卷 33, 编号 3 (2025)

INTRODUCTION: The anatomy of the celiac trunk and superior mesenteric artery, due to their clinical significance, has been studied quite well both in abdominal surgery and oncology. At the same time, there is much less information about peculiarities of the structure and catheterization of the inferior mesenteric artery (IMA) in angiographic operations, which was the reason for studying this issue.

AIM: To study the architecture of the IMA and the peculiarities of its catheterization based on X-ray contrast angiography data.

MATERIALS AND METHODS: The study included 20 patients (13 men, 7 women; mean age (56.0 ± 7.0) years) with colorectal cancer and colorectal cancer metastases to regional lymph nodes, who underwent intra-arterial neoadjuvant/adjuvant therapy. X-ray endovascular intervention was performed using a Siemens Artis Zee device. In 10 patients, angiography was performed through the femoral access, in 10 patients — through a puncture of the brachial artery. The identified features of the structure of the IMA, were structured using a modified classification of H. Yada.

RESULTS: Type I of the IMA structure according to H. Yada was detected in 70%; type II — in 15%; type III — in 10%; type IV — in 5%. Basic morphometric parameters of the IMA were: diameter — (2.90 ± 0.67) mm, length to the level of separation of the first branch — (29.8 ± 15.9) mm, separation angle — (32.0 ± 7.4)°. The revealed structural features of the inferior mesenteric artery make access through the upper limb using an MPA catheter preferable.

CONCLUSION: Four variants of the structure of the IMA circulation according to H. Yada’s classification were confirmed, and its main morphometric parameters were established based on our clinical material. Access through the upper limb using an MPA catheter with the primary visualization of the IMA at the level of the fifth lumbar vertebra with subsequent pulling up and orientating the catheter tip toward the anterior wall of the left semicircle of the aorta is optimal for catheterization of the IMA and its branches.

INTRODUCTION: Bleeding is the most common complication of endoscopic resection of mucous membrane of a hollow organ, which most often accompanies removal of large polypoid masses (PMs). However, currently endoscopic techniques have been developed that allow for effective prevention of this complication.

AIM: Comparison of the effectiveness of endoscopic methods of preventing bleeding when removing large PMs of colonic mucosa: prophylactic clipping and prophylactic ligation of polyp stalk.

MATERIALS AND METHODS: The study included patients with single pedunculated PMs with a feeding stalk of ≥ 5 mm thickness, located in different parts of the colon. Exclusion criteria were the presence of other large (≥ 10 mm) epithelial masses in the colon, as well as the use of antiplatelet agents and anticoagulants. Patients of group A (n = 32) were planned to undergo bleeding prevention by ligating the PM stalk using an original ligating device, patients of group B (n = 32) by prophylactic clipping of the stalk with a metal endoclip. The time of surgical intervention, intraoperative and immediate postoperative bleeding rate were compared, and technical difficulties in the use of prophylactic hemostasis techniques were recorded.

RESULTS: Sixty-one out of sixty-four surgical interventions were performed without technical difficulties. In two cases, prophylactic clipping of the stalk was initially planned, but during the surgical intervention ligation was used due to technical peculiarities of the operation. The average time of surgical intervention using the prophylactic ligation method was (16 ± 3) minutes, using clipping — (12 ± 2) minutes. No bleeding was recorded during surgical interventions and in the immediate postoperative period in any of study cases.

CONCLUSION: Both methods provide reliable prophylactic hemostasis, effective in almost 100% of cases. However, the prophylactic clipping method has a number of technical limitations: it should be used with caution when removing a PM with a short or a thick stalk. In these cases, the method of choice for the endoscopist may be the prophylactic ligation.

INTRODUCTION: Diabetic retinopathy (DR) is one of most common chronic complications of diabetes mellitus (DM). The pathogenesis of DR is complex and involves interaction of many molecular mechanisms, and far not all of them have been studied.

AIM: To determine the level of matrix metalloproteinases and kynurenines in the blood of patients with type 2 DM (T2DM) with different stages of DR.

MATERIALS AND METHODS: Four groups of patients were formed: Group 1 (control) — 21 healthy individuals; Group 2 — 21 patients with prediabetes, Group 3 — 21 patients with T2DM, Group 4 — 63 patients with T2DM and DR. Then patients with DR were divided into groups (n = 21): Group 5 — non-proliferative stage of DR, Group 6 — preproliferative DR, Group 7 — proliferative DR. In the blood serum, the following parameters were determined: the content of metalloproteinases (MMP) types 2 and 9 (MMP-2, MMP-9) by the enzyme immunoassay; in blood plasma — the concentration of kynurenines by the high-performance liquid chromatography.

