Ministry Of Health Of The Russian Federation

Chronic non-specific low back pain (CNSLBP) is a debilitating condition that affects millions of people worldwide, significantly impacting quality of life and imposing a substantial socioeconomic burden. Traditional treatment approaches often rely on a one-size-fits-all strategy, failing to account for individual variations in pathophysiological mechanisms, drivers, and the principles of personalized medicine. Furthermore, an overemphasis on biomechanical findings from imaging may lead to ineffective interventions and unnecessary surgical procedures, obscuring other important factors that contribute to pain perception. While highlighting the limitations of universal treatment approaches, in this review we present a practical clinical approach aimed at elucidating the main pathophysiological mechanisms and various factors underlying the development and maintenance of CNSLBP in order to create a personalized treatment program. In conclusion, this review underscores the need for personalized therapeutic strategies that take into account the unique characteristics of each patient, recognizing the complex interaction of biological, psychological, social, and other factors that contribute to the development of individual pain. By combining a comprehensive understanding of the complexities of this condition, we aim to improve clinical outcomes and provide information on the development of effective personalized treatment algorithms, particularly in the field of neurological practice.

The global telemedicine technology (TMT) regulatory landscape is currently evolving in a number of ways. The goal is to carry out an analytical examination of the institutional and legal frameworks for medical treatment including telemedicine consultation (TMC) in Russian Federation and foreign countries. The regulatory legal regulation of 22 international healthcare systems was included in the final version of the review. The review’s findings allow for the identification of the most important organizational and legal facets of delivering healthcare via TMC abroad: the majority of foreign nations lack comprehensive legal regulations governing the use of TMT in healthcare; the ability to establish a diagnosis within the context of TMC only follows an initial in-person consultation with a doctor; conducting TMC exclusively by licensed medical professionals and medical organizations; the option to conduct TMC via government-designed platforms and publicly accessible information platforms; requiring the patient to be informed about the benefits and drawbacks of TMT prior to consultation and to provide written or verbal informed consent; and requiring adherence to standards and recommendations during TMC, application, and in-person admission of the patient. The analysis demonstrates how commonplace TMC is abroad. However, there are currently no well-defined organizational or regulatory requirements for the use of TMC in the delivery of medical care, which calls for additional research into global experience and the identification of best practices that may be expanded throughout the Russian Federation.

OBJECTIVE The purpose of this study was to present a newly designed 3D-printed personalized model (3D PPM) of a radiofrequency needle guide with a maxillary fixation for gasserian ganglion (GG) puncture. METHODS Implementation of 3D CT–guided radiofrequency therapy of the GG with and without use of 3D PPM was analyzed. The following parameters were assessed: radiation time, dose area product, air kerma reference point, pain severity during the puncture needle insertion, prosopalgia regression degree (according to visual analog scale) and the severity of facial numbness (according to the Barrow Neurological Institute scale) in the early postoperative period, and postpuncture complications. RESULTS Pain severity reduction was equivalent in both groups, and postoperative facial numbness was not observed. A statistically significant difference in radiation exposure parameters was revealed: radiation time was 181.67 ± 2.99 and 310.50 ± 18.46 seconds (p < 0.001); dose area product was 950.97 ± 115.41 and 1545.48 ± 135.04 µGy*m ² (p < 0.005); and the air kerma reference point was 114.53 ± 16.81 and 190.88 ± 17.48 mGy (p < 0.005) in groups 1 and 2, respectively. The severity of pain during a puncture needle insertion was assessed as mild in 62.5% and 25%, moderate in 37.5% and 41.6%, and severe in 0% and 33.3% of patients in groups 1 and 2, respectively. No serious perioperative complications were observed. CONCLUSIONS The use of 3D PPM allows for controlled needle insertion, reducing the radiation dose to the patient and medical staff, reducing pain during a puncture needle insertion into the area of the foramen ovale, and minimizing the risk of postoperative complications.

