Aging is an irreversible process that proceeds individually in each case. It is known that the matrix metalloproteinase (MMP) system is involved in processes associated with aging. The aim of the study was to investigate changes in the levels of MMPs (MMP-1, MMP-2, MMP-3, MMP-7), their tissue inhibitors (TIMP-1, TIMP-2), and complexes MMP-9/TIMP-1, MMP-9/TIMP-2 involved in vascular wall remodeling in conditionally healthy men of different age groups, taking into account modifiable risk factors (RF) for cardiovascular diseases (CVD). Materials and methods. The study included 151 men: 30 (20%) young adults; 41 (27%) middle-aged; 62 (41%) elderly; and 18 (12%) senile. The levels of MMP-1, -2, -3, -7, -9, TIMP-1, -2, as well as MMP-9/TIMP-1 and MMP-9/TIMP-2 complexes were determined. Concentrations were calculated using calibration curves in a computer program (ng/ml or pg/ml). Additionally, MMP/TIMP ratios were calculated (e.g., MMP-3/TIMP-1, MMP-3/TIMP-2). Results. With age, MMP-1 and MMP-3 predominate in men, while in the elderly group, levels of MMP-9/TIMP-2 complexes are elevated. Smoking and other CVD risk factors significantly increase the levels of MMP-1, -2, -3, and TIMP-1 across all age groups, while in elderly individuals, the formation of MMP-9/TIMP-2 complexes decreases. Levels of MMP-9 and MMP-9/TIMP-2 complexes decrease with age; however, the presence of risk factors, especially smoking, increases these indicators in elderly and senile age groups. TIMP-1 levels change in a wave-like pattern with age, but risk factors and smoking consistently increase them across all groups. Conclusion. The study revealed a correlation between CVD risk factors and MMP levels in conditionally healthy men of different age groups. Multidirectional changes in MMPs and TIMPs were established. The most significant indicators show a decrease in MMP-9 and MMP-9/TIMP-2 levels with age, their increase in the presence of risk factors (especially smoking) in elderly and senile age groups, as well as wave-like dynamics of TIMP-1 with a consistent increase under the influence of risk factors.

Hypoxia is a typical pathologic process, but at present the mechanisms of its profound effect on the organism have not been fully disclosed. Evaluation of serum solid-phase structures in animals under hypoxia may help in understanding the disorders occurring in the body. The multiplicity of pathophysiologic changes in the organism under hypoxia requires the search for effective antihypoxants. The extracts of black currant and medicinal raspberry are promising antihypoxants. The aim of the study was to investigate the morphology of blood serum and the state of homeostasis of rats against the background of acute hypoxia of different genesis with the use of antihypoxants. Object and methods. The study was performed on 480 white mongrel rats. The animals were divided equally into 16 groups. According to group affiliation, animals received intragastrically extracts of black currant, medicinal raspberry, a mixture of these extracts in the ratio of 1:1 and cytochrome C, which was administered intramuscularly, for 15 days. Models of hemic, histotoxic and hypoxic normobaric hypoxia were used. Blood was taken from rats to study the structures of the solid phase of serum by the method of wedge dehydration (formation of dry film - facies) using the diagnostic kit “Lithos-System” with the help of microscope MZ12 “Leica” and video camera “Leica DFC 490” and analyzed digital images. Results. The obtained experimental data indicate pronounced differences in protective-adaptive reactions of the rat organism to acute hypoxia of different genesis, but the introduction of antihypoxants into the organism contributes to the reduction of negative consequences of hypoxia fusion and the highest efficiency is demonstrated by a mixture of extracts of medicinal raspberry and black currant in the ratio 1:1.

Introduction. Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic immune-inflammatory pathologies of the gastrointestinal tract. This study focuses on the role of artificial intelligence (AI) in the morphological diagnosis of IBD, endoscopic visualization, outcome prediction, and patient monitoring. Aim: To summarize data on the application of AI methods in the diagnosis and treatment of IBD, including digital image analysis, remission prediction, inflammation activity evaluation, and the automation of histological and endoscopic assessment processes. Materials and methods. Modern studies on the use of machine learning (ML) and deep learning (DL) technologies in the diagnosis of IBD were analyzed. Special attention was paid to histological image processing methods, neural network algorithms for inflammation staging, and the use of AI for real-time endoscopic visualization. Results. AI technologies provide more accurate and objective determination of histological inflammation activity using Geboes, Nancy, and Robarts indices. Deep neural networks (CNN) enable automatic classification of inflammation stages and the detection of residual inflammation, which is critical for preventing relapses and reducing colorectal cancer risk. Endocytoscopy and real-time visualization algorithms improve the accuracy of early detection of mucosal dysplasia. Neural networks and other ML algorithms demonstrate high sensitivity and specificity in distinguishing CD from UC and assessing histological remission. Conclusion. AI is becoming an integral part of IBD diagnostics, enhancing the accuracy of morphological studies, optimizing endoscopic methods, and reducing error rates. Integrating AI into clinical practice expands treatment possibilities, including personalized approaches and long-term patient monitoring.

