During pregnancy, it is important to maintain the balance of oxidative metabolism to preserve the health of the mother and the unborn child. Gestation induces the process of production of an increased amount of free radicals, which play a role in the formation and differentiation of the placenta, and the antioxidant link of metabolism compensates the oxidative load in the body, controlling oxidative stress. The prevalence of redox processes over antioxidant defence leads to perinatal complications and increased risk of impaired fetal development and neonatal diseases. Vitamin D, whose additional supplementation prevents pregnancy complications, plays an important role in preserving and increasing the antioxidant capacity of the organism.

The aim of the study was to determine the level of oxidative stress markers and vitamin D in pregnant women with normal and increased body weight, and to determine their relationship.

Object and methods. Vitamin D concentration and the level of thiol status, lipid peroxidation and total antioxidant activity were investigated in 78 pregnant women with normal and overweight and obesity living in Khanty-Mansiysk Autonomous Okrug – Yugra.

Results. Physiological values of thiol status and lipid peroxidation indices and increased indices of total antioxidant activity were found in all groups, and intergroup differences were observed. The most pronounced difference between the groups was found in the index of lipid peroxidation, in pregnant women with obesity is higher compared to pregnant women with normal body weight. Vitamin D concentration is below the required level (30 ng/ml) in all groups. The study established a negative relationship between the level of lipid peroxidation and vitamin D, and a positive relationship between body mass index and lipid peroxidation.

Conclusion. Obesity affects oxidative metabolism, aggravating free radical oxidation, accompanied by an increase in oxidative stress markers. At the same time, the antioxidant defense system is activated, compensating and counteracting excessive ROS production. The relevance of vitamin D deficiency, as well as its antioxidant properties, has been confirmed. For pregnant women living in the northern region, especially in the presence of pre-gestational excess body weight or obesity, it is necessary to develop a set of preventive measures, including additional intake of vitamin D in a dosage that ensures its physiological level.

Relevance. Acute infectious bacterial and viral pneumonias are among the most common acute infectious diseases. In Russia, more than 1.5 million cases of community-acquired pneumonia are registered annually, which makes this pathology one of the leading causes of death from infectious diseases. The development and implementation of innovative rehabilitation methods during treatment and at the posthospital stage is an urgent task of healthcare aimed at reducing labor losses, the level of disability and economic costs.

Materials and methods. A systematic analysis of domestic and foreign literature for 2000-2024, published in leading peer-reviewed scientific journals and indexed in the PubMed, Scopus, Web of Science and RSCI databases, was conducted. The inclusion criteria for publications in the review were: studies of the physiological and pathophysiological aspects of the use of oxygen-helium mixtures (OHM), clinical studies of the effectiveness of OHM in respiratory diseases, data on the epidemiology and contagiousness of bacterial and viral pneumonia.

Objective of the study. Systematization and critical analysis of scientific data on the physiological effects, mechanisms of action and clinical use of oxygen-helium mixtures in the complex therapy and rehabilitation of patients with respiratory diseases, including bacterial and viral pneumonia of varying severity. Development of a conceptual model of complex therapy using heated OHM in inpatient and outpatient settings, as well as an assessment of the effect of this technique on hemodynamics, respiratory function and psychoemotional status of patients.

Results. Based on the analysis of literary data, the key mechanisms of the therapeutic effect of CGS were identified: reduction of airway aerodynamic resistance due to transformation of turbulent flow into laminar flow, improvement of ventilation-perfusion relations, optimization of oxygen transport to tissues and increase in the efficiency of carbon dioxide elimination. Promising areas of clinical application of CGS in various pathologies of the respiratory system were determined: obstructive disorders of the upper and lower respiratory tract, acute respiratory distress syndrome, bronchial asthma, COPD, pneumonia of various etiologies, including those associated with COVID-19. The potential positive effect of CGS on the psychoemotional status of patients was demonstrated, which is especially significant in chronic respiratory diseases.

Conclusions. Oxygen-helium mixtures are a promising method of complex therapy and rehabilitation of patients with respiratory diseases. The unique physical properties of helium provide a multifactorial therapeutic effect, including improved pulmonary ventilation, reduced work of breathing, optimized gas exchange, and prevention of atelectasis. The safety of use, absence of toxic effects and metabolic changes make CGS the method of choice for patients with limited sensitivity to standard pharmacotherapy. The introduction of treatment methods using CGS has high socio-economic significance in the context of increasing incidence of respiratory pathologies.

Relevance. Climate change and its seasonal fluctuations significantly affect the development of the fetus, affecting the morphometric parameters and the weight of the newborn. In the conditions of the temperate continental climate of the Kirov region, climatic factors such as air temperature, daylight hours and solar radiation levels can have a significant impact on the physiological processes in pregnant women and, as a result, on the growth and development of the fetus.

Goal. To identify the relationship between climatic conditions, morphometric parameters of the fetus and the weight of the newborn in the temperate continental climate of the Kirov region.

Object and methods. The study included 1,200 pregnant women without pronounced obstetric and extragenital pathology who underwent at least two ultrasound examinations during pregnancy. The main morphometric parameters of the fetus were evaluated: biparietal size (BPR), frontal-occipital size (LPR), head circumference (OH), abdominal circumference (OH) and femoral length (DBК). Climatic data (average temperature, number of sunny days and length of daylight) for each trimester were obtained based on the climatic characteristics of the Kirov region.

Results. The analysis revealed a positive correlation between the temperature of the first trimester and fetal BPR, as well as between the number of sunny days in the third trimester and fetal coolant. Single-factor analysis of variance showed statistically significant differences in the average weight of newborns between the groups. Regression analysis confirmed that the temperature of the first trimester and the number of sunny days in the third trimester are significant predictors of birth weight, explaining 18% of its variation.

