Kazan medical journal

BACKGROUND: Insulin resistance contributes to the clinical course of type 1 diabetes mellitus and increases complication risk in adults.

AIM: This study aimed to assess the clinical characteristics of type 1 diabetes mellitus and prevalence of its complications among men and women with and without insulin resistance.

METHODS: Overall, 317 adults with type 1 diabetes mellitus were examined. The participants were divided into two groups: group 1, 81 patients with insulin resistance; and group 2, 236 patients without insulin resistance. Lipid metabolism parameters and prevalence of macrovascular and microvascular complications were assessed in each group. Anthropometric and laboratory studies included serum creatinine levels with subsequent estimation of glomerular filtration rate, total cholesterol, high- and low-density lipoproteins, triglycerides, and urinary albumin excretion in a random sample. Instrumental examinations involved electroneuromyography, duplex ultrasound scanning of the lower-limb arteries, and fundus examination. Insulin resistance was defined as an estimated insulin sensitivity ≤5.02 in men and ≤5.64 in women. Quantitative data with non-normal distribution were presented as median and 95% confidence interval. For normally distributed variables, the mean and standard deviation were calculated. Categorical data were presented as absolute and relative frequencies. Differences in quantitative parameters were assessed using the Mann–Whitney U test and differences in categorical indicators using the χ² test. P < 0.05 indicated significant differences.

RESULTS: Insulin resistance prevalence among all patients was 25.6%. Compared to patients without insulin resistance, men and women with insulin resistance more frequently had overweight or obesity (men: 57.1% vs 12.3%, p < 0.001; women: 56.4% vs 21.3%, p < 0.001), higher total cholesterol levels (men: 5.3 vs 4.6 mmol/L, p < 0.001; women: 5.6 vs 4.7 mmol/L, p < 0.001), and increased low-density lipoprotein levels (men: 3.4 vs 2.8 mmol/L, p < 0.001; women: 3.2 vs 2.7 mmol/L, p < 0.001). Men with insulin resistance were more likely to experience hypertension (47.6% vs 14.9%, p < 0.001), atherosclerosis (38.1% vs 14.9%, p = 0.004), diabetic nephropathy (54.8% vs 18.4%, p < 0.001), and retinopathy (81.0% vs 56.1%, p = 0.008). Hypertension (46.1% vs 13.9%, p < 0.001) and atherosclerosis (30.8% vs 11.5%, p = 0.010) were more prevalent in women with insulin resistance.

CONCLUSION: The clinical course of type 1 diabetes mellitus in patients with insulin resistance is characterized by increased cholesterol and low-density lipoprotein levels, higher prevalence of overweight or obesity, and greater incidence of macrovascular complications compared to patients without insulin resistance.

BACKGROUND: The diagnosis of the long-term outcomes of endoscopic treatment for choledocholithiasis is understudied, resulting in dissatisfaction in both patients and surgeons.

AIM: To study the diagnostic capabilities of various integrated methods for the long-term assessment of the major duodenal papilla and bile duct function after different transpapillary interventions for choledocholithiasis.

METHODS: Sixty-seven patients with choledocholithiasis aged 19 to 83 years (mean age 61.3 ± 5.7 years) underwent hepatobiliary scintigraphy, endosonography, and duodenoscopy 12 to 36 months after transpapillary interventions. Patients were divided into two groups. Group 1 (n = 36) received sphincter-preserving treatment, and group 2 (n = 31) received non–sphincter-preserving treatment. We assessed the diameter of the choledochus, wall thickness, and presence of gallstones in the common bile duct. We used nonparametric Mann–Whitney tests to conduct a statistical analysis of the between-group differences. We analyzed the parameter relationships using nonparametric correlation analysis and the calculation of gamma rank correlation coefficients.

