Vol 7, No 4 (2025)

BACKGROUND: With rare exceptions, the initiation and development of cutaneous melanoma is associated with endogenous pigmentation processes within its morphological substrate. It is a pressing task to identify and statistically confirm the predictors of various chromoproteins (endogenous pigments) in samples of superficial spreading cutaneous melanoma. This information is crucial for developing comprehensive, personalized treatment and rehabilitation plans for patients with melanoma of skin or other locations.

AIM: This study aimed to evaluate the role of multiplex analysis parameters of endogenous pigmentation components in the morphological substrate of superficial spreading melanomas in order to assess the feasibility of using these parameters to develop a rehabilitation program.

METHODS: This was a comparative study of the histopathology, ultrastructure, and spectroscopy of 128 samples of superficial spreading melanoma that were excised during definitive surgery. Two comparison groups were formed, one with a predominance of radial (horizontal) tumor growth (n=83) and one with a predominance of vertical tumor growth (n=45). The control group (n=10) included patients who had no signs of skin conditions in their medical history or at the time of death (cadaver material).

RESULTS: The malignant transformation of a tumor, as evidenced by its transition from a radial to a vertical growth phase, was associated with decreased initial fluorescence and lower detection rates of endogenous pigment components in the second group of cases. Binary logistic regression revealed statistical correlations between tumor growth phases and endogenous pigment components, and demonstrated the high statistical significance of correlations identified for tyrosine (p=0.01554), tryptophan (p=0.00769), and phenylalanine (p=0.01753).

CONCLUSION: Combined histopathological and spectroscopic testing followed by multiplex analysis revealed a significant number of statistically confirmed endogenous pigmentation components in samples of superficial spreading melanoma. Predictors of melanin and lipopigments provide valuable diagnostic and predictive information regarding the invasive potential of melanomas for modification of diagnostic and rehabilitative paradigms for these tumors skin and other locations.

BACKGROUND: Speech therapy is considered the cornerstone of rehabilitation for patients with post-stroke aphasia. Its effectiveness increases when combined with non-invasive brain stimulation (NIBS). However, some studies do not support the superiority of combined therapy. Conflicting results may be explained by a lack of awareness about the most effective neuromodulation strategies for different clinical and pathogenetic phenotypes in patients with aphasia.

AIM: This study aimed to evaluate the phenotype-associated effectiveness of speech recovery immediately after a course of routine adjuvant repetitive transcranial magnetic stimulation (rTMS) in patients with post-stroke sensorimotor aphasia.

METHODS: The retrospective observational study included 770 patients, aged 27 to 83 years, with confirmed post-stroke sensorimotor aphasia (52.7% male) and 40 healthy volunteers, aged 30 to 82 years (52.5% male). Speech dysfunction was assessed using the Speech Function Assessment Scale (SFAS), with a score range of 1 to 25. Based on the identified patterns of electroencephalographic interhemispheric cross-correlation in symmetrical leads corresponding to the Broca’s area and its homologue, patients were divided into four phenotypes. Phenotype 1: positive correlation with a positive lag (leading activation of the dominant hemisphere) or zero lag. Phenotype 2: positive correlation with a negative lag (leading activation of the non-dominant hemisphere). Phenotype 3: negative correlation. Phenotype 4: no correlation. Depending on their phenotype, patients received high-frequency rTMS to the affected hemisphere and low-frequency rTMS to the unaffected hemisphere. In the control subgroups, NIBS was not performed. Clinical efficacy was assessed immediately after the end of treatment using the criterion of transitioning to a group with better recovery parameters and specific SFAS scores.

RESULTS: Both rTMS strategies demonstrated better clinical effectiveness in patients with phenotype 3, in phenotype 2 patients in the high-frequency rTMS subgroup, and phenotype 4 patients in the low-frequency rTMS subgroup. Patients with phenotype 1 reported lower clinical effectiveness in the rTMS subgroups than in the control subgroup.

CONCLUSION: The effectiveness of speech recovery after a course of adjuvant rTMS in patients with post-stroke sensorimotor aphasia depends on the alignment of the neuromodulation strategy with the phenotype of the interhemispheric interaction between the Broca’s area and its homologue.

Comorbidities, such as asthma and obesity, present significant medical and social challenges. Their biological mechanisms are closely interrelated with mental and behavioral factors, forming a vicious circle where traditional pharmacotherapy is often insufficient. Unlike other publications, this review takes an in-depth look at the essential role of multidisciplinary rehabilitation in the management of comorbidities. The focus is to review the current evidence on the importance of a personalized, multimodal diagnostic approach that incorporates bioimpedance analysis, indirect calorimetry, and biochemical and genetic marker assessments in order to develop individualized nutritional support programs.