Conclusions. The climatic conditions of the temperate continental climate of the Kirov region have a significant impact on the morphometric parameters of the fetus and the weight of the newborn. Low temperatures and a limited number of sunny days in the first trimester can slow down early fetal growth, especially the development of the bone system. Favorable climatic conditions in the third trimester, including higher temperatures and an abundance of sunlight, contribute to an increase in fetal weight and an improvement in its morphometric parameters. Taking into account seasonal climatic factors in pregnancy management in regions with pronounced seasonality can help optimize perinatal outcomes and develop personalized recommendations for pregnant women.

Variability of anatomy of the vesicular duct is an important aspect in surgical treatment of biliary tract. The classical variant is the fusion of the vesicular duct with the common hepatic duct at an acute angle in the middle third of the hepatic-duodenal ligament to form the common bile duct. However, there are also atypical anatomical variants, which can complicate diagnostics of biliary tract diseases and the operative treatment, especially during the laparoscopic cholecystic surgery. Understanding these variations is the key to reduce the risk of postoperative complications and improve the quality of medical care. Purpose of our work was to study the features of the clinical anatomy of the cystic duct.

Materials and methods. We analyzed domestic and foreign literature on this topic. This study included 350 medical histories of patients hospitalized in the surgical department of the State Autonomous Healthcare Institution "Central City Clinical Hospital No. 18 named after Professor K.Sh. Zyatdinov" in Kazan with the main clinical diagnosis: cholelithiasis, chronic calculous cholecystitis or acute calculous cholecystitis in the period from 2022 to 2024. Results and discussion. In the high variant of confluence, the fusion of the cystic duct with the common hepatic duct was found in 23 patients (88.5%), and the variant of confluence of the cystic duct with the right hepatic duct was found in 3 cases (11.5%). Among 62 cases of low confluence, 55 (89%) had confluence with the common hepatic duct from the lateral side, 5 patients (8%) had a parallel arrangement with the common hepatic duct, and 2 patients (3%) had a spiral course of the cystic duct with confluence with the common hepatic duct from the medial side.

Results and their discussion. The study revealed that in the high variant of the cystic duct entry in 23 patients (88.5% of cases), it merged with the common hepatic duct, and the variant of the cystic duct entering the right hepatic duct was observed in 3 cases (11.5%). Among 62 cases of low fusion, 55 (89%) had an entry into the common hepatic duct from the lateral side, 5 patients (8%) had a parallel location with the common hepatic duct, and 2 patients (3%) had a spiral course of the cystic duct entering the common hepatic duct from the medial side. These data emphasize the importance of taking into account abnormal anatomy to prevent intraoperative complications such as biliary tract injury.

Conclusion. Developmental anomalies of bile ducts in adults are not uncommon pathology, but they usually proceed without specific clinical manifestations. Accumulation of knowledge about the anomalous return of the cystic duct reduces the number of possible intraoperative complications

Introduction. In recent years there has been an frequency increase of endometrial hyperplasia in the structure of gynecological morbidity. Atypical endometrial hyperplasia represents important clinical relevance in the basis of progression to endometrial cancer. There are significant contradictions in the interpretation of endometrial hyperplasia in modern classifications, which are differ from the data provided in ICD-10.

The aim of the study. This review aims to analyze the modern interpretation of endometrial hyperplasia in the concept of tumor progression.

Materials and methods. The analysis of PubMed, Embase, Cochrain databases was performed, and the latest publications on the problem of GE with an emphasis on AGE were studied using the keyword "atypical endometrial hyperplasia".

Results. The study presents a morphological classification of endometrial hyperplasia and shows a modern understanding of the progression of different nosological forms of this pathology. It is noted that endometrial hyperplasia is a clinical and morphological diagnosis based on anamnestic data, complex clinical and instrumental research and competent interpretation of morphological results.

Conclusion. Morphological analysis is the most precise method for diagnosing different types of endometrial hyperplasia, provided that the surgical material is collected correctly. The histological structure and changes at the cellular level are assessed Only on the basis of a comprehensive assessment is a final morphological conclusion made about the nature of the diagnosed pathological process. Perfect interpretation of histological material requires a highly qualified morphologist, as well as the availability of modern laboratory equipment. 

There is a truly unique anatomical structure in the human body that connects the two articular surfaces of the pubic bones of the pelvis. This is the pubic symphysis. When analyzing the modern scientific literature, it becomes obvious that there is a whole large trend devoted to determining the "morphofunctional norm" for a specific age period of human life using lifetime imaging techniques. The aim of the study was to determine the height, width, thickness, and X-ray density of the pubic symphysis in men and women in the second period of adulthood using computed tomography (CT) imaging techniques.

Object and methods. The work is based on the results of CT examination of 31 men from 36 to 60 years old and 25 women from 36 to 55 years old with normal pelvic dimensions without pathology of its bones and ligaments, as well as pelvic organs Each of them obtained consent for the study, which was performed as indicated to exclude possible pathology of pelvic bones. The CT study consisted of determining the width, height, and thickness of the pubic symphysis, as well as determining the X-ray density in its upper and lower sections.

Results. Comparative analysis of the data reveals a tendency to predominance of the parameters of width, thickness and X-ray density in the upper part of the pubic symphysis in the sample of male subjects (p > 0.05). The parameters of X-ray density in the lower parts of pubic symphysis have insignificant prevalence in the sample of female subjects (p > 0,05). At the same time, the indices of pubic symphysis height are practically equal in both sexes.

