Monoclonal gammopathy of renal significance is a condition caused by the proliferation of a clone of B-lymphocytes or plasma cells that does not reach the criteria required for the initiation of treatment for oncohematological indications, but is characterized by the secretion of nephrotoxic paraprotein. There are many morphological variants of this disease and their diagnosis requires the use of additional research methods. This article presents a clinical observation of a 54-year-old patient admitted to the nephrology department with nephrotic syndrome. According to the results of nephrobiopsy, the patient was diagnosed with monoclonal fibrillary glomerulonephritis. Additional examination of the patient did not reveal signs of lymphoproliferative disease.

In the educational process of medical and veterinary higher educational institutions, cadaveric material is actively used, which is difficult to obtain and preserve for a long time. One of the solutions for long-term preservation of educational material is the production of preparations from them using silicone and epoxy plastination methods. In this case, methods for preserving brain preparations are of value, which initially, due to its soft structure, is easily destroyed during the educational process. The article discusses new methods of brain plastination based on a sample of scientific data from PUBMED, Elibrary, Google Scholar for the period from 2017 to 2024. 14 articles from a sample of 1095 articles were analyzed. Currently, several authors propose new methods using polyester resins, additional staining for contrasting the gray and white matter of the brain, new methods of placing in acrylic boxes and creating 3D-models, processing with corn starch and enclosing in transparent thermal film, impregnation with gum arabic or paraffin, combining various plastics during plastination to improve the performance properties of the preparations.

Aim. To study of oxidative processes in testicular tissues after gamma irradiation.
Material and methods. Using the polarographic method, the rate of oxygen absorption on endogenous and exogenous substrates (V_end, V_suc, V_glu, V_dnf) and with specific inhibitors of tissue respiration of amytal and sodium malonate (V_am, V_mal) in testicular tissues at different times (3, 10, 40 days) after total single gamma irradiation (1.0 Gr).
Results. It was found that, in the testicular tissues of rats at different times (3rd, 10th, 40th day) after total single gamma irradiation (1.0 Gy). In the early period (72 hours) after irradiation, (V_end) decreased by 14.7 % (p < 0.05), (V_suc) by 18.6 % (p < 0.05) and (V_glu) by 10.9 % (p < 0.05) compared with the control. After 10 days, on the contrary, there was an increase in (V_end) by 108.2 % (p < 0.05), in the presence of exogenous succinate and glutamate substrates, increased (V_suc) by 45.1 % (p < 0.05) and (V_glu) by 112 % (p < 0.05), SD_dnf decreased by 12.8 % (p < 0.05), and with inhibitors, low-resistance respiration (MRD) increased by 9.4 % (p < 0.05). On day 40 (V_end, V_suc, V_glu) increased by 120.7 % (p < 0.05), 124.8 % (p < 0.05) and 97.1 % (p < 0.05), respectively, SD_dnf decreased by 11.5 % (p < 0.001), amytal resistant respiration (ARD) by 30.6 % (p < 0.05) and MRD by 11.7 % (p < 0.05).
Conclusion. Increased oxygen uptake was accompanied by a significant decrease in SD_dnf in both experimental groups (10th and 40th days), which suggested the threat of disconnection of oxidation and phosphorylation processes. A decrease in MPD also indicates a decrease in the contribution of fatty acids (FA) to the energy supply of testicular tissue.

Introduction. Functional foods are products that, in addition to taste and nutritional value, have a physiological effect on the human body. ω-6 and ω-3 fatty acids, when consumed in the form of triglycerides from various food sources, undergo digestion in the small intestine, allowing absorption and transport into the blood and subsequent assimilation into the body, including the brain, retina, heart and other tissues. Amino acids must be obtained from food because the human body lacks the metabolic pathways necessary to synthesize some amino acids. In nutrition, amino acids are classified as essential and non-essential.
Aim. To determine the fatty acid and amino acid composition of black soldier fly larvae for use as a dietary supplement.
Materials and methods. In the experiment, the fatty acid and amino acid composition of the larvae of the black soldier fly (Hermetia illucens) was studied with the subsequent goal of using the insect as a component in dietary supplements. We assessed the amino acid and fatty acid composition of the larvae. Hermetia illucens were grown on four different diets; the group with the highest weight obtained was taken to determine the amino acid and fatty acid composition. To determine amino acids, Hermetia illucens were selected at the pre-pupa stage, dried in a SNOL 58/350 cabinet at 105 oC, and analyzed on an lc-20ad prominence liquid chromatograph. Amino acid analysis was carried out on an lc-20ad prominence liquid chromatograph, lysine 4.3%, valine 1.4%, leucine 4.6%, arginine 6.7%, isoleucine 2.8%, histidine 2.0%, methionine 2 were obtained %, phenylalanine 3.4%, tryptophan 1.7%, threonine 2.9%.
Results. Dried samples in a SNOL 58/350 cabinet at 105 °C were obtained by extracting the crushed mass of larvae with petroleum ether. The sample was examined on a Chromatek-Crystal 9000 chromatograph No.: 2191672 and contains lauric acid up to 53%, myristic acid 5%, palmitic acid 5%, oleic acid up to 5%, omega-3 and omega-6.

