Vol 22, No 4 (2025)

Relevance: Machine learning methods are widely used today in the search for pharmacological compounds. The nature and internal structure of chemical and biological data are highly specific, and the vast majority of drugs act simultaneously on multiple biotargets. Given this, the development of new artificial neural network architectures for analyzing the relationships between the biological activity and structure of chemical compounds, taking into account the specific nature of chemical and biological information and the interactions of compounds with multiple biotargets, is important and scientifically relevant task.

Objective: To create a new architecture for a modular multi-target fully connected convolutional neural network based on correlation convolution of energy spectra of multiple docking to multiple biotargets, for the in silico searching biological active compounds.

Materials and methods: Ensemble multiple docking of 234 compounds with antimicrobial activity against S. aureus and 537 compounds with anxiolytic activity into 10 and 22 relevant biotargets, respectively, and the generation of their energy spectra of multiple docking were performed using the original MSite program and AutoDock Vina program. Using the obtained energy spectra of multiple docking, two modular multi-target fully-connected convolutional correlation neural networks were constructed using the original FCCorNet program. These networks describe the dependences of the levels of antibacterial activity against S. aureus and anxiolytic activity of chemical compounds on the energies of their modular neural networks. The accuracy and statistical significance of the constructed neural network models were assessed using correlation analysis, one-way analysis of variance, and threshold classification.

Results and discussion: The accuracy of the constructed neural network model for the antimicrobial S. aureus activity was Acc = 78.9 %, with statistical significance p = 3.44 × 10^-12. The accuracy of the constructed neural network model for anxiolytic activity was Acc = 61.3 %, with statistical significance p = 6.68 × 10^-8. The accuracy of predicting the antimicrobial S. aureus activity exceeds the accuracy of predicting the anxiolytic activity, which is probably due to a more complex systemic multi-target mechanism for implementing psychotropic effects, in comparison with the antibacterial action of chemical compounds. The obtained results prove the high validity of using the new architecture of the modular multi-target fully connected convolutional correlation neural network based on the energy spectra of multiple docking for in silico searching biological active substances.

Conclusion: A new artificial intelligence method for in silico searching biological active compounds has been developed: a modular multi-target fully connected convolutional correlation neural network based on the energy spectra of multiple docking into relevant biotargets. Multivariate statistics methods demonstrated high accuracy and statistical significance of the constructed neural network models, reaching p = 3.44 × 10^-12 for antibacterial activity against S. aureus and p = 6.68 × 10^-8 for anxiolytic activity. The developed methodology can be used for in silico searching new highly active compounds with various types of systemic multi-target biological and pharmacological activity, taking into account their integrated affinity for relevant target proteins.

The uterus is structurally an unique organ, the endometrium of which undergoes constant cyclical changes with the onset of puberty of the body. Little is known about the presence of lymphatic vessels in the endometrium of the uterus during pregnancy or outside of this condition, although the presence of lymphatic vessels in the myometrium and perimetrium has been established. Considering the importance of lymphatic vessels in other organs and tissues, lymph circulation through them can play a key role in establishing and maintaining pregnancy. The aim of the work is to summarize the literature data on the presence of structural components of the lymphatic system in the uterine wall during pregnancy or in the absence of it. The search for literature on the topic of the work was carried out using the e-library and Pubmed databases up to and including 12.11.2025 in accordance with the PRISMA methodology. In the early stages of pregnancy (I trimester), lymphangiogenesis occurs in the endometrium of the uterus, stimulated by cytotrophoblasts and NK cells, which ensures the outflow of intercellular fluid and protects the fetus from triggering a rejection reaction. It has been shown that human trophoblasts produce molecules that promote the formation of lymphatic vessels in the endometrium of the uterus during pregnancy, such as VEGF-C, Ang-2, as well as D2-40 and LYVE-1. In late pregnancy (II and III trimesters), lymphatic vessels are not found in the mature placenta, which may be due to active suppression of their growth (antilymphangiogenesis). At the same time, none of the main lymphatic markers – PROX-1, VEGFR-3, LYVE1 and D2-40 – are expressed by endothelial cells of placental vessels, which suggests that the role of markers of lymphangiogenesis is likely to decrease with the development of pregnancy. The additional experimental studies are needed to confirm this hypothesis. The lymph outflow from the myometrium and perimetrium of the uterus during pregnancy coincides with that in the absence of it.