Conclusion. The obtained results of lifetime analysis of height, width, thickness of pubic symphysis and X-ray density in its upper and lower parts in individuals of both sexes in the second period of adulthood expand scientific ideas about its structure, allowing to reproduce specific characteristics of its age-sex norms. 

Actuality. Surgery for patients with pulmonary tuberculosis should be accompanied by a complex of rehabilitation measures with an algorithm for the formation of rehabilitation programs depending of the patients functional state and of volume of surgical intervention.

Aim: to study the effectiveness of rehabilitation measures depending on the degree of functional impairments considering the volume of surgical interventions in patients operated on for advanced destructive pulmonary tuberculosis.

Object and methods. The study included 109 patients who were divided into 4 groups: group 1 – with lung resections and segmentectomies (73 people), group 2 – with bilateral staged atypical lung resections in combination with unilateral delayed thoracoplasty (14 people), group 3 – with lobectomies and bisegmentectomies (13 people),  group 4 – with pneumonectomies (9 people). A rehabilitation program was compiled for each observed group. The effectiveness of rehabilitation measures was assessed by spirometry, oxygen saturation, goniometry, visual analog pain scale (VAS), Borg CR10 scale, mMRC dyspnea scale.

Results. In each study group, changes in lung function indicators were observed, in groups 1-3, the indicators of VC; FEV1; FEV1/VC — the Index Tiffeneau (IT) changed, in group 4, significant changes were only from IT. The severity of shortness of breath on the mMRC scale and the severity of perceived stress on the Borg CR10 scale decreased in each group. The intensity of the pain syndrome decreased in each study group according to VAS.

Conclusion. Rehabilitation of patients who have undergone surgery of pulmonary tuberculosis in a specialized sanatorium becomes more effective and achieving positive recovery results with the use of rehabilitation programs, depending on the severity of functional disorders of patients and different volumes of surgical intervention. 

Relevance. Recurrent patellar dislocation is a frequent consequence of knee ligament injuries, especially in children and adolescents. Repeated dislocations cause joint instability, which entails the development of degenerative-dystrophic changes and a significant deterioration in the patient's quality of life. Despite the rarity of congenital patellar dislocation (0.45–1%), it is of particular clinical significance due to severe functional impairment.

Objective: to summarize modern approaches to diagnosis, classification and treatment of congenital and posttraumatic patellar dislocation in children and adolescents with an emphasis on surgical methods, their modifications and clinical efficacy.

Materials and methods. The literature and clinical cases were analyzed, including the experience of leading Russian clinics and original treatment methods (for example, the Gafarov and Akhtyamova method using an external fixation device, the Krogius-Volkov-Friedland operation). The article considers pathogenetic mechanisms of patellar dislocation, including anatomical and biomechanical changes, as well as features of congenital pathology.

Results. Differentiated approaches to treatment depending on the degree of dislocation and severity of anatomical changes are presented. A clinical case of successful treatment of a patient with Down syndrome is described. The results of conservative therapy and surgical intervention in children are compared. The high efficiency of early arthroscopy and lateral release with Yamamoto suture application in patients with connective tissue dysplasia is emphasized. Modern low-traumatic techniques are described, including arthroscopic fixation of the medial patellofemoral ligament using anchor sutures.

Conclusions. The choice of treatment tactics requires an individual approach based on the clinical picture, anatomical features and severity of pathology. In congenital forms, surgical treatment using combined techniques is mainly indicated. Early surgical intervention in children with signs of dysplasia allows to reduce the risk of relapses and improve remote functional results. Arthroscopic techniques are less traumatic and provide good clinical outcomes with proper diagnostics and technique.

Relevance. Almost 450 new cases of renal cell carcinoma and almost 160 deaths from cancer are detected annually. Of particular interest to patients with metastatic renal cell carcinoma who often undergo radical nephrectomy prior to the appointment of combined immunotherapy is the assessment of further renal damage that occurs while taking tyrosine kinase inhibitors and immune checkpoint blockers.

Objective: to compare renal damage in patients with metastatic RCC with a single kidney taking two drug therapy regimens: ipilimumab + nivolumab and pembrolizumab + axitinib.

Object and methods. A retrospective study included 100 patients (73% men and 27% women) with metastatic renal cell carcinoma of the unfavorable prognosis group who had previously undergone unilateral radical nephrectomy for the underlying disease.  50 patients received ipilimumab + nivolubab combined immunotherapy, while 50 patients received pembrolizumab + axitinib. In these groups, CKD was observed in 83.0% and 77.3% of patients, respectively (80.2% of the total sample). Patients receiving pembrolizumab + axitinib were slightly older (median 63.0 years and 57.0 years, p = 0.019).Damage to a single kidney was assessed during 28-36 weeks of combination therapy, which corresponded to 12 drug injections in each group.

Results. Acute renal injury (AKI) after the 1st administration of ipilimumab + nivolumab was observed in 10%, while after the 1st administration of pembrolizumao + axitinib - in 11% (p = 1,000). The maximum difference in AKI between the studied groups was noted after the 10th administration: AKI occurred in 25% and 6% of cases in the groups of patients receiving ipilimumab + nivolumab and pembrolizumab + axitinib, respectively, but the differences were also statistically insignificant (p = 0.513). Despite the older age of patients receiving pembrolizumab + axitinib, the average creatinine in the ipilimumab + nivolumab group was  43.0 mmol/L higher than in patients in the pembrolizumab + axitinib group (p < 0.001). Over the entire duration of therapy, urea in the ipilimumab + nivolumab group was 1.7 mmol/L higher (p = 0.010) than in the pembrolizumab + axitinib group with initially comparable parameters. The maximum difference in urea between the groups was observed after the 5th and 12th administration of the drugs, amounting to 2.6 mmol/l and 2.7 mmol/l, respectively (p = 0.009 and p = 0.032, respectively).

