Background. The relevance of the problem is related to the high prevalence of chronic endometritis (CE); its role in female infertility, implantation failures during assisted reproductive technology procedures, and recurrent miscarriage; as well as the lack of a unified strategy in the diagnosis and treatment of this pathology. The present systematic review with a meta-analysis focuses on evaluating the impact of CE and its therapy on the outcome of in vitro fertilization. In addition, the effect of CE of various severity on the outcomes of assisted reproductive technologies is analyzed. Objective. To analyze the effect of CE of varying severity and its treatment on the outcomes of in vitro fertilization. Methods. Using PubMed, Medline, Scopus, Embase, ELibrary, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry, and Russian Science Citation Index, a systematic search was conducted for articles published over the past 12 years that met the following criteria: randomized controlled trial examining the effect of CE of varying severity on fertility and ways to treat it. The following indicators were calculated: ongoing pregnancy/live birth, clinical pregnancy, and miscarriage rates. A total of 4145 patients (from ten studies) were included. A meta-analysis was performed using Stata 11.0 software (The Cochrane Collaboration, Oxford, UK). The heterogeneity was considered low at I² <30%, moderate at 30–50%, and high at >50%. Results. Women with CE exhibited lower ongoing pregnancy/live birth (OR 1.97; p = 0.02) and clinical pregnancy rates (OR 2.28; p = 0.002) as compared to women without it. CE treatment increased the ongoing pregnancy/live birth (OR 5.33; p < 0.0001) and clinical pregnancy rates (OR 3.64; p = 0.0001). In vitro fertilization outcomes were comparable in women treated for CE and women without CE (ongoing pregnancy/live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Women with severe CE exhibited lower ongoing pregnancy/live birth (OR 0.43; p = 0.003) and clinical pregnancy rates (OR 0.40; p = 0.0007). Mild CE showed no significant effect on in vitro fertilization outcomes (ongoing pregnancy/ live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Conclusion. The conducted meta-analysis showed that CE significantly reduces the ongoing pregnancy/live birth and clinical pregnancy rates in infertile women undergoing in vitro fertilization. Noteworthy is that antimicrobial therapy in such patients improves the results of assisted reproductive technologies, which are comparable to those of patients without CE. The negative impact of this pathology on the implantation capacity of the endometrium is most often observed in the severe form, while its mild form has virtually no effect on the in vitro fertilization outcome.

Background. Today, no unified clinical classification of vulvar lichen sclerosus is registered (is yet to be registered?). Isolation of pathogenetically and clinically different variants of its course enable new approaches to the treatment to be developed. Objective. To develop a pathogenetic therapy for the sclerosing variant of vulvar lichen sclerosus, taking into account its clinical and immunological characteristics. Methods. A prospective cohort study was conducted from 2018 to 2022 on the basis of Regional Clinical Hospital No. 2, Krasonodar, Russia. 292 patients aged 20 to 70 years were histologically diagnosed with vulvar lichen sclerosus. After a clinical examination using the scale for assessing subjective and objective clinical signs of vulvar lichen sclerosus, 154 patients with a sclerosing variant of the disease course were selected for the study. The control cohort consisted of 30 women of the same age category without vulvar lichen sclerosus, taking into account the exclusion criteria. The study involved a clinical assessment (in points) of objective and subjective criteria characteristic of this variant of vulvar lichen sclerosus, as well as an assessment of the level of cytokines (interleukin-20; interleukin-23; interleukin-10; tumor necrosis factor α, interferon γ) in peripheral blood of the patients from the main and control groups. One month after the immunotherapy with sodium deoxyribonucleate, the authors evaluated its clinical efficacy (using Numerical rating scale for pain (vulvodynia) and Vulvar pruritus severity scale) and immunological efficacy (repeated assessment of the level of the studied cytokines). Analysis and statistical processing of the obtained data were performed using Graph Pad Prism version 6.0 (GraphPad Software, Inc., San Diego, CA). Results. Depigmentation of the vulvar skin against the background of vulvar sclerosis and thickening features a sclerosing variant of vulvar lichen sclerosus compared to vulvar atrophy. Stenosis of the vaginal vestibule is either absent (51.3%) or predominantly corresponds to grade I, and is less specific than depigmentation and even skin atrophy. The subjective signs include a severe vulvar pruritus without or with moderately expressed (in 68.1%) vulvodynia. An immunological study showed a statistically significant increase in the level of interleukin-20 (p < 0.0001), interleukin-23 (p < 0.0001), interferon-γ (p < 0.03), tumor necrosis factor α (p < 0.009) in patients with maximal tissue sclerosis with respect to the control group, along with a statistically significant decrease in the level of anti-inflammatory interleukin-10 (p < 0.01). The immunological efficacy of sodium deoxyribonucleate was confirmed by a statistically significant (compared to baseline) decrease in interleukin-20 (p < 0.0001), interferon-γ and tumor necrosis factor α (p < 0.002), interleukin-23 (p < 0.012) without statistical differences with the control group (except for interleukin-23, the level of which decreased after therapy but remained statistically higher (p < 0.01) than in the control group). Clinical efficacy of immunotherapy was confirmed by a statistically significant (p < 0.001) reduction in vulvodynia and vulvar pruritus after the treatment. Conclusion. The obtained data demonstrate characteristic clinical features and immunological differences in relation to the norm in women with the sclerosing variant of vulvar lichen sclerosus, thereby justifying the use of sodium deoxyribonucleate in this variant with confirmed clinical and immunological efficacy.