Aim . To study the clinical-biochemical parameters, APOE gene polymorphism in women with gallstone disease (GSD) with/without type 2 diabetes mellitus (T2DM). Materials and methods . In the open, single-stage, single-center, observational, cross-sectional, uncontrolled case-series study, 137 women with GSD were examined, including 71 patients with GSD and T2DM (Group 1), 66 patients – GSD without T2DM (Group 2) comparable age and BMI. The inspection included clinical examination, biochemical blood tests, including lipid profile, APOE gene polymorphism identification by PCR. Results . In group 1 met more often than in group 2 pain in the right hypochondrium (97.2 % vs. 86.4 %), in the left hypochondrium (42.3 % vs. 22.7 %), belching (88.7 % vs. 59.1 %), heartburn (78.9 % vs. 50.0 %), bitterness in the mouth (87.3 % vs. 57.6 %), stool disorders (83.1 % vs. 48.5 %, p < 0.05 in all cases). In group 1 were significantly higher than in group 2, TG (1.9 [1.5; 2.6] vs. 1.4 [1.0; 2.0] mmol/l), atherogenic coefficient (AC) (3.9 [3.1; 4.5] vs. 3.4 [2.5; 4.4] units), HDL-C – significantly lower (1.1 [1.0; 1.3] vs. 1.2 [1.1; 1.6] mmol/l). HypoHDL-C (69.0 % vs. 45.5 %) and hyperTG (66. 2% vs. 36.4 %) significantly more often observed in group 1. Systolic (140,0 [130,0; 150,0] and 130,0 [120,0; 130,0] mmHg, р < 0,001), diastolic blood pressure (SBP, DBP) (90,0 [80,0; 90,0] and 80,0 [80,0; 90,0] mmHg, р < 0,001), in group 1 higher than in group 2. APOE gene alleles frequency in group 1 and 2 is similar. There were no differences in the lipidogram in carriers of different alleles of the APOE gene in group 1. Conclusions . The presence of GSD and T2DM in group 1, both with cholecystolithiasis and after cholecystectomy, is associated with more conspicuous gastroenterological symptoms, lipid metabolism disorders, SBP, DBP increase, compared to group 2. There were no differences in the frequency of the alleles of the AРOE in groups 1 and 2, as well as in the lipidogram of carriers of different alleles of the AРOE in group 1.

Relevance . A distinctive feature of the influenza is the risk of severe complications, including cardiovascular (myocarditis or pericarditis) and nervous (encephalitis, meningoencephalitis and arachnoiditis) systems. Vaccination against influenza can significantly reduce the risk of disease, including complications and deaths. The aim of our study was to evaluate the epidemiological effectiveness of a quadrivalent inactivated split influenza vaccine in the 2023 –2024 season. Materials and methods . The study investigated the effectiveness of the tetravalent inactivated split vaccine Ultrix Quadri®. Vaccination data were collected in the regions of the Russian Federation as of January 1, 2024, in which a statistically significant amount of Ultrix Quadri® vaccine was used. The work was carried out using methods of variational statistics. The indicators of relative and attributive risks were evaluated, the Cochrane-Mantel-Hensel approach was applied, taking into account the assessment of heterogeneity of the results, and the effectiveness of the vaccine was evaluated. Results . The study showed that the risk of getting the flu among those vaccinated with Ultrix Quadri® vaccine was 122 (88-170) times lower than in those not vaccinated, which indicates the high epidemiological effectiveness of the vaccine. Cases of influenza among those vaccinated were observed in December 2023 - January 2024, that is, at the beginning of the epidemic season, during the period of the greatest rise in morbidity. At the same time, in absolute terms, their number was minimal. (414 cases out of 9.7 million vaccinated). From February to June 2024, the incidence of influenza among those vaccinated with the studied vaccine (with the exception of isolated cases) was not recorded. Conclusion . The conducted study demonstrated the high real epidemiological effectiveness of the Ultrix Quadri® vaccine during the epidemic season of influenza and ORI 2023/2024.

