Kazan medical journal

BACKGROUND: Investigation of immune checkpoint expression on T-lymphocytes is essential for determining immunotherapy strategies for colorectal cancer.

AIM: The work aimed to examine the expression of immune checkpoints on T-lymphocytes in regional lymph nodes in patients with colorectal cancer.

MATERIAL AND METHODS: Flow cytometry was used to evaluate the expression levels of immune checkpoints (CTLA-4, PD-1, TIM-3) on T-lymphocytes in regional lymph nodes in 105 patients with stage III colorectal cancer. The control group included 75 patients with nonneoplastic colon diseases. The Mann–Whitney U-test was used to compare two independent groups. ROC analysis was performed to identify diagnostic threshold values. Differences were considered statistically significant at p < 0.05.

RESULTS: In the regional lymph nodes of patients with colorectal cancer, CTLA-4 expression increased 7.9-fold on T-helper cells [42.9% (25.1%–59.8%) in the main group vs 5.4% (2.8%–7.8%) in controls; p < 0.001], and 4.5-fold on cytotoxic T-lymphocytes [35.0% (16.9%–52.8%) vs 7.8% (3.5%–12.7%); p < 0.001]. PD-1 expression increased 1.5-fold on CD4-positive T-lymphocytes [46.9 (33.5; 62.9)% in the main group vs 31.7 (18.9; 42.7)% in controls, p < 0.001], and 2.2-fold on cytotoxic T-lymphocytes (p < 0.001). TIM-3 expression on cytotoxic T-lymphocytes in regional lymph nodes reached 3.8 (2.3; 6.6)% in patients with colorectal cancer, exceeding the control value of 2.3 (1.5; 4.1)% by 1.7 times (p < 0.001). Statistically significant threshold values for CTLA-4 expression in regional lymph nodes were established at ≥ 11.1% for T-helper cells and > 20.1% for cytotoxic T-lymphocytes.

CONCLUSION: In patients with colorectal cancer, the expression of the co-inhibitory receptors CTLA-4 and PD-1 is increased on both T-helper cells and cytotoxic T-lymphocytes in regional lymph nodes, whereas TIM-3 expression is elevated on CD8+ T-lymphocytes.

BACKGROUND: Platelet microvesicles are a promising marker of oncological process activity and dynamics, which allows predicting complications in patients with cancer to guide further management.

AIM: This work aimed to evaluate the role of platelet microvesicles in complication development in patients with ovarian cancer.

MATERIAL AND METHODS: The prognostic role of platelet microvesicles in complication development was studied in 71 patients with ovarian cancer at the Department of Oncology of A.I. Burnasyan Federal Medical Biophysical Center (FMBC, Moscow, 2020–2023). To compare the hemostasis parameters in healthy volunteers and patients with thrombosis, a sample of patients (n = 100) in the Department of Gastric Surgery of A.I. Burnasyan FMBC during the postoperative period and a control group of healthy volunteers (donors from the Department of Blood Transfusion, n = 50) were formed. We performed thromboelastography and determined the general tendency of coagulation, functional activity of platelets and fibrinogen, activity of fibrinolysis and physical and mechanical properties of the formed clots.

Platelet aggregation was evaluated using a laser platelet aggregation analyzer. Cytofluorimetric analysis was performed on a standard flow cytometer using specialized software. The obtained data were processed using Statistica 10.0 statistical package. The normality of distribution of the actual data was determined using the Shapiro–Wilk test. The median and interquartile range were used to describe the groups. Analysis of variance was performed using the Kruskal–Wallis (for independent observations) and Friedman (for repeated observations) tests.

RESULTS: Patients with cancer had significantly increased levels of microvesicles in peripheral blood (43.8 × 106 per mL of plasma; p = 0.0001) compared with surgical patients. High levels of microvesicles are accompanied by platelet hyperaggregation: low platelet aggregation rates corresponded to low microvesicle levels (p = 0.001), and patients with fatal thromboembolic complications and patients with ovarian cancer were predominantly in the group with high platelet microvesicle levels (>35 × 106 per mL of plasma, p = 0.0001). When evaluated as a mortality predictor, the level of microvesicles in patients with ovarian cancer was found to have a sensitivity of 61.5% (54.7–82.3) and a specificity of 93.6% (83.5–98.1).