Relevance. Modern medicine is closely intertwined with engineering and technology. Robotic surgery is one of the most promising and fastest growing fields in the world. The growth of the global surgical robots market is driven by several factors including aging population, rising income levels, increasing healthcare expenditure, benefits of robotic surgeries, rising incidence of chronic diseases and support from government authorities and advancements in diagnostic technologies. Robots enable complex surgical interventions with minimal invasiveness. At the same time, there are barriers to the development of robotic technology, such as the high cost of robots and procedures, as well as a shortage of qualified specialists. The purpose of study. Evaluate the possibilities of robotic technology application in surgery. Materials and methods. In the course of the present study, we searched and analyzed current literature data from domestic and foreign sources on the application of robotic technologies in surgery. Results. Since the introduction of robotic systems in surgery, such as da Vinci, medical practice has undergone significant changes. Robotic-assisted surgical interventions have been of particular interest and demand in recent times and are gradually being introduced into various fields of modern medicine. Robotic surgical technologies provide higher precision and minimally invasive procedures, which helps to reduce the patient's recovery time and decrease the rate of postoperative complications. One of the main advantages of robotic surgery is the ability to perform complex manipulations with a high degree of precision. Three-dimensional image magnification and stability of the instruments allow the surgeon to better see and control the process, which, in turn, minimizes the risk of damage to healthy tissues and organs. Conclusion. Robotization is currently becoming increasingly widespread in various branches of medicine, including surgery. Modern robotic technologies are used in surgical interventions in limited anatomical areas where vital structures are located, contribute to improved visualization of the operated area, increasing the accuracy of the surgeon's actions and reducing the likelihood of complications.

Uterine fibromyoma is a common benign formation that can complicate the course of pregnancy. Modern approaches to the surgical treatment of this pathology in pregnant women require special attention from the point of view of ethics and safety for both mother and fetus. The relevance of this topic is due to the growing number of pregnant women with fibromyomas, which requires the development of optimal treatment strategies. The aim of the study is to analyze modern methods of surgical intervention for uterine fibromyoma in pregnant women, as well as to assess the ethical aspects and possible risks associated with such interventions. Materials and methods. The authors analyzed the domestic and foreign literature on the surgical treatment of uterine fibromyoma in pregnant women, applied a sociological method and content analysis. The analysis was carried out using data obtained from various sources: medical recommendations, follow-up results and clinical recommendations. Results. It turned out that modern surgical methods, such as laparoscopic myomectomy, are the most effective for the treatment of uterine fibromyoma in pregnant women. They have a minimal number of complications and have a positive effect on the course of pregnancy. Conclusions. Timely diagnosis, an integrated approach to patient management and the use of modern treatment methods, including laparoscopic myomectomy, can minimize risks, improve pregnancy and childbirth outcomes, and improve women's quality of life.

Relevance. This article presents the results of a series of patients who underwent reverse shoulder arthroplasty through a deltopectoral approach without tenotomy or complete cutting of the subscapularis tendon. We believe that the approach we have developed, which allows us to preserve the anatomical attachment of the lower portion of the subscapularis muscle, will reduce the number of complications associated with damage to the area of tendon refixation and reduce the risk of fatty degeneration of the muscle due to early rehabilitation. Aim: improve treatment outcomes in patients after reverse shoulder arthroplasty. Object and methods. In 19 patients, reverse shoulder arthroplasty was performed using a deltopectoral approach with a partial incision of the subscapularis muscle. We cut off 30-50% of the upper part of the tendon, preserving the anatomical attachment of its lower part to the lesser tubercle. Postoperative results were assessed in all patients, X-ray data were studied, range of motion in the joint was measured, subscapularis muscle function was assessed using the lift-off test, joint functionality and pain intensity were analyzed using the ASES and VAS pain scales. Results. Postoperative results were assessed in all patients, X-ray data were studied, range of motion in the joint was measured, subscapularis muscle function was assessed using the lift-off test, joint functionality and pain intensity were analyzed using the ASES and VAS pain scales. Conclusions. deltopectoral approach with partial cutting of the subscapularis tendon provides adequate access to the shoulder joint for installation of a reverse endoprosthesis. Preserving the anatomical attachment of the lower portion of the subscapularis tendon reduces the risk of damage to the refixation zone in the postoperative period and atrophy of the subscapularis muscle.