Relevance . Pneumococcal infection remains one of the most significant health problems worldwide. Vaccination of adults against it has been carried out in the Russian Federation for over 10 years. During this time, more than 9 million people have been vaccinated. However, data on the level of coverage among adults of certain risk categories are not routinely collected. Our study in 2019 showed that it was low in most groups. Given the significant increase in the volume of vaccination over the past five years, it seems appropriate to conduct a study to assess changes in the level of coverage. Aim . To study the level of vaccination coverage against pneumococcal infection in adult risk groups in the Russian Federation. Materials and methods . An observational descriptive retrospective epidemiological study was conducted. Information on the number and contingents of people vaccinated against pneumococcal infection was collected by sending a request to the executive authorities of the constituent entities of the Russian Federation in the field of healthcare. The depth of data collection was 8 years (from 2015 to 2023 inclusive), information was received from 74 out of 89 regions. In addition, federal statistical observation forms were used: No. 5 «Information on preventive vaccinations» and No. 6 «Information on the contingents of children and adults vaccinated against infectious diseases», data from the Unified Interdepartmental Information and Statistical System. The results obtained were compared with the indicators obtained in the 2019 study, which was conducted according to a similar design. The analysis was carried out using descriptive statistics methods. Results . The coverage rate of vaccination against pneumococcal infection among the adult population in the Russian Federation increased from 1.5% in 2018 to 7.7% in 2023. The most significant coverage rates were achieved among persons subject to conscription for military service (78.5%) and persons over 60 years old, living in residential care facilities (87.7%). By 2023, vaccination coverage has increased among the following risk categories: individuals with chronic bronchopulmonary diseases (from 15.1% in 2018 to 47.9% in 2023), chronic heart diseases (from 3.8% to 17.0%), patients with endocrine diseases (from 1.1% to 17.6%), liver diseases (from 4.0% to 12.0%), healthcare workers (from 4.9% to 19.7%), school and preschool employees (from 3.1% to 12.9%), employees of residential care facilities (homes for elderly, nursing homes, ect.) (from 0.1% to 26.9%), the elderly population as a whole (from 1.4% to 12.7%), and working-age men (from 1.4% to 7.0%). There was virtually no increase in coverage among all groups of immunocompromised patients (1.0% in 2018, 6.2% in 2023), the working population with risk factors harmful to the respiratory system (0.9% in 2018, 5.0% in 2023), workers in the oil and gas and chemical industries (1.3% in 2018, 1.8% in 2023). Conclusion . The obtained results indicate the need to develop a strategy of measures to promote increased vaccination coverage in risk groups that are insufficiently covered by vaccination against pneumococcal infection.

The strategy of correcting the composition of the intestinal microbiota shows significant promise for the treatment of gastrointestinal diseases. There is a confirmed link between the state of the colonic microbiota and human pathologies. Monkeys—in particular, rhesus macaques—are recognized as the best animal model to study the mechanisms controlling the development of both acute and chronic inflammation. The similarity of key anatomical and physiological systems between macaques and humans provides significant advantages for conducting biomedical research aimed at evaluating the safety and efficacy of microbial drugs designed to normalize intestinal microbiocenoses using these animals. The aim of the study was to analyze the taxonomic composition of the intestinal microbiota of rhesus macaques of different ages kept in captivity. Seventeen fecal samples collected from clinically healthy rhesus macaques kept in captivity were included in the study. DNA was isolated from fecal samples using a MagMAX Microbiome Ultra Nucleic Acid Isolation Kit. Samples were analyzed by metagenomic sequencing of the V3–V4 region of the 16S rRNA gene. Analysis of the 16S rRNA metagenomic sequencing data showed that the intestinal microbiota of rhesus macaques is dominated by the bacteria belonging to the Firmicutes, Bacteriodetes, and Actinobacteriota phyla, which are also predominant in humans, and that the ratio between them varies in different age groups. A decrease in Actinobacteriota abundance and Firmicutes/Bacteriodetes ratio was observed with age. The α diversity of gut microbiota was not statistically different between different age groups of rhesus macaques, while the highest absolute values of alpha diversity were observed in the group of young individuals. The analysis of differential abundance showed that the gut microbiota of young individuals was enriched with butyrate-producing bacteria, indicating that the local intestinal immunity was not disturbed. Older individuals showed an increased content of Streptococcus and Lachnospiraceae, which may be interpreted as a marker of inflammation reflecting the age-related specificities of the monkey gut microbiota. The gut microbiota of rhesus macaques varies between age groups, with less variation being observed within the groups of babies and young individuals than in the group of old individuals. The results of sequencing monkey intestinal microbiota demonstrated the similarity of its composition to the human intestinal microbiota, the specificities of the age-related changes in the taxonomic composition of the intestinal microbiota of rhesus macaques, which to certain extent allows the use of rhesus macaques as a model to study the age dynamics of human intestinal microbiota, which is promising for age-related studies of various substances, compositions and other factors affecting human body potentially capable of exerting positive or negative effects on the human microbiota.

