Journal of Clinical Practice

BACKGROUND: The success of treating the patients with chronic ischemia of the lower limbs consists of a number of components, such as the full-scale diagnostics; the re-vascularisation volume, the therapeutic means (including the use of modern developments in angiogenesis); the engagement of specialists from the adjacent fields. AIM: the improvement of treatment results in patients with chronic ischemia in the lower limbs and developing an optimal treatment and diagnostic algorithm for this group of patients. METHODS: The analysis included the treatment results of 218 patients with chronic ischemia of the lower limbs (136 males, 82 females; the mean age was 67±6 years), of which 144 patients were operated, 74 were treated conservatively. Diagnostics and examination methods: ultrasound angioscanning, single-photon emission computed tomography combined with three-phase scintigraphy and computed tomography, consulting by a neurologist and a cardiologist, electroneuromyography by prescription from the neurologist and additional examinations by prescription from the cardiologist. The follow-up was implemented as the control out-patient examinations or upon the repeated hospitalization. The follow-up period was 6 months. RESULTS: The distribution of patients by the degree of ischemia as per the classification by А.V. Pokrovsky was the following: IIА — 57 (26.1%), IIB — 31 (14.2%), III — 42 (19.2%), IV — 88 (40.5%) patients. The number of open-access surgeries conducted was 56 (25.7%), with 64 endovascular (29.4%) and 24 hybrid ones (11.0%); conservative therapy was administered to 40 patients (18.3%), conservative therapy accompanied by additional administrations of plasma-free auto-platelet lysate — 34 (15.6%). In the group of operated patients, there were no significant differences depending on the method of surgical treatment at the early post-surgery period and after 6 months of follow-up (p >0.05). Among the patients receiving conservative therapy, the best results at the follow-up of 6 months were reported in patients, in which the standard therapy was accompanied by stimulation of angiogenesis with auto-platelet factors (p <0.05). The presence of ischemic neuropathy was investigated in 98 patients. Neuropathy was detected in 69 cases using the method of electroneuromyography. After prescribing the neurotropic therapy, resolving of neuropathic pain was reported in 52 (75.4%) patients. CONCLUSION: The multi-disciplinary approach developed by us for the diagnostics and treatment of patients with chronic ischemia of the lower limbs, allows for improving the treatment results, while the extended spectrum of diagnostic methods allows for evaluating the risk factors, for determining the optimal treatment tactics and for objectively evaluating the dynamic changes of the patient status.

BACKGROUND: Within the framework of the experiment on using the innovative technologies in the field of computer vision for analyzing the medical images and on further usage of these technologies in the healthcare system of the City of Moscow, the research was carried out using the equipment based on the artificial intelligence (AI-service) for the purpose of automatization of the morphometry of the prostate gland using the magnetic resonance imaging (MRI), for the issue is topical due to the high incidence of urological diseases among men. Unlike the 11 previous systems, oriented at the retrospective analysis, this solution helps the radiologists in shortening the time of describing the examination results and in increasing their accuracy. AIM: to evaluate the quality and the validity of automatic morphometry of the prostate gland by the MRI results using the technologies of artificial intelligence in the settings of practical healthcare. METHODS: A prospective diagnostic research in accordance with the methodology of reporting results of scientific research involving the STARD 2015 diagnostic tests was conducted during the period from April until October of 2024. A total of 560 MRI results were used and compared to the data from the morphometric AI-service. RESULTS: An evaluation of the accuracy of using the AI-service for the morphometry of the prostate gland was carried out. A total of 7 clinical monitoring procedures were conducted using 560 MRI datasets with the complete conformity reported in 71.6%. The rate of false-negative cases was 3.9%, technical defects were found in 3.8% of the cases. The integral clinical evaluation has achieved the range of 88.0–97.0%, confirming the high diagnostic quality. The predominant errors were the ones related to the contouring of the gland (52%) and incorrect measurements (13%), often related to the prolapsing of the prostate gland apex. CONCLUSION: The automatization of routine measurements greatly contributes to the standardizing the processes of describing the results obtained by radio-diagnostic methods. This aspect is of special importance from the point of view of providing the continuity of medical aid in case of patients presenting to various medical organizations. The artificial intelligence technologies for the automatization of the prostate gland measurements have demonstrated high clinical value in 92.0%, which indicates their accuracy and quality. These data can be used for developing new MRI-based automated morphometry products.

