Introduction. Malignant gliomas are among the most lethal and difficult to treat types of tumors, given their aggressiveness and infiltrative nature of growth, as well as localization. Photodynamic therapy (PDT) is a promising method and direction, and is an intraoperative local laser therapy used after surgical removal of the tumor. Purpose of the study. To analyze the clinical outcomes and prognosis in patients with glioblastoma treated with PDT compared to patients who did not receive it. Material and methods. This retrospective study included patients diagnosed with glioblastoma treated at the Polenov Russian Scientific Research Institute from January 2011 to December 2017. PDT included irradiation of the postoperative resection cavity with a 662 nm semiconductor laser after intravenous injection of Photoditazine. The main efficacy indicators were recurrence rate and survival time, which were compared in the PDT and non-PDT groups. Univariate and multivariate analyses were used to determine prognostic factors. In addition, adverse events and prognostic factors were analyzed in the PDT group. Results. The PDT and non-PDT groups included 39 and 55 patients, respectively. The local recurrence rate was significantly lower in the PDT group than in the non-PDT group (50.8 % vs. 84.1 %), and the distant recurrence and dissemination rates were also lower in the PDT group than in the non-PDT group (20.5 % vs. 44.3 %). Median progression-free survival and overall survival were significantly higher in the PDT group than in the non-PDT group (recurrence-free survival: 11.9 vs. 7.6 months, respectively, and overall survival: 21.5 vs. 13.1 months, respectively). Multivariate analysis of the PDT groups showed that younger age was an independent prognostic factor. Conclusion. PDT with Photoditazine provided effective local control with minimal side effects. The survival time of patients treated with PDT was significantly higher than that of patients who did not receive PDT.

Introduction. Glioblastoma is the most aggressive primary brain tumor, characterized by rapid progression and a median survival of no more than 12–18 months. Fluorescence-guided surgery should be of critical importance, as it allows visualization of the tumor and facilitates its complete removal, which is essential for increasing survival. Purpose of the study. Comparative analysis of remote treatment results in patients with glioblastoma using fluorescent surgery and white light surgery without fluorophores. Material and methods. A single-center, retrospective study included 54 patients with newly diagnosed glioblastoma (24 patients in the main group with fluorescent surgery; 30 patients in the control group with white light surgery without fluorophores). In the main group, 11 patients used 5 ALA (20 mg/kg) orally, and 13 patients received Photoditazine (1 mg/kg) intravenously. Preoperative magnetic resonance imaging (MRI) data allowed complete resection of contrast-positive tumor areas, according to the operating surgeon, in all patients. The groups were representative in terms of gender, age, tumor size, preoperative Karnofsky index, tumor resection radicality, and volume of postoperative adjuvant therapy. All patients underwent surgery using an operating microscope. Control of resection radicality was assessed based on contrast-enhanced MRI data performed within 24 hours after surgery. Remote treatment results were assessed based on overall and relapse-free survival data, taking into account stratification by MGMT promoter status as a predictive biomarker of response to adjuvant therapy. Results. The GTR97 % index in the fluorescent surgery group was 91.70 %, while in the control group it was only 60 %. The median free-progression survival in the fluorescence-guided surgery group was 10.1±1.1 months, in the control group (with white light surgery, without fluorescence-guided surgery) was 6.3±1.3 months (p=0.049). The median overall survival in the fluorescence-guided surgery group was 19.2±1.5 months, in the control group (with white light surgery, without fluorescence-guided surgery) was 13.6±1.4 months (p=0.075). The MGMT promoter status in patients was the main predictive independent prognostic factor (p>0.05), influencing the median overall and recurrence-free survival in both groups. The median overall survival in patients with a methylated MGMT promoter (MGMT+) in the fluorescent surgery group was 25.3±1.3 months, in the control group (with white light surgery, without fluorescent surgery) 16.8±1.1 months (p=0.068). For patients with an unmethylated MGMT promoter (MGMT-), the median overall survival in the fluorescent surgery group was 17.1±1.4 months, in the control group 11.0±1.9 months (p=0.083). Conclusion. Fluorescence-guided surgery not only increases the radicality of the surgical intervention, ensuring more accurate detection of the tumor and its resection, but also increases the median overall and relapse-free survival in patients with glioblastoma.

