Science and Innovations in Medicine

Background. Considering the wide prevalence of COVID-19 (SARS-CoV-2) worldwide and in the Russian Federation, high frequency of its mutations and non-persistent post-infection and post-vaccination immunity, the epidemic potential of COVID-19 persists. The experience of the pandemic demonstrated high mortality among individuals with coronavirus and ACS (acute coronary syndrome), specifically, from myocardial infarction (MI).

Aim: to create a multifactorial model for prediction of myocardial infarction using laboratory and instrumental data of progression of COVID-19 in ACS patients.

Material and methods. The open prospective non-randomized study included 104 patients with ACS due to severe COVID-19 hospitalized in 2022. To solve the problem of early prediction of MI among patients, observation groups were formed: Group 1 (n=35), patients with unstable angina and Group 2 (n=69) with MI. All patients underwent round-the-clock monitoring of vital functions using a dynamic bedside monitor. Laboratory parameters (general clinical and biochemical), cytokine levels (1b, 2, 4, 6, 10, interleukins, γ interferon, tumor necrosis factor α) and instrumental parameters (CT of chest organs, EchoCG) were studied. Scores were calculated using the SOFA (Sepsis-related Organ Failure) and SAPS II (Simplified Acute Physiology Score) scales. Statistical data processing was performed in the SPSS 25.0 software suite. Mathematical modeling was performed using multidimensional logistic regression. An analysis of the characteristic curves (ROC curves) in the predicted probability of developing MI in the multidimensional model was performed. The results were considered statistically significant at p<0.05. Based on the data obtained, a multidimensional logistic regression model was constructed with step-by-step inclusion or exclusion of predictors using the Wald algorithm.

Results. The prognostic model included SAPS II scores, cytokines (γ interferon, TNFα), and CT scans. The analysis revealed that the developed mathematical model for assessing the risk of MI in patients with ACS on the background of severe COVID-19, created by the method of multidimensional logistic regression based on cytokine profile, lung CT and SAPS II scale, has a sensitivity of 98.6% and a specificity of 85.7%.

Conclusion. Early predictors of MI development have been established in COVID-19 patients with ACS: the degree of lung damage according to CT data, the number of points on the SAPS II scale, levels of interferon and tumor necrosis factor, on the basis of which a mathematical model has been built that allows predicting MI in patients with severe COVID-19.

Aim: identification of protein glycosylation features in various clinical forms of multiple sclerosis.

Material and methods. We studied the indicators of glycome, viz. interleukin-6 (IL-6) and P-selectin glycoprotein (SELP) in 135 patients with various forms of multiple sclerosis (MS): relapsing-remitting MS (RMS) - 71, secondary progressive MS (SPMS) - 49, primary progressive MS (PPMS) - 15 patients. An ELISA Multiscan FC analyzer was used at 450 nm using appropriate diagnostic kits. Statistical processing was performed using to the Mann - Whitney criterion. Multiple comparisons of groups of different MS course were performed using the Kruskal - Wallis test. Correlation analysis was performed based on Spearman’s rank correlation coefficient. Statistical reliability of conclusions was determined at the 5% level of significance.

Results. This study attempted to identify the relationship between IL-6 and SELP levels and MS shape, duration, and severity, revealing only a significant association of SELP with disease duration for RMS. There were no data on the relationship of these indicators with the age and sex of patients.

Conclusions. The studies carried out show a certain specificity of changes in glycosylation of proteins in multiple sclerosis, which makes it possible to use them as markers for diagnosing various forms of multiple sclerosis and similar diseases. Despite the fact that the study showed a significant association only in SELP and only with the duration of the disease in relapsing-remitting MS, it is possible to obtain additional results with an increase in the number of patients included in the study, as well as with the inclusion of other glycome parameters in the study.

The current stage of technological evolution in healthcare is characterized by the synergy of biomedical sciences and digital technologies, shaping a new paradigm of evidence-based medicine. Generative artificial intelligence (GenAI), with its potential to process heterogeneous data and generate predictive models, is a key driver for the personalization of medical services. This study conducted a multi-level analysis of the institutional and technological aspects of developing a scientific and medical cluster. A scientific-medical educational cluster (SMEC) represents a promising organizational and economic model aimed at consolidating the resources of science, education, practical healthcare, and business to achieve strategic public health goals.

Aim: to study modern approaches to the development of scientific-medical educational clusters as a tool for addressing strategic objectives of public health and healthcare organization on the regional level.

Material and methods. The study utilized a systems approach, a content analysis method for research data on the issue, and an analytical method for assessing the effectiveness of the cluster model in the context of Russian regions.

