexotron^® Magnum may be of greater interest for patients with pain associated with chondromalacia and articular cartilage damage, requiring more significant mechanical joint support.

Background: The problem of acute cerebrovascular accidents associated with infectious diseases is particularly pressing. Long-term risk factors (RFs) for stroke, such as arterial hypertension, diabetes, and atherosclerosis, are of particular importance. Infectious agents act as triggers for acute vascular accidents through mechanisms of systemic inflammation, endothelial dysfunction, and hypercoagulability.

Objective: Analysis of clinical cases of infectious diseases complicated by stroke, assessment of risk factors, inflammatory markers, and hemostasis.

Materials and methods: A single-center retrospective observational study was conducted, including 26 patients with verified stroke secondary to acute infectious pathology. An analysis of stroke types, demographic indicators, comorbid background, etiologic structure of infections, laboratory parameters of inflammation and hemostasis is presented.

Results: Long-term risk factors were identified in 25 patients (96%). Stroke triggers included COVID-19, influenza, hemorrhagic fever with renal syndrome, viral-bacterial infections, and sepsis. Death occurred in 10 patients (38%) (COVID-19 – 50%, influenza – 20%). A comparison of the groups of deceased and surviving patients indicates the severity of inflammation (an increase in C-reactive protein above 100 mg/L in both groups) and hemostatic disorders: D-dimer levels in the deceased group were 5 times higher than in the surviving group (p=0.002).

Discussion: The obtained data confirm the significant role of infectious diseases as a trigger for stroke. Stroke was most frequently associated with COVID-19, but influenza, hemorrhagic fever with renal syndrome, sepsis, and viral-bacterial pneumonia also contributed significantly. High levels of C-reactive protein and D-dimer reflect the severity of systemic inflammation and hemostatic disorders, and a marked increase in D-dimer can be considered an unfavorable prognostic sign.

Conclusion: Infections may be a key risk factor for stroke. Identification and monitoring of long-term stroke risk factors and laboratory markers of inflammation and hemostasis in patients with infectious diseases are essential. Prevention of infection-associated strokes includes vaccination, treatment of chronic infections, and timely administration of anticoagulant therapy when indicated in at-risk patients. A D-dimer level >1000 ng/mL has been proposed as a potential prognostic marker of adverse outcome, which requires further validation.

Sarcopenia is based on a complex, multifactorial pathophysiology. Key mechanisms include skeletal muscle anabolic resistance (a reduced ability of muscle tissue to respond with protein synthesis to amino acid intake and physical activity), chronic subclinical inflammation (inflammaging), dysregulation of the IGF-1, PI3K, Akt, and mTORC1 signaling axis, insulin resistance, increased proteolysis via the ubiquitin-proteasome and autophagy, mitochondrial dysfunction with impaired mitophagy, and degeneration of the neuromuscular junction. The contribution of these processes leads to a deterioration in the quality and quantity of muscle fibers with aging. Risk factors for sarcopenia are divided into primary (age-related changes) and secondary (comorbidities, sedentary lifestyle, protein and micronutrient deficiencies). Current research confirms that the best clinical outcomes are achieved with a combination of progressive strength training, adequate protein intake (rich in essential amino acids), and correction of nutrient deficiencies, combined with targeted interventions for sarcopenia-associated metabolic pathways.

HIFEM and HIFES hardware technologies deserve special attention in the prevention and correction of sarcopenia.

Chronic urticaria (CU) is a condition caused by known and unknown causes, characterized by the appearance of wheals or angioedemas, each lasting no more than 24 hours, daily or almost daily for more than 6 weeks. Most cases of CU include chronic spontaneous urticaria (CSU), which has no apparent external cause and occurs without any specific external trigger, while induced urticaria (CIU) is caused by a specific external stimulus. In one-third of patients, the disease may occur in a combined form of CSU and CIU Combined forms of urticaria (CSU+CIU) are a condition characterized by a more severe course and treatment resistance. Comorbid associations of several CIU have been described, but large-scale studies of the prevalence and evaluation of treatment efficacy for such combinations have not been conducted. Ebastine is an antihistamine suitable for use in urticaria. The study was aimed to demonstrate the efficacy of ebastine in patients with various types of urticaria. In the treatment of CSU, the drug demonstrates high clinical efficacy at standard doses. This article demonstrates the efficacy of ebastine in various urticaria phenotypes, including comorbid CSU and CIU. The efficacy and reliable safety profile of standard doses of ebastine in the treatment of CSU, and in more complex cases (combined forms of urticaria) – escalated cases—provides disease control, which allows ebastine to be recommended as the drug of choice.

