Astronomy and Computing

Khripun A.I., Alimov A.N., Orlov S.Y., Chelyapina T.P.

ntroduction. The diagnosis of acute pancreatitis poses no significant difficulties. Nonetheless, accurately predicting the potential severity of the disease during its early stages remains a challenge with existing diagnostic methods. Delayed diagnosis of pancreatic necrosis and the late initiation of intensive therapy contribute to a more severe disease course.Materials and methods. The paper presents a case of recurrent choledocholithiasis as a complicating factor in acute biliary pancreatitis in a 58-year-old woman. A standardized technique of endoscopic ultrasound allowed for the timely identification of signs indicative of developing pancreatic necrosis, enabling the prevention of its progression through papillary sphincterotomy, choledocholithotripsy, and pancreatic stenting.Results and discussion. Endosonographic features of pancreatic necrosis are visualizable in the early stages of acute pancreatitis. Changes such as Wirsung duct dilation and hypoechoic lesions in the pancreatic parenchyma provide grounds for pancreatic duct stenting with an expected clinical efficacy. The performance of endoscopic retrograde interventions in acute pancreatitis, including pancreatic stenting in particular, can halt the progression of pancreatic necrosis and contribute to a more rapid clinical and laboratory recovery.Conclusion. The presented case demonstrates the high informativeness and effectiveness of endoscopic methods in the early diagnosis and treatment of acute biliary pancreatitis.

Itkulov A.F., Ibatullin A.A., Baikov D.E., Eybov R.R., Timerbulatov M.V.

Introduction. Diverticular disease refers to common non-neoplastic diseases of the colon, accounting for 30–60% of all pathologies of the organ. According to clinical guidelines, the treatment strategy for complicated forms of diverticulitis is predominantly conservative. However, certain forms of chronic complicated diverticulitis require surgical intervention, particularly sigmoid resection.Materials and methods. The study involved a retrospective analysis of robot-assisted, laparoscopic, and open sigmoid resections for chronic complicated forms of diverticular disease of the colon. From 2014 to 2023, a total of 85 patients underwent surgery at the Clinic of Bashkir State Medical University. In Group 1, 24 patients (28.3%) underwent surgery, in Group 2 — 28 patients (32.9%), and in Group 3 — 33 (38.8%). The results were processed using mathematical statistical methods, MS Excel XP, and Statistica 10.0 software.Results and discussion. The comparative analysis of minimally invasive surgical interventions and open surgeries revealed that the application of minimally invasive surgery, specifically robot-assisted and laparoscopic approaches, is associated with reduced hospital stay and fewer postoperative complications compared to similar metrics observed with open surgical procedures.Conclusion. The study findings indicate the advantages of robot-assisted surgeries in certain cases, which, as an alternative method, do not fall short of traditional laparoscopic surgical techniques. Moreover, robot-assisted interventions are associated with earlier postoperative recovery and reduced hospital stay.

Каrabina E.V., Sakaeva D.D., Lipatov O.N.

