Vol 9, No 4 (2024)

Currently, the use of artificial intelligence (AI) in gynecology is at the initial stage of its implementation. To date, cervical cancer (cervical cancer) is the second most common malignant tumor. Untimely diagnosis of the disease has a serious impact primarily in remote regions of the country, which is directly related to the lack of laboratory equipment, difficulties in transporting materials, as well as the lack of highly qualified cytologists and colposcopists. AI-based programs for reading cytological images, HPV identification and colposcopy have been created to date, which makes it possible to increase the availability of visual screening for women throughout the country, including those living in remote regions. In addition, it helps to improve the timely diagnosis of breast cancer in women through cervical screening using AI systems.  The review presents the main categories of AI, including machine learning methods, and includes foreign and domestic research on AI-based technologies for performing cytological examination and colposcopy, published between 2019 and 2024. The search for literature sources was conducted on the PubMed platform. The search queries included the following keywords: “cervical screening”, “artificial intelligence in gynecology”, “artificial intelligence in colposcopy”, “artificial intelligence in cervical screening". It was found that AI programs for the interpretation of Pap smear (Al-Pap) are 5.8% more sensitive to the detection of CIN2+ than manual counting with a slight decrease in specificity. In studies based on AI processing of colposcopic images, the percentage of coincidence between the results and the histological conclusion was higher than when interpreted by specialist doctors by 16.64%. When identifying HSIL+ with artificial intelligence, a higher sensitivity was revealed, 11.5% higher than the conclusion of the colposcopist, while the specificity was practically comparable. The Russian Federation is actively developing a domestic digital portable colposcope on the basis of the Samara State Medical University of the Ministry of Health of the Russian Federation, together with specialists from the Almazov National Medical Research Center of the Ministry of Health of the Russian Federation, as well as the Peter the Great St. Petersburg Polytechnic University for reading and interpreting colposcopic images.

Portal hypertension, one of the serious consequences of liver cirrhosis, contributes to the aggravation of complications such as ascites, varicose veins of the esophagus, stomach and anterior abdominal wall, splenomegaly and hepatic encephalopathy.

This review article evaluates the biomolecular mechanisms that determine the role of human constitutional characteristics as a prognostic factor for portal hypertension and the course of liver cirrhosis. A search for publications and an analysis of literary sources was conducted using the PubMed and eLibrary.ru databases, mainly for the last 10 years. A search for publications was performed by keywords, as a result of which 6418 works were found (3623 full-text papers), 108 publications were studied, of which 23 publications were referenced.

The analysis of papers resulted in the identification of one of the leading biomolecular mechanisms that determine the correlation between the constitutional features of the body, namely, an increased endomorphic component, and the risk of developing portal hypertension. The greatest influence on the endomorphic component of body composition derives from proinflammatory factors, insulin resistance and the absence of insulin sensitization syndrome caused by food intake.

Aim – to evaluate in vitro the biocompatibility and osteoconductivity of a hybrid graft based on a bioorganic matrix, human bone marrow mesenchymal stromal cells (BM-MSC) and osteogenic growth factors.

Material and methods. Bioorganic matrices were studied for biocompatibility with human BM-MSC culture used in traumatology and orthopedics. For promoted osteogenic differentiation of BM-MSCs, allogeneic plasma enriched with soluble platelet factors was used. The osteogenic potential of BM-MSCs by the synthesis of mRNAs of early (transcription factor 2 (Run X2), alkaline phosphatase (ALP)) and late genes (osteopontin (OSP)) of osteogenesis was analyzed. The properties of cell adhesion and proliferation of MSCs in the conditions of a three-dimensional hybrid graft by the MTT test and fluorescence microscopy were assessed.

Results. The biocompatibility of the studied bioorganic matrices with human BM-MSCs was established. The collagen matrix promoted rapid cell adhesion and proliferation between the scaffold fibrils. It has also been established that allogeneic platelet-rich plasma affects the osteogenic differentiation of human BM-MSCs in vitro, increasing the expression of marker genes RunX2, ALP, OSP. When modeling a hybrid graft in vitro, the formation of a tight contact between the alloimplant and collagen biopolymer using MSCs was shown.

Conclusion. The biological properties of the developed hybrid cell-tissue graft characterize its biocompatibility and osteoconductivity of its constituent components, which makes it promising for use in regenerative medicine, especially in reconstructive surgery of bone defects.

Aim – to determine the nature of changes in the quality of life in social isolation and risk factors associated with it in elderly patients with visual impairment.

