2026, volume 22

Objective: quantitative assessment of occupational risk to the health of dairy production workers based on the results of periodic medical examinations. Material and methods. The study was conducted at modern milk processing enterprises in the Saratov region and included 237 women of the main professions with an average age of 44.6±7.8 years and professional experience of 11.8±6.1 years. Primary morbidity was analyzed using primary medical examination data over a fve-year period, while overall morbidity was analyzed using in-depth primary medical examination data. The occupational attribution of diseases was assessed by calculating the relative risk (RR) and the etiologic proportion (EF). Results. In the structure of the pathology detected in diferent years of observation, diseases with high blood pressure predominated (15.8–19.6%), disorders of the autonomic nervous system, unspecifed (10.6–13.7%), dorsopathies (7.6–9.8%), obesity (6.4–7.6%), thyroid diseases (6.2–7.8%). The analysis of causal relationships between diseases and working conditions established signifcant high risks for diseases of the musculoskeletal system (2.2 (1.3–3.6), EF – 54%), nervous system (2.9 (1.6–5.1), EF – 65%) and endocrine system, eating disorders and metabolic disorders (2.7 (1.1–6.8), EF – 63%), which indicates their production conditionality. Conclusion. A quantitative assessment of the health risks identifed a moderate risk in relation to the likelihood of developing endocrine and metabolic pathologies and an average risk of developing diseases of the musculoskeletal system and nervous system.

Objective: to evaluate the antimycobacterial activity of implants based on polylactide (PLA), polycaprolactone (PCL), and chitosan impregnated with silver nanoparticles and antituberculosis drugs (ATDs). Material and methods. This in vitro study comprised two experiments, each performed in triplicate. Bioresorbable implants based on PLA/PCL and chitosan impregnated with silver nanoparticles, silver proteinate, or one of seven ATDs (delamanid, linezolid, bedaquiline, moxifoxacin, capreomycin, isoniazid, amikacin) were investigated. Antimycobacterial activity was assessed by agar difusion, BACTEC MGIT 960, and broth microdilution using the Mycobacterium tuberculosis H37Rv reference strain. Results. Silver nanoparticles at high concentration (0.034–0.042 nmol/mL) demonstrated bactericidal activity lasting 35 days. Silver proteinate showed only marginal inhibitory efect against M. tuberculosis, delaying culture growth by 5 days compared to the control. ATDs, with the exception of delamanid, were released within the frst 1–3 days and exhibited bactericidal activity against M. tuberculosis, after which antimycobacterial activity declined. Conclusion. Implants impregnated with silver nanoparticles provided a prolonged bactericidal efect against M. tuberculosis, which justifes the need for further investigation of these implants.

Objective: to identify predictors of early postoperative atrial fbrillation (POAF) in patients over 60 years of age with preserved ejection fraction following isolated coronary artery bypass grafting (CABG). Material and methods. A retrospective analysis included data from 195 patients (mean age 64 ± 7.2 years; 73% male) who underwent isolated CABG. The study examined medical history, laboratory and instrumental parameters before and after surgery, intraoperative indices, and medication therapy. Clinically signifcant paroxysms of atrial fbrillation were defned as episodes lasting more than 30 seconds occurring within the frst 7 days post-CABG. Results. POAF developed in the early postoperative period in 43 patients (22%), constituting Group 1. The remaining 152 patients (78%) formed Group 2. Comparative analysis revealed statistically signifcant diferences between the groups in the severity of New York Heart Association functional class (FC) for chronic heart failure (CHF) (p<0.001) and left atrial diameter (LAD). Specifcally, LAD was 41 [38–43] mm in Group 1 vs 38 [35–41] mm in Group 2 (p=0.007). The combination of CHF FC III and an LAD>38 mm signifcantly increased the likelihood of developing POAF (odds ratio 8.909, 95% confdence interval 2.855–27.801; p<0.001). Conclusion. In patients over 60 years old with a preserved ejection fraction undergoing isolated CABG, the predictor for the development of POAF is the combined presence of an enlarged left atrium (diameter>38 mm) and CHF FC III.

