Journal «MEDICINA» 2/2026

The review presents modern achievements in the application of graph neural networks to solve urgent problems in bioinformatics and medicine. The article focuses on the fundamental reasons why graph neural networks should be used to analyze biological and medical data, and the basic principles of their application. The theory of creating graph neural networks is in the trend of artificial intelligence development and provides great prospects for realizing the advantages of machine learning in practice. The effectiveness of their use is due to the ability to generalize heterogeneous information, resistance to incomplete, fuzzy and noisy data; the ability to work with large amounts of information, including graph structures; good adaptation of the models used and compatibility with modern methods of parallel computing. In this regard, progressive achievements have been achieved in biomedical research, traffic forecasting, genomics, applied to knowledge graphs and in other applications. Examples of effective use of graph neural networks in bioinformatics and medicine are given, and future research directions are outlined. It has been shown that the use of GNN significantly increases the accuracy of diagnosis, accelerates the creation and testing of new drugs, and raises the level of interaction between the use of advanced computer technologies and patient treatment.

Key words: graph neural networks (GNN), graph representation training, deep learning on GNN, medical visualization and interpretability of data, recommendation systems for safe and effective medicines, prediction of properties of molecules and protein structure

A global step in the fight against tobacco was the adoption of the WHO Framework Convention on Tobacco Control in 2003, which includes the organization of monitoring of the prevalence of tobacco consumption. The main condition for monitoring is its organization based on representative surveys of the population and its individual groups, as well as taking into account new forms of tobacco and nicotine-containing products. The article presents data from a twenty-year monitoring of the prevalence of tobacco and nicotine-containing product consumption based on representative surveys of the adult population: the Global Adult Tobacco Survey (2009 and 2016) and the Sample Survey of Population Health (2019-2024). The survey samples were formed based on the file of population registration sites in all regions of the Russian Federation using random selection with a probability of selection proportional to size. Based on the microdata of the surveys, the authors calculated the prevalence of tobacco/nicotine consumption, smoking and non-smoking tobacco, electronic cigarettes, vapes, and heated tobacco products, as well as secondhand smoke, among the entire adult population, men, women, and different age groups. The monitoring data indicate a decrease in tobacco consumption, although the prevalence of tobacco/nicotine consumption remains high. The rate of decrease in tobacco consumption among women was 1.4 times higher than among men, while the rate of increase in nicotine-containing product consumption among women was 3 times higher. Some consumers have switched to combined use of products. Among women, the proportion of such consumers was twice as high as among men. The introduction of a ban on smoking in public places has significantly reduced the exposure of the population to ambient tobacco smoke and electronic cigarette aerosol.

Key words: tobacco consumption monitoring, nicotine consumption monitoring, behavioral risk factors, tobacco, nicotine-containing products, electronic cigarettes, vapes, heated tobacco products, secondhand smoke, prevalence of consumption, Russian Federation

On May 20, 2026, an expert council was held with the participation of 12 leading Russian oncologists, dedicated to current treatment options for triple-negative breast cancer (TNBC). The meeting reviewed the results of the phase III CamRelief registration trial (JAMA, 2025), Russian experience with neoadjuvant chemotherapy at N.N. Blokhin NMRC of Oncology (2016–2025), and practical aspects of camrelizumab use in early and locally advanced TNBC. Four preliminary theses were formulated: (1) inclusion of camrelizumab in Russian clinical guidelines; (2) post-neoadjuvant strategy; (3) patient selection criteria; (4) acceptability of chemotherapy component substitution in Russian clinical practice. This publication is the first part of a paired article; the second part is dedicated to pharmacoeconomic justification of camrelizumab use.