Conclusion. Combined immunotherapy with ipilimumab + nivolumab in patients with metastatic RCC in patients with a single kidney has a more pronounced deterioration in renal function compared with combined immunotherapy with pembrolizumab + axitinib. 

Relevance. The incidence of hypersensitivity pneumonitis (HSP) is 1.64–2.21 cases per 100,000 population per year. The combination of HSP and cardiovascular diseases (CVD) leads to mutual aggravation of the course of pathologies, changes in the clinical picture and worsening of the prognosis. Accumulation of knowledge about the mechanisms of mutual influence of HSP and CVD is important for optimization of treatment and diagnostic approaches. Objective: to study the factors influencing the prognosis of hypersensitivity pneumonitis in patients associated with cardiovascular diseases.

Object and methods. A retrospective analysis of the database of 228 patients with HSP was performed. The main group consisted of 152 patients with HSP in combination with CVD, the comparison group - 76 patients without CVD. In the main group, the following subgroups were identified: with arterial hypertension (55 people), with ischemic heart disease (40 people), with atrial fibrillation (34 people) and with chronic heart failure (23 people). A comprehensive analysis of clinical symptoms, spirography results, diffusing capacity of the lungs (DLCO), computed tomography, echocardiography, vascular stiffness indices and the severity of comorbidity according to the Charlson index was performed.

Results. The Charlson index indices were significantly higher in patients with HPP and CVD (from 2.3 to 6.9 points in different subgroups) compared to the group without CVD (1.02 points). All patients showed a statistically significant correlation of the Charlson index with age, systolic pressure in the pulmonary artery, fibrosis area according to the Warrick scale, FVC indices and diffusing capacity of the lungs. In patients with CVD, additional predictors of an increase in the Charlson index were vascular stiffness parameters (aortic pulse wave velocity, reflected wave propagation time) and structural heart parameters (thickness of the posterior wall and interventricular septum of the left ventricle, left ventricular myocardial mass). The most pronounced mutual aggravation was found in the subgroup of patients with HPP and chronic heart failure.

Conclusion. The combination of hypersensitivity pneumonitis with cardiovascular diseases significantly aggravates the course of both pathologies. Early detection of risk factors and assessment of concomitant conditions using the Charlson index allows optimizing the diagnosis and treatment of this category of patients. Particular attention should be paid to older patients with signs of pulmonary hypertension, fibrotic changes in the lungs and decreased diffusion capacity of the lungs. 

Aim of the study: to conduct a systematic review of the literature on the evaluation of implant survival outcomes after total ankle arthroplasty, the number of revision surgeries.

Materials and methods. The search for scientific articles was conducted by two independent researchers in the Elibrary, Pubmed, Research Gate, and Google Academy databases in two languages: Russian and English. The search depth was 5 years. A total of 247 publications were analyzed, including: Pubmed: – 52; Research Gate – 100; Google Academy – 66, Elibrary – 29. After the final selection, 6 scientific papers were included in the study, of which 2 were national registries, 3 were retrospective and 1 was a prospective cohort study.

Results. The average survival rate of ankle endoprostheses in the early postoperative period (1–2 years) is close to 100%, in the medium term (5-7 years) the implant survival rate is at the level of 90%, the 10-year survival rate of endoprostheses has values from 77% to 87.5%. The average value of the revision surgery rate over 19 years is 12.9%.

Conclusion. The service life of ankle joint endoprostheses is close to 100% during the first 2 years. However, in the long term, the implant survival rate is in the range of 77%-87.5%. The reasons leading to the need for revision interventions have not been fully studied. According to the authors, unresolved axial deformations during ankle joint endoprosthetics directly affect the survival of the implants. Of course, additional research is needed to understand this issue in more detail.

Relevance. Cholelithiasis is a multifactorial disease, which is characterized by the formation of concretions in the gallbladder. Currently, cholelithiasis is one of the most common diseases in the practice of a general practitioner, gastroenterologist, surgeon. The study and identification among the population of the factors of development of this pathology contributes to earlier diagnosis, treatment of gallstone disease, prevention.

The aim of the study is to improve the results of diagnostics and treatment of patients with GI by revealing the risk factors of development and allocation of risk groups for this pathology. Materials and methods: review of modern foreign and domestic literature on modifiable and non-modifiable risk factors of cholelithiasis, their participation in pathogenesis.

Results. Among modifiable development factors the most important for the development of cholelithiasis the following should be emphasized: excessive body weight, forced weight loss, low physical activity, bad habits, hormone therapy.

Conclusions. The most significant risk factors for the development of cholelithiasis have been identified. Special attention was paid to the consideration of hypodynamia, obesity, bad habits, drugs, neuroendocrine dysfunction on the probability of GI. An association between various diseases (type 2 diabetes mellitus, hypothyroidism, nonalcoholic fatty liver disease, Crohn's disease) and the presence of concrements in the gallbladder has been found. It is established that various risk factors can influence on pathogenesis of cholelithiasis that is reflected on clinical picture of the disease depending on their specificity and influence on the organism.

Chronic heart failure (CHF) is a condition in which the heart cannot provide sufficient blood supply to the body. This disease requires constant monitoring and treatment. The purpose of this article was to analyze scientific publications on the effectiveness and safety of using telemedicine consultations in monitoring patients with chronic heart failure. The article highlights the benefits of telemedicine monitoring for patients with CHF, describes new methods and approaches used in telemedicine monitoring in this group of patients, including the use of modern technologies and innovative solutions.

