Exosomes: the key of sophisticated cell–cell communication and targeted metastasis in pancreatic cancer

Pancreatic cancer is one of the most common malignancies. Unfortunately, the lack of effective methods of treatment and diagnosis has led to poor prognosis coupled with a very high mortality rate. So far, the pathogenesis and progression mechanisms of pancreatic cancer have been poorly characterized. Exosomes are small vesicles secreted by most cells, contain lipids, proteins, and nucleic acids, and are involved in diverse functions such as intercellular communications, biological processes, and cell signaling. In pancreatic cancer, exosomes are enriched with multiple signaling molecules that mediate intercellular communication with control of immune suppression, mutual promotion between pancreas stellate cells and pancreatic cancer cells, and reprogramming of normal cells. In addition, exosomes can regulate the pancreatic cancer microenvironment and promote the growth and survival of pancreatic cancer. Exosomes can also build pre-metastatic micro-ecological niches and facilitate the targeting of pancreatic cancer. The ability of exosomes to load cargo and target allows them to be of great clinical value as a biomarker mediator for targeted drugs in pancreatic cancer.

Manifestation of Suicidal Behavior of Adolescents and Their Rehabilitation in Modern Conditions

Research relevance: socialization includes all the processes of communication with upbringing, education and culture, thanks to which a person gets the opportunity to participate in public life and social character. The whole environment of a person is involved in the process of socialization: family, neighbors, peers in children’s institutions, schools, the media, etc. Research objectives: specialized psychiatric or suicidal methods are medical and psychotherapeutic methods of treatment aimed at treating mental and behavioral disorders that lead to suicidal behavior and preventing the onset and recurrence of suicidal activity. Research materials and methods: psychological forms of prevention of suicidal behavior include the formation of anti-suicidal behavior, changes in personal attitudes, self-esteem, level of motivation, etc. includes targeted psychocorrection programs. Research results: reconstruction of the education system and public education will be successful only if it is the work of the whole society. Conclusions: it is important to focus all social life, social-cultural environment, education and training system on the younger generation.

‘Long Covid’ (post-covid syndrome): Mechanism of occurrence, diagnosis and rehabilitation

The article is devoted to the study of an urgent problem of modern humanity – the fight against a pandemic caused by a new coronavirus infection, namely: the study of the mechanism of development of ‘long Covid’ (post-covid syndrome), a new clinical and laboratory method of its diagnosis, issues of drug and non-drug rehabilitation of patients who have suffered COVID‑19. The paper describes the etiopathogenesis of post-covid syndrome (PS), the distinctive features of which are the defeat of the cardiovascular, respiratory, nervous, digestive, immune systems of the body, ENT organs and musculoskeletal system. For the diagnosis of post-covid syndrome, a monochrome nanoparticle analyzer (MAN) has been tested for the first time in the Russian Federation, which allows determining pathophysiological shifts in the homeostasis system. It was found that the MAN method has a sufficiently high diagnostic sensitivity (78%), and shifts in the homeostasis system in post-covid syndrome are statistically significant (p < 0.001). A fundamentally important point of this study is that an algorithm has been developed for noninvasive diagnosis of PS by saliva (oropharyngeal flushes), based on the detection of a high contribution to the scattering of laser radiation in the mid-frequency range of the spectrum on nanoparticles ranging in size from 119 to 121 nm. The article also pays special attention to medicinal and non-medicinal methods of treatment of patients with ‘long Covid’ experiencing the consequences of a new coronavirus infection. It has been established that the best effect is provided by complex treatment combining methods of the traditional European school (drug therapy with the use of cardiovascular drugs, nootropic agents, chondroprotectors, vitamins and mineral complexes, hormones, hepatoprotectors, biostimulants, sedatives and anti-inflammatory drugs and other drugs) and non-drug methods of restorative treatment practiced by Oriental medicine (acupuncture, hirudotherapy, massage, osteopathy, etc.).

“Long covid” (postcovid syndrome). Mechanism of occurrence, diagnosis and rehabilitation

Introduction. The article is devoted to the study of the mechanism of occurrence of postcovid syndrome, a new laboratory method for its diagnosis and issues of drug and non-drug rehabilitation of patients who have suffered COVID-19.The purpose of this work was to study the possibilities of using the method of monochrome analysis of nanoparticles for instrumental and laboratory diagnostics of postcovid syndrome and to substantiate the use of complex therapeutic approaches to the treatment of patients.Materials and methods. The biomaterial (saliva) of 250 patients who underwent COVID-19 in mild, moderate and severe forms, with a slight predominance of males, in the age range from 18 to 75 years, who were in the Center of Eastern and European Medicine (Moscow) on rehabilitation treatment in the period from June 2020 to September 2021, was studied by the method of monochrome analysis of nanoparticles. According to the results of the work carried out, it was found that the most typical saliva spectrum of patients diagnosed with “postcovid syndrome” was multimodal (three or more peaks) with the greatest contribution (45%) to light scattering on agglomerates of nanoparticles with a diameter of more than 1000 nm, with detectable nanoparticles of the middle sub-range of the spectrum from 119 to 122 nm with a 15% contribution to light scattering and an increased contribution to light scattering up to 41% on small nanoparticles with a diameter of 22 nm.Results. Analysis of the results of the study showed a statistically significant (p < 0.01) appearance of a peak of 119 nm on the histogram of patients, which was not observed either in the group of practically healthy individuals (control group) or in the group of patients with general somatic pathology (comparison group). Conclusions. An algorithm for non-invasive diagnosis of postcovid syndrome by saliva was developed. Also, special attention was paid during the study to the development of an integrated approach to the rehabilitation of patients who have undergone a new coronavirus infection, including medicinal and non-medicinal methods of treatment. >< 0.01) appearance of a peak of 119 nm on the histogram of patients, which was not observed either in the group of practically healthy individuals (control group) or in the group of patients with general somatic pathology (comparison group).Conclusions. An algorithm for non-invasive diagnosis of postcovid syndrome by saliva was developed. Also, special attention was paid during the study to the development of an integrated approach to the rehabilitation of patients who have undergone a new coronavirus infection, including medicinal and non-medicinal methods of treatment.

