Annals of the Russian academy of medical sciences

The progressive increase in the number of cesarean sections, which is not accompanied by a decrease in the perinatal mortality rate, is an urgent problem not only in obstetrics, but in the health care system in general. The frequency of operative delivery is influenced by both medical and non-medical factors. Moreover, the frequency varies across regions of the world and countries with different levels of economic development. At the present stage, the increase in the number of surgical deliveries in developed countries is due to changes in population health indicators (age, morbidity). The attention of WHO and associations of obstetricians and gynecologists is drawn to the development of measures to stabilize and reduce the frequency of cesarean sections. However, the proposed measures to reduce it through administration in obstetric hospitals and non-medical measures do not have an effect. There is evidence of an increase in the incidence of complications for the mother and fetus when indications for cesarean section are limited. A safe reduction in the frequency of caesarean sections is possible only with an integrated approach, including new solutions that improve the quality of medical care in general (social measures to support families, optimization of medical processes, introduction of decision support systems, improvement of medical technologies for pregnancy and childbirth).

Radiomic image analysis of kidney stones has significantly improved the accuracy of kidney stone type prediction. Such advances in medical imaging technologies and machine learning are likely to be more widely used in routine clinical management of KSD in the near future. However, there is still room for further improvement of machine learning algorithms to improve the sensitivity and specificity of automatic classification methods. Creating a network of centralized database for each type of stone, including demographic and general information about patients, urine, blood parameters, other laboratory tests, treatment methods and their results, will allow the development of a more reliable machine learning algorithm for personalized medicine for KSD.

Currently, the epidemic process of healthcare-associated infections (HAI’s) has a number of features, including a decrease in the intensity of manifestations of the epidemic process of HAI’s in surgery with a simultaneous increase in the proportion of severe forms of infections with loss of function or organ, a high risk of developing HAI’s in children with low and extremely low body weight, the spread of HAI’s pathogens with high epidemic potential, bacteria multiresistant to antimicrobial drugs, a decrease in the frequency of exogenous infection and an increase in infections associated with the formation of a hospital clone. At the same time, it should be noted that there are clear trends in the development of medical technologies, primarily in surgery, concerning the intensification of surgical treatment methods, a decrease in the aggression of medical technologies, an increase in the use of various implants, as well as organ and tissue transplantations. At the same time, the epidemic process of HAI predominantly involves microorganisms from the group of ESKAPE pathogens, which have the ability to “escape” the biocidal action of antimicrobial drugs and a high epidemic potential, necessary and sufficient for their epidemic spread in the hospital environment. In this regard, a mandatory condition for combating the formation of a “hospital” strain (clone) and the further development of group diseases of patients and employees of a medical organization is the introduction of systemic genetic monitoring of microorganisms circulating in the hospital environment using a risk-oriented approach based on systematically organized epidemiological diagnostics. This approach is determined by the need for timely identification of groups and risk factors, both in the context of individual units and the medical organization as a whole, in order to develop effective preventive and anti-epidemic measures.

A brain-computer interface (BCI) is a system that measures brain activity and converts it in real-time into functionally useful outputs to replace, restore, enhance, supplement, and/or improve the natural outputs of the brain. In invasive BCIs, electrodes are placed intracranially for more accurate and faster data exchange between the brain and external devices. The primary medical objective of these technologies is to compensate for motor or speech function in patients with tetraparesis and anarthria. In recent years, the emergence of new neuroimplants for BCIs and the results demonstrated in clinical trials have led to a notable increase in interest in these systems from the scientific community, investors, and the public. This review compares different types of medical invasive BCIs, analyzes and discusses the achievements and unsolved problems of clinical application of these neurotechnologies, as well as possible consequences and risks of their wider use.

Background. The calculation and comparison of medical and demographic indicators in the context of the subjects of the Russian Federation and the country is not only a scientific, but also an applied tool for assessing the effectiveness of public policy measures, regional programs and the health system. The use of intensive indicators for comparing the subjects of the Russian Federation with each other is incorrect. To do this, it is more correct to use standardized values, since this eliminates the influence of differences in the gender-age composition of aggregates on the magnitude of the compared intensive indicators.

Aims — to conduct a comparative analysis of demographic indicators in the subjects of the Russian Federation using common and standardized coefficients on the example of mortality from the main causes.

Methods. In this work, the method of direct standardization was applied using Rosstat data on the average annual population of the Russian Federation and data on the number of deaths from various causes for the period 1990–2021. The actual structure of the average annual population in the analysis was replaced by a standardized one calculated based on the European Standard of the population structure of 2013.

