Depression is a mental disorder characterized by sadness, loss of interest and pleasure, decreased ability to experience joy, feelings of guilt or low self-esteem, as well as sleep and appetite disturbances and increased fatigue. Despite the accumulated clinical experience, the task of improving depression treatment methods remains significant. Experimental studies have demonstrated the potential antidepressant properties of aqueous extracts of white mulberry and taraxacum officinale. The aim of our study was to investigate changes in the concentrations of corticotropin-releasing hormone and corticosterone in depressed rats exposed to extracts of white mulberry, taraxacum officinale, a 1:1 mixture of the two, and St. John's wort extract. Materials and methods. The study was conducted on 180 male Wistar rats, using a "social" stress model to simulate depression. All animals were divided equally into six groups and, according to group assignment, received intragastrically distilled water, aqueous extracts of white mulberry, common dandelion, a 1:1 mixture of both, and 2 ml of St. John's wort extract for 20 days prior to depression modeling. The rats' neuroendocrine status was assessed by determining serum corticotropin-releasing hormone and corticosterone concentrations using an enzyme-linked immunosorbent assay on day 21 of the experiment. Results. Stress-induced depression has been shown to be accompanied by hyperactivation of the hypothalamic-pituitary-adrenal axis, caused by impaired feedback inhibitory effects of endogenous glucocorticoids due to glucocorticoid receptor dysfunction. This, in turn, contributes to the development of a complex of underlying reactions, including decreased levels of neurotrophic factors and the development of neurogenic inflammation. Conclusion. Treatment with plant extracts reduced hypothalamic-pituitary-adrenal axis activity by inhibiting corticotropin-releasing hormone and corticosterone levels in stress-induced depression. A 1:1 mixture of aqueous extracts of white mulberry and dandelion demonstrated the most pronounced positive effect. 

Objective: to study the prevalence and characteristics of polymorbid pathology in elderly and senile patients with chronic kidney disease in outpatient practice.

Materials and methods. A cross-sectional study of 787 CKD patients was conducted: 630 elderly patients (median age 67 years) and 157 senile patients (median age 77 years). BMI, GFR by CKD-EPI formula, proteinuria, comorbidities, lipid profile, and CKD awareness were assessed.

Results. Obesity was detected in 53.2% of elderly and 46.1% of senile patients. Arterial hypertension was diagnosed in 84.3% and 93.6%, diabetes mellitus in 85.6% and 92.4%, respectively. CKD stages C2 (51.3% and 46.2%) and C3 (23.5% and 40.2%) were most common. CKD awareness was only 10.6% in the first group and 21.0% in the second. Only 26% and 22.9% of patients received nephrological consultation, respectively.

Conclusion. Elderly and senile patients with CKD demonstrate high prevalence of cardiovasculorenal metabolic risk factors with critically low awareness of kidney disease and insufficient nephrological control. 

Surgeons are the first physicians to provide medical care to wounded patients with ear injuries at the frontline stages up to Level 3. These circumstances determine the importance of providing surgeons with a clear and easy-to-use classification of acubarotrauma to make appropriate and timely decisions regarding treatment and evacuation measures.

Objective. Optimization of medical evacuation measures carried out by surgeons in patients with acubarotrauma by introducing a new classification of the latter and information technologies to support medical decision-making.

Materials and methods. Based on the results of diagnostics and treatment of acubarotrauma in the first months of the SVO, a new classification was developed. Then, a statistical observational study of the "before-after" type was conducted. It consisted of the analysis of the preliminary diagnosis of "acubarotrauma" confirmed by otolaryngologists, made by surgeons at the forefront of evacuation. An application was developed to support the establishment of the diagnosis of acubarotrauma according to the proposed classification. A survey was conducted on the Likert scale to assess the ease of use by surgeons of the proposed classification of acubarotrauma.

Results. Statistically significant changes were noted in the dynamics of the indicator of confirmation by an otolaryngologist of a preliminary diagnosis established by surgeons after the latter had become familiar with the classification of acubarotrauma (p=0.001, the method used was paired Student's t-test). The results of a survey among surgeons regarding the convenience of using the new classification of acubarotrauma showed that the answer "completely agree" for 7 statements was given by 67.5% to 79.9% of respondents. The developed application for assistance in making a medical decision could be used by surgeons only starting from level 3, in medical units where there was no otolaryngologist.

Conclusion. The introduction of the developed classification of acubarotrauma at the forefront of combat zones has increased the number of acubarotrauma diagnoses confirmed by otolaryngologists, previously made by surgeons. 

Secondary hyperparathyroidism (SHPT) is a severe complication in patients with chronic kidney disease (CKD) stage 5D receiving maintenance hemodialysis. Concomitant thyroid pathology occurs in 83-86% of patients with SHPT, requiring a comprehensive surgical approach. The choice of technique and extent of surgical intervention remains controversial.

Objective. To improve the outcomes of surgical treatment of secondary hyperparathyroidism in patients with CKD stage 5D through pathomorphological justification of the extent and technique of surgical interventions, considering concomitant thyroid diseases.

Material and Methods. Treatment analysis of 130 patients with CKD stage 5D and SHPT (54 men, 76 women; ratio 1:1.41) was conducted. Patients were divided into 2 groups. Group 1 (n=74): parathyroidectomy (PTX) with revision of all possible locations of parathyroid glands (PG) combined with thyroidectomy. Group 2 (n=56): PTX without thyroid intervention, including subgroup 2a (n=47) – PTX with extensive revision, and subgroup 2b (n=9) – selective PTX via minimally invasive approaches. Laboratory tests (Ca, P, iPTH, thyroid hormones), instrumental diagnostics (ultrasound, scintigraphy with ⁹⁹ᵐTc-pertechnetate and ⁹⁹ᵐTc-sestamibi, CT), and pathomorphological examination of removed tissues were performed.

Results. Preoperative iPTH level was 2396.76 (1440.90; 2500.00) pg/ml, 10-20 times higher than target values. Ultrasound revealed thyroid nodules in 83.1% of patients. In Group 1, good results were achieved in 97.3% of patients, recurrence in 2.7% (ectopic PG). In Group 2a, good results were observed in 91.5%, in subgroup 2b – only in 44.4%, recurrences – in 55.6% (p<0.001). Pathomorphologically identified: PG adenomas – 16.5%, diffuse hyperplasia – 29.5%, diffuse-nodular hyperplasia – 51.6%. Diffuse-nodular hyperplasia develops in patients with dialysis duration of 10.44±4.00 years and is refractory to medical therapy. Thyroid pathology included: colloid goiter – 86.5%, toxic diffuse goiter – 2.7%, autoimmune thyroiditis – 15.6%, papillary cancer – 2.7%.