Introduction: Nowadays, there is a high level of dental diseases among the population, which are the main etiological factors in the formation of dentition defects, requiring their restoration by dental implantation. At the same time, there is often a loss of teeth and pronounced atrophy of the alveolar process, which creates certain difficulties at the surgical stage, resulting in singnificant rehabilitation period increase.

Material and methods: The article presents the clinical results of the practical application of dental implantation with palatal exposure (vestibular bone shield) with milled and anodized implants. A three-year research was conducted in 103 clinical cases, where the patients' age was 50–68 years old. The obtained data were evaluated using the MS Office Excel system.

Results: The combination of the positive properties of the dental implantation method with palatal exposure (vestibular bone shield) with milled and anodized tooth neck implants significantly reduces trauma, increases safety, and shortens the rehabilitation period for patients. In addition, the milled and anodized tooth neck of the dental implants ensures optimal mucogingival integration on the exposed palatal side. This eliminates the need for alveolar ridge reduction and bone augmentation.

Conclusions: The practical application of dental implantation method with palatal exposure (vestibular bone shield) with milled and anodized tooth neck implants clinically confirms the effectiveness due to its low invasiveness and significant reduction in the time required for comprehensive surgical and orthopedic rehabilitation of patients.

Introduction: Metatarsalgia is a widespread pathology of the forefoot, manifesting as pain syndrome and functional limitations. When conservative treatment is ineffective, the "gold standard" for surgical correction is the Weil osteotomy with screw fixation of the fragments. However, this method is associated with the risk of implant-related complications (such as migration, screw fracture, foreign body reaction) and requires a long period of load restriction and rehabilitation. As an alternative, the technique of performing the Weil osteotomy without internal fixation is considered, which potentially allows for reduced recovery times due to the possibility of earlier axial loading.

Objective: To compare long-term functional outcomes and the frequency of postoperative complications after the Weil osteotomy with screw fixation and without it.

Materials and methods: A retrospective cohort study was conducted, including 146 patients (297 osteotomies) who underwent surgery between 2022 and 2024. Patients were divided into two groups: Group 1 (standard technique with fixation using 2.0 mm Herbert screws, n = 89 patients, 159 osteotomies) and Group 2 (technique without implant fixation, n = 57 patients, 138 osteotomies). The mean follow-up period was 18 months. Outcomes were assessed using the validated functional AOFAS Lesser Metatarsophalangeal-Interphalangeal Scale (LMIS) and the Visual Analog Scale (VAS) for pain intensity, as well as control radiography data. All intra- and postoperative complications were recorded. Statistical analysis was performed using the Mann – Whitney U test and χ² test (significance level p < 0.05).

Results: Analysis of functional outcomes revealed no statistically significant differences between the groups: the mean AOFAS LMIS score in Group 1 was (70.8 ± 15.2), and in Group 2 it was (77.3 ± 12.7) (p = 0.11). Pain intensity on the VAS was also comparable: (3.8 ± 2.1) and (3.2 ± 1.9) points, respectively (p = 0.14). However, the analysis of complications revealed significant advantages of the fixation-free technique: the incidence of transfer metatarsalgia in Group 1 reached 31.5 %, while in Group 2 it was only 17.5 % (p = 0.04). The rate of revision interventions was twice as high in the fixation group (18.0 % vs. 8.8 %, p = 0.04). Furthermore, a statistically significant reduction in recovery time was recorded in Group 2 – (6.3 ± 1.8) weeks versus (8.2 ± 2.1) weeks in Group 1 (p < 0.01).

Conclusion: The fixation-free Weil osteotomy demonstrates long-term functional results and levels of pain syndrome comparable to the classical technique. At the same time, the fixation-free technique offers a number of significant advantages: a significantly lower incidence of transfer metatarsalgia (a 44 % reduction) and the need for revision surgeries (a 51 % reduction), as well as a 23 % shorter functional recovery period. Thus, the Weil osteotomy technique without internal fixation is a clinically feasible and promising alternative to the standard approach, allowing for minimized complication risks and accelerated return of patients to active life.

Introduction: The introduction of remote methods in healthcare to increase treatment adherence requires exploring new forms of doctor-patient interaction. One of these aspects is the gamification of patients. In Russian medical science, the phenomenon of patient gamification remains poorly understood, and there is a lack of scientific data on the attitude of practicing physicians to this process.