Introduction. One of the key issues associated with the off-label use of antitumor drugs is safety. Typically, the advantages of such prescriptions in oncology are linked to the potential clinical benefits outweighing the risks of complications.Aim. To assess the safety of the off-label antitumor drug therapy in comparison with the on-label drug administration in the context of real clinical practice among oncologists in the Tula region.Materials and methods. The study was conducted at the Tula Regional Clinical Oncology Center, Russia. Over a six-month period in 2019, clinical data, provided by the regional information system, were analyzed for 919 completed treatment cases of 201 patients over 18 years of age who received antitumor drug therapy for malignant neoplasms. The study enrolled patients who had at least one hospitalization and got off-label antitumor drug therapy, as well as those receiving on-label drug treatment. The study assessed the safety of the off-label antitumor drug therapy in comparison with that of the on-label treatment, estimating the frequency of adverse events (AEs), spectrum of adverse events, severity of adverse events, fatal outcomes, treatment delays and discontinuations, and hospitalizations due to toxicity. A comparative analysis involved the results of using off-label and on-label antitumor drug therapy in terms of the aforementioned parameters. Results and discussion. No unforeseen adverse events were revealed in the study. The spectrum of adverse events encompassed 40 clinical and laboratory abnormalities with varying frequencies across the studied groups. Adverse events were observed in the majority of patients across both studied groups (83% and 86%). A predominance of grade I and II toxicity was noted. In some instances, therapy was discontinued and treatment was suspended; however, the frequency of these occurrences was significantly lower compared to current literature data. One fatal outcome due to complications from the administered therapy was recorded. All adverse events were reported in both studied groups with similar frequencies. The most commonly observed adverse events in both groups included hepatotoxicity, anemia, thrombocytopenia, nephropathy, cephalalgia, leukocytosis, skin toxicity, dyslipidemia, hypertension, bone pain syndrome, and dizziness. Other adverse events occurred sporadically with similar frequency. The most severe presentations were noted in the following adverse events: thrombocytopenia, gastrointestinal toxicity, leukocytosis, hyperglycemia, and immune-mediated diabetes mellitus with ketoacidotic coma.Conclusion. In real clinical practice, the safety of off-label and on-label antitumor drug therapy reveals no significant difference.

Beylerli О.A.

Hyponatremia refers to a common and potentially dangerous electrolyte imbalance observed in neurosurgical patients, particularly following traumatic brain injuries, subarachnoid hemorrhages, brain tumors, and pituitary surgeries. The paper discusses primary causes and pathophysiology of hyponatremia, including the syndrome of inappropriate secretion of antidiuretic hormone, central adrenal insufficiency, and cerebral salt wasting syndrome. The paper presents differential diagnostic approaches for accurately identifying the underlying causes of hyponatremia, as well as therapeutic strategies that include hypertonic sodium solution infusions, hydrocortisone replacement therapy, and the use of vasopressin receptor antagonists. The study delineates the potential complications associated with overly rapid correction of sodium levels, such as osmotic demyelination syndrome. It emphasizes the importance of accurate diagnosis and timely treatment to enhance patient outcomes and minimize the risk of complications.

Beylerli O.A., Musaev E.R.

In recent years significant advancements have been made in immunotherapy and its application in various types of malignancies. However, standard treatment methods for malignant gliomas, including glioblastoma, have not undergone substantial transformations. The main barriers to the application of immunotherapy in these tumors are associated with the specific characteristics of the tumor microenvironment, immunosuppressive status of the central nervous system, protective function of the blood-brain barrier, and challenges in interpreting neuroimaging data. Additionally, gliomas are characterized by low PD-L1 expression, low mutational burden, and high heterogeneity, which limits the effectiveness of immunotherapy. Nevertheless, clinical studies demonstrate promising results with the use of immune checkpoint inhibitors, viral therapies, vaccination, and adoptive T-cell therapy. The integration of immunotherapy with radiation therapy to enhance the immune response obtains high potential for managing oncological issues. Further research in this area, including the development of glioblastoma-specific biomarkers and adaptation of immunotherapy to the characteristics of tumor microenvironment will significantly improve the treatment outcomes for malignant gliomas.

Kagarmanova A.S., Baikov D.E., Itkulov A.F., Khafizov M.M.

The most significant factors influencing the effectiveness of bladder cancer treatment include a tumor subtype, degree of cellular anaplasia, assessment of the invasion depth into the bladder wall, identification of carcinoma in situ, extent of renal function impairment, quality of diagnostic procedures, accurate interpretation of the obtained data, continuity of care among specialists, and the patient’s motivation for treatment. The advent of ultra-high-field magnetic resonance imaging, 640-slice computed tomography, development of new radiopharmaceuticals, and advancements in software technology shape a multimodal approach aimed at identifying optimal diagnostic methods for bladder cancer. The present paper reviews a potential of multiparametric magnetic resonance imaging for determining the degree of neoplastic invasion into the layers of the bladder wall, a value of computed tomography with intravenous contrast enhancement in diagnosing locally advanced forms of the disease, and capabilities of positron emission tomography as a promising method for non-invasive characterization of tumor physiology with sensitivity in the picomolar range. The paper discusses advantages and disadvantages of the imaging modalities used in the diagnosis of urothelial carcinoma. In addition, the study explores the perfusion computed tomography as an alternative imaging technology for evaluating the layers of the bladder wall to be utilized in cases of absolute contraindications to magnetic resonance imaging.

