Additional opportunities for using computer technologies in expert analysis of laboratory data

The presented work reflects the author’s algorithm of mathematical processing and possible interpretations of the results obtained when creating expert analytical systems using computer technology. As initial parameters for the construction of neural networks of the second level, it is proposed to use individual results of calculations of the ratios of a number of laboratory indicators capable of forming a single functional cluster (leukogram, indicators of water-electrolyte balance, protein fractions, etc.). Further, using the proposed calculation algorithm and the archive database, structural features in the ′deformation′ of the ratio panel were compared against the background of the growth of each indicator, a matrix table was built reflecting the degree (correlation coefficients, KCr) of the coincidence of the features of the formation of the structure of the obtained panels of the parameters determined in individual observations. At high values of KCr, a conclusion is made about their (determined parameters) unified participation in the mechanism of emerging disorders. Thus, the system allows you to establish a leading complex of associated relationships by changes in the structure of ratios in the selected panel, corresponding to the dynamics of deviation of the target (analyzed) indicator, thereby differentiating the different mechanisms of formation of pathological deviations in this patient, the manifestation and balance of their values in the system-wide response, to evaluate the specific value of the absolute indicator as the final result of such interaction at the time of examination of the patient. The approach used, proposed by the authors, allows us to evaluate not only quantitative relationships, but also the features of the manifestation of the functional properties of the evaluated indicators. All of the above significantly expands the informativeness of the obtained laboratory data, allowing us to build a reasonable paradigm of the connections of the emerging complex of pathological disorders in each individual case. In the list of references, the authors cite publications as concrete examples of the use of the proposed approach in assessing a complex of disorders with different pathological processes using different panels in calculations.

Biomarkers of tumor microenvironment of malignant neoplasms of kidneys, urinary bladder, and prostate gland (literature review)

The development of malignant tissue transformation is accompanied by the accumulation of immune system cells or tumor microenvironment cells (MCO) in it. Three variants of immune cell accumulation were identified: the ‘immune desert’ phenotype, ‘hot’ tumors, with a cytolytic T-cell response. The review presents immunotherapeutic strategies of exposure in order to enhance the ability of McO to initiate immune mechanisms capable of blocking the development of tumor tissue. The analysis of the presented data on the importance of immuno-oncological biomarkers as laboratory indicators of the therapeutic effectiveness of drug therapy aimed at restoring key immune defense pathways in oncourological diseases was carried out. The results of the study of the effectiveness of immuno-oncological biomarkers for assessing the state of antitumor immunity in malignant neoplasms of the bladder, kidneys, prostate gland are summarized.

Dynamics of morphological and immunohistochemical changes in myocardium during hypothyroidism modeling in experiment

An experimental model of hypothyroidism was obtained by thyroidectomy. The operation was carried out on 57 sexually mature male rats weighing 250–300 g. The experiment lasted 45 days. Laboratory animals were removed from the experiment on days 7th, 14th, 21st, 28th, 35th and 45th. As a control, 15 rats were used that were not operated on. For histological examination, pieces of rat myocardium were taken from the left and right ventricles. The pieces were fixed in 10% buffered formalin for 10 days. Histological sections were prepared in a standard manner. Sections were stained with hematoxylin and eosin, picrofuchsin according to van Gieson, toluidine blue, according to Mallory. Results of the study: In the myocardium of rats, hemodynamic disorders, edema, hydropic degeneration of cardiomyocytes, myocytolysis, fragmentation of muscle fibers, colliquation necrosis, compression and atrophy of muscle fibers were found. An immunohistochemical study revealed a decrease in the expression of desmin and sarcomeric actin.

Comparative analysis of resistance of main etiological agents of chronic osteomyelitis isolated from association and in monoculture

Introduction. To date, a significant number of works have been published devoted to the analysis of the sensitivity of the leading causative agents of osteomyelitis to modern drugs, however, in the available literature there are no data on a comparative analysis of the antibiotic resistance of bacteria isolated from the osteomyelitis focus from the association and in monoculture. Purpose of the work: to compare the resistance profiles of the leading causative agents of osteomyelitis, depending on the bacterial composition of the focus of infection.Materials and methods. The study included 216 clinical isolates, of which 114 were isolated as part of two-component associations, 102 – in a monoculture from pathological material in patients with chronic osteomyelitis who were treated in the purulent department of National Medical Scientific Centre of Traumatology and Orthopedics n.a. academician G.E. Ilizarov (Kurgan, Russia) from 2018 to 2020. To analyze the resistance profiles, depending on the type of microorganism, modern drugs used in the clinic for the treatment of osteomyelitis were taken into account.Results and its discussion. Effective drugs against P. aeruginosa strains isolated from the association were polymyxin and meropenem, and in monoculture–polymyxin, piperacillin/tazobactam, tobramycin; in relation to strains of K. pneumoniae isolated from the association, it was imipenem, in monoculture – amikacin. S. aureus strains isolated both from the association and in monoculture were highly susceptible to antibacterial drugs.Conclusion. The analysis of the sensitivity of the leading causative agents of osteomyelitis, isolated in monoculture and from the association, to the antibacterial drugs used in the clinic, showed significant differences in the resistance profiles between the groups: for S. aureus strains, 4 antibiotics tested out of 13, for P. aeruginosa strains – 7 out of 13, for K. pneumoniae strains – 12 out of 16. The tested antibacterial drugs were less active against P. aeruginosa and S. aureus strains isolated from associations. In contrast, the percentage of resistant strains of K. pneumoniae was higher among monocultures.

