Science and Innovations in Medicine

Aim – to obtain new data on the quantitative macromicroscopic anatomy of the iliac-intestinal region in the intermediate fetal period of human ontogenesis from the 16th to the 22nd week of development.

Material and methods. The study was performed on 30 subjects of both sexes (18 female and 12 male fetuses) using the following methods: macro- and microscopic preparation, N.I. Pirogov sawing, histotopographic method, morphometry, and variation-statistical methods. All the morphometric data obtained were subjected to variation-statistical processing in Windows XP-based Excel 2010 and Statistics 13.0 application software packages. When testing statistical hypotheses in this study, the critical level of statistical significance (p) was assumed to be 0.05. The Student’s t-test was used to assess the reliability. A set of tools for macromicroscopic preparation of the fetus was used.

Results. During the period of development in question, the position of the ileum has slight vertical deviations, which affects the formation and magnitude of the angle between the ileum and the cecum, as well as between the ileum and the ascending colon. The predominant shape of the cecum is cylindrical (80%), less often conical (20%). There is an uneven growth of the walls of the cecum, where the lateral wall prevails over the medial one, which is associated with the formation of flap structures. The ileo-intestinal opening is oval in shape, the frenules are weakly pronounced, with a more pronounced ileo-colon lip. Semilunar folds are differentiated on the mucous membrane of the cecum from 16-17 weeks, and a free muscle band is also determined. The omental and mesenteric bands are not pronounced. There is no morphological boundary between the appendix and the cecum. From 19-20 weeks, the presence of 1-2 gausters is noted. The quantitative parameters of the iliac-intestinal region are characterized by a gradual twofold increase in values.

This review discusses the role of membrane components in the initiation and progression of endometrial cancer. Cancer cells that are the substrate of the tumor growth are subject to multiple interactions both among themselves and with the tumor microenvironment.The cell membrane of tumor cells undergoes changes, resulting in simplified antigenic structure and the expression of molecules found in embryonic tissues, changes in the intercellular contacts that maintain epithelial homeostasis. Dense contacts form the basis for the preservation of normal endometrial histological organization. These changes also affect intercellular contacts, leading to the alteration of mechanical properties and invasive growth of tumor cells. In addition, components of dense contacts are participants of intracellular signal transduction pathways. The review highlights the potential role of claudin proteins, specifically in tight junctions and intracellular signaling, as promising targets for further study. Epithelial-mesenchymal transformation (EMT) represented in normal tissues in processes of reparation, plays a significant role in endometrial cancer progression, and the altered characterization of E-cadherin and β-catenin is important in understanding EMT’s role in the disease. Researchers are focusing on the E-cadherin as a component of oncogene activation pathways. Hyperestrogenemia (high serum estrogen levels) is known to underlie Type I endometrial adenocarcinoma. Additionally, estrogen receptors and claudins are implicated in intracellular signaling activating cell proliferation both in the norm and in the course of disease. Recent research also involved other molecules serving as targets for estrogens, e.g. claudin proteins. Change of clausin expression profiles mediated by sex hormones manifest both in suppression and replacement of one protein with another. Further study of cell membrane-associated markers has the potential to provide insights into tumor biology and aid in the development of new therapeutic approaches for endometrial cancer.

Aim – to build a multivariate model for predicting adverse outcomes of acute coronary syndrome with and without ST segment elevation in patients with post-COVID syndrome.

Material and methods. The study included 118 patients (61 men and 57 women) with acute coronary syndrome and post-COVID syndrome. All patients underwent medical history review, clinical examination, laboratory tests, coronary angiography, echocardiography, electrocardiography, and molecular genetic marker testing. The influence of each factor on the probability of developing a combined endpoint, including the total number of cardiovascular complications and fatal outcomes, was assessed using logistic regression analysis. The statistical significance of the model was determined by the χ² test. The sensitivity and specificity of the model were assessed using ROC analysis.

Results. The constructed multivariate regression model showed that the development of an unfavorable outcome in patients with acute coronary syndrome in combination with PCS is associated with the presence of chronic heart failure, elevated soluble fms-like tyrosine kinase-1, hypokinesis zones on echocardiography, carrier status of the TT/AA genotype of the genetic marker rs2285666 of the ACE2 gene (χ² = 38.416, p <0.001). The sensitivity of the model is 93.5%, and the specificity is 21.8%, the accuracy is 76.6%, the area under the curve (AUC) = 0.8.