Results. Key systemic limitations were identified: fragmented management, shortage of personnel and management competencies, and insufficient focus of scientific research on public health priorities. The challenges of forming scientific and medical educational clusters in the current context and ways to address them were identified.

Conclusion. Organization of scientific-medical clusters is a key factor in the development of an innovative healthcare ecosystem, ensuring the integration of academic science, educational institutions, the business sector, and government regulation. Key factors for the success of scientific and medical educational clusters in the region include the leading role of the healthcare authority in coordinating all cluster participants; focus on public health priorities determined based on epidemiological analysis and monitoring data; integration of educational programs in artificial intelligence management and healthcare economics into cluster activities to train personnel capable of working in an interdisciplinary environment; investments in innovations with achievable medical, demographic and economic indicators.

Aim: to evaluate the diagnostic value of 20 biomarkers in lung cancer and to determine their informative value for potential use in clinical practice.

Material and methods. The study included 85 patients with non-small cell lung cancer (NSCLC) and 190 healthy volunteers. Biomarker levels were measured using modern immunological and biochemical methods. Statistical analysis included the Mann–Whitney U test, and diagnostic performance was assessed by the area under the receiver operating characteristic curve (AUC). For markers showing an inverse association, an additional ROC analysis was performed with inversion of the outcome variable. Optimal biomarker cut-off values were determined using the Youden’s index.

Results. Patients with NSCLC demonstrated statistically significant changes in the concentrations of most of the studied biomarkers after strict Bonferroni correction. Increased levels of CEA, CA 125, HE4, B2M, high-sensitivity C-reactive protein (hsCRP), D-dimer, CYFRA 21-1, and LRG-1 were observed, along with decreased levels of ApoA1, ApoA2, TTR, ApoA4, RANTES, and VEGFR1. The highest AUC values were shown by HE4 (0.903), ApoA2 (0.860), CYFRA 21-1 (0.836), ApoA1 (0.795), D-dimer (0.793), TTR (0.790), ApoA4 (0.784), B2M (0.765), and LRG-1 (0.757).

Conclusion. Certain blood biomarkers demonstrate high AUC values, indicating their potential utility for the diagnosis of NSCLC. The combined use of multiple biomarkers may improve the effectiveness of minimally invasive lung cancer diagnostics, which warrants further investigation. Validation of these findings in multicenter studies is required.

Aim: to develop an algorithm for selecting the optimal surgical intervention for patients with metastatic colorectal cancer complicated by obstructive intestinal obstruction.

Material and methods. The study is based on an analysis of the treatment outcomes of 202 patients with metastatic colorectal cancer complicated by obstructive intestinal obstruction. The patients were divided into two groups. Group 1 included 119 patients who underwent primary tumor removal as the first stage. Group 2 included 83 patients who underwent only symptomatic drainage surgery to relieve intestinal obstruction.

Results. The one-year mortality rate was 37 patients (31.1%) in Group 1 and 51 (61.4%) in Group 2. Multivariate analysis identified predictors influencing the one-year mortality rate: the number of internal organs affected by metastases, albumin/globulin ratio, Krebs index, MCV index, and the planned targeted therapy regimen.

Conclusion. Based on this analysis, a step-by-step decision-making algorithm was developed to determine the indications for primary tumor removal, and a computer program was created to calculate the one-year mortality risk in patients with metastatic colorectal cancer.

An original way for reconstruction lateral wall of the attic after separate atticoanthrotomy is proposed and demonstrated using a clinical case. Patient P. (33 years old) with chronic left-sided epitympanoantral suppurative otitis media. Left-sided mixed hearing loss of grade 3 (air-bone interval 50-55 dB). Under general anesthesia, a retroauricular approach to the tympanic cavity was performed, separate atticoanthrotomy was performed, pathological contents of the middle ear cavities were removed, and autofascia and autocartilage were harvested. According to the original technique, the cartilage plates were placed together and sutured with a 4-0 size absorbable braided polyglactin 910 suture using an atraumatic needle. The needle was first inserted through the center of both cartilage plates from front to back, withdrawn, and re-inserted near the previous needle entry point from back to front. The resulting loop was not tightened. Next, the cartilage was re-inserted from front to back near the previous needle entry point, forming a second loop through which the end of the suture without the needle was threaded. Both loops were then tightened. The suture was passed from the external auditory canal through the attic into the antrum and out into the external auditory canal. The sutured plates were placed in the attic so that their ends were adjacent to the posterior wall of the external auditory canal. The ends of the sutures were tightened with a trial knot so that the tension of the suture pressed the cartilaginous plates against the posterior wall of the external auditory canal. A mark was made where the knot touched the outer edge of the posterior bony wall of the external auditory canal, the knot was unraveled, a groove was made in the area of the mark, the ends of the suture were retightened, and a knot was tied in the groove. Ossicular chain reconstruction with a 2.25 mm partial prosthesis, tympanoplasty with fascia and cartilage, wound suturing, and packing of the external auditory canal were performed. After one year, the air-bone interval was 10 dB. Computed tomography of the temporal bones showed no recurrence of cholesteatoma, and reconstruction of the lateral wall of the attic was satisfactory.