Background. Initial dual antihypertensive therapy is currently considered as the first management step for the majority of patients with arterial hypertension. However, it often fails to achieve the target blood pressure levels. An approved algorithm for predicting the failure of dual antihypertensive therapy is still to be developed. Objectives. To establish predictors of dual antihypertensive therapy failure in patients with high and very high cardiovascular risk and to create a model for predicting negative outcome of dual antihypertensive therapy. Methods. The paper presents a prospective comparative non-randomized clinical trial. The recruiting of participants and recording of results were carried out in March–December 2019 with 3 months of the follow-up period. The trial involved examination of 88 patients with poor blood pressure control, stage II and III arterial hypertension, high and very high cardiovascular risk of stages 1–3. Clinical and laboratory examination was carried out in compliance with the current regulatory documents. Additional examination included tests for uric acid, high-sensitivity C-reactive protein, as well as respiratory polygraphy and computerized capillaroscopy. All patients were prescribed dual antihypertensive therapy. The primary search for predictors was performed using the binary logistic regression. The predictive model was developed by stepwise variable selection. The diagnostic significance of the binary classifier was assessed by means of ROC-curve analysis; the calculation was performed using MedCalc 20.218 software (MedCalc Software Ltd., Belgium). Results. Administration of two hypotensive drugs appears to be effective in 33% of patients. The final model for predicting negative outcomes of dual antihypertensive therapy included such independent predictors as interventricular septal thickness, daily mean systolic blood pressure, and area density of the capillary network. The odds ratio accounted for 9.1 (95% confidence interval 3.12; 26.82). The area under the ROC curve based on the multiple binary logistic regression model comprised 0.805±0.05 with 95% confidence interval: 0.707-0.882 (p<0.0001). The sensitivity and specificity of the method amounted to 83.1 and 69.0%, respectively. The prediction accuracy comprised 77.3%. Conclusion. The development of patient-oriented algorithms for selection of hypotensive treatment is considered to be essential due to poor blood pressure control during dual antihypertensive therapy. The developed prognostic model may be applied when managing hypertension.

