Annals of the Russian academy of medical sciences

Cardiorenal syndrome is a clinical and pathogenetic complex involving the simultaneous development of damage to the cardiovascular system and kidneys as a complication of various diseases. The development of cardiorenal syndrome always leads to a significant deterioration of the immediate and long-term prognosis, lengthening hospital stay, including intensive care, and increasing the need for dialysis and other treatment methods, as well as in-creasing the cost of care. Therefore, it is important to search for early diagnostic markers for cardiorenal syndromes, especially those that allow accurate assessment of the risk of development. Establishing diagnostic markers for cardiorenal syndromes is possible through identification of key pathogenic mechanisms, with endothelial dysfunction being universal in all disease processes. The provision of medical care for patients with cardiorenal syndrome can only be effective in a multidisciplinary expert-level hospital. University clinics meet these requirements most effectively.

During pregnancy, there is an increased tendency to develop rhythm disturbances. The treatment of arrhythmias in pregnant women, including the use of antiarrhythmic drugs, has significant features and presents significant problems for medical professionals. The use of most drugs in this group during pregnancy is unsafe due to potential teratogenic effects. Some drugs can cause complications such as birth defects, pregnancy loss, premature birth, infant death, or developmental delays. Preconception counseling regarding the risk of arrhythmia recurrence during pregnancy, consideration of ablation before pregnancy, effective treatment, and close monitoring of high-risk patients can be critical to a successful pregnancy outcome for both mother and fetus. Much attention in the article is paid to the safety of the treatment of rhythm disorders during pregnancy, the features of the use of specific antiarrhythmic drugs, their effect on the body of the mother and fetus, as well as the algorithm of their use in various types of arrhythmias are considered in detail.

Background. Among the most significant risk factors for the development of cervical cancer is human papillomavirus (HPV) infection. Stratifying patients by risk of progression is essential for a differentiated approach to cervical cancer treatment. There are currently insufficient studies examining the relationship between HPV-associated cervical cancer and risk factors for progression to assess survival prognosis. Aims — to assess the role of HPV infection in the formation of postoperative risk factors for progression and survival prognosis in patients with cervical cancer. Methods. A retrospective study was conducted involving 194 patients with stage I–II cervical cancer (TNM) after radical hysterectomy according to Wertheim with a course of radiation therapy at the Republican Oncology Center named after prof. G.V. Bondar of the Ministry of Health of the Donetsk People’s Republic from 2014 to 2022. PCR testing was used to form groups with HPV-positive and HPV-negative status. A comparative analysis of differences in the frequencies of data between the groups, such as age, cervical cancer stage, size, histological type and degree of differentiation of the tumor, LVSI, and depth of stromal invasion (DSI), was performed using the χ² criterion. The association of HPV status with overall survival (OS) and relapse-free survival (RFS) was estimated using the Kaplan-Meier method. To study the influence of risk factors on survival rates in the HPV-positive group, univariate and multivariate analysis of the Cox proportional hazards regression model was used. Results. HPV-positive status was determined in 118 patients (60.82%), HPV-negative status in 76 (39.18%). In HPV infection, the number of patients with moderate tumor differentiation prevailed (p = 0.003). LVSI (p = 0.045), with DSI more than 1/3 of the cervical myometrial thickness (p = 0.006), with a tumor size of > 4 cm (p = 0.027). The 5-year OS rates with HPV-positive status and HPV-negative status were 92.37 and 98.68% (p = 0.027), 5-year RFS — 83.05 and 98.68% (p = 0.0001). In multivariate analysis, the significant factor for OS was the histological type of adenocarcinoma (p = 0.008), for RFS – adenocarcinoma (p = 0.031) and the degree of moderate differentiation (p = 0.013) and GSI > 1/3 of the myometrial wall (p = 0.013). Conclusions. An association between HPV infection in cervical cancer and decreased OS and RFS has been established. Significant prognostic factors associated with an increased risk of recurrence in cervical cancer included the histological type of adenocarcinoma, the degree of moderate differentiation, and a GSI greater than one-third of the cervical wall thickness. The results of clinical and pathological parameters in cervical cancer are important for risk stratification and treatment strategies.