Musculoskeletal disorders, such as osteoarthritis (OA), impact approximately 250 million individuals, contributing to disabilities among those over 50 years old. OA primarily manifests as pain, leading to functional impairments, fatigue, depression, and reduced muscle strength. The condition of kinesiophobia exacerbates pain and complicates rehabilitation efforts. Therefore, a comprehensive approach is essential, comprising psychotherapeutic treatments and physical therapy to reinforce movement confidence and diminish anxiety. The aim – to assess the clinical effectiveness of the rehabilitation system, "Hardware and Software Multimedia Complex for Remotely Controlled Rehabilitation of Patients using Virtual Reality Technologies 'DEVIRTA,'" in restoring mobility in patients with the pain due to degenerative conditions and residual limb or spine injuries. Object and methods. 62 participants, averaging 63.9±9.4 years old, with 22 males and 40 females, were included and divided into two distinct groups. The first group, consisting of 34 individuals, focused on those with degenerative joint conditions of non-inflammatory origin and injury after-math. The second group comprised patients experiencing reflex musculotonic syndromes due to degenerative spinal ailments (17 individuals) and outcomes of non-complicated lumbar spine compression fractures (11 individuals). The medical rehabilitation agenda included group therapeutic exercise sessions, low-intensity magnetic therapy, magnetic laser therapy, and a motor rehabilitation program utilizing virtual reality technology DEVIRTA-DELPHI. The rehabilitation duration spanned 10 days. Results. Findings reveal that during the second phase of medical rehabilitation incorporating virtual reality, individuals with degenerative conditions and injury-induced limb and spine issues showed a reduction in pain (p < 0.05) and exhibited enhanced lumbar flexibility and faster walking speeds. There was also a notable reduction in kinesiophobia as measured by the Tampa scale (p < 0.05) and an improvement in psycho-emotional well-being (p > 0.05). Conclusion. Conducting rehabilitation using virtual reality technology proves beneficial in alleviating pain and enhancing both functional ability and emotional health in individuals with musculoskeletal disorders. Virtual reality adeptly reduces the severity of kinesiophobia and stabilizes the psycho-emotional state. The DEVIRTA system can be seamlessly integrated into rehabilitation plans for patients dealing with degenerative or injury-related limb and spine conditions.

According to the International Agency for Research on Cancer GLOBOCAN (Cancer Today), breast cancer ranks first in the structure of mortality from cancer among women. In recent decades, there has been a steady trend in the treatment of breast cancer to minimize the volume of radical surgical treatment in order to improve the quality of patients lives and comply with the principles of oncological adequacy. A sentinel lymph node biopsy (SLNB) is an alternative to axillary lymphatic dissection in patients with clinically intact regional lymph nodes (cN0). This allows patients to avoid such formidable and often disabling complications of lymphatic dissection as – prolonged postoperative lymphorrhea and lymphatic swelling of the upper extremity (lymphostasis). Thanks to SLNB in combination with neoadjuvant therapy (NAT), which is most effective in HER2-positive tumors, the number of patients who underwent organ-preservation surgical treatment is steadily increasing. World trends go further and in the range of studies an attempt to abandon the implementation of SLNB has already been made in some groups of patients with early breast cancer. This article analyzes the experience and results of performing a fluorescent signal lymph node biopsy using indocyanine green after effective neoadjuvant polychemotherapy with target therapy in patients with early sporadic HER2-positive breast cancer in the oncology department of Botkin Hospital.