Background. Mathematical modeling is widely used in medicine to analyze the body systems in terms of their structure, work and interrelations. The present study investigates factors associated with the adaptation potential of the cardiovascular system, develops multiple regression models for the dependence of the adaptive potential on these factors, and compares the significance of the linear model with non-linear ones. Objectives. To determine changes in the circulatory system in students during the examination period and develop a mathematical model for predicting the adaptive potential of the cardiovascular system. Methods. The cohort observational study enrolled 74 students of Kirov State Medical University, aged 18–23 years, who gave consent to the survey. The participants were divided into two cohorts depending on the dominant type of the autonomic nervous system (group 1 — individuals with the dominance of sympathetic part of the peripheral division of the autonomic nervous system (n = 54) and group 2 — individuals with vagotonic type of regulation (n = 20)). The relationship between the hemodynamic parameters and the initial autonomic tone was considered as the main relevancy criterion of the study. Comparative analysis of hemodynamic parameters depending on the dominant type of autonomic nervous system was carried out in the cohorts. Development of the regression model was based on 74 observations. Data description included median (Me) and interquartile range representing 25th and 75th percentiles. The indicators in independent samples (cohorts) were compared using the non-parametric Mann—Whitney U test. Correlation analysis of relationships between the studied variables involved Spearman’s criterion (r). Differences and correlations were considered significant at p = 0.05. Calculations and analyses were performed using spreadsheets in Statistica Advanced 10 for Windows RU (Statsoft, Russia). Results. The state of the cardiovascular system significantly depends on the dominant type of the autonomic nervous system. Such parameters as stroke volume, cardiac index, cardiac minute output, circulatory efficiency were established to be significantly higher, whereas diastolic blood pressure, mean arterial pressure, cardiovascular index — lower in individuals with activation of the sympathetic part of the autonomic division of the peripheral nervous system. The study revealed significant correlations between the parameters of central hemodynamic and anthropometric parameters depending on the dominant type of the autonomic nervous system. Conclusion. Significant differences of hemodynamic parameters depending on the dominant type of autonomic system indicate the relevance of neurohumoral mechanisms of cardiovascular regulation. The values in adaptive potential exceeded 2.0 points, indicating the stress of the cardiovascular adaptation. The correlation regression analysis showed the greatest significance of the multiple linear regression model developed by the authors for predicting the adaptive potential of the cardiovascular system.

Background. Establishing regularities in postmortem intervals comprises one of the main tasks of the forensic science of death and cadaveric phenomena. The knowledge of these regularities is directly related to reconstructing the postmortem conditions and, consequently, to determining the postmortem interval. Objective. To analyze postmortem changes in cadaver tissues and dynamics of their impedance parameters under the conditions of natural biocenosis. Methods. The study involved the cadavers of model biological objects – eight pigs, aged one to two months, weighing up to 10 kg. Experimental studies of cadaver decomposition were carried out under natural biocenosis conditions, daily for 28 days with two replications. Changes in cadaver tissues during decomposition were recorded and analyzed. The subject of biophysical studies was the tissue impedance parameters of three diagnostic zones of the biological object: the musculocutaneous flap, the cartilaginous part of the third rib and the calcaneal tendon. Impedance measurements for each postmortem interval were performed at five studied current frequencies: 100 and 120 Hz, 1, 10 and 100 kHz. A total of 2,400 readings were taken. Statistical analysis of the study results was carried out by means of Statistica 8.0 (StatSoft Inc., USA). Results. Postmortem biological changes in cadaver tissues correlate with the nature of their impedance dynamics. The study of impedance under conditions of natural biocenosis established its identical dependence on the postmortem interval for all current frequencies of the study of all diagnostic zones of model biological objects: in the initial interval of 0–4 days, the impedance gives a “surge” followed by a smoother decrease. Cadaver tissues were recorded to indicate the presence of impedance dispersion in general in the studied frequency range and the absence of dispersion directly for high frequencies. Conclusion. Understanding the causes and essence of postmortem processes contributes to assessing and substantiating changes in any characteristics of tissues measured quantitatively, including impedance indicators, as well as to predicting the prospects of their use for specific practical purposes, in particular, for determining the postmortem interval.