CONCLUSION: Patients with ovarian cancer have high levels of circulating procoagulant microvesicles.

BACKGROUND: Early and specific diagnosis of urgent abdominal conditions is prioritized in contemporary surgical practice because it facilitates minimally invasive interventions and improves postoperative outcomes.

AIM: To assess the diagnostic value, specificity, and sensitivity of selected biochemical markers and establish reference values for identifying acute mesenteric ischemia.

MATERIAL AND METHODS: The biochemical markers of acute mesenteric ischemia were analyzed in 40 patients admitted at the Surgical Department of Ryazan Regional Clinical Hospital between January and November 2023. Two patient groups were formed: the main group included 24 patients with acute reversible mesenteric ischemia, and the control group comprised 16 patients with atherosclerotic or embolic bowel gangrene. The following candidate markers were evaluated: diamine oxidase, tumor protein p53, and nitric oxide. A prospective study was conducted. Statistical analysis was performed using StatTech 4.2.7. Quantitative variables were assessed for distribution using the Shapiro–Wilk test. The two groups were compared based on quantitative variables using the Mann–Whitney U test. The diagnostic utility of the quantitative indicators of outcome prediction was evaluated using ROC curve analysis. The cut-off quantitative variable value was determined based on the maximum Youden index.

RESULTS: Tumor protein p53 levels ≥40.30 μmol/L, diamine oxidase ≥5.59 μmol/L, and nitric oxide ≥48.13 μmol/L were predictive of acute mesenteric ischemia before the onset of irreversible bowel wall damage. The sensitivity and specificity of tumor protein p53 were 83.3% and 100%, respectively, and 100% and 94.4% for diamine oxidase and 100% and 91.1% for nitric oxide.

CONCLUSION: Diamine oxidase, tumor protein p53, and nitric oxide are good biochemical markers for the early diagnosis of acute mesenteric ischemia.

BACKGROUND: The study of the female reproductive system remains relevant owing to the prevalence of pathologies that exhibit symmetrical and asymmetrical features.

AIM: To identify morphological asymmetry patterns in the ovaries and fallopian tubes across their different anatomical regions.

MATERIAL AND METHODS: Ultrasound of the ovaries was performed in 23 women aged 30–55 years (mean age: 43.0 ± 0.7 years) without reproductive system pathology and with no more than two pregnancies in history, with the last occurring >5 years prior to the study. The participants were in the premenopausal period and had normal pelvic dimensions. The length, width, and anteroposterior size of each ovary were measured, and ovarian volume was calculated. Micrometric analysis was conducted using postmortem material from 23 women of similar age, without reproductive system pathology, and deceased due to injuries unrelated to abdominal or pelvic organs. The thickness of the mucosal and muscular layers at the intramural part, isthmus, ampulla, and infundibulum of the fallopian tubes were measured. Statistical analysis included Student’s t-test to assess significant mean differences, Pearson’s correlation coefficient to evaluate proportional variability between parameters, and the Mann–Whitney U test to compare independent samples by the value of the fallopian tube parameters.

RESULTS: Comparative analysis of the linear dimensions (i.e., length [p = 0.4041], width [p = 0.9443], anteroposterior size [p = 0.9525], and volume [p = 0.4215]) of the ovaries in women during the second period of adulthood based on ultrasound examination revealed larger right-sided measurements, averaging 1.557% greater. Micrometric measurements of the fallopian tubes during cadaveric examination showed a right-sided predominance averaging 0.649%. The Pearson correlation coefficients calculated to assess the proportional relationships between corresponding parameters of the right and left fallopian tubes indicated a strong positive correlation. The minimum correlation coefficient was 0.992 based on ultrasound data and 0.982 based on cadaveric material. Although no significant differences were found between the parameters of both ovaries and both fallopian tubes, percentage-based deviations demonstrated an average right-sided predominance of 0.731%.

