HERALD of North-Western State Medical University named after I.I. Mechnikov
Рeer-review medical academic journal. Founded in 2009 Editor-in-Cheif: Vadim .I. Mazurov Founders: Eco-Vector LLC, I.I. Mechnikov North-Western State Medical University Publisher: Eco-Vector LLC
Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal exclusive license to first publication. Authors are able to distribute the manuscript and/or the article in accordance with Self-Archiving policy of the journal (see details). The manuscript can be accepted for publication only by decision of the Editor-in-Chief and the Editorial board of the journal in accordance with the Manuscript stelection policy of the journal (see details). Published Article will be distributed in print and electronic version an will be available under subscription with Delayed Open Access or in Immediate Open Access under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). The access model depends on the publisher's decision or is determined by a separate Open Access publishing agreement with the authors. An exclusive license for publication granted by authors allows the publisher to use the article in the following ways: Reproduction of the Article or its sections or parts, as well as the metadata of the Article in any languages, in any material form, including on paper and electronic media, as a separate work in the journal and/or databases (local or in the Internet) of the publisher and/or other persons, at the discretion of the publisher; Distribution of the Article or its sections or parts, as well as the metadata of the Article in any languages, on any medium as part of the journal and/or databases of the publisher or other persons, at the discretion of the publisher, or as an independent work around the world whether on Open-Access terms or for a fee without remuneration to the Author; Making the Article or any of its sections or parts, as well as the Article’s metadata in any languages, publicly available in such a way that any person can access the Article from any place, including via the Internet, and at any time of their own choosing; Granting permission/s for the use of the Article or its sections or parts, as well as its metadata in any languages, to third parties with notice to the Author made by posting relevant information on the journal’s website, without paying remuneration to the Author; Processing the Article (i.e., editing, correcting, annotating, tagging, translating to any languages, typesetting) and using the revised (translated) Article in the aforementioned ways. Other rights not directly transferred to the publisher under this License Agreement, including patent rights to any process, method etc., described by the Authors in the manuscript, as well as trademark rights, are reserved for the Authors. All the Copyright statements for authors are present in the standart Publishing Agreement (Public Offer) to Publish an Article in an Academic Periodical 'HERALD of North-Western State Medical University named after I.I. Mechnikov'. - DOWNLOAD the print-version of the License Agreement. READ the details online (tap to see in details) Author’s license agreement (public offer) on the publication of an article in a scholarly journal “HERALD of North-Western State Medical University named after I.I. Mechnikov” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “HERALD of North-Western State Medical University named after I.I. Mechnikov” (further-the Journal) in accordance with the conditions stated below. I. General Provisions This Agreement, in accordance with clause 2 of Article 437 of the Civil Code of the Russian Federation, is a public offer (hereinafter referred to as the Offer) requiring full and unconditional acceptance (Acceptance), which, in accordance with Article 438 of the Civil Code of the Russian Federation, means the sending by the Author of his/her materials by way of uploading the same to the online electronic system designed to accept manuscripts for consideration, and subsequently posted in the corresponding section of the Journal’s website on the Internet information and telecommunications network (hereinafter referred to as the Internet). In accordance with the current legislation of the Russian Federation regarding the observance of copyright on electronic information resources, all materials found in a website, including submitted and published in electronic journals, may not be reproduced in whole or in part in any form (electronic or printed) without the prior written permission of the Publisher. Prior permission can be given by publishing an article in the open access with Creative Commons license. The journal requires license users to reference the original source, i.e., the publication, if the Author permits use of the public materials in the context of other documents. II. Terms used in the Agreement “Author” refers to an individual (or individuals) whose creative work has led to the creation of the manuscript of a scientific Article, or to a representative of these persons. “Manuscript” is the result of intellectual activity in the form of a scientific work containing text, graphic and numerical data, audiovisual information, program code and other elements submitted by the Author for publication in the Journal; it is also the mean “a draft of an Article submitted by the Author to be published in the Journal”. “Offer” is the current agreement (an offer to the author for the publication of an Article in the Journal). “Publication” is the process of placement of an Article in the Journal. “Article” is the manuscript that has been published in the Journal (after successful selection, editing, type-setting, copyediting, proofreading, translation). “Acceptance of the offer” refers to the full and unconditional acceptance of the offer on the terms specified in paragraph 3 of this agreement (the Author accepts offer by submitting a Manuscript to the Publisher via the online electronic submission system on the Journal’s Internet website). “Journal” is a scientific peer-reviewed periodical registered as a mass media entity in the Roskomnadzor register of the Russian Federation and ISSN-center. “Submission” is an electronic appeal of the Author to the Publisher for the publication of an Article in the Journal by uploading the manuscript and accompanying materials to the online electronic submission system on the Journal’s Internet website). “Publisher” refers to Eco-Vector, which is the Publisher of the journal. Article metadata includes the information that are intended for inclusion in International Scientific Databases and search engines, namely the following: title of the Article; information about each of the Authors (surname and first name; patronymic; place of work with the postal address indicated, contact information (e-mail)); abstract; keywords; thematic rubricator: UDC (Universal Decimal Classification) or other library and bibliographic classification and subject indexes; list of references. “Editorial board” is the creative team that prepares the journal for publication. “Parties” refers to the Author and the Publisher. “Author Guidelines” are the requirements for Articles published in the Journal, posted in the “For authors” section of the Journal’s Internet website. III. Subject of the Agreement (Offer) Under this