Kazan medical journal

BACKGROUND: The lack of a unified approach to assessing postoperative complications in children with extravisceral neck tumors hinders risk stratification and selection of the optimal management strategy.

AIM: The study aimed to compare the prognostic accuracy of the Clavien–Dindo classification (CDC) and Comprehensive Complication Index (CCI) for predicting prolonged hospitalization (>8 days) and adverse oncologic outcomes.

METHODS: Data from 153 patients (≤17 years) who underwent extravisceral neck tumor resection at the Dmitry Rogachev National Medical Research Center between 2012 and 2022 were analyzed. Postoperative complications were graded using CDC and CCI. Univariable and multivariable logistic regression, Cox regression, survival analysis, and ROC analysis were performed, and model comparison techniques were applied.

RESULTS: Of the operated children, the median age was 2.9 years (1.2–8.3; 0.1–17.9), and 49% were boys. Severe complications (CDC ≥ IIIa) were conventionally reported in 13.1% of patients (20/153), whereas minor complications were determined in 24.8% (38/153). The median CCI for the entire cohort was 0 (0–20.9) and 21.8 (8.7–32.4) among those with recorded complications. Using CCI, 22.2% (34/153) of patients were identified to have severe complications (CCI ≥26.2), versus 13.1% (20/153) using CDC ≥ IIIa. Prognostic models using either CCI or CDC showed comparable discrimination (AUC >0.84), sensitivity of 62.7%–68.7%, and specificity of 80.2%–83.7%. The model including CCI retained advantages by information criteria, whereas the CDC-based model may be clinically useful when complication classification needs to be considered. Complications were not associated with local recurrence or with overall survival.

CONCLUSION: Combined CCI and CDC enable more precise stratification by complication severity and, when incorporated into a prognostic model, accurately predicts prolonged hospitalization in approximately 8 of 10 patients.

BACKGROUND: The course of metabolic dysfunction-associated steatotic liver disease after bariatric surgery remains a critical clinical problem.

AIM: To evaluate changes in noninvasive indices of hepatic steatosis and fibrosis in patients with morbid obesity and type 2 diabetes mellitus 1 year after bariatric surgery.

METHODS: This study included 85 patients who underwent bariatric surgery at the Institute of Clinical and Experimental Lymphology between 2019 and 2024: mini-gastric bypass (n = 60) or sleeve gastrectomy with single-anastomosis ileal bypass (n = 25). Glycated hemoglobin (HbA₁c), triglyceride, low-density lipoprotein cholesterol, C-reactive protein, alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, and alkaline phosphatase levels were assessed before surgery and 1 year postoperatively. Moreover, noninvasive hepatic steatosis indices, namely, Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), Lipid Accumulation Product (LAP), and St-index, were evaluated. Fibrosis indices included the Fibrosis Index Based on Four Factors (FIB-4) and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS). Changes in parameters were analyzed using the Wilcoxon signed-rank test, whereas correlations were assessed with Spearman rank analysis.

RESULTS: A 32% decrease in mean body weight was observed 1 year after surgery (p = 2.4 × 10⁻¹¹), and 62 patients (72.9%) achieved clinical remission of diabetes. Significant decreases were observed in HbA1c (p = 1.4 × 10⁻¹¹), triglycerides (p = 3.3 × 10⁻⁸), low-density lipoprotein cholesterol (p = 2.6 × 10⁻⁴), C-reactive protein (p = 2.1 × 10⁻⁸), alanine aminotransferase (p = 3.7 × 10⁻⁹), aspartate aminotransferase (p = 1.3 × 10⁻⁵), γ-glutamyltransferase (p = 9.0 × 10⁻⁶), and alkaline phosphatase (p = 7.6 × 10⁻⁵) and in all hepatic steatosis indices (FLI: p = 7.8 × 10⁻¹⁰; St-index: p = 5.3 × 10⁻¹¹; HSI: p = 2.5 × 10⁻¹⁰; and LAP: p = 2.5 × 10⁻¹³). No significant changes were found in fibrosis indices (FIB-4: p = 0.208; NFS: p = 0.112). Decreases in steatosis indices were associated with weight loss (FLI: r = 0.503, p = 0.001; St-index: r = 0.425, p = 3.1 × 10⁻⁴; HSI: r = 0.853, p = 2.6 × 10⁻⁴; and LAP: r = 0.252, p = 0.008). Changes in LAP correlated with a decrease in HbA₁c (r = 0.355, p = 4.3 × 10⁻⁴), and changes in St-index and HSI were linked to changes in estimated glucose utilization rate (r = −0.502, p = 1.7 × 10⁻⁴ and r = −0.269, p = 0.001, respectively).