Objective: to assess the awareness of women with diabetes mellitus (DM) regarding pregnancy preparation and planning. Material and methods. A cross-sectional survey was conducted among 94 non-pregnant women aged 18– 45 years with type 1 and type 2 DM using an original 20-item questionnaire. Additional clinical and laboratory data were obtained from electronic medical records. Results. The majority of women with DM (81.9%) had not previously planned their pregnancy; 71% had suboptimal glycated hemoglobin levels. Unplanned pregnancies were signifcantly more often associated with threatened miscarriage (62.5% vs 18% in planned pregnancies; p=0.004). Knowledge about safe contraceptive methods in the context of DM was poor: 48% of respondents reported that they had never discussed this topic with their endocrinologist. Despite the proven efcacy and safety of low-dose combined oral contraceptives regarding carbohydrate metabolism and diabetic vascular complications, 77.6% of women preferred barrier methods. Conclusion. The study revealed insufcient awareness among women with DM regarding the importance of pregnancy planning, as well as poor knowledge about safe contraceptive methods and the target level of glycated hemoglobin.

Objective: to assess, in the allelic model, associations of HNF1B rs4430796, CASC17 rs1859962, CASC8 rs1447295, and CCAT2 rs6983267 with prostate cancer (PCa) risk. Review methodology. A systematic review and meta-analysis of genetic association studies was performed according to PRISMA 2020 (Preferred reporting items for systematic reviews and meta-analyses), PRISMA-S, and STREGA (STrengthening the REporting of Genetic Association studies). Searches were conducted in PubMed/MEDLINE, Google Scholar, eLIBRARY, CyberLeninka, journal websites, and reference lists; variant annotation databases were used only to verify rsID, locus, alleles, and frequencies. Twenty-nine publications were included in qualitative synthesis and 62 genotype strata in quantitative synthesis. Allelic odds ratio (OR) were recalculated de novo from 2×2 tables, and efect direction was harmonized by efect allele. Hardy – Weinberg equilibrium in controls was tested using Wigginton’s exact test. The primary random-efects model used the Paule – Mandel τ² estimator and Hartung – Knapp confdence intervals; DerSimonian – Laird was used for sensitivity analysis. Prediction intervals, Bonferroni correction, Egger’s test, an adapted Q-Genie-based domain assessment, and Venice/GRADE credibility assessment were applied. Conclusion. HNF1B rs4430796 showed the most stable inverse association: OR 0.81, 95% confdence interval (CI) 0.78–0.84, 95% prediction interval 0.78–0.84; p<0.001, I²=0.0%. CASC17 rs1859962 was associated with increased risk: OR 1.19, 95% CI 1.14–1.25, 95% prediction interval 1.14–1.25; p<0.001, I²=0.0%, although 40% of strata deviated from Hardy – Weinberg equilibrium. CASC8 rs1447295 showed a signifcant but highly heterogeneous association: OR 1.23, 95% CI 1.09–1.39, 95% prediction interval 0.73–2.06; p<0.001, I²=81.9%. CCAT2 rs6983267 showed no robust association: OR 1.03, 95% CI 0.92–1.16, 95% prediction interval 0.68–1.57; p=0.557, I²=76.6%; Egger’s test p=0.028. HNF1B rs4430796 represents the most reproducible signal; CASC17 rs1859962 and CASC8 rs1447295 require cautious interpretation; CCAT2 rs6983267 is not confrmed as a robust risk marker. Isolated clinical testing of these single nucleotide polymorphisms is not warranted; however, their laboratory detection is essential for population-based studies and polygenic risk scores, thereby justifying the development of a real-time PCR-based test system for their genotyping.

Objective: to evaluate the efectiveness of respiratory and respiratory muscle training in elderly patients with chronic heart failure (CHF) during the rehabilitation period after total hip arthroplasty (THA) for femoral neck fracture. Material and methods. A single-center interventional prospective comparative study of 100 patients with CHF of stages I–II, who underwent rehabilitation measures after THA for femoral neck fracture, with an average age of 68.4±3.1 years, was conducted. Rehabilitation measures included physical therapy, physiotherapy, and hardware mechanotherapy, and the main group of patients additionally underwent respiratory and respiratory muscle training. The efectiveness of rehabilitation measures was assessed using the six-minute walking test and the Harris scale. Results. The group of patients who additionally underwent respiratory and respiratory muscle training demonstrated better results of the six-minute walking test (p<0.024), higher values of the Harris scale or satisfaction with treatment (p<0.033), as well as a reduction in the duration of inpatient treatment (p<0.031). Conclusion. The results demonstrate the positive efect of respiratory and respiratory muscle training in elderly patients with femoral neck fractures and CHF after THA during the rehabilitation period.

