Dear readers of the “Baikal Medical Journal”!

We present to your attention the spring issue of the Baikal Medical Journal, in which we have collected the most interesting scientific materials.

Introduction. Diabetic foot syndrome is one of the severe complications of diabetes mellitus. This combination of pathological processes occurring in the foot is induced and aggravated by diabetes mellitus. Most often, diabetic foot syndrome is a consequence of angiopathy, neuropathy, osteopathy; it may be accompanied by infectious and ulcera-tive lesions, leading to amputation of the extremity.
The aim of the study. To assess the results of diagnosis and treatment of diabetic foot syndrome, following the intro-duction of a multidisciplinary approach.
Materials and methods. A retrospective analysis of 151 medical records of patients diagnosed with diabetic foot syndrome was carried out. There were 87 (57.6 %) men and 64 (42.4 %) women; the mean age was 63.6 ± 1.0 years. 
The most of patients (139 (92.1 %)) were diagnosed with type 2 diabetes mellitus.
Results. A multidisciplinary approach to the diagnosis and treatment of diabetic foot syndrome was achieved through the efforts of a team of specialists consisting of a surgeon, general practitioner, endocrinologist and vascular surgeon. 
The average glycemic level in the examined patients was higher than normal and amounted to 10.6 ± 0.4 mmol/l. In 111 of patients, the correction of carbohydrate metabolism was carried out with insulin, in the remaining observations – with tableted hypoglycemic drugs. All patients received treatment aimed at eliminating the main links in the pathogenesis of diabetic foot syndrome. Local conservative treatment was carried out in 66 cases, surgical treatment – in 85 cases. 
The majority of surgical interventions (40–47 %) were minor surgeries (preserving the supporting function of the leg), in 20 (23.5 %) patients surgeries were performed on the arteries, in 19 (22.4%) – high amputations (above the ankle joint), in 6 (7.1 %) – opening of foot phlegmon. The average duration of treatment for diabetic patients with diabetic foot syndrome was 17.1 ± 0.6 days.
Conclusion. Patients with diabetic foot syndrome were diagnosed with severe disorders of carbohydrate metabolism with the presence of angiopathy and neuropathy. A multidisciplinary approach to the diagnosis and treatment of diabetic foot syndrome makes it possible to identify the main links in pathogenesis and, based on existing protocols, to per-sonalize the treatment. This makes it possible to preserve the supporting function of the extremity in most patients and to reduce the number of high amputations.

Background. Periprosthetic infection is a serious complication of large joint replacement surgery. To date, there is no consensus on the choice of surgical tactics for treating this category of patients.
The aim of the work. To determine the effectiveness of one-stage and two-stage revision hip and knee replacement surgery in reducing periprosthetic infection.
Materials and methods. We analyzed the results of revision replacement surgery in 78 patients with deep periprosthetic infection of the hip and knee joints. In 38 patients, one-stage revision replacement surgery was used, in 40 patients – two-stage. Treatment results were assessed 1 year after the surgery. Out of 78 patients, in 45 (57.7 %) choosing the type of revision replacement surgery was made according to the algorithm developed at the Irkutsk Scientific Centre of Surgery and Traumatology.
Results. Using revision replacement surgery made it possible to stop the infectious process in 64.1 % of patients. 
The best results were obtained after two-stage revision surgery, in which relief of the infectious process was achieved in 72.5 % of cases. The choice of treatment tactics for patients according to the algorithm improved the results of two-stage revision joint replacement surgery up to 87.5 %.
Using the criteria proposed in the algorithm when assessing the positive and negative results of revision surgery made it possible to confirm the effectiveness of the algorithm in 80% of patients and to identify the probable reasons for the maintenance of periprosthetic infection: incorrect choice of the type of surgery, the presence of extensive bone defects, the presence of polyallergy.
Conclusion. Analysis of the results of revision arthroplasty for periprosthetic infection made it possible to confirm the effectiveness of the proposed algorithm for choosing the type of surgery, to establish the highest effectiveness of two-stage revision surgery compared to one-stage surgery, and also to determine the probable causes of negative treatment results.

Background. In the modern world, the role of artificial intelligence in healthcare is becoming increasingly significant, providing new opportunities to transform traditional methods of diagnosis, treatment and medical data management. 
This technological breakthrough not only improves the efficiency of medical procedures, but also opens up new per-spectives in the prevention and treatment of diseases.
The aim. To emphasize the need to create a personalized health model using artificial intelligence to help an individual achieve and maintain optimal health and well-being.
In the field of personalized treatment, artificial intelligence plays an important role, taking into account the unique characteristics of each patient. Algorithms analyze genetic information, medical history and responses to previous therapies to develop optimal treatment plans. This opens the way to individualized medicine, where the approach to each patient is based on his or her unique characteristics.
Despite all the positive aspects, the introduction of artificial intelligence in healthcare also raises questions of data privacy, ethical issues and technology security. However, if these issues are resolved, artificial intelligence promises to significantly improve the quality and accessibility of medical treatment, opening new horizons in healthcare.
Results. In this article, we describe breakthroughs in artificial intelligence technologies and biomedical applications, identify problems of using and further development in medical artificial intelligence systems and summarize the economic, legal and social consequences of using artificial intelligence in healthcare, and propose a scheme for constructing a model of individual human health using artificial intelligence.
Conclusion. The results of the analysis of modern scientific literature allow us to draw a conclusion about the potential for creating more effective and personalized approaches to the problem of individual health using integrated artificial intelligence technologies. The proposed methodology can serve as the basis for the development of innovative deci-sion support systems in medicine and improving the quality of medical care.