Objective. To study the oncological treatment results of patients with right-sided complicated colorectal cancer. Material and methods. The presented study analyzed the treatment results of 38 patients: with acute intestinal obstruction (23 patients) and peritonitis caused by tumor destruction with its perforation (15 patients). The surgical stage of treatment consisted of performing a right-sided hemicolectomy with the formation of an end-to-side small-colonic anastomosis according to the technique adopted at the department (patent No. 2709253). The frequency of 3- and 5-year survival and the presence of cancer progression were assessed. Results. In acute intestinal obstruction, the 3-year survival rate was 78%, 5-year survival – 43%. In case of tumor perforation with peritonitis, the 3-year survival rate is 53%, while progression was detected in only 20% of patients. Discussion. According to modern literature, in case of tumor disintegration with perforation and peritonitis, the 3-year relapse-free survival rate is from 15% to 42%, in case of acute intestinal obstruction, the 5-year survival rate is up to 42%, and the 3-year survival rate is up to 78%. Our results are consistent with these statistics. Conclusion. Radical surgeries for complicated cancer of the right half of the colon are applicable in practice, and the oncological treatment results correspond to the data published by other clinics.

The aim of the study: to divide a heterogeneous group of patients with chronic heart failure, taking into account the parameters of body composition and severity of painful symptoms. Object and methods. The study involved 298 patients with CHF. The body composition was assessed: the presence of sarcopenia and obesity (with the calculation of the muscle mass index), functional class, left ventricular ejection fraction, markers galectin-3, hsCRP sodium uretic peptide, Bartel index. A 10-point Edmont scale was used to assess the severity of painful symptoms. A two-stage cluster analysis was performed. Results. Three clusters were identified in the patient structure: the share of the first in the overall structure was 23.2%, the second – 61.1%, the third – 15.8%. It was determined that the first cluster includes patients with sarcopenic obesity. They are characterized by the maximum galectin level and ejection fraction in the sample. They have low walking speed, dynamometry, NТ-proBNP. The intermediate position is occupied by patients of the second cluster (patients with isolated body composition disorder or without it). They are characterized by high walking speed, dynamometry indicators, 6-minute walking test value, Barthel index. Patients of the third cluster are people with low body weight and sarcopenia. They have the maximum Sarcopenia Fast questionnaire level with low walking speed, T6W value, dynamometry indicators and significantly reduced ejection fractions and a high NТ-proBNP level. Patients of the first cluster have the most pronounced pain and fatigue with the lowest level of depression. In patients of the second cluster, pain, fatigue, drowsiness, nausea, shortness of breath, anxiety, and well-being are expressed much less than in patients of the other clusters. And patients of the third group have the highest level of drowsiness, nausea, appetite disorders, shortness of breath, depression, anxiety, and deterioration of well-being. Conclusions. The structure and severity of distressing symptoms varies depending on the cluster and, accordingly, the patient's body composition, which can be used in constructing algorithms for providing palliative care to patients with CHF.

Introduction. Venous thromboembolic complications (VTE) include pulmonary embolism (PE) and deep vein thrombosis (DVT) of the lower extremities. Due to high mortality and serious complications, growing diversity and complexity in the treatment of VTE, research into the problems of optimization and experience in making medical decisions remains relevant. Aim. Analysis of existing practices of making medical decisions upon admission of patients with PE to a multidisciplinary hospital, as well as development of recommendations for their optimization. Materials and methods. An analysis of modern Russian and foreign clinical guidelines, literary scientific sources, statistical reports, and data on medical care standards for multidisciplinary medical organizations concerning the organization of diagnostics and treatment of PE was conducted. Results. The conducted analysis allowed to identify the main difficulties in making medical decisions in patients with pulmonary embolism. In the multidisciplinary Clinics of the Samara Medical University, an SOP (standard operating/working procedures) was developed and implemented, which streamlined the distribution of tasks by competence, quality assurance and logical sequence of actions in the treatment of VTE and PE. Discussion. It is essential to ensure multidisciplinary interaction between different specialists, which effectively facilitates adequate assessment of the patient's condition and planning of further treatment. Diagnosis and treatment of VTE should not be the prerogative of one narrow medical specialty. It is necessary to involve a wide range of specialists, including cardiologists, pulmonologists, cardiovascular surgeons, hematologists, neurologists, radiologists, as well as almost the entire spectrum of surgical specialties. Continuous serious attention should be paid to the education and information of medical personnel. Conclusion. Lack of experience, lack of agreed protocols for PE treatment and a well-established multidisciplinary approach to routing in a multidisciplinary hospital can lead to delays in providing effective emergency care. Experience in using modern diagnostic methods, standardized clinical routes and protocols for PE treatment contribute to improving the quality of diagnosis and therapy. However, achieving more effective results requires ongoing training and education of medical personnel, as well as the introduction of systems for regular monitoring and evaluation of treatment outcomes. The problems of optimizing medical decisions in PE require a comprehensive approach, including both organizational changes and improvement of clinical practice, which will help reduce mortality and improve treatment outcomes.