agreement, the Author grants the Publisher, free of charge for the entire period of validity in accordance with the legislation of the Russian Federation, an exclusive license to use the Article created by the former for publication in the Journal, as well as the rights to use the article in the following ways: Reproduction of the Article or its sections or parts, as well as the metadata of the Article in any languages, in any material form, including on paper and electronic media, as a separate work in Journals and/or databases (local or in the Internet) of the Publisher and/or other persons, at the discretion of the Publisher; Distribution of the Article or its sections or parts, as well as the metadata of the Article in any languages, on any medium as part of the Journal and/or databases of the Publisher or other persons, at the discretion of the Publisher, or as an independent work around the world whether on Open-Access terms or for a fee without remuneration to the Author; Making the Article or any of its sections or parts, as well as the Article’s metadata in any languages, publicly available in such a way that any person can access the Article from any place, including via the Internet, and at any time of their own choosing; Granting permission/s for the use of the Article or its sections or parts, as well as its metadata in any languages, to third parties with notice to the Author made by posting relevant information on the Journal’s website, without paying remuneration to the Author; Processing the Article (i.e., editing, correcting, annotating, tagging, translating to any languages, typesetting) and using the revised (translated) Article in the aforementioned ways. Other rights not directly transferred to the Publisher under this Agreement, including patent rights to any process, method etc., described by the Author in the Article, as well as trademark rights, are reserved for the Author. The territory where the rights to the Article are allowed to be used is the whole world. The validity of this Agreement commences only if the manuscript of the Article is accepted for publication in the Journal and only from the moment of sending a notification of acceptance of the Article for publication to the Author from the official e-mail of the Journal. The rights are granted by the Author to the Publisher free of charge; the publication of the Article in the Journal does not entail any financial deductions to the Author. If the Publisher decides to reject the Submission or refuse to publish the Article in the Journal (i.e., retraction of the published Article), this Agreement becomes invalid. The decision to refuse publication will be sent to the Author at the e-mail address specified in the Submission. IV. Rights and Duties of the Parties The Author guarantees that: s/he holds the copyright the exclusive rights to the materials submitted to the Publisher as part of the manuscript of the Article; the rights granted to the Publisher under this agreement have not been previously transferred and will not be transferred to third parties in the future during the duration of the Agreement; the manuscript contains all references to the cited authors and/or publications (materials) provided for under the current copyright legislation; the Author has obtained all the necessary permissions for all information and other materials s/he holds no copyright to and that are used in the manuscript of the Article; the Article manuscript contains only materials permitted to be published in the open press in accordance with the current legislative acts of the Russian Federation, and its publication and distribution will not lead to the disclosure of secret (confidential) information (including state secrets); the Author has informed co-authors about the terms of this Agreement and has received their consent to execute this Agreement under the terms provided for in the Agreement. The Author carries certain obligations under the terms of the Agreement: s/he should prepare and submit the manuscript of the Article in accordance with the Author Guidelines posted on the Journal’s website; the Author should not use an electronic copy of the Article for commercial purposes and in other journal publications without the consent of the Publisher; in the process of preparing a manuscript for publication, the Author is obligated to undertake the following: make corrections to the text of the manuscript that have been marked by the peer-reviewers and accepted by the editorial board, and/or as necessary, upon the request of the Publisher and the editorial board, finalize the manuscript of the Article; revising and proofreading the manuscript of the Article in accordance with the editorial recommendations; suggest only the minimum of corrections to the type-setted (layout) Article. The Author has the following rights and duties: Use preprint or prior-to publication versions of an unpublished Article in the form and content accepted by the Publisher for publication in the Journal. Such prior-to-publish versions can be placed as electronic files on the personal websites of the Author (co-authors) or on the protected external websites of the employers of the Author; however, the Author cannot use the unpublished version(s) for commercial sale or for systematic external distribution by a third party (i.e., post on social media). The author or co-authors must, in turn, carry out certain duties, namely: include the following warning in the prior-to-publish version: “This is prior-to-publish version of the article accepted for publication in (Journal’s name), © Eco-Vector (year)”; provide the corresponding electronic link to the Publisher’s website at https://journals.eco-vector.com/ and/or via the DOI. Copy or transfer a copy of the published Article in whole or in part to colleagues free of charge for their personal or professional use, for the promotion of academic or scientific research, or for informational purposes of the Author’s employer. Use materials from a published Article in a book written by one of the co-authors. Use figures, tables and text excerpts from the Article for his or her (or co-authors’) own training purposes, or to include them in other published works in printed or electronic format by a third party, or to submit them in electronic format on an internal computer network, or on the public website of the Author (co-authors) or his/her employer. Include the Article in educational collections for use in the classroom, either for free distribution to the Author’s (co-authors’) students or in electronic format on a local server for access by students as part of the training course, as well as for internal training programs at the institution of the Author’s employer. The Publisher, for its part, is obliged to: publish the Author’s article in the Journal in printed and electronic form in accordance with the terms of this Agreement; if necessary, as so decided by the Journal’s editorial board, provide the Author with the proofreading of the manuscript and make a reasonable editing; provide to the Author the unlimited access to the final electronic version of the published Article (Version of Record) through the online electronic submission system on the Journal’s Internet website; comply with the Author’s rights as provided for by the current