Introduction. Perinatal hypoxia is a leading cause of long-term impairment of higher nervous activity, yet its effect on the sexual dimorphism of cognitive function remains insufficiently understood.
Aim. To assess the development of spatial learning and complex food-procuring behaviour in rat pups exposed to acute normobaric hypoxia (ANH) in early ontogenesis, with attention to sexual dimorphism.
Materials and methods. The study was performed on Wistar rat offspring (328 pups: control — 164, experimental — 164; males and females equally). On postnatal day 2 (P2) the experimental group underwent 2-hour ANH (8% O₂, 92% N₂; 37 °C); controls were kept under normoxia. On days 42–47, spatial memory was assessed in the Barnes maze (6 days) and place-conditioned food-procuring behaviour in a complex food maze (4 days). Data were analysed by ANOVA/MANOVA with the Fisher LSD post-hoc test; p < 0.05 was considered significant.
Results. Learning occurred in both groups but was significantly slower after ANH. In the Barnes maze, the escape latency by day 6 decreased by 78.6% (control males) and 56.8% (control females) versus only 47.1% and 48.6% in the experimental group; on the final day the latency of experimental males exceeded the control by 200%. A comparable deficit was found for error counts and in the food maze. The key finding was an inversion of sexual dimorphism: normally females learned faster and more accurately than males, whereas after ANH they fell behind males and showed the deepest deficit — about twice as many errors as control females by the end of training. The effects of "ANH", "sex" and their interaction were confirmed by analysis of variance.
Conclusion. Acute normobaric hypoxia on P2 produces a persistent deficit of spatial learning and memory lasting into adolescence and reverses the normal sexual dimorphism of higher nervous activity, rendering females more vulnerable. These data justify accounting for sex when modelling perinatal hypoxic brain pathology.

Introduction. One of the state's most important priorities is improving the health of the younger generation in Russia's northern and Arctic regions, which are economically and strategically important. According to scientists, the rise in childhood illnesses is due to unhealthy diets, unbalanced macronutrient composition, and vitamin and essential chemical deficiencies.
Objective. To assess the dietary intake of calcium, magnesium, zinc, copper, and selenium in primary school children in the northern Tyumen region.
Materials and methods. Using the ASPON-nutrition program, the intake of Ca, Mg, Zn, Cu and Se with 3-day food rations was studied in 117 schoolchildren in grades 1-4, average age 8,2±1,7 years. Of these, 52 were residents of Salekhard (Arctic: 18 boys (34.6%), 34 girls (65.4%)), and 65 were residents of Khanty-Mansiysk (Subarctic: 21 boys (32.3%), 44 girls (67.7%)). Based on the identity of the food set, the groups were combined. The median was compared with the physiological need (PR) in accordance with MR 2.3.1.0253-21.
Results. Primary school children in the Arctic and Subarctic regions demonstrated a deficiency in all studied chemical elements critical for growth, physical development, mental performance, and immune and antioxidant defense: Ca – 79.5% of the PR, Mg – 84% of the PR, Zn – 85%, Cu – 76% of the PR, Se – 54% of the PR. This deficiency may lead to the development of cardiovascular, endocrine, oncological, immune, and other diseases.
Conclusion. Supplementing with calcium, magnesium, zinc, copper, and selenium in the form of VMC and enriching their diets with them is an effective and safe measure to prevent inadequate intake of these micronutrients in children and associated metabolic disorders and disease development.

Classical angiomorphology developed as a largely descriptive discipline, studying the geometry of the vascular wall usually in isolation from the flow that generates and sustains it. This paper argues that arterial form is materialized hemodynamics: a stable outcome of shear-dependent remodeling rather than a predetermined design. Computational fluid dynamics (CFD) is presented as an instrument of morphology itself, making visible the determinants of form that appear on no anatomical specimen – wall shear stress, pressure fields, flow helicity and oscillation. The paper outlines a programme of functional-computational morphology of the vascular bed, in which the description of geometry is completed by reconstruction of the flow that shaped it, and the taxonomy of anatomical variants is reframed as a question of their hemodynamic equivalence. The methodological foundations of the approach are set out: a redefined object of study (the wall–flow system), the status of computed fields (wall shear stress, oscillatory shear index, relative residence time) as morphological attributes, a shift of the unit of observation from type to individual, and the principles of the discipline – functional determination of form, quantitative formalization, hemodynamic equivalence, computational experiment, biological interpretation and mandatory validation. The technology of investigation, from imaging and segmentation to validation against 4D flow MRI, is presented as a basis for critical appraisal of computed attributes. Applicability is demonstrated across vascular beds – atherosclerosis, aneurysms, coronary stenosis, hepatic arterial reconstruction in liver transplantation, and portal hypertension. Limitations and directions of development are outlined, including wall compliance (fluid–structure interaction), growth-and-remodeling models, and machine-learning methods. The limits of the method are stated explicitly: the computed flow is a testable hypothesis about the vessel, not the vessel itself.

