Vol 10, No 3 (2025)

Aim – to carry out a quantitative assessment of the healing of tubular bone fracture modeled by applying a hole defect in it and to analyze existing methods of bone regenerate morphometry.

Material and methods. The data were obtained on 30 white mature rats, which had a hole defect made in the tibiae. Morphological and morphometric studies of the regenerate were performed on the 3rd, 10th, 15th, 24th and 45th days after surgery on histological sections.

Results. Microscopically the tibial regenerate in mature rats is characterized by the presence of hematoma from 3rd to 10th days, as well as granulation tissue from 3rd to 24th days, fibroreticular tissue, woven bone from 3rd to 45th days, and lamellar bone, from 10th to 45th days of reparative osteogenesis. Along with the well-known structures of the bone regenerate, muscle fibers have been identified in its granulation tissue. Due to the peculiarities of the structural organization of fibroreticular tissue, woven and lamellar bones and their localization in the regenerate, it is proposed to distinguish organized and unorganized layers in the first, and typical and atypical (disorganized) components in the rest. Histomorphometry was used to obtain data on the actual values of the areas of hematoma, granulation, fibroreticular tissue, woven and lamellar bones on 3rd, 10th, 15th, 24th, 45th days after fracture modeling, their percentages to the total area of the regenerate and the dynamics of their changes from one period to another.

Conclusion. The histomorphometry data of the tibial regenerate on the 3rd, 10th, 15th, 24th and 45th days after surgery, as well as the revealed features of its histostructure, supplement the available information on bone fracture healing and can be used for fundamental medicine.

Aim – to study the morphological structure of lyophilized amniotic membrane preliminarily subjected to physical decellularization.

Material and methods. An experimental study of the preservation of the anatomical structure of lyophilized amniotic membrane was performed on four groups of amniotic membrane fragments. Group 1: AM impregnated with glycerin and dried over silica gel; Group 2: AM impregnated with glycerin, treated ultrasonically and lyophilized; Group 3: AM treated ultrasonically and lyophilized; Group 4: native AM without preservation. The biomaterial was studied using light microscopy and scanning electron microscopy.

Results. Physical methods of influencing biological tissue have an expected effect on cell viability and allow obtaining a completely decellularized amniotic membrane. Additional treatment with glycerol before physical action on biological tissue for the purpose of decellularization does not have a significant effect on the preservation of cellular structures. It should only be noted that in the amniotic membrane impregnated with glycerol, more fragments of epithelial cell membranes are preserved and the basement membrane is more preserved.

Conclusion. The decellularization method developed by us using physical methods does not introduce any chemicals into the processed biomaterial that can have an unpredictable effect on regenerating tissues. Preservation of the amniotic membrane by lyophilization allows obtaining a morphologically integral, elastic and durable biomaterial.

Aim – evaluation of the features of using a digital clinical calculator for an objective assessment of the cardiovascular risk in elderly patients in a routine outpatient practice.

Material and methods. The methodology for calculating the value of cardiovascular risk used in the calculator is based on the recommendations for the prevention of CVD of the European Society of Cardiology (2021). The program provides the functionality of calculating the personalized quantitative value of the probability of fatal and non-fatal cardiovascular events over a period of 10 years.

Results. The calculator matrix uses five significant initial variables: patient’s age, gender, smoking, systolic blood pressure and low-density lipoprotein cholesterol. The program provides for use directly in outpatient settings, works in any browser, does not require downloading to a device, can be used in a mobile phone version, and allows the user to form a conclusion for printing and saving on electronic media.

Conclusion. The calculation of an objective numerical indicator of risk of CVD, which lends itself to accurate mathematical and statistical assessment, allows the calculator to be used to solve the following tasks: monitoring and reclassification of cardiovascular risk in elderly patients, a weighted assessment of indications for correction of modifying factors and intensification of treatment, dynamic control of the effectiveness of the treatment methods used; the result of the calculator is stored as an electronic medical document. The program can be used in any medical information system as a module of the medical decision support system through the integration subsystem.

Currently, the primary method for identifying transient disorders of local contractility of the left ventricular myocardium in patients with coronary atherosclerosis remains visual assessment of myocardial contractility under physical or pharmacological stress testing. Visual assessment of myocardial contractility, especially in stress tests, requires extensive experience in conducting such studies. However, visual assessment by even the most experienced operator remains subjective. Consequently, a principal focus in diagnosing left ventricular regional wall motion abnormalities has been, and remains, the development of methods for objective quantitative assessment of functional status across different left ventricular myocardial segments. A significant success in this area was the development of speckle-tracking echocardiography technique, which allows for a quantitative assessment of myocardial deformation during its contraction and relaxation.