legislation, as well as protect them and take all necessary measures to prevent copyright infringement by third parties. The Publisher has a right to: conduct an expert evaluation of the manuscript (peer-reviewing and editorial evaluation) and invite the Author to make the necessary changes (revisions) to the manuscript; provide editing, copyediting, type-setting, proofreading, tagging, indexation and translation of the Article’s manuscript without altering the main content; in any subsequent authorized use by the Author (and/or other persons) of the Journal and/or Article (including any separate part or fragment thereof), require that a link to the Journal, Publisher, Author or other copyright holders, the title of the Article, the Journal’s volume/issue, and the year of publication be specified in the Journal; post preliminary and/or advertising information about the upcoming publication of the Article in the media and other information sources; make changes to the offer in accordance with the procedure established by the offer. The editorial board of the Journal, headed by the editor-in-chief, has the exclusive rights to select and/or reject materials sent to the Journal editorial office for publications purposes. The manuscript sent by the Author to the Journal editorial office is not subject to return. The editorial board of the Journal does not enter into correspondence about rejection of submissions. In all cases not stipulated and not provided for in this agreement, the parties are obliged to be guided by the relevant current laws of the Russian Federation. V. Acceptance of the Offer and Execution of the Agreement. Terms of the Agreement The Author accepts the Offer by submitting the manuscript on the Article to the Publisher through the electronic manuscript submission system on the Journal's Internet website. Acceptance of the offer by the author creates an Agreement in writing (Articles 438 and 1286.1 of the Civil Code of the Russian Federation) on the terms of the offer. This Agreement is valid for the duration of the exclusive rights to the Article. When transferring (alienating) the exclusive right to the Article by the Author to a third party, this Agreement does not terminate. VI. Procedure for changing and terminating the Agreement The Publisher has the right to unilaterally change the terms of this Agreement, in advance, at least 10 (ten) calendar days before the entry into force of the intended relevant changes, but with notice to the Author through the Journal’s website or by e-mail to the Author’s e-mail address specified in the Author’s Submission. The changes will take effect from the date specified in the relevant notification. If the Author rejects the changes to the terms of this Agreement, s/he has the right to notify the Publisher by sending a written notification through the online manuscripts submission system, making sure that the same is sent to the official e-mail address of the editorial office. This Agreement may be terminated prematurely, either by agreement of the parties at any time, or on other grounds provided for in this Agreement. The Author has the right to unilaterally withdraw from the execution of this Agreement by sending the Publisher a corresponding notification in writing at least 60 (sixty) calendar days in advance before the expected date of publication of the Article in the Journal. Termination of the Agreement for any reason does not release the parties from liability for any violation of the terms of the Agreement that occurred during the validity period. VII. Responsibility The parties are responsible for non-fulfillment or improper fulfillment of their obligations under the Agreement in accordance with the current relevant legislation of the Russian Federation. All information provided by the Author must be reliable. The Author is expected to provide accurate and complete the information to the Publisher. When using false information received from the Author, the Publisher is not responsible for the negative consequences caused by his actions on the basis of the false information provided. With regard to the content of the Article, the Author is solely responsible for compliance with the requirements of the laws of the Russian Federation pertaining to advertising, copyright and related rights’ protection, protection of trademarks and service marks, and the protection of consumer rights. The Publisher does not bear any responsibility under the agreement: for any actions that are a direct or indirect result of Author’s illegal actions; for any loss incurred by the Author, regardless of whether the Publisher could have foreseen the possibility of such losses or not. The Publisher is released from liability for violation of the terms of the Agreement if such violation is caused by force majeure, including actions of state authorities (including the adoption of legal acts), fire, flood, earthquake, other natural disasters, lack of electricity and/or computer network failures, strikes, civil unrest, riots, etc. VIII. Dispute resolution Disputes and disagreements will be resolved by the parties through negotiations, and in case of failure to reach an Agreement they will strive to seek resolution in accordance with the current legislation of the Russian Federation. If there are unresolved disagreements, the parties agree to resolve the disputes in court at the jurisdiction covered by the Publisher’s location in accordance with the current legislation of the Russian Federation. IX. Miscellaneous All notifications, messages, requests, etc. (with the exception of documents that must be sent as originals in accordance with the laws of the Russian Federation) are considered received by the Author if they were transmitted (sent) by the Publisher through the Journal’s website (including by publication), fax, e-mail based on the address specified in the Submission, and other communication channels. The parties recognize the legal force of notifications, messages, requests, etc., transmitted (sent) by the above methods. In the event of claims against the Publisher related to the violation of the exclusive copyright and other intellectual property rights of third parties when creating an article or in connection with the execution of this Agreement by the Author, as well as in connection with the use of the Article by the Publisher in accordance with the Agreement, the author undertakes: To immediately take measures to resolve disputes with third parties soon after receiving Publisher’s notification, and if necessary, enter into legal proceedings on the Publisher’s side and take all appropriate actions needed to exclude the Publisher from the list of defendants; To reimburse the publisher for the legal costs incurred and expenses and losses caused by the application of measures to secure the claim and execute a court decision, and the money paid to a third party for the violation of exclusive copyright and other intellectual property rights, as well as other losses incurred by the Publisher in connection with the Author’s non-compliance with the guarantees provided by them under this Agreement. X. Legal address and details of the Publisher Eco-Vector Address: 191186, St. Petersburg, Aptekarsky Pereulok, 3 letter A, room 1N TIN: 7806423692; KPP: 784101001; OGRN: 1099847039907.