The purpose of the survey is to study the opinion of the medical community about the gamification of patients in the healthcare system of the Russian Federation. The task is to develop a study design to study the position of doctors towards gamification of patients.

Research methodology: The article announces an open, non-randomized multicenter cross-sectional cohort study, which is planned to be conducted in a pilot mode in the Volgograd Region in public and private healthcare institutions.

Results and discussion: The study is presented in the form of a survey of specialists with higher medical education who are engaged in real clinical practice. The sample will consist of at least 150 doctors of various specialties from various medical institutions in the Volgograd region. The survey is presented in the form of 15 questions reflecting the age, gender, specialty, work experience in the specialty of the respondents and their attitude to various aspects of gamification of patients, including questions on definitions, monetization, organizational aspects and emotional attitude to gamification. Of particular interest is the attitude of doctors towards the monetization of such interventions, as well as the study of their willingness to personally implement the technique, as well as the identification of potential barriers to the introduction of gamified interventions into the healthcare system. The tasks, methods, data processing and the overall design of the study are highlighted.

Conclusion: The presented research design will fill a gap in the study of the perception of gamification by the medical community. The results can be used to develop practical recommendations for integrating gamified interventions into clinical practice.

When planning implant surgery, preceded by sinus lift, it is necessary to study the anatomical and topographic features of the maxillary sinus, specifically its volume, shape, type of pneumatization, the presence of internal bony septa in the sinus floor, and the volume of bone tissue located above the apices of the maxillary teeth.

The aim of the study was to evaluate the volume of the maxillary sinus in men and women of different age groups depending on the composition of the dentition by sectioning skeletonized skulls. A total of 254 certified skulls were examined. Subjects were divided into age groups (25–34, 35–44, 45–54, 55–64, 65 years and older) and groups based on the presence and/or absence of chewing teeth, excluding third molars.

Research methodology: The 254 skeletonized skulls studied were also divided into three groups: the first included 48 skulls with premolars and molars; the second included 148 skulls with at least one missing premolar and/or molar; and the third included 58 skulls with no premolars or molars. A window was cut into the anterior wall of the sinus in the fossa canina region using a micromotor and a carbide bur to better visualize the internal surface of the maxillary sinus. The width, depth, and height of the maxillary sinus were measured, and the volume of the maxillary sinus was then calculated. Cone-beam computed tomography of the skeletonized skulls was also performed, along with measurements of the width, depth, and height of the sinus and a calculation of its volume.

Results of determining the average maxillary sinus volume on dry specimens showed that the largest sinus volume was also observed in men aged 55-64 years, while the smallest was observed in men aged 45–54 years in all three groups, depending on the presence and/or absence of molars in the upper jaw. The sinus volume on the right was larger than on the left in most cases. The loss of molars increases the volume of the maxillary sinus.

The aim of the study was to determine the structural features of the testes in cases of dietary magnesium deficiency and its pharmacological correction.

Materials and methods: An experimental study was conducted on 50 outbred sexually mature male rats weighing 200–300 g. Hypomagnesemia was modeled for 12 weeks using a magnesium-deficient diet. The animals were divided into 5 experimental groups. The first group was the control group, animals were kept on a complete diet, the second group consisted of animals with dietary magnesium deficiency, and the third, fourth, and fifth groups received pharmacological correction with magnesium preparations: Magne B6, Magnevitol and Bishofit respectively. Animals from which testes were isolated were randomly selected from the group for histological examination. Microscopic preparations were prepared using standard histological techniques. Morphometric analysis of the testes was assessed using a standard method, determining Sertoli cell and spermatogonial counts. Statistical processing of the results was performed using Prism 8 software (GraphPad Software Inc., USA).

Results: When counting the number of spermatogenic epithelial cells and sustentacular cells, a significant 22 % decrease in these cells was noted in the hypomagnesemia group of animals, indicating the onset of degenerative changes in the spermatogenic epithelium. In the experimental groups receiving magnesium supplements from weeks 9 to 12 of magnesium deficiency, a statistically significant increase of 17.5–18 % in the examined cells in the convoluted seminiferous tubules (p < 0.05) was observed, indicating the reversibility of the characteristic structural changes in the testes associated with hypomagnesemia.