Conclusions. Comprehensive diagnostics using iPTH determination, ultrasound, scintigraphy, and intraoperative revision of all possible PG locations achieves target iPTH levels in 97.3% of patients when combined with thyroidectomy and in 91.5% with isolated PTX with extensive revision. Selective PTX via minimally invasive approaches results in recurrence in 55.6% of cases. Development of diffuse-nodular PG hyperplasia with dialysis duration of 6-14 years indicates the need for early surgical intervention upon appearance of clinical manifestations of SHPT. High frequency of concomitant thyroid pathology (83.1%) requires thorough preoperative diagnostics and readiness to perform thyroidectomy.

The purpose of the study. To determine changes in the concentration of endothelial dysfunction markers and the lipid spectrum in patients with chronic myeloid leukemia who receive the second-generation tyrosine kinase inhibitor bosutinib.

Materials and methods. Using a continuous sampling method, the study included 47 patients with a diagnosis of chronic myeloid leukemia, chronic phase, who were transferred to line II therapy. The lipid spectrum indicators, as well as the levels of endothelin-1, vascular endothelial growth factor, and homocysteine, were evaluated using an enzyme-linked immunosorbent assay.

Results. The level of C-reactive protein did not change. In 8 (17.02%) patients, an increase in the level of endothelin-1 was detected (17.23 (15.56;21.02) before therapy versus 72.16 (67.35;80.83) pg/ml, p<0.001), vascular endothelial growth factor (88.81 (78.99;96.46) before therapy versus 623.35 (612.56;650.36) pg/mlml, p<0.001) and homocysteine (186.64 (169.21;214.64) before therapy versus 691.54 (650.65;740.36) ng/ml, p<0.001) by month 12 of bosutinib therapy. After 12 months, correlations were found for OH with VEGF (rxy=0.659, p<0.001), with ET-1 (rxy=0.423, p=0.013), with homocysteine (rxy =0.553, p=0.001), and LDL cholesterol with VEGF (rxy=0.396, p=0.020), with ET-1 (rxy=0.360, p=0.036), with homocysteine (rxy =0.403, p=0.018).

Conclusions. The obtained data show a significant endothelial dysfunction in patients with chronic myeloid leukemia receiving the second-generation tyrosine kinase inhibitor bosutinib at a dose of 500 mg, manifested in an increase in the levels of endothelin-1, vascular endothelial growth factor, and homocysteine, as well as in the lipid spectrum indicators by the 12th month of treatment, which requires long-term monitoring of patients in order to prevent cardiovascular diseases in oncohematological patients.

Objective: To systematize literature data on the role of biomechanical disorders in the pathogenesis of primary arterial hypertension and hypotension as manifestations of somatoform autonomic dysfunction (SAD) of the cardiac type, and to analyze the evidence base for manual osteopathic methods in their correction.

Materials and Methods. Literature search was conducted in Scopus, Web of Science, PubMed, and RSCI (Russian Science Citation Index) databases from 1991 to 2025. Inclusion criteria: original studies, systematic reviews, and meta-analyses on autonomic regulation of the cardiovascular system, somatoform autonomic dysfunctions, somatic dysfunctions, and manual/osteopathic methods for blood pressure correction; publications in Russian and English. Exclusion criteria: conference abstracts without full-text versions, single case reports, publications with unavailable full text. Of 412 initially identified sources, after removing duplicates (n=89) and screening by titles and abstracts (excluded n=156), 167 publications were selected for full-text analysis. After assessing compliance with inclusion criteria, 135 sources were included in the final analysis.

Results. Current concepts of the pathogenesis of primary blood pressure disorders in the structure of SAD were analyzed. Data on somatic dysfunctions of various anatomical regions and their relationship with autonomic dysregulation of the cardiovascular system were systematized. A critical analysis of the evidence base for manual and osteopathic correction methods was presented.

Conclusion. Available data suggest a potential role of biomechanical factors in the pathogenesis of primary BP disorders in SAD; however, the level of evidence for most described mechanisms and therapeutic approaches remains insufficient. High-quality randomized controlled trials are needed to verify theoretical concepts.

A systematic review of the literature sources contained in the RSCI, PubMed, and Scopus databases from 1947 to 2025 was conducted using the keywords: "BCG", "tuberculosis immunoprophylaxis", "tuberculosis vaccine", "tuberculosis immunodiagnostics". The study included 100 of the most significant publications on this issue. Tuberculosis infection prevention is one of the least used, but an essential component of curbing the tuberculosis epidemic. Vaccination, screening for tuberculosis infection and the provision of preventive treatment are key elements of tuberculosis prevention among the population. In this paper, we reviewed the history of the BCG vaccine and its current importance in clinical practice, as well as promising new TB vaccines. In addition, much attention is paid to the possibilities of immunological diagnosis of tuberculosis infection in modern conditions. 

Relevance. Herpesvirus infections and herpes zoster are widespread. In the Russian Federation in 2024, the incidence of herpes zoster was 16.7 per 100,000 population, with an increasing incidence among individuals aged 18–44 years. HIV infection is one of the risk factors for herpes zoster development.

The aim of the study is to determine the clinical features of herpes zoster in young (18–44 years) and middle-aged (45–59 years) individuals and its contribution to the structure of herpesvirus infections.

Material and methods. The study was conducted at the clinics and departments of infectious diseases with epidemiology and dermatovenerology of Samara State Medical University. A retrospective analysis of 451 medical records of patients with herpesvirus infections from 2022 to April 2025 was performed. Statistical processing included Pearson and Spearman correlation analysis, Fisher's exact test, and Student's t-test.

Results. Herpes zoster accounts for 12.2% of all herpesvirus infections and 22.6% of α-herpesviruses. Varicella-zoster virus is part of mixed infections in 14.9% of cases. The proportion of young patients was 35.6%, middle-aged – 31%, elderly and senile – 33.4%. In young patients  (18–44 years) without pronounced immunodeficiency, Varicella-zoster virus reactivation is associated with stress, fatigue, and concomitant diseases, while in middle-aged individuals (45–59 years) it is associated with acute respiratory viral infections and hypothermia. Early medical consultation (1–3 days) is typical for patients aged 18–44 years, while late consultation (4–7 days or more) is characteristic of individuals aged 45–59 years. The disease begins acutely with rash appearance; localized form predominates. In the 18–44 age group, the trunk is more often affected (71.4%), while in the 45–59 age group, the head and trunk are involved with equal frequency. Late presentation is associated with more extensive rash. Pain syndrome and other clinical manifestations (headache, weakness, eye and ear involvement, tissue edema, lymphadenitis) are more pronounced in middle-aged patients. HIV-infected patients demonstrate more severe course, longer hospitalization (12.1±2.8 days vs 9.3±2.1 days, p=0.02), and more frequent lymphopenia (75% vs 30%, p=0.04).

Conclusion. The incidence of herpes zoster is increasing among young and middle-aged individuals. Herpes zoster in young patients represents a new epidemiological reality requiring a multidisciplinary approach. Screening of all herpes zoster patients for HIV infection, blood glucose level, and glycated hemoglobin at initial presentation is necessary, which will improve early diagnosis, prevent complications, and reduce treatment costs. 