RESULTS: Long-term duodenoscopy after transpapillary interventions allows us to estimate the preservation coefficient of the intramural choledochus, that is, the degree of sphincter of Oddi dissection of less than 30% and greater than 70%. When this parameter exhibited a low value, the following conditions were detected significantly more often by endosonography: increased diameter of choledochus ≥ 7 mm (p = 0.007; the reference value is ≤6 mm), wall thickening of the common bile duct > 1 mm (p < 0.001), aerobilia and transient dilatation of the choledochus with water load (p = 0.001 and p = 0.01, respectively), and a gallstone in the common bile duct (p = 0.002). Correlation analysis showed a meaningful (p < 0.05) relationship between radiopharmaceutical agent transit time > 20 minutes and the dysfunction index (γ = 0.750 for dysfunction index > 1; γ = −0.785 for dysfunction index ≤ 1), which indicates the risk of decompensation of barrier function and possible complications with persistently slow transit.

CONCLUSION: The integrated approach using hepatobiliary scintigraphy, endosonography, and duodenoscopy is an unbiased assessment method of the major duodenal papilla and bile duct function after transpapillary interventions for choledocholithiasis.

BACKGROUND: Laser Doppler flowmetry is an effective method for the diagnosis of initial periodontitis.

AIM: To evaluate the microcirculation using laser Doppler flowmetry in patients with mild and moderate localized traumatic periodontitis.

METHODS: We evaluated the periodontium in patients with mild (102 participants) and moderate (67 participants) localized periodontitis. We performed a standard physical examination and used laser Doppler flowmetry to investigate the level and intensity of periodontal circulation and microvascular vasomotor activity (general microcirculation index, standard deviation of perfusion fluctuations, coefficient of variation, and shunting index). The data were processed using statistical methods (Fisher’s exact test, Student’s t test, risk ratio calculation).

RESULTS: We recorded a reduction in the average periodontal perfusion in both mild and moderate localized periodontitis in the lesion region compared with the test region (an area of clinically healthy periodontium on the contralateral jaw). For example, in mild periodontitis, perfusion was 10.4 ± 2.01 PFU in the lesion region and 15.28 ± 1.16 PFU in the test region (p < 0.001); in moderate periodontitis, perfusion was 7.01 ± 0.97 PFU and 13.98 ± 0.83 PFU, respectively (p < 0.001). The coefficient of variation was also lower in the lesion region: 12.16 ± 2.2 and 13.56 ± 5.0 (p < 0.001) in mild periodontitis and 10.32 ± 1.63 and 15.54 ± 3.8 (p < 0.001) in moderate periodontitis. We identified a lower standard deviation: in mild periodontitis, it was 1.38 ± 0.32 in the lesion region and 1.59 ± 0.65 in the test region (p < 0.001), and in moderate periodontitis, it was 1.35 ± 0.17 and 1.65 ± 0.44, respectively (p < 0.001). In addition, we observed an increased number of functional arteriole-venular shunts: in mild periodontitis, this number was 1.20 ± 0.08 in the lesion region and 0.84 ± 0.05 in the test region (p < 0.001), and in moderate periodontitis, it was 1.09 ± 0.09 and 0.91 ± 0.12, respectively (p < 0.001).

CONCLUSION: Abnormal microcirculation in localized traumatic periodontitis occurs even at the initial stage of the disease (i.e., at the preclinical level). Regardless of the severity, tissue perfusion in the lesion region is reduced and the number of functional capillaries is decreased, leading to congestion in the periodontium.

BACKGROUND: Predicting outcomes in chronic kidney disease remains challenging in modern medicine. It may be addressed using stratification systems based on biomarkers, including metabolic, electrolyte, inflammatory, and instrumental indicators.

AIM: This study aimed to assess the prognostic value of surface-enhanced Raman spectroscopy of blood serum in evaluating all-cause mortality in hemodialysis patients with end-stage chronic kidney disease.