Description of a clinical case. The article presents a rare case of obstructing adhesion – ileocolic intussusception in an adult patient. The patient had no predisposing factors for intussusception (previous surgeries on the abdominal organs, intestinal tumors). The clinical picture had an atypical course. There were no signs characteristic of acute obstructing adhesion and other acute surgical pathology. The patient was admitted to the therapeutic unit with a diag-nosis of exacerbation of chronic pancreatitis. A differential diagnosis was made between acute appendicitis, Meckel’s diverticulum and pancreatitis. Ultrasound examination of the abdominal organs revealed a ring-shaped formation in the right iliac region. A blood test showed no signs of acute inflammation. Contrast-enhanced computed tomogra-phy of the intestine also revealed a well-defined mass in the right iliac region. Repeated diagnostic studies were also carried out, which did not clarify the situation and did not give a reliable result. The clinical picture of acute obstruct-ing adhesion developed on the day 3 in hospital. The patient was consulted by a surgeon and underwent surgery, which allowed to identify the cause of the obstruction – ileocolic intussusception. Reduction of intussusception was performed, the intestine was found to be viable during exploration, but no intestinal resection was performed. 
The patient was discharged with recovery. The treatment result was assessed as good.
Conclusion. The peculiarity of this clinical observation is that the pathology is characteristic of pediatric patients. 
In adults, intussusception is extremely rare and occurs mainly in patients with intestinal tumors. Diagnosis was dif-ficult due to the atypical picture of intestinal obstruction. This clinical observation indicates the difficulties of choosing the right surgical tactics in patients with an atypical clinical picture of the disease. In such doubtful cases, diagnostic laparoscopy can be additionally included in the range of research methods.

Background. Differential diagnosis of neuromuscular diseases is one of the most difficult areas in neurology. Molecular genetic research in these patients is of particular importance. The article presents a clinical case of 5q spinal muscular atrophy type III (Kugelberg – Welander disease), confirmed by molecular genetic testing.
Description of the clinical case. The article presents the clinical observation of a patient with an initial diagnosis of Erb – Roth myopathy. A genetic study was carried out. The analysis of the presence of exon 7 of the SMN1/SMN2 genes showed the absence of a signal corresponding to exon 7 of the SMN1 gene. A search for deletions in the SMN1 gene showed the homozygous deletion of exons 7–8 of the SMN1 gene in the proband. Homozygous deletion of exons 7–8 of the SMN1 gene causes 5q proximal spinal muscular atrophy. As a result of determining the num-ber of copies of the SMN1 and SMN2 genes, 0 copies of exons 7–8 of the SMN1 gene and 4 copies of exons 7–8 of the SMN2 gene were registered, which confirms the diagnosis of 5q spinal muscular atrophy type III.
Conclusion. Adult patients suffering from neuromuscular diseases are recommended to undergo confirmatory DNA diagnostics to prescribe pathogenetic treatment, which increases their chances of survival. In young people with a clinical diagnosis of neuromuscular disease, genetic testing is required to clarify the diagnosis and further treatment tactics.

Description of a clinical case. The article presents a clinical observation of a 77-year-old patient with newly diag-nosed Frederick’s syndrome, which is a combination of a permanent form of atrial fibrillation and complete atrioven-tricular block. An exacerbation of chronic pancreatitis was the reason for hospitalization of the patient. The patient had no complaints of bradycardia or syncope, but treatment of the underlying disease was difficult due to the development of acute kidney injury against the background of chronic kidney disease and uncompensated chronic heart failure. 
The cause of the development of Frederick’s syndrome was pronounced myocardium remodeling due to diseases that make up the classic complex of metabolic syndrome – coronary heart disease, arterial hypertension, type 2 dia-betes mellitus and obesity.
Conclusion. The analysis of a few domestic and foreign literature sources showed that the development of Frederick’s syndrome is associated with a worsening prognosis and the development of various complications, which is usually underestimated by attending physicians. Taking into account the difficulties of diagnosis and management of patients with this pathology, it is necessary to be wary of the development of Frederick’s syndrome, especially in comorbid elderly and senile patients. Timely medical correction and referral of the patient for surgical treatment will improve the prognosis and reduce mortality in patients with atrial fibrillation.