Conclusions: The study revealed that magnesium deficiency resulted in a statistically significant reduction in the number of examined cells in the convoluted seminiferous tubules of rat testes. In the testes of rats in the experimental groups receiving magnesium supplements, a restoration of spermatogonia and Sertoli cell counts was observed, indicating the reversibility of the identified structural and functional changes.

Cervical insufficiency is the main point in the realization of premature birth. The issues of early diagnosis and correction of this condition remain unresolved today. This work is devoted to a comparative analysis of the course of pregnancy and perinatal outcomes in groups of women with cervical insufficiency, which was corrected by obstetric pessary and cervical cerclage against the background of intravaginal progestogens up to 34 weeks of gestation.

The work investigates the method of transpedicular fixation (TPF), which is widely used at present in the surgical treatment of various spinal pathologies. The technique allows for correction of deformations and stabilization of the spinal column, while the layout and extent of the metal structure are determined by the nosology and preferences of the surgeon. Biomechanics methods, including computer modeling and numerical calculations, were used to assess the stress-strain state of one of the TPF variants. The purpose of the study was to conduct a comparative assessment of the simplified PTK model with the results of standard modeling, and to substantiate the validity of the proposed approximation method for further scientific research. The main objective of the study was to create three-dimensional models of spinal-motor segments and the transpedicular system (TPS), followed by the calculation of their stress-strain state under compression load using the finite element method (FEM). The simulation was performed in SolidWorks Simulation using static analysis to determine stresses and deformations. The study examined a biomechanical model of the lumbar (L1–L5) spine of a patient at the Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of the Saratov State Medical Uni-versity named after V.I. Razumovsky. Special attention is paid to the balance between the accuracy of the geometric representation of the model and computational efficiency, as well as possible errors associated with sampling and approximation. The results of the study showed that the maximum equivalent stresses arising from a 400 KN load on the lumbar spine in a solid-state non-polygonal model exceed the stresses in the polygonal model by no more than 7–10 %, which is sufficient to assert the possibility of estimating the VAT of spinal segments using a simplified model.

The aim of the study was to identify associations between the levels of biologically significant micro- and macroelements in the human body and the expression of standard fNIRS indicators.

Research methodology: The study involved students from state universities, native residents of three regions of the European part of Russia: Arkhangelsk and Volgograd Oblasts, and the Republic of Crimea, aged 18–25 years (49 men and 51 women). The elemental status of the subjects was assessed based on the content of biologically significant micro- and macroelements (Al, As, B, Be, Ca, Cd, Co, Cr, Cu, Fe, Hg, I, K, Li, Mg, Mn, Na, Ni, P, Pb, Se, Si, Sn, V, Zn) in hair samples. Chemical analysis of the biological material was performed using standard methods of inductively coupled plasma atomic emission spectroscopy at the ANO Center for Biotic Medicine (Moscow). To assess the hemodynamic response of the cerebral cortex in the near infrared range, a Cortivision Poton Cap C20 device (Cortivision, Poland) equipped with 20 optodes (10 sources and 10 detectors) with a sampling frequency of 7.8125 Hz was used. Statistical processing of the results was performed in SPSS for Windows (ver. 20).

The results of the study: The obtained results showed that hemoglobin concentration in the cerebral circulation, reflecting the overall level of metabolic activation, is directly related to the content of essential cationic macronutrients (Na, K, Ca, Mg) and inversely related to the content of heavy metals and toxicants (Pb, Hg, Sn, As, Ni).

Conclusion: These data necessitate further development of individualized cerebral metabolism based on the body's elemental status, particularly for individuals with cardiometabolic and neurocognitive disorders. Furthermore, the potential for widespread implementation of functional near-infrared spectroscopy in research and clinical practice as a simple and effective method for neuroimaging brain function is demonstrated.

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis and an increased risk of cardiovascular complications. Systemic inflammation and excessive production of proinflammatory cytokines contribute to myocardial remodeling and the development of subclinical dysfunction. Of particular interest is the relationship between joint inflammatory changes and cardiac dysfunction in PsA.

Objective: To determine the features of myocardial involvement in patients with psoriatic arthritis depending on joint changes.