Background. Breast cancer (BC) is the most prevalent malignant neoplasm among women, requiring surgical treatment in early stages. Despite the implementation of breast-conserving surgeries, the prevention of early postoperative wound complications remains a significant challenge, as their development leads to delays in adjuvant treatment, prolonged recovery periods, and deterioration in patients' quality of life. Objective: to optimize the prediction of postoperative complications in breast cancer patients by developing a novel surgical approach and a method for predicting wound complications based on local thermometry and microcirculation assessment. Materials and Methods. This single-center comparative retrospective study included 210 patients with stage 0-IB breast cancer, divided into two groups: the study group (n = 105) who underwent surgery using the developed Z-shaped approach, and the control group (n = 105) who underwent surgery with the standard linear approach. The groups were comparable in age, disease stage, comorbidities, and molecular-biological tumor type. Microcirculation was assessed using the "LAKK-M" laser analyzer, while thermometry was performed using the CG320 thermal imaging hardware-software complex with the "IR MED" program. Pain syndrome was evaluated using the Verbal Rating Scale (VRS) and the Pain Intensity Questionnaire. Results. The Z-shaped approach significantly reduced the incidence of early postoperative complications to 3.8% compared to 27.6% with the classical approach (p < 0.05). The frequency of inflammatory infiltrates in the postoperative wound area in the study group was 1.9% versus 11.4% in the control group (p < 0.05), and the frequency of seromas was 1.9% versus 14.2%, respectively (p < 0.05). ROC analysis showed that microcirculation was the primary predictor of wound complications (AUC = 0.673; 95% CI 0.507-0.710; p = 0.03). At microcirculation values below 15 perfusion units, the sensitivity for inflammatory infiltrate development was 35.7% with a specificity of 92.9%, while for seroma prediction, sensitivity was 71.4% and specificity was 60.2%. Conclusions. The developed Z-shaped approach for breast-conserving surgeries and the method for predicting early postoperative complications based on microcirculation assessment and local thermometry significantly reduce the frequency of early postoperative complications and allow for timely prediction of their development, contributing to optimized treatment of early-stage breast cancer patients.

Relevance. Hernias of the obturator canal are extremely rare in surgical practice. This type occurs in 0.07% to 1% of all known hernias, in which the contents of the pelvic or abdominal organs penetrate through the obturator foramen. The hernias in question occur predominantly in elderly women of low nutrition with a large history of childbirth. This is explained by the peculiarities of the anatomical structure of the female pelvis: its pronounced slope, the larger size of the obturator foramen, the more vertical position of the obturator canal compared to the male, and the weakness of the pelvic floor muscles. Diagnosing an obturator hernia is very difficult. Being difficult to diagnose cases, strangulated hernias of the obturator canal are detected at the treatment stage and are accompanied by high mortality. Mortality for these manifestations ranges from 12% to 70%, with postoperative measurements in 11.6% of cases. These statistics provide the majority of observations provided by reputable Japanese colleagues [3]. Conclusions. Hernias of the obturator foramen, due to their rare occurrence and lack of clear clinical manifestations, are difficult diagnostic cases. Knowledge of the symptoms characteristic of this pathology, the use of computed tomography of the abdominal cavity and pelvis with contrast enhancement is extremely important, influencing the adoption of a reliably correct, quick decision for surgical intervention, largely determining the outcome of the disease. Specific diagnostics for determining obturator foramen hernia are not covered in clinical recommendations. Due to the fact that this clinical pathology is quite complex for a surgeon to quickly determine, it is detected at the stage of complications and is accompanied by high mortality. The leading clinical picture for a strangulated hernia of the obturator foramen is signs of intestinal obstruction. Correctly and timely preoperative diagnosis is crucial for the surgeon to decide on tactics. In the case of a clinical picture of intestinal obstruction, one should act on the basis of national clinical recommendations, not forgetting to manually check the location of the hernia, which will significantly reduce the time for diagnostic searches and reduce postoperative mortality in case of a strangulated hernia of the obturator foramen.