Key words: triple-negative breast cancer, camrelizumab, neoadjuvant chemoimmunotherapy, clinical guidelines, expert council, PD-1 inhibitors

Introduction. Triple-negative breast cancer (TNBC) is diagnosed in approximately 12,700 Russian women annually, with aggressive disease course, high relapse risk within three years, and significant healthcare burden. Treatment of metastatic TNBC costs the mandatory health insurance system RUB 4.8–7.2 million per patient – substantially exceeding the cost of a neoadjuvant immunotherapy course – making relapse prevention a compelling economic priority. Aim. To conduct a comprehensive pharmacoeconomic evaluation of camrelizumab in neoadjuvant treatment of stage II–III TNBC in the Russian healthcare context, supporting its inclusion in state reimbursement programmes. Methods. Markov model with lifetime horizon; cost-effectiveness analysis, budget impact analysis, dominance analysis. Clinical data source: CamRelief trial (JAMA, 2025). Payer perspective: Russian OMS. Results. In the base case (neoadjuvant + adjuvant phases), ICER was RUB 2.14 million/QALY, below the willingness-to-pay threshold of RUB 4.10 million/QALY. In the priority scenario specifically endorsed by the Expert Council – neoadjuvant phase only, without subsequent adjuvant immunotherapy – per-patient costs fall to RUB 1.52 million and ICER decreases to RUB 666,100/QALY, 6.2-fold below the threshold and is unprecedented in immunotherapy in Russia. When accounting for prevented GDP losses (RUB 2.44 million/patient), this regimen achieves full social cost-neutrality. Prevention of metastatic progression yields additional cohort-level savings of ≥RUB 3.1–4.7 billion. Conclusion. Camrelizumab has been included in the Russian Essential Medicines List (ZHNVLP). Urgent next steps are integration into RUSSCO and Ministry of Health clinical guidelines and OMS reimbursement tariffs. The neoadjuvant monophase regimen represents the optimal balance of efficacy, safety, and state economic benefit.

Key words: triple-negative breast cancer, camrelizumab, pharmacoeconomics, cost-effectiveness analysis, budget impact analysis, health technology assessment, essential medicines list, neoadjuvant immunotherapy

Objective. To analyze the role of wearable transdermal sensors for continuous alcohol monitoring (primarily wrist-worn BACtrack Skyn and WrisTAS devices) in the treatment of alcohol use disorder and relapse prevention. Methods. A narrative synthesis of data from randomized controlled trials, cohort and observational studies, systematic reviews, and meta-analyses published between 2006 and 2026. Searches were conducted in PubMed, Semantic Scholar, ScienceDirect, and OpenAlex. After screening 357 full-text articles, 48 of the most relevant sources were selected for final analysis. Results. The most compelling evidence comes from integrating continuous monitoring with contingency management – a system of material reinforcement for verified abstinence. Randomized trials demonstrate odds ratios of 8–9 in favor of contingent reinforcement, an increase in the proportion of abstinent days from 23–31% to 54–85%, and a reduction in standard drinks per week from 40 to 11. The technical accuracy of modern wrist-worn sensors in laboratory settings reaches an area under the ROC curve (AUROC) of 0,97 (sensitivity 89,8%, specificity 90,6%); however, in field settings, sensitivity to individual drinking days decreases to 54–78%. A key advantage of continuous monitoring is the ability to characterize drinking episode dynamics (rate of ascent, area under the curve), which independently predicts alcohol-related consequences. Device acceptability among patients is high (81–96% would use them again), with stigma, skin reactions, and the lack of standardized data interpretation algorithms remaining the main barriers. Conclusion. Wrist-worn transdermal sensors are a promising tool for objectifying alcohol consumption and supporting behavioral interventions for AUD. Transitioning to routine clinical practice requires large multicenter RCTs with observation periods of at least 48 weeks, the development of automated analytical pipelines, and cost-effectiveness analyses.