In order to study the mechanisms of adaptation to loads that require high endurance, the article analyzes and systematizes the literature and the results of our own studies of the duration of the RRNN interval of the cardiointervalogram/heart rate (HR) in the prone position among athletes, in particular, among cross-country skiers. It has been established that the value of RRNN depends on sports specialization (maximum for athletes training for endurance), on the length of training and the level of sportsmanship (for cross-country skiers, with an increase in the level of skill, the value of RRNN increases, and heart rate decreases), on the periods of the annual cycle. So, the athlete K.D. it is maximum in the preparatory period (1497 ms/40 beats/min), but lower in the competition (1477 ms/40.6 beats/min) and in the transition (1467 ms/ 40.8 beats/min) periods. The value of RRNN also depends on the stage of the training camp, or TCB. So, the athlete K.D. from the beginning of the TS to its end, it gradually increases - from 1423 ms to 1572 ms, and the heart rate decreases accordingly from 42.1 to 38.1 beats/min. It was shown that the type of vegetative regulation of heart activity in elite skiers does not change during the annual cycle (all members of the Tatarstan team had type IV regulation according to the classification of N.I. Shlyk, i.e. vagotonia). This confirms the notion that endurance training increases the influence of the parasympathetic system on the activity of the heart. The results of the study of the elite skier-racer K.D. (the first author of the article), fixing the volume and intensity of the training load in all three periods of the annual cycle, as well as the results of a study of the Tatarstan national team (without fixing the loads), revealed that, in general, throughout the season, including in the preparatory period, the median RRNN correlates with the volume (Vkm; Vmin) training loads (the higher they are, the greater the median RRNN). However, the competitive period is characterized by an inverse dependence of the median RRNN on the volume (Vmin) of the load, which is regarded as a reflection of the formation of an anxiety state in this period, although the formation of an anxiety state in the team of Tatarstan (n = 8) was not detected in the competitive period (they have a median of RRNN in the preparatory period was 1430 ms/42 beats/min), and in the competition period – 1490 ms/40.2 beats/min). The authors conclude that even a palpatory calculation of the heart rate of a cross-country skier in conditions of clinostasis (rest) can serve as a guideline in managing the training process, since an increase in heart rate with exercise therapy indicates a decrease in physical performance, and a progressive decrease in heart rate (up to 38 beats/min) – on its increase, as well as on the formation of the synthesis of non-neuronal acetylcholine (ACh). It is assumed that excessive production of non-neuronal ACh, which can lead to weakness of the sinus node, is prevented by a significant increase in ANS SO activity in elite skiers.

Relevance. Terrorist acts of modern times lead to multiple wounds, destruction of soft tissues, organs, bones and joints, causing combined and combined mine-explosive wounds and explosive injuries.
The purpose of the study. Analysis and synthesis of data on the provision of specialized care and the use of medical rehabilitation for victims who were in the zone of terrorist operations.
Materials and methods. The results of diagnosis and treatment of 46 injured people who entered the institute in 2023-2024 from different regions of the Russian Federation were analyzed: Sevastopol (3), Moscow Crocus City (12), Belgorod (11), Kursk (20). All the victims were civilians.
Results. The use of a differentiated approach in the provision of specialized care, including a one-time assessment of the condition upon admission based on instrumental data, stabilization of the condition, revision and additional removal of all injuries, taking into account the severity of the victim by different teams, early prevention of complications and early rehabilitation, contributes to the recovery of victims. In these conditions, it is necessary to form a comprehensive program that includes aspects of medical, professional, and socio-psychological assistance that promotes early recovery.
Conclusions. Mine-explosion injuries to injured civilians who were in the combat zone are combined and multiple in nature. When providing specialized assistance to such victims, comprehensive instrumental diagnostics and a differentiated approach are necessary, which contributes to the early prevention of complications and early rehabilitation. The formation of a comprehensive program includes medical, professional and sociopsychological aspects and contributes to early recovery.