Tuberculosis and sarcoidosis are granulomatous diseases and can cause similar symptoms. In addition, both diseases can affect the lungs, whаt makes difficult to diagnose them differentially. An observation from practice is given: staged surgery of a patient with a combination of sarcoidosis and pulmonary tuberculosis. Patient M., 34 years old, contact with a tuberculosis patient has not been established. A CT scan of the chest organs in January 2021 revealed changes in the lungs. Upon further examination: the sample with the tuberculosis recombinant allergen was negative, Mycobacterium tuberculosis (MBT) was not detected in the sputum analysis. A video-assisted lung biopsy (atypical S2 right lung resection with paratracheal lymphadenectomy) was performed. The morphological picture corresponded to sarcoidosis in the active phase of the process. The primary care pulmonologist prescribed Metipred at a dose of 12 mg. In November 2021, after of decrease in the dosage of Мetipred, the patient noted a severe paroxysmal cough. The patient was examined again :tuberculin skin-test dated 06/14/2022 - papule of 12 mm, sputum analysis from 06/23/2022 revealed MBT DNA with preserved drug sensitivity to all anti-tuberculosis drugs. When sowing on dense nutrient media, growth of MBT was detected. According to the CT scan of the chest dated 08/18/2022, consolidated inflammation in the upper lobe on the right lung, interstitial changes and lymphadenopathy of the intrathoracic lymph nodes (IGLU) were detected. On 10/20/2022 he entered CTRI Federal State Budgetary Budgetary Educational Institution regarding infiltrative tuberculosis of the right operated lung. An individual chemotherapy regimen had been prescribed. He received methylprednisolone 12 mg for 1 month, then the dose was reduced to 8 mg. During the control after 2 months, bacterial excretion stopped, but there was a negative X-ray dynamic as appearance of fresh focal shadows. The dosage of Methylprednisolone has been increased to 12 mg. The control showed positive clinical and radiological dynamics after 4 months. In order of local sanitation and reducion the time of drug treatment resection of the right lung (upper lobectomy and part of the S4 with partial pleurectomy) was performed. DNA of MBT and acid-fast mycobacteria ++ were found in the resection material. Histologically, the phase of mild progression of the tuberculosis process was identificated. In order to reduce оverstretching of the remaining parts of the right lung and reduce the risk of progression of tuberculosis, extrapleural thoracomyoplasty with resection of the I-IV ribs and removal of a group of paratracheal lymph nodes was performed after 1 month. Histological examination of the lymph nodes revealed granulomatosis without necrosis. The dosage of methylprednisolone was reduced to 8 mg 1 month after surgery. With a control CT scan of chest after 3 months, there was a negative X-ray dynamic, despite the ongoing TB therapy according to sensitivity MBT data. The changes were regarded as destabilization of the course of sarcoidosis, which was confirmed by the results of histological examination of lymph nodes and negative microbiological studies on MBT of them. The patient resumed taking meteliprednisolone at a dosage of 12 mg, and underwent an extracorporeal methods course to induce remission of sarcoidosis and potentiate the effect of corticosteroids. After 6 months, there was a positive trend in the form of partial resorption of focal changes. The patient returned to his usual lifestyle.

Brachymetacarpia is a rare congenital malformation (incidence less than 1:1000 of the population), characterized by shortening of one or more metacarpal bones, leading to deficient length of the corresponding hand rays. The pathology is more commonly observed in females. Currently, there are no generally accepted indications for surgical treatment of this pathology and no unified approach to selecting a surgical technique. Objective: To demonstrate, using a clinical case, the possibilities of brachymetacarpia correction with a mini external fixation device (mini-EFD), evaluate the advantages of this method and its results. Materials and methods. A clinical case of an 11-year-old female patient with a 16 mm shortening of the 4th ray of the right hand, pain syndrome, and functional impairments is presented. Surgical treatment was performed using a monolateral mini-EFD, osteotomy of the 4th metacarpal bone, and staged distraction. The results were evaluated using radiography, range of motion measurements, dynamometry, Visual Analog Scale (VAS) for pain, and the DASH questionnaire. Results. The length correction period was 25 days, with 34 days of stabilization in the external fixation device. After removal of the mini-EFD, restoration of the 4th ray length of the right hand and complete ossification of the regenerate were observed. The range of motion in the metacarpophalangeal joint was restored to 90 degrees (initially 70 degrees). The hand grip strength asymmetry was 10% with dominance of the right side (initially 5% with left side dominance). The VAS score decreased from 6 to 1 point, and the DASH score from 64 to 5 points. The patient was completely satisfied with the treatment outcome. Conclusions. Surgical treatment of patients with shortened hand rays is indicated when grasping function is impaired and pain syndrome is present. The use of mini-EFD is an effective method for correcting ray length in brachymetacarpia, providing controlled distraction, regenerate ossification, and precise lengthening. Fixation of osteotomized fragments in the mini-EFD provides sufficient stability for active movements in the hand joints, allowing early rehabilitation and achieving better functional results.