BACKGROUND: Only a few literature sources data show the relation of the VDR gene polymorphism and the susceptibility to developing dental caries. Within this context, investigating the structure of the dental enamel and the changes of its resistance under the effects of vitamin D and remineralizing therapy among the persons with the homozygous polymorphism of the VDR gene (А/A) is topical. AIM: to investigate the effects of vitamin D and the toothpaste with remineralizing contents on the structure of the enamel surface of the impacted teeth extracted from the individuals with homozygous polymorphism of the VDR gene. METHODS: In 2023–2025, within the premises of the Dentistry Department of the Federal State Budgetary Institution of Continuing Professional Education “Central State Medical Academy”, a total of 200 students aged 22–25 years were screened with undergoing a genetic testing to reveal the polymorphism of the VDR gene. Out of the 36 assessed subjects, 18 individuals were detected with the homozygous А/А allele that are currently undergoing orthodontic therapy and requiring an extraction of the impacted molars. A total 24 of extracted teeth were tested with submerging them into the artificial saliva with an addition of various media. The dental samples were distributed into four groups: only artificial saliva (I, control); 1000 IU of cholecalciferol per 100 ml (II); processing with remineralizing toothpaste (III); vitamin D and remineralizing toothpaste (IV). The evaluation of the structure of the dental enamel was carried out using the method of confocal profilometry with measuring the Ra and Rp roughness parameters. RESULTS: In group II with the presence of cholecalciferol, changes were revealed in the roughness parameters (Ra, Rр) of dental enamel surface, in group III (processing with remineralizing toothpaste) the Ra and Rр parameters had similar digital values. As for the samples from the group IV, comparing to the group I, smoothness was revealed in the dental enamel surface, which is confirmed by the Rа and Rр (p >0.001) parameters. This effect can be explained by the synergic action of the cholecalciferol and the remineralizing components of the toothpaste on the structure of the enamel. CONCLUSION: In the individuals with homozygous polymorphism (А/А) of the VDR gene, significant changes were revealed in the parameters of dental enamel roughness (Ra and Rр) after the combined use of cholecalciferol and remineralizing toothpaste, which is related to the smoothening of surface due to the formation of the homogeneous layer consisting of the microRepair microcrystals.

Physical activity is recognized as the most important non-medicinal tool for the prevention of cardiovascular diseases, however, the highest efficiency is demonstrated by the programs combining various types of physical load. The present review summarizes the current scientific data on the effects of combined physical activity, including the aerobic exercises of moderate and high intensity and the muscle strengthening exercises, as well as the ones affecting the system of cardiometabolic regulation. A disclosure is provided for the multi-level adaptation mechanisms, encompassing the physiological, vegetative, hormonal, molecular and epigenetic levels. It was justified that combined training modalities possess the synergetic effects, facilitating the decrease of blood pressure, the increase in the cardiac rhythm variability, the improvement of insulin sensitivity, the decrease of chronic inflammation and the activation of cardioprotective transcription programs. A detailed description was provided for the key molecular pathways participating in the adaptational response (AMP-activated protein kinase, mTOR, PGC-1α, autophagia and the unfolded protein response), as well as the role of exerkines — the signaling molecules produced in response to physical load. Special attention was paid to the epigenetic modifications, including the methylation of DNA, the regulation of microRNA and the telomere stability, as the mechanisms of long-term protection from the cardiovascular diseases. The data provided emphasizes the necessity of introducing the combined modalities of physical activity into the programs of individual and populational prevention. Besides, further research is required on the optimal combination of intensity, extent and patterns of physical load for various population categories for the purpose of maximizing the protective adaptation of the cardiovascular system.

