Vol 79, No 4 (2024)

The purpose of this publication was to update knowledge about non-alcoholic fatty liver disease (NAFLD) and fibrogenesis, as well as factors that have a positive or negative prognostic value in relation to the formation and progression of liver fibrosis. This review article contains the current literature dates about pathogenetic factors of the development of liver fibrosis in NAFLD and conceptual ideas about its diagnosis at this moment. Obviously, along with genetic and epigenetic factors, hyper- and disproduction of organokines affect to the progression of the disease. Evaluation of the quantitative and qualitative composition of the microbiota, the integrity of the epithelial intestinal barrier are perceptual fields for research this problem. Non-invasive proprietary and non-proprietary scales for assessing the risk of steatosis and fibrosis, transient elastometry are suitable for routine assessment of individual risk of disease development and progression. This scientific review demonstrates proofs of necessity to develop individual strategies for the management of patients with NAFLD in relation to its metabolic activity and the stage of liver fibrosis.

Background. Currently, data on hospital mortality and the frequency of complications of myocardial infarction in patients aged 75 and older with myocardial infarction with ST-segment elevation (STEMI) and without ST-segment elevation (NSTEMI) are inconclusive. New carefully planned retrospective and prospective studies are needed to clarify them.

Aims — to compare hospital mortality and the frequency of myocardial infarction complications among patients admitted to a cardiology ward with the possibility of percutaneous coronary intervention, with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) in patients ≥ 75 years of age.

Methods. A retrospective analysis of medical records of 437 consecutively enrolled patients aged ≥ 75 years, hospitalized in a cardiology department due to myocardial infarction during 2020–2021, was conducted. This section of the study included patients with STEMI (174 patients) and NSTEMI (119 patients). Considering the presence of statistically significant differences between the compared groups (STEMI and NSTEMI) based on clinical and anamnestic data, pseudo-randomization was performed using propensity score matching (PSM) based on all studied clinical and anamnestic data and the administered treatment, resulting in two groups of 78 patients each.

Results. The frequency of myocardial infarction complications differed between patients with STEMI and NSTEMI before PSM. Atrial fibrillation occurred significantly more often in patients with STEMI compared to those with NSTEMI: in 26.4 and 16.0% of cases, respectively (p = 0.034). Atrioventricular blocks of 2–3rd degree complicated the course of myocardial infarction in 14.4% of patients with STEMI and 5.0% of those with NSTEMI (p = 0.011). After PSM, the frequency of all developed complications among patients with STEMI and NSTEMI didn`t show statistically significant differences. The incidence of deaths before PSM didn`t differ statistically significantly. After PSM, the death rate also remained comparable: at STEMI 28.2% and at NSTEMI 15.4% (p = 0.131).

Conclusions. This study demonstrated no statistically significant difference in hospital mortality rates and the development of myocardial infarction complications in comparable groups of patients with STEMI and NSTEMI after balancing the groups using the “pseudo-randomization” method among individuals aged 75 years and older, this may be due to the retrospective nature of the study and the small sample of patients. To further clarify the obtained data, prospective research of similar design with patient randomization at the inclusion stage is required.

Background. Molecular genetic tests play an important role in the care of patients with cancer. Prescribing a number of precision medicines requires concomitant diagnostic testing. Clinical guidelines accelerate implementation of approved clinical interventions, including molecular genetic testing.

Aims — to analyze and compare recommendations for ordering molecular genetic testing in non-small cell lung cancer (NSCLC) between Russian and foreign guidelines.

Methods. The study included guidelines published in the Rubricator of Clinical Guidelines of the Ministry of Health of Russia, the European Society of Medical Oncology, the American Society of Clinical Oncology and the National Network of Multidisciplinary Oncological Institutions. Recommendations for genetic testing to identify sensitizing mutations in genes in NSCLC and information on study methods were extracted from the selected guidelines.

Results. This resulted in a list of genes recommended for testing in NSCLC: EGFR, BRAF, ALK, ROS1, NTRK, ERBB2, MET, RET, KRAS. The list of genes recommended for testing was the same in all included guidelines, except the Rubricator guideline. Recommendations for assigning tests to identify gene variants within guidelines for the same association tended to have the same level of evidence. However, for some genes, the level of evidence differed between associations. We found that not all guidelines describe research methods. An analysis of the recommended testing methods has shown that a significant proportion of studies are recommended to be conducted using next-generation sequencing, including using genetic panels.

Conclusions. The results of the analysis show the differences between foreign and Russian guidelines in the approaches to prescribing molecular genetic testing and methods of performing it. Currently, EGFR, BRAF, ALK, ROS1, ERBB2, MET, RET are the main genes recommended for testing, and studies are usually performed in metastatic NSCLC. A significant proportion of studies are recommended to use NGS, including the use of genetic panels.

The aim of this article is to analyse a new trend in the cataract surgery, to clarify what a definition, positioning by manufacturer, standards of the extended depth-of-focus (EDOF) IOLs. In this review we classify the different types of the EDOF lenses based on their optical principle and discuss the recently specific calculation and indications for implantation of the extended depth-of-focus intraocular lenses.

Nephrotoxicity is one of the main dose-limiting factors for cisplatin in anticancer chemotherapy. The limitations of traditional indicators of renal function, such as blood creatinine and urea nitrogen, encourage the search for new informative markers that allow early diagnosis of cisplatin-induced nephrotoxicity in order to properly maintain kidney health and timely correct the treatment plan. This review provides a general description of biomarkers of acute kidney injury (AKI), which have received special attention in this aspect today. Experimental and clinical data from recent years regarding these indicators in cisplatin-induced AKI are presented, with an emphasis on one of the most promising biomarkers, kidney injury molecule 1 (KIM-1).