The review presents the results of studies indicating that the determination of left ventricular myocardial deformation indices may become an alternative to the traditional method, devoid of such disadvantages as the subjectivity of visual information perception and very high requirements for the operator’s qualification level. Deepening knowledge about the mechanisms, clinical significance of various myocardial deformation indices, the improvement of both the speckle-tracking echocardiography technique itself and the algorithms of automated processing of data creates a real prospect for its introduction into clinical practice as the main method for identifying transient disorders of local left ventricular contractility in patients with hemodynamically significant coronary atherosclerosis.

Aim – creation of a computer program using a modern programming language that allows remote assessment of patient treatment adherence based on the national KP-25 scale.

Material and methods. The program we developed was implemented using the modern programming language Python 3.8. This electronic assistant allows the user to automatically collect and systematize compliance data, conduct statistical analysis and store patient survey data. All these processes, depending on the operator’s goals, can be carried out using local and cloud servers. If it is necessary to transfer data remotely, the program has the functionality to ‘depersonalize’ data about the respondent, which ensures safe and correct accumulation and storage of data.

Results. The program allows the user to evaluate 6 technical indicators calculated using formulas: importance of drug therapy, importance of medical support, importance of lifestyle modification, readiness for drug therapy, readiness for medical support, readiness for lifestyle modification. Calculation using integrated formulas also allows the user to display the result of the commitment calculation on the user’s screen in four aspects: 1) commitment to lifestyle modification, 2) commitment to drug therapy, 3) commitment to medical support, 4) integral commitment to treatment. After the end of testing, the program saves the patient’s answers to an Excel file located in the root folder of the program in the form of percentages, which are generated depending on the patient’s response in accordance with the classical algorithm for interpreting the results of the questionnaire using integrated formulas.

Conclusion. This software product can potentially be used in the scientific process in conducting cohort and population-based studies aimed at assessing compliance in routine medical practice, as well as integrated into existing and promising medical information systems.

Aim – to evaluate the effectiveness of the continuing professional education program “Multidisciplinary approach to managing patients with a confirmed diagnosis of 5q spinal muscular atrophy” (36 hours; hereinafter referred to as the SMA5q CPE Program) as a tool for improving the level of competence of doctors within multidisciplinary teams providing medical care to SMA5q patients.

Material and methods. The study used the materials completed by course teachers and students who had completed training under the SMA5q CPE Program. These materials included entrance control forms, final certification forms, and certification reports, which were provided by the Institute of Higher and Continuing Professional Education of the N.P. Bochkov Medical Genetic Research Center.

Results. As of January 2025, 136 students from 39 administrative entities of the Russian Federation had completed the training. During the final certification of the training program, all students demonstrated a relatively high level of competence in completing test tasks: 70-80% correct answers were given by 96 students, 81-90% by 36, 91-100% by 4. At least one control question was answered by 42 students, two by 85, and all three questions, by 9 doctors.

Conclusions. The SMA5q CPE Program has proven effective in improving the competencies of doctors who make up a multidisciplinary team. The implementation of this SMA5q CPE Program can increase the availability and effectiveness of high-cost pathogenetic therapy for patients with SMA5q.

Aim – to compare standard and mesenteric approaches to surgical treatment of patients with pancreatic head cancer invading the portal and/or superior mesenteric veins and to evaluate their advantages.

Material and methods. Surgical treatment of 192 patients with pancreatic head cancer with portal and/or superior mesenteric vein invasion was performed. In 43 (22.4%) cases, pancreatoduodenal resection was performed through the mesenteric approach, in the remaining 149 (77.3%) patients, the standard approach to surgical treatment was used.

Results. The median duration of operations with the mesenteric approach was 290 min., with the standard one, 300 min., the median blood loss was 1120 ml and 1800 ml, respectively, p=0.0002. No statistically significant differences in the long-term treatment results were found for mesenteric and standard approaches: progression of pancreatic head adenocarcinoma was diagnosed in 48.8% and 49%, respectively; the median overall survival was 24.5 months and 22.3 months; the median progression-free survival was 21.3 months and 22.1 months, respectively. Analysis of long-term treatment results depending on the type of approach and the degree of radicality of surgical intervention showed that the incidence of local relapse with standard access in non-radically operated patients is significantly higher (40.6% vs 7.7%, p = 0.001).

Conclusion. The advantages of the mesenteric approach over the standard approach to surgical treatment of patients with pancreatic head cancer with portal and/or superior mesenteric vein invasion are as follows: 1) it makes it possible to assess the prevalence and operability of the tumor as early as at the beginning of the surgical intervention; 2) it ensures a significantly higher frequency of operations in the R0 volume; 3) it ensures significantly less blood loss during surgery; 4) after circular resection of the main veins it provides more opportunities to perform end-to-end plastic surgery, which reduces the risk of thrombosis due to the formation of only one anastomosis and reduces the time of clamping of the main veins, reducing the risk of liver and intestinal ischemia.