Material and methods. A clinical group was formed of 115 participants with visual impairment aged 60–74 years who were in conditions of social isolation for a month. In accordance with the Helsinki Declaration, social isolation was determined on the basis of a 15-point scale, and a questionnaire on quality of life was used to measure changes in the quality of life. Risk factors included socio-demographic, clinical categories and indicators of functional status.

Results. The results of linear mixed models with random intersections comparing quality of life indicators before (3.30) and after social isolation (1.78) were significant (p<0.001). During social isolation, 87% of participants with visual impairment experienced a decrease in quality of life (-2.39), while 13% of participants had an increase in quality of life (0.58). The following risk factors were associated with social isolation: low income (38%, p<0.001), lack of higher education (29%, p=0.002), lung disease (25%, p=0.04), functional or sensory disorders, including difficulties with cooking (28%, p=0.004), difficulty in walking the distance of one block (26%, p=0.03), hearing impairment (23%, p=0.02) and visual impairment (24%, p=0.01). Gender (p=0.39), ongoing pain (p=0.75), difficulties with daily activities (p=0.09), urinary incontinence (p=0.82), diabetes mellitus (p=0.87) and cognitive impairment (p=0.06) were insignificant.

Conclusion. The period of social isolation led to a very significant decrease in the overall quality of life in the sample of elderly people with visual impairment. The leading risk factors for social exclusion were low income and lack of higher education.

Aim – to study the clinical and immunological indicators of COVID-19 convalescents 1 and 3 months after the disease in dynamics with the determination of predictors of the development of changes in the lungs.

Material and methods. The object of the study was 35 patients aged 22 to 75 years in the dynamics of COVID-19 disease, divided into two groups according to the identified clinical and immunological disorders. Markers of cellular (CD-3, CD-4, CD-8, CD-19) and humoral immunity, cytokines (IL-6,8, TGF-β, TNF-α), CEC were determined in all examined patients. Statistical processing of the obtained results was carried out using the Statistica 10.0 software suite.

Results. It was found that all the subjects retained clinical and immunological changes during the entire follow-up period, which indicates an ongoing disease. At the same time, significant differences in the severity of changes in individuals were revealed, taking into account age and the presence of chronic somatic pathology, expressed primarily in violation of the parameters of the T-system of immunity. In patients with the development of post-Covid changes in the lungs, characteristic immunological features were revealed, taking into account age.

Conclusions. A violation of the identified indicators of the immune system may indicate the persistence of the virus, which means a prolongation of a specific inflammatory response with the risk of extensive tissue damage. The tendency towards the formation of humoral immunity persists in both groups within three months after recovery. Humoral immunity was formed by the end of 1 month after the disease in both groups and continued to persist throughout the entire follow-up period. In the risk group for the development of pneumofibrosis in the outcome of a new coronavirus infection, the combination of IL-8 and TGF-β is the most optimal, despite their significant decrease in dynamics compared with the acute period.

Aim – to evaluate the effectiveness of the YOLOv8 algorithm for automatic segmentation of demyelination lesions in various locations in patients with multiple sclerosis.

Material and methods. The study included 120 patients with a clinically confirmed diagnosis of multiple sclerosis who underwent contrast-enhanced MRI. The MRI data from patients with different types of disease progression were analyzed. T1-weighted, T2-weighted, and FLAIR sequences were used for the analysis. The YOLOv8 algorithm was adapted for medical imaging and trained on manually annotated MRI scans. Model performance was evaluated using precision, recall, and F1-Score metrics.

Results. The YOLOv8 model demonstrated high segmentation performance with a precision of 0.79, recall of 00.73, and F1-Score of 0.65. The model effectively identified demyelination lesions in various locations typical for multiple sclerosis. However, there remains a need to improve recall to minimize the missed lesions. Testing on independent data confirmed the stability of the results of the model.

Conclusion. The YOLOv8 algorithm shows significant potential for automatic segmentation of demyelination lesions in multiple sclerosis patients. This method could be successfully implemented in clinical practice, enabling faster diagnosis and improved monitoring of disease progression. Further optimization of the model, through data augmentation techniques and hybrid architectures, may enhance both segmentation accuracy and recall.

Aim – to study the frequency of single-nucleotide variants (SNV) rs1801133 and rs1801131 of the MTHFR gene; rs1801394 of the MTRR gene, rs1805087 of the MTR gene and rs1051266 of the SLC19A1 gene in women with epilepsy and to evaluate their associations with major congenital malformations (MCM) of the fetus.