Role of myocardial bridges in arterial remodeling and atherosclerosis development
Myocardial bridges represent segments of coronary arteries partially covered by myocardial muscle fibers. Although myocardial bridges were previously thought to be rare, recent studies indicate an increase in their prevalence, which has been associated with acute coronary syndromes, arrhythmias, myocardial infarction, and even sudden cardiac death. Some authors suggest that myocardial bridges may contribute to the formation of atherosclerotic plaques in the proximal part of the coronary arteries. Autopsy findings also demonstrate increased atherosclerotic plaque formation at sites of arterial obliteration, suggesting a shared pathogenic mechanism in the intima-media layer. This review summarizes current knowledge regarding the role of myocardial bridges in vascular remodeling and atherosclerosis progression, while identifying gaps requiring further investigation. The authors conducted a search of publications in the electronic databases PubMed, Google Scholar, and eLibrary using the following keywords: “atherosclerosis and myocardial bridges”, “myocardial bridges and cardiovascular diseases”, “pathophysiology of myocardial bridges”, “visualization of the cardiovascular system”, “myocardial bridges”. All works published between 1951 and 2024 were included. The obstructive mechanism involves compression of the intramural segment of the coronary artery by myocardial tissue during systole. Hemodynamic conditions created by myocardial bridges typically feature elevated wall shear stress due to the narrowing of the arterial lumen during systole, thereby minimizing plaque formation within the bridge itself. However, proximal to the myocardial bridges, wall shear stress decreases, creating favorable conditions for atherosclerotic plaque development. Myocardial bridges influence the thickness of the intima and the area of the arterial lumen, as well as the segments located proximally and distally. The location, thickness, and length of myocardial bridges directly affect the degree of obstruction and intimal hypertrophy. Vascular remodeling under mechanical forces plays a crucial role in maintaining vessel function, and its disruption can lead to cardiovascular disease.
Cardiotoxicity and cardiac arrhythmias in cancer therapy: a review of current evidence
Cardiac arrhythmias are among the most frequent and clinically significant manifestations of anticancer therapy-induced cardiotoxicity. Despite substantial progress in oncology and the increasing availability of targeted and immunological treatments, the incidence of cardiovascular complications, including rhythm disturbances, continues to rise. This article provides a comprehensive review of current evidence on the association between various types of anticancer therapies — including traditional cytotoxic chemotherapy, targeted therapies, immune checkpoint inhibitors, Chimeric antigen receptor T-cell therapy, and Bispecific T-cell engager therapy — and the development of arrhythmias. Special attention is given to pathophysiological mechanisms, including direct cardiomyocyte toxicity, electrophysiological disturbances due to ion channel blockade, ischemic myocardial injury, and inflammatory changes. The review outlines the clinical manifestations of common arrhythmias such as atrial fibrillation, ventricular tachycardia and atrioventricular block caused by different classes of anticancer drugs. Additionally, it discusses modern approaches to the diagnosis, screening, and prevention of arrhythmic complications in patients with cancer. A key emphasis is placed on the importance of a multidisciplinary approach involving close collaboration among cardiologists, oncologists, and clinical pharmacists to optimize treatment safety and efficacy while preventing potentially life-threatening conditions. Finally, the article highlights the need for further research into molecular mechanisms and the development of standardized monitoring algorithms in patients undergoing anticancer therapy, including the application of digital health technologies and artificial intelligence.
Cardio-rheumatology: present and future. Part II
Patients with rheumatic diseases exhibit a markedly increased risk of developing and accelerating cardiovascular pathology, which is largely attributed to the significant role of chronic inflammation as one of the etiological factors in both atherogenesis and heart failure. Achieving sustained clinical and laboratory remission of the Immune-mediated inflammatory disease has been shown to reduce the risk of cardiovascular complications. Given the direct association between persistent inflammation and a wide range of comorbid conditions, this factor must be carefully considered when planning and implementing rational pharmacotherapy in multimorbid patients. It is well established that pharmacological agents used in rheumatology exert diverse effects on the cardiovascular system. Over the past decade, growing research interest has been directed toward the potential application of anti-inflammatory agents with different mechanisms of action for both the prevention and treatment of atherosclerosis and ischemic heart disease. Particular attention has been paid to the modulation of the “NLRP3 inflammasome – interleukin-1 – interleukin-6 – C-reactive protein” signaling pathway. According to several studies, inhibition of this cascade may contribute to reduced likelihood of cardiovascular events. This review summarizes current data on the effects of various classes of antirheumatic drugs on the cardiovascular system, including both their beneficial and adverse effects.
