BACKGROUND: Risk stratification systems, one of the optimal solutions for differential diagnosis of nodular pituitary disorders, are currently under development. The high prevalence of pituitary diseases makes it necessary to evaluate the effectiveness of risk stratification systems and to widely implement them into routine clinical practice. AIM: To evaluate the effectiveness of modern risk stratification systems used to diagnose nodular pituitary disorders. MATERIAL AND METHODS: A total of 1,606 medical records of patients operated on for nodular pituitary disorders in 20062014 were analyzed. The preoperative ultrasonography results and cytological findings were evaluated. The ultrasonography results were classified using the TI-RADS system, while the biopsy data were classified using the TBSRTC system. The surgery protocol and the pathomorphological data were the truth criterion. The effectiveness of the TI-RADS and TBSRTC systems, as well as their contribution to the performance of endocrinologists in outpatient clinics, was analyzed. RESULTS: Cluster analysis revealed a significant volatility of ultrasonography signs in the TI-RADS category, while there was no dominant sign that could be considered the diagnostic standard. Factor analysis proved the consistency of the imaging TI-RADS system based on individual signs. The signs being evaluated are characterized by high significance level but different priorities depending on the type of putative pathology. Discriminant analysis revealed that TI-RADS was a robust and versatile system to be used for various types of nodular pituitary disorders. The overall effectiveness of the TI-RADS system in diagnosis of pituitary tumors was low: it was characterized by 75.4% sensitivity, 84.7% specificity, and 80.1% accuracy. However, this system concretized the indications for fine-needle aspiration biopsy and drew the cytologists attention to the likelihood of pituitary tumor. The implementation of the TBSRTC system reduced the percentage of non-informative (by 9.8%) and controversial results (by 1.7%). Cytological examination was more effective in detection of pituitary cancer compared to ultrasonography (91.0% accuracy, 94.9% specificity, and 76.5% sensitivity). The impressions of ultrasound technicians and cytologists were concordant in 873 (54.4%) cases. A survey conducted among endocrinologists in outpatient clinics showed that implementation of the TI-RADS and TBSRTC risk stratification systems reduced the decision time (p0.001) and errors both in diagnostics (p0.001) and treatment approach selection (p0.001). CONCLUSION: The combined use of the TI-RADS and TBSRTC systems allows one to personalize the treatment approaches for patients with nodular pituitary disorders. The implementation of these systems has a positive effect on endocrinologists performance as it reduces the decision time and the likelihood of making errors in diagnosis and treatment strategy selection.

Chronic gastroduodenitis (CGD) is one of the most common diseases in children. Current data on the prevalence and incidence of CGD in children vary greatly from different sources, and therefore it is difficult to form strategies aimed at preventing CGD at an early age, which leads to an increase in the number of patients with late diagnoses, as well as a decrease in the quality of life of patients and their families, and has significant socio-economic consequences. The aim of the study was to assess the prevalence of CGD among children living in the large administrative center of the Central Federal District, the city of Yaroslavl. A retrospective analysis of the clinical, endoscopic and morphological status of the upper digestive tract in children with chronic digestive diseases examined in the conditions of the consultative and diagnostic center (CDC) of the Regional Children's Clinical Hospital (RCCH) for the period 2017-2021 was carried out. Based on the data obtained, the following statistical indicators were calculated: gender-age composition of patients with CGD, morbidity, prevalence for specific annual indicators and age groups. At the time of the retrospective analysis, 2,416 children were diagnosed with CGD. In 2021, the incidence was 4.92 per 1,000 children, and the prevalence was 20.61 per 1,000 children, these indicators change every year in waves. Our data on the prevalence of CGD in the city of Yaroslavl are underestimated and have a wide spread in different age categories. The problem raised in our study requires in-depth study on additional samples of children in this region.

INTRODUCTION: Gastric cancer remains one of the leading causes of oncological morbidity and mortality. AIM: To determine the effectiveness and safety of wedge resections of stomach in patients with early gastric cancer (EGC) in comparison with endoscopic intraluminal treatment methods. MATERIALS AND METHODS: Assessment of the immediate and long-term (5 years) prognosis of 164 patients with EGC who underwent wedge resection of stomach and endoscopic intraluminal interventions was performed. One hundred twenty eight patients were operated on in the volume of endoscopic intraluminal mucosal resection or submucosal dissection (the mean age 68.5 9.2 years; men 53.7%). In 36 patients (the mean age 65.3 7.8 years; men 66.7%), according to gastroscopy in combination with chromogastroscopy, narrow-band magnification endoscopy, the tumor dimensions exceeded those recommended for endoscopic methods. Due to contraindications for classic resection interventions in such patients, wedge resections of the stomach were performed. RESULTS: In the comparison groups there was no postoperative mortality, however, in the group with use of endoscopic methods, complications were noted (perforations of the stomach and bleeding). All the complications were eliminated endoscopically. In the group of wedge resections, there were no postoperative complications, but in the long-term result, the five-year survival rate was lower than in the group of endoscopic treatment (75.0% versus 92.2%; 2 = 8.10, p = 0.004) due to a more severe comorbid pathology in the patients of wedge resection group. CONCLUSION: Safety and equal effectiveness of wedge gastric resections was established in the long-term oncological result in patients with EGC in comparison with intraluminal endoscopic methods.

Introduction. The incidence of gastric cancer remains high, despite the increase in the share of stage I–II cancers — 37.1% in 2019. Surgical treatment remains relevant even in patients with “early” forms of gastric cancer (EGC). Therefore, the reliable means for determining the surgeon volume in such patients are to be urgently developed.Aim. To estimate the probability of building a stable predictive model for patients with EGC in order to choose the proper surgical intervention.Materials and methods. Th e research involved the data obtained from “Database of patients with gastric cancer, reflecting statistics of patients with a particular variant of surgical intervention, treated at Yaroslavl Regional Clinical Oncological Hospital during the period from 2009 to 2019”. All patients (n = 266) received different volume of surgery: intraluminal surgery (n = 128), wedge gastric resection (n = 36), classical gastrectomy or subtotal gastric resection (n = 102). According to the volume of intervention, the patients were ratified into several study groups. Statistical analysis involved case records of three groups of patients and was conducted using MedCalc Statistical Soft ware version 20.022 and Statistica 12.5.Results. Ten factors were identified to form a patient model corresponding to each method of surgical treatment. Th e fairness of the division of patients into groups was checked by ROC-analysis in order to determine sensitivity and specificity of the set of criteria for the division. Th e following characteristics of the mathematical model were obtained by means of ROC analysis: concordance coefficient = 88.24%, AUC = 0.893; index J = 0.811; Se = 87.92; Sp = 89.04; +LR = 3.27; -LR = 1.31.Conclusion. Introduction of this approach into clinical practice decreased the rate of gastrectomies and gastric resections by 15% for the last three years.

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