The rapid development of information technology in healthcare, the growth of data volumes and the complexity of diagnostic and treatment methods have led to the fact that artificial intelligence has begun to be used more and more often in this industry.

The article examines the current state of artificial intelligence development in two leading healthcare countries: the Russian Federation and the United States of America. The choice of comparison objects is due to the openness of official sources of information on the state of the industry, as well as the high actual level of development of digitalization of medicine in these countries. The comparison was carried out on five points: prevalence, legal regulation, development directions, responsibility for development and the possibility of integration with the existing digital healthcare circuit.

Introduction. Meningiomas account for 18–34 % of all intracranial tumors in adults and are the second most common among all intracranial neoplasms. Recurrence and progression account for 25 %, on average, even after radical tumor resection and radiotherapy., that worsens the prognosis and functional outcome of the disease significantly. Clinical manifestations often occur with large tumor sizes, initial symptoms are not taken into account by patients and by doctors during follow-up after surgery.

Purpose. To assess the clinical features in patients with recurrence and progression of intracranial meningiomas and to identify the features of clinical manifestations in the progression of meningiomas.

Materials and methods. The study was based on patients (132 cases) with recurrence and progression of intracranial meningiomas with Grade I–III according to histology, who were treated in the Department of Neurosurgery No. 4 of the Polenov Neurosurgical Institute in the period of time from 2014 to 2024. Assessment of clinical neurological symptoms was performed according to standard methods in clinical practice. The results were evaluated using the software system STATISTICA 10.0.

Results. The multifactorial analysis of the clinical manifestations of the disease in recurrent intracranial meningiomas was performed, the main trends in oncogenesis were identified, and the most common clinical symptoms of tumor progression were identified, which must be taken into account by doctors during follow-up after surgery.

Every day, the number of scientific studies in the global medical community is growing, emphasizing the importance of the immune system in the prognosis and course of oncological diseases. The lymphocyte-monocyte index has already demonstrated its prognostic role in some forms of tumor disease. However, its significance in glioblastomas has not been fully determined.

The aim of the study is to study the prognostic value of the lymphocyte-monocyte index for patients with glioblastoma.

Material and methods. The study included 45 patients with primary supratentorial glioblastoma over the age of 18 who had reached the first relapse of the disease. In each case, the level of leukocytes, lymphocytes, monocytes and LMR (ratio of lymphocytes to monocytes) in peripheral blood before surgery was assessed, and symptomatic treatment with glucocorticosteroids was taken into account. The histological diagnosis was established in accordance with the WHO classification of Central nervous system tumors in 2021. All patients after the neurosurgical stage of treatment received standard antitumor treatment (radiation therapy, chemotherapy with temozolomide). The effect of LMR on the median of the first relapse-free period was studied.

Results. A significant increase in the absolute number of monocytes was found in patients receiving dexamethasone therapy (p = 0.014). At the same time, the appointment of GCS did not affect the level of lymphocytes and LMR. The median of the first relapse-free period was statistically higher in patients with an LMR of more than 4 (p = 0.05; 47 vs 30.5 weeks).

Conclusions. Low LMR is a marker of the prognosis of early recurrence of the disease for patients with glioblastomas. It is important to note that despite the fact that the level of monocytes was directly correlated with the appointment of glucocorticosteroids to patients, the LMR was not affected by the appointment of this group of drugs.

CAR T-cell therapy of patients with B-cell malignancies demonstrates high efficacy and an acceptable safety profile. However, some patients do not respond to treatment or quickly relapse. One of the reasons for an inadequate response to CAR T-cell therapy may be the emergence of cancer cells escape variants that do not express the epitope recognized by the CAR. Using CAR T-cells with dual specificity could help mitigate this issue. In this study, we developed CAR T-cells specific to human CD19 and CD20 by exploring four configurations of antigen-recognition domains: two in the biCAR format and two in the dualCAR format. Expression of two independent CARs (dualCAR) driven by a single promoter was found to be the most promising format.

Objective. To evaluate the potential and prospects of the transradial approach as an alternative to the transfemoral approach during hepatic artery chemoembolization (HAE) in the treatment of patients with liver malignancies.

Material and methods. Patients, who underwent CEPA, were divided into two groups depending on the arterial access: through the radial artery (first group) or through the femoral artery (second group). Next, a retrospective analysis of the clinical indicators and effectiveness of this treatment method, technical aspects and complication rates, was carried out when comparing the use of given groups in patients who underwent CEPA.