Iron deficiency conditions are particularly significant in obstetrician-gynecologist practice, as they are most common among women of reproductive age with normal menstrual cycles, pregnant women, and women in the perimenopausal period. This article presents an analysis of data from the international literature on the role of iron deficiency and the possibilities for its correction in gynecological practice. Oral iron supplements are currently the first-line treatment for anemia. Today, the rationale for prescribing iron supplements to women with anemia is unquestionable, and the wide range of medications available requires physicians to carefully select the right one, taking into account their efficacy and safety. Research results show that iron protein succinylate is equally effective as iron salts in the treatment of iron deficiency anemia, while oral administration of iron protein succinylate does not result in hepcidin blockade or the development of gastrointestinal adverse effects. Prescribing oral iron supplements at optimal, low therapeutic doses helps minimize side effects and increases iron bioavailability, maintaining high efficacy and patient compliance.

Background: The persistent tendency to postpone childbearing determines the increase in the proportion of patients with reduced ovarian reserve (ROR) in assisted reproductive technology (ART) programs. In addition to an increase in the frequency of chromosomal abnormalities, an important pathogenetic mechanism of age-associated decline in oocyte quality is mitochondrial dysfunction due to the progressive depletion of endogenous coenzyme Q10 (CoQ10), a key cofactor of oxidative phosphorylation and a major intracellular antioxidant.

Objective: Systematic analysis of the biological mechanisms of CoQ10 action and assessment of the clinical effectiveness of its use in ART programs in women with ROR based on current data.

Results: An age-related decrease in CoQ10 synthesis (due to impaired Pdss2 and Coq6 gene expression) reproduces the pathological patterns of oocyte mitochondrial dysfunction: a decrease in ATP production and an increase in the frequency of spindle abnormalities. The largest meta-analysis (Lin et al., 2024; 6 RCTs; n=1529) showed that the preliminary use of CoQ10 was associated with a statistically significant increase in the clinical pregnancy rate (OR=1.84, 95% CI 1.33–2.53), the number of oocytes obtained and quality embryos, a decrease in the dose of gonadotropins and the rate of cycle discontinuation. According to network meta-analyses, among other adjuvants, CoQ10 demonstrates the greatest efficacy in relation to the frequency of live birth compared with DHEA, growth hormone and testosterone. The available evidence base is characterized by significant limitations: small samples, predominance of surrogate markers over live birth as the primary endpoint, and heterogeneity of administration regimens.

Conclusion: CoQ10 has a clear pathogenetic rationale for adjuvant use in ART programs in women with ROR and a favorable safety profile. However, current international clinical guidelines (ESHRE, ASRM) do not include CoQ10 in the list of recommended interventions due to insufficient evidence. Its use is individual and requires informing the patient about the current status of the drug.

Background: Anal incontinence is a common problem in women who have suffered perineal trauma during childbirth. Symptoms of anal incontinence are socially disabling and significantly reduce quality of life.

Key findings: Current understanding of anal incontinence necessitates in-depth knowledge of the functioning of the rectal sphincter apparatus and diagnostic and therapeutic approaches to this problem. Surgical treatment of anal sphincter insufficiency includes various sphincteroplasty options, including restoration of the levator ani muscle. The long-term effectiveness of surgical correction of sphincter insufficiency varies; early and detailed diagnosis of muscle defects and functional impairments improves treatment outcomes, allowing for the development of an individualized, multimodal treatment approach. Alternative techniques (sacral neuromodulation, artificial sphincter implantation, and graciloplasty) are used in cases with severe damage, anal sphincter denervation, and in cases where other techniques have proven ineffective.

Conclusion: Modern approaches to sphincteroplasty focus on restoring anatomy and function, taking into account individual characteristics, with the choice of technique based on a balance between its benefits and potential risks.

Objective: Evaluation of the effectiveness of topical therapy using a complex of natural antimicrobial peptides and cytokines (Superlymph) in patients with thin endometrium (TE) and reproductive dysfunction prior to in vitro fertilization and embryo transfer (IVF).

