2024, volume 20

Objective: to develop a prognostic algorithm of nocturnal hypoglycemia (NH) based on the glucose monitoring mobile application data. Material and methods. The retrospective analysis of 524 continuous glucose monitoring (CGM) profiles of patients with type 1 diabetes mellitus was performed. CGM was performed using the Medtronic iPro2 system for 6-7 days, overnight periods of CGM were analyzed to identify systematic NH. There were 239 patients included in the study, among them 65 (27.1%) were identified as having systematic NH. Models of 7-point glycemic profiles were built and their data were uploaded to the DiaLog GM mobile application to calculate standardized glucose monitoring parameters. The prognostic model of NH was developed based on the logistic regression method. Results. According to the results of regression analysis the most significant predictors of NH included in the prognostic model were: glycated hemoglobin (p=0.001), using of insulin pump therapy (p=0.001), time below target range level 1 (p<0.001), coefficient of variation for glucose (p=0.02). The area under the ROC curve for the prediction model was 0.917; the optimal cut-off point for the predicted probability of NH was 0.317, with model sensitivity of 85% and specificity of 90%. Conclusions. The developed prediction model based on data from a specialized mobile application allows to improve the existing approaches to NH risk assessment due to higher predictive ability.

Objective: to substantiate the indications for repeated courses of electrical stimulation using a temporary implanted epidural electrode in patients with traction neuropathies after hip replacement. Material and methods. A method of puncture implantation of epidural electrodes was used to conduct a course of electrical stimulation. An analysis of 162 electrode implantations was performed. The results of treatment of 73 patients with neuropathies of the sciatic (n=65) and femoral (n=8) nerves after hip replacement are presented. The follow-up period was 5.5 years. Results. There was a 2-fold increase in the number of hospitalizations for every 4.5 months of interval between endoprosthetics and the first course of electrical stimulation. Depending on the initial neurological deficit, an increase in the number of hospitalizations by an average of half is predicted to increase muscle strength by 1 point. The maximum number of hospitalizations in this category of patients is 8, the average number of hospitalizations is 3. Conclusion. Indications for repeated courses of electrical stimulation using a temporary implanted epidural electrode in patients with traction neuropathies after hip replacement are substantiated. Epidural electrical stimulation allows you to relieve pain associated with traction damage to nerve axons; repeated courses of electrical stimulation contribute to a more complete restoration of nerve function.

The article describes a case of treatment of a giant gastric polyp complicated by bleeding and chronic duodenal obstruction by a new method of endoscopic surgical hemostasis by endoscopic polypectomy using a polymer alginate hemostatic sorbent. The proposed endoscopic polypectomy method using a local hemostatic agent made it possible to prevent hemorrhagic complications, create conditions for full-fledged reparative regeneration, which made it possible to exclude recurrence of the polyp at the site of its removal in the long term.

Objective: based on the analysis of the results of surgical treatment of patients with elbow contractures caused by ossification, assess the need to improve the planning and tactics of surgical interventions. Material and methods. According to the data of the primary medical documentation and a questionnaire, a retrospective analysis of the invasiveness of surgical intervention and the results of surgical treatment was performed, 406 patients of this category in the National Medical Research Center of Traumatology and Orthopedics n. a. R. R. Vreden in 2011-2021. Results. The development of late postoperative complications was characteristic of the overwhelming (about 80%) number of patients surveyed. The dominant (54.9%) complications were post-rehabilitation long-term pain and lack of movement in the operated joint. About 35% of patients rated the functional state of the operated elbow joint as satisfactory and poor. Approximately 30% of patients rated their general condition and quality of life below the average normal values. Conclusion. The existing technique of preoperative examination, planning and performing surgery for elbow contractures caused by ossification needs to be improved, since in about a third of patients it does not allow achieving stable results and does not provide a full volume of painless movements in the elbow joint in the medium and long-term observation periods.

Objective: to determine the role of the TNFSF11 gene polymorphisms rs9594738 and rs9594759 in the development of knee osteoarthritis in postmenopausal women. Material and methods. The case-control study included 483 postmenopausal women. Of these 157 were diagnosed with primary knee osteoarthritis. The remaining 326 women without signs of joint disease were included in the control group. Molecular genetic studies included determination of TNFSF11 rs9594738 and TNFSF11 rs9594759 gene polymorphisms using the real-time polymerase chain reaction. Results. Analysis of genetic markers distribution in two groups of women showed a decrease in the frequency of rs9594738 polymorphism TT genotype among the patients with osteoarthritis (odds ratio 0.59; 95% confidence interval 0.36-0.97; p=0.049). The distribution of this polymorphism alleles, as well as alleles and genotypes of TNFSF11 rs9594759 gene polymorphism in the group of women with osteoarthritis did not differ significantly from the results of the control group (p>0.05). Conclusion. An association of TNFSF11 rs9594738 gene polymorphism with knee osteoarthritis in postmenopausal women has been established. Further research of TNFSF11 gene polymorphic variants role in the knee osteoarthritis etiopathogenesis are needed to develop individual approaches to the prevention and treatment of the above disease.