Background. The variety of current methods for assessing the healthcare personnel resources remains insufficient to completely evaluate the actual staffing and needs of certain medical institutions. Using a combination of different sources of data enables a more comprehensive picture of the healthcare personnel situation to be obtained. Objective. To identify the potential for improving approaches to assessment of the personnel situation in community pediatric services at the regional level. Methods. The present study involved data from Krasnodar Krai, Astrakhan and Volgograd Oblasts: Federal Statistical Monitoring form No. 30 “Information on Medical Organization” for 2007–2022, as well as depersonalized data from the regional registers of medical workers and assigned population of Krasnodar Krai as of 01.01.2023. The methodology involved statistical and analytical methods. The study estimated the following parameters: community pediatric staffing in relation to? the child population, the staffing level of pediatric full-time positions, the rate of part-time jobs, and the average number of children per pediatrician. Results. The study justified the possibility of using additional sources of data to evaluate the personnel situation in local, municipal or regional healthcare institutions. The authors suggested an interactive analytical board for graphical visualization of the current state of healthcare human resources. Conclusion. The introduction of additional sources of information and monitoring in the healthcare human resources policy encourages a systematic comprehensive approach to estimating the staffing requirements.

Background. Inflammatory process in periapical tissues causes tooth extraction in more than 50% of cases. The development of chronic apical periodontitis can be triggered by an intracanal infection in undetected/missed root canal of the mandibular molars. The morphology of mandibular molars is distinguished by additional canals in the mesial root in some cases. Different studies reveal the middle mesial canal in 4.5% to 26% of cases with quite high incidence in youth. The dental therapy has been searching for effective approaches to diagnosis and treatment of chronic periodontitis, enabling the focus of chronic inflammation to be eliminated and the tooth to be saved. Case descriptions. The paper presents clinical cases of patients with destructive changes in bone tissues in the periapical region of the mesial root in mandibular molars. The developing of this pathology is associated with missed anatomy in the mesial root during primary endodontic treatment. The patients underwent clinical examination consisting of basic methods (interview, examination) and additional techniques (intraoral radiography). An additional middle mesial canal in the root of the mandibular molar was identified taking into account the complex morphology of the root system of the tooth and verified by its careful analysis and radiography. The final clinical diagnosis, chronic apical periodontitis (K04.5), was made following the obtained diagnostic results and the ICD-10 classification. Diagnostic examination and endodontic retreatment were performed using a dental operating microscope. Conclusion. An operating dental microscope provides visualization of microscopic anatomotopographical details, promoting the efficiency of diagnosis and treatment of chronic apical periodontitis in mandibular molars. Using dental microscope facilitates systematization of the data obtained during the examination, making a final clinical diagnosis, and development of a reasonable personalized treatment plan focused on detecting an additional middle canal in the mesio-buccal canal of the mandibular molar. Due to the suggested approach, the long-term outcomes of endodontic treatment can be an objective assessed in dynamics, thereby improving the quality of treatment for chronic apical periodontitis in patients.

Background. Acute coronary syndrome is widespread in the adult population and has clear diagnostic criteria. In pediatric practice, this pathology is rare, and often implies difficulties in diagnosis. Case description. A 16-year-old male with negative paternal history, hypercholesterolemia, dyslipidemia, and excessive body weight developed myocardial infarction on the background of acute tonsillitis. In the onset of the disease, the adolescent demonstrated clinical signs of acute respiratory infection and coronary spasm. Electrocardiogram revealed ST segment elevation above the baseline in leads I, II, III, aVF, V₄–V₆ and biochemical markers of myocardial necrosis. Echocardiography revealed signs of focal hypokinesis of the left ventricle, newly detected degree 2 mitral regurgitation. Percutaneous coronary angiography revealed no signs of coronary artery stenosis. The patient received conventional medical treatment of acute myocardial infarction as well as antibacterial therapy. He was discharged in satisfactory condition. After 1 year of follow-up after the myocardial infarction the patient showed no pathologic changes both on stress-echocardiography and electrocardiogram. Three-year catamnesis appeared to be favorable. Conclusion. The presented clinical case demonstrates the individual mechanism of acute coronary syndrome development in children. Pediatricians should be aware of the risk of developing acute coronary syndrome against the background of infectious pathology.