The analysis showed that patients with both asthma and obesity require a comprehensive management strategy that includes three components: a diet to modulate systemic inflammation, a structured physical rehabilitation program combining aerobic exercise, breathing exercises and inspiratory muscle training, and a lifestyle modification program. Multidisciplinary rehabilitation is shown to simultaneously target the key components of asthma and obesity pathogenesis, such as systemic inflammation, respiratory mechanical limitations, and metabolic dysfunction, to improve asthma control, facilitate weight loss, provide a sustained improvement in functional parameters and a significant enhancement in quality of life, and minimize the medication burden.

This article provides a comprehensive understanding of the methodology for developing and implementing rehabilitation programs for patients with comorbidities. The proposed structured strategies, including diagnostic algorithms, physical rehabilitation protocols, and effectiveness criteria, represent the primary research and practical contributions of this work, facilitating the clinical implementation of this integrated strategy and optimizing treatment outcomes for a challenging patient population.

A modern medical rehabilitation system should consider two factors: the specific characteristics of a medical condition and the underlying pathophysiological mechanisms. This review describes the current state of the medical rehabilitation system for cardiac surgery patients, including its characteristics, issues, and future prospects. It also justifies the need for rehabilitation specialists to be involved in every stage of cardiac surgery care.

The modern medical rehabilitation system tends to transfer primary responsibility for rehabilitation activities to rehabilitation therapists. Other specialists are involved under the guidance of rehabilitation therapists to provide a multidisciplinary approach. However, the primary role of a rehabilitation therapist is not feasible because of the unique characteristics of cardiovascular diseases, significant differences in preoperative and postoperative management algorithms for patients with various cardiac surgical conditions, and inability to predict hemodynamic responses following surgical treatment. The maximum potential of extended rehabilitation is achieved through the involvement of a multidisciplinary team led by a cardiac surgeon. Other specialists, including rehabilitation therapists, should participate using not a consultative format, but a dynamic, project-based approach that considers all the specific features of a patient’s cardiac surgery and associated medical condition. This approach enables timely and effective adjustments to the rehabilitation program. The addition of a rehabilitation therapist to a cardiac surgery team led by a cardiac surgeon can significantly improve the quality and effectiveness of rehabilitation care for patients undergoing cardiac surgery.

Despite the availability of clinical guidelines, the organization of cardiac surgery rehabilitation needs to be improved. Cardiologists and cardiac surgeons often lack of awareness of the current capabilities of rehabilitation medicine and the necessity of early initiation of rehabilitation care. Moreover, the rehabilitation system does not keep pace with advancements in cardiac surgery, failing to consider the specific features of cardiac surgical conditions. The revitalization of the Russian rehabilitation system, the development of clinical guidelines regulating all stages of rehabilitation for various patient profiles, and the implementation of extended rehabilitation principles in cardiac surgical care processes remain unsystematic and unstructured. Therefore, this issue requires active research.

Von Hippel–Lindau disease is a rare, congenital, multisystemic hereditary disorder classified as a phakomatosis. It is characterized by multiple benign and malignant angiomatous tumors. Hemangioblastoma of the central nervous system is classified as a rare, highly vascularized, benign tumor. This is one of the most common tumor types associated with von Hippel-Lindau disease. The condition usually has a long asymptomatic phase, so it often goes undiagnosed until adulthood.

This work presents positive rehabilitation outcomes for a 16-year-old girl with von Hippel-Lindau disease, which manifested as multiple cystic and solid lesions in the posterior cranial fossa. Rehabilitation took place at the Medical and Rehabilitation Research Center Russkoye Pole. A long rehabilitation period allowed for the gradual achievement of clinical goals, such as restoration of clear consciousness, safe and stable movement patterns, motor skills, voice and respiratory functions, and functional swallowing. A significant improvement in quality of life was observed after the patient received comprehensive, long-term medical rehabilitation from a multidisciplinary team. The local psychologists helped the girl and her mother overcome their difficult situation caused by the disease and adopt an optimistic outlook on their future, despite the high risk of new tumors.Continuous rehabilitation efforts enabled the girl to successfully graduate from school and enter a higher education institution.

The girl did not fully recover. Targeted therapy with belzutifan was prescribed because of the presence of slow-growing lesions in the brain and spinal cord. The planned duration of the targeted therapy is three years.