Breast cancer remains a serious public health problem worldwide. Screening programs for malignant breast tumors have been developed to reduce mortality, increase treatment effectiveness, improve prognosis, and enhance patient quality of life after treatment. Over the past few decades, medicine has evolved from the first mention of the need for early cancer diagnosis to the active implementation of artificial intelligence programs aimed at improving the quality of screening. Modern technologies open up new opportunities, reducing physician workload and increasing the effectiveness of prevention. This article examines the results of breast cancer screening in the Russian Federation based on statistical data. A comparison of screening effectiveness in global practice is provided. It presents global literature data on the application of artificial intelligence programs in breast cancer screening, as well as current and anticipated long-term results of integrating a decision support system into practical healthcare to improve the effectiveness of breast cancer screening programs. For this literature review, sources published in open scientific databases such as PubMed and Elibrary, as well as those included in the Russian Science Citation Index (RSCI), Higher Attestation Commission (VAK), Russian Science Citation Index (RSCI), SCOPUS, and Web of Science (Web of Science) were selected. The search strategy included keywords and Boolean operators to more precisely select relevant publications. The following key terms were used “breast cancer”, “breast cancer screening”, “clinical guidelines”, “cancer diagnostics", and “methodological guidelines”, with the AND and OR operators used to combine terms. Publication selection was limited to articles from the past five years to include the most current information. Literature sources beyond this time period were used for historical reference to reflect changes in approaches and methods for diagnosis and treatment. This work is based on the current 2021 Russian Federation clinical guidelines for breast cancer, as well as methodological guidelines for breast cancer screening as part of medical examinations for certain groups of the adult population. This approach allows for a comprehensive and balanced understanding of the current state of the problem and methods of breast cancer diagnosis in Russia.

Background. Primary adrenal insufficiency (PAI) is an endocrine disorder caused by the gradual destruction of all three layers of the adrenal cortex and characterized by insufficient secretion of cortisol and aldosterone. This condition significantly reduces patients’ quality of life, making its timely diagnosis crucial. Autoimmune disorders are the etiological factor in approximately 80% of PAI cases, making the search for predictive markers in innate immune genes one of the most promising areas for predicting the odds of developing PAI. Aims — to study the associations between single nucleotide polymorphisms in the TLR2 and TLR9 genes and the development of PAI. Methods. The study included 222 individuals: 72 patients with PAI and 150 controls. For the study, DNA was isolated from venous blood and subsequently analyzed using real-time PCR with fluorescently labeled probes. Statistical analysis of the results was performed using Fisher’s exact test (Fi), the χ² test, the χ² test with Yates’ correction, calculation of the odds ratio and 95% confidence interval. Results. The study revealed that the A allele (p < 0.001) and the heterozygous genotype (p < 0.001) of the rs5743708 polymorphism in the TLR2 gene were associated with the risk of developing PAI. Conversely, the homozygous genotype GG (p < 0.001) reduced the odds of the pathology development by 11-fold. Analysis of the rs352140 single nucleotide polymorphism in the TLR9 gene also demonstrated an association between the A allele (p = 0.030) and the homozygous AA genotype (p = 0.0171) with the odds of developing PAI. Conclusions. Based on the data obtained in this and our previous study, a scheme was proposed that includes four polymorphic markers to predict the odds of developing 1-HH.

Background. Despite significant progress in controlling leprosy incidence, the problem of relapses remains relevant, especially in endemic regions. Analysis of long-term dynamics of relapses and factors influencing their development is necessary to optimize treatment tactics and follow-up observation. Aims — to study the frequency, structure and risk factors for leprosy relapses based on a 70-year retrospective observation, to evaluate the evolution of therapeutic approaches and their impact on disease recurrence. Methods. A retrospective continuous cohort study was conducted. We analyzed 1165 medical records of patients with verified leprosy registered at the Astrakhan Leprosy Dispensary in 1951–2020. A total of 465 relapse cases (1959–2019) were studied. The association of relapses with the clinical form, type of therapy and duration of remission was assessed. Descriptive statistics, χ² test and multivariate logistic regression analysis were used. Results. The dynamics of relapses had three periods: a high frequency period in the era of dapsone monotherapy (1959–1976; 297 cases; 63.9%); a steady decline period with the introduction of combined therapy (1977–1990; 80 cases; 17.2%); a period of sporadic relapses (1991–2019; 88 cases; 18.9%) with near-complete elimination after 2008 (3 cases). It was found that 68.8% of relapses developed in patients with an initial multibacillary (MB) form of leprosy. Multivariate analysis identified independent risk factors: MB form (OR — 4.8; 95% CI: 3.2–7.1; p < 0.001), dapsone monotherapy (OR — 6.2; 95% CI: 4.1–9.3; p < 0.001), irregular/incomplete treatment (OR — 3.9; 95% CI: 2.5–6.1; p < 0.001), and high bacterial index (OR — 5.3; 95% CI: 3.4–8.2; p < 0.001). Conclusions. The problem of leprosy relapses in modern conditions has been solved due to the transition to standardized WHO multidrug therapy. The key risk factor is the MB form. The obtained data substantiate the need for differentiated follow-up observation of patients depending on the initial clinical form and received therapy.

On the 90th Anniversary of Academician of the Russian Academy of Sciences Igor Ivanovich On February 20, 2026, the 90th anniversary was celebrated by Igor Ivanovich Zatevakhin, an outstanding scientist, a world-renowned surgeon, a prominent public figure, a talented teacher, an Honored Scientist of the Russian Federation, a recipient of the Government of the Russian Federation Prize in Science and Technology, the Head of the Department of Faculty Surgery at the Institute of Surgery of the Pirogov Russian National Research Medical University, and the Honorary President of the Russian Society of Surgeons.