Background The real-world effectiveness of intravenous (IV) belimumab in treating systemic lupus erythematosus (SLE) has been demonstrated in various countries through the OBSErve (evaluation Of use of Belimumab in clinical practice SEttings) program. Here we describe the clinical effectiveness of IV belimumab for treating SLE in real-world clinical practice in the Russian Federation. Methods In the retrospective, observational OBSErve Russia study (GSK Study 215349), eligible physicians enrolled adults with SLE receiving IV belimumab as part of their standard care. De-identified data were collected from patient medical records from September 2021 to March 2022. The primary outcome was the physician-assessed overall clinical response at 6 months post-index versus index (belimumab initiation) among patients receiving belimumab for ≥6 months. Other endpoints included change in Safety of Estrogens in Lupus Erythematosus National Assessment – SLE Disease Activity Index (SELENA-SLEDAI) score and glucocorticoid use. Results Overall, 59 patients initiated IV belimumab, mainly due to the previous regimen not being effective and to decrease glucocorticoid use (76.3% each); 15.3% of patients started belimumab within the first year of SLE diagnosis. Only 13.6% of patients discontinued belimumab within the first 6 months, mainly due to loss to follow-up and loss of insurance/reimbursement. At 6 months post-index, among patients who completed ≥6 months of belimumab therapy (full analysis set, n = 53), 90.6% and 60.4% had an overall clinical improvement of ≥20% and ≥50%, respectively. Mean (standard deviation, SD) change in SELENA-SLEDAI score from index to 6 months post-index was −5.9 (4.3). Mean (SD) glucocorticoid dose decreased from 12.2 (7.3) mg/day at index to 8.6 (5.1) mg/day at 6 months post-index (n = 50). Conclusions Patients with SLE receiving IV belimumab for 6 months in real-world settings in the Russian Federation experienced overall clinical improvements and reductions in glucocorticoid use, which is an important long-term strategy of SLE treatment.

Compared to the year of the COVID-19 (COronaVIrus Disease 2019) pandemic outbreak, the year 2023 witnessed an increased number of cases when patients with new coronavirus infection were transferred from non-infectious hospitals to infectious ones, which led to the assumption of the transition of SARS-CoV-2 (Severe acute respiratory syndrome-related coronavirus 2) infection to the category of nosocomial infections. Objective of the study: to study the dynamics of changes in the frequency of hospitalization of patients with a confirmed diagnosis of COVID-19 in the Irkutsk Regional Infectious Diseases Clinical Hospital from noninfectious hospitals to confirm the hypothesis about transition of the new coronavirus infection to the category of nosocomial infections. Materials and methods of the study. A retrospective analysis of 510 inpatient observation medical records of patients with a confirmed diagnosis of COVID-19 who were admitted to the Irkutsk Regional Clinical Institution and were treated in 2020 (250 medical records) and 2023 (260 medical records) was carried out. Statistical processing of the study results was carried out using the data analysis package in Microsoft Excel and online calculators on the website https://medstatistic.ru/index.php. Statistical significance was assessed at p≤0.05. Conclusion. The results obtained showed that over time the new coronavirus infection acquires features of nosocomial infections. This study demonstrates an increased average age of patients, as well as an increase in the number of patients with different comorbidities with a simultaneous shorter staying at hospital due to a decreased proportion of severely ill patients. In both the periods compared, women predominated among patients.

