Malignant hyperthermia manifests as hypermetabolism of striated voluntary muscle. Generally, this condition occurs during general anesthesia when inhalational anesthetics and succinylcholine are used. During the malignant hyperthermia attack, the oxygen consumption increases, lactate accumulates, the production of CO2 grows and excessive heat is generated. The crisis of malignant hyperthermia is a dangerous and potentially terminal complication of general anesthesia that requires rapid resolution in the shortest possible time. The only drug that can stop the acute state of malignant hyperthermia – dantrolen, is currently prohibited for import in Russia and is not legalized. Treatment of malignant hyperthermia is extremely difficult for all anesthesiologists in Russia and a great danger for patients with this condition.

Based on the analysis of 160 patients aged 30 to 60 years who were treated in the neurological department at the Engels City Hospital № 2 State Autonomous Health Institution with a diagnosis of acute cerebral circulation disorder of the ischemic type with damage to the vessels of the vertebro-basilar basin, an analysis of the main factors affecting the development of ischemic stroke was carried out. The study shows that the main risk factors for ischemic stroke, regardless of sex, include the presence of hypertension and is a risk factor for ischemic stroke. Moreover, the longer the duration of hypertension, the higher the risk of stroke. Moreover, the longer the duration of hypertension, the higher the risk of stroke. By analyzing the data that were obtained during the study, circumstances were established that were equally likely to affect members of both sexes. Such factors include: the presence of arterial hypertension, signs of impaired lipid metabolism, hypodynamy. In addition to common factors, those that were most common among females – the presence of signs of obesity and male – current smoking – were identified. All these circumstances can contribute to the development of acute cerebral circulation disorder of the ischemic type. Taking into account the main risk factors for ischemic stroke, we formulated the principles that underlie the prevention of the development of this complication. In this regard, it is important to identify and prescribe treatment for this pathology in a timely manner, in which periodic dispensary examinations are assigned an important role. The accuracy with which such routine work should be performed helps to timely detect signs of an increase in blood pressure in the subject. Send him in time for an examination, which will be carried out in full, which will help to make a correct diagnosis.

Every year the number of people suffering from metabolic syndrome is growing steadily. Associated obesity, type II diabetes mellitus is currently among the most common diseases. Cytokines produced by adipose tissue play the role of regulators in metabolism, with obesity, a change in their secretion occurs and the balance is disturbed, which leads to the development of insulin resistance, and later – metabolic syndrome and type II diabetes mellitus. The study of the mechanisms of the influence of adipokines, in particular adiponectin and leptin, on energy, carbohydrate and lipid metabolism are of greatest interest due to their key role in the development of metabolic disorders.

Relevance. Damage to the nervous system during the progression of systemic lupus erythematosus (SLE) is not only one of the most common phenomena, but also an unfavorable prognostic criterion for the patient. At the moment, more than 19 types of neurolupus manifestations are known in both adult patients and children. The main problem is the non-specificity and variability of neuropsychiatric symptoms, which can be associated not only with the pathogenesis of SLE, but also with other factors caused by the influence of the environment, psychosomatics, and concomitant diseases. Currently, there is no "gold standard" for diagnosing this type of pathology, and sometimes the selection of therapy does not correspond to the etiology of the lesion. Also, the urgency of this problem proves the lack of a clear classification of neurological complications of SLE, which can be used by specialists at the present time. The links of the pathogenesis of the development of both systemic lupus erythematosus itself and lesions of the nervous system in this disease are not fully understood. The purpose of this study. To study the pathogenesis and symptomatic manifestations of neurolupus, presented in the studies of Russian and foreign scientists, with the subsequent systematization of the information obtained. Material and methods. A study was made of materials from foreign and domestic literature of recent years on the issue of classification, pathogenetic and symptomatic problems of the neurological manifestation of systemic lupus erythematosus. Results. The prevalence of neurolupus among SLE patients reaches 95% of cases, expressed both in a single syndrome and in multiple simultaneous clinical manifestations. Lesions of both the central and peripheral nervous systems, as well as psychological disorders, are caused by the toxic effect of actively produced cytokines and interleukins, the deposition of immune complexes and thrombotic vasculitis, an increase in the BBB permeability and the penetration of autoantibodies tropic to the structures of the nervous tissue through it. At the moment, the classification of 2018 most fully covers all possible morphological manifestations of neurolupus, highlighting focal and diffuse lesions of the central nervous system, as well as peripheral. The most common occurrence among SLE patients is headache, which is not a specific manifestation, strokes, aseptic encephalomyelitis, cognitive disorders and depression. Conclusions. Neurolupus is a very common and poorly understood complication of systemic lupus erythematosus, which needs more detailed coverage in the medical literature. With a wide polymorphism of clinical manifestations, the neuropsychiatric syndrome of SLE is a real threat to the patient's life. The lack of a clear classification in clinical guidelines, huge gaps in knowledge about the pathogenesis of nervous pathologies, the similarity of the clinical picture of other diseases and the undeveloped diagnostic tactics of this pathology can lead to ineffectiveness of the therapy, irreversible damage to the nervous tissue and even death.