Results. The study showed that the radial approach provided superior technical results and clinical effectiveness. Patients with radial access had a significantly lower incidence of hepatic artery spasms and spent less time in the hospital in the postoperative period. However, pain scores assessed using the visual analogue scale (VAS) remained statistically similar in both groups. The use of the radial approach for CEPA also resulted in a significant reduction in the overall complication rate (72.5 % versus 84.1 % with the transfemoral approach, P = 0.027).

Conclusion. Our results confirm that the radial approach is an effective, safer, and promising alternative to the femoral approach for CEPA in patients with liver malignancies.

Relevance. Prolactinoma is one of the most common neuroendocrine tumors of the pituitary. Its prevalence 77,6 per 100,000 patients with pituitary masses. The first line of treatment for prolactinomas is drug therapy with dopamine agonists (DA). Cabergoline is the medicine of choice because it is more effective and has a better safety profile. In approximately 15 % of patients who fail to achieve remission of the disease even on the maximum tolerated dose of cabergoline, they are recommended to undergo transsphenoidal adenomectomy (TSA). However, in real clinical practice, when surgical treatment is performed despite achieving or nor achieving maximum tolerated dose of DA including being considered as first line of treatment. Knowing that risk of complications of TSA at the centers of excellence is practically zero and the development of remission is expected immediately after surgery, the choose of using TSA in the treatment of prolactinomas is being discussed.

Purpose and objectives of the study. Using the example of a specialized neurosurgical hospital, study the population of patients operated prolactinomas, determine the reasons for performing TSA, compare the contribution of known factors influencing remission of the disease after surgical treatment, and identify among them the most significant for the study population.

Materials and methods. The study included patients with prolactinoma who performed TSA at the V.A. Almazov National Medical Research Center in the period from 01.2018 to 03.2023, and the diagnosis of prolactinoma was confirmed by data from a morphological study of the surgical material (excatly, cells adenoma expressed prolactin). Based on the results of TSA, patients were divided into 2 groups depending on the outcome of the operation: a group of patients with succesful surgery and a group where there was no effect from the TSA (unsuccessful operation). The outcome of the operation was considered succesful when: 1) the fact of normoprolactinemia for 1 year after TSA, 2) to a significant (more than 50 %) reduction in the need for DA.

Results. The study included 60 patients with prolactinoma who performed TSA. Among the included patients, there were 36 men (60 %) and 24 women (40 %). The median age at diagnosis was 43 (Q1–Q3: 38–47) years for men and, 52 (Q1–Q3: 41–60) years for women. In 26 (43 %) patients, the indications for surgery corresponded to clinical recommendations: meanwhile 34 patients (56 %) were operated on at the request of the patient/doctor’s choice. Patients didn’t differ in age in the two groups (p = 0.447). Patients in the unsuccessful surgery group received DA therapy for a longer period of time (48 against 9 months, p < 0.001) and their weekly dosage was higher compared to patients with a positive effect from surgery (4 vs. 2 mg/week, p < 0.001). There was a statistically significant difference in such indicators as visual field impairment, deficiency of hormones of the anterior pituitary gland before/after surgery (p > 0.05).

Conclusion. In the study population, TSA was successful in 38 of them (63 %). The factors determining TSA success were the value of preoperative prolactin — 2476.5 ng/ml, the degree of invasion into the cavernous sinus according to the Knosp classification, the weekly dosage and duration of DA therapy.

The frequency of malignant neoplasms during pregnancy has recently become a usually problem in modern medical practice. On average, 1 in 1,000 women will experience cancer during pregnancy. The most common pregnancy-related cancers include cervical, breast, ovarian, malignant melanoma, malignant lymphomas and leukemia, as well as colon and thyroid cancers. The main factor of late diagnosis and poor treatment results is the non-specificity of the symptoms of the disease in the early stages. The occurrence of difficulty at the diagnostic stage is an underestimation of the indications for conducting a diagnostic search. Signet ring cell carcinoma of the stomach is characterized by an aggressive course, rapid metastasis, and therefore is more often diagnosed in late stages and is a prognostically negative histological variant of stomach cancer. Stomach cancer during pregnancy is estimated to complicate 0.026–0.1 % of all pregnancies In this clinical case, an example of the course of signet ring cell carcinoma of the stomach against the background of pregnancy with dichoric diamniotic twins with increasing protein-energy deficiency is given.

Familial Mediterranean Fever (FMF) is a rare monogenic autoinflammatory disease that typically manifests in early childhood. The disease is characterized by its prevalence within a specific ethnic group. Nevertheless, FMF can also manifest in later stages of life among individuals with or without an ethnic background. We present two case reports of FMF patients, where the onset of the disease occurred in the third decade of life. These cases emphasize the importance of including monogenic autoinflammatory diseases in the differential diagnosis of adults presenting with fever of unknown origin and exhibiting typical FMF symptoms regardless of ethnicity.