Molecular pathways of liver regeneration: A comprehensive review

Long-term outcomes depend heavily on the possibility of performing radical resection. To evaluate long-term results in perihilar cholangiocarcinoma (PHC) patients from the perspective of a new understanding of radical resection. Consecutive PHC patients who underwent surgical resection at A.V. Vishnevsky Center of Surgery from 2011 to 2018 were retrospectively reviewed. Fifty eight (87.9%) patients underwent hemihepatectomy (14 extended hemihepatectomies), while 2 (3%) underwent extrahepatic bile duct resection only, 6 (9.1%) underwent S4b, and 5 underwent en bloc resection of the extrahepatic bile duct. The influence of the bile duct wedge R status, nodal status, microvascular invasion, microlymphatic invasion, perineural invasion, liver invasion, and surrounding adipose tissue invasion on survival was tested by Cox's models. Survival rates depending on pathological parameter numbers were compared by log-rank tests. Wedge resection, nodal status, microvascular invasion, microlymphatic invasion, perineural invasion, liver invasion, and surrounding adipose tissue invasion served as extended criteria for curability (R+, 1 to 7 parameters). For R0 resection status and R1 resection status (R+1, R+2), 7 and 5 parameters were negative, respectively. For R1+ resection status (R+3, R+4, R+5, R+6, R+7), 3 to 7 parameters were positive. Patients who underwent R0 and R1 resections had 5-year survival rates of 100%; the 1- 2- 3-year survival rates were 63%, 49%, 33% for patients who underwent R1+ resections, respectively. The expanded criteria for determining radical resection levels correlated with long-term outcomes (р = 0.0001). The new concept for radical resection can accurately reflect surgical treatment results and contribute to selecting appropriate adjuvant therapies in PHC patients. The study was carried out in accordance with the framework of the "Multimodal treatment of primary and secondary malignant tumors of the liver and pancreas" (state registration № 315030310062).

Clostridioides difficile infection in patients with nonalcoholic fatty liver disease-current status

To identify factors affecting the mental and physical health of first-year medical students during the period of rapid SARS-COV-2 spread in the COVID-19 pandemic to develop effective strategies for managing student well-being and education quality during global pandemics. 656 first-year students of Sechenov University aged 17 to 23 years (17.91 ± 1.01 years) were included in an online anonymous survey. The study consisted of two assessment phases: in traditional training in September-December 2021 and in distance learning in January-March 2022. The State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory, the Cantril Self-Anchoring Scale, and an original questionnaire were used for evaluation. During the rapid COVID-19 spread in COVID-19 pandemic, most first-year medical students had a high level of reactive anxiety, accompanied by depressive disorders and vegetative-somatic manifestations that significantly reduced their adaptive potential, life quality and academic performance. All first-year students regardless of age were shown to be sensitive to stressful situation. The females demonstrated more pronounced psycho-vegetative changes compared to the males. Students of medical, pediatrics and medico-preventive faculties reacted more strongly to the current situation than students of dental and pharmaceutical faculties. The identified changes in the psycho-vegetative student status were associated, first of all, with the difficult sanitary-epidemiological SARS-COV-2 situation and related financial problems. Students considered the transition to distance learning to be the most important support measures. Temporary transition to distance learning led to the significant decrease in the anxiety level, correction of depressive and vegetative manifestations, and significant increase in the life quality that was of great importance for the education quality. Significant student support measures during COVID-19 pandemic were also financial, psychological and informational assistance. The obtained results made it possible to develop the effective strategies for managing student health and education quality during global pandemics.