Introduction. Femoral neck fractures (FNF) are a complex problem in traumatology, especially in an ageing population. Despite the widespread use of osteosynthesis with three parallel cannulated screws, the complication rate remains high. The biplane double support screw fixation (BDSF) method proposed by O. Filippov has shown promising results in foreign studies, but has not been used or studied in the Russian Federation.

The aim of the study was to evaluate the effectiveness of the BDSF method in comparison with standard osteosynthesis in the treatment of FHF fractures.

Materials and methods. A comparative study of 78 patients with femoral neck fractures (Garden types I-IV) was conducted. The patients were divided into two groups: 1st (n=38) – osteosynthesis using the BDSF method; 2nd (n=40) – osteosynthesis with three parallel screws. To simplify the BDSF surgical technique, an original guide device was developed. The assessment included clinical and functional indicators (HHS scale, VAS) and radiological criteria up to 12 months.

Results. The frequency of consolidation in the BDSF group was 89.4% versus 75% in the comparison group (p<0.001). The average fusion time was significantly shorter in the 1st group (4.1±2.4 months versus 6.3±2.9 months; p<0.001). Cervical shortening >5 mm was observed in 26.3% of patients after BDSF and in 55% after standard osteosynthesis (p=0.002). The incidence of aseptic necrosis of the femoral head was lower in the BDSF group (5.2% vs. 17.5%; p=0.001). Functional results at 12 months on the HHS scale were comparable, but the BDSF group showed a tendency towards better scores (89.6±4.7 points vs. 82.7±7.4 points).

Conclusion. Osteosynthesis of femoral neck fractures using biplane double support screw fixation is an effective and safe alternative to the standard technique. The BDSF method allows for a higher frequency and faster consolidation times, as well as significantly reducing the risk of key complications such as varus collapse, neck shortening, and aseptic necrosis. The developed guide device optimises the implementation of the technique.

The results obtained justify the feasibility of introducing the BDSF method into widespread clinical practice in the Russian Federation.

Introduction. Freiberg–Köhler disease is a rare form of osteochondropathy of the second metatarsal head characterized by avascular necrosis, destruction of the articular surface, and secondary osteoarthritis. The disease predominantly affects adolescent and young adult females and is accompanied by severe pain, limited mobility, and foot deformity. Even with early diagnosis, conservative treatment is often insufficient to prevent disease progression, making surgical intervention necessary.

Aim: To evaluate the effectiveness of the collagen membrane Chondro-Scaffold in the surgical treatment of Freiberg–Köhler disease.

Object and methods. A retrospective analysis of clinical data from 28 patients was performed to assess the effectiveness of a technique combining shortening osteotomy and implantation of the Chondro-Scaffold collagen membrane using functional (AOFAS and VAS) and radiographic parameters. Postoperative follow-up was carried out at 3, 6, and 12 months.

Results. The use of the Chondro-Scaffold collagen membrane resulted in a significant improvement in foot function, as demonstrated by an increase in the AOFAS score from 46.2 to 89.5 and a decrease in pain intensity from 7.6 to 1.5 according to the VAS scale.

Conclusion. The use of the Chondro-Scaffold collagen membrane is a promising approach in the surgical treatment of Freiberg–Köhler disease, leading to improved clinical and functional outcomes and enhanced patient quality of life. Further studies are required to evaluate long-term effectiveness. 

The theory of universal synthetic communication in the 19th century was supported by almost all neurohistologists. The theory had attractive and convenient explanations and declared the modular functioning of neurocytes. So why was it later completely rejected and replaced by the neural doctrine? The main thing is that it was not possible to explain the causes of the appearance and establish patterns of development of syncytial interneuronal and interneuritic connections. And even more so, to prove their functional feasibility. Moreover, all the works of the founder of the neural doctrine Santiago Ramén y Cajal and his followers were performed using the chrome-silver Golgi's method. It allows us to obtain hyperimpregnated pictures of neural structures that hide subtle interneuronal syncytial connections. They were identified among the complex arborizations in the illustrations in the monographs of Ramén y Cajal using the method of computer unmasking. A review of the literature will provide an objective insight into the ongoing discussion about syncytial connections in the nervous system.

Oncopathology is one of the main causes of mortality and makes diagnosis difficult due to the asymptomatic course of metastases and non-specificity of analyses. Tumours act as stressors, causing metabolic disorders and altering metabolic regulation. The adrenal glands respond to stressors and their changes, especially in the fascicular and reticular zones, may indicate long-term tumour exposure. However, the literature is insufficient to highlight the impact of various benign and malignant tumours on the morphofunctional state of the adrenal glands. The studied patterns of changes in the morphofunctional state of the adrenal glands in various malignant tumors of the abdominal organs can be used to predict the course of oncopathology, assess the effect of concomitant pathology on the course of the disease and the effectiveness of treatment on the outcome. The revealed age and sex characteristics of changes in the morphofunctional state of the adrenal glands in various malignant tumors of the abdominal organs can be used as the basis for methods of preventing deaths.

The aim of the work was to summarize and systematize the scientific literature data on the synthesis of perilymph in the inner ear. The search for sources was carried out using the Pubmed biomedical research system and the Elibrary scientific electronic library until 01.08.2025. There are two main hypotheses for the synthesis of perilymph. Hypothesis I. – the formation of perilymph by filtration of blood plasma from the vessels of the inner ear. Arterioles branch off from the labyrinthine artery, dividing into capillaries with pores for the passage of molecules, which are filtered out by the blood-labyrinth barrier. Due to the pressure gradient, sodium and potassium ions, as well as molecules up to 100 daltons, pass through the capillaries, forming a primary blood filtrate. It enters the perilymphatic space, where its cells regulate the composition of the perilymph. The perilymph is removed from the inner ear through the perilymphatic duct into the subarachnoid space, where it mixes with cerebrospinal fluid. Hypothesis II. – formation of perilymph from cerebrospinal fluid. This is possible only if the barrier that separates the cerebrospinal fluid from the perilymph in the area of the perilymphatic duct is damaged. Such a message allows the cerebrospinal fluid to directly affect the volume and composition of the perilymph if the formation of fluid from blood plasma is difficult (for example, with hypovolemia). Cerebrospinal fluid can act as an ion buffer if the local regulation of the ionic composition is disrupted, it is a medium into which metabolic products are released from the perilymphatic space. Currently, the issue of perilymph synthesis remains not fully understood, and additional research is needed to clarify the issue. 

Background. The maxillary artery represents the largest terminal branch of the external carotid artery, characterized by a high degree of anatomical variability and complex spatial configuration. Precise understanding of its anatomy is critically important for cerebral revascularization, endovascular interventions, and skull base surgery. Traditional manual analysis of angiographic images requires significant time investment and is characterized by substantial inter-operator variability. Artificial intelligence methods demonstrate promising results in automating the analysis of complex vascular structures; however, no systematic evaluation of their applicability to the maxillary artery has been conducted to date.

Objective. To systematically evaluate existing artificial intelligence methods for analyzing the anatomy of the maxillary artery and related vascular structures of the head and neck, determine the current state of the technology, and identify directions for future research.