METHODS: This prospective study included 58 patients of both sexes, aged 33–73 years (mean age: 57.0 ± 12.9 years) on maintenance hemodialysis. Over the 3-year follow-up, 13 deaths were recorded. An additional comparison group was formed, comprising 75 individuals (mean age: 51.33 ± 13.12 years; p < 0.01) with estimated glomerular filtration rate corresponding to chronic kidney disease stages I–IIIa, to identify spectral characteristics associated with the mortality phenotype. According to current criteria, chronic kidney disease is diagnosed based on persistent signs of renal dysfunction, including a specific estimated glomerular filtration rate level, present for ≥3 months. However, the duration of asymptomatic stages of chronic kidney disease cannot be determined. Multivariate analysis was used to evaluate the statistical association between serum spectral characteristics and survival in 26 hemodialysis patients. To develop the prognostic model, least squares discriminant analysis was applied, which is a machine learning technique used for classification.

RESULTS: Data of the cohort of patients undergoing maintenance hemodialysis was analyzed: 13 individuals who died within 3 years following blood sampling and 5 groups of 13 individuals each, randomly selected from the remaining 45. Each group was formed independently. The model was tested over five iterations and the results averaged. The most prognostically significant spectral peaks were 731, 839, 1240, 1391, and 1578 cm^-1. The model demonstrated an 83% sensitivity, 79% specificity, and 81% accuracy and an area under the ROC curve of 0.86. Notably, two of the five frequencies significant for survival prediction overlapped with those characteristic of creatinine and urea (637, 724, 1001, 1095, 1238, and 1393 cm⁻¹), which enable differentiation between stages I–IIIa of chronic kidney disease and end-stage renal disease, yielding a 71% sensitivity, 95% specificity, and 83% overall accuracy.

CONCLUSION: Combined surface-enhanced Raman spectroscopy of blood serum and mathematical modeling presents high predictive accuracy with minimal labor input.

The global prevalence of chronic obstructive pulmonary disease among individuals aged >40 years is approximately 10%. The disease’s progression, often leading to early disability, underscores its significant medical and social impact. Further research of risk factors, particularly genetic underpinnings, of chronic obstructive pulmonary disease is essential for developing effective primary prevention strategies in genetically predisposed individuals. This review aimed to analyze international and Russian scientific sources on genetic polymorphisms associated with chronic obstructive pulmonary disease and their roles in disease pathogenesis and examine the pharmacogenetic aspects of therapy, specifically how genetic variation affects drug efficacy and safety. Full-text articles published between 2000 and 2024 and indexed in PubMed, eLIBRARY.RU, Google Scholar, and ResearchGate were analyzed. This review summarizes key genetic studies on chronic obstructive pulmonary disease, including comorbidities and pharmacogenetic characteristics of commonly used drugs. Research on heritable factors confirmed that genetic susceptibility increases the risk of chronic obstructive pulmonary disease. Several variables influence therapeutic response, among which genetic factors are critical for guiding treatment choices. Large-scale genome-wide association studies have identified chronic obstructive pulmonary disease-associated loci that contribute to our understanding of disease pathogenesis. Polygenic risk scores based on multiple single-nucleotide polymorphisms have demonstrated efficacy in predicting disease risk and severity and may be useful in predictive medicine. The investigation of genetic polymorphisms offers promising opportunities for the advancement of personalized approaches to the prediction, prevention, and treatment of chronic obstructive pulmonary disease.