RESULTS: Significant differences were recorded in the studied parameters between healthy individuals and patients with diabetes. Subsequently, the results of patients with different stages of DR were compared with the data of patients with diabetes without vascular complications. In the preproliferative stage of DR, an excess of blood MMP-2 by 87.9% (p = 0.030) and MMP-9 by 37% (p = 0.049) was recorded relative to the individuals with diabetes. In the proliferative stage of DR, the levels of MMP-9 and MMP-2 were higher than those of not only the comparison group, but also the groups of non-proliferative and preproliferative stages of DR. In the preproliferative stage of DR, an increased concentration of 3-hydroxykynurenine was also recorded. The maximum increase in kynurenines was noted in the final stage of DR (p < 0.05 relative to the groups of non-proliferative and preproliferative DR).

CONCLUSIONS: In the analyzed groups of individuals, the concentrations of kynurenines increased as the underlying disease progressed. The level of MMP-9 was higher in diabetes mellitus, and in the proliferative stage of DR, the values of MMP-9 and MMP-2 increased.

INTRODUCTION: Cardiac structure, function and metabolism, as well as the immune system biology significantly differ in men and women. Identification of differences of the myocardial response to the concomitant diseases in women compared to men could provide insight into the mechanisms underlying heart failure (HF) in women and men.

AIM: A comparative analysis of the cardiovascular risk profile, structural and functional myocardial parameters and heart failure biomarkers in the population of men and women, and investigation of gender differences in the relationships of these parameters with metabolic syndrome (MS).

MATERIALS AND METHODS: The ‘Learn Your Heart’ cross-sectional study data were analyzed on a population sample aged 35–69 years (n = 2,380), of which 989 men (41.5%) and 1,391 women (58.5%). History data (bad habits, diseases) and laboratory data, including high-sensitivity troponin T (hs-TnT) and N-terminal propeptide of the brain natriuretic peptide (NT-proBNP) were used. The presence of MS was determined based on AHA/NHBLI 2009 criteria. Echocardiography was used to evaluate structural and functional parameters with phenotyping of systolic and diastolic dysfunction of the left ventricle (LV).

RESULTS: Men were more likely to smoke and have a history of myocardial infarction, while women were more likely to have heart failure and diabetes (p < 0.05 for all). Men had higher triglyceride levels, while women had higher body mass index and low-density lipoprotein cholesterol (all p < 0.05). Ejection fraction and global longitudinal strain (GLS) of the LV, adjusted for bad habits and diseases (heart failure, diabetes, myocardial infarction), had lower values in men, and diastolic dysfunction of the LV was more distinct in women (p < 0.001 for all). The hs-TnT level was higher in men, the frequency of elevated LV filling pressure (E/é) and NT-proBNP concentration exceeded 125 pg/ml in women (all p < 0.05). In women, a stronger negative association was recorded between MS and the é lateral (p = 0.001), é septal (p = 0.003) and GLS (p = 0.013) of the LV.

CONCLUSION: In a population sample aged 35–69 years, gender differences in the structural and functional heart characteristics were identified: lower values of ejection fraction and GLS of LV, higher hs-TnT levels in men and higher levels of LV filling pressure (E/é) and NT-proBNP and stronger negative relationships of MS with relaxation parameters (é lateral, é septal) and LV contractility in women.

INTRODUCTION: In the field of sports physiology, the need to study the determinants of the effectiveness of various types of physical activity is quite urgent. A variety of physiological and psychophysiological parameters as potential predictors of purposeful physical activity determines the need to search for a new algorithm for system analysis carried out using modern methods of mathematical data processing. In this regard, it is relevant to use artificial neural networks and multifactorial regression analysis in order to solve the stated tasks.

AIM: To carry out a system analysis of the individual physiological and psychophysiological determinants of human physical activity in order to predict its effectiveness.

MATERIALS AND METHODS: One hundred twenty young men who did not have sports grades and did not regularly attend sports clubs voluntarily participated in the study. The subjects' motivational basis of behavior, basic physical qualities, physiological and psychophysiological parameters were evaluated. Forecasting the direction of performance was carried out using the constructed models of artificial neural network technology and multifactorial regression analysis.