Materials and methods. The systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive literature search was performed in electronic databases PubMed, Scopus, Web of Science, and IEEE Xplore from inception through December 2024. Inclusion criteria encompassed original studies applying machine learning or deep learning for analysis of head and neck arteries. Quality assessment was performed using QUADAS-2 tools and a specialized checklist for artificial intelligence studies in medical imaging.

Results. Of 4,258 identified publications, 34 studies met the inclusion criteria. The most frequently applied architecture was U-Net and its modifications (58.8% of studies). The mean Dice coefficient for vessel segmentation was 0.87 (95% confidence interval: 0.84-0.91). Artificial intelligence methods reduced analysis time from 14.2±3.6 minutes to 4.9±0.4 minutes. Clinical acceptability of automated segmentations was 92.1%. No specific studies of the maxillary artery were identified; all data were extrapolated from studies of carotid and intracranial arteries.

Conclusions. Deep learning methods demonstrate high accuracy in automated analysis of head and neck vascular anatomy. Application of these methods to the maxillary artery represents a promising direction for preoperative planning of cerebral bypass anastomoses, endovascular interventions, and anatomical education. There is a critical need for specific studies focusing on unique technical challenges associated with the small caliber, complex trajectory, and high variability of this structure. 

The article is dedicated to the Doctor of Historical Sciences, Professor, Full Member of the Academy of Social Sciences of the Russian

Federation, Honored Worker of the Higher School of the Russian Federation Gennady Stepanovich Shchurov, who would have turned 90 on August 30, 2025. The authors of the article aimed to reveal the life story of this person. The study was based on a systematic approach, which included the principles of historicism, objectivity and scientificity. Archival materials, monographs, newspaper publications and scientific articles dedicated to G.S. Shchurov, covering various periods, were used as sources. Gennady Stepanovich left a rich scientific legacy for historians of medicine, cultural historians, historians of Pomorye and historians of the Fatherland as a whole. His name is among the unique scientists of the Arkhangelsk State Medical Institute (ASMI) – Northern State Medical University (NSMU), where he went the entire scientific path from assistant, associate professor to professor, head of the department. For almost 40 years he worked at the Department of Marxism-Leninism and Political Economy, which changed its name more than once (currently – the Department of Humanities of NSMU). In 2025, it will be 20 years since the creation of the museum complex and the Society for the Study of the History of Medicine of the European North at NSMU, founded by Professor G.S. Shchurov.

Relevance. Acral melanoma of the skin is a rare subtype of melanoma, accounting for approximately 3% of all melanoma cases, with unique histological, biological, and epidemiological characteristics. It is more common in individuals of Asian and African descent, characterized by late diagnosis and high malignancy, making its study crucial for improving screening and treatment, particularly in industrially developed regions.

Objective. To investigate the characteristics of acral melanoma of the skin in a large industrial region (Samara Region) by analyzing the dynamics of incidence, mortality, and comparison with melanomas of other localizations.

Materials and Methods. A retrospective analysis was conducted on data from 218 patients with acral melanoma (localization: palms, soles, fingers, nail bed, dorsal surfaces of hands and feet) diagnosed and treated in the Samara Region from 2000 to 2022. Statistical methods included calculation of absolute and relative indicators, crude incidence and mortality rates per 100,000 population, trend analysis (linear and polynomial approximation), and comparison with general skin melanoma data.

Results. The absolute number of acral melanoma cases increased from 65 (2000–2010) to 153 (2011–2021), with a growth rate of 135.38% (compared to 39.41% for other melanomas). Crude incidence rates ranged from 0.06 to 0.3 per 100,000 populations (compared to 5.17–8.36 for other melanomas). Acral melanoma accounted for 3.01–4.98% of all melanoma cases. Mortality increased (linear trend y=0.025x + 0.0204; R²=0.5501). The male-to-female ratio of cases was 1:2.53, and for deaths, 1:1.81, indicating a more aggressive course in women.

Conclusions. Acral melanoma is a distinct subtype with a high growth rate in incidence and mortality, necessitating specialized screening programs. The findings are extrapolatable to the Russian Federation, highlighting the need for further research.

Background. Telemedicine consultations (TMC) are currently an integral part of the Russian Federation's healthcare system. By overcoming and reducing such well-known factors as time and distance, TMC thereby increase the availability of medical care without losing its quality. The implementation of the telemedicine module in thoracic surgery in many countries is characterized by insufficient use of this resource, despite the obvious proven advantages of the technology.

Aim: to analyze the annual results of using TMC in providing medical care to thoracic surgical patients in the Samara Region.

Materials and methods. This analysis is based on the experience of implementing and conducting TMK in the surgical thoracic department of the Samara Regional Clinical Hospital named after V.D. Seredavin from January 1, 2025, to December 31, 2025. The following methods were used in the study: descriptive, statistical, and sociological. The comparative part is based on data from the PubMed, Medline, and ELibrary databases. Statistical data was processed using the validated statistical package SPSS. When analyzing the effectiveness of TMC, we evaluated not only the immediate medical and diagnostic results and the outcomes of patient support, but also the quality of technological and logistical processes in the organization of telecommunications. During this period, 138 TMC were conducted in the "Doctor–Doctor" module and 113 TMC were conducted in the "Doctor–Patient" module.

Results. With a reasonable systematic approach to the implementation of telemedicine consultations, their effectiveness in many cases is not inferior to that of similar traditional services with comparable safety and significant resource savings for both the patient and the healthcare system. The widespread introduction of TMС into the practice of thoracic surgical services has helped optimize the work schedules of specialists. The number of visits to TMС applicant health facilities decreased by 28.6% from 133 in 2023 to 95 in 2025 (p ˂ 0,01). The number of repeated consultation requests also decreased by 15.6%, which indicates the completeness and quality of the conclusions and recommendations received (p ˂ 0,01). At the same time, conducting TMС allows for assessing the quality of medical care provided in the primary hospitalization facility.

Conclusion. TMK in the organization of thoracic surgical care in the Samara region is currently at the stage of sustainable development. Ensuring a high level of accessibility to this specialized section is achieved, among other things, by improving the basic modules and increasing the commitment of the medical community. The results of treating patients using TMС make a significant contribution to reducing mortality from manageable causes. 

Relevance. In 2025, it is 100 years since the birth of a number of outstanding healthcare organizers of the Arkhangelsk region – graduates of the Arkhangelsk State Medical Institute (ASMI), who made a significant contribution to the development of medicine and healthcare in the European North of Russia. Preserving the historical memory of physician-organizers of the wartime and post-war generations is an important task of modern medical education and science.

The aim of the study: perpetuation of the memory of outstanding healthcare organizers of the Arkhangelsk region – graduates of the Arkhangelsk State Medical Institute of 1948, born 100 years ago.