Objective: to conduct a comparative analysis of the effectiveness of surgical treatment for patients with metastatic lesions of the thoracic spine from anterior and posterior approaches according to the literature. Methodology for writing a review. The search was carried out in the PubMed and Scopus databases. Search words and phrases: "thoracic spine", "metastatic lesion", "spinal cord", "management of thoracic spine metastasis". Search depth for the last 15 years. 13 publications were included in the final analysis. Conclusion. Both approaches are effective, but data such as blood loss, duration of surgery, neurological changes and pain intensity are significantly better in patients who underwent anterior approach. At the same time, in this group the development of respiratory failure is more common, and the 30-day mortality rate is higher compared to group of posterior approach. In the group of posterior interventions there was a significantly higher level of postoperative CSF leakage and wound infection, as well as worsening neurological deteriorations. The frequency of failure of implanted structures and revision interventions for wound hematomas and recurrent tumor growth is almost the same.

Objective: to carry out a comparative analysis of IOL fitting accuracy in patients with eye length less than 22.0 mm using Barrett Universal II, Kane, Hoffer Q and artificial intelligence formulas. Material and methods. The results of 88 phacoemulsification cataract operations with implantation of monofocal lOLs were analyzed. Preoperative biometry and IOL calculations were performed on the IOL Master 700. The accuracy of IOL fitting was also determined using the LensCalc program, which is based on artificial intelligence (DecisionTreeClassifier). Results. The eye length of the patients ranged from 19.8 to 22 mm. The prediction of the target refraction hit was the most accurate when using Barrett Universal II formulas as opposed to Hoffer Q (Z=2.12; p=0.034). The mean value of the target refraction hit error was not different when using the Barrett Universal II formula compared to the Kane formula (p>0.05). Using artificial intelligence it was found that higher accuracy in the results of IOL optical power determination was achieved when using the Barrett Universal II formula. Conclusion. Based on a comparative analysis of the study results and assessment of IOL fitting accuracy using artificial intelligence, it was found that the Barrett Universal II formula (4th generation) is more accurate in determining the optical power of lOLs in "short" eyes than the Hoffer Q formula (3rd generation). The results obtained using the Barrett Universal II formula, in contrast to the Hoffer Q formula, do not differ from the data calculated using the Kane formula (5th generation), which, according to the results of most studies, is the most accurate IOL selection formula at present (p>0.05).

Objective: comparative analysis of the used methods of surgical treatment of pelvic organ prolapse. Methodology for writing a review. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search and analysis of articles published in the scientific databases e-Library, PubMed, Google Scholar for the period from 2015 to 2023 was carried out. After excluding publications that did not correspond to the search, 50 articles were selected for analysis. Conclusion. According to the study, each of the currently used methods of surgical treatment of pelvic organ prolapse has its own advantages and disadvantages, which makes it possible to select the optimal surgical option in each specific case. The determining factors when choosing a surgical intervention are the following factors: the patient's age, the presence of comorbid pathologies, including benign neoplasms, planning or not planning a pregnancy in the future.

Objective: to study the bacteriological landscape of nasal secretions from the middle nasal passage in patients with chronic rhinosinusitis (CRS) aged 60 to 95 years and to identify the most significant genera and types of microorganisms characteristic of the treatment of chronic rhinosinusitis in this age group. Material and methods. Taking into account the inclusion and non-inclusion criteria, 83 patients were selected, of which the following groups were formed by age and presence of CRS: group 1 (comparison group 1) — patients without CRS aged 60-74 years (n=24); group 2 — (comparison group 2) patients without CRS aged 75-95 years (n=20); group 3 — patients with CRS aged 60-74 years (n=22) and group 4 — patients with CRS aged 75-95 years (n=18). All patients received swabs from the middle nasal passage. The obtained samples were sent for bacteriological examination to identify microorganisms. Results. The level of representatives of the genera Staphylococcus spp. with CRS in the elderly and senile 66.6 and 16.6%, respectively, Enterococcus spp. were seeded 66.6 and 16.6%. The presence of Klebsiella pneumoniae (16.6%), Klebsiella oxytoca (5.8%) and Pseudomonas aeruginosa (11.1%) indicates the risk of long-term persistent upper respiratory tract infections. In the group of patients with CRS aged 60-74, representatives of the genus Candidiales (5.5%) were seeded. Conclusion. S. aureus, S. haemolyticus and Enterococcus faecalis were the overwhelming species in elderly patients (60-74 years old). Microflora diversity in patients aged 75-95 years Klebsiella pneumoniae (16.6%), Klebsiella oxytoca (5.8%) and Pseudomonas aeruginosa (11.1 %) it affects the course and possible complications of CRS.

The article is dedicated to the Doctor of Medical Sciences, Associate Professor of the Department of Human Anatomy Koshkina Ksenia Alekseevna (1899-1945). The work describes the main stages of her scientific biography, as well as the history of the creation under her leadership and the direct participation of unique anatomical preparations "the corpse of an adult man with reconstituted vessels and nerves of the whole body" and "the corpse of an adult man with reconstituted muscles of the whole body". For 85 years, these drugs have been the central exhibits of the fundamental educational and anatomical museum of the Department of Human Anatomy of Saratov State Medical University named after V. I. Razumovsky.