Introduction. Cholecystoduodenal fistula is a rare complication of cholelithiasis and extremely rarely manifests as massive bleeding from the upper gastrointestinal tract. Only 15 similar clinical cases have been described in the world literature. Objective: To present a clinical case of a biliodigestive fistula complicated by upper gastrointestinal bleeding, and to analyze the features of diagnosis and treatment of this pathology. Materials and methods. A clinical case of a 62-year-old patient with cholelithiasis complicated by cholecystoduodenal fistula and massive gastrointestinal bleeding is described. An analysis of literature data with systematization of 15 similar cases was conducted. Results. A patient with a known history of cholelithiasis and biliodigestive fistula developed massive bleeding from the upper gastrointestinal tract with hemorrhagic shock. Endoscopic examinations revealed a fixed hemorrhagic clot and a duodenal bulb ulcer. Despite conservative therapy and endoscopic hemostasis, on the 8th day, rebleeding occurred requiring emergency surgical intervention. Intraoperatively, cholecystoduodenal and cholecystotransverse fistulas with ongoing bleeding were identified. A 2/3 gastric resection with Roux-en-Y reconstruction, cholecystectomy, and right hemicolectomy were performed. Conclusion. Cholecystoduodenal fistula complicated by bleeding requires surgical treatment, as significant bleeding from large arteries is rarely eliminated by conservative treatment or endoscopic hemostasis. The presented case is the 16th in world surgical practice, which emphasizes the need for further study of this pathology and the development of effective treatment methods.

Postradiation epidural fibrosis is one of the rare complications of cancer treatment in patients receiving radiation therapy, leads to a mosaic clinical picture, including manifestations of polyneuropathy, caudogenic intermittent lameness syndrome and can significantly affect the quality of life of patients. Depending on the type of cancer, the volume of the affected tissues and the level of damage to the spine, radiation fibrosis syndrome is characterized by a diverse clinical picture. The main clinical manifestations of post-radiation fibrosis of the spinal canal at the level of the lumbar spine are pain, numbness, paresthesia in the lower extremities. A thorough history and physical examination, combined with the use of neuroimaging data, help establish an accurate diagnosis and select an effective treatment. When studying the problem of post-radiation fibrosis, it is extremely difficult to predict the time, risk group and specificity of characteristic symptoms, given the development of pathology in elderly and senile patients, against the background of existing degenerative changes in the spine. However, there is a close relationship with dosage, anatomical impact, nature of damage and clinical symptoms. Conservative methods of treating post-radiation fibrosis with spinal canal stenosis include the use of analgesic, antiinflammatory therapy. With a prolonged course of pain syndrome, insufficient effectiveness of conservative treatment, local blockades or epidural injections are carried out. In the absence of the effect of conservative treatment, indications for surgical intervention arise.

Atherosclerotic lesion of the extracranial carotid arteries is one of the main causes of ischemic stroke. Computed tomography is a widely available, non-invasive method that allows us to evaluate not only the anatomical features of the brachiocephalic arteries and the degree of stenosis, but also the structure of the plaque. In recent years, there has been increasing evidence of an association of ischemic stroke not only with the degree of stenosis, but also with the presence of plaque vulnerability. Identification of signs of plaque instability using non-invasive diagnostic methods, such as CT angiography, has the potential to evaluate the risk of vascular events, reduce the need for invasive diagnosis, and facilitate timely identification of indications for surgical intervention.

The aim of the study is to evaluate the possibilities of determining the postmortem interval by non-linear programming in conditions of changing ambient temperature. A computer simulation of the cooling of the core of a corpse under conditions of linearly varying ambient temperature was performed and the possibilities of determining the postmortem interval with changes in the ambient temperature regime by non-linear programming were analyzed. It has been established that non-linear programming can be successfully used to determine the postmortem interval in conditions of changing ambient temperature. To do this, the computational algorithm of the method should take into account the ambient temperature recorded during the primary thermometry of the corpse at the place of its discovery as a constant. The obtained approximation estimates, depending on the increasing or decreasing nature of the ambient temperature, represent, respectively, the maximum or minimum limit value of the postmortem interval. The magnitude of the bias of the approximation estimate and the actual time of death can be calculated using the developed regression equations, the implementation of which requires a preliminary determination of the value of the average ambient temperature for the postmortem period estimated by non-linear programming. The proposed adaptation of the non-linear programming method is recommended for expert determination of the postmortem interval in conditions of changing ambient temperature.