Introduction. The menisci of the knee joint (medial and lateral) play an important role in shock absorption and stabilization. Their tears are among the most common injuries, especially in athletes and older individuals. The main treatment methods are partial or total meniscectomy and reconstruction (meniscal repair). The relevance of this issue lies in the increasing number of surgeries and the potential long-term complications, including accelerated osteoarthritis (OA).
Objective. To systematize and analyze existing data on the long-term outcomes of meniscectomy, identify factors influencing these outcomes (patient age, anterior cruciate ligament status, and level of physical activity), and propose practical recommendations for optimizing treatment and rehabilitation.
Materials and Methods. A literature review was conducted, including randomized trials, meta-analyses, and clinical observations, focusing on the evaluation of outcomes following meniscectomy and meniscal repair. Data were considered on the incidence and severity of osteoarthritis, functional outcomes (WOMET, Lysholm scale, IKDC, OARSI), and reinjury rates in different age groups. Special attention was paid to meniscal preservation strategies and combined ACL reconstruction in the context of longterm results.
Results. Partial or total meniscectomy increases the load on the articular cartilage, thereby contributing to OA progression. Several randomized trials have shown a faster increase in radiographic and clinical signs of OA in the meniscectomy group compared to placebo surgery. Younger patients (under 22) have a higher risk of recurrent tears and poorer functional outcomes due to greater physical stress. Meanwhile, no statistically significant differences in reconstruction failure rates were noted in patients over 40. Combined ACL reconstruction and meniscal repair yield more favorable long-term results, though the literature is contradictory. Some studies indicate a lower rate of recurrent tears with simultaneous ACL reconstruction and meniscal suturing, potentially linked to improved stability and additional stimulation of healing (release of growth factors and stem cells during tunnel drilling). Preserving the meniscus through reconstruction (repair) is associated with better functional outcomes and a lower risk of OA compared to meniscectomy. Resection (especially total) more often leads to reduced scores on the IKDC, WOMET, and Lysholm scales, as well as increased pain syndrome.
Conclusions. Complete or partial meniscectomy significantly increases the risk of osteoarthritis and decreases joint functionality. Preference should be given to reconstructive procedures (meniscal repair), especially in the red and red-white zones of the meniscus, which have better blood supply and regenerative potential. Patients under 22 carry a higher risk of recurrent tears, necessitating more aggressive repair strategies and rigorous rehabilitation oversight. Combined ACL reconstruction and meniscal repair can improve stability and reduce reinjury risk, although further research is needed to confirm this effect. An individualized approach to meniscal tears—considering patient age, activity level, and tear type—as well as the use of biological agents and comprehensive rehabilitation (exercise, weight management, regular check-ups) promotes more favorable long-term outcomes and helps prevent osteoarthritis.

Relevance. Peptic ulcer disease is a common disease that occurs in 5–10 % of the world population. Despite the sharp decrease in morbidity and hospitalization rates of patients with peptic ulcer disease of the stomach and duodenum, for the last 30 years lethality in such patients remains at a high level, and complications occur with a frequency of 10–20 %.
Purpose: to present the literature review of foreign researchers devoted to the modern trends of complications treatment in patients with peptic ulcer and duodenal ulcer disease.
Material and methods. Literature sources in English on this topic in PubMed, MEDUNE, Google Scholar databases were analyzed. The review highlights clinical studies devoted to the treatment of complications of gastric and duodenal ulcer disease: ulcer bleeding, perforative ulcer, and pyloroduodenal stenosis.
Conclusion. Complications of gastric and duodenal ulcer disease remain complex therapeutic and surgical problems. Despite the achieved successes, the results of treatment of complications remain unsatisfactory, which requires further study and search for their improvement.

Skin melanoma is one of the most malignant tumors and is responsible for 70.3% of deaths in the group of skin cancers in the Russian Federation. Skin melanoma is characterized by a steady increase in the incidence among the working-age population, both in Russia and abroad (annual increase in incidence is about 3–4%). At the moment, for stages I-II of skin melanoma, practitioners have been using only clinical (clinical form of melanoma, localization, gender, age, etc.) and standard pathomorphological prognostic factors for many years. For thin skin melanoma, the presence of ulceration, Breslow thickness, mitotic index, lymphovascular invasion, and presence of regression are the most significant prognostic biomarkers. The most informative predictors are needed to improve the stratification of patient prognosis. For a more accurate and individual prognosis, regular integration of already known clinical and morphological factors of the tumor with other prognostic characteristics, such as, for example, lymphovascular invasion, as well as with molecular genetic parameters, is necessary. A more accurate assessment of the risk of progression of "thin" melanoma of the skin stages IA-IB may in the future help the choice, application of new treatment approaches, as well as the frequency and volume of follow-up examinations by an oncologist.