Conclusions. Telemedicine interventions undoubtedly benefit patients with CHF, reducing the number of hospitalizations for all reasons and improving quality of life, although there are still a number of issues that need to be addressed. The authors believe that other aspects should also be considered, since telemedicine is not the only component of CHF treatment and cannot replace face-to-face consultations. 

Relevance. Atherogenic dyslipidemia is a key factor in the development of atherosclerotic cardiovascular diseases, which for many years remain the leading cause of mortality worldwide. Cardiovascular mortality can be reduced and prevented by correcting modifiable risk factors, in particular by eliminating hypercholesterolemia.

Purpose of the study. To evaluate treatment adherence, side effects and negative events of triple cholesterol-lowering therapy.

Materials and methods. Alirocumab therapy at a dose of 150 mg/ml once every 2 weeks for 3 months was performed in 103 patients living in the Moscow region with atherogenic dyslipidemia. All patients had a high or very high cardiovascular risk group. Before starting alirocumab therapy, patients received monotherapy with atorvastatin at a dose of 40–80 mg or combination therapy with atorvastatin in combination with ezetimibe or fenofibrate.

Results. A decrease in total cholesterol and LDL cholesterol with additional alirocumab therapy was observed in all 103 patients. No exacerbations of coronary heart disease, new cases of acute cerebrovascular accident and transient ischemic attacks were registered. No negative dynamics in the glycemic profile of patients with type 2 diabetes mellitus was revealed. The treatment was not accompanied by obvious adverse reactions and complications.

Conclusion. A three-month course of triple lipid-lowering therapy was characterized by high patient adherence to treatment, good tolerance and no complications. Combined lipid-lowering therapy contributed to the clinical stabilization of coronary heart disease, did not have a negative impact on the course of diabetes mellitus, and was not accompanied by adverse reactions. 

Relevance. The problem of standardization of foot bone lesions and regeneration of bone structures in diabetic foot syndrome has currently acquired particular relevance due to the complexity of the mechanisms of occurrence of this pathology, extended zones of lesions and resistance to the use of traditional methods of treatment.

The aim of the study. Standardization and optimization of surgical care for patients with destructive form of diabetic neuroosteoarthropathy.

Materials and methods. The work summarized and presented classifications of bone structure lesions, taking into account the convenience of their use in practical surgery. An original approach to solving one of the urgent problems of modern surgery, concerning the treatment of pathological processes in the bone elements of the feet in patients with diabetic foot syndrome, was proposed and implemented.

Conclusions. 1. The developed approach to the reconstruction of bone elements of the foot ensures an increase in the efficiency of regenerative processes of bone structures. 2. The introduction of this technique significantly reduces the rehabilitation period for patients with restoration of the supporting function of the lower extremities due to targeted surgical intervention in the area of affected tissues. 

Relevance. Dysbaric osteonecrosis is a pathology of the skeletal bones that develops against the background of decompression disorders in divers, submariners, divers and caisson workers. The highest frequency of this pathology is observed in divers-fishermen (50–77%); in commercial divers it is 16–55%, in caisson workers – 25–35%, and in military divers this figure is significantly lower – 2–5%. The main pathogenetic causes of the development of dysbaric osteonecrosis are gas embolism of blood vessels of the microcirculatory bed by bubbles of free gas (nitrogen), as well as mechanical damage to the endothelium of capillaries and bone marrow, which leads to their inflammation, edema, hypercoagulation and compartment syndrome. This causes a violation of intraosseous blood flow, the development of ischemia and the initiation of necrotic processes in bone tissues.

Materials and methods. The studies were conducted on high-field magnetic resonance tomographs with a magnetic field induction of 1.5 T "Ingenia" (Philips) and "Magnetom Symphony" (Siemens) according to standard protocols with obtaining T1, T2 and PD-weighted images, as well as images using the effect of signal suppression from fat tissue (FS). MRI scanning was performed of the most frequently affected, according to literary sources, anatomical areas – shoulder, hip and knee joints, covering the parts of the diaphyses adjacent to the joints. The localization, distribution and type of specific pathological changes characteristic of dysbaric osteonecrosis were assessed. A total of 54 divers were examined, who were divided into 3 groups: 1) divers performing deep-sea diving descents of more than 60 m. (having additional diving qualifications of deep-sea diver and aquanaut); 2) divers performing diving descents up to 60 m; 3) divers performing diving descents in normobaric conditions (having an additional diving qualification of hydronaut).

Results. The conducted MRI studies have shown that dysbaric osteonecrosis most often affects deep-sea divers and aquanauts, and the presence of episodes of acute decompression sickness in the anamnesis increases the risk of its occurrence. The published data on the predominant localization of lesions: in the head of the humerus, metaepiphyses and diaphysis of the femur have also been confirmed.

Conclusion. Based on the results of the study, it can be stated that regular MRI monitoring of the skeletal bones is indicated for divers at risk (performing deep-sea diving descents and having episodes of acute decompression sickness in the anamnesis). 

The article presents a comparison of tick-borne encephalitis incidence in Russia and European countries. The analysis of tick-borne encephalitis incidence over a five-year period (2018-2022) revealed that it is higher in Russia than in European countries. The increase in tickborne viral encephalitis incidence is explained by climate change, incomplete vaccination coverage of the population, migration of the virus from the wild to the immediate environment of humans, and an increase in the number of ticks. The article examines the incidence of tick-borne encephalitis based on a sample of scientific data from PUBMED, Elibrary, Google Scholar, epidemiological reports of the European Center for Disease Prevention and Control, state reports "On the state of sanitary and epidemiological well-being of the population in the Russian Federation" in the period from 2018 to 2022. 3 articles from a sample of 2402 articles were analyzed.