CONCLUSION: In patients with morbid obesity and type 2 diabetes mellitus, noninvasive hepatic steatosis indices decreased and fibrosis indices remained unchanged 1 year after bariatric surgery (mini-gastric bypass or sleeve gastrectomy with single-anastomosis ileal bypass).

BACKGROUND: Liquid biopsy is a promising method used for analyzing tumor-derived genetic material in plasma and cerebrospinal fluid. These biological fluids are characterized by low concentrations of such material. Pre-amplification is hypothesized to enhance detection sensitivity.

AIM: This study aimed to assess the detectability and content of extracellular tumor genetic material in plasma and cerebrospinal fluid from patients with glioma using droplet digital polymerase chain reaction with and without pre-amplification.

METHODS: The study investigated plasma and cerebrospinal fluid samples from 25 patients newly diagnosed with glioma who were scheduled for partial or total tumor resection. DNA was extracted from 2.5–5 mL of cerebrospinal fluid and 5 mL of plasma. Each sample was examined by droplet digital polymerase chain reaction for IDH1 R132H and TERT promoter (C228T and C250T) mutations. Mutation analysis was performed on both isolated and pre-amplified DNA. The false-positive threshold was determined through experiments that analyzed wild-type samples and no-template controls. Statistical analysis was conducted using the Mann–Whitney and Wilcoxon tests for paired data and Spearman’s correlation test.

RESULTS: The sensitivity and specificity of cerebrospinal fluid liquid biopsy without pre-amplification were 14.3% and 100% for grade 1–3 gliomas, respectively, and 50% and 100% for grade 4 gliomas. After pre-amplification, the values were 57.1% and 50% for grade 1–3 gliomas and 75% and 80% for grade 4 gliomas. Extracellular DNA levels showed a significant correlation with tumor volume, malignancy grade, and contrast enhancement pattern (i.e., none, moderate/heterogeneous, intense, and ring-shaped).

CONCLUSION: Liquid biopsy with DNA pre-amplification demonstrates limited sensitivity and specificity in glioma detection. However, it enables assessment of key tumor characteristics, which may be useful for therapeutic decision-making.

BACKGROUND: The diagnosis of hypertensive nephropathy is primarily based on the clinical diagnostic criteria for detecting renal dysfunction in hypertension. However, in some cases, these criteria are insufficient for establishing an accurate diagnosis.

AIM: To determine the morphometric ranges of various renal structures that can serve as criteria for detecting hypertensive nephropathy.

METHODS: Histological and morphometric analyses were performed on renal tissue samples obtained postmortem from 138 patients (one sample per individual). The patients were divided into two groups: the study group, which included 61 individuals with hypertension and laboratory signs of hypertensive nephropathy, and the comparison group, which comprised 77 patients with hypertension but without clinical or laboratory signs of nephropathy. ROC analysis was conducted to determine optimal threshold values for the percentage of sclerotic glomeruli and the Kernohan index of interlobular arteries that distinguish between patient groups with and without hypertensive nephropathy. Data distribution was assessed using the Kolmogorov–Smirnov test. For nonparametric variables, the median and interquartile range (25th–75th percentiles) were calculated. The groups were compared using the Mann–Whitney U test. The critical level of statistical significance for hypothesis testing was set at p = 0.05.