Materials and methods: A total of 74 patients with PsA, 43 men, 31 women; mean age (50.5 ± 12.4) years, who received outpatient and inpatient treatment were examined. All patients underwent standard laboratory tests, transthoracic echocardiography with pulsed-wave and tissue Doppler imaging, as well as ultrasound examination of the joints. Echocardiography assessed systolic and diastolic function, left ventricular (LV) mass, and geometry. Synovitis and enthesitis were identified by joint ultrasound. Statistical analysis was performed using standard methods, with significance set at p < 0.05.

Results: Disease duration correlated with impaired diastolic function of both ventricles. High disease activity according to the DAPSA index and elevated C-reactive protein levels were associated with reduced LV ejection fraction. The presence of synovitis and enthesitis was accompanied by increased myocardial mass and signs of diastolic dysfunction.

Conclusions: In patients with PsA, a relationship was established between joint inflammatory changes and cardiac dysfunction, highlighting the need for comprehensive monitoring to ensure early detection of cardiovascular complications.

The surgery of Schlemm's canal is related to microinvasive surgery for primary open-angle glaucoma, which is why this area in ophthalmology is rapidly advancing and is a priority. The goal is to develop a technique for canal dilation performed during non-penetrating deep sclerectomy, as well as to assess its impact on the condition of Schlemm's canal and the hydrodynamic parameters of the eye.

Materials and methods: This paper presents an analysis of the results of non-penetrating surgery with Schlemm's canal dilation in 30 patients (30 eyes) with advanced primary open-angle glaucoma (main group) compared to standard technology for minimally invasive non-penetrating surgery (30 patients, 30 eyes). All patients underwent ophthalmoscopy, biomicroscopy, keratorefractometry, computer perimetry, tonometry, tonography, gonioscopy, pachymetry, optical coherence tomography of the optic nerve head and anterior segment with measurement of the longitudinal and transverse axis diameters, as well as the area of sagittal scanning of Schlemm's canal.

Results and discussion: The hypotensive effect after surgery was more pronounced in the main group of patients at 45.3 %, compared to 39.3 % in the control group (p < 0.05). The hypotensive effect in the main group was due to a significantly greater outflow of intraocular fluid. The difference between the mean values of the outflow facility coefficient of intraocular fluid in the main group, (0.3 ± 0.05) mm³/mm Hg × min, and the control group, (0.24 ± 0.04) mm³/mm Hg × min, was statistically significant (p < 0.001). Six months after surgery, the average area of Schlemm's canal was 41.7 % larger than that of the control group patients. The difference between the mean values of the area of Schlemm's canal in the main group, (1996.7 ± 232.4) µm², and the control group (1163.4 ± 226.9) µm², was statistically significant (p < 0.001).

Conclusion: Canal dilation during non-penetrating glaucoma surgery allows for the safe elimination of Schlemm's canal collapse, significantly expanding its lumen, normalizing intraocular hydrodynamics, and contributing to the stabilization of visual functions.

Introduction: Recurrent anterior shoulder dislocation is a common consequence of traumatic injuries associated with structural defects of the anteroinferior glenoid. The Bristow – Latarjet procedure remains one of the most effective surgical techniques for restoring glenohumeral stability by transferring the coracoid process to reconstruct the anterior bony buttress. However, postoperative resorption of the coracoid bone graft occurs in a substantial proportion of patients even when the procedure is performed correctly. This process may compromise the stability of the shoulder joint and increase the risk of recurrent instability. Consequently, biological methods aimed at enhancing osteointegration have gained growing attention, particularly the use of autologous bone marrow aspirate clot (BMAC), which contains mesenchymal stromal cells and osteoinductive factors capable of supporting bone healing.

The aim of the study: To assess the effect of BMAC application on the remodeling of the bone graft following the Bristow – Latarjet procedure and to compare postoperative changes in bone density and graft volume with the classical surgical technique.

Materials and methods: A prospective study included 22 patients with recurrent anterior shoulder dislocation. The patients were divided into two equal groups: the main group (n = 11), in which BMAC was applied to the graft surface, and the comparison group (n = 11), who underwent the conventional procedure. Bone marrow aspirate was harvested from the iliac crest and converted into a coagulated clot fixed onto the graft. Multislice computed tomography was performed at 2 days, 2 months, and 6 months postoperatively. Bone mineral density (HU) was measured at three anatomical levels, and graft volume was assessed via 3D reconstruction.