Key words: alcohol use disorder, continuous alcohol monitoring, transdermal alcohol concentration, wearable sensors, BACtrack Skyn, contingency management, relapse prevention, objective alcohol consumption assessment

Introduction. The presence of treatment motivation determines the likelihood of achieving positive outcomes in substance use treatment. An integrative study of the correlates of motivation for treatment in patients with alcohol and stimulant dependence may help identify common and specific biopsychosocial characteristics associated with the need for substance use treatment. Objective: To study and conduct a comparative analysis of the correlations between motivation for treatment and sociodemographic, clinical, and psychological characteristics in patients with alcohol dependence (AD) and stimulant dependence (SD). Materials and Methods. A cross-sectional study included 138 patients with alcohol dependence (F10.20; F10.21) and 102 patients with stimulant dependence (F15.20; F15.21). The study used data from the following sources: patients’ clinical charts, the «Stages of Change Readiness and Treatment Eagerness Scale» (SOCRATES), the Differential Emotions Scale (DES), the State-Trait Anxiety Inventory (STAI), the Hamilton Depression Rating Scale (HDRS), the State-Trait Anger Expression Inventory (STAXI), the «Type of Attitude Toward Illness» questionnaire (TOBOL), the Toronto Alexithymia Scale (TAS), and the Purpose-in-Life Test (PIL). Results. For both groups, common positive correlates of motivation for treatment were identified, including older age, later age of onset of withdrawal syndrome, number of previous treatment episodes, duration of remissions following treatment, the ratio of remission duration to illness duration, and the «Life Productivity» (PIL) score. A negative correlation between motivation for treatment and the severity of «Depression» (HDRS) was observed in both groups. In patients with SD, motivation for treatment was associated with a good relationship with the father, longer illness duration, and the explicit emotions of «Guilt» (DES) and «Interest» (DES). In patients with AD, treatment motivation was correlated with a positive attitude toward relatives, family demands to stop substance use, awareness that substance use interferes with work, and the «Life Process» (PIL) score. Additionally, in the AD group, treatment motivation negatively correlated with the severity of «Alexithymia» (TAS-26), «Trait Anxiety» (STAI), «Anger Proneness» (STAXI), and an anxious type of attitude toward illness (TOBOL). Comparative analysis indicates that in the SD group, motivation for treatment is more strongly associated with the duration of withdrawal syndrome and the emotion «Interest» (DES) than in patients with AD. In patients with AD, motivation for treatment is more strongly positively associated with the age of onset of withdrawal syndrome and the «Life Productivity» (PIL) score. The AD group shows a significantly stronger negative correlation between readiness for treatment and «Anger Proneness» (STAXI) compared to the SD group. Conclusion. The identified common and specific correlates of motivation in patients with AD and SD justify the need for a differentiated approach to treatment and rehabilitation interventions.

Key words: alcohol dependence, stimulant dependence, correlates, motivation for treatment, emotions, social and clinical factors

Severe traumatic brain injury (TBI) remains one of the leading causes of death and disability worldwide. The key pathogenetic mechanism is secondary brain injury driven by excitotoxicity, neuroinflammation, oxidative stress, and neuronal apoptosis. Sedative therapy in neurocritical care has traditionally been used to control intracranial pressure and synchronize with the ventilator, but current evidence indicates its potential as an active neuroprotective intervention. Objective. To analyze current understanding of the molecular mechanisms of neuroprotection achieved with sedative and anesthetic agents in patients with severe TBI, evaluate the clinical efficacy of various sedation strategies, and identify promising directions for the development of this method. A review of Russian and international literature from 2012 to 2026 was conducted using PubMed, Scopus, eLibrary, and Cochrane Library databases. Systematic reviews, meta-analyses, clinical guidelines were included, randomized controlled trials, experimental studies on neuroprotective effects of sedative drugs. Results. Sedative agents exert neuroprotective effects by modulating key components of secondary injury: inhibition of NMDA receptors (xenon, ketamine), activation of PI3K/Akt/mTOR and Nrf2 signaling pathways (sevoflurane, xenon), and suppression of NLRP3 inflammasome and neuroinflammation (dexmedetomidine, sevoflurane). Clinical studies have demonstrated that propofol and sevoflurane effectively reduce intracranial pressure, while dexmedetomidine and xenon improve cerebral oxygenation and neurological outcomes. Promising directions include inhaled sedation (sevoflurane, xenon, argon), the use of new drugs (ciprofol, remimazolam), and combined strategies. Conclusions. Sedative therapy in TBI extends beyond symptomatic control, becoming an active neuroprotective intervention. An optimal strategy requires a personalized approach that considers the pharmacological properties of the drugs, the specific features of the injury course and individual patient factors. 

