Annals of the Russian academy of medical sciences

To study the effectiveness of surgical and non-surgical methods of vaginoplasty in patients with Mayer–Rokitansky–Kuster–Hauser syndrome by comparing themselves. This systematic review includes all publications in English about studies that which compare non-surgical vaginoplasty methods with surgical ones and surgical methods between themselves for the period 1975–2023. The review is written according to the PRISMA checklist. Randomized and non-randomized original clinical trials (comparative retrospective, randomized controlled, retrospective, etc.) were used for the analysis. After searching for and eliminating duplicates, 780 articles were screened, 739 of which were excluded for mismatching titles and abstracts. As a result, 23 studies were selected for qualitative synthesis. Taking into account the experience of clinical use and scientific and practical data, it can be noted the first-choice treatment should begin with non-surgical methods, but besides them, there are many options for surgical vaginoplasty methods using intestinal segments, a segment of the peritoneum, amnion, skin grafts, autologous vaginal tissue cultured in vitro, etc. Thus, there is a need for more randomized controlled trials comparing various methods of creating a neovagina in patients with Mayer–Rokitansky–Kuster–Hauser syndrome.

Background. The detection rate of obstructive changes in the coronary arteries in patients with suspected coronary artery disease (CAD) during invasive examination remains low, resulting in an unjustified increase in the burden on healthcare facilities. A study of the clinical and cost effectiveness of strategies for the primary diagnosis of CAD determines the prospects for optimizing patient routing processes and reducing costs in the healthcare system.

Aims — to evaluate the clinical and cost effectiveness of invasive coronary angiography (ICA) in patients with suspected obstructive CAD.

Methods. The retrospective study included 620 patients with low and moderate pretest probability (PTP) of CAD aged ≥ 18 years who underwent elective ICA at the Almazov National Medical Research Centrе from January to May 2025. According to the results of ICA, CAD was considered obstructive if coronary artery stenosis ≥ 50% was detected. To carry out economic calculations based on the results of ICA, two groups of patients were formed. The first group consisted of 335 patients with obstructive CAD, and the second group consisted of 285 patients without obstructive changes in the coronary arteries. Direct medical costs for inpatient ICA were calculated. The potential costs of a diagnostic strategy using coronary computed tomography angiography (CCTA) were assessed as a comparison method. Cost effectiveness analysis was performed using the tariff method of cost estimation and the cost minimization method.

Results. The clinical effectiveness of ICA in the examined cohort of patients with suspected CAD was 54%. Myocardial revascularization was performed in 38.1% of cases. An invasive strategy for the primary diagnosis of CAD is less effective than CCTA. Using a noninvasive approach, cost savings reach 17.7% of the total cost of ICA.

Conclusions. In real clinical practice, the detection rate of obstructive CAD remains low during routine invasive examination. This study demonstrates the lack of cost effectiveness of the invasive approach in patients with suspected CAD. Non-invasive CCTA in low and moderate PTP of obstructive CAD may be a promising tool for optimizing the clinical and cost effectiveness of algorithms for verifying coronary atherosclerosis by reducing the number of ICA and increasing its diagnostic value.

Anti-drug strategy at the national and regional levels requires a search for new approaches that answer the question: how to get a result in the future by determining the potential of the present. In the mechanisms of counteracting the drug business, in the field of drug use prevention in conjunction with the activities of participants in the implementation of the interdepartmental strategic direction, the development of (digital) technological foresight situations is of particular importance. The aim of the study is to present the predicted development of the drug situation in the region using foresight scenarios determined on the basis of identified trends for the development of practical measures for implementation established by strategic guidelines. The sub-goal was to analyze the drug situation data for the period from 2014 to 2024 based on the results of interdepartmental interaction of subjects of the drug prevention system in the region to form breakthrough points. The researchers concluded that foresight technologies are at the intersection of strategizing and forecasting, because they combine elements of long-term goal setting (strategy) and analysis of possible future scenarios (forecasting). Foresight technologies are a bridge between understanding (forecast) and designing the future (strategy), which allows you to proactively shape it, including the opinions of experts, citizens, and industries. According to the authors, the assessment of the results of interdepartmental interaction of subjects of the drug prevention system in the region will help determine breakthrough points for the formation of technological foresight. The use of the technology foresight methodology to analyze the processes of the anti-drug strategy in the region opens up prospects for the development of the situation using empirical validation, interdisciplinary cooperation to solve practical problems. The authors concluded that the integration of foresight into the interdepartmental anti-drug activities of the region, the country will allow identifying long-term trends and risks, choosing optimal and consensus response measures, and developing algorithms for action to approximate a specific scenario. In the long term, this sets the right guidelines for digitalization and the development of self-regulation processes, optimizes resources.