Background. The peritoneum is a dynamic serous membrane involved in fluid transport, immune defense, inflammatory response, and tissue repair. A detailed understanding of its anatomy and histophysiology is essential for assessing the mechanisms of peritoneal inflammation and for developing modern therapeutic approaches.
Objective. To summarize current concepts of peritoneal anatomy, physiology, and its response to inflammation.
Materials and methods. A literature review was performed using Russian and international sources focusing on peritoneal structure, microcirculation, lymphatic drainage, mesothelial function, and the pathophysiology of peritonitis.
Results. The peritoneum was shown to be a highly specialized organ with marked histological and functional heterogeneity. Mesothelial cells, the glycocalyx, submesothelial stroma, vascular and lymphatic networks provide barrier, transport, fibrinolytic, and immunoregulatory functions. During inflammation, cellular and humoral responses are activated, with increased exudation, leukocyte migration, adhesion molecule expression, and cytokine production; impaired fibrinolysis promotes fibrin deposition, adhesions, and fibrosis.
Conclusion. The peritoneum should be regarded not only as a serous membrane, but also as an active immunometabolic organ. Further investigation of its structure and inflammatory responses is important for improving the prevention and treatment of peritonitis, adhesions, and other peritoneal complications.

Background. Toluene is one of the most widely used industrial aromatic hydrocarbons with polytropic toxicity. Its gastrotoxic effect remains poorly characterised: available data mainly concern clinical manifestations and macroscopic changes, whereas subcellular alterations of specialised gastric cells and their reversibility have not been studied.
Objective. To assess structural and morphometric changes in chief cells of the rat fundic stomach at different intervals after chronic inhalation toluene intoxication.
Material and Methods. Forty-eight sexually mature outbred male rats (150–180 g) were allocated to an experimental (n=24) and a control (n=24) group. Experimental animals were exposed to toluene vapour at ten-fold the occupational exposure limit for 4 h daily, 5 days a week, over 60 days. Material was sampled on days 1, 7, 30 and 60 of the post-exposure period (6 animals per group per interval). Organometry, light and electron microscopy, stereological and computer-assisted morphometric analysis (MORPHOLOG software) were applied. Statistical processing — STATISTICA 10.0.
Results. On days 1 and 7 gastric mucosal thickness decreased by up to 20% and chief cell counts by 36% and 26%, while the submucosa thickened by 55% and 33%; the submucosa-to-mucosa index nearly doubled (0.273±0.01 and 0.231±0.04). Ultrastructurally, nuclear chromatin condensation was observed with a 42% and 69% increase in the heterochromatin fraction and a 2.3- and 2.8-fold rise in the heterochromatin-toeuchromatin area ratio, marginal chromatin layer thickening to 0.81±0.03 and 0.89±0.05 µm, dilatation of rough endoplasmic reticulum cisternae with massive degranulation, mitochondrial crista destruction with a 34.5% and 40.4% reduction in crista area, decreased area of low- and medium-density secretory granules, and morphological markers of apoptosis. By days 30 and 60 most parameters approached control values, except chief cell numbers.
Conclusions. Chronic inhalation toluene intoxication elicits a biphasic chief cell response — acute destruction (days 1–7) and restitution (days 30–60). Mitochondrial dysfunction appears to be the key injury mechanism, followed by suppression of synthetic activity and induction of apoptosis. Reversibility of most ultrastructural changes by day 60 indicates substantial compensatory and reparative capacity of the gastric epithelium, whereas the unrecovered cell population size points to a risk of atrophic transformation.