Material and methods. The study included 61 women with epilepsy who have children: 20 had different fetal MCM (main group), 41 patients had children born without MCM (comparison group). DNA was extracted from blood, and the genotyping of five SNVs into four genes was analyzed by polymerase chain reaction. The frequencies of genotypes and alleles in the mothers of the main and the comparison group were determined, the differences were assessed using Pearson's chi-squared criterion (χ²) and Fisher's exact criterion.

Results. There were no statistically significant differences in the frequencies of genotypes and alleles for all analyzed SNVs between the main group and the comparison group. There were no statistically significant differences in the frequencies of genotypes and alleles of SNV of the studied genes of the folate cycle in mothers of children with malformations (n = 14) and without malformations (n = 22), taking valproic acid. A statistically significant relationship was revealed between the carrier of a certain haplogroup of the mother and the formation of fetal MCM.

Conclusion. The MCM in a child is a multifactorial phenomenon in which genetic factors with a small effect size can play a significant role only in the case of certain unfavorable combinations.

Soft tissue sarcomas are rare malignancies, accounting for approximately 1% of all malignancies in adults, with approximately 15–20% of all soft tissue sarcomas arising in the retroperitoneal space. Guidelines for the surgical treatment of retroperitoneal sarcomas are still lacking. Criteria for unresectability remain unclear, and indications and compliance with surgical treatment vary.

A special focus is made on vascular resections in retroperitoneal sarcomas. Surgical intervention with resection of the main vessels in case of their involvement allows for a radical operation and naturally improves long-term results. However, only isolated cases of surgical interventions with resection of the main vessels for retroperitoneal sarcomas are described in the literature.

The article describes a unique clinical case of a two-stage successful surgical treatment of a patient with retroperitoneal liposarcoma and invasion of the aorta and left common iliac artery. At the first stage, an intravascular graft stent was installed. The second stage was en bloc tumor removal, nephrectomy and left hemicolectomy, resection of the infrarenal segment of the abdominal aorta and left common iliac artery.

The discussion provides an analysis of publications on the role of vascular resections in retroperitoneal sarcomas.

The technique of two-stage surgical treatment using endoprosthetics of the main vessel at the first stage, compared to one-stage resection and prosthetics, used in our work has a number of advantages: no need for intraoperative prosthetics of the vessel; no clamping of the abdominal aorta and iliac arteries to form anastomoses; minimal blood loss and reduced surgery time; reduced risk of thrombosis and embolism.

Taking into account the above advantages, this technique can be recommended for retroperitoneal sarcomas with invasion of the main vessels.

Aim – to study the pathomorphological features of various forms of isolated sphenoiditis.

Material and methods. We analyzed the data of surgical biopsy material of 23 patients aged 18 to 68 years who were on inpatient treatment at the Regional Clinical Hospital named after N.A. Semashko in the period of 2019–2022.

Results. In our study, it was found that in the structure of isolated sphenoiditis, the most common is the polypous-cystic form of the sphenoidal sinus lesion, which is diagnosed statistically significantly more often than the fungal isolated sphenoiditis (p=0.001). The results of the pathomorphological study in all our observations showed a picture of a nonspecific chronic inflammatory process. As a rule, we observed a mucous membrane lined with atrial respiratory epithelium with varying degrees of edema of the plate. In our observations, as a rule, the structure of the epithelium was normal, and the most frequent change was local desquamation in the polypous and cystic forms and sphenochoanal polyp. In the case of mucocele, a local decrease in epithelial height was revealed without reliable signs of squamous cell metaplasia. In the case of the polypous-purulent form, local desquamation occurs, but with areas of atrophy. In polypous fungal forms, only signs of local desquamation were found. The change in the ratio of goblet, supporting and ciliated cells concerned, as a rule, changes in the number of goblet-shaped cells towards an increased (polypous, cystic forms), normal (sphenochoanal polyp) or reduced (fungal, mucocele, polypous-purulent) quantity. The basement membrane was of the usual structure (in polypous-purulent and fungal forms), in some cases thickened. The most pronounced thickening was registered in the case of sphenochoanal polyp, to a lesser extent, in polypous sphenoiditis with bright eosinophilic infiltration, minimally in mucocele. We observed the most active inflammation in the proper plate (with signs of edema) of the mucous membrane in the polypous form, in other forms of lesion this manifestation was moderate (fungal) or reduced (cyst). Edema of the lamina was most pronounced in the polypous form; minimal edema was seen in the sphenochoanal polyp, polypous-fungal form, and there was no edema in other forms. The data obtained indicate that at the time of the interventions, the process in the sinus was not aggravated. The range of features characteristic exclusively of a particular morphology of the lesion identified in our studies is minimal. The pathomorphological landscape of lesions of the sphenoid sinus, obtained in our study, generally corresponds to the picture of lesions of other groups of paranasal sinuses.