Plechev V.V., Timerbulatov M.V., Sufiyarov I.F.

Introduction. Surgical site infections of the postoperative period are well recognized as one of the most pressing issues in modern surgery. Surgical site infections significantly complicate the postoperative course, necessitates costly treatment, and may require additional surgical interventions, thereby extending hospital stays and adversely impacting quality of life of the patients. The suture material can facilitate the adhesion of microorganisms to its surface; thus, it is considered as one of the important factors contributing to the development of surgical site infections.Aim. To evaluate and compare the clinical experience of applying the Abaktolat suture material featuring an antimicrobial coating used during surgical interventions.Materials and methods. A retrospective randomized study was conducted involving 49287 patients who were treated across five various medical institutions primarily for abdominal pathologies. The Abaktolat suture material was applied in 25749 patients, of whom 15626 (60.7%) underwent emergency surgeries, while 10123 (39.3%) underwent elective procedures. The second group included 23538 patients who received standard suture material.Results and discussion. The study demonstrated a statistically significant reduction in the incidence of postoperative infectious complications during emergency surgeries by more than four times (RR 4.23, 95% CI (4.08–4.96), p < 0.0001), and almost by two times during elective surgeries (RR 1.96, 95% CI (1.62–2.37), p < 0.0001) in the group that received Abaktolat, compared to those receiving standard suture materials. In addition, the average length of hospital stay was reduced by 21.6% (2.6 days).Conclusion. Thus, the use of the Abaktolat suture material is a justified method for the prevention of surgical site infections, particularly in emergency surgery settings. This approach significantly reduces the incidence of infectious complications during the postoperative period, enhances the overall quality of recovery, and leads to substantial financial savings in the treatment of surgical patients.

Pechetov A.A., Vishnevskaya G.A., Volchanski D.A., Lednev A.N., Danilov I.I., Gulova N.V.

Introduction. Since ancient times tracheostomy is known as a surgical procedure that ensures airway patency. According to current views, a non-idiopathic cicatricial tracheal stenosis develops within six weeks following the initiation of mechanical ventilation. When a patient presents with a characteristic history and complaints, the diagnosis of cicatricial tracheal stenosis poses no challenges.Aim. To present a series of observations of patients who underwent tracheostomy in childhood, whereas the cicatricial tracheal stenosis was diagnosed only in over 35 years after the onset of airway obstruction symptoms.Materials and methods. The study involved five patients (two men and three women) aged between 43 and 63 years. All patients had undergone tracheostomy in childhood, followed by subsequent decannulation. For over 35 years, the patients were monitored under the diagnosis of bronchial asthma. When a tracheal stenosis was identified, all patients underwent circular tracheal resection.Results and discussion. The duration of the surgical procedure ranged from 110 to 240 minutes. No complications that required re-surgery were recorded. All patients achieved healing of the tracheal anastomosis. The postoperative hospitalization period ranged from 10 to 15 days. The incidence of tracheal complications remains 0.2%–25%. The clinical onset of tracheal stenosis typically occurs within the first few months following decannulation. Functional diagnostic methods reveal a pattern of bronchial obstruction, which necessitates the administration of inhalation therapy using various groups of bronchodilator and anti-inflammatory medications. The most informative instrumental diagnostic techniques for tracheal diseases include laryngotracheoscopy and computed tomography.Conclusion. A history of tracheostomy or mechanical ventilation in patients presenting with complaints of dyspnea requires meticulous attention due to the risk of the development of cicatricial tracheal stenosis.

Islamov R.N., Sharipov R.A., Tukfatullin R.K., Sidorov I.V., Yagafarova R.K.