The pathogenesis of neurodegenerative diseases is associated with proteopathy and the abnormal aggregation of specific proteins, including amyloid-β and tau protein in Alzheimer's disease, α-synuclein in Parikinson disease, and TDP-43 and FUS in amyotrophic lateral sclerosis. Etiological factors may include viral infections because of the protective functions of the above proteins in relation to specific viruses. In turn, the latter may enhance the expression of retroelements. Another cause of neurodegenerative diseases is physiological aging, as it activates retroelements and is associated with proteopathy of antiviral proteins, which normally suppresses the expression of retroelements. It is assumed that the etiological factors of amyotrophic lateral sclerosis, Alzheimer disease, and Parkinson disease include the associated genetic polymorphisms, most of which localize within intronic and intergenic regions where retroelement genes are located. Thus, the etiological factors of neurodegenerative diseases include genetic predisposition to the excessive activation of retroelements, aging, and viral infections, thus causing pathogenic proteopathy and the aggregation of amyloid-β, tau protein, α-synuclein, TDP-43, and FUS. As a result, these proteins lose their ability to inhibit retroelements by causing their excessive activation and an inflammatory immune response to their transcripts. In turn, the expression products of polymorphic retroelements enhance the production of antiviral proteins and their proteopathy and aggregation. A vicious circle develops that promotes the progression of the condition; this circle may be broken by inhibitors of retroelements and specific microRNAs that may become the basis for targeted therapy for neurodegenerative diseases. As such, these processes do not induce nucleotide DNA sequence damage; rather, they indicate the epigenetic mechanisms of these diseases.

Extracellular vesicles are membrane-limited nanovesicles of endosomal or plasma membrane origin present in most biological fluids. They are capable of transporting various substances and are considered biomarkers of pathological conditions. In preeclampsia, increased levels of placental extracellular vesicles containing antiangiogenic factors have been observed. Moreover, placental extracellular vesicles in preeclampsia are characterized by low strongly anti-inflammatory factor levels and increased high-mobility group nuclear protein levels, indicating cellular damage. Similar to other pathological conditions, the onset of preeclampsia is accompanied by increased extracellular vesicle concentrations, which are detectable as early as 11 weeks of gestation. This review aimed to highlight the role of extracellular vesicles in the course of pregnancy and in the development of preeclampsia. Full-text review and original research articles published in Russian and English were comprehensively analyzed using the eLibrary.Ru, Google Scholar, and PubMed databases, covering the period from 1989 to 2024. The search employed the following keywords: плацентарные внеклеточные везикулы (placental extracellular vesicles), внеклеточные везикулы во время беременности (extracellular vesicles during pregnancy), and внеклеточные везикулы и преэклампсия (extracellular vesicles and preeclampsia). Severe preeclampsia has been associated with a significant increase in the number of extracellular vesicles of various origins. Several authors have demonstrated that placental extracellular vesicles can enter the fetal circulation; however, whether they induce a harmful effect on the fetus remains unclear. Placental extracellular vesicles play a crucial physiological role during pregnancy. They serve as indicators of gestational progression, which makes it possible to quantify them for the prediction of various pregnancy complications.

Global rehabilitation practices involving remote technologies in delivering medical and social services to individuals with spinal column and spinal cord injuries were evaluated to assess the potential of integrating telemedicine into comprehensive rehabilitation strategies for this population in the Russian Federation. Accessible publications from PubMed and eLIBRARY.RU from 2020 to 2025 were analyzed. The following keyword combinations in English and Russian were used: spinal cord injury / повреждение позвоночника и спинного мозга, traumatic spinal cord disease / травматическая болезнь спинного мозга, telemedicine / телемедицина, telerehabilitation / телереабилитация, remote rehabilitation / дистанционная реабилитация, remote monitoring / дистанционное сопровождение, remote format / дистанционный формат, video consultation / видеоконсультация, видеосопровождение / video-based support, and remote medical support format / дистанционный формат медицинского сопровождения. Telemedicine, using dedicated equipment and communication tools, provides access to medical and social support for individuals with spinal column and spinal cord injuries. In contemporary international practice, telemedicine services for individuals with spinal column and spinal cord injuries focus on preventing secondary conditions and enhancing physical function and daily activity, psychosocial adaptation, health management, and caregiver engagement. These services are delivered by telephone, video conferencing, or web-based platforms. Positive outcomes associated with remote technologies include improvements in clinical parameters, physical and daily functioning, psychological well-being, and overall quality of life. Moreover, telemedicine is promising for educating and supporting caregivers of individuals with traumatic spinal cord disease. It is a cost-effective complement to in-person care, helping prevent rehospitalizations and contributing to the medical and social rehabilitation of this patient population.