Background. Penetrating keratoplasty is widely used for visual rehabilitation, yet graft survival is limited by rejection, endothelial failure, infection and delayed epithelial coverage. Persistent and recurrent epithelial defects are associated with infectious complications and graft opacification, which makes control of surface epithelial regeneration a relevant task.
Objective. To provide a cytological characterisation of epithelial layer formation on the corneal graft after penetrating keratoplasty and to assess the influence of pharmacological support on this process.
Material and Methods. A prospective non-comparative observational study of 20 patients (12 with bullous keratopathy, 8 with corneal ulcer) who underwent penetrating keratoplasty in 2024; mean age 59 years (range 27–82). Donor material of category 3A was obtained from donors aged 25–60 years within 16–20 h after death and stored in preservation medium at +4 °C for no longer than three days. Graft diameter did not exceed 8.25 mm; all procedures were performed by a single surgeon. Postoperatively, alongside antiseptic and steroid agents, sodium hyaluronate eye drops were prescribed, and from day 10 methylethylpyridinol hydrochloride (Vixipin) for 10–15 days. Follow-up was 3 months; impression cytology (Leukodif 200 staining) was performed on days 2–3, 7–10 and 60–90.
Results. No infectious complications occurred. The graft remained transparent in 15 patients, semi-transparent engraftment was observed in 4, and graft lysis occurred in one case during the second month. Visual improvement was achieved in 11 of 12 patients with bullous keratopathy and in 4 of 8 with corneal ulcer. Epithelialisation began on days 1–2; up to two thirds of the epithelial cover formed within the first two days, after which the process slowed markedly with a persisting central defect that closed over the following 2–3 days. By days 8–10 the epithelial layer had formed in all patients. On day 2 cytograms were dominated by elongated process-bearing cells of irregular shape; in patients with corneal ulcer, abundant neutrophils and lymphocytes and cells with dark cytoplasm and numerous inclusions were additionally present. By days 10–12 mature superficial-layer cells predominated with single neutrophils; by days 60–90 no differences between groups were detected.
Conclusions. Restoration of the corneal graft epithelium begins through migration of mature epitheliocytes from the margins of the recipient's own cornea. Delayed epithelialisation in patients operated on for corneal ulcer is related to persisting activity of inflammatory agents and matrix metalloproteinases. Inclusion of anti-inflammatory agents and preparations containing sodium hyaluronate and an antioxidant in the postoperative regimen was accompanied by formation of a full-thickness stratified epithelium.

Background. The advance of fetal surgery and early postnatal correction of malformations raises the demand for precise anatomical and topographic data on the fetal sternocostal complex. Information on the muscles and ligaments acting on the sternum and ribs during the fetal period remains fragmentary and largely descriptive.
Objective. To systematise available data on the structural features of the muscles and ligaments acting on the sternum and ribs of the human fetus and to identify promising directions for further research.
Material and Methods. A literature search was performed in Russian and English in eLIBRARY, Springer Nature, Wiley Journals, PubMed and Scopus with a 20-year depth, using combinations of the keywords anatomy, morphology, thoracic cage, sternum, ribs, deformation, fetus. The initial set comprised over 800 publications, of which 80 sources were selected after relevance assessment.
Results. By weeks 16–22 all elements of the thoracic cage are present and continue to differentiate. The thoracic muscles derive from somitic myotomes and, although morphologically formed in the fetal period, remain functionally immature owing to low myofibril density and the presence of embryonic myosin heavy chain isoforms. The diaphragm is the best studied: its stagewise formation, closure with acquisition of a domed shape and differentiation into sternal, costal and lumbar parts have been described. The intercostal muscles occupy the intercostal spaces with the typical oblique fibre orientation, yet the bundles are thin and loose with a predominance of the connective tissue component; accessory respiratory muscles are covered by isolated reports only. Ribs and vertebrae form from sclerotomes, and the sternum from paired mesenchymal plates fusing in the midline. The retrosternal ligament is currently regarded not as a discrete structure but as a complex of the anterior pericardium, diaphragmatic–sternal connections and fibrous strands exerting traction on the sternum and contributing to the pathogenesis of pectus excavatum. Three competing hypotheses on the role of intrathoracic pressure in the formation of chest wall deformities are systematised.
Conclusion. In the fetal period the muscles acting on the sternum and ribs are morphologically formed but functionally immature. They operate in a specific mechanical environment — wide intercostal spaces, cartilaginous ribs, an incompletely ossified sternum and highly hydrated tissues – in which muscle contraction produces not a ventilatory effect but local displacements and tensions that shape growth and spatial organisation. The least studied and most promising directions are fetal chest wall mechanobiology, ontogenesis of the ligamentous apparatus, spatial omics and the integration of morphology with function.

Objective: To present a review of foreign literature devoted to the treatment of patients with intestinal stomas and postoperative ventral hernias.
Materials and methods. Analysis of 25 English-language publications identified in PubMed, MEDLINE, and Google Scholar databases. The study covered surgical tactics, techniques of intestinal stoma formation, hernia repair techniques, as well as immediate and long-term treatment outcomes and their complications.
Results. The incidence of postoperative ventral hernias combined with intestinal stomas ranges from 6.5% to 14.8%. The number of intestinal stomas is steadily increasing due to increased volume of emergency operations for complicated abdominal organ diseases. Parastomal hernia is the most common complication of colostomy and enterostomy; five years after its elimination, the risk of repeat intervention reaches 19%. Key factors for hernia prevention include preoperative stoma site marking, selection of a lateral approach through the rectus abdominis muscle, and prophylactic mesh implant placement. The question of the permissibility of simultaneous closure of intestinal stoma and abdominal wall repair remains controversial: some authors confirm the safety of combined intervention and its advantages for patient quality of life, while others insist on a staged approach, especially in the presence of chronic infection. The use of funnel-shaped intraperitoneal meshes reduces the recurrence rate of parastomal hernias to 4.8%.
Conclusion. A uniform standard for surgical treatment of patients with intestinal stomas and postoperative ventral hernias has not been established. Large-scale prospective studies are needed to determine the optimal tactics and staging of surgical interventions in this patient population.