Introduction. Tuberculosis remains a significant public health issue, ranking second only to COVID-19 in terms of mortality from infectious diseases, with more than 10 million individuals affected annually. Despite a decline in incidence rate, its diagnosis continues to be challenging, particularly in cases with negative results from microbiological and histological examinations.Aim. To compare the effectiveness of surgical diagnostic methods for tuberculosis during the pre-analytical phase of bacteriological verification.Materials and methods. The retrospective study, conducted at the Republican Clinical Tuberculosis Treatment Dispensary of the Republic of Bashkortostan, analyzed data from 1272 patients who were hospitalized in the Tuberculous Pulmonary Surgery Unit from 2021 to 2023 and underwent bacteriological diagnostics, including microscopy and polymerase chain reaction.Results and discussion. The results indicate that out of 1272 surgeries, 65.2% involved resection procedures, with confirmed tuberculosis infection in 83.1% of patients. Bronchoalveolar lavage identified mycobacteria in 153 patients (20.5%), whereas sputum collection revealed them in 106 patients. The new collection method, although less effective, demonstrated a detection rate of 15.7% through molecular genetic analysis.Conclusion. Surgical diagnostic methods for tuberculosis appeared to be effective, detecting mycobacterium tuberculosis in 83.1% of cases, surpassing the standard sputum collection method, which has a detection rate of 10.8% via molecular genetic analysis. Bronchoalveolar lavage proved to be more productive, yielding 20.5% positive results on a molecular genetic basis, 11% microscopically, and 8% through culture. Although the new method is less effective, it is recorded as being more accurate than the standard, with detection rates of 15.7% molecularly, 6.6% microscopically, and 5.2% through culture.

Papoyan A.O., Urmantsev M.F., Pavlov V.N.

Introduction. Robot-assisted radical prostatectomy is considered to be the “gold standard” for the radical treatment of prostate cancer, achieving excellent oncological outcomes with a low incidence of complications.Aim. To analyze and compare the efficiency of Da Vinci Xi and Da Vinci Si surgical systems applied in performing robot-assisted radical prostatectomy. Materials and methods. 165 patients were divided into two groups: Xi-group (n = 77) and Si-group (n = 88). The perioperative characteristics and oncological outcomes were analyzed and compared.Results. The demographic, clinical, and oncological characteristics of the two patient groups appeared similar and comparable. Interventions involving the preservation of the neurovascular bundle, the pelvic fascia, and the puboprostatic ligament were performed using Xi system significantly more often. The surgery duration was significantly shorter in the Xi-group. The postoperative recovery time and the incidence of postoperative complications appeared to be identical across both groups. No differences were revealed in the rates of positive surgical margins or biochemical recurrence.Discussion. Reasons behind the reduced operative time were considered as follows: first, the docking of the Xi system is more user-friendly, resulting in decreased docking time; second, the operational efficiency of the Xi system had been enhanced, thereby leading to reduced workflow times; third, a number of collisions between robotic arms was significantly lower during the procedure, which accelerates the surgical process.Conclusion. A robot-assisted radical prostatectomy performed by an experienced professional, using the Da Vinci Xi or Da Vinci Si surgical systems, appears to be safe and feasible without an increased risk of serious complications. However, the Xi system ensures better perioperative outcomes with comparable oncological results.

Gareev I.F., Yasinskaya A.S., Roumiantsev S.A.

Glioblastoma is recognized as the most aggressive type of primary brain tumor. Despite recent advances in understanding the molecular mechanisms involved in the biology of glioblastoma, patient survival rates remain disappointing, primarily due to the lack of effective treatment options. Tumor necrosis factor receptor-associated protein 1 (TRAP1), a member of the heat shock protein 90 (Hsp90) family, refers to a protein predominantly localized in the mitochondria that regulates both cellular metabolic reprogramming and mitochondrial apoptosis. This protein is highly expressed in several types of tumors, including colorectal cancer, breast cancer, prostate cancer, and lung cancer, and is often associated with drug resistance. However, TRAP1 is also downregulated in certain cancers such as ovarian cancer, bladder cancer, and renal cancer, where its lower expression correlates with poorer prognoses and chemoresistance. The role of TRAP1 lies in enhancing or suppressing oxidative phosphorylation, with the impact of such regulation on tumor development and progression being a matter of ongoing debate. These observations prompt further investigation into the mechanisms responsible for the dual role of TRAP1 as both an oncogene and a tumor suppressor in specific types of tumors, particularly glioblastoma. The present study reviews the role of TRAP1 in the development and progression of glioblastoma and discusses the potential of targeting TRAP1 as a novel therapeutic approach against tumors.