Material and methods. The methodological basis of the study consisted of a systematic approach based on the principles of historicism, objectivity and scientificity, as well as general scientific methods (generalization, analysis, synthesis, induction). The materials included documents from the State Archive of the Arkhangelsk Region, newspaper publications, books, scientific articles, and interviews with contemporaries.

Results. Biographies of seven healthcare organizers born in 1925 and graduated from ASMI in 1948 are presented: L.A. Kupsik (Karmanova), M.I. Gornushkina, Yu.V. Shneyveys (Panova), K.N. Grosheva, Z.I. Kosheva, A.V. Spasennikova (Korovina), G.G. Shubina. During the Great Patriotic War, all of them were home front workers or participants in military operations. After graduation, they worked in various areas of healthcare: chief physicians of hospitals and maternity hospitals, heads of district and city health departments, deputies of the regional health department, deputies at various levels. Two heroines of the article lived to celebrate their 100th anniversary. L.A. Kupsik supervised rehabilitation treatment, working as chief freelance specialist in physiotherapy. M.I. Gornushkina headed the Koynas district hospital for 53 years. Yu.V. Shneyveys created the Central Basin Hospital for Water Transport Workers named after N.A. Semashko and headed the Northern Water Transport Health Department. K.N. Grosheva was deputy head of the Arkhangelsk Regional Health Department, engaged in the distribution of graduates and development of scientific medical societies. Z.I. Kosheva was the only representative of ASMI in the Supreme Soviet of the USSR, chief freelance therapist of the city, participated in creating the sanatorium "Belomorie". A.V. Spasennikova headed the city children's clinical hospital, developed pediatric services and the sanatorium-resort system of the region. G.G. Shubina – participant of the Great Patriotic War, awarded the Order of the Red Banner and the Order of the Patriotic War of the II degree, headed the maternity hospital named after K.N. Samoilova. All heroes of the article were awarded the title "Honored Doctor of the RSFSR" and decorated with orders and medals.

Conclusion. Healthcare organizers of the Arkhangelsk region – graduates of ASMI of 1948 demonstrated professional loyalty to their chosen cause and readiness to take responsibility in the difficult conditions of the post-war period. Under their leadership, thousands of medical specialists were trained, hospitals were built and modernized, and the sanatorium-resort system and rehabilitation service of the region were developed. While working in practical healthcare, they made a significant contribution to the development of higher and secondary medical education in the European North of Russia. Their destinies and achievements are the heritage of the North and an example for the modern generation of healthcare workers. 

Background. An urgent problem in modern phthisiology is the increasing number of patients with pulmonary tuberculosis accompanied by concomitant diseases and significant risk factors. Chronic obstructive pulmonary disease (COPD) and tobacco smoking are among the five most significant risk factors for tuberculosis development. Pneumoconioses, including pulmonary silicosis, are also important occupational risk factors, with tuberculosis infection occurring in almost 40% of cases. The combination of these factors creates significant difficulties in the diagnosis and treatment of pulmonary tuberculosis.

Objective. To demonstrate the clinical course features and effectiveness of comprehensive treatment in a smoking patient with widespread destructive pulmonary tuberculosis combined with COPD and pneumoconiosis.

Materials and methods. A clinical case of a 54-year-old male patient, a miner by profession, with a long history of tobacco smoking (30 years, smoking index 60) is presented. Retrospective observation, clinical analysis, radiography, MSCT of the chest, microbiological sputum examination, bronchoscopy, and spirometry were utilized. The diagnosis was established as infiltrative pulmonary tuberculosis in the phase of cavitation and dissemination with multidrug resistance (HR) combined with COPD and bullous pulmonary emphysema. Treatment included anti-tuberculosis chemotherapy for MDR-TB, COPD therapy, nicotine replacement therapy, and surgical intervention (combined resection of the left lung).

Results. Through a comprehensive approach, positive clinical, laboratory, and radiological dynamics were achieved after 2 months of treatment: cessation of bacterial excretion, normalization of inflammatory markers, and partial resolution of infiltrative changes. The patient completely quit smoking. After 3 months, successful surgery was performed. Pathohistological examination confirmed tuberculous etiology with signs of pneumoconiosis (multiple coniotic nodules in the lung and lymph nodes). The postoperative period was uncomplicated, and clinical cure was achieved.

Conclusion. A comprehensive treatment approach including correction of concomitant pathology (COPD, tobacco smoking), properly selected antituberculosis therapy, and timely surgical treatment enabled clinical cure of a patient with widespread destructive tuberculosis combined with COPD and pneumoconiosis in the shortest possible time.

Relevance. 30% patients who infected syphilis during the long time have got complications characterized as tertiary syphilis. Vascular complications often manifest after 15–30 years. An aortic aneurysm is one of the rare cardiovascular syphilis manifestation. Due to the fact that it is a rare complication, timely diagnosis and the correct treatment choice for such patients are important.

The aim of the study. To analyze the diagnosis’ features and surgical treatment tactics for patients with syphilitic aortic aneurysm. Materials and methods. This paper describes a clinical case of a patient with ruptured syphilitic descending thoracic aortic aneurysm and signs of aortoesophageal fistula formation. The data analysis was performed retrospectively.

Results. Patient P. was admitted to the clinic in April 2024. For two weeks he had been complaining of cough and epigastric pain. The examination revealed ruptured thoracic aortic aneurysm (I71.1). The patient underwent left carotid subclavian bypass surgery and thoracic endovascular aortic aneurysm repair. Six months later according to endoscopic examinations and computer tomography an aortoesophageal fistula was established.

Conclusion. Identification of patients with syphilitic vascular complications is difficult. A syphilitic aortic aneurysm feature is its long-term asymptomatic course, which makes it difficult to early detection and treatment.

Currently, there is no clear consensus in surgical practice on the treatment of postoperative seromas, including the anterior abdominal wall after abdominoplasty. The gold standard remains the postoperative observation of patients with ultrasound examination of the surgical area and puncture treatment with serom. However, such tactics are possible only in the early postoperative period. If puncture treatment is unsuccessful, the tactics of excision of the mesothelial lining of the seroma more effective. Such operations are performed through a large incision in the skin. The clinical case demonstrates the successful application of the endoscopic technique of ablation of the lining of a large chronic seroma, which was a complication of abdominoplasty. Puncture and drainage treatment in the early postoperative period did not yield results. A decision has been made on endoscopic treatment using minimally invasive technologies. A clinical example of the successful use of endoscopic techniques for the treatment of large (maximum diameter 22 cm) chronic postoperative anterior abdominal wall seroma is shown. This technique can be used in clinical practice as a safe way to treat such postoperative complications. 

Introduction. Cryptococcal meningitis remains one of the most lethal opportunistic infections in patients with HIV, with mortality rates ranging from 30% to 75% depending on geographic region and timeliness of treatment initiation. Timely diagnosis is challenging due to nonspecific clinical presentation and absence of classic meningeal signs in the majority of patients, requiring high clinical suspicion when managing patients with profound immunosuppression.