Diagnosis and management of cerebral venous and sinus thrombosis in patients recovering from COVID-19
BACKGROUND: Cerebral venous thrombosis is a multifactorial and difficult-to-diagnose disease, complicated by venous stroke, intracerebral hemorrhage, progressive cerebral edema, dislocation syndrome, and even death. The broad variability of clinical symptoms and lack of pathognomonic manifestations complicate timely diagnosis of cerebral venous thrombosis. AIM: To identify significant risk factors for cerebral venous thrombosis and to evaluate the dynamics of neuroimaging findings at 1, 3, and 6 months after cerebral venous thrombosis onset in young and middle-aged patients with a history of COVID-19, comparing outcomes between those treated with direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). METHODS: Young and middle-aged patients with a history of novel coronavirus infection (COVID-19) were examined and divided into two groups depending on the presence or absence of cerebral venous thrombosis. The main risk factors, structural features of the major arteries and cerebral venous sinuses, as well as the course of cerebral venous and sinus thrombosis during anticoagulant therapy (with direct oral anticoagulants and vitamin K antagonists) at 1, 3, and 6 months after the development of cerebral venous thrombosis were analyzed. RESULTS: We examined 120 young and middle-aged patients with COVID-19 divided into 2 groups: Group I – 70 patients who developed cerebral venous thrombosis during COVID-19 – 21 (30%) men and 49 (70%) women; Group II – 50 patients who had COVID-19 without cerebral venous thrombosis development – 27 (54%) men and 23 (46%) women. The main risk factor for developing cerebral venous thrombosis among women in the first group (with cerebral venous thrombosis during COVID-19) compared to the second group (patients who had COVID-19 without developing cerebral venous thrombosis) was the use of combined oral contraceptives: 22.9% and 4.0%, respectively (р = 0.001). Among group I patients, 32 (45.7%) cases of cerebral venous thrombosis were accompanied by the development of venous stroke: ischemic in 13 (18.6%) patients, hemorrhagic in 7 (10%), mixed (ischemic stroke with hemorrhagic infiltration) in 12 (17.1%) patients. In a comparative analysis of the variants of the structure of the cerebral arteries (absence of the posterior communicating arteries, pathological tortuosity of the internal carotid artery [ICA], trifurcation of the ICA, open arterial circle of Willis) and venous sinuses (presence of hypo-/aplasia), no statistically significant difference was detected. The analysis of the course of cerebral venous thrombosis during treatment with vitamin K antagonists (warfarin) and direct oral anticoagulants in 53 patients with cerebral venous thrombosis (age 41 ± 12 years) at 1,3, and 6 months after the development of cerebral venous thrombosis onset showed that with anticoagulants, recanalization was observed in 44 (83%) patients: complete – in 21 patients (47.7%), partial – in 23 (52.3%). Recanalization was absent in 9 (17.0%) cases. No recurrent cerebral venous thrombosis cases were observed among the study patients. CONCLUSION: Verification of cerebral venous thrombosis in the context of COVID-19 necessitates a detailed examination of risk factors, patient history, assessment of clinical manifestations, and comprehensive implementation of laboratory and instrumental, as well as neuroimaging diagnostic methods. Timely verification and immediate initiation of anticoagulant therapy ensure a relatively favorable prognosis for the disease course.
Copyright (c) 2025 Eco-Vector https://creativecommons.org/licenses/by-nc-nd/4.0/
Cognitive status and anxiety levels in female patients during the preoperative period
BACKGROUND: Postoperative complications remain the primary cause of prolonged treatment duration, decompensation of existing comorbidities, and unfavorable clinical outcomes. One of the key concerns in surgery and anesthesiology is postoperative cognitive dysfunction, induced by the combined effects of surgical trauma and anesthetic agents. AIM: To assess the prevalence of cognitive impairment and anxiety among female patients admitted for elective surgical treatment. METHODS: A single-center, cross-sectional study was performed, enrolling female patients scheduled for surgical intervention on reproductive organs. During enrollment, a standard preoperative examination was conducted, along with testing using the Montreal Cognitive Assessment (MoCA) and the State-Trait Anxiety Inventory (STAI) by C.D. Spielberger (adapted by Yu.L. Khanin). RESULTS: Assessment of the main domains of cognitive status using the MoCA questionnaire revealed that female patients initially presented with varying cognitive statuses. Based on this test, two study groups were identified: Group A included 22 female patients without cognitive impairment (mean MoCA score: 28.4 ± 1.4 points; mean age: 37.2 ± 11.9 years), while Group B comprised 10 female patients with cognitive impairment (mean MoCA score: 22.9 ± 2.1 points; mean age: 49.1 ± 19.9 years). No statistically significant differences in age were found between the groups (p = 0.06), but significant differences were observed on the MoCA test (p < 0.001). Anxiety assessment with the Spielberger–Khanin scale revealed a high level of trait anxiety in both groups: mean scores were 45.9 ± 8.3 in Group A and 45.6 ± 4.2 in Group B (p = 0.722). For state anxiety, mean scores were 44.5 ± 8.4 and 43.6 ± 6.7, respectively (p = 0.436), indicating a moderate level. CONCLUSION: Among female patients admitted for surgical treatment of reproductive system diseases, 31.3% exhibited newly diagnosed cognitive dysfunction, as well as state and trait anxiety associated with the upcoming surgery and anesthesia. Therefore, preoperative assessment of cognitive status and anxiety levels is essential to prevent worsening of existing cognitive impairment, postoperative cognitive dysfunction, or delirium.