Objective: To develop for personalized antithrombotic prophylaxis during hip or knee arthroplasty. Material and methods. The study included 260 patients of both sexes who underwent hip or knee arthroplasty for primary Kellgren – Lawrence grade III–IV osteoarthritis were divided into retrospective (n=184) and prospective (n=76) groups depending on the perioperative antithrombotic prophylaxis strategy used. In addition to routine tests, a thrombin generation assay was performed. Statistical methods, including nonparametric descriptive statistics and decision tree learning, were used to analyze the fndings. Results. We developed a perioperative antithrombotic prophylaxis strategy involving low-molecular-weight heparins and tranexamic acid, taking into account the state of the hemostatic system and the result of the ML-algorithm for predicting major bleeding. The trial showed stable prophylactic efcacy (no throm-botic complications) and improved safety (reduction of major bleeding from 29.9 to 9.2%). Conclusion. The efective-ness and safety of the developed algorithm have been demonstrated, surpassing the standard tactics for perioperative antithrombotic prophylaxis.

This case report justifes the feasibility of a two-stage surgical management of a 38-year-old patient with a complicated unstable compression-comminuted ThXII and LIV fracture (AO Spine type A4). The patient sufered multiple-level spinal injuries after a fall from a height. Six days after an emergency LIII–LIV laminectomy, he underwent a two-stage procedure in a single session: transpedicular fxation of the ThXI–LI and LIII–LV with kyphosis correction, followed by thoracophrenolumbotomy, ThXII and LIV corpectomy, anterior decompression, and interbody fusion with cages and osteoinductive material. The postoperative period was uneventful. After 6 months, muscle strength in the lower extremities increased from 2 to 4 points (according to the Medical Research Council), the American Spinal Injury Association status improved from C to D, and pelvic organ function was restored. The Oswestry Disability Index decreased from 82 to 18%. Thus, the two-stage combined treatment in one surgical session is efective and safe. The intraoperative neuro-monitoring and modern implants minimizes the risk of neurological complications and ensures biomechanical stability.

We present a clinical case of a 51-year-old patient with a left-sided LV–SI intervertebral disc herniation associated with persistent lumbosacral pain radiating along the posterior aspect of the left lower limb, numbness in the left foot, and episodes of weakness in the afected extremity. Preoperative magnetic resonance imaging MRI revealed an LV–SI disc herniation measuring up to 7.5 mm, cranial migration of the herniated material up to 1.0 cm in the left para-median sector, spinal canal stenosis, and deformation of the left nerve root. Following left-sided LV–SI microdiscectomy, the removed material underwent immunohistochemical examination for mast cells; this patient demonstrated the most pronounced mast cell infltration among the studied specimens. In the early postoperative period, a neuropathic pain component persisted, followed by gradual regression of symptoms. This observation suggests a possible relationship between pronounced MRI signs of nerve root compression, the clinical picture of radiculopathy, and marked mast cell infltration of the herniated disc material; in this context, MRI characteristics may be considered indirect indicators of the possible biological activity of the removed tissue.

Objective: A morphological and morphometric study of trepanobioptates of bone tissue was performed in patients of three groups 180 days after sinus lift surgery using diferent compositions of osteoplastic material: group 1 – Cerabone granules (100%); group 2 – Cerabone with autobone shavings in the ratio of 25%/75%; group 3 – Cerabone with autobone shavings in the ratio of 50%/50%. Material and methods. The microscopic picture was evaluated on hematoxylin and eosin-stained sections, the volume fractions of the main components of the regenerate and the indicators of cellular activity were determined. Results. It was found that all groups showed direct osteogenesis with the formation of mature spongy bone. The highest volume of newly formed bone tissue (BV) was achieved in group III (34.5%), while the lowest was achieved in group I (25.75%). The indicators of osteoblastic activity (N.ob, Ob.S) and material integration (MatBS/BS) were also highest in group III (70.2%). Conclusion. The obtained data indicate the advantage of using combined bone-plastic materials with an equal ratio of Cerabone and autologous bone to optimize reparative osteogenesis during sinus lifting and emphasize the need for morphometric control of the efectiveness of various compositions of osteoplastic materials in reconstructive surgery.