The morbidity and survival rates of patients with bladder cancer, depending on various causes, have been studied by many authors. However, there are a limited number of studies using the analysis of patient survival at the population level. Patient survival information can optimize the therapy and prevention of bladder cancer. The results of survival of patients with this disease in different gender and age categories should be studied more actively. The aim of the study was to study the observed and relative survival of patients with bladder cancer in gender-age groups in the Samara region for the period 2010–2012.The materials of the study were the primary records of 1059 patients for the period from 2010 to 2012. To obtain the results of survival, an actuarial method was used. To assess the reliability of the comparison of the obtained indicators, the Z and p criteria were used. In the course of the study, when assessing the 1-year and 5-year cumulative survival of patients with bladder cancer, there were lower rates of observed survival compared with the relative one.There were no statistically significant differences in the 1-year and 5-year relative survival rates for men and women. The 5-year observed survival rate for women was significantly higher than for men. With increasing age, survival rate for bladder cancer declines. The indicators of 1-year and 5-year relative survival of patients aged 50–59 years were significantly higher than the corresponding indicators of 60–69 years old. In the age group of 40–49-year-olds, there was a significantly higher relative survival rate of women compared with men.

The frequency of occurrence of geriatric syndromes (senile asthenia, depression, cognitive disorders) investigated in relation to some factors of cardiovascular risk (arterial hypertension, obesity) in patients of older age groups – residents of the city (1st sample) and rural (2nd sample) of Smolensk region. A comprehensive geriatric assessment of 480 patients over 65 years old was carried out with the analysis of case histories and outpatient records. The scale for screening senile asthenia (“Age is not a hindrance”), MMSE scale, GDS-15 was used. The analysis of the obtained results showed that the frequency of occurrence of senile asthenia among the residents of the village was lower than among the residents of the city (p <0.05). In both samples, the incidence of depression was twice as high in patients with senile asthenia and was associated with the female sex. At the age of 65–74, the >incidence of depression among rural residents was comparable to urban residents (31% and 29.7%, respectively, p ˃ 0.05), but among people over 75 years of age, its prevalence was lower among rural residents (35, 5% versus 52.3%, respectively, p < 0.05). A decline in cognitive status in patients under 75 years of age is associated with high blood pressure, while in those over 75 years of age, this relationship was inverse. The prevalence of obesity was higher in patients without senile asthenia.

In this article, the authors indicate the main methods of surgical treatment of patients with varicose veins of the lower extremities. The main issues related to endovenous methods of varicose vein obliteration are analyzed and described. Literary sources were searched for by keywords in the international abstract database PubMed. gov, as well as the Russian RSCI system over the past 20 years. Over 50 scientific publications have been studied. With the use of modern methods of treating patients with varicose veins of the lower extremities, the number of outpatient procedures is increasing, while improving the quality of life.

A case of late diagnosis of primary antiphospholipid syndrome in a patient with recurrent miscarriage is presented. The pronounced immunological activity of the antiphospholipid syndrome with severe arthritis, fibrosing alveolitis mimicked systemic lupus erythematosus.

The paper presents a clinical case of a 38-year-old woman who had an anomalous confluence of the right pulmonary vein, both into the inferior vena cava and into the left atrium, which corresponds to be the "scimitar" syndrome. The abnormal pulmonary vein made several bends before draining into the left atrium, which is described in foreign literature as a "meandering pulmonary vein". To clarify the diagnosis, a CT scan of the chest with bolus contrast enhancement and a deep analysis of literature sources were performed.

The article presents our experience of observing two different approaches for endoscopic retrograde drainage in patients with malignant pathology of the pancreatobiliary zone, complicated by the bile duct obstruction. In one case, in case of dysfunction of the installed uncovered stent as a result of incrustation with bile salts and/or tumor invasion, stent-to-stent restenting was performed. In the second case, if it was impossible to pass the guidewire retrogradely beyond the area of the tumor narrowing, an alternative method was used – bringing it down by percutaneous transhepatic access towards the endoscope to install a retrograde stent delivery system along it using the "Rendezvous" method.

