Vol 28, No 4 (2025)

BACKGROUND: The number of patients under long-term follow-up who have been treated for rectal cancer (RC) continues to increase annually. A distinctive feature of surgical treatment is that, in addition to its primary therapeutic effect, it is invariably associated with operative trauma of varying severity. Patient quality of life may be remarkably impaired by the development of low anterior resection syndrome (LARS), which leads to social and occupational maladaptation. Previous studies have demonstrated the importance of pelvic magnetic resonance imaging (MRI) for accurate assessment of RC at the stage of primary diagnosis; however, the use of an original pelvic MRI protocol for the evaluation of functional disorders in this patient population has not previously been investigated.

AIM: To perform a correlation analysis between pelvic MRI findings after multimodal treatment of RC, the patterns and timing of scar–fibrotic changes in the presacral space following anterior and low anterior resection of the rectum, and functional disorders manifested as LARS.

METHODS: The study presents MRI findings from 40 patients after multimodal treatment of locally advanced RC stages T3 (crm+)–4N0–2M0, including neoadjuvant radiotherapy and systemic cytotoxic therapy. The subsequent treatment stage, performed 3–4 months later, consisted of sphincter-preserving surgery in the form of anterior or low anterior rectal resection. Pelvic MRI changes observed 3–24 months after multimodal treatment were analyzed, including presacral fibrosis and pelvic organ prolapse, and correlated with the severity of LARS assessed using the validated Low Anterior Resection Syndrome (LARS) score questionnaire.

RESULTS: The severity of presacral scar formation demonstrated a strong positive correlation (0.912) with substantial functional impairment according to the LARS questionnaire. A moderate inverse correlation was observed with tumor location less than 5 cm from the anal verge (−0.329) and with the postoperative period of up to 6 months (−0.356).

CONCLUSION: Knowledge of post-radiation and postoperative pelvic MRI patterns and the characteristics of scar–fibrotic changes allows prediction of the development of functional disorders in the form of low anterior resection syndrome. Follow-up of patients with pelvic scarring should be individualized, with determination of optimal intervals between imaging examinations to enable monitoring and prediction of functional recovery of the rectal sphincter apparatus.

Post-stroke cognitive impairment (PSCI) represents a considerable medical and social problem, acting as a key factor contributing to increased disability among patients who have experienced stroke. Current epidemiological data indicate a high prevalence of PSCI, reaching up to 96% when comprehensive neuropsychological testing is applied. The socioeconomic burden of PSCI is associated with an increased risk of mortality, the development of affective disorders, and the need for long-term specialized care, as well as substantial direct and indirect economic losses (Fragment 7). The aim of this review is to analyze current scientific evidence regarding effective approaches to comprehensive rehabilitation and the improvement of disability assessment (DA) criteria for patients with PSCI. The authors conducted a scientific data search covering the period from 2018 to 2025 in international bibliographic databases, including PubMed / Ovid MEDLINE, ScienceDirect, Google Scholar, and eLIBRARY. As a result, 77 relevant studies were selected for analysis. The review of the scientific data demonstrates that modern rehabilitation of patients with PSCI is based on the principles of a multidisciplinary approach integrating cognitive training, dosed physical activity, noninvasive neuromodulation, and psychotherapeutic support. Combined rehabilitation strategies aimed at modulating neuroplasticity mechanisms have been shown to be the most effective. It was found that the existing DA system has systemic limitations in the objective assessment of the cognitive component of disability, failing to adequately account for the substantial impact of executive dysfunction on activities of daily living and work capacity. Promising directions for the development of care systems for patients with PSCI include the creation of integrative rehabilitation–expert data transfer models, the implementation of standardized neuropsychological diagnostic protocols using validated scales (e.g., MoCA and functionally oriented tests), and the modification of DA criteria in accordance with current concepts of PSCI pathogenesis and clinical manifestations. The implementation of these approaches may optimize the effectiveness of rehabilitation programs and improve the accuracy and efficiency of DA in patients with PSCI.

In the context of global urbanization and the increasing prevalence of metabolic syndrome (MetS), the impact of environmental factors characteristic of industrial cities on the incidence and severity of cerebrovascular diseases (CVD) has become particularly relevant. This narrative review analyzes the interaction between the pathophysiological components of MetS (insulin resistance, hypertension, dyslipidemia, and visceral obesity) and environmental factors specific to industrial cities. The available evidence demonstrates that these factors act synergistically to exacerbate key mechanisms of vascular injury, including systemic inflammation, oxidative stress, and endothelial dysfunction. This interaction contributes to the accelerated development and progression of atherosclerosis and cerebral microangiopathy, as well as to an increased risk of both first-ever and recurrent acute CVD. The review highlights the heightened vulnerability of patients with MetS to the adverse effects of air pollutants, which creates a vicious pathogenic cycle clinically manifested by more severe neurological deficits, poorer functional outcomes, accelerated cognitive decline, and reduced effectiveness of rehabilitation programs. It is also noted that existing prognostic scales (e.g., CHA₂DS₂-VASc) and medical–social disability assessment criteria do not account for exposures to environmental factors, thereby limiting their clinical utility and contributing to suboptimal rehabilitation outcomes in patients with CVD and its sequelae. Based on the analyzed data, there is a clear need to develop comprehensive predictive and preventive strategies that encompass not only individualized correction of metabolic disturbances and the implementation of personalized rehabilitation programs, but also large-scale environmental and urban planning interventions aimed at reducing air and noise pollution. In addition, the development of rehabilitation programs oriented to urban environmental conditions is required to reduce the medical, social, and economic burden on healthcare systems in industrial regions.