The importance of gas chromatography-mass spectrometry steroid profiling in selecting surgical strategy for large adrenal tumors
BACKGROUND: The selection of surgical strategies for large adrenal tumors remains clinically critical. For determining eligibility for endoscopic video-assisted surgery, the absence of malignancy features is essential. Steroid metabolome analysis by gas chromatography-mass spectrometry (GC-MS) provides the highest diagnostic yield for detecting early signs of malignancy during preoperative evaluation and, according to multiple studies, exceeds the accuracy of radiologic imaging techniques. AIM: To evaluate the clinical utility of urine steroid profiling by GC-MS for preoperative diagnosis and surgical decision-making in large malignant adrenocortical neoplasms. METHODS: Patients with adrenal tumors larger than 50 mm and without clinical or laboratory signs of hypercortisolism were examined. Based on histological analysis, the following diagnoses were established: adrenocortical carcinoma, adrenocortical adenoma (with malignancy grade assessed using the Weiss scoring system), and rare adrenal diseases (schwannoma, ganglioneuroma, myelolipoma, etc.). Patients with adrenocortical adenomas smaller than 50 mm served as the control group. Urinary steroid profiles were analyzed by gas chromatography-mass spectrometry in all patients before surgical treatment. The Mann-Whitney U test was used for comparison of urinary steroid excretion. RESULTS: According to gas chromatography-mass spectrometry (GC-MS), 23 patients (33.8%) with adrenal tumors >50 mm exhibited biochemical features of adrenocortical carcinoma (ACC) prior to surgery, which was later confirmed histologically. In patients with adrenocortical adenoma and a malignancy score of 2 on the Weiss scale (n = 16, 23.5%), urinary excretion of tetrahydro-11-deoxycortisol, androgens, progestogens, and mineralocorticoids was significantly higher than in patients with adrenocortical adenoma lacking malignant features (n = 14) and the control group (n = 30). No statistically significant differences were observed in the urinary excretion of 9 ACC biomarkers compared to patients with confirmed ACC. Open adrenalectomy was recommended for patients with large adrenal tumors and GC-MS evidence of malignancy. CONCLUSION: Preoperative GC-MS detection of early malignant features in large adrenal tumors is critical for determining the optimal surgical approach. Minimally invasive adrenalectomy is not recommended for large adrenal lesions with GC-MS signs of malignancy.
Effectiveness of caries prevention in patients with high mineralization level of permanent teeth
BACKGROUND: Dental caries is one of the most common diseases, present in about 95%–98% of the world’s population, which represents a serious public health problem. Since the 1980s of the 20th century, many studies have shown that caries resistance depends on the mineralization of tooth enamel during tooth eruption. An important stage in the formation of a child’s dental status is the process of enamel maturation, the period when dental caries is most likely to occur. Some studies suggest that tooth development is independent of external factors and is controlled mainly by genetics, while others suggest that development is also influenced by external factors. Interventions for the prevention of tooth decay have been studied many times, but the data on remedies for the prevention of tooth decay in teeth with high mineralization are inconsistent. AIM: To identify the clinical and morphological criteria of highly mineralized teeth and to evaluate the efficacy of caries prevention measures in patients with highly mineralized permanent teeth. METHODS: The first stage consisted of determining the clinical and morphological parameters of teeth extracted for orthodontic indications in children aged 9 to 15 years. Next, patients were followed for one year, divided into groups based on their use of calcium- and phosphorus-containing preparations, hydroxyapatite, or no supplementation. The following examinations were performed: assessment of the DMFT (decay, missing, filled teeth) index, enamel resistance testing, and quantitative light-induced fluorescence (QLF) measurements. RESULTS: 86 people took part in the study. As a result of the study, the clinical and morphological criteria of highly mineralised teeth were clarified. Clinical criteria: fissure enamel is dense, smooth, and shiny; fissures are of open type, grooved; the enamel surface is dense and smooth in the maxillary, lingual, and approximal areas; absence of enamel defects in the form of stains or pigmentation; teeth erupted on time and symmetrically, have a correct anatomical shape; and a high level of acid resistance is determined. Thus, ΔF was in the range from −2.3 ± 0.05 to 0%, the Simple Hygiene Score ranged from 0 to 1.12 ± 0.03, and the TER-test had values up to 26.31 ± 2.03% in patients with high mineralisation of teeth. Morphological criteria: Enamel openings are not more than 2 μm. The depth of penetration of enamel bridges into dentin is up to 5–10 μm. In each enamel bridge, there are up to 5–6 enamel tunnels with increased density and smaller diameter. On the slice, there are no changes along the entire length of the enamel surface, and the whole pattern is homogeneous. The study found that in patients aged 9–15 years old, daily home prophylaxis with preparations containing calcium and phosphorus, as well as preparations containing hydroxyapatite for a year, allows for the preservation of the structure of enamel, as well as helps to prevent enamel caries during the period of the replacement bite. CONCLUSION: In patients with a high level of tooth mineralization, the degree of resistance does not significantly change with the use of drugs for home prophylaxis, but maintains the structure of enamel during overbite period.