Introduction. In recent years, there has been an increase in the frequency of various nosological forms of endometrial hyperplasia, which is diagnosed in 38-72% of women of reproductive age. The information content of the applied instrumental diagnostic methods ranges from 47 to 89%. In the pathogenesis of endometrial hyperplasia, an important role is played by the imbalance of the processes of proliferation, differentiation and death of cells.
The aim of the study. This review aims to study the information content of instrumental diagnostic methods in patients with different types of endometrial hyperplasia, as well as to analyze some indicators of apoptosis in the blood and endometrial tissue in patients with endometrial hyperplasia without atypia and in patients with atypical endometrial hyperplasia.
Object and methods. A comprehensive clinical, instrumental and biochemical study was conducted on 36 patients of reproductive age (mean age 45.7±3.41 years) with different types of endometrial hyperplasia. All patients were examined using clinical, echographic, hysteroscopic and morpho-biochemical methods. The patients were divided into two groups. Group 1 included 25 (69.4%) patients with endometrial hyperplasia without atypia; Group 2 included 11 (30.6%) patients with atypical endometrial hyperplasia. A comparative analysis of the diagnostic methods used was conducted and compared with the morphological method.
Results and its discussion. A study of some indicators of apoptosis in the blood and endometrial tissue in patients from the studied groups was performed. It was noted that patients with endometrial hyperplasia without atypia and atypical endometrial hyperplasia had a violation of the regulation of cellular homeostasis due to an imbalance of apoptosis factors and cell proliferation.
Conclusion. A decrease in the concentration of factors initiating apoptosis is accompanied by a decrease in the induction of programmed endometrial cell death. Dysregulation of apoptosis leads to a decrease in the content and abolition of cyclic changes in the number of apoptotic cells in the endometrium.

Introduction. Somatoform autonomic dysfunction (SAD) can aggravate an existing disease or be combined with other mental disorders (e.g., depression, anxiety, and hypochondria). Patients with SVD are accompanied by pain of various localizations, for example: cardiovascular, gastrointestinal, respiratory or urogenital, and at the same time they experience pain in the spine.
Purpose of the study: To study the therapeutic effects of a magnetic posture corrector in patients with chronic spinal diseases and autonomic disorders.
Materials and methods. The study included 107 patients - men n = 61 and women n = 46 aged 18-64 years. All patients were diagnosed with chronic spinal diseases, more often of the cervicothoracic region 69 (64.5%) than the lumbosacral 38 (35.5%) p = 0.278, in most cases deforming lesions of the spine predominated 56 (52.3%) p = 0.175. Many patients had combined pathology of the spine. Patients were tested with the questionnaire of A.M. Vein, and to assess the HRV (heart rate variability), daily electrocardiogram monitoring was performed. The first examination took place on the 3rd-4th day of hospital stay, a repeat (final) examination was performed after 12 months. The division into groups was random (even and odd numbers as they were admitted), the 1st group (main) included n = 54 patients who received a magnetic posture corrector, the 2nd (control) group n = 53, correctors without magnets. The total time of wearing the corset was no more than 6 hours per day.
Results. After 12 months of the study, the HRV indicators were restored in the main group; SDNN by 58.9% (p = 0.091), SDANN by 35.1% (p = 0.084), RMSSD by 55.4% (p = 0.172) and pNN50 by 44.9% (p = 0.042), indicating the restoration of the activity of the vegetative balance. Almost the same changes in the spectral indices of the sympathetic link LF and VLF to the parasympathetic HF, with the restoration of the LF/HF index by 45.7% (p = 0.012). In the control group, the SDNN, SDANN, RMSSD and pNN50 indices, both initially had low standard values, and at the end of the study practically did not improve.
Conclusions. Our study revealed that the use of a magnetic posture corrector helps to reduce vegetative disorders in patients with chronic spinal diseases. Wearing a magnetic posture corrector for 12 months stabilizes the autonomic nervous system, which is reflected in the improvement of heart rate variability. These changes are confirmed by the questionnaire of A.M. Vein; in the group of patients who wore a magnetic posture corrector, at the end of the study, the number of patients with severe autonomic dysfunction significantly decreased from 38.9% to 20.4%, p < 0.05. Accordingly, the number of patients with no VD increased from 14.8% to 35.2%, p < 0.05.