Objective. To conduct a prospective analysis of a clinical case of cryptococcal meningoencephalitis in a patient with profound immunosuppression due to HIV infection, with critical evaluation of diagnostic and therapeutic approaches, identification of systemic problems, and formulation of practical recommendations to prevent similar cases in the future.

Materials and methods. A detailed retrospective analysis of medical documentation was performed for a 46-year-old male patient with HIV infection stage 4B receiving antiretroviral therapy. The patient was admitted to a regional infectious disease hospital with complaints of cephalgia, fever, and altered consciousness. Comprehensive laboratory and instrumental examination was performed, including four lumbar punctures with cerebrospinal fluid analysis, magnetic resonance and computed tomography of the brain, and immunological studies. Consultations with related specialists were conducted, including telemedicine consultation with a federal center.

Results. Despite comprehensive examination and ongoing treatment including antimycotic therapy, the patient died 27 days after admission due to progressive cerebral edema secondary to cryptococcal meningoencephalitis. The diagnosis of cryptococcal infection was confirmed only at the third lumbar puncture, resulting in a 19-day delay in specific therapy. Critical deficiencies in patient management were identified, including suboptimal dosing of antifungal agents and absence of amphotericin B administration—the first-line drug for cryptococcal meningitis treatment.

Conclusion. This clinical case convincingly demonstrates the necessity of implementing routine screening for cryptococcal antigen in patients with CD4+ lymphocyte counts below 100 cells/μL, performing repeat cerebrospinal fluid examinations when initial results are negative in the setting of persistent high clinical suspicion, and strict adherence to recommended doses of antimycotic agents from the first days of suspected cryptococcal infection. Critical analysis of diagnostic and therapeutic errors enables formulation of specific practical recommendations for improving outcomes in this extremely vulnerable patient population. 

Background. Within the framework of the National Healthcare Project and the Federal project "Combating Cardiovascular Diseases," increasing the volume of endovascular interventions is a key priority. Multispiral computed tomographic coronary angiography (MSCT-CA) is a noninvasive alternative to traditional coronary angiography with high diagnostic accuracy for coronary artery disease (CAD) and atherosclerosis of various localizations. MSCT-CA implementation has been hindered by organizational and methodological barriers and lack of clearly defined role in cardiology diagnostic algorithms.

Objective. To demonstrate the role and place of MSCT-CA in screening and early detection of cardiovascular diseases using a clinical case of an asymptomatic patient with multifocal cardiac and vascular pathology.

Materials and methods. A clinical case of patient M., 68 years old, who presented to V.P. Polyakov Samara Regional Clinical Cardiology Dispensary in November 2020 for CT follow-up after COVID-19 pneumonia (38% lung involvement). Chest CT revealed significant coronary artery calcification. Medical history: arterial hypertension for 5 years (maximum BP 200/110 mmHg), hypertensive crises with dizziness, situational antihypertensive therapy. No prior cardiac evaluation, no angina symptoms. MSCT-CA with contrast enhancement of coronary arteries and brachiocephalic trunk (BCT) arteries was performed.

Results. MSCT-CA revealed hemodynamically significant stenoses: left anterior descending (LAD) artery up to 75%, posterior descending and diagonal arteries up to 90%, and right internal carotid artery (ICA) stenosis up to 78%. Verification invasive coronary angiography confirmed critical LAD-diagonal artery bifurcation stenosis Medina (1-1-1) 99-75-99% with aneurysm and severe arterial wall calcification. LADdiagonal artery stenting was performed with two coronary stent implantation. Uncomplicated postoperative course. Dual antiplatelet therapy (aspirin 100 mg + clopidogrel 75 mg), statins 40 mg, antihypertensives, and β-blockers were prescribed. Elective right eversion carotid endarterectomy under general anesthesia was performed. Intraoperatively, atherosclerotic plaque with thrombosis was identified. ICA clamping time 25 minutes. Uneventful postoperative course, discharged on day 5. The regional program "Healthcare Development of Samara Region 2021-2030" includes MSCT-CA provision beyond basic mandatory health insurance with annual funding of 20 million rubles (≈3,100 additional studies).

Conclusions. MSCT-CA is an effective noninvasive screening method for early detection of coronary and brachiocephalic artery atherosclerosis in asymptomatic patients with risk factors (age >60 years, arterial hypertension, post-COVID-19). The method enables timely patient selection for invasive CAG and revascularization, medication therapy adjustment, and initiation of follow-up care. MSCT-CA inclusion in examination programs accelerates clinical decision-making and contributes to reducing mortality from myocardial infarction and circulatory diseases. Organizational strategy should include MSCT-CA reference center development, outpatient registry formation for patients with examination indications, and additional financial support. 

Background. Dyslipidemia is a major risk factor for cardiovascular events after kidney transplantation. Insufficient data are available in the Russian literature on the prevalence of dyslipidemia in kidney transplant patients and the effectiveness of lipid-lowering therapy regimens.

Study objective: to determine the incidence of dyslipidemia in kidney transplant patients, the frequency of lipid-lowering therapy, and its effectiveness.

Subject and methods. This multicenter retrospective cohort study included four sequential stages: Stages I and II – selection of kidney transplant patients based on inclusion and exclusion criteria; Stages III and IV – identification of a group of patients with and without dyslipidemia from the total number of patients included in the study. During Phase IV, the following will be performed: demographic and general clinical characteristics of patients, characterization based on the presence of risk factors for cardiovascular events; identification of patients on and without lipid-lowering therapy; patients with the following lipid metabolism parameters: LDL-C ≥1.4 mmol/L and TG ≥1.7 mmol/L; LDL-C <1.4 mmol/L and TG <1.7 mmol/L; LDL-C ≥1.4 mmol/L and TG <1.7 mmol/L; and LDL-C <1.4 mmol/L and TG ≥1.7 mmol/L; analysis of the frequency of prescription of lipid-lowering therapy and its effectiveness. 

Background. Ischemia-reperfusion injury (IRI) remains a significant complication following liver transplantation, associated with early allograft dysfunction and worse outcomes. Predicting the risk of IRI could guide the selection of organ preservation strategies and posttransplant management.

Objective. To develop and validate a clinical risk scoring system for predicting severe IRI in liver transplantation.

Materials and Methods. A retrospective analysis of 1,238 liver transplantations performed at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2000 to 2025 was conducted. Severe IRI was defined as peak transaminase levels >1,000 IU/L within the first 7 postoperative days. Donor, procedural, and recipient factors were evaluated using multivariable logistic regression to construct a simplified risk scoring system.

Results. Complete data were available for 827 patients, among whom 312 cases of severe IRI were recorded, accounting for 37.7% of the cohort. Independent predictors included donor age with an odds ratio of 1.04 per year, cold ischemia time with an odds ratio of 1.17 per hour, and portal vein thrombosis with an odds ratio of 1.52. The developed IRI Risk Index (IRI Score), ranging from 0 to 9 points, stratified patients into low-risk (0–2 points) with an IRI rate of 35.6%, intermediate-risk (3–5 points) with a rate of 42.1%, and high-risk (≥6 points) with a rate of 52.2%. The area under the ROC curve was 0.555 (p<0.001). High-risk patients comprised 2.8% of the cohort.