Results: The main group demonstrated a slower decline in bone density and significantly reduced graft resorption. At 6 months, the graft volume remained at (1.23 ± 0.11) cm³, compared with a nearly twofold reduction in the comparison group – (0.74 ± 0.25) cm³. Bone density above and between the screws decreased less markedly in the BMAC group, suggesting enhanced osteointegration and more active remodeling. The use of BMAC did not increase surgical duration, technical complexity, or complication rates.

Conclusion: The application of BMAC improves the biological environment for graft osteointegration and reduces the degree of graft resorption after the Bristow – Latarjet procedure. This technique is safe, technically feasible, and may significantly enhance the reliability of anterior glenoid reconstruction. Further randomized clinical studies are required to confirm these findings and determine the role of BMAC in standard treatment protocols for anterior shoulder instability.

Several clinical cases of central serous chorioretinopathy (CSC) in young patients are presented. This disease is of considerable interest to ophthalmology, because it is in this age group that it manifests itself most actively and can lead to a persistent decrease in visual functions. The study involved patients with a characteristic clinical picture of CSF, in whom a local detachment of the sensorineural layer of the retina was identified during the examination. To verify the diagnosis and determine treatment tactics, a modern diagnostic algorithm was used, including optical coherence tomography (OCT), which allows visualizing structural changes in the retina, and fluorescence angiography (PHAG), which accurately determined the localization of filtration points and fluid seepage through the pigment epithelium. Based on the diagnostic data obtained, laser intervention was performed in patients with an active filtration point that remained under dynamic monitoring. The technique consisted in the precise application of laser coagulates directly into the seepage zone, which ensured the blocking of pathological filtration. In the postoperative period, careful monitoring of patients' condition was carried out using control ophthalmological examinations. The results showed that laser intervention led to significant regression of exudative detachment and complete restoration of the anatomical structure of the retina in all treated patients. Dynamic observation using OCT diagnostics confirmed the stability of the achieved anatomical results, which correlated with an improvement in functional parameters. The data obtained indicate the high efficiency of retinal laser coagulation in the treatment of CSC in young patients, especially in cases with a clearly identifiable filtration point. A comprehensive diagnostic approach using modern imaging techniques and subsequent targeted laser intervention make it possible to achieve not only anatomical restoration of retinal structures, but also a significant improvement in visual functions. The presented clinical observations confirm the expediency of active treatment tactics for this pathology and demonstrate good long-term treatment results.

Background: Premenstrual syndrome (PMS) is a common condition among women of reproductive age and is characterized by pronounced psychoemotional and somatic disturbances that significantly reduce quality of life. According to recent national reviews and clinical studies, PMS remains an underestimated cause of temporary disability and maladaptation, particularly in populations with high cognitive workloads. Pain syndromes – mastalgia, headache, abdominal pain, and musculoskeletal discomfort – represent the leading components of the PMS clinical picture and frequently coexist with emotional lability and sleep disturbances. Despite its high prevalence, PMS remains insufficiently recognized, and standardized tools for pain assessment and dynamic symptom monitoring are still lacking.

Objective: To evaluate the effectiveness of the PMS BOT Telegram-based system in the diagnosis, dynamic monitoring, and clinical assessment of PMS-related symptoms.

Materials and methods: The study included 158 women of reproductive age: 70 with clinical manifestations of PMS and 88 controls. The PMS BOT chatbot facilitated daily symptom reporting, assessment of pain intensity and psychoemotional disturbances, and the generation of individualized menstrual diaries. Additional diagnostic tools included the Visual Analog Scale (VAS), the PSST questionnaire, algometry, assessment of micronutrient status (B-vitamins, 25-OH vitamin D, ferritin), and measurement of stress-related hormones (cortisol, noradrenaline, adrenaline, serotonin, prolactin).

Results: The chatbot improved adherence (80 % active participation for ≥3 cycles) and provided standardized data collection. The most frequent PMS symptoms were emotional lability (97.1 %), insomnia (71.4 %), and muscle tension (61.4 %). The symptom period decreased from 9–10 to 6–8 days.

Conclusion: The PMS BOT Telegram chatbot is an effective and accessible digital tool for PMS diagnosis and monitoring, improving quality of care and supporting personalized approaches in gynecology.