In vitro and in vivo effects of mesoporous silica nanoparticles (MSN) on the functional activity of platelets were studied in experiments on white rats. MSN particles, neither uncoated nor coated with calcium alginate, induced spontaneous platelet aggregation when added to platelet-rich plasma, but significantly enhanced ADP-induced platelet aggregation. Subcutaneous administration of uncoated and calcium alginate-coated MSN resulted in increased maximum size and rate of platelet aggregate formation 1 day post-injection. In contrast, cellulose-coated MSN had no significant effect on platelet function in vitro or in vivo, suggesting their potential as carriers for targeted drug delivery.

The optimal balance of the intestinal microbiota is considered to be an essential part of the human body that affects many metabolic processes. However, the exact role of the gut microbiota in metabolism is still not fully understood. To investigate the metabolic role of gut microbiota, the content of short-chain fatty acids and tryptophan metabolites was studied in mice with sodium dextran sulfate-induced colitis. It was found that the production of short-chain fatty acids increased on experimental day 14, but by experimental day 60, they completely disappeared. At the same time, indoles of bacterial origin increased on experimental day 60.

The effect of optical stimulation at a frequency of 10 Hz (OS10Hz) on temporal parameters of sensorimotor activity in healthy subjects (n=32) was studied. The expression of the activation response was determined by the ratio of spectral power values (SPα2, μV2) of the high frequency (10-13 Hz) subrange of the α-rhythm of the initial EEG with closed and opened eyes and the frequency of the maximum α-peak (IAPF). A test for simple motor reaction time was performed under normal and OS10Hz conditions. According to the change in the variability of simple motor reaction time (SDSMRT) under OS10Hz compared to the normal conditions, the subjects were classified into two groups: those who showed a decrease (group 1) and those who showed an increase (group 2) in SDSMRT. The subjects of group 1 had significantly higher IAPF (in the O1 lead with eyes closed) and activation reaction intensity (in the O2, O1, P4, P3, and F3 leads) compared to the subjects of group 2. The obtained data suggest that OS10Hz changes the parameters of psychomotor reactions of an individual, and the direction of changes is mediated by individual features of the initial EEG.

Here, we have discussed the molecular mechanisms of p53-responsive microRNAs dysregulation in response to genotoxic stress in diffuse large B-cell lymphoma (DLBCL) patients. The role of micro ribonucleic acids (microRNAs) in p53-signaling cellular stress has been studied. MicroRNAs are the small non-coding RNAs, which regulate genes expression at post-transcriptional level. Many of them play a crucial role in carcinogenesis and may act as oncogenes or suppressor of tumor growth. The understanding of the effect of p53-responsive microRNA dysregulation on oncogenesis achieved in recent decades opens wide opportunities for the diagnosis, prediction and of microRNA-based cancer therapy. Development of new bioinformatics tools and databases for microRNA supports DLBCL research. We overview the studies on the role of miRNAs in regulating gene expression associated with tumorigenesis processes, with particular emphasis on their role as tumor growth-suppressing factors. The starting point is a brief description of the classical microRNA biogenesis pathway and the role of p53 in regulating the expression of these molecules. We analyze various molecular mechanisms leading to this dysregulation, including mutations in the TP53 gene, DNA methylation, changes in host-genes expression or microRNA gene copy number, mutations in microRNA and microRNA biogenesis genes.