RESULTS: In patients with hypertensive nephropathy, the following renal parameters were altered: kidney mass decreased by 11% (p = 0.036); the percentage of sclerotic glomeruli increased 1.75-fold (p = 0.027); the Kernohan index of interlobular arteries increased 1.4-fold (p = 0.001); and the connective tissue area in the cortical and medullary layers increased by 1.4 (p = 0.022) and 1.8 times (p = 0.001), respectively. ROC analysis identified the threshold values for differentiating patients with and without hypertensive nephropathy: for the percentage of sclerotic glomeruli, 11.11% (the Youden index, 0.57; specificity, 0.854 [0.761–0.909]; and sensitivity, 0.732 [0.596–0.867]), and for the Kernohan index of interlobular arteries, 0.24 (the Youden index, 0.56; specificity, 0.824 [0.746–0.902]; and sensitivity, 0.739 [0.612–0.866]).

CONCLUSION: The percentage of sclerotic glomeruli and the Kernohan index of interlobular arteries can be used as diagnostic criteria for hypertensive nephropathy.

Ultraviolet cross-linking of corneal collagen is an innovative technique designed to increase corneal strength in keratoconus by creating additional cross-links within the macromolecules of the extracellular matrix. The method is based on exposing the cornea to ultraviolet A radiation (370 nm) after saturation of the stroma with a photosensitizer (riboflavin). In the standard (Dresden) protocol—the conventional method of ultraviolet cross-linking—the minimum thickness of the de-epithelialized cornea must be at least 400 μm to prevent potential endothelial cell damage from a cytotoxic dose of ultraviolet radiation. However, in some patients with keratoconus, corneal thickness falls below this threshold, which limits the applicability of the standard clinical protocol. As a result, modified cross-linking techniques have been proposed for patients with thin corneas. This review presents various approaches developed to address this issue. In general, the safety and efficacy of modified techniques, including transepithelial, accelerated, intraoperative hypoosmotic swelling ones, or techniques involving contact lenses or donor corneal lens, have shown satisfactory outcomes: in most cases, corneal ectasia progression can be halted without serious postoperative complications. Nevertheless, each technique has its own advantages and limitations. The choice of technique depends on the resources of the clinic, the individual characteristics of the patient’s cornea, and the surgeon’s expertise. It should be noted that in practice modified cross-linking protocols for thin corneas are used much less frequently than the standard procedure, underscoring the need for further research to evaluate their clinical efficacy and safety.

Alveolar ridge atrophy following tooth loss is a significant concern in implant dentistry. The ridge height may reduce by up to 50% within a year after tooth extraction. Guided bone regeneration has evolved from an experimental technique to a reliable bone replacement method; however, several issues remain that require further research. Vertical augmentation of major defects remains technically challenging, with no consensus on the best osteoplastic materials and membranes. Furthermore, complications such as premature membrane exposure and infections may limit treatment efficacy. This systematic review examines the use of guided bone regeneration in dentistry and maxillofacial surgery during the last decade. An analysis found that guided bone regeneration provides predictable horizontal and vertical bone augmentation of 3–5 mm and 2–5 mm, respectively. Implant survival in restored bone is comparable to that in intact bone, exceeding 96% over 5 years. Innovations include biologically active substances, such as platelet-enriched plasma and hyaluronic acid, pure magnesium resorbable membranes, ceramics with osteogenic ions, three-dimensional bioprinted scaffolds, and mesenchymal stem cell technologies. Improving guided bone regeneration with new biomaterials and modern techniques will expand clinical indications and provide more favorable long-term outcomes of bone augmentation.