Objective: to improve treatment outcomes in patients with infected pancreatic necrosis through the rational use of minimally invasive technologies.
Materials and methods. A retrospective-prospective analysis of treatment results was conducted on 137 patients with infected pancreatic necrosis. The control group consisted of 53 patients who underwent open necrosectomy. In the main group (84 patients), a developed treatment algorithm was applied using minimally invasive technologies: puncture-draining interventions, video-assisted retroperitoneoscopy, and percutaneous necrectomy.
Results. In the control group, postoperative complications developed in 50 (94.3%) patients, with a mortality rate of 54.7%. In the main group, postoperative complications were observed in 32 (38.1%) patients, with a mortality rate of 33,3%. The developed devices for necrectomy allowed for a reduction in operation time by 45.6% (p = 0.04).
Conclusions: The application of the developed treatment algorithm and instrumentation using minimally invasive technologies allowed for a reduction in the frequency of postoperative complications from 94.3% to 38.1% and mortality from 54.7% to 33,3% in patients with infected pancreatic necrosis.

The article presents a clinical case of the supervision of a patient who received a severe combined injury as a result of a road traffic accident: closed craniocerebral injury, multiple fractures of the bones of the limbs and chest, damage to the organs of the thoracic and abdominal cavities.
Aim: to review a clinical case of providing emergency care to a patient with severe combined trauma after an accident, to show the effectiveness of a staged and multidisciplinary approach to the management of a patient with severe polytrauma resulting from an accident.
Materials and methods. The study used materials from the medical documentation of the surgical department of the City Clinical Hospital named after. Archbishop Luke of Tambov", Regional Medical Information System.
Results and discussion. In a multidisciplinary hospital, the following diagnostic and treatment measures were carried out aimed at making a diagnosis, developing tactics for managing the patient, combating traumatic shock, and eliminating respiratory failure. After relative stabilization of the patient’s condition, the patient urgently underwent drainage of the pleural cavity in order to eliminate hemopneumothorax and laparotomy, the purpose of which was to stop intra-abdominal bleeding; on the 9th day the patient was transferred to level 3 trauma center, where surgical interventions for limb fractures were performed on the 20th, 42nd and 63rd days after injury. Such a step-by-step, multidisciplinary approach to the management of a patient with polytrauma resulting from an accident contributed to a successful diagnostic search, development of the most optimal treatment measures in terms of methods and time parameters, the absence of severe and life-threatening complications, early recovery and recovery of the patient.
Conclusions. A staged multidisciplinary approach involving highly qualified specialists, timely elimination of life-threatening injuries with parallel anti-shock measures, selection of the optimal sequence of surgical interventions for limb fractures in terms of timing and condition of the patient, early mobilization measures contributed to the successful treatment and recovery of the patient with polytrauma as a result of an accident.

Introduction. A comminuted fracture of the scapula with displacement of bone fragments can cause the development of severe post-traumatic deformation with persistent loss of function of the upper limb.
Objective – to present the results of surgical treatment of three patients with various fractures of the scapula.
Materials and methods. The analysis of surgical treatment of 3 patients of working age with comminuted fractures of the scapula with a dubious prognosis for the restoration of the function of the upper limb in the case of choosing a conservative treatment strategy was performed. After a preliminary analysis of the computed tomography data, the surgical technique protocol and the choice of implants were determined. Surgical treatment was carried out in the early post-traumatic period. The early postoperative period was uneventful and without complications in all cases. The follow-up period after surgery ranged from 6 weeks to 6 months.
Results. In all 3 cases, X-ray consolidation of fractures was noted, the return of the full function of the upper limb. The median on the DASH questionnaire was 11.7 points.
Conclusion. Based on the results of the proposed observations, it seems appropriate to evaluate the positive clinical, functional (complete recovery of the function of the upper limb) and radiological results (stable fixation, the process of fracture consolidation), despite a severe injury to the scapula, often leading to a permanent loss of working capacity and significantly limiting normal daily activities.

Relevance. Imported malaria cases in the Russian Federation are detected annually. In the absence or delayed treatment it can lead to patients´ complications and death.
The aim of the work is to present and analyze a fatal tropical malaria clinical case with secondary diseases caused by Klebsiella pneumoniae.
Materials and methods. The work was carried out on the basis of the clinic and the Department of Infectious Diseases with Epidemiology of Samara State Medical University. A clinical case of tropical malaria severe course in a patient on the 18th disease day admitted in a malarial algid state.
Results. Sepsis, pneumonia, and meningitis were found in a patient with tropical malaria. Klebsiella pneumoniae was isolated from the patient's biomaterials. The development of secondary diseases caused by Klebsiella pneumoniae contributed to the patient's condition worsening and the multiple organ failure progression. The late etiotropic treatment led to the multiple organ failure and patient´ death.
Conclusions. The clinical example demonstrates the vital need for the epidemiological history correct interpretation, malaria early diagnosis and treatment.