CONCLUSION: Comparative analysis of the ovarian sizes and micrometric measurements of the fallopian tubes showed a positive correlation between the corresponding right and left parameters.

BACKGROUND: The onset of mental disorders associated with chronic ethanol use without dependence and safe threshold for alcohol consumption remain unclear.

AIM: To describe changes in the spontaneous behavior patterns of rhesus macaques in response to long-term alcohol consumption in a free-choice model.

MATERIAL AND METHODS: Behavioral responses of mature male rhesus macaques were evaluated using the ethogram-based time-interval method. The study included six animals with low ethanol consumption and eight animals with high ethanol consumption. Ethanol consumption was measured prior to (baseline) and during the initiation period (62 days) and at the start and end of the phase of alcohol motivation maintenance (688 days of continuous access to 4% ethanol and water). Two 30-day withdrawal periods were completed in the middle and end of the motivation maintenance phase. Analysis of variance was conducted using the Kruskal–Wallis test.

RESULTS: During the initiation phase and two motivation maintenance periods, the median ethanol consumption was 0.6, 0.5, and 0.8 g/kg/day for the low-consumption group and 1.6, 2.4, and 2.8 g/kg/day for the high-consumption group, respectively. The animals from the high-consumption group demonstrated a 9% decrease in body weight by the end of the observation period (p = 0.030). Ultrasound examination showed no hepatic or cardiac abnormalities. The baseline intergroup differences in stereotypy (p = 0.023), front-of-cage position (p = 0.023), and sitting position (p = 0.006) persisted throughout the experimental period. At the end of the motivation maintenance phase, the low-consumption group revealed a lower frequency of the slumped posture (p = 0.035). However, an increase was noted in the frequency of the front-of-cage position in the high-consumption group (76%; 60%–98% confidence interval; p = 0.006) compared to baseline (48%; 28%–63% confidence interval), which remained increased in the subsequent withdrawal period (83%; 53%–95% confidence interval; p = 0.008).

CONCLUSION: The 2-year alcohol consumption of male rhesus macaques in the free-choice model induced transient and prolonged changes in the spontaneous behavior patterns of the animals.

Female infertility is one of the least investigated forms of reproductive dysfunction. This review presents promising molecular factors associated with infertility and analyzes the mechanisms involved in its manifestation and progression. Globally, up to 17.5% of couples experience infertility, which can negatively affect individual health and society as a whole. Female-related factors account for approximately 37% of cases. The presence of numerous factors associated with chronic inflammatory diseases of the reproductive system, including genetic and environmental influences, pose significant challenges for treatment of this patient population. Epigenetic mechanisms represent promising targets for regulation. MicroRNAs (miRNAs) are short non-coding RNA sequences that are approximately 18–25 nucleotides long. They regulate a wide range of various physiological processes within the cell, including cell growth, signal transduction, apoptosis, and pathological processes. Several miRNAs, including miR-324, miR-155, miR-335-5p, miR-9119, miR-23a, miR-27a, and miR-146b-5p, may be associated with female infertility. The role of long non-coding sequences influencing the activity of key targets involved in granulosa cell maturation is also highlighted. These factors have been shown to act as regulatory RNAs and mediate the decidualization of stromal cells. Particular attention is given to circulating miRNAs such as let-7b, miR-29a, miR-30a, miR-140, and miR-320a.