Suprascapular neuropathy is a type of disease, which up until recently was considered quite rare and observed mainly among the athletes. On the contrary, this problem is observed quite often, especially as a professional disease among the individuals involved in heavy manual labour. The syndrome of suprascapular nerve compression is a complex problem, combining a multitude of reasons and resulting in the atrophy of the supraspinal and infraspinous muscles. The compression of the suprascapular nerve is developing due to its complex anatomy, the presence of additional bony and other types of structures in the area of the scapular notch, as well as due to the traumatic lesions of the rotator cuff and of the scapular spine. There is an opinion that the contraction of the damaged supraspinal and infraspinous muscles may cause contusion- related changes in the suprascapular nerve, which may persist after the reconstruction of the rotator cuff. The provided research summarizes the data available on the suprascapular neuropathy, especially combined with massive rotator cuff tears, as well as on the reasons of its development, the clinical manifestations, the diagnostics and the comparative results for various treatment methods. An analysis was conducted of the main research results obtained using the surgical treatment for suprascapular neuropathy, in particular, the arthroscopic decompression combined with the treatment of rotator cuff abnormalities. The analysis of literature data has shown that, in case of the presence of space-occupying masses or bone deformities in the area of the scapular notch, surgical correction shows significant positive results. In case of damaged rotator cuff, the combination of arthroscopic release of the suprascapular nerve with its reconstruction provides good clinical results, promoting to the decrease of the pain syndrome during the postoperative period, however, no significant differences were reported when restoring the rotator cuff both with the release procedure and without it. Most part of the patients with chronic pain syndrome and degenerative changes can be successfully treated conservatively. Despite the fact that the relation of rotator cuff tears and suprascapular neuropathy is undoubtful, many researchers describe the absence of statistically significant difference in the clinical results of reconstructing the rotator cuff together with arranging the procedure of arthroscopic release and without it. Thus, probably, the indications to arthroscopic release of the suprascapular nerve should be clearly limited to cases of its neuropathy based on the data obtained during the research including larger samples of patients.

BACKGROUND: In clinical practice, diagnosing of systemic transthyretin amyloidosis (ATTR-amyloidosis) with the impairment of the nervous and cardiovascular systems became possible due to the accessibility of genetic diagnostics and due to the growth of knowledge on this disease. CLINICAL CASE DESCRIPTION: A clinical case is presented of transthyretin amyloidosis, manifesting as polyneuropathy with significant neuropathic pain syndrome, with the development of severe vegetative insufficiency and with the impairment of the cardiovascular system in a 63 years old male. This clinical pattern, developing for 3 years, was associated with multiple encounters of the patient to various specialists — rheumatology physicians, neurosurgery specialists, endocrinologists, neurologists, internists, including surgical interventions in the spinal cord, carotid artery and cardiac vessels. The disease has lead to the development of severe cachexia and incapacitation of the patient. CONCLUSION: Taking into consideration that ATTR-amyloidosis manifests with the clinical signs of lesions in various organs and systems, and this is interpreted by the specialists within the framework of their specific field apart from the general etiology of the disease. The patient gets prescribed with multiple examinations and symptomatic medications, which causes a delay in the diagnostics and in setting the correct diagnosis. This clinical case describes the classical form of transthyretin amyloidosis, which, upon timely diagnostics, has its pathogenetic therapy.

BACKGROUND: Penetrating keratoplasty provides a possibility of restoring vision in patients with various corneal diseases, however, just like any surgical intervention, the operation is associated with certain risks and has a number of contraindications. One of the unfavorable prognostic factors in cases of penetrating keratoplasty is uncompensated glaucoma. Penetrating keratoplasty can result in the reactive postoperative hypertension, however, this is not a standard situation. In patients with a history of glaucoma, this complication occurs much more often than in patients without previously diagnosed glaucoma. The increase of intraocular pressure during the postoperative period in patients suffering from glaucoma, can lead to the progression of the disease and to the development of the transplant disease. CLINICAL CASE DESCRIPTION: This article presents a clinical case of a patient with juvenile glaucoma, which underwent several glaucoma surgeries and later he received an Ex-PRESS implanted glaucoma drainage. The drainage implant was in contact with the posterior surface of the cornea, as a result of which, initially local and further total endothelial-epithelial corneal dystrophy has developed with the formation of stromal cloudiness and progressing of pain syndrome. The drainage was removed and subsequently a decision was drawn up on arranging a penetrating corneal keratoplasty, for the critical flicker fusion rate was 30 Hz, which allowed for expecting a sufficiently high vision acuity during the postoperative period. However, despite the maximal hypotensive regimen, the intraocular pressure remained high, due to which, for the purpose of decreasing it before corneal transplantation, a transscleral diode laser cyclophotocoagulation was used. CONCLUSION: The presented clinical case demonstrates the efficiency of transscleral diode laser cyclophotocoagulation in a patient with uncompensated glaucoma in terms of the quality of preparation to penetrating keratoplasty.