RESULTS: Based on the statistical processing of the obtained parameters (division into clusters, rank correlation, neural network modeling, linear regression), an algorithm was created for the correct and reliable identification of the direction of the effectiveness of physical activity when the study participants realized the basic physical characteristics (strength, dexterity, endurance, speed). The study participants were divided into homogeneous clusters: ‘effective in running disciplines’ (70 boys) and ‘effective in strength disciplines’ (50 boys). The models constructed using artificial neural network technology with the involvement of various parameters, allowed identification of the determinants of the effectiveness of physical activity (ROC sensitivity: 75.7, 86.0 and 96.5%). According to the calculated parameters of the regression equation the result was predicted in high-speed quality with an accuracy of 87.9% (p ≤ 0.001), and in power quality with an accuracy of 70.8% (p ≤ 0.004).

CONCLUSION: The complex of mathematical and statistical methods of analysis selected in the work can be introduced for identification and system analysis of motor activity of individual physiological and psychophysiological determinants of physical activity to predict its effectiveness in young men.

INTRODUCTION: Currently, there is no unified classification of variant anatomy of cerebral vessels, which underlies the contradictory character of data on the prevalence and clinical picture of such developmental variants as the posterior trifurcation of the internal carotid artery (ICA).

AIM: To present a clinical case of diagnosis and confirm the anatomical norm of the posterior trifurcation of the ICA.

The article describes diagnostic search in a 51-year-old female patient with a chronic tension headache. On examination, a fusiform aneurysm of the left ICA was suspected, but it was not confirmed by computed angiography, which detected posterior trifurcation of the ICA.

CONCLUSION: The posterior trifurcation of the ICA in the analyzed clinical case is a finding not being a pathological condition. Anatomical differentiation of a complete posterior trifurcation and fusiform aneurysm of the ICA in chronic tension headache postulates the posterior trifurcation of the ICA being a variant of normal structure of the circle of Willis, which is of a principal clinical significance. For the first time the trifurcation of the ICA is presented as ontogenetic resource of the arterial system of the human brain, an ontogenetically determined variant of structure, and not ‘an embryonic type of structure’ of the circle of Willis, preserved due to delayed reduction of the posterior communicating arteries.

INTRODUCTION: In the last decade, patients with various surgical pathologies have been demonstrating an increase in uncomplicated erosive and ulcerative lesions (EULs) of the proximal part of the gastrointestinal tract (GIT). Knowledge of the current prevalence of this pathology has both scientific and practical significance.

AIM: Assessment of the prevalence of uncomplicated EULs in the upper GIT in a multidisciplinary surgical hospital and analysis of factors that determine the structure of the identified prevalence.

MATERIALS AND METHODS: Meta-analysis of 20 clinical studies from eLibrary, PubMed databases from 2010 to 2023 devoted to uncomplicated EULs of GIT, stomach and duodenum.

RESULTS: Based on the examination of 4,337 patients (data of domestic literature sources) and 13,024,812 (data of foreign sources), the prevalence of acute erosive and EULs of the upper GIT ranged from 7.4 to 100% and from 1.7 до 100% respectively. High heterogeneity of samples confirms a wide variation of the incidence of the analyzed kind of lesion both in our country and abroad determined by the influence of various factors, specific to both each patient and the profile of a surgical hospital.

CONCLUSION: The meta-analysis demonstrates a high range of incidence of uncomplicated acute EULs of the proximal GIT, which requires further clarification of the true prevalence of the pathology under study and of other causes that influence the development of destructive pathological alterations.

INTRODUCTION: The review is devoted to social and hygienic monitoring (SHM), a system of monitoring the state of the environment and health of the population, allowing to establish cause-and-effect relationships between them. It is used for all stages of processing data on environmental parameters, socio-economic indicators and medical and demographic characteristics of the population. All regions of the Russian Federation have experience in SHM. Every year, hundreds of thousands of instrumental measurements of human environmental factors are performed as part of its implementation. A huge amount of data has been accumulated at the federal and regional levels, the analysis of which is the basis for making informed decisions in order to improve the sanitary and epidemiological situation and well-being of the population, as well as for the development and implementation of effective measures and activities to eliminate risk factors. Today, the SHM system is provided with modern tools and methods, it is constantly being improved, responding to emerging requests.

AIM: To analyze and summarize the regulatory framework and scientific literature on social and hygienic monitoring in order to identify promising areas for its further development.

The search for scientific articles was carried out in the eLibrary, Google Scholar, CyberLeninka databases, and regulatory documentation was searched in the TekhExpert system.

CONCLUSION: Based on the results of the study, several promising areas for further development of the SHM system can be identified. The urgent tasks include the development of a single document on social and hygienic monitoring, optimization of sampling programs and laboratory tests, and the introduction of molecular genetic monitoring, which will allow for individual multifactorial health risk assessment. In addition, it is necessary to expand interdepartmental interaction and information exchange in order to form a single database of SHM results to solve urgent problems of public health protection.