Local cryotherapy is a treatment method used for injuries, musculoskeletal diseases, connective tissue diseases, and post-surgical rehabilitation. Novel technologies such as non-contact cooling with cold gases, augmented compression, and skin temperature regulation, have improved the effectiveness of cryotherapy and expanded its applications. However, it is still important to improve treatment protocols and determine optimal exposure parameters. Therefore, publications on the use of local cryotherapy in traumatology and orthopedics were reviewed to systematize clinical practice approaches and determine the key principles for the development of the treatment option. This article reviews studies on various local cryotherapy options used to treat musculoskeletal diseases and to rehabilitate patients after joint surgery, sport-related injuries, and bone tissue damage. It describes the mechanisms of action and the factors that influence the treatment effectiveness and safety. Local cryotherapy offers several therapeutic benefits, including reduced inflammation and pain, faster recovery of joint function, and reduced need for analgesics. Although more research is needed to confirm its effectiveness, local cryotherapy shows promise as a treatment for bone tissue healing. Most of the current evidence of effectiveness has been obtained from preclinical studies in animal models. Additional studies are required to confirm the applicability and safety of this treatment option in clinical practice. These studies should aim to optimize treatment parameters and evaluate treatment safety. Further randomized studies in humans are also needed. Local cryotherapy has been shown to effectively treat musculoskeletal diseases and rehabilitate musculoskeletal injuries. However, more research is needed to optimize treatment regimens based on the location of the injury and the area of cooling. Further research is needed to develop personalized, local cryotherapy protocols that consider patient characteristics, therapy goals, and the nature of the disease.

BACKGROUND: Studying mortality indicators among the working-age population, with its structure and characteristics by sex and age groups considered, provides basis for addressing organizational issues related to workforce preservation and health protection.

AIM: To analyze mortality indicators among the working-age population in the Republic of Tatarstan by sex, age, and causes of death from 2013 to 2023.

MATERIAL AND METHODS: Data were obtained from the Federal State Statistics Service, Unified Interdepartmental Information and Statistical System, Territorial Body of the Federal State Statistics Service for the Republic of Tatarstan, and Ministry of Health of the Republic of Tatarstan. Social and hygienic, statistical, and analytical approaches were employed. Student’s t-test was used to assess the significance of differences, and mortality trends were evaluated using least squares regression with built-in Microsoft Excel functions.

RESULTS: The all-cause mortality among the working-age population decreased in 2013–2019. The highest mortality rates were noted during the peaks of the COVID-19 pandemic, in 2020 and 2021 (462.0 and 514.3 per 100,000 population, respectively). Excess mortality was attributed to COVID-19 and cardiovascular diseases. Mortality rate changes among the working-age population since 2013 demonstrated a linear trend with a positive forecast through 2026, indicating a decrease in all-cause mortality regardless of sex.

CONCLUSION: During the COVID-19 pandemic, up to 2023, higher excess mortality rates were observed among working-age men, resulting in a mortality rate 3.8 times higher than that of women aged over 35 years.

BACKGROUND: Nonadherence to vaccination in the general population poses a major obstacle to achieving epidemiological well-being.

AIM: To assess vaccination adherence among parents of preschool-aged children in selected cities in Russia and Belarus.

MATERIAL AND METHODS: A cross-sectional descriptive study was conducted using an anonymous online survey administered to parents whose children attended preschool institutions in Almetyevsk, Kazan, Makhachkala, Nizhny Novgorod, and Rybnoye in Russia and Gomel in Belarus. The questionnaire included 16 items with single or multiple response options. Overall, 801 participants were surveyed. Statistical analysis was performed using R 4.3.1 (RStudio). Proportions with 95% confidence intervals and standard errors (P ± p) were calculated. The independent-sample t-test was used for normally distributed variables and the Mann–Whitney U test and Kruskal–Wallis test for asymmetrically distributed variables.

RESULTS: A positive attitude toward vaccination was reported by 76.2 ± 11.7% of respondents (range across cities: 56%–91%). The main motivations for vaccinating children were protection against serious infections (68.8% ± 7.3%), concern about access to educational institutions (16.2% ± 9.6%), and recommendations from healthcare providers (9.1% ± 5.8%). Negative attitudes were identified in some parents, including fear of adverse reactions (13.5%), concerns about vaccine safety (8.3%), and the belief that children should only be vaccinated against the most dangerous diseases (9.1%). Furthermore, 47.6% of the respondents expressed interest in receiving additional information about vaccination. The preferred sources of information were consultations with pediatricians (78.3%), printed educational materials (28.3%), dedicated websites (23.2%), lectures on clinic websites (17.2%), and hotline consultations (15%). Only 11.9% of the respondents favored information obtained through social media.