Background. Pulmonary involvement in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is an important cause of mortality. The main variants of AAV are granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA).

Aims — to define the prevalence of pulmonary involvement in AAV patients and describe its computed tomography (CT)-patterns.

Methods. A retrospective study was conducted. The study included patients with GPA and MPA. The diagnosis was established in accordance with the American College of Rheumatology (1990) criteria of GPA or the Chapel-Hill (2012) conference AAV definitions, as well as the classification criteria of GPA and MPA of the American College of Rheumatology and the European Alliance of Associations for Rheumatology (2022). All patients underwent chest CT. The primary endpoint was lung involvement, as determined by the results of a clinical and instrumental examination.

Results. 243 patients (median age of onset 49.0 (35.0; 59.0); 167 (68.7%) women) with AAV were included in the study, including 171 with GPA and 72 with MPA. Lung damage was established in 175 (72.0%) patients (121 (70.8%) in GPA and 54 (75.0%) in MPA). The following variants of pulmonary involvement in AAV were registered: parenchymal infiltrates — 103 (58.9%); alveolar hemorrhage — 33 (18.9%); nodular disease — 58 (33.1%); cavities — 28 (16.0%); subclinical interstitial lung disease (ILD) — 43 (24.6%); ILD — 8 (4.6%); signs of fibrosis — 135 (77.1%); bronchiectasis — 24 (13.7%); and pleural effusion — 3 (1.7%). In GPA patients, cavities were more prevalent (p < 0.001), so alveolar hemorrhage was in MPA (p < 0.001). PR3-ANCA (OR: 3.25; 95% CI: 1.40–7.49) and general symptoms (fever, weight loss) (OR: 2.41; 95% CI: 1.28–4.54) were associated with pulmonary damage according to the logistic regression model.

Conclusions. Pulmonary involvement in AAV is frequent. Among 243 patients with MPA and GPA who underwent a CT scan of the chest, 72% had lung abnormalities. These findings may have important implications for the diagnosis and management of AAV lung manifestations.

Artificial intelligence (AI) in healthcare can be used to solve a wide range of tasks, such as diagnosis, treatment and self-monitoring of patients. This review is devoted to the problem of polypharmacotherapy, the development of adverse drug reactions as a consequence of it and the use of AI in this field. AI allows to analyze drug interactions, identify possible adverse drug reactions and suggest optimal combinations of drugs and drug regimen. The use of clinical decision support systems, which are developed in various countries, has shown improved efficiency of the doctor’s work and increased patient’s safety with the help of AI. The use of AI in polypharmacotherapy requires further research and development to improve software products that would allow evaluating not only paired, but also multiple drug interactions.

For many centuries, scientists have been trying to find an answer to the question: why do living organisms age? Many scientific theories have been proposed to explain individual mechanisms of aging. However, even their integral analysis does not allow us to develop a universal theory of aging. At the same time, all existing theories classify aging as a purely negative phenomenon of life. Target of review — to show the fundamental role of aging in the evolutionary development of living matter. A fundamentally new interpretation of the biological meaning of aging in the process of ontogenesis and the development of living nature as a whole is given in the form of a hypothesis of the collection, formation and archiving of structural information in the tissues of the body at the molecular level. It is assumed that evolutionary development is carried out through mutation of genome molecules and the conformation of protein molecules. These transformations result from the search by organic molecules for new information, which is archived in their structure in the form of rigid blocks. As information archives grow, the functionally active part of the organic molecule decreases. These changes are at the heart of the aging process. Upon reaching the limit of archival accumulation of new information, structural formations cease their vital activity and undergo metabolic processing by their own body or other organisms of the biosphere. A hypothesis has been put forward about the basic mechanism of aging of the body in the form of collection, processing and archiving of molecular biological information. The continuous exchange between organisms of constantly improving structural blocks of molecular information in the biosphere through universal metabolism determines the evolutionary development of living matter as a whole.

The article provides an overview of the main stages of work on the prevention of diseases associated with iodine deficiency in the USSR and the Russian Federation, highlights the current state of the problem, and presents data from studies of iodine provision of the population of the Russian Federation conducted in the period 2020–2023. Ways to solve the problem of diseases associated with iodine deficiency at the present stage are proposed in the context of the Health and Demography national projects at the federal and regional levels. Assessing the scale of the threat of uncompensated iodine deficiency to the health and intelligence of current and future generations, it is obvious that the law on population iodine prevention in Russia is necessary.

April 1, 2024 marked the 60th anniversary of the birth of a prominent scientist, an outstanding specialist in the field of oncology, laureate of the State Prize of the Russian Federation in the field of science and technology, Knight of the Order of Friendship, Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences Ivan S. Stilidi.

On May 29, 2024, the 60th anniversary of the birth of the largest specialist and outstanding scientist, one of the leading Russian specialists in the field of microsurgery and oncology, a talented healthcare organizer, innovator and teacher, director of the Levshin Institute of Cluster Oncology, head of the Department of Oncology, Radiotherapy and Reconstructive Surgery of the N.V. Sklifosovsky Institute of Clinical Medicine was celebrated Federal State Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University) Ministry of Health of the Russian Federation, laureate of the State Prize of the Russian Federation in the field of science and technology, twice laureate of the Prize of the Government of the Russian Federation in the field of science and technology, Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences Igor V. Reshetov.