Cutaneous melanoma, a malignant neoplasm, has shown a steady increase in incidence and high mortality in the Russian Federation and worldwide over the past decades. These factors motivate researchers and clinicians to identify new therapeutic targets with high selectivity to minimize adverse effects during antitumor therapy. The components of intracellular signaling pathways are of particular interest as potential molecular targets. This review aimed to analyze studies investigating signaling pathways in tumor cells and their role in melanocyte malignant transformation and to assess signaling cascade components as potential targets for melanoma therapy. Scientific data search was performed in the databases PubMed and RSCI. The following keywords were used: меланома (melanoma), BRAF, таргетная терапия (targeted therapy), малигнизация (malignant transformation), сигнальный путь (signaling pathway), and MAPK. Overall, 164 publications were analyzed, of which 62 were selected for inclusion in the study. The review covered studies published between 2012 and 2025. Scientific data revealed alterations in the extracellular signal-regulated kinase signaling cascade and its relationship with the protein kinase B pathway. Key driver mutations were identified, and targeted therapy strategies inhibiting various signaling pathway components were summarized. Thus, dysregulation of the extracellular signal-regulated kinase and protein kinase B signaling pathways contributes to melanoma progression, and their targeted inhibition suppresses the proliferative and metastatic activity of melanoma cells.

Within the national program “Digital Economy of the Russian Federation,” it is relevant to examine job specifics of IT specialists and their impact on performance status. Changes in this area necessitate reviewing approaches to disease prevention. For this purpose, we performed a retrospective analysis of publications on job specifics and working conditions of IT specialists to identify relevant issues and approaches to their prevention in the current context. The search was performed in PubMed (using MeSH terms) and eLIBRARY.RU. The search depth was 1972–2024. The MeSH terms and keywords were related to work with computers and information systems, as well as occupational risk factors and outcomes. In total, 3647 publications on relevant disorders and work system components were reviewed. A more detailed analysis included meta-analyses, systematic reviews, randomized controlled studies, cohort studies, case–control studies, and the most significant cross-sectional studies (a total of 86 publications). Working with visual display terminals increases the risk of subjective complaints of visual processing disorders, dry eye, and ocular hypertension, as well as musculoskeletal discomfort, dysautonomia, sleep disorders, and psychological disorders. There was no increased risk of reproductive disorders; however, there is evidence of the impact on fertility. Priority areas for prevention programs should include control of cognitive workload and occupational stress, improved workplace ergonomics and lighting conditions, prevention of visual processing disorders, and psychological support. The programs must take into consideration the changes in workflow.

High-resolution imaging has increased the detection rate of adrenal gland neoplasms, necessitating changes in the management of patients with adrenal incidentalomas. Despite existing guidelines, the treatment strategy in patients with incidental adrenal gland neoplasms of <4 cm remains debatable. According to the updated EHS/ENSAT guidelines on incidentalomas (2023), benign neoplasms with ≤10 HU do not require further imaging examinations. For neoplasms of <4 cm with a native density of 11–20 HU, a follow-up examination after 12 months is recommended. This paper presents a clinical case of adrenocortical cancer with autonomous cortisol secretion, which originated from a nonfunctioning right adrenal gland neoplasm of <2 cm. The tumor was detected accidentally during abdominal and retroperitoneal ultrasound and computed tomography; however, malignant transformation did not occur until 11 years later. A comprehensive preoperative assessment, including biochemical and imaging examinations, confirmed that the patient was eligible for elective surgery. A pathological examination confirmed an oncocytic adrenocortical carcinoma (Ki-67: 40%).

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Bracchiglione J, Meza N, Franco JVA, Escobar Liquitay CM, Novik AV, Ocara Vargas M, Lazcano G, Poloni D, Rinaldi Langlotz F, Roqué-Figuls M, Munoz SR, Madrid E. Semaglutide for adults living with obesity. Cochrane Database of Systematic Reviews. 2025, Issue 10. Art. No.: CD015092. DOI: 10.1002/14651858.CD015092.pub2.

The editorial board of the “Kazan Medical Journal” expresses its sincere gratitude to the reviewers for their fruitful cooperation in the preparation of articles. In 2025, our reviewers were.Абдулганиева Д.И. (Казань, Россия)