Geraskinа M.M., Galitsynа A.B., Shuvaev V.A., Gosteva S.S.

Introduction. Posterior reversible encephalopathy syndrome (PRES) refers to a relatively obscure syndrome with unclear pathogenesis, leading to patient disability, occurring in 58% of cases against a background of arterial hypertension. Clinical manifestations include cephalalgia, epileptic seizures, and visual disturbances, potentially culminating in complete blindness. The clinical case represents a rare life-threatening condition that may pose challenges for an attending physician regarding the appropriate therapeutic strategy.Aim. To demonstrate the occurrence of posterior reversible encephalopathy syndrome during an anterior resection of the rectum, as well as to discuss the correct therapeutic strategy.Materials and methods. A 63-year-old female patient with a history of chronic arterial hypertension was admitted for surgical intervention due to rectal cancer. The operation was performed under general anesthesia and marked by unstable hemodynamics, with blood pressure rising to 160/100 mmHg. After awakening, the patient exhibited loss of vision and coordination disturbances, accompanied by uncontrolled arterial hypertension, with blood pressure rising to 182/130 mmHg. Magnetic resonance imaging revealed areas of hyperintense signal bilaterally in the occipital lobes without signs of diffusion restriction. The neurological deficits were managed through a comprehensive therapeutic regimen, utilizing nootropics, antioxidants, and antihypoxic agents, in conjunction with appropriate antihypertensive treatment. Vision was restored within two weeks.Results and discussion. The management of posterior reversible encephalopathy syndrome following a hypertensive crisis during surgical intervention should encompass etiological treatment, alongside correction of neurological symptoms utilizing relevant pharmacological agents. An appropriate and timely treatment obtains high potential to resolve the syndrome.Conclusion. Posterior reversible encephalopathy syndrome may develop in patients with a history of arterial hypertension and manifest as a sudden onset of hemodynamic instability during and after surgical intervention, potentially leading to cortical blindness. In such cases, antihypertensive therapy, in conjunction with corrective medications, is advisable.

Каrabina E.V., Sakaeva D.D., Lipatov O.N.

Introduction. One of the key issues associated with the off-label use of antitumor drugs is safety. Typically, the advantages of such prescriptions in oncology are linked to the potential clinical benefits outweighing the risks of complications.Aim. To assess the safety of the off-label antitumor drug therapy in comparison with the on-label drug administration in the context of real clinical practice among oncologists in the Tula region.Materials and methods. The study was conducted at the Tula Regional Clinical Oncology Center, Russia. Over a six-month period in 2019, clinical data, provided by the regional information system, were analyzed for 919 completed treatment cases of 201 patients over 18 years of age who received antitumor drug therapy for malignant neoplasms. The study enrolled patients who had at least one hospitalization and got off-label antitumor drug therapy, as well as those receiving on-label drug treatment. The study assessed the safety of the off-label antitumor drug therapy in comparison with that of the on-label treatment, estimating the frequency of adverse events (AEs), spectrum of adverse events, severity of adverse events, fatal outcomes, treatment delays and discontinuations, and hospitalizations due to toxicity. A comparative analysis involved the results of using off-label and on-label antitumor drug therapy in terms of the aforementioned parameters. Results and discussion. No unforeseen adverse events were revealed in the study. The spectrum of adverse events encompassed 40 clinical and laboratory abnormalities with varying frequencies across the studied groups. Adverse events were observed in the majority of patients across both studied groups (83% and 86%). A predominance of grade I and II toxicity was noted. In some instances, therapy was discontinued and treatment was suspended; however, the frequency of these occurrences was significantly lower compared to current literature data. One fatal outcome due to complications from the administered therapy was recorded. All adverse events were reported in both studied groups with similar frequencies. The most commonly observed adverse events in both groups included hepatotoxicity, anemia, thrombocytopenia, nephropathy, cephalalgia, leukocytosis, skin toxicity, dyslipidemia, hypertension, bone pain syndrome, and dizziness. Other adverse events occurred sporadically with similar frequency. The most severe presentations were noted in the following adverse events: thrombocytopenia, gastrointestinal toxicity, leukocytosis, hyperglycemia, and immune-mediated diabetes mellitus with ketoacidotic coma.Conclusion. In real clinical practice, the safety of off-label and on-label antitumor drug therapy reveals no significant difference.