Materials and methods: Ninety patients with TE and diagnosis N97.2: Female infertility of uterine origin (oocyte implantation defect) were included. Groups I (n=45) received Superlymph, Group II (n=45) received autologous platelet-rich plasma (PRP) injections into the endometrial submucosal layer, and Group III (n=45) included women with normal endometrial thickness (male factor infertility). Research methods included clinical, laboratory (smear microscopy and real-time PCR of vaginal contents), biochemical, functional (pelvic ultrasound, Doppler ultrasound), morphological, and immunohistochemical (IHC) tests (CD138 determination).

Results: After treatment, M-echo in the second phase of the cycle increased from 5.8 and 5.4 mm in Groups I and II, respectively, to 7.3 mm in both groups; sclerosis of the spiral arteries of the endometrium significantly decreased, and the endometrial structure corresponded to the day of the menstrual cycle; laboratory testing showed no local inflammation. The pregnancy rate in Group I was 42.2%, while in Group II it was 37.7%, with an absolute difference in rates of 4.5% in favor of Superlymph. The odds of pregnancy and live birth were comparable between the groups (OR=1.12, 95% CI: 0.67–1.86, p=0.83 and OR=1.23, 95% CI: 0.67–2.25, p=0.65, respectively). Pregnancy outcomes were also comparable and did not differ statistically significantly from the control group.

Conclusion: Therapy using the Superlymph complex in patients with TE and infertility before IVF is no less effective than PRP therapy.

Hyperreactio luteinalis is a rare condition characterized by ovarian enlargement due to multiple theca-lutein cysts and likely associated with elevated human chorionic gonadotropin (hCG) levels or an abnormal ovarian response to hCG [1]. Hyperreactio luteinalis is most often seen in conditions with elevated hCG levels, such as trophoblastic disease, multiple pregnancy, or nonimmune hydrops fetalis, but can also occur in normal singleton pregnancies [2]. This article presents a clinical case of large theca-lutein cysts that developed in the third trimester of pregnancy with a favorable outcome. During follow-up until delivery at 37-38 weeks, a progressive increase in the size of the ovarian cysts was noted. A partial resection of both ovaries was performed during a cesarean section. The postoperative period was uneventful, and a follow-up ultrasound two months later revealed complete regression of the theca-lutein cysts.

Background: Prostate cancer (PCa) with bone metastases is one of the most aggressive forms of the disease, accompanied by severe pain, decreased quality of life (QOL), and limited treatment options. Standard treatments, including androgen deprivation therapy and chemotherapy (CT), are often insufficiently effective in advanced stages, necessitating the search for new targeted approaches.

Objective: Systematization of the current data on prostate-specific membrane antigen (PSMA)-targeted theranostics, with a focus on radioligand therapy with ¹⁷⁷Lu-PSMA-617, and analysis of the clinical efficacy, safety profile, and promising development directions for this method.

Methods: A review of publications in PubMed, Scopus, and Web of Science was conducted, including key clinical trials (VISION, TheraP, PSMAfore). Data on survival, biochemical response, patient selection criteria, and toxicity profile were examined.

Results: Radioligand therapy with ¹⁷⁷Lu-PSMA-617 demonstrated significant improvements in overall survival, time without radiological progression, and biochemical response rate compared with standard treatment and chemotherapy. The most common adverse events were xerostomia and mild to moderate hematologic toxicity. The use of PSMA-PET/CT proved to be a key tool for patient selection, with higher PSMA expression correlating with better treatment outcomes. Promising development areas include combinations with PARP inhibitors and the use of α-emitting radiopharmaceuticals (²²⁵Ac-PSMA).

Conclusion: Therapy with ¹⁷⁷Lu-PSMA-617 represents a breakthrough in the treatment of prostate cancer with bone metastases, demonstrating significant improvements in survival and quality of life. The inclusion of radioligand therapy at earlier stages and the development of combination strategies open up new prospects for personalized oncourology.

Background: Breast cancer is characterized by pronounced molecular heterogeneity, which determines differences in prognosis, sensitivity to therapy, and the potential for breast-preserving and reconstructive interventions. The most aggressive course is observed in triple-negative and Her2/neu-positive breast cancer types, which justifies the need for a comprehensive assessment of factors influencing the effectiveness of neoadjuvant treatment and the choice of surgical approach.

Objective: Evaluation of the impact of immunohistochemical (IHC) subtype and neoadjuvant drug treatment regimens on clinical and pathological response, as well as their relationship with the choice of surgical intervention in patients with prognostically unfavorable forms of breast cancer (BC).