According to international research data, COVID-19 increases the risk of developing hypertensive and metabolic disorders. Aim of the study was to assess the risks of hypertensive and metabolic disorders in pregnant women with COVID-19 and to identify potential markers of these conditions. Material and methods . The study involved 265 pregnant women, infected in the first, second, and third trimesters of pregnancy, and uninfected with COVID-19, from 2020 to 2022. Spectrophotometric methods were used to evaluate blood level of glucose, total cholesterol, high- and low-density lipoprotein (LDL), and triglycerides. ELISA was used to measure content of oxidized LDL and apolipoprotein B (apo B). Results . Gestational arterial hypertension (GAH) developed more frequently in women with COVID-19 infected in the second trimester compared to those infected in the third trimester (15.7 and 6.1 % cases, respectively, p = 0.044). Gestational diabetes mellitus (GDM) was more commonly diagnosed in pregnant women with COVID-19 than in those uninfected (17.2 and 4.0 % cases, respectively, p = 0.015), particularly in those infected in the second and third trimesters (17.6 and 18.9 %, respectively). Pregnant women with COVID-19 showed an increase in glucose levels by 1.14 times ( p = 0.001), oxidized LDL by 1.24 times ( p = 0.042), and apo B protein by 1.14 times ( p = 0.025) in blood serum. Conclusions . Infection with COVID-19 in the second trimester of pregnancy increases the risk of GAH by 2.56 times, and in the second and third trimesters, the risk of GDM by 4.3 times. Increase of glucose, oxidized LDL, and apo B content in blood serum may have prognostic significance in the development of hypertensive disorders.

Aim Natural orifice specimen extraction surgery (NOSES) has gained significant importance in treating cancers. The current study is a meta‐analysis that aimed to assess the short‐term efficacy and long‐term prognostic impact of NOSES and conventional laparoscopic (CL) surgery in the treatment of colorectal cancer (CRC). Method Published reports in several medical databases up to February 2024 were searched and information pertinent to outcomes of NOSES and CL in retrospective and randomized studies to treat CRC was collected. Pooled weighted/standardized mean difference (WMD/SMD), odds ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) were calculated using a fixed‐effects model or random‐effects model, and meta‐analysis was subsequently performed using Stata. Results Thirty‐one studies with a total of 4637 patients were included in this meta‐analysis. When compared with CL , NOSES had significant advantages in several indicators, such as wound infection [ OR = 0.22 (95% CI 0.13–0.38); Z = 5.56, p = 0], incisional hernia [ OR = 0.24 (95% CI 0.11–0.54); Z = 3.44, p = 0.001], blood loss [ WMD = −10.17 (95% CI −14.75 to −5.60); Z = 4.36, p = 0], incision length [ WMD = −4.94 (95% CI −5.27 to −4.60); Z = 29.10, p = 0.00], postoperative pain [ WMD = −1.43 (95% CI −1.69 to −1.18); Z = 11.02, p = 0.00], use of additional analgesics [ OR = 0.57 (95% CI 0.39–0.82); Z = 3.06, p = 0.002], hospital stay [ WMD = –1.25 (95% CI −1.58 to –0.93); Z = 7.65, p = 0.00], gastrointestinal recovery [ WMD = −13.42 (95% CI −17.77 to −9.07); Z = 6.05, p = 0.00], first flatus [ WMD = −0.50 (95% CI −0.68 to −0.32); Z = 5.34, p = 0.00] and cosmetic result [WMD = 2.11 (95% CI 0.92–3.30); Z = 3.47, p = 0.001]. However, NOSES required a significantly longer duration of surgery [WMD = 14.13 (95% CI 6.70–21.56); Z = 3.73, p = 0.00]. There were no significant differences in postoperative anastomotic leakage, intra‐abdominal infection, lymph node harvest, proximal and distal margins, 5‐year disease‐free and 5‐year overall survival and pelvic floor function. Conclusion NOSES is considered an efficient surgical method of treatment for CRC that allows patients to have long‐term favourable oncological outcomes while recovering faster with minimal pain. However, these findings still require confirmation through studies on large population cohorts.

N-Aryl-2,3-dimethyl-4-oxo-3,4,5,6-tetrahydro-2H-2,6-methanobenzo[g][1,3,5]oxadiazocin-11-carboxamides were obtained by the three-component reaction of N-aryl-3-oxobutanamides, salicylic aldehyde, N-methylurea in ethanol in the presence of potassium hydrosulfate. The structure of the obtained compounds was determined by 1H, 13C NMR spectroscopy and X-ray diffraction analysis data. The analgesic activity of the synthesized compounds was studied.