Conclusions. Against the background of a huge number of cases of acute and chronic rhinosinusitis, the absolute prevalence of isolated sphenoiditis, even with a relative magnitude of 5% of the total, is also very significant. Determining the phenotypes of isolated sphenoiditis is very important for building a consistent treatment strategy, especially against the background of a large number of tactical and diagnostic errors. For more effective and visual performance of such data analysis, we have developed a “Checklist for pathomorphological examination in pathology of the sphenoid sinus”. The pathomorphological landscape of lesions of the sphenoid sinus, obtained in our study, generally corresponds to the picture of lesions of other groups of paranasal sinuses. Examination of the autopsy material showed the presence of polypous changes in the sphenoid sinus and obstruction of the anastomosis in almost half of the observations.

Aim – to compare the results of soft tissue stabilization operations for transposition of the tendons of the long radial and ulnar extensors of the wrist and arthrodesis of the wrist joint in patients with rheumatoid arthritis.

Material and methods. The study included 69 patients. Twenty-four patients (the main group) underwent transposition of the long radial and ulnar extensors of the wrist (ECU+ECRL transposition) with their subsequent tenodesis. Forty-five patients (the control group) underwent arthrodesis of the wrist joint. The DASH questionnaire was used to assess the functional status before and after surgery. The EQ-5D index was used to assess the quality of life, visual assessment scale (VAS) was used to assess pain, and disease activity was assessed using the DAS28 index. The average follow-up period for patients after surgery was 6 months.

Results. The functional status of patients after surgery, assessed by the DASH scale, was significantly better in the main group of patients (39.41±10.17) compared to the control group (46.4±15.8), p<0.05. Both groups showed positive dynamics of pain according to the VAS, as well as an improvement in the quality of life. In the group of patients with ECU+ECRL transposition, carried out at stages II-III of Larsen's wrist damage, the functional status of the hand according to DASH after surgery was significantly better compared to patients who underwent tendon transposition at stages IV-V of wrist damage, their median being 38 and 48 points, respectively. Conclusions. ECU+ECRL tendon transpositions are an effective method for stabilizing the wrist joints and correcting hand deformities, but they have a number of limitations, the most important of which is the degree of damage to the wrist joints and the severity of the deformities. The effectiveness of soft tissue techniques is significantly reduced when performing surgical interventions at stages IV and V of hand damage according to Larsen.

Aim – to evaluate the effect of cinnamic acid derivative on changes in mitochondrial enzymes activity in rats brain tissue under conditions of experimental Parkinson's disease.

Material and methods. Parkinson's disease was modeled in male Wistar rats by direct injection of rotenone solution (5 mg/ml) into the striatum. The analyzed compound 4-hydroxy-3,5-di-tretbutyl cinnamic acid and the reference ethylmethylhydroxypyridine succinate were administered orally in equivalent doses (100 mg/kg) for 30 days from the moment of pathology modeling. Next, a brain supernatant was obtained by differential centrifugation, in which changes in the activity of enzymes: citrate synthase, succinate dehydrogenase, cytochrome c oxidase and aconitase were evaluated. The obtained results were processed statistically. During the analysis, the StatPlus 7.0 application software suite was used.

Results. During the study, it was found that the administration of 4-hydroxy-3,5-di-tretbutyl cinnamic acid to rats increased the activity of citrate synthase, succinate dehydrogenase, cytochrome c oxidase and aconitase relative to untreated animals by 109.7% (p<0.05); 53.6% (p<0.05); 65.0% (p<0.05) and 63.1% (p<0.05), respectively, whereas against the background of the use of the reference, the activity of these enzymes increased by 56.3% (p<0.05); 57.7% (p<0.05); 71.7% (p<0.05) and 49.1% (p<0.05), respectively. At the same time, the activity of citrate synthase in animals treated by 4-hydroxy-3,5-di-tretbutyl cinnamic acid was higher than that in rats treated by the reference by 34.2% (p<0.05).

Conclusions. The study showed that the course administration of 4-hydroxy-3,5-di-tretbutyl cinnamic acid to animals with experimental Parkinson's disease is accompanied by an increase in the activity of mitochondrial enzymes, which may reflect the significant effect of this compound on the processes of mitochondrial biogenesis, mitophagy and generation of mitochondrial reactive oxygen species.