Key words: traumatic brain injury, neuroprotection, sedation, intracranial pressure, neuroinflammation, intravenous anesthetics, inhalation anesthetics

Introduction. Zinc is a key cofactor of many enzymes and regulatory proteins, affecting hemostasis, blood rheology and microcirculation processes, while its deficiency and excess modify thrombosis and blood fluidity in different ways. Zinc complex compounds with N-alkenylimidazoles have previously demonstrated antihypoxic, anti-inflammatory and wound healing properties, which led to the study of their effect on the hemostasis system and microcirculation. Objective of the study: to evaluate the effect of zinc chloride complexes with N-alkenylimidazoles on the hemostasis system and blood rheology parameters. Material and methods. Zinc chloride complex compounds (Acizol-Cl, Allyl-Cl, Allyl-2-Cl, Propargyl-Cl) were studied in comparison with acetylsalicylic acid (ASA), pentoxifylline, and heparin in vitro on the blood of healthy donors and in vivo on male rats. Platelet aggregation, P-selectin (CD62P) expression, coagulogram parameters, microhemodynamic parameters, and tissue oxygenation were evaluated using laser flowmetry, optical oxygenation, and wavelet analysis of blood flow fluctuations. Results. Zinc chloride complexes prolonged activated partial thromboplastin time (APTT) without changing prothrombin time (PV) and fibrinogen levels, while Allyl-Cl and Allyl-2-Cl showed pronounced antiplatelet activity comparable to ASA with a more significant increase in the latency period of aggregation. All complexes almost completely suppressed platelet activation (CD62P expression), and Allyl-Cl and Allyl-2-Cl improved microcirculation, increasing perfusion and flux, enhancing oxygen utilization and efficiency of oxygen metabolism, as well as increasing the amplitudes of neurogenic, myogenic, and pulse fluctuations in blood flow. Conclusion. Zinc chloride complex compounds, N alkenylimidazole derivatives, have a combination of antiplatelet and mild anticoagulant effects with improved microcirculation and tissue oxygenation. Allyl derivatives (Allyl-Cl, Allyl-2-Cl) are of particular interest as potential agents for the prevention and treatment of thrombosis and conditions accompanied by microcirculatory and hypoxic disorders, which requires further preclinical and clinical studies. 

Key words: zinc, hemostasis, zinc complexes, microcirculation, microhemodynamics, oxygenation, P-selectin

Relevance. Modeling is an integral part of experimental medicine, the basis for fundamental research and preclinical drug testing. Improving modeling capabilities, their validation, and extrapolation to clinical data poses significant challenges, but is crucial. This is particularly true for modeling endocrinopathies. Similar methodological approaches for modeling adrenal dysfunction are particularly limited. Objective. To analyze existing experimental methods for modeling endocrine pathologies using adrenal diseases as an example to assess current capabilities of preclinical research in endocrinology and pharmacology, and further improve pharmacotherapy for these pathologies. Materials and methods. A search and analysis of Russian and foreign literature sources for 2005-2025 was performed using the keywords: «modeling of endocrinopathies», «adrenal pathology», «experimental endocrinology», «modeling of endocrinopathies», «adrenal pathology», «experimental endocrinology» in the PubMed, eLIBRARY, Web of Science, and Google Scholar databases. Results and discussion. Modern models of endocrinopathies move away from standard and «rough» methods of suppressing adrenal secretion with large doses of GCS or other agents, as well as performing radical adrenalectomy. New methods generally focus on finding animal models that are morphologically and functionally similar to the human body and more closely match the standards for human pathologies, such as Acomys mice and golden hamsters. Specific strains with specific rare nosologies that cannot be reproduced without genetic engineering are also being developed, such as H-2W18 and Clcn2R180Q/+ mice. A noticeable trend is toward the transition of experiments into the theoretical field of mathematical modeling of pathological processes, which complements in vivo experiments. Conclusion. Further improvement of methods for modeling adrenal endocrinopathies facilitates both the study of adrenal pathology and the correction of existing tactics for the use of drugs that realize their pharmacodynamic activity through the hormonal systems of the adrenal glands.