Cardiovascular toxicity is one of the most common complications of chemotherapeutic treatment. The most common method for diagnosing cardiovascular toxicity is to assess the structure and function of the left ventricle.

The aim of the study was to investigate structural and functional changes in the myocardium of the left ventricle and left atrium in patients with acute myeloid leukemia during chemotherapeutic treatment.

Materials and methods: the study included 110 patients with newly diagnosed acute myeloid leukemia who were prescribed polychemotherapy with anthracycline drugs. The parameters of the structure and function of the left ventricle were assessed based on transthoracic echocardiography using the specle-tracking technique and determination of the global longitudinal deformation of the left ventricle.

Results. In patients with acute myeloid leukemia and verified cardiovascular toxicity, significant changes in the size (EDR, SSR) and volume of the left ventricle (EDV, ESV) were detected. Impaired systolic function was manifested by a decrease in the left ventricular ejection fraction and relative global longitudinal deformation, with a decrease in LV GLS preceding a decrease in LV EF. Diastolic dysfunction in patients with identified cardiovascular complications of anthracycline-containing polychemotherapy was manifested by a decrease in the E/A ratio, e' septal, e' lateral.

Conclusions: In patients with acute myeloid leukemia receiving anthracycline-containing polychemotherapy, structural and functional changes in the left ventricular myocardium are detected, consisting in an increase in the size and volume of the left ventricle, as well as in the occurrence of systolic and diastolic dysfunction. A reliable sign of cardiovascular toxicity is a decrease in the global longitudinal deformation of the left ventricle. 

Sarcoidosis and pulmonary tuberculosis are the most common granulomatous diseases affecting lung tissue. At the same time, these nosologies have completely different treatment methods, which requires timely and correct assessment of the patient's condition and the establishment of a correct diagnosis. A practical observation is given showing the long-term course of the tuberculous process under the guise of pulmonary sarcoidosis. Patient C, 37 years old, has not had contact with tuberculosis patients. Changes in the lungs were detected in 2020, due to which further investigation and ruling out of the diagnosis of tuberculosis. Fibrobronchoscopy with the MBT complex did not detect any mycobacteria. The cytological picture was regarded as granulomatous inflammation without specificity. In this case, the patient was diagnosed with sarcoid of the lungs in an active phase.Metipred 32 mg per day for one year was prescribed.. Since November 2021, he noted deterioration in his condition and a negative trend, in the form of increased focal infiltrative changes on both lungs on CT on 10/06/22. During bronchoscopy, MBT DNA was detected and MBT growth in the crop was detected. Applied to the FGBI "CTRI" where resistance to HR was established and appropriate TB therapy was implemented. After 4 months of treatment positive clinical and radiological changes were noted. 

Objective. To present the clinical and pathomorphological analysis of a rare case of adenomatoid tumor of the epididymis with a description of the diagnostic and morphological characteristics of this neoplasm.

Materials and methods. A comprehensive examination was conducted on a 41-year-old patient with a painless mass in the left half of the scrotum, including clinical examination, ultrasound, magnetic resonance imaging, biochemical blood analysis for tumor markers, and histopathological examination of the surgical specimen using routine (hematoxylin and eosin staining) and immunohistochemical methods (detection of pancytokeratin AE1/AE3, calretinin, CD31, and D2-40 expression).

Results. A solid yellowish mass, 2 cm in diameter, originating from the head of the left epididymis was found in the patient. Histologically, the tumor was represented by chains of cells, clusters, trabeculae, and gland-like structures formed by large cells with epithelioid morphology. Immunohistochemical examination revealed pronounced cytoplasmic coexpression of pancytokeratin AE1/AE3 and calretinin, absence of CD31 expression, and positive membrane reaction to D2-40 (podoplanin), confirming the mesothelial origin of the tumor.

Conclusion. Adenomatoid tumor of the epididymis is a rare benign tumor of mesothelial origin that cannot be accurately verified by clinical, instrumental, and laboratory data alone. Pathomorphological examination with mandatory immunohistochemical analysis is crucial for diagnosis, allowing the establishment of the mesothelial histogenesis of the tumor. Surgical treatment with excision of the tumor node within healthy tissue margins is an adequate and sufficient method of therapy, leading to complete recovery. 

Introduction. Historically, HIV-infected patients were denied liver transplantation due to concerns about poorer outcomes compared to the non-infected population. Due to advances in antiretroviral therapy and improved understanding of the immunological status of these patients, transplantation has become a viable treatment option.

Case Description. This report describes a 56-year-old HIV-positive man with multiple comorbidities who underwent liver transplantation for end-stage liver disease due to chronic hepatitis B. The early post-transplantation period was complicated by severe sepsis, multiple organ failure, and graft dysfunction.

Treatment Methods. Comprehensive therapy included prolonged vasopressor support, renal replacement therapy, multiple blood transfusions, and targeted antimicrobial therapy.

Results. The patient was successfully treated and discharged in stable condition with a functioning graft.

Conclusion. This case demonstrates that even severe infectious complications after liver transplantation in polymorbid HIV-positive patients can be successfully treated with appropriate multidisciplinary intensive care.

Proper cooling of donor liver is critical for transplantation, as it extends organ viability and minimizes tissue damage. Our mathematical model, although simplified, revealed that standard cooling methods do not provide uniformity: cooling rates of different liver regions vary significantly. This creates a risk of temperature gradient within the organ and uneven ischemic tissue damage. The results emphasize the need to improve cooling techniques to ensure more uniform temperature distribution in the donor organ.