Relevance. The treatment of soft tissue sarcomas, a rare and diverse type of cancer, requires an integrated approach that involves a multidisciplinary team of specialists. Surgical removal of the primary tumor is recommended in specialized centers after a thorough diagnosis and development of an individualized treatment plan. It is crucial to assess the risk of local recurrence even before surgery and to ensure continuity of care for patients who undergo non-curative operations. Radio- and chemoresistance in sarcomas limits the effectiveness of radiation therapy and chemotherapy, and delays in initiating treatment can worsen the prognosis. However, modern radiotherapy equipment and techniques for reducing radiation doses allow us to overcome resistance in malignant cells and reduce tumor size.
Description of the clinical case. A patient with a suspected malignant neoplasm of the right parotid salivary gland underwent surgery, according to the results of the histological examination, and a carcinosarcoma of the salivary gland G3 (pT2N0M0) was confirmed. However, the edge of the resection was not indicated. One month after the surgical removal of the tumor, the patient experienced a local recurrence of the disease. However, they did not receive any further antitumor treatment at that time. Only one year later, they were admitted to an oncological clinic, where they received palliative radiation therapy after verification of the local relapse and consultation with the federal center. The irradiation was carried out in two stages: multifractionated hypofractional irradiation in a single dose of 3.7 Gy twice a day for a total dose of 19 isoGy, followed by a 3-week break and daily hypofractionated irradiation in a single dose of 3 Gy for a total of 61 Gy. Against the background of treatment, we were able to achieve a reduction in tumor mass by 85% compared to the initial size. We also saw a reduction in pain and an improvement in the general somatic status and quality of life of the patient. Unfortunately, this positive response was short-lived due to the aggressiveness of the histological form of the disease. In this clinical case, surgery to remove the residual tumor was not performed.
Conclusion. Hypofractionated radiation therapy is an effective treatment option for recurrent rhabdomyosarcoma in the parotid salivary gland, as it allows for a significant reduction in tumor formation. However, due to its biological characteristics and aggressive nature, it requires continuous and urgent comprehensive treatment.

Relevance. According to statistical data, multifocal fractures of the humerus are quite rare, accounting for approximately 6% of all skeletal bone fractures. Fractures of the proximal humerus and diaphysis of the humerus have a bimodal distribution, as they have both high-energy and low-energy mechanisms of injury.
The aim of the study is to demonstrate and analyze the technique of surgical treatment of complex fragment fracture of the proximal humerus and diaphysis of the humerus using a clinical case as an example.
Object and methods. Patient V., 37 years old on 12.04.2024 sustained an injury to the right humerus as a result of a fall from a bicycle at high speed. He was admitted to the emergency room of the R. R. Vreden Federal State Institution of Medical and Research Centers, where he was diagnosed with a closed splinter fracture of the proximal part and diaphysis of the right humerus with dislocation of the fragments.
Results. The present study presents a traumatologic pathology, namely, a complex fragmentary metadiaphyseal fracture combined with a 4-fragment fracture-dislocation of the humeral head with dislocation of the fragments. The radiologic picture of the fracture at different stages of treatment and the technique of surgical intervention with the Philos long plate are described. The period of fusion of this fracture was 6 months. The final functional result was 97 points on the ConstantMurley scale. On the DASH scale - 1 point. When assessing the function of the shoulder joint: flexion – 170 degrees, abduction – 170 degrees, external rotation – 30 degrees, internal rotation – to the level of the lumbar bone.
Conclusions. The surgical treatment of fractures involving both the head and diaphysis of the humerus is a subject of debate. The reasons for this are the rarity of this injury and the different mechanism of injury from low-energy to high-energy. Currently, the preference is given to osteosynthesis with the aim of restoring the medial calcaneus of the proximal humerus and reducing the risks of aseptic necrosis of the humeral head.

Objective: to present a clinical case of neurosarcoidosis demonstrating the difficulties in diagnosing this disease and to discuss the features of its clinical manifestations, diagnosis, and treatment.
Materials and Methods. A clinical case of a 28-year-old patient with neurosarcoidosis is described. The diagnostic process included clinical examination, laboratory tests, neuroimaging (CT and MRI of the brain), lymph node biopsy with histological and immunohistochemical examination, and autopsy.
Results. The patient presented with symptoms such as severe headache, disorientation, anisocoria, sensory impairment, epileptic seizures, and psychomotor agitation. Brain MRI revealed leptomeningeal enhancement of the contrast agent. Lymph node biopsy confirmed granulomatous lymphadenitis characteristic of sarcoidosis. Despite the recommended glucocorticoid therapy, the disease progressed, and the patient died due to cerebellar infarction and cerebral edema. Autopsy verified sarcoidosis with involvement of the leptomeninges, spleen, and lymph nodes.
Conclusions. Neurosarcoidosis is a rare disease with diverse clinical manifestations, making timely diagnosis challenging. A comprehensive approach, including clinical examination, neuroimaging, histological examination, and exclusion of other diseases, is crucial for establishing the diagnosis. Timely initiation of immunosuppressive therapy may improve the prognosis of the disease.