Key words: modeling of endocrinopathies, adrenal pathology, experimental endocrinology

For many years, scabies has remained one of the most common highly contagious dermatoses. The leading role in the epidemiology of scabies is played by the incidence of children and adolescents, which is often due to their lack of immunity to the pathogen and more frequent direct contact with the skin of patients. The aim is a retrospective epidemiological analysis of the incidence of scabies in children in the Republic of Tatarstan. Methods. The data of statistical medical documentation were analyzed using the descriptive epidemiological study methodology in the IBM SPSS Statistics 23 program. The incidence rates per 100 thousand of the population of the Republic of Tatarstan, the structure of patients with scabies by gender, age and social factors among children were determined. The comparison of indicators was carried out using the Pearson chi-square (χ2) test. Results. In the Republic of Tatarstan for 2015-2024, the average annual number of scabies cases is 29.1 ± 10.5 with a maximum rate in 2024 (48.0 per 100 thousand children) and a minimum value in 2021 (19.0 per 100 thousand children). During the analyzed period, there was a stable registration of scabies cases both among girls – 47%) and boys – 53%. At the same time, the share of cases among preschoolers is almost the same – 50.9% (including children under two years of age – 8%) and children over 7 years of age – 49.1%. Conclusion. Scabies remains one of the most common contagious skin diseases, which is registered in different age, sex and social groups of the population. 

Key words: scabies, children, morbidity

The aim of the study. Analysis of publications devoted to the study of the mechanism of injury in horse-drawn trauma. Materials and methods. An analysis of 26 sources was conducted. The search was conducted in the electronic databases PubMed, Web of Science, Google Scholar, eLIBRARY.RU from 2012 to February 2026. Conclusions. The topic under consideration is related to the specificity of injuries sustained as a result of horse-drawn trauma. The specificity is determined by the mechanism that led to the damage. Injuries can be inflicted both by the animal itself (during movement or at rest), and by a cart driven by horse-drawn transport. The mechanism of injury to a victim of horse-drawn trauma, caused by a fall from an animal or falling out of a horse-drawn cart. Injuries caused by the action of the hooves of pack animals. Injuries sustained by the claws and/or teeth of animals (sled dogs in dog sleds) used to transport goods and people to the body and limbs of the victim. The specific nature of the injuries depends largely on the geography of the area where the draft animals are used for a particular purpose.

Key words: horse-drawn transport, damage, injury, equestrian sport

Orthohantavirus viruses cause mainly two nosological forms: hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. Hemorrhagic fever with renal syndrome is endemic in the Russian Federation, and its epidemiology, pathogenesis, and clinical manifestations are well studied. No cases of hantavirus cardiopulmonary syndrome have been reported in Russia before. The outbreak of hantavirus cardiopulmonary syndrome on the MV Hondius cruise ship, which was traveling from Argentina to Cape Verde in May 2026, has raised concerns among the global medical community about the potential for a pandemic spread of this infection. Based on the analysis of published studies, the article presents current information on the etiology, distribution, sources of infection, mechanisms, and routes of transmission of the causative agents of hantavirus cardiopulmonary syndrome. Special attention is paid to the epidemiology of the Andes virus, the only orthohantavirus that can be transmitted from person to person. The article describes the current mechanisms and routes of transmission of the Andes virus. It is suggested that the Andes virus cannot spread in a pandemic manner.

Key words: orthohantaviruses, Andes virus (Orthohantavirus andesense, ANDV), Sin Nombre virus (SNV), hantavirus cardiopulmonary syndrome