Conclusion. A multivariate regression model was constructed and tested to predict, with high accuracy, the development of an unfavorable outcome of acute coronary syndrome in combination with post-COVID syndrome.

Aim – to determine the prognostic significance of global longitudinal strain of the left ventricle (GLS) and soluble stimulating growth factor (sST2) in patients with chronic heart failure (CHF) after myocardial infarction (MI) in the annual follow-up period.

Material and methods. The study included 96 patients with CHF who were hospitalized with acute MI. All subjects underwent speckle-tracking echocardiography and determination of concentrations of sST2, vascular endothelial growth factor (VEGF), N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP). After 12 months patients were assessed for cases of stroke, recurrent myocardial infarction, hospitalization for unstable angina or decompensation of CHF, and cardiovascular death, forming a combined endpoint (CEP).

Results. The development of CEP was registered in 44 (45.8%) patients with initially lower left ventricular ejection fraction and GLS, higher left ventricular myocardial mass index, index of impaired local contractility, basal diameter of the excretory tract, as well as a higher score on the Syntax scale and concentrations of CRP, NT-proBNP and sST2. During the ROC-analysis for the development of CEP, optimal thresholds for sST2 and NT proBNP were determined, which were 36.1 ng/ml and 427 pg/ml, respectively. The multifactorial analysis made it possible to develop a mathematical model for predicting adverse outcomes within 12 months after MI, which included such indicators as GLS – odds ratio (OR) 0.51 (0.39; 0.72), the number of points on the Syntax scale – OR 3.05 (2.2; 6.8), concentrations of NTproBNP – OR 2.9 (1.45; 5.1) and sST2 – OR 3.3 (1.65; 7.51).

Conclusion. The developed prognostic model includes factors reflecting various links in the pathogenesis of CHF, which provides an integrated approach to assessing the risks of recurrent cardiovascular events after MI.

Aim – to evaluate the effectiveness of surgical treatment for colorectal cancer in patients aged 75–90 years (WHO, 2002) in the early postoperative period after laparoscopic and open surgeries. The primary outcome was the total length of hospital stay (bed-days). Secondary outcomes included intraoperative blood loss, C-reactive protein (CRP) levels, postoperative pain (VAS), and the incidence of general and surgical complications.

Material and methods. The study included colorectal cancer (CRC) patients (75–90 years old) who underwent laparoscopic (LS) or laparotomic (LT) surgery. A comparative analysis of demographic, clinical-laboratory, and surgical data was performed.

Results. The LS group demonstrated a shorter hospital stay (10 (3) vs. 10 (7) days, p≤0.001) and lower intraoperative blood loss (50 (20) vs. 150 (150) ml, p≤0.001) compared to the LT group. The LT group had significantly higher CRP levels on days 3 and 5 (p≤0.001) and a higher incidence of complications (pneumonia, anemia, acute urinary retention), 18 (33.9%) vs. 6 (7.2%), p≤0.001. Operative time (p=0.002) and postoperative complications significantly influenced hospital stay duration.

Conclusion. Laparoscopic surgery results in a shorter hospital stay, reduced intraoperative blood loss, lower inflammatory response, and decreased postoperative pain and complication rates. These advantages make it the preferred method for treating elderly patients with colorectal cancer, especially in the presence of comorbidities.

Aim – to assess the safety of a hand-sewn intracorporeal ileo-transverse anastomosis.

Material and methods. The retrospective study included patients from the Omsk Regional Cancer Registry from 2015 to 2023. It included patients with colon cancer (ICD-10 C18), who underwent a laparoscopic right colectomy. In the study group patients had hand-sewn intracorporeal anastomoses dene under an original method, terminus-terminal invagination ileo-transverse anastomosis; in the control group patients had hand-sewn ‘side-to-side’ extracorporeal anastomoses.

Results. 89 patients were enrolled: 42 in the study group and 47 in the control group. No cases of anastomotic leakage were found in the study group versus 2 (4.3%) in the control group (p=0.496). Grade 3 and higher surgical morbidity was equal in both groups: 2 (4.8%) versus 5 (10.7%), p=0.550.

Conclusion. The hand-sewn original intracorporeal anastomosis is safe and can be considered by experienced laparoscopic surgeons. Further study is needed for a detailed comparative analysis with established techniques.

Aim – to evaluate the incidence and risk factors of chronic post-traumatic pain in patients who suffered an anterior cruciate ligament (ACL) and/or knee joint meniscus (CC) injury.