Introduction. Migration of implantable materials is a rare but significant complication of surgical interventions in urological practice. Objective: to present an analysis of two clinical cases of unusual migration of fixing Capron (nylon) structures in the urinary system.
Materials and methods. Two clinical observations are described: a case of migration of a fixing Capron suture into the kidney parenchyma after nephropexy and a case of transurethral migration of a supporting loop after surgery for urinary incontinence. Diagnostics was carried out using clinical examination, ultrasound imaging, computed tomography, and endoscopic methods.
Results. In the first case, the migration of the Capron suture into the kidney parenchyma was successfully resolved through laparoscopic removal of the structure and replacement with a polypropylene one. In the second case, spontaneous transurethral migration of the fixing loop occurred without the development of stricture and with preservation of the functional result of the operation.
Conclusion. The presented observations demonstrate the possibility of gradual migration of Capron structures through the tissues of the urinary system without developing serious complications. These cases emphasize the importance of suture material selection in urological operations and the need for long-term patient monitoring.

Craniosynostosis is the premature closure of cranial sutures, leading to skull deformation, cranio-cerebral disproportion, and potentially resulting in the development of intracranial hypertension, persistent neurological, and cognitive impairments. Magnetic resonance imaging (MRI) complemented by dynamic contrast-enhanced MR perfusion, allows for a detailed assessment of intracardiac structures, as well as evaluation of cerebral blood flow parameters in areas of suspected brain compression in children with craniosynostosis.
Purpose of the study: еvaluate cerebral blood flow parameters (CBV and CBF) in children with craniosynostosis using contrast-enhanced dynamic MR perfusion in the preoperative stage.
Object and methods. Forty-eight children with various types of craniosynostosis were examined: 10 (20%) had sagittal suture synostosis, 15 (31%) had metopic suture synostosis, 9 (19%) had unilateral coronal suture synostosis, 6 (13%) had bicoronal synostosis, 2 (4%) had lambdoid synostosis, and 6 (13%) had involvement of all sutures. Color perfusion maps of CBF and CBV were constructed using the syngo.via system (Siemens).
Results. According to MR perfusion data, in areas of compression (frontal lobes) relative rCBV and rCBF indices in metopic craniosynostosis were 88.3 ± 24.6% and 85.5 ± 19.6% respectively, compared to the occipito-parietal regions. In cases of unilateral coronal synostosis, in the compression zone (ipsilateral frontal lobe) relative to the contralateral frontal lobe, they were 95.3 ± 3.1% (rCBV) and 93.1 ± 2.2% (rCBF), and relative to the occipital lobes, 84.4 ± 5.2% (rCBV) and 87.3 ± 8.2% (rCBF). In cases of bicoronal synostosis, in the frontal lobes they were 86.2 ± 19.7% (rCBV) and 86.4 ± 14.7% (rCBF) relative to the occipito-parietal regions. In cases of sagittal suture closure, in the temporal lobes relative to the frontal and occipital lobes, they were 99.1 ± 3.2% (rCBV) and 98.1±2.4% (rCBF).