Background. Over a long period, an open capsular synovectomy technique was recommended for villous nodular synovitis and synovial chondromatosis of the knee joint. However, such surgical treatment is accompanied by significant trauma to the joint tissue and frequent postoperative recurrence. Currently, it is advisable to assess the possibilities of modern treatment methods (arthroscopic cold plasma ablation) for rare diseases of the knee joint.
The aim of the study. To assess the possibilities of arthroscopic cold plasma ablation in a series of clinical observa-tions of the surgical treatment of patients with rare diseases of the knee joint synovium in a statistically small sample.
Material and methods. Surgical treatment was performed in 14 patients with diseases of the knee joint synovium. 
We carried out clinical and radiological examinations, computed tomography and magnetic resonance imaging, multi-detector computed tomographic angiography, ultrasound examination, Dopplerography of the vessels of the lower extremities, biochemical examination of synovial fluid, arthroscopy with targeted biopsy and subsequent morphological examination of the synovial membrane.
Results. In 7 patients with pigmented villous nodular synovitis, the following surgeries were performed: in 1 patient with the diffuse form – an open subtotal capsular sinovectomy; in 6 patients with the nodular form – an arthroscopic partial cold plasma capsular sinovectomy of the knee joint. In 7 patients with synovial chondromatosis, an arthroscopic removal of cartilage flaps and partial cold plasma ablation of synovial folds and knee joint villi were carried out.
Conclusion. Arthroscopic cold plasma ablation with bipolar electrodes in various modes of the Qvantum-2 (Arthro-Care, USA) using anterior, posterolateral and suprapatellar approaches makes it possible to carry out less traumatic and radical, without damaging deep layers of cartilage and capsule, surgical treatment of rare diseases of the knee joint synovium. In diffuse forms of pigmented villous nodular synovitis, it is advisable to continue comparative studies of various surgical methods of capsular sinovectomy (open and arthroscopic techniques).

The article presents a clinical case of congenital hypothyroidism. A child (girl) was born from a mother who was diag-nosed with hypothyroidism. The child is from dichorionic diamniotic twins. During intrauterine development, growth retardation of the second fetus was observed. The child was born by Caesarean section, with low body weight; the condition after birth was severe due to respiratory distress syndrome and prematurity. According to the result of neonatal screening, the level of thyroid-stimulating hormone was 305.75 µIU/ml, and ultrasound examination revealed thyroid gland agenesis. A diagnosis of hypothyroidism was made. A slight valvular stenosis of the pulmonary artery, an aneurysm of the interatrial septum with a defect, an incomplete vascularization of the retina of both eyes, and an inguinal hernia were revealed. The presence of dysembryogenesis stigma (hernia, aneurysm of the interatrial septum, low ears, macroglossia, moderate marbled cyanosis, flat-bridged nose, moderate hypotension) indicates the hereditary nature of the disorders.
A theoretical analysis of possible candidate genes for the development of hypothyroidism was carried out. It was shown that the TSHR, NKX2-5, THRA, TSHB, TRHR, TBL1X, IRS4, PAX8, FOXE1, NKX2-1 genes are responsible for congenital hypothyroidism. It is noted that these genes are the regulators of the development and maturation of the thyroid gland or encode thyroid hormone receptors.
Conclusion. For better understanding the etiopathogenetic mechanisms of the formation of congenital hypothyroid-ism, it is necessary to consider the possibility of confirmatory DNA diagnostics.

Background. Hereditary liver diseases are a serious problem in all age groups. Diagnosis of the hereditary liver disor-ders in many cases turns out to be difficult, and before final diagnosis, the patient can change more than one doctor and lose time, which can lead to a worsening of the disease. Therefore, the issue of timely diagnosis of hereditary liver diseases remains relevant.
The lecture discusses the issues of diagnosing hereditary diseases occurring with liver damage. Both monogenic syndromes and multifactorial diseases are reviewed. Urea cycle disorders, aminoacidopathias and organic acidurias, lysosomal storage diseases, mitochondrial and peroxisomal diseases, disorders of fatty acids β-oxidation, carbohy-drate, lipid and cholesterol metabolism disorders and other diseases are described.
The article describes the syndromes of liver disorders that occur in hereditary diseases; presents the combinations of individual syndromes having diagnostic significance. The pathogenetic aspects of the development of hepatic manifestations of hereditary diseases are considered.
Conclusion. Symptoms of liver damage are often in the practice of any physician. Most of them are the manifesta-tions of somatic pathology. However, certain combinations of symptoms of liver damage (syndromes) indicate heredi-tary pathology. Therefore, it is extremely important to know the main liver syndromes in specific hereditary diseases, to understand the etiopathogenesis of such disorders and to carry out proper differential diagnosis.