Currently, the issue of diastasis recti is increasingly being addressed in Russian and international literature. Diastasis recti is most common in women of childbearing age and leads to a reduced quality of life, impaired aesthetic function, and is a factor in the development of linea alba hernias. Isolated diastasis is not an indication for surgical treatment, therefore, the relevance of research into non-surgical treatments is increasing. The study of non-surgical treatment for diastasis as a method for preventing the development of linea alba hernias is a priority in the development of herniology over the next twenty-five years. This review presents non-surgical treatment options and a new approach to the problem of conservative management of patients with diastasis recti.

Niemann-Pick disease is a rare genetic disorder with an autosomal recessive inheritance pattern, which belongs to a group of sphingolipid metabolism diseases. According to available data, Niemann-Pick disease type B is caused by mutations in the SMPD1 gene, which is located on the short arm of chromosome 11. A missense substitution leads to insufficient production of the lysosomal enzyme acid sphingomyelinase, which is responsible for the breakdown of sphingomyelin. As a result, sphingomyelin accumulates in the cells of the reticuloendothelial system, leading to abnormalities in various organs.

This article describes a clinical case of an adolescent girl with Niemann-Pick disease type B, in whom typical changes in the internal organs were identified using several medical imaging modalities.

Long QT syndrome (LQTS) is a heterogeneous hereditary or acquired myocardial repolarization disorder associated with a high risk of torsades de pointes ventricular arrhythmia and sudden cardiac death. This review traces the evolution of scientific understanding of LQTS from the first clinical descriptions in the 1950s to modern advances in molecular genetics. Particular attention is paid to key stages in the pathophysiological conceptualization of the syndrome, including the role of the sympathetic nervous system, T-wave alternans, the introduction of β-blockers and left cardiac sympathetic denervation, as well as the identification of genes responsible for various LQTS subtypes (KCNQ1, KCNH2, SCN5A, etc.). Current research directions are reviewed: the use of induced pluripotent stem cells, gene correction methods (siRNA, CRISPR/Cas9), and artificial intelligence for diagnosis and risk stratification. The contribution of domestic researchers to the development of clinical and genetic approaches to studying the syndrome is noted. The accumulated experience indicates a transition from empirical therapy to personalized management of patients with LQTS and outlines prospects for further research in the areas of genetic modifiers, pathogenetic treatments, and digital technologies in cardiology.

Current scientific data demonstrate a radical revision of the concept of periodontitis as a localized inflammatory process in favor of its consideration as a powerful driver of systemic inflammation. The pathogenetic role of specific periodontal pathogens, especially Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, is realized through the activation of Toll-like receptors and NF-κB-dependent pathways, which leads to a massive release of proinflammatory cytokines and the formation of a stable systemic inflammatory response. Metastatic spread of bacteria and their toxins creates conditions for the development of distant pathological foci in the cardiovascular system, which is confirmed by the detection of periodontal pathogens in the myocardium, pericardial fluid and vascular intima. The key mechanism of systemic impact is the development of endothelial dysfunction through decreased NO synthase activity and activation of VCAM-1 and ICAM-1 adhesion molecules. Progression of the inflammatory process leads to structural changes in the myocardium through activation of fibrotic processes and creates prerequisites for the development of arrhythmias. Systematic analysis of long-term consequences has established an increased risk of developing cardiovascular diseases and the formation of multimorbid conditions in patients with periodontitis. The concept of periodontal pockets as a reservoir for systemic dissemination of pathogens substantiates the multifactorial nature of the systemic impact of periodontitis through microbiological, microcirculatory, immunological and metabolic mechanisms. The data obtained substantiate the need to revise clinical approaches to the diagnosis and treatment of periodontitis with the development of integrated therapeutic strategies aimed at correcting the local inflammatory process and its systemic manifestations.