BACKGROUND: Regardless of ownership structure, information systems are crucial for the digital transformation and process optimization of healthcare organizations.

AIM: This study aimed to digitally transform and improve the implementation of biomedical, scientific, and applied developments and information systems into patient-oriented products and services, integrating them with educational programs and medical technologies.

METHODS: How biomedical technologies are transferred to a similar segment of the online market was analyzed. Furthermore, experimental studies with feedback from test groups were conducted. Various elements of the platform were examined, and data were collected to improve and systematize this online service. The strengths and weaknesses of the websites of similar medical clinics were evaluated. Four common problems were identified: difficult navigation, outdated visual design, slow page loading speeds, and lacking collaboration and commercialization opportunities.

RESULTS: A prototype of Kazan Federal University’s digital ecosystem (online platform) of biomedical technologies was developed. It includes a user-friendly, three-click process from start of search for services and products to submitting a request for consultation and/or purchase. In 2024, the prototype was posted for public access on the official Kazan Federal University website.

CONCLUSION: This international, competitive electronic platform of the biomedical translational ecosystem provides conditions for product and service localization in biomedical and healthcare sectors.

This study aimed to demonstrate the potential of intentional replantation in treating a crown-root fracture of tooth 8 (ISO designation 11) that occurred 6 months earlier in a 12-year-old male. A crack in the coronal portion of the tooth extended from the center of the incisal edge apically beyond the cervical margin. Intraoral radiography and cone-beam computed tomography revealed a vertical fracture line extending 3 mm apical to the alveolar crest and bone loss in the apical region and around the mid-root area. During surgery, the root was atraumatically extracted. Its length (12 mm) and an extra-alveolar time of <1 minute enabled tooth preservation—intentional replantation of the root into the socket. The tooth was stabilized using a wire-composite splint for root canal therapy. The root canal was mechanically and chemically prepared and temporarily filled with calcium hydroxide. Gingival margin approximation was performed using sutures. Splinting was maintained for 3 weeks. The patient received anti-inflammatory therapy, antibiotics, and antiseptic mouthwashes. Sutures were removed 3 weeks postoperatively. The root canal was re-instrumented and obturated. Tooth 8 was restored with a glass fiber post and composite resin. After tooth preparation, a CAD/CAM composite crown was fabricated and adhesively cemented. At 11-month follow-up, nearly complete bone defect healing was observed. Intentional replantation was highly effective in crown-root fracture management, enabling tooth preservation despite an unfavorable prognosis.

The Kazan internal medicine school is famous for its outstanding researchers. Professor Valentin E. Anisimov stands out as a passionate researcher, an experienced teacher and mentor, a scholarly doctor, and an active public figure. Valentin E. Anisimov made a significant contribution to the development of medicine and education both in Kazan and Moscow. He had many areas of expertise, including vitaminology, cardiology, hepatology, and gerontology. His publications covered such important issues as coronary atherosclerosis, dietetics, hormone therapy, and biochemical blood changes and their testing methods. Professor Valentin E. Anisimov is best remembered both as a researcher and a chronicler of the Kazan internal medicine school. He participated in multiple international conferences, shared his achievements and expertise with colleagues. Professor Valentin E. Anisimov played an important role in the training of scientists by teaching students and postgraduates. As a teacher, he was focused on the professional development of recent graduates. His invaluable contributions to the science and history of medicine have gained deep respect in the academic and medical communities.

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Wang HZ, Hayles EH, Fiander M, Sinn JKH, Osborn DA. Probiotics in infants for prevention of allergic disease. Cochrane Database of Systematic Reviews. 2025. Issue 6. Art. No.: CD006475. DOI: 10.1002/14651858.CD006475.pub3.