Conclusion. The IRI Score enables early identification of patients at elevated risk for severe IRI and provides a specific algorithm for decision-making regarding the use of machine perfusion. The simplicity of the index and its reliance on pre-transplant variables make it practical for clinical application.

Post-transplant diabetes mellitus is one of the most common metabolic disorders developing in liver and kidney recipients without prior diabetes. This complication has a significant impact on the course of the post-transplant period, leading to an increase in the frequency of infectious and cardiovascular events. Recent studies confirm that the presence of post-transplant diabetes mellitus worsens long-term transplant outcomes, including reduced graft function and increased risk of mortality, which highlights the need for early identification of patients with increased metabolic risk and optimization of preventive measures. The most significant risk factors for the development of post-transplant diabetes mellitus include advanced age, increased body mass index, dyslipidemia, chronic viral infections, and the use of diabetogenic immunosuppressive drugs. The multifactorial nature of post-transplant diabetes mellitus necessitates careful systematization of available data, which allows for a more comprehensive analysis of its mechanisms. However, the lack of standardized approaches to early detection and risk stratification continues to limit the effectiveness of clinical management of patients. The purpose of this review is to systematize data on the risk factors for post-transplant diabetes mellitus and to analyze modern methods for its early diagnosis in liver and kidney recipients. 

Background. Ischemia-reperfusion injury remains a central challenge in clinical transplantology, determining outcomes particularly when using organs from expanded criteria donors and donors after circulatory death. Hypothermic oxygenated machine perfusion (HOPE) has established itself as an effective strategy for donor organ protection; however, existing preservation solutions (UW, HTK) were developed for static cold storage and are not optimized for oxygenated perfusion conditions. Current understanding of pathogenesis has revealed the key role of reverse electron transport in mitochondria and ferroptosis — mechanisms not addressed by classical solutions.

Aim. To analyze approaches to developing a next-generation universal perfusion solution (MITOPERF) optimized for protection against key mechanisms of ischemia-reperfusion injury: oxidative stress, mitochondrial reverse electron transport, ferroptosis, and inflammatory response.

Materials and methods. An experimental perfusion solution MITOPERF was developed, containing 18 pharmacologically active components with multitarget action: mitochondrial protectors, antioxidants, antiferroptotic agents, immunomodulators, and energy substrates. The study was performed on 36 male Wistar rats  (18 — liver model, 18 — kidney model). Animals were randomized into groups: Custodiol (control), MITOPERF, and modified Custodiol ex tempore (Custodiol-M). We modeled 30-minute warm ischemia (DCD conditions), 2-hour hypothermic oxygenated perfusion, and 60-minute normothermic reperfusion. Biochemical injury markers (ALT, AST, creatinine, lactate), ferroptosis markers (4-HNE, GPX4), functional parameters (bile production, glomerular filtration rate), and histological changes were evaluated.

Results. MITOPERF provided a 76% reduction in ALT (169±91 vs 694±247 U/L, p<0.05) and 64% reduction in creatinine (121±46 vs 334±97 μmol/L, p<0.05) compared to control. The ferroptosis marker 4-HNE concentration decreased more than 2-fold, GPX4 activity increased nearly 2-fold. Bile production in the MITOPERF group exceeded control by 2.4 times (0.74±0.24 vs 0.31±0.15 μL/min/g, p<0.05), glomerular filtration rate — by 3.2 times (0.76±0.29 vs 0.24±0.12 mL/min/g, p<0.05). Modified Custodiol-M showed intermediate protective effect (43–55% reduction in injury markers).

Conclusion. The experimental solution MITOPERF demonstrated proof of concept for effective protection of parenchymal organs from ischemia-reperfusion injury during hypothermic oxygenated preservation. Comparable protection of liver and kidney confirms action on universal pathogenetic mechanisms. Modified Custodiol ex tempore may be recommended for clinical implementation as an accessible alternative not requiring new drug registration.

Aim. To evaluate the efficacy of dual hypothermic oxygenated machine perfusion (D-HOPE) in reducing ischemia-reperfusion injury (IRI) in human donor livers with moderate macrosteatosis by analysing markers of oxidative stress, antioxidant defence, inflammatory response, morphological changes, and post-transplant clinical outcomes.

Materials and Methods. A prospective pilot study enrolling 7 human donor livers with macrosteatosis of 30–50%, verified by urgent intraoperative histological examination (Oil Red O staining of frozen sections). Organs were sequentially allocated to a control group — static cold storage at 4°C in HTK solution (n=3) — or to the D-HOPE group — dual hypothermic oxygenated perfusion at 10 °C for 4 hours using the Aferetica PerLife system with continuous monitoring of portal resistance (target range  0.15–0.25 mmHg/(ml/min/g)), lactate clearance, and perfusate pH (n=4). Portal flow was maintained at 0.25–0.35 ml/min/g; oxygen partial pressure at 60–80 kPa. Assessed parameters included markers of oxidative stress (malondialdehyde, MDA), antioxidant enzyme activity (superoxide dismutase, catalase, glutathione peroxidase), interleukin-6 (IL-6) concentration in the perfusate, morphological signs of hepatocyte injury (cytoplasmic vacuolisation, karyopyknosis) scored in 10 high-power fields (×400) by two independent blinded pathologists, and clinical outcomes over a 6-month follow-up period. Statistical analysis: one-tailed Mann–Whitney test (a priori directional hypothesis), Spearman correlation analysis; significance threshold p<0.05. Data are presented as M±SEM.

Results. The D-HOPE group demonstrated a statistically significant reduction in MDA at the time of reperfusion (T3): 3.9±0.7 vs. 5.8±1.2 nmol/mg protein in the control group (p=0.029; reduction of 33%). Antioxidant enzyme activity in the D-HOPE group significantly exceeded control values: superoxide dismutase 18.7±2.8 vs. 12.3±2.1 U/mg protein (p=0.029); catalase 203±34 vs. 145±28 U/mg protein (p=0.029); glutathione peroxidase 13.2±2.1 vs. 8.9±1.6 U/mg protein (p=0.029). Perfusate IL-6 concentration at the end of perfusion was 52±14 pg/ml. Hepatocyte cytoplasmic vacuolisation at 2 hours post-reperfusion (T4): 38±9% in D-HOPE vs. 65±11% in controls (p=0.029); karyopyknosis: 11±3% vs. 18±4%. Portal resistance in the D-HOPE group declined by 39% over the 4-hour perfusion period (p=0.063 from baseline). Lactate clearance was 50%. Correlation analysis revealed associations between MDA (T3) and peak ALT (ρ=0.79, p=0.036), between MDA (T3) and serum bilirubin on post-operative day 7 (ρ=0.71, p=0.074), and between vacuolisation (T4) and ICU length of stay (ρ=0.83, p=0.021). Peak ALT values: 820±190 U/L (D-HOPE) vs. 1,180±340 U/L (control), representing a 31% reduction. Total bilirubin on post-operative day 7: 41±11 vs. 62±16 μmol/L. ICU length of stay: 2.8±0.9 vs. 4.3±1.4 days. During the 6-month follow-up, the control group recorded hepatic artery thrombosis (n=1, 33%) and biliary stricture (n=1, 33%); no vascular or biliary complications were observed in the D-HOPE group. All recipients are alive.