CONCLUSION: Some parents of preschool-aged children in Russia and Belarus demonstrate negative attitudes toward vaccination. Parents show a strong willingness to receive information from healthcare professionals.

Internal abdominal hernias are rare abdominal hernias. Several internal abdominal hernias are associated with diagnostic challenges owing to the extremely low incidence of complicated forms of this condition. This report presents a clinical case with a description of the surgical intervention and postoperative management. A 42-year-old woman was urgently admitted to the surgical department with a presumptive diagnosis of sigmoid diverticulitis or sigmoid mesoappendix torsion. Diagnostic laparoscopy showed an incarcerated ileal loop 120.0 cm proximal to the ileocecal junction, entrapped within a defect of the left broad ligament of the uterus. The incarceration was released and the defect sutured. Moreover, the postoperative course was uneventful. The surgical wound healed by primary intention, and no febrile episodes occurred. Gastrointestinal function recovered, and the patient passed a formed stool on postoperative day 2. The patient was discharged in satisfactory condition on post-admission day 4, with recommendations for follow-up by a surgeon and gynecologist. This case report reveals that rare internal abdominal hernias can present with various clinical manifestations, complicating the diagnostic process.

This article analyzes the organizational and structural transformation stages of the Republican Clinical Hospital, the leading healthcare institution of the Republic of Tatarstan. This study utilized archival documents and historiographic sources to provide a historical retrospective of the forms and methods used to implement state healthcare decisions and personal initiatives of key administrators. It presents key developments in the systematic advancement of infrastructure projects that have determined the hospital’s evolution as a state institution, integrating various objectives of the national healthcare system into its clinical practice. The article highlights the hospital’s multidisciplinary profile and its role in preserving and transmitting professional traditions among physicians and healthcare personnel at all levels. An axiological approach was employed to explore the role of corporate values within the medical community and the historical forms through which these values were expressed in administrative decisions and consolidation of the medical staff. Moreover, the article examines the stages of the evolution of the Republican Clinical Hospital as a distinctive sociocultural system, presenting the factors that influenced its establishment and development, including regional patterns of morbidity and the need for new clinical infrastructure. Additionally, the role of Kazan State Medical University and other academic institutions in Kazan in facilitating the integration of medical science into clinical practice is emphasized.

Over 200-year history of the establishment and development of the Kazan Medical School has drawn attention from researchers. An evident focus on surgery is noteworthy. Thus, the historical milestones of Kazan surgery and the contributions of surgical scientists are significant. Furthermore, each medical discipline results from the collaborative efforts of individual departments. Analysis of their respective contributions is crucial for comprehending the development of medical education and scientific research. Therefore, the present study provides a historical reconstruction of the events surrounding the establishment of the Surgery Department of the Faculty of Pediatrics at the Kazan Medical Institute during the first decade of the Soviet state. Documents retrieved from the collection of the State Archive of the Republic of Tatarstan were used. Additionally, archival documents and protocols, including detailed records of pertinent events, reports from the Surgery Department highlighting the academic staff, scientific research, methodological and teaching activities, and reports from the Medical Institute Council, were examined. Moreover, the archival repository of the Kazan Medical University, specifically the Domrachev Foundation, contributed to the study. This study presents the department’s early activities that were often inconsistent and sometimes contradictory, highlighting significant gaps in its historical record. The date of the department’s establishment was determined through archival data analysis. The first decade of the department’s existence was associated with broader and complex social and political transformations during the early Soviet period of Russian history. The annals of the Kazan Medical Institute have been supplemented with fragments of the history of the Surgery Department of the Faculty of Pediatrics that had been missing.

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Livingstone-Banks J, Vidyasagaran AL, Croucher R, Siddiqui F, Zhu S, Kidwai Z, Parkhouse T, Mehrotra R, Siddiqi K. Interventions for smokeless tobacco use cessation. Cochrane Database of Systematic Reviews. 2025. Issue 4. Art. No.: CD015314. DOI: 10.1002/14651858.CD015314.pub2