Introduction. A significant shortage of high-quality donor organs remains one of the most pressing challenges, especially when it comes to extended criteria donors or asystolic donors. The solution to this problem arises at the intersection of surgical skill, advanced biomedical technologies and a deep understanding of the mechanisms of ischemia-reperfusion injury (IRI). Objective. This study was carried out to substantiate and refine the technique of extracorporeal ex-vivo perfusion of a liver graft on an animal model using the Ex-Stream perfusion apparatus for extracorporeal oxygenation according to TU 32.50.21-002-75538036-2020 (RU holder Transbiotek LLC, St. Petersburg, Russia, manufacturer Biosoft-M LLC, Moscow, Russia). Materials and methods. The study was conducted on male pigs weighing 15–30 kg (n = 5). The study is based on the analysis of the results of hypothermic oxygenated perfusion of the liver transplant in a vivarium using a cardiopulmonary bypass apparatus. The study was conducted according to the following protocol: the donor liver was removed from the animal with the formation of a temporary venovenous bypass, pharmaco-cold preservation of the organ using the Ex-Stream apparatus and its subsequent replantation. Results. The following results were obtained in a series of 5 observations. Tissue damage markers (AST, ALT, LDH, GGTP) showed a gradual increase in their level in the perfusate over the course of ischemia. The average values of AST and ALT increased by 2-3 times, LDH - by 1.5-2 times, and GGTP - by 1.2-1.5 times compared to the initial values. The level of malondialdehyde, reflecting oxidative stress, increased by an average of 30–40% by the end of the experiment, while the level of glutathione decreased by 20–25%. Concentrations of proinflammatory cytokines (TNF-α, IL-6, IL-1β) in the perfusate increased 2–4 times compared to baseline values, indicating the development of an inflammatory response. Microscopic examination with hematoxylin and eosin staining revealed signs of ischemic damage to hepatocytes, such as cytoplasmic vacuolization, nuclear pyknosis, and disruption of the beam structure. The degree of damage increased with increasing ischemia time. Mason staining showed a moderate increase in connective tissue in the portal tracts and pericentral zones, indicating initial fibrotic changes. Ultramicroscopic examination (transmission electron microscopy) revealed swelling of mitochondria, disruption of the integrity of their cristae, expansion of the endoplasmic reticulum and formation of autophagosomes in hepatocytes. Oxygen consumption by liver tissue gradually decreased during the experiment, reaching 60-70% of the initial level by the end of the observation. Carbon dioxide production also decreased, but to a lesser extent, amounting to 75-85% of the baseline values. Analysis of the perfusate using a potentiostat-galvanostat IPS showed a gradual decrease in the oxidation-reduction potential, indicating an increase in hypoxia and depletion of antioxidant reserves. The activity of superoxide dismutase and catalase, key antioxidant enzymes, decreased by 30-40% and 20- 30%, respectively, compared with the initial values, indicating a weakening of the antioxidant defense. Conclusion. The obtained results indicate that the developed model using the Ex-Stream device is reproducible and allows for effective study of the state of ischemia-reperfusion injury. This opens up opportunities for conducting a larger and more comprehensive series of experiments, the results of which will be the subject of our further research.

t Obturator prostheses can be populated by microorganisms and function as a reservoir of infection. After resection of the upper jaw, the obturators are also exposed to microorganisms living in the nose and paranasal sinuses. The aim is to evaluate in vitro biofilm formation by various types of oral bacteria on titanium and polyesteresterketone (PEEK) samples from experimental groups.
Materials and methods. A total of 115 samples were prepared, which, depending on the treatment, were divided into 6 groups: group 1 (control) included 15 samples of smoothtreated titanium alloy - T-a; group 2 – 20 samples of titanium treated with laser – T-l; group 3 – 20 samples of smooth-processed PEEK; group 4 – 20 samples of PEEK modified with a laser – PEEK-l, group 5 – 20 samples of PEEK treated with PEEK-p; group 6 – 20 samples of PEEK treated with a laser and plasma – PEEK-lp. Titanium discs were milled from titanium alloy, PEEK discs were prepared from PEEK rods and subsequently subjected to laser texturing with micro grooves. Reference strains of Streptococcus mutans, Streptococcus oralis, Candida albicans, Staphylococcus aureus, Porphyromonas gingivalis, and Fusobacterium nucleatum were used. Results. The smallest number of all types of microorganisms was observed on the surface of PEEK samples treated with plasma, as well as laser+plasma, i.e. in groups 5 and 6. The highest attached CoES were Fusobacterium nucleatum, Streptococcus mutans, and Streptococcus oralis. Samples from PEEK are comparable to titanium alloy in many aspects and may be the best choice in some specific treatment situations, which confirmed the null hypothesis. Our observations allowed us to obtain valuable information about the influence of various types of surface treatment on its topography, which can serve as a basis for the development of improved surface properties of materials. The use of PEEK as an alternative to metal is excellent. Therefore, permanent upper jaw obturator with PEEK fixation can be considered as a promising method of treating patients with acquired maxillary defects.

The implementation of the basic principles of digital pedagogy is important for the modernization of educational activities at medical universities. One of the important steps of such modernization is to provide educational programs and disciplines implemented within their framework with a sufficient number of electronic and multimedia textbooks, including the most complex sections. One of such sections of the discipline "Propaedeutics of internal diseases" is lung auscultation. This section contains an extensive theoretical base, which may make it difficult to master this topic with a traditional approach to the educational process. In addition, in order to successfully master this skill, students need to perform independent lung auscultation in patients with various diseases of the respiratory system, which is not always achievable in real educational practice. Both theoretical and practical aspects of this patient examination method can be implemented in appropriate multimedia and electronic manuals, simulators and simulators. Conclusions. The manual "Lung Auscultation" developed at SamSMU can increase the efficiency of assimilation of the material, which will improve the formation of competencies among students, in terms of mastering the most important component of a physical examination of a patient – auscultation and aimed at a full-fledged examination of the patient, conducting a diagnostic search, interpreting the data obtained, making the correct diagnosis and prescribing optimal treatment.