Neuroimmune mechanisms of pruritus in atopic dermatitis

Atopic dermatitis is a chronic hereditary recurrent skin disease. One of the most pronounced symptoms of this dermatosis is itchy skin. Pruritus accompanies atopic dermatitis in more than 80% of cases. This review presents modern data on the mechanisms of pruritus formation in atopic dermatitis. The issues of etiological factors, neuroimmune interactions, peculiarities of skin dysfunction, as well as the role of stress are considered. The relevance of studying the topic is due to the high prevalence of atopic dermatitis among the population, a decrease in the quality of life and the lack of effective therapy. Analysis of the literature indicates the need for a comprehensive assessment of the pathogenetic mechanisms of the development of pruritus in atopic dermatitis. A more in-depth study of the mechanisms of neurogenic inflammation in atopic dermatitis will contribute to the development of new methods of diagnosis and treatment.

‘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.).

Aduvant therapy of depression with hopantenic acid

Adequate SSRI monotherapy does not produce a sufficient clinical effect in some patients, and about 30% of patients do not respond to therapy at all. Favorable experience of combined prescription of SSRIs with various nootropic (neuroprotective) agents has been described in the literature.The aim of the study was to investigate the efficacy and tolerability of hopantenic acid as an adjuvant therapy for depression. We obtained significant data that inclusion of hopantenic acid at a dose of 2000 mg per day in a 12-week complex antidepressant therapy with paroxetine (20 mg per day) statistically significantly reduces the severity of depression symptoms. The drug's effect is achieved by improving patients' cognitive functions, reducing anxiety symptoms and side effects of SSRIs. Improved efficacy and tolerability of antidepressant therapy with hopantenic acid in the long term will allow to achieve more significant improvement in the quality of life of patients.

Netakimab in treatment of moderate to severe forms of psoriasis

The article presents an overview of published sources on etiology, pathogenesis and treatment of psoriasis, and described the treatment of moderate to severe psoriasis with new biologics netakimab.

Surgical treatment as option in treatment of metastatic hormone-sensitive prostate cancer after prior drug treatment

Currently, there is no consensus on the place of prostatectomy in the complex treatment of patients with metastatic prostate cancer. A description of a clinical case of complex treatment and observation of a patient with prostate cancer with an unfavorable baseline prognosis and the presence of bone metastases with a good clinical result is presented.

Prognostic and predictive factors in early stages of classic Hodgkin’s lymphoma

Rationale. In the early stages of classical Hodgkin’s lymphoma (cHL), the cure rate reaches 85–95 %, but the long-term effects of therapy can worsen overall survival. Current trials for early stages of Hodgkin’s lymphoma with favorable prognosis address the task of maintaining cure rates while reducing sequelae. For early unfavorable stages, the challenge is to improve cure rate without increasing toxicity.Purpose. To assess the potential significance of individual risk factors for optimal choice of the first line chemotherapy in early-stage Hodgkin lymphoma.Materials and methods. This single-center retrospective study included 290 patients with early stage cHL who had received ABVD – based (n = 249; 86 %) or BEACOPP‑21 – based (n = 41; 14 %) combined modality therapy from 2000 to 2017. Progression-free survival (PFS) and overall survival (OS) were assessed in Cox regression analysis including 12 clinical parameters.Main results. At a median follow up of 60 months for the entire group, OS was 95 % and PFS was 89 %. In a multivariate analysis PFS, at 5 years, was significantly inferior in patients with mediastinal bulk, baseline lymphocytopenia (≤ 0.6 × 109/L, р = 0.002; < 1.0 × 109/L, р = 0.000) and male gender; OS was inferior only in patients with an absolute lymphocytopenia (AL). In patients with AL, PFS after ABVD-based regimen was, respectively, 12 % in the high-risk group with mediastinal bulk and 56 % without it. PFS of patients without AL when treated with ABVD did not differ compared to BEACOPP‑21 within the same prognostic group: 95.2 % vs. 92.3 % for non-bulky and 86.4 % vs. 84.2 % for bulky disease. In the absence of AL, mediastinal bulk remained the main and only risk factor in multivariate analysis.Conclusions. The ABVD regimen is highly effective in the first line of chemotherapy for cHL, except for cases with baseline lymphocytopenia, in which the early usage of the BEACOPP regimen in the escalated or 14-day variants might be justified. In patients with mediastinal bulk, standard chemotherapy is not effective enough even in the absence of AL; therefore, if an intermediate PET/CT scan is available, it seems more appropriate to use a milder ABVD regimen on the first line and leave intensive therapy for patients with proven refractory disease. Prospects for improving the efficiency are opened with the new N-AVD and A-AVD schemes, the benefits of which should be evaluated, first of all, in patients with AL and mediastinal bulk.