On the example of a clinical case, the possibilities of radiation diagnosis of a rare type of injury received from a construction and installation gun are shown. The modern possibilities of radiation diagnostics in the detection of injuries and complications in a gunshot wound of the chest are shown. Ultrasound data on the presence of intrapleural contents allowed us to determine the penetrating nature of the wound. The data obtained by polypositional chest radiography gave an idea of the localization and size of the foreign body. During chest CT, an accurate anatomical characteristic of the wound canal was given, the exact localization of the foreign body was indicated, an intrapulmonary hematoma, a lung contusion were identified, the exact nature and volume of the intrapleural contents were determined. In the postoperative period, CT revealed PE and infarct pneumonia, and scintigraphy assessed the total deficit of lung perfusion, which affected the treatment tactics. In the diagnosis of complications of breast injury such as intrapulmonary hematoma, infarction pneumonia, inflammatory changes in the soft tissues of the chest wall, ultrasound diagnostic data are comparable with CT results.

The Russian Federation belongs to the countries with very high cardiovascular risk. Data on risk factors for death in people of old age and long-livers are not well understood. Objective. To summarize the experience of organizing treatment and inpatient rehabilitation of elderly patients and long-livers with cardiovascular diseases, to assess their cardiovascular risk factors. Methods. The study involved 50 patients, aged from 77 to 97 years (average age – 86.6 ± 4.9 years), who underwent treatment and rehabilitation for cardiovascular diseases. 32 (64 %) people corresponded to old age, and 18 (36 %) people over the age of 90 years were long-livers. There were 36 (72 %) women and 14 (28 %) men. Results. All 50 patients had arterial hypertension. Angina pectoris was diagnosed in 49 (98 %) patients. One myocardial infarction was suffered by 4 (8 %) people, two – 3 (6 %). 7 (14 %) people had a stroke, and another (2 %) suffered from the disease twice. Atrial fibrillation was diagnosed in 8 (16 %) patients, diabetes mellitus – in 11 (22 %). Сarotid arteries stenoses were found in 23 (95.8 %) patients, in 5 of them up to 50–55 %, including one occlusion. All patients were discharged with improvement after complex therapy in accordance with guidelines. Conclusions. A system for the rehabilitation of elderly patients and long-livers with cardiovascular diseases has been developed. Patients of older age groups have very high cardiovascular risk and prevalence of cardiovascular risk factors. Relatively small increases in blood pressure, the degree of arterial stenosis of a less hemodynamically significant level, and the use of combined therapy for cardiovascular diseases are factors that make it possible to survive until the age of long-livers.

Transplantation allows us to confidently save the lives of previously doomed patients. Unfortunately, this colossal achievement of human progress has a problematic side – the shortage of donor organs. The use of animal organs could solve it. Currently, the issues of xenotransplantation have become relevant again after the experimental xenotransplantation of the kidney of a genetically modified pig in 2021, and the xenotransplantation of the heart in 2022. This practice raises a number of ethical questions. Is it ethical to put humanity at risk by saving one person? Is it ethical to limit the civil rights of a xeno-recipient? Will xenotransplantation create another reason for discrimination? Can the creation of xenochimeras be considered an unacceptable interference in the Divine plan from a religious point of view? Is it ethical to use higher animals for xenotransplantation? Will an increase in the number of xenotransplants create a risk of the identity of the human race? Will xenotransplantation create new questions about equitable organ allocation? The sources of scholars of theologians related to the main Abrahamic religions on this topic are analyzed. Consideration of theological approaches to the new ethical problems presented by xenotransplantation does not allow us to find a unanimity of opinion. However, as this new branch of medical science makes concrete clinical progress, the attitude of society, religious leaders and ordinary believers towards it will improve. From an individual point of view, Judaism does not object to xenotransplantation to prolong and save human life, even in the case of non-kosher animals with genetic modifications. The preservation of life outweighs other values almost without exception. Xenotransplantation, even from a pig, is hailed as a life-sustaining medical intervention from a Jewish ethical perspective by most authors. In Christianity, the motivation is to try to follow the example of Jesus Christ in bringing healing to all those in need. While physiological healing is important, the ultimate goal is the overall well-being of the individual, which requires spiritual, mental, and social well-being in addition to physical health. The most correct generalization about Islamic bioethical views on xenotransplantation would be that, given the state of science, the final ethical and legal definition remains ambiguous, but in general, xenotransplantation as a means of saving human life may be acceptable.