Background. The rise in antibiotic resistance of Streptococcus pyogenes in chronic tonsillitis remains a global issue, exacerbated by irrational use of antibacterial drugs, low patient adherence to therapy, and the spread of resistant strains. The discrepancy between the relatively high in vitro sensitivity of microorganisms and the reduced clinical efficacy of drugs in vivo is of particular concern and requires an in-depth analysis of the causes of such disparities.

Aim. The study aims to evaluate the efficacy of various groups of antibacterial drugs in vitro and in vivo used to treat chronic tonsillitis during exacerbations.

Material and methods. Based on outpatient records and microbiological studies, a group of patients was identified in whom S. pyogenes was the primary significant factor in the development of chronic tonsillitis. The sensitivity of the pathogen to commonly used antibacterial drugs was assessed using the disk-diffusion method. Clinical efficacy of antibiotic therapy was evaluated based on objective criteria. Additionally, isolates of S. pyogenes co-incubated with antibacterial agents were analyzed using Raman spectroscopy.

Results. The analysis revealed discrepancies between in vitro disk-diffusion data and clinical outcomes. According to the disk-diffusion test, 87.6% of patients showed sensitivity to semi-synthetic penicillins, yet incomplete or absent clinical efficacy was observed in 28.2% of cases. Slightly better results were obtained with inhibitor-protected penicillins. Macrolides, demonstrating 88.5% efficacy in vitro, failed to achieve full therapeutic effects in 26.6% of patients. Comparable results were observed with cephalosporins. The lowest in vitro sensitivity of S. pyogenes was noted for fluoroquinolones, leading to inadequate clinical efficacy in 28.0% of patients. Raman spectroscopy enabled the assessment of sensitivity to one of the most frequently used antibacterial agents.

Conclusions. The significant gap between laboratory and clinical data is attributed not only to potential antibiotic resistance mechanisms (which are also discussed) but also to the influence of internal factors that must be considered when selecting etiotropic therapy for chronic tonsillitis during exacerbations.

Background. Chronic post-traumatic pain (CPTР) occurs in 15-50% of patients who have suffered knee joint injury (KJ). Post-traumatic pain is considered as one of the predictors of the development of post-traumatic osteoarthritis (PTOA). Early changes in the knee joint, characteristic of the development of PTOA, can be determined using magnetic resonance imaging (MRI).

Aim – to evaluate the relationship between CPTР and structural changes in the knee joint, which are determined using MRI.

Material and methods. The study group consisted of 98 patients, 48% women and 52% men, aged 39.2 ± 14.7 years, who had suffered a knee joint injury with damage to the anterior cruciate ligament (ACL) and/or meniscus (confirmed by MRI data), and experiencing pain ≥4 points on a numerical rating scale (CRS) of at least one month after the injury. The patients were followed up for 12 months. CPTР was determined with pain persistence for at least 3 months at the level of 4 points on the CRS. Repeated MRI was performed 12 months after inclusion in the study. Changes in the knee joint according to the MRI data were quantified using the WORMS system.

Results. CPTР was detected in 45.9% of patients. According to the initial MRI parameters, the groups of patients with CPTР (n=45) and without CPTP (n=53) significantly differed in cartilage morphology (minimal changes were more often detected in patients without CPTР), the presence of osteophytes, damage to the medial collateral ligament and rupture of the medial meniscus body. Almost all patients in both groups had ligament damage and meniscus rupture (with varying degrees of severity), as well as synovitis; about a third of the examined individuals had signs of bone marrow edema. After 12 months observations between patients with and without CPTР showed a significant difference in MRI parameters such as cartilage morphology, osteophytes of the medial condyle of the femur, damage to the posterior cruciate and medial collateral ligaments, rupture of the body, anterior and posterior horns of the medial meniscus, rupture of the anterior horn of the lateral meniscus, synovitis. Thus, severe cartilage damage (≥2 by WORMS) was noted in 82.1% of patients with CPTР and 43.4% without CPTР (p <0.05), synovitis in 95.6% and 24.5% (p <0.05).

Conclusion. CPTР, which occurs after the knee joint injury, is associated with structural changes in the joint, which can be regarded as an early stage of PTOA.

August 28, 2025 marks the 95th anniversary of the birth of Aleksei A. Lebedev, the founder of the Samara Scientific and Pedagogical School of Pharmacologists, which has all-Russian and international recognition in the field of “Pharmacology of the Kidneys and Water-Salt Metabolism”.

The milestones of A. A. Lebedev’s biography are presented. His influence on the development of pharmacology, training of scientific and pedagogical personnel in the field of pharmacology, clinical pharmacology and clinical medicine in Russia is analyzed.