Objective. Development of a mathematical model to optimize donor liver cooling and minimize the risk of ischemia-reperfusion injury.

Materials and methods. For modeling the liver cooling process, the Navier-Stokes equation system was used, accounting for porous media and heat transfer parameters. The calculations employed a standard cooling method with coolant delivery through the hepatic artery at constant pressure and temperature. The study was performed using the PHOENICS software package, which provided dynamic data on coolant flow velocity, pressure distribution, temperature, and temperature gradients within the liver over time. The model considers the anatomical features of the liver and the main characteristics of the vascular network.

Results. Numerical modeling showed that liver cooling occurs unevenly. Segments located closer to the coolant inlet cool first, while distant segments reach optimal temperature significantly later. The temperature difference between various segments during cooling reaches critical values, which may lead to heterogeneous ischemic damage. Complete cooling of the organ in the proposed model occurs within 720 seconds, with significant temperature gradients observed between central and peripheral areas of the liver throughout most of the cooling process.

Conclusions. Existing liver cooling methods require optimization to ensure uniform temperature distribution across all segments. A modification of the technique using variable coolant supply pressure and multipoint perfusion is proposed. The resulting mathematical model can be used to develop improved cooling methods for donor organs, which will enhance their preservation, reduce the risk of ischemiareperfusion injury, and improve transplantation outcomes. Further development of the model involves accounting for more detailed anatomical features and physiological parameters of the liver.

Background. Cerebral palsy is the leading cause of primary disability among neurological diseases in the Russian Federation, according to the Federal Bureau of Medical and Social Expertise of the Ministry of Labor of Russia. Resting-state functional MRI (rs-fMRI) is a modern neuroimaging technique that allows identification of functional changes in the brain connectome of children with cerebral palsy and tracking their reorganization during neurorehabilitation. This is critically important for developing effective treatment strategies and medical-social rehabilitation programs.

Objective. To evaluate the potential of resting-state functional MRI as a tool for analyzing the therapeutic efficacy of neurorehabilitation interventions using the specialized "Reforma-TЭKT" suit.

Object and methods. The study was performed using a 1.5 Tesla MR scanner. Changes in the functional connectivity of resting-state brain networks were analyzed in 30 patients with cerebral palsy before and after rehabilitation with the "Reforma-TЭKT" neurorehabilitation suit.

Results. Intergroup statistical analysis revealed significant differences (p < 0.05) in the functional connectivity of the default mode network in all 30 cerebral palsy patients compared to the control group. Dynamic assessment showed increased functional connectivity between the medial prefrontal cortex, lingual working network (left inferior frontal gyrus), right frontoparietal cortex, and right middle frontal gyrus. Simultaneously, decreased connectivity with components of the attention network was observed.

Conclusion. The use of resting-state functional MRI in patients with cerebral palsy enables detection of changes in the brain connectome. With correct methodological approach, this neuroimaging technology can serve as an objective tool for monitoring therapeutic efficacy. The results obtained in this study contribute to improving rehabilitation strategies for patients undergoing treatment for the consequences of perinatal central nervous system damage.

Rationale. Right ventricular dysfunction plays an important role in the course of chronic heart failure and its outcomes. Right ventricular systolic function is closely related to afterload; therefore, it is important to assess right ventricular-arterial coupling.

Objective. To determine the values of right ventricular-arterial coupling (RVAC) parameters during transthoracic echocardiography in healthy subjects and in patients with chronic heart failure and pulmonary hypertension.

Material and methods. 41 patients with chronic heart failure due to coronary heart disease or dilated cardiomyopathy with signs of PH were examined. The average age of the patients was 69.2 ± 10.1 years; 12 women (29%), 29 men (71%). In 27 of patients with CHF and PH (65.9%), the left ventricular ejection fraction (LVEF) was within normal limits. Echocardiographic examination assessed various parameters of RVAC, such as the ratios of TAPSE (tricuspid annular plane systolic excursion), peak systolic tissue velocity of the lateral tricuspid annulus (S′), RVFAC (fractional area change), RVGLS, and RVFWLS to pulmonary artery systolic pressure (PASP).

Results. In patients with chronic heart failure and pulmonary hypertension, all measures of RVAC were significantly different from the control group  (P < 0.0001), regardless of the left ventricular ejection fraction value. All the indicators of RVAC demonstrated high sensitivity and specificity in relation to RV-arterial uncoupling. In the control group, there was a decrease in RVAC rates in older individuals. The most diagnostic accuracy among RVAC parameters was demonstrated by RVGLS/PASP and RVFWLS/PASP.

Conclusions. Application of RVAC parameters in the RV function assessment increases the detection of RV-arterial uncoupling in chronic heart failure and pulmonary hypertension. 