Conclusion. Dual hypothermic oxygenated perfusion provides statistically significant protection of moderately macrosteatotic donor livers from IRI, as assessed by biochemical, antioxidant, and morphological criteria. MDA and morphological markers demonstrated predictive value for post-transplant clinical outcomes. These preliminary data support the conduct of multicentre randomised trials to validate the technique and subsequently develop personalised perfusion protocols.

Aim. To determine normative values of the area under the curve of bioelectric activity of masseter and temporal muscles in patients with intact dentitions and physiological occlusion.

Materials and methods. Thirty-four patients (14 men and 20 women) aged 18–44 years with intact dentitions in the absence of third molars were examined. Electromyographic study was performed using a 4-channel "Synapsis" electromyograph by surface electromyography method. Bioelectric activity of masseter muscles (m. masseter) and temporal muscles (m. temporalis) was recorded bilaterally during three functional tests: relative physiological rest (10 seconds), maximum voluntary clenching (10 seconds), and arbitrary chewing of an almond kernel. The area under the electromyographic signal curve was analyzed as an integral indicator of muscle activity.

Results. At rest, the mean values of bioelectric activity area were 25.2–27.7 μV×ms for all studied muscles without significant differences between them. During maximum clenching, a significant increase was recorded: for temporal muscles up to 318.4–326.8 μV×ms, for masseter muscles up to 533.4–572.1 μV×ms with masseter/temporalis ratio coefficient from 1.63 to 1.79. During arbitrary chewing, the activity area was  227.2–227.9 μV×ms for temporal muscles and 359.9–370.9 μV×ms for masseter muscles (coefficient 1.57–1.63). The activity area during maximum clenching exceeded the indicators during chewing by an average of 1.5 times.

Conclusion. Reference values of bioelectric activity area of masticatory muscles in individuals with intact dentitions have been established. A regular predominance of masseter muscles over temporal muscles during functional loads was revealed, due to anatomical and physiological features and the nature of occlusal contacts. The obtained data can serve as a normative basis for diagnosing functional disorders of the masticatory apparatus and monitoring the effectiveness of prosthetic treatment.

Relevance. It is known that acute severe pancreatitis (ASP) is accompanied by water-electrolyte metabolism disorders with the development of dehydration, hypercoagulation, hypoperfusion of internal organs, which leads to a natural lesion of the microcirculatory bed of the intestinal wall, contributes to the development of non-occlusive intestinal ischemia and is accompanied by a high risk of sepsis and death.

Objective: to identify the features of ultrasound diagnostics of non-occlusive intestinal ischemia in acute severe pancreatitis and compare with morphological data of autopsy.

Materials and methods. The results of intestinal ultrasound examination in 25 patients with acute severe pancreatitis were analyzed. Inclusion criteria: acute severe pancreatitis, assessment of the severity of patients according to the SOFA scale - 5-12 points, APACHE 2 - 15-38 points. Abdominal examination was performed using a mid-range ultrasound device (SAMSUNG HS-60 RUS) with a 3.5 MHz convex and 7.5 MHz linear transducers. Two groups of patients were divided based on the timing of intestinal ischemic changes: Group 1 — early intestinal ischemia (up to 7 days after the onset of the disease) — 18 patients; Group 2 — late intestinal ischemia (from 7 days onward) — 7 patients. Morphological and histological studies were performed in 22 cases.

Results. According to ultrasound data, all patients with OLT showed signs of intestinal paresis with small intestinal lumen dilation up to 3.5 cm and no peristalsis from the first day of hospital stay. Mesenteric tissues were of medium echogenicity and had a layered structure. On days 3–7 from the moment of admission to the hospital, ultrasound examination revealed changes in the walls of the small intestine against the background of intestinal paresis: a spasmodic fragment of the small intestine without peristalsis was located, flattened on the infiltrated mesentery of increased echogenicity. In 3 cases, blood flow in the walls of the small intestine was not obtained in the color Doppler mode, in 8 cases, arterial blood flow was traced only along the mesenteric edge of the intestine. In the later stages (7–21 days), signs of edema of the small intestinal wall with single small hyperechoic inclusions in the wall structure (gas bubbles) were revealed. Changes in the colon with thickening of the walls of various sections up to 7–10 mm, wall structure of decreased echogenicity with infiltration of the submucosal layer. It was not possible to obtain an arterial spectrum in the color Doppler mode. Histological changes in the intestinal mucosa ranged from acute necrobiotic to complete necrotic. Thus, in some areas of the colon and small intestine, acute vascular changes with hemorrhages in the colonic mucosa predominated, while in others, complete mucosal necrosis with complete structural disruption was observed.

Conclusion. Dynamic color Doppler ultrasound allows for the assessment of the condition of the small and large intestinal walls, which allows for the determination of the presence of inflammatory or ischemic changes in the walls of the small and large intestines. 

Introduction. This study is dedicated to the quantitative analysis of the parietal lobes in the pediatric brain using magnetic resonance morphometry. The parietal lobes play a key role in tactile perception, spatial body orientation, and the regulation of goal-directed movements. In early childhood, a period marked by intensive brain development, the parietal lobes undergo significant structural changes, which justifies the need for detailed morphometric analysis. The obtained data contribute to a deeper understanding of normal nervous system development and improve the accuracy of diagnosing pathologies associated with structural abnormalities of the parietal lobes, such as attention deficit hyperactivity disorder, autism spectrum disorder, epilepsy, and cognitive impairments.

Aim. To perform a detailed study of morphometric parameters of the parietal lobe brain structures in neurologically healthy children to identify age- and gender-related variations.

Methods. The study included 49 children aged between 2 months and 18 years. All observations were divided into two age groups: from birth to 7 years (17 subjects) and from 7 to 18 years (32 subjects). Morphometric analysis of the parietal lobes was performed using the FreeSurfer software, the following parameters were analyzed: volume of each parietal lobe structure, surface area, and cortical thickness.

Results. Age-related changes in the volume, surface area, and cortical thickness of various parietal lobe structures were identified. Although no statistically significant gender differences in the morphometric parameters of these structures were found, there was a tendency for increased relative sizes (normalized to intracranial volume) in boys compared to girls. The data indicate complex and heterogeneous developmental dynamics of the parietal lobe during ontogenesis, manifested in both symmetrical and asymmetrical changes.

Conclusion. This study demonstrates the effectiveness of using morphometry for analyzing the development of parietal lobe structures in neurologically healthy children. The obtained morphometric measures may serve as comparative reference data for studies of structural changes in various neurological conditions.