Functional changes in the spine as predictors of comorbidities in patients with ankylosing spondylitis
BACKGROUND: Advanced ankylosing spondylitis can be characterized by the formation of disabling spinal deformities. However, the effect of cervicothoracic kyphosis on the cardiovascular system is poorly understood. In routine rheumatology practice, the occiput-to-wall distance is used as a reliable method to confirm the presence of kyphosis in patients. AIM: To assess the association between kyphosis (measured by occiput-to-wall distance, the occiput-to-wall distance) and the development of comorbidities in patients with late-stage ankylosing spondylitis. METHODS: The study included men with advanced-stage ankylosing spondylitis. As part of the standard assessment of the primary disease, clinical and laboratory examinations were performed, including additional measurement of myostatin levels. Cardiovascular status was also evaluated using echocardiography and ultrasound examination of the brachiocephalic arteries. RESULTS: Forty men (33 to 67 years old) with advanced ankylosing spondylitis participated in the study. All patients were divided into 2 groups: 1) with the occiput-to-wall distance < 10 cm (n = 45%), 2) with the occiput-to-wall distance ≥ 10 cm (n = 55%). The analysis of cardiovascular system status showed that all patients in the occiput-to-wall distance ≥ 10 cm group had hypertension (100% vs 66.7%, p = 0.005) with predominance of grade 2 arterial hypertension (45.5% vs 27.8%, p = 0.010) in contrast to the occiput-to-wall distance ≥ 10 cm group. Echocardiography revealed statistically significant reductions in left ventricular function values in the occiput-to-wall distance ≥ 10 cm group compared to the occiput-to-wall distance < 10 cm group. Notably, the occiput-to-wall distance ≥ 10 cm group was more frequently overweight (86.23 ± 14.03 vs. 74.83 ± 14.44, p = 0.016) with a predominance of class I–II obesity (45.5% vs. 11.1%, p < 0.001). Also in our patients we found a correlation between serum myostatin level and the occiput-to-wall distance (r = 0.404, p = 0.01), ASDAS (Axial Spondyloarthritis Disease Activity Score; r = 0.405, p = 0.009) and BASFI (Bath Ankylosing Spondylitis Functional Index; r = 0.344, p = 0.03). CONCLUSION: The occiput-to-wall distance increase should be considered as a predictor of the development of cardiovascular pathology, which is confirmed by echo-CG, and other comorbidities. Patients with progressive cervicothoracic kyphosis are characterised by lower values of left ventricular ejection fraction, which may be due to adaptation mechanisms caused by spinal axis displacement. In the future, myostatin measurements should be considered as a complementary method for assessing the function of the cardiovascular system and skeletal muscles.
Biofilm-forming activity of Enterococcus faecalis on basic materials of removable dental prosthetic bases
BACKGROUND: According to a number of authors, Enterococcus faecalis is characterised by low biofilm-forming ability on polymeric plastics. Such a feature of enterococci allows them to be considered marker strains in determining the resistance of plastics used in dentistry to microbial colonisation. This determines the need to study the aspects of interaction between clinical strains of Enterococcus faecalis and the main structural polymeric materials used for the manufacture of the bases of removable dental prostheses. AIM: To study the biofilm-forming activity of Enterococcus faecalis strains isolated from the oral cavity on the basic materials of bases of removable dental prosthetic structures. METHODS: The study included individuals with dental defects (code K08.1 according to the International Classification of Diseases). In order to assess the oral microbiota, isolate clinical strains of Enterococcus faecalis, and cultivate the on the following materials: hot-curing acrylic material Etacryl-02, thermoinjection polymer Deflex Acrynel, and thermoplastic monomer-free material Perflex T-Crystal, biomaterial was collected from patients of the observation groups from the central apex area of dental defects using swab probes. Statistical analysis was performed using the Shapiro–Wilk test, Student’s t-test, and χ²-test. RESULTS: Bacterial film formation was most pronounced on the acrylic material hot curing acrylic material (coefficient of biofilm-forming activity ranged from 16.7 to 30.6). The same index was in the range of 4.6–10.1 when studied on thermoplastic monomer-free material, and for thermoinjection polymer — 1.2–2.7. It was found that 12.5% of Enterococcus faecalis strains formed an intensive biofilm on thermoplastic monomer-free material and hot curing acrylic material simultaneously, 25% — on thermoinjection polymer and hot curing acrylic material. A quarter of strains practically did not form biofilm on thermoplastic monomer-free material and thermoinjection polymer simultaneously, the remaining 37.5% of strains formed moderately pronounced bacterial film on all three variants of materials. CONCLUSION: Enterococcus faecalis can be classified as a marker microorganism for investigating the resistance of dental prosthetic base materials to microbial colonization. At the stage of prosthetic planning, enterococci should be detected in the oral cavity for rational polymer selection.