Antiseptic treatment of the root canal system is a key stage of endodontic treatment and largely determines its clinical outcome. There are a number of well-established and alternative variations of irrigation solutions. In this regard, there is a need for choice, which is difficult due to the insufficient amount of information and its fragmentation. The purpose of this systematic review is to evaluate the comparative effectiveness of various irrigation solutions in the antiseptic treatment of root canals. To solve this problem, a meta-analysis was conducted examining various irrigants. The study was searched from PubMed and Web of Science databases with the keywords: “irrigation solutions”, “irrigation efficiency”, “sodium hypochlorite”, “chlorhexidine”, “EDTA”, “root canal disinfection”, “irrigation protocol”, “ultrasonic activation”. All the papers included in the meta-analysis were analyzed for the risk of bias. At each stage of the analysis, an attempt was made to reduce the chance of an operational error to 0. As a result, 4 studies out of 4122 analyzed were included. It was found that the literature search is limited by the lack of elaboration of the topic. When analyzing the data, care must be taken and possible limitations of the study must be taken into account. Solutions based on active chlorine demonstrated the most pronounced antimicrobial activity, while phytopreparations showed significantly more variable results and require additional study. This may be due to the fact that chemical antiseptics have pronounced oxidative and proteolytic effects and are able to penetrate deeply into tissues, whereas plant extracts have a limited spectrum of activity and poorly disrupt the biofilm structure. Regression analysis taking into account the “solution exposure” covariate showed that there was no significant effect of exposure time on the degree of reduction in microbial load.

Predictable healing of the post-extraction socket remains a clinically relevant challenge, as natural alveolar ridge resorption may significantly reduce bone volume and complicate subsequent treatment planning. Although autologous platelet concentrates have gained broad clinical attention, their effectiveness across different clinical scenarios remains inconsistent, highlighting the need for a structured synthesis of current evidence. This review summarizes the available data on the use of PRP, PRF, L-PRF and A-PRF for socket healing after tooth extraction, addressing their impact on postoperative pain, swelling, soft-tissue healing, and preservation of the alveolar ridge. The search-analytical process included 19 clinical studies, most of which were randomized controlled trials. A majority of reports (78.9%) demonstrated at least one positive clinical outcome associated with platelet concentrates. The most frequently observed benefits included reduction of postoperative pain, accelerated epithelialization, decreased incidence of alveolitis, and, in several studies, improved preservation of bone volume. PRF and its modifications were shown to provide more consistent clinical outcomes than PRP, particularly during early healing phases. However, heterogeneity in centrifugation protocols, variability of study designs and small sample sizes limit the generalizability of findings and hinder the development of uniform clinical recommendations. This review offers clinicians a consolidated understanding of the potential applications of PRP and PRF in post-extraction healing, clarifies the true scope of their clinical benefits, and identifies areas where further high-quality research is required.

Background. More than 40 million people worldwide suffer from atrial fibrillation. Atrial fibrillation is often combined with chronic heart failure (CHF). All patients with atrial fibrillation and CHF, regardless of the left ventricular ejection fraction, are prescribed anticoagulants. Direct oral anticoagulants (DOACs) apixaban and rivaroxaban are widely used in patients with atrial fibrillation. However, to date, there is very little data comparing these two drugs.

Aims — сomparative evaluation of the clinical efficacy and safety profile of DOACs (apixaban and ravaroxaban) in patients based on real clinical practice data.

Methods. The study materials were based on the results of the analysis of commercial data on the use of DOACs (apixaban, rivaroxaban) from the depersonalized Optum Clinformatics Data Mart database for the period from January 1, 2013 to December 31, 2020. The primary efficacy indicator was a comprehensive indicator of ischemic stroke. The primary safety indicator was a comprehensive indicator of gastrointestinal bleeding. Information on adverse reactions was obtained from a specialized website VigiAccess (http://www.vigiaccess.org). As an analytical tool, attribute statistics methods were used to determine the risk of developing a particular condition against the background of using the analyzed drug relative to the comparison drug.

Results. During the analysis of two compared drugs (rivaroxaban versus apixaban), the following values of statistical parameters were obtained: AR — 0.3% (95% CI: 0.08–0.52%); OR — 1.61 (95% CI: 0.43–2.80); PAR — 0.15% (95% CI: 0.03–0.34%). The use of rivaroxaban increases the likelihood of developing ischemic stroke compared to the use of apixaban by 0.15% in the entire population. According to the electronic resource VigiAccess, 174,234 reports of adverse events were identified for apixaban (as of 16.07.2025), and 177,285 similar reports for rivaroxaban as of the same date. Circulatory disorders were noted in the total number of reports in 7% of cases for apixaban, and in 9% for rivaroxaban. Apixaban and rivaroxaban are substrates of both CYP3A4 and P-glycoprotein (P-gp). Coadministration with CYP3A4 and P-gp inhibitors increases plasma concentrations of DOACs and increases the risk of bleeding. Coadministration with CYP3A4 and P-gp inducers decreases plasma concentrations of DOACs and increases the risk of thrombosis and thromboembolic events.

Conclusions. Apixaban and rivaroxaban demonstrate similar efficacy in relation to the primary goal — prevention of stroke and thrombosis. The safety and efficacy of therapy with OPA is determined by optimizing the choice of drug and its dose, taking into account possible drug interactions, and dose adjustment in case of liver and kidney dysfunction.