Material and methods. The study group consisted of 148 patients (48.0% women, 37.9 ± 13.1 years old) who had suffered an injury to the PC and/or meniscus of the CS, confirmed by magnetic resonance imaging (MRI). The inclusion criterion was moderate/severe pain (≥4 on the numerical rating scale, NRS 0-10) 1 month after the injury. Patients were examined after 3, 6, and 12 months with an assessment of pain (NRS) and the KOOS index, signs of neuropathic pain (painDETECT), anxiety and depression (HADS a and HADS d), central sensitization index (CSI), pain catastrophization (PCS), fibromyalgia symptoms (FiRST), fatigue (FACIT). An MRI scan was performed after 6 and 12 months. The plasma concentrations of a number of biomarkers (HCRP, NTX, ADAMTS-5, COMP, MMP3, MMP9, MMP13, substance P) were studied.

Results. After 3 months, pain with movement ≥4 NRS was observed in 58 (39.2%) patients. These patients formed the group with chronic post-traumatic pain (CPTP+), patients with lower pain intensity or absence (≤4 NRS) formed the control group (CPTP-). In patients with CPTP+, compared with the CPTP- group, pain at rest and at night was significantly higher (p <0.001). A significant difference in pain during movement, at rest, and at night, as well as all KOOS scales, remained between the CPTP+ and CPTP- groups after 6 and 12 months. In the CPTP+ group, there was a tendency to a higher frequency of signs of neuropathic pain, anxiety and depression, central sensitization index, pain catastrophization scale and fatigue, however, the difference with the CPTP- group was unreliable. The concentration of biomarkers in the CPTP+ and CPTP- groups did not differ. There was a significant association between CPTP and the female sex (odds ratio = 3.18; 95% confidence interval 1.606-6.297, p<0.001), meniscus injury (OR = 2.132; 95% CI 1.07-4.252, p=0.03), osteitis (OR = 5.734; 95% CI 2.106-15.609, p<0.001) and synovitis (OR = 2.35; 95% CI 1.186-4.656, p=0.013) according to MRI, surgery (reduced the risk of CPTP, OR = 0.385; 95% CI 0.195-0.759, p<0.005), initially severe pain (≥7 NRS, OR = 5.553; 95% CI 1.696-18.179, p=0.002), signs of highly probable CS (CSI ≥40, OR = 3.915; 95% CI 1.147-13.368, p=0.021) and severe depression (HADS ≥ 11, OR = 4.12; 95% CI 1.672-21.983, p=0.05).

Conclusion. CPTP occurs in almost 40% of patients after knee joint meniscus injury. Risk factors for CPTP are female gender, meniscus injury, osteitis and synovitis (MRI data), initially severe pain, central sensitization, and depression.

Aim – to carry out a comparative assessment of the accuracy and time of calculating the area of the wound surface using mobile applications.

Material and methods. Wound areas were measured using mobile applications +WoundDesk, ImitoWound and V2F in four blocks of the study: schematic 2D image of soft tissue wounds (block I), volumetric (3D) models of wounds in fractures of the shoulder and leg (block II), experimental wounds in laboratory animals (block III) and assessment of combined wound defects upper and lower jaws in patients (IV block). In the first block, four groups were identified: the 1st group was measured by the area of schematic wounds on a flat surface; in the 2nd, 3rd and 4th groups, by the area of schematic wounds painted on cylindrical surfaces with a diameter of 7, 10 and 20 cm, imitating the surfaces of the forearm, shoulder and head, respectively.

Results. In block I, there is a direct relationship between the curvature of the examined wound surface and the accuracy of determining its area. In the second block, the measurements obtained using the ImitoWound mobile application turned out to be the most accurate, 96.22±3.41% and 97.80±2.37%. In the III block of the study conducted on laboratory rats of the Wistar line, the average deviation when using +WoundDesk was 90.84±7.51%, V2F – 88.96±9.52%, ImitoWound – 92.51±2.54%. In the IV block of the study, when analyzing the accuracy of determining the area of defects of superficial soft tissues in patients with facial defects, the ImitoWound mobile application and the Autoplan complex showed similar results.

Conclusion. Most wounds encountered in medical practice have a complex configuration that changes during treatment, changing from one form to another, which calls into question the expediency of using the presented mobile applications as the main method of conducting planimetric studies in medicine.