Analysis of genetic polymorphism associations with cardiometabolic risk factors and phenotypic age in individuals without significant pathology
BACKGROUND: Against the background of significant achievements in the treatment and prevention of various diseases, the direction of “medicine for the healthy” currently does not adequately meet the public demand for active longevity. Developing age assessment systems (epigenetic, biochemical and other “clocks”) allow us to get closer to the assessment of biological age, which is an important step towards finding technologies that can slow down aging. AIM: To identify the relationship between clinical characteristics, phenotypic age and genetic factors in a cohort of people without clinically significant pathology who lead a healthy lifestyle. METHODS: A single-center, cross-sectional study was conducted. A retrospective analysis of clinical, laboratory and instrumental examination results of participants in wellness programs at the “First Line” preventive medicine resort was performed. Genetic polymorphism was determined using commercially developed biochip technology. Gene polymorphisms (222 single nucleotide variants) potentially associated with cardiometabolic risks according to published scientific data were analyzed. RESULTS: In a cohort of 29 patients aged 27 to 68 years, 14 single nucleotide variants were identified, associated with changes in systolic (rs6920220 of the TNFAIP3 gene, rs1137101 of the LEPR gene) and diastolic (rs1137101 of the LEPR gene, rs7903146 of the TCF7L2 gene, rs12255372 of the TCF7L2 gene) blood pressure, dyslipidemia (rs266729 of the ADIPOQ gene, rs1045642 of the ABCB1 gene, rs1815739 of the ACTN3 gene), increased body weight (rs4961 of the ADD1 gene), as well as with decreased phenotypic age (rs17553719 of the AQP3 gene, rs1801197 of the CALCR gene, rs2470152 of the CYP19A1 gene, rs1800955 of the DRD4 gene, rs17782313 of the MC4R gene). Most of these associations have not been previously studied or have been reported in only a few publications. CONCLUSION: The assessment of the influence of a wide range of genetic polymorphisms seems to be a promising direction for the future choice of effective strategies for prolonging life in the absence of diseases. The success of new technologies and methods to slow down aging largely depends on the introduction of a multidisciplinary approach that combines various fields: clinical, genetic, “multi-omic” (including metabolomic), microbiomic, immune, psychological and others.
Successful treatment of victims with closed abdominal trauma with damage to the duodenum (clinical observations)
This article presents two clinical observations of successful treatment of victims with closed abdominal trauma complicated by duodenal injury, with an emphasis on key aspects of treatment and prevention of complications. Injuries to internal organs in closed abdominal trauma pose a serious threat to the lives of victims, especially in cases of damage to the duodenum. Despite the fact that duodenum injuries constitute a relatively small proportion of all abdominal injuries, they are accompanied by a high mortality rate, reaching 30% in isolated injuries and up to 80% in combined injuries. Diagnosis of such injuries is a particular problem. The absence of pathognomonic symptoms, as well as the frequent combination with other injuries (e.g., pancreas, retroperitoneal hematomas, or pelvic fractures) complicates the timely detection of these injuries. In addition, inadequate surgical tactics can lead to severe postoperative complications, including duodenal fistula (2%–16%), intra-abdominal abscess (15%), and pancreatitis (0.5%). The high incidence of severe complications and significant mortality emphasizes the importance of studying effective diagnostic methods, surgical tactics, and postoperative management of patients with duodenal injury. According to the literature, the incidence of duodenal injury in closed abdominal trauma ranges from 0.6 to 5% of all abdominal injuries. The most common injuries are to the retroperitoneal part of the intestine; the horizontal part is injured in 30%–40% of cases, the descending part in 20%–30%, and the upper part in 15%–22%. A significant problem is the recognition of retroperitoneal ruptures in combination with pancreatic injury and the presence of retroperitoneal hematomas caused by kidney injury or pelvic bone fracture. There are no pathognomonic symptoms of duodenal injury.
Metachronous development of Hodgkin’s lymphoma and nodal marginal zone lymphoma in a patient with Sjögren’s syndrome: a case report
According to various population-based studies, lymphoproliferative disorders develop 2–10 times more frequently in individuals with autoimmune pathology compared to the general population. Patients with Sjögren's disease/syndrome exhibit 10–44 times increased risk of lymphoma development compared to the general population. This predisposition is primarily driven by chronic B-cell stimulation from autoantigens produced by exocrine glands and other organs. However, no clear therapeutic guidelines for the management of these patients have been published. This report presents a unique case of metachronous development of Hodgkin's lymphoma and nodal marginal zone lymphoma in a patient with Sjögren’s syndrome. The diagnostic workup is described in detail, including histopathological and immunohistochemical findings as well as imaging studies, along with the therapeutic approaches employed. The main difficulty in treatment was the alternation of recurrent course of lymphomas amid immunological dysregulation and autoaggression aggravated by checkpoint inhibitors, especially immune damage to the liver. The issue of the formation of an optimal therapeutic approach in this category of patients is raised in this article. The article examines the relationship between autoimmune pathology and lymphoproliferative disorders, addressing fundamental questions about the primacy of pathological processes and the development of optimal diagnostic and therapeutic approaches for this patient category.