The article is devoted to the history of kidney transplantation as a medical technology, covering three key stages: the period of awareness, formation, and establishment. The work thoroughly examines the evolution of understanding kidney function, starting from ancient times, and the development of renal replacement therapies, including dialysis and early transplantation experiments. Special attention is paid to the contributions of scientists and surgeons such as Emerich Ullmann, Alexis Carrel, Yuriy Voronoy, and Joseph Murray in developing surgical techniques and overcoming immunological barriers. Key achievements in organ preservation, tissue immunology, and immunosuppression, which made successful allotransplantations possible, are described. The history of transplantology in Russia is separately highlighted, including the early experiments of V.P. Demikhov and successful clinical operations under the guidance of B.V. Petrovsky. The article emphasizes that modern kidney transplantation is the result of centuries of efforts by numerous researchers whose work laid the foundation for saving thousands of lives.

In the mid-20th century, a high incidence of helminthiasis among the population was recorded in the European North of the USSR (Arkhangelsk Region and Nenets Autonomous Okrug), which served as a trigger for the formation of helminthological squads in 1961 to combat these diseases. The helminthological squads included medical workers, teachers of the Arkhangelsk State Medical Institute and students of this university who expressed a desire to help sick people. The squads were supervised by employees of the regional sanitary and epidemiological station, the activities of the squads were controlled by the head of the biology department of the Arkhangelsk State Medical Institute, Professor Elizaveta Vladimirovna Sorochenkova. The work of helminthological squads has proven its effectiveness, for example, in the village of Nelmin Nos in the Nenets Autonomous Okrug, the incidence of diphyllobothriasis among the population decreased from 44.7% in 1961 to 2.9% in 1986. Not only did the squads have the status of treatment and prevention, they were also engaged in research activities in the parasitological field. Upon completion of the squad's work, students wrote scientific articles on parasitology, spoke at conferences at various levels, and some of them devoted themselves to scientific work in their later lives. The squad movement in the helminthological profile existed for almost 30 years. A significant role in the organization of the squads belongs to Professor E.V. Sorochenkova, who would have turned 110 in 2024. She headed the Department of Biology at the Arkhangelsk State Medical Institute for 25 years (from 1957 to 1982). In 2023, the Department of Biology celebrated its 90th anniversary. The article shows the main stages of the development of E.V. Sorochenkova as a scientist and the development of the Department of Biology of the Arkhangelsk State Medical Institute, without which the organization of helminthological detachments in the European North of the USSR would not have taken place.

Introduction. Prevention of adaptation diseases, particularly distress syndrome, is an urgent task in preventive and industrial medicine. The quality of life of employees is associated with their socio-psychological, psycho-physiological, and functional states. A prolonged state of distress can lead to a breakdown of the body's adaptive mechanisms and the development of chronic diseases. The aim of the study was to identify potentially feasible methods for the prevention of distress among workers in various professions. Materials and methods. A survey was conducted among 54 employees of a large industrial city-forming enterprise using developed questionnaires "Subjective assessment of working conditions" and assessment of the presence and severity of stress symptoms. The presence of symptoms of occupational stress was considered at the physiological, psychological, and social levels. Results. Using Spearman's nonparametric correlation method, relationships were established between the subjective assessment of working conditions by an employee, the severity of stress symptoms, and indicators of quality of life. Direct statistically significant associations were found between the conditions of work activity and physiological, social, and integral indicators of stress. An inverse correlation was found between role functioning due to emotional state and social signs of stress. Direct correlations were established between the "Mental Health" indicator (presence of depression and anxiety) and psychological signs of stress, as well as the integral stress indicator. The results demonstrate that the working environment and factors of the labor process have a significant impact on personnel, provoking the development of stress and a decrease in the quality of life. Conclusion. It seems relevant to continue applied scientific research aimed at developing elements of a promising system for predicting and early prevention of vegetative disorders (adaptation diseases) among employees of large industrial facilities. Such a system should be adapted to the existing structure of production processes and relationships at specific specialized city-forming enterprises.