The history of medicine is written not only by bright events in the medical field, new discoveries and innovations, but also by the people who create these events. One of the worthy representatives of the medical field of activity is Ivan Vasilyevich Krivonogov. Covering the history of his life and work during the existence of the Russian Empire is a pressing task against the background of the emergence of new, previously unknown facts of the doctor's biography. The purpose of this study was to clarify some facts from the life of Doctor of Medicine Ivan Vasilyevich Krivonogov, to search for previously unknown biographical data. The methodological basis of the study was a systematic approach based on the principles of historicism, objectivity and scientificity, as well as general scientific methods (generalization, analysis, synthesis, induction). The materials for the study were documents from the State Archives of the Arkhangelsk Region, newspaper articles, book publications, documents of the electronic library of the State Public Historical Library, scientific articles, etc. Ivan Vasilyevich came from a merchant family, his father traded in consumer goods in Arkhangelsk. He successfully graduated from the Imperial Military Medical Academy in St. Petersburg in 1891, after which he devoted his entire life to medicine. In 1896, physician Krivonogov defended his dissertation, becoming a doctor of medicine. From 1896, he worked as a junior and then senior physician of the Special White Sea Department of the Border Guard, and lived in Arkhangelsk. During the Russo-Japanese War, he was a physician, and then the head of the hospital for the reception of the wounded and sick from the Far East, created in response to a request for help from the Grand Duchesses Maria Pavlovna and Ksenia Alexandrovna. He was one of the founders of the Arkhangelsk Society for the Study of the Russian North (1908), and a co-founder of the Arkhangelsk Photographic Society (1909). Ivan Vasilyevich headed the Society of Arkhangelsk Physicians from 1913 and was in charge of the society's hospital. On December 10 (23), 1913, in the byelections, Krivonogov I. V. was elected to the IV State Duma from the first and second congresses of city voters, where he joined the progressive faction. Undoubtedly, the presented data significantly supplement the biography of the doctor known to date, who became part of the history of medicine and whose memory should be honored by his grateful descendants. 

Relevance. The ideas about the mechanisms of stroke development have changed over the centuries, being influenced not only by the level of technology, but also by the scientific and philosophical thought of the corresponding era.

Objective of the study: to analyze the evolution of ideas about the causes, methods of diagnosis and treatment of ischemic stroke from the Ancient World to the present day.

Materials and Methods. A historical analysis of medical literature, scientific works and clinical practice of different eras associated with the study and treatment of stroke was carried out.

Results. The transformation of the concept of ischemic stroke from the ancient Greek "apoplexy" to the modern understanding of the pathophysiology of cerebral ischemia is traced. Two main historical periods in the study of stroke are distinguished, separated by the discoveries of European scientists of the 19th century. The evolution of diagnostic methods from clinical observation to modern neuroimaging technologies, as well as the development of therapeutic approaches from symptomatic treatment to reperfusion therapy and the organization of specialized care are described.

Conclusions. Knowledge of the historical path of development of ideas about ischemic stroke allows us to understand modern approaches to its diagnosis and treatment, to evaluate the contribution of outstanding researchers and the role of scientific and technological progress in improving care for patients with cerebrovascular pathology.

Research objective: to conduct a comprehensive analysis of Alexis Carrel's (1873–1944) scientific contribution to the development of transplantology and tissue engineering, as well as to investigate his philosophical and social views in the context of the historical epoch of the first half of the 20th century.

Tasks: to study in detail Carrel's main scientific achievements in medicine, including the development of the arteriovenous anastomosis method and the creation of an extracorporeal perfusion apparatus. To investigate the controversial aspects of his activities and views, including his attitude towards eugenics.

Materials and methods. The study is based on the analysis of Carrel's scientific publications, his book "Man, the Unknown," biographical materials, and historical sources from the first half of the 20th century. Methods of historical analysis, comparative research, and contextual analysis are applied. Archival materials from the Rockefeller Institute for Medical Research and other scientific institutions associated with Carrel's activities are used.

Discussion. The article examines the significance of Carrel's scientific discoveries for the development of transplantology. Special attention is given to his work on the arteriovenous anastomosis method, the creation of an extracorporeal perfusion apparatus, and the development of tissue cultivation methods outside the organism. The influence of these achievements on modern organ transplantation protocols is analyzed. Carrel's philosophical and social ideas, as expressed in "Man, the Unknown," are considered in the context of the eugenics movement of the early 20^th century. His critique of Western civilization and proposals for "improving" human nature are discussed. A parallel is drawn between Carrel's views and general trends in science and society of that time. The contradictory nature of Carrel's personality as an outstanding scientist and thinker with ambiguous social views is analyzed. His activities during World War II and connections with the Vichy government are examined.

Conclusions. Alexis Carrel made a fundamental contribution to the development of transplantology and tissue engineering, laying the foundations for many modern methods and concepts in these fields. His philosophical and social views, including ideas on eugenics, reflected the contradictory tendencies of his time and cannot be evaluated outside of their historical context. Carrel's scientific legacy has had a significant and long-term impact on modern medicine, especially in the fields of transplantology and vascular surgery. Further objective historical assessment of Carrel's activities is necessary, taking into account the full complexity of his personality and the era in which he lived and worked. 

Relevance. The Great Patriotic War became a serious test for Soviet citizens, when the causes of high mortality were not only military actions, but also infectious diseases, the spread of which was facilitated by deteriorating sanitary and hygienic conditions.

The aim of the study: to study the activities of the employees of the Department of Infectious Diseases of the Arkhangelsk State Medical Institute in the fight against infectious diseases during the Great Patriotic War.

Materials and methods. An analysis of archival documents, monographs, book publications, scientific articles and scientific bibliographic reference books related to the activities of the Department of Infectious Diseases of the Arkhangelsk State Medical Institute in 1941–1945 was conducted.

Results. It was established that the main infectious threats in the North of the USSR were pathogens of dysentery, typhoid and typhus. The activities of the department under the leadership of D.V. Nikitina's work included teaching advanced training courses for medical personnel of the Northern Fleet, providing medical care to infectious patients and the wounded, publishing information brochures, consulting work in hospitals, developing methods of sanitization, and adapting the educational process to military conditions.

Conclusions. The multifaceted work of the staff of the Department of Infectious Diseases of the Arkhangelsk State Medical Institute made it possible to prevent large-scale epidemic outbreaks in the Arkhangelsk Region and reduce the incidence of infectious diseases compared to other regions of the USSR, which is confirmed by statistical data.