Materials and methods: A retrospective study of 500 patients with stage II–III breast cancer was conducted. IHC types, neoadjuvant therapy regimens, clinical response, residual cancer burden (RCB), and the nature of surgical treatment were analyzed. Nonparametric statistical methods and categorical data analysis were used.

Results: Statistically significant differences were found between the subtypes in terms of Ki-67 levels, differentiation grade, and disease stage (p< 0.05). The rate of complete pathological response (RCB-0) was highest in the Her2/neu-positive subtype (70.2%) and lower in the triple-negative and luminal B, Her2/neu-positive subtypes (46.9 and 46.5%, respectively). Clinical response did not differ between the groups (p=0.312). The type of surgical intervention did not achieve statistically significant differences between the groups (p=0.066), but a tendency towards differences was noted. Differences were also found in the choice of specific oncoplastic and reconstructive techniques (p=0.021).

Conclusion: IHC subtype is a significant predictor of pathological response, but does not independently influence the choice of the extent of surgical intervention, which is determined primarily by clinical and anatomical factors. The obtained data substantiate the need to consider RCB when assessing therapy efficacy and planning treatment.

Objective: Evaluation of the effect of semaglutide on lipotoxicity in patients with type 2 diabetes mellitus (DM2).

Materials and methods: A single-center prospective study included 63 patients aged 40–69 years with DM2 and obesity (body mass index 30.0–39.9 kg/m²) on metformin monotherapy (1000–2500 mg/day) and a glycated hemoglobin level of 7.0 to 9.0%. 59 patients completed the observation. For 6 months, patients received semaglutide 1 times a week with a dose titration of up to 1.0 mg, and the effectiveness of the therapy was evaluated at 3 and 6 months. Lipotoxicity was analyzed within the framework of the lipometabolic continuum using a comprehensive assessment of fat and muscle mass (anthropometry, bioimpedansometry, dual-energy X-ray absorptiometry in the Total Body Composition mode), carbohydrate metabolism, insulin resistance and secretory capacity of pancreatic β cells, lipid profile (total cholesterol, low-density lipoproteins, high-density lipoproteins, triglycerides), free fatty acid (FFA) and adiponectin levels, and biochemical and instrumental markers of liver status, including ultrasound and shear wave elastography with METAVIR fibrosis score.

Results: Semaglutide therapy leads to a decrease in FFA and triglyceride levels, transformation of the body composition with a decrease in fat mass, including visceral fat, an improvement in insulin sensitivity at various levels, including adipose tissue, an increase in β cell function and an improvement in the functional and structural state of the liver. Semaglutide had the greatest anti-lipotoxic effect in patients with initially more pronounced lipotoxicity.

Conclusion: Based on the data obtained, it can be concluded that semaglutide therapy contributes to a multicomponent anti-lipotoxic effectin patients with DM2 and obesity.

Non-alcoholic fatty liver disease (NAFLD) is regarded as a clinical marker of systemic metabolic dysfunction and an important component of the cardiometabolic multimorbidity phenotype. The aim of this review is to summarize current evidence on the association of NAFLD with cardiovascular prognosis and disorders of carbohydrate and lipid metabolism, and to present the potential role of ursodeoxycholic acid (UDCA) in the comprehensive management of these patients. The literature search methodology included an analysis of publications indexed in PubMed/MEDLINE, Scopus, the Cochrane Library, and eLIBRARY for 2018–2026, clinical guidelines, as well as key studies from previous years. The available evidence indicates that UDCA should be considered as a component of comprehensive NAFLD therapy due to its ability to promote the elimination of excess free fatty acids from hepatocytes and, at the same time, exert a favorable effect on the associated cardiometabolic risk.

Federal Law No. 323-FZ «On the Fundamentals of Citizens’ Health Protection» guarantees every Russian citizen the right to high-quality medical rehabilitation. According to Article 40 of this law, medical rehabilitation is a set of measures aimed at restoring or compensating for lost bodily functions, maintaining health, early detection and correction of disorders, as well as preventing disability, improving quality of life, and social adaptation. The main areas where the first stage of rehabilitation is carried out include neurology, cardiology, internal medicine, oncology, pulmonology, traumatology and orthopedics, cardiovascular surgery, and neurosurgery. Using the Federal Center for Brain and Neurotechnology (FCBN), Federal Medical and Biological Agency as an example, this article examines the organizational aspects of the first stage of rehabilitation: the rehabilitation start time, the composition of the multidisciplinary team, the interaction procedures between specialists, internal documentation, and payment criteria based on the patient’s treatment complexity coefficient.