Proximal humeral fractures in Finland

Aims Proximal humeral fractures (PHFs) are common. There is increasing evidence that most of these fractures should be treated conservatively. However, recent studies have shown an increase in use of operative treatment. The aim of this study was to identify the trends in the incidence and methods of treatment of PHFs in Finland. Methods The study included all Finnish inhabitants aged ≥ 16 years between 1997 and 2019. All records, including diagnostic codes for PHFs and all surgical procedure codes for these fractures, were identified from two national registers. Data exclusion criteria were implemented in order to identify only acute PHFs, and the operations performed to treat them. Results During the 23-year study period, 79,676 PHFs were identified, and 14,941 operations were performed to treat them. The incidence of PHFs steadily increased. In 2019, the overall incidence was 105 per 100,000 person-years (105). The sex-adjusted incidence for females was 147.1 per 105, and the age-adjusted incidence for patients aged ≥ 80 years was 407.1 per 105. The incidence of operative treatment for PHFs rose during the first half of the study period and decreased during the second half. The use of plate osteosynthesis in particular decreased. In 2019, the incidence of operative treatment for PHFs was 13.2 per 105, with 604 operations. Conclusion Although the incidence of PHFs is steadily increasing, particularly in elderly females, the incidence of operative treatment is now decreasing, which is in line with current literature regarding their treatment. Cite this article: Bone Joint J 2022;104-B(1):150–156.

State’s Authority Concerning Health Protection in Ordinary Times and During Epidemics

Life and health as fundamental matters are major concerns for every human being. To this end, he / she should be assisted by the community in which they live. If the foundation of social life is the personalistic principle, the recognition of the primacy of the dignity of the person, among other values, is constructed on the principles of subsidiarity and solidarity. It is the role of the healthcare institution to create such conditions, in which the safest and the most effective methods of treatment and prevention are available, and the individual can consciously select which of these realises his or her good to the greatest extent, in accordance with the recognised hierarchy of values, the accepted worldview, and life goals. The aim of this article is to analyse the relationship between the community and the individual, in the field of healthcare, under normal conditions and during epidemics. The existence of specific threats may suggest that exceptions to the fundamental rules of social life: autonomy, subsidiarity, and social solidarity, are permissible. However, the recognition of the fundamental value of the dignity of the person, requires the community to apply the same rules as in normal times, although many activities of public institutions are intensified in times of more serious danger.

Prospects of using cilostazol in combined treatment of patients with obliterating atherosclerosis of lower limb arteries

Despite intensive study of pathophysiology, of molecular and cell mechanisms of progression of atherosclerosis, development and introduction of a wide range of new conservative and surgical treatment methods, until now the diseases of lower limb arteries (DLLA) are one of the most urgent problems of the modern vascular surgery and medicine in general. Intensive development of roentgen-endovascular methods of treatment for the diseases of lower limb arteries has led to a considerable revision of the tactics of management of this category of patients in the recent years. Despite the achievements of roentgen-endovascular surgery, frequency of obstructions after surgical revascularization of limbs remains high, both in early and late postoperative periods. It should also be noted that despite the intensive development of methods of therapy of patients with DLLA, frequency of limbs amputation in this category of patients remains high. One of the urgent problems of management of patients with DLLA after endovascular treatment is the problem of restenosis. In the recent years, new efficient methods of pharmacotherapy of DLLA have been developed and introduced into clinical practice, which allows significant improvement of medical prognosis in this category of patients and improvement of the outcomes. It should be noted that standard approaches to antithrombotic therapy in patients after endovascular surgeries based on use of antiaggregant drugs, can only decrease the rate of thrombotic complications, but not of restenosis, which, from the point of view of pathophysiology, is mainly hyperproliferative condition. Among promising approaches to treatment of restenosis, there is use of cilostazol, efficiency of which after endovascular surgeries on coronary and peripheral arteries has been proven in a number of studies.

The Main Criteria for The Effectiveness of Treatment of Iron Deficiency Anemia Associated with Helicobacter Pylori

This article discusses the main criteria for the effectiveness of treatment of iron deficiency anemia associated with Helicobacter pylori. New methods used in its treatment will be discussed, the problems encountered in this process and methods of treatment will be discussed. Keywords: treatment, deficiency anemia, Helicobacter pylori, health system, etiological factors.

Conservative Management of Ankyloglossia by Diode Laser: A Case Report

Ankyloglossia or tongue-tie is a congenital condition that results when the inferior lingual frenulum is too short and is attached to the tip of the tongue, limiting its normal movements. Ankyloglossia can lead to different problems such as difficulties in breastfeeding, speech impediments, poor oral hygiene, malocclusion, inability to deglutition, thus being an undesired problem in normal life activity. Among various methods of treatment of ankyloglossia, laser-assisted lingual frenotomy is the simplest, safest, and less traumatic with the most promising results. Here, a case of ankyloglossia and its management by frenotomy with diode laser is reported in a four-year-old female child. After performing partial frenectomy (frenotomy) using a diode laser of 980nm there was an immediate tongue protrusion and slight improvement of phonetics of the patient immediately and altogether improved after six months.