Results. Since the European Standard for the Age Structure of the Population (ESP 2013) is currently the closest to the age structure of the population of the Russian Federation, it is recommended to use it when calculating standardized coefficients. Based on the example of assessing the mortality rates of the population in the context of the subjects of the Russian Federation, intensive indicators were initially calculated, which are presented in the form of a rating scale. When analyzing the rating of the subjects of the Russian Federation with the highest indicators of standardized mortality from all causes in 2022, the highest-ranking places were occupied by regions that previously showed “imaginary well-being” (when calculating total mortality), and a detailed assessment of which was not required. When calculating the indicators of general and standardized mortality of the population due to diseases of the circulatory system, followed by the compilation of ratings of subjects of the Russian Federation with the highest and lowest mortality rates, six subjects of the Russian Federation who were in the rating of subjects for the highest indicators of total mortality, after recalculation on standardized coefficients dropped out of it. A similar situation was observed when calculating the indicators of general and standardized mortality of the population from neoplasms, followed by the compilation of ratings of the subjects of the Russian Federation with the highest and lowest indicators.

Conclusions. Thus, using the methodology of direct standardization at the federal level allows comparing the subjects of the Russian Federation with each other on several medical and demographic indicators.

Accommodation disorders play an important role in the formation and progression of refractive errors in the modern world. Habitual accommodative excess is observed in patients starting from childhood up to the age of presbyopia, and may have a different nature. This article summarizes prevailing ideas about etiology, classification, diagnosis and treatment of accommodation disorders. The authors of the article proposed their own etiopathogenetic classification of habitual accommodative excess, which includes following groups: habitual accommodative excess in progressive myopia; habitual accommodative excess in uncorrected hyperopia and/or astigmatism; habitual accommodative excess at pre-presbyopic age; habitual accommodative excess in patients taking psychotropic medications; habitual accommodative excess as a result of acute ciliary stress after refractive surgery; habitual accommodative excess due to anisometropia; habitual accommodative excess in patients with keratoconus. The concept of acute ciliary stress was introduced for the first time. Acute ciliary stress is characterized by acute dysfunction of the ciliary muscle in early postoperative period of refractive surgery due to exposure to a femtosecond laser vacuum ring and microvascular dysfunction. This classification includes not only the causes and mechanisms of development of accommodation disorders, but also includes a differentiated approach in treatment of habitual accommodative excess.

Background. Tuberculous inflammation is mediated by a complex molecular signaling pathway, the analysis of which makes it possible to identify promising biomarkers and targets for the development of new diagnostic, prognostic and pharmacological approaches in order to improve the effectiveness of anti-tuberculosis chemotherapy. Determining the relationship between key inflammatory cytokines, the multidrug-resistant protein P-gp and the activity of specific inflammation in the surgical material of patients with pulmonary tuberculosis may prove to be a novel tool in the development of pathogenetic therapy and personalized medicine.

Aims — to characterize molecular and genetic profiles of tuberculomas and identify genes that correlate with the expression of the ABCB1 gene of the P-gp protein in the surgical material of patients with pulmonary tuberculosis. Research objectives: 1) to obtain molecular and genetic characteristics of tuberculosis by real-time PCR and compare it with the activity of tuberculous inflammation; 2) to carry out a correlation analysis between the expression of the ABCB1 gene and key cytokines of the tuberculosis process: IL-6, IL-10, IFN-γ, TGF-β, TNF-α, IL-1β.

Methods. A prospective cohort study was conducted on the basis of the FSBI CTRI. The object of the study was the surgical material of 35 patients diagnosed with multiple pulmonary tuberculomas. Histological examination methods were used for the morphological assessment of the surgical material. A real-time quantitative PCR method was used to analyze gene expression. Statistical processing was performed using the GraphPad Prism Version 7.04 software package (GraphPad Software, USA). The data is presented as a median with an interquartile range. The nonparametric Mann–Whitney U-test was used to compare the two groups. All p-values were two-sided and p < 0.05 was considered statistically significant. The correlation between the variables was estimated using the Spearman correlation coefficient. The correlation analysis was carried out in the Microsoft Office Excel 2010 Software.

Results. The study revealed that the highest level of expression of ABCB1 gene of the P-gp protein is observed in tuberculomas with high activity of tuberculous inflammation, and its expression is correlated with the expression of the IL6 gene (p < 0.001) and the expression of the IL10 gene (p < 0.01). Tuberculomas of this group are also characterized by higher expression of the TGFB1, TNF and IL1B genes, compared with the group of moderate activity of specific inflammation.

Conclusions. The data obtained indicate that in addition to pro-/anti-inflammatory cytokines, the P-gp protein plays an important role in the pathogenesis of tuberculous inflammation, especially with its high activity. Further clarification of the P-gp role in tuberculous inflammation may be an important step for the development of new approaches to treat tuberculosis using methods of HDT and personalized medicine.