Urmantsev M.F., Tavabilov R.I., Bakeev M.R.

Renal cell carcinoma (RCC) has previously been considered as a single disease. However, it is currently characterized as a heterogeneous group of tumors that differ in histological features, genetic abnormalities, and variable clinical course. In normal cells, energy is produced by the cleavage of chemical bonds in nutrients through the oxidation of fats, proteins, or carbohydrates. Mutational alterations in genes associated with RCC, including VHL, FLCN, PTEN and SDH, lead to abnormal cellular adaptation to changes in oxygen status, iron metabolism and nutrients. The present paper reviews the known genetic abnormalities observed in RCC and their impact on metabolic alterations. Understanding the genetic and metabolic mechanisms underlying RCC is crucial for the development of effective therapies. Targeting specific genetic abnormalities or metabolic pathways represents a promising approach to the RCC treatment. In addition, studies into the metabolic basis of RCC contribute to the development of new biomarkers for early diagnosis and monitoring of the disease. Moreover, investigating the role of VHL, FLCN, PTEN, and SDH genes in the development of RCC provides valuable information on the molecular mechanisms behind the disease. As a result, it may lead to the development of new treatment strategies aimed at restoring the normal function of these genes or compensating for their abnormalities. Overall, an integrated approach to the study of RCC that considers genetic, metabolic, and clinical aspects will ensure that more effective treatments are developed and prognosis for patients with this disease are improved.

Nartaylakov M.A., Shakurov D.F., Loginov M.O., Fayzillin E.S., Borzenkov Е.А., Salimgareev I.Z.

Introduction. Splenic artery aneurysms refer to the most common visceral artery aneurysms. However, they are diagnosed quite rarely, since about 80% of them appear asymptomatic. Clinically, splenic artery aneurysms manifest themselves through their complications, including hemorrhage into pancreatic cysts or intra­abdominal bleeding due to their rupture, leading to lethality up to 8.5%. Other complications of splenic artery aneurysms appear extremely rare. The gold standard for the diagnosis of splenic artery aneurysms refers to digital subtraction angiography that enables their exact localization to be determined and aneurysm embolization to be performed. Materials and methods. In the period from 2015 to 2023, we observed 51 patients who underwent endovascular interventions on the splenic artery for hypersplenism (n = 32) and aneurysms (n = 19). In most cases, the aneurysms were asymptomatic. The paper presents a rare clinical case of splenic artery aneurysm complicated by recurrent intestinal bleeding. Results and discussion. Examination (EGD, CS) did not detect the source of recurrent intestinal bleeding. Contrast CT revealed a splenic artery aneurysm. Celiac angiography detected a large aneurysm (52×41 mm) of the splenic artery, closely adjacent to the lower horizontal branch of the duodenum. Endovascular embolization of the splenic artery was performed proximal to the aneurysm, resulting in complete occlusion of blood flow through the splenic artery and aneurysm. No repeated episodes of intestinal bleeding were observed after the intervention, thereby indicating the effectiveness of hemostasis. No signs of splenic ischemization were detected by clinical and examination data due to the preservation of blood flow through short splenic vessels. Conclusion. Endovascular embolization of the splenic artery is found to be an effective treatment for its complicated aneurysms.