Conclusion. The development and implementation of new reconstructive techniques in chronic suppurative otitis media surgery expands the capabilities and enhances the physician’s skills. The proposed technique for forming the lateral attic wall after separate atticoanthrotomy effectively restores the anatomical relationship between the middle ear and the external auditory canal and has practical significance.

Aim: to perform a comparative evaluation of a newly developed device for removing foreign bodies from soft tissues.

Material and methods. A minimally invasive endoscopic system has been developed to facilitate the removal of foreign bodies from soft tissues while decreasing the procedure duration and intervention-related injury. An experimental study was performed using a comparative group design. Blind gunshot wounds were simulated in porcine thigh specimens (pistol shots from a distance of 25 meters). In the main study group (20 wounds) extraction was performed using the developed device, in the comparison group (20 wounds), using a standard Grasper’s clamp under ultrasound guidance. The bullet extraction time was measured with a stopwatch, and the extent of soft tissue damage was quantified by the volume of soft tissue excised.

Results. The duration of bullet extraction in the study group MED [Q1;Q3] 178,5 [148,5; 223,7] s was shorter than in the control group: MED [Q1;Q3] 322,0 [248,5; 350,0] s (p=0.001). The number of muscle fragments extracted along with bullets was higher in the control group (31 fragments) than in the study group (9 fragments). The novel device reduced intervention-related trauma in the study group compared to the control group.

Conclusion. The novel device for extraction of foreign bodies from soft tissues demonstrated a significant reduction in tissue trauma and a shorter procedure time in an experimental model. The combined use of endoscopic and ultrasound guidance enhances targeting precision, facilitates secure grasping and stable retention of the foreign body, and enables its minimally traumatic extraction.

Aim: to evaluate the effect of preoperative botulinum toxin type A (BoNT-A) administration on the early postoperative period in patients with large incisional ventral hernias (IVH) compared with a control group.

Material and methods. A retrospective analysis of 19 patients with IVH class W3 (EHS classification) was performed. The main group (n=9) included patients who received preoperative BoNT-A injections (Dysport 900-1000 U or Xeomin 200 U) into the lateral abdominal muscles under US guidance followed by TAR repair. The control group (n=10) included patients operated without BoNT-A preparation (methods: TAR, Rives-Stoppa, TAR+bridge). The operative time, intensity of pain syndrome according to VAS on days 1, 3 and 5, the duration of opioid analgesic use, the frequency and structure of complications, and the length of hospital stay were evaluated.

Results. In the BoNT-A group, pain intensity was significantly lower on day 1 (VAS median 18.0 [11.5; 26.0] mm vs. 43.5 [40.0; 52.8] mm in control, p<0.001), day 3 (11.0 [8.5; 13.0] mm vs. 41.5 [38.0; 42.8] mm, p<0.001) and day 5 (2.0 [1.0; 3.5] mm vs. 31.5 [29.0; 33.0] mm, p<0.001). The overall complication rate in the BoNT-A group was 11.1% (surgical site hematoma in 1 patient) vs. 70.0% in the control group (p=0.027), with no infectious complications recorded in the BoNT-A group (0% vs. 40.0% in control, p=0.087). The median length of hospital stay in the BoNT-A group was 8.0 [7.0; 8.0] days vs. 9.0 [8.0; 15.8] days in the control group (p=0.095).

Conclusion. Preoperative botulinum therapy is a safe and effective method that significantly reduces the intensity of postoperative pain and the frequency of complications in patients with large ventral hernias.

The article presents a clinical case of treatment of a patient with chronic post-traumatic osteomyelitis of the femur. A fundamentally important point was the analysis of the CT scan results in the Autoplan hardware and software complex (APC) system according to the developed method and the construction of a 3D model of the lower extremities. As a result, the osteomyelitis focus was visualized. Based on the 3D model and using the intraoperative navigation of the “Autoplan” software suite, the patient underwent a femoral sequester-necrectomy. The assessment of the immediate and long-term treatment results was carried out.