Aim. To assess the diagnostic value of incisional (punch) biopsy for preoperative morphological verification and T-stage staging of primary cutaneous melanoma, compared with routine histopathological examination of the surgical specimen.
Materials and methods. Clinical data of 332 patients referred to the S.P. Botkin Center with suspected cutaneous melanoma of the trunk and extremities, who underwent incisional (punch) biopsy at primary diagnosis, were analysed retrospectively. Patients with histologically confirmed melanoma underwent comprehensive work-up and surgery with subsequent morphological examination of the surgical specimen and TNM pathological staging. Accuracy of pT staging, sensitivity, specificity, and positive and negative predictive values were calculated; analysis was performed in IBM SPSS Statistics 27.
Results. Melanoma was verified in 100 of 332 patients; in a further 3 patients initially diagnosed with dysplastic nevus, excisional biopsy confirmed melanoma in situ. pT of the surgical specimen matched that of the incisional biopsy in 78 patients; it was higher in 13 and lower in 9. Accuracy of preoperative pT staging was 87.00 %, sensitivity 97.08 %, specificity 97.02 %, positive predictive value 98.00 %, negative predictive value 98.70 %. Mean duration of incisional biopsy was 7–12 min versus 24 min for excisional biopsy, with lower blood loss and fewer postprocedural complications.
Conclusion. Incisional (punch) biopsy is an adequate method for preoperative verification and pT staging of cutaneous melanoma: although slightly inferior to excisional biopsy in accuracy and specificity, it is superior in simplicity, speed, blood loss and complication rate. Improving preoperative staging accuracy warrants further study, including development of a standardised "pT-oriented" dermoscopy algorithm.

Background. Publications on calcaneal tendon injuries report poor functional results of their treatment due to the failure of tendon sutures and the development of fractures.
Aim. The aim of the study was to improve tenoraphy technology and improve treatment outcomes for calcaneal tendon injuries.
Materials and methods. The present study was performed on 262 objects: 57 corpses and 13 limbs separated and amputated for medical reasons, 14 calves, 178 patients with injuries. The macromicroscopic anatomy of 70 cadaverous calcaneal tendons has been studied on the basis of histotopograms of 70 cadaverous calcaneal tendons. 42 tendons of corpses or severed and amputated limbs of people served as the material for the development of a new tenoraphy technology, 27 unfixed tendons of calves served as the experimental research material. Microsurgical tenoraphy technology was developed and substantiated in the experiment, its clinical approbation and comparative analysis with the outcomes of traditional tenoraphy methods in 139 patients were carried out in 39 people with calcaneal tendon injuries. The results of the clinical trial were evaluated no earlier than a year after surgery, taking into account the number of complications and the functional result according to the American Orthopedic Foot and Ankle Society scale.
Results. The data obtained during the study of macromicroscopic tendon anatomy became the anatomical basis for improving tenoraphy technology, which was achieved by developing a tool for atraumatic retention of tendon stumps and microsurgical tendon suture, which ensured the preservation of the structure and precise adaptation of tendon stumps (p<0.001), increasing the mechanical strength of their connection. Its use in the clinic allowed to obtain significantly higher functional results in comparison with the outcomes of traditional tenoraphy (p<0.001).
Conclusion. The results obtained substantiate the expediency of introducing the developed tendon suture technology into widespread clinical practice.

Objective: to evaluate the results of a comprehensive study of GENDER of various nature in the surgical material of patients with a directional diagnosis of pulmonary tuberculosis and to show the need for surgical verification of education for diagnostic and prognostic purposes.
Materials and methods. The study was a single-center cohort longitudinal retrospective. The study included 189 patients with a definitive diagnosis of pulmonary tuberculosis who underwent medical and diagnostic surgery. Morphological, microbiological, and molecular genetic studies of the surgical material were performed on all of them. All patients did not receive anti-tuberculosis therapy before surgery. The result of the Diaskintest test upon admission was positive in 141 patients (74.6%), negative in 36 (19%), and doubtful in 12 (6.3%). When examining sputum for the presence of mycobacterium tuberculosis (MBT) before surgery, the results of luminescent microscopy, PCR, and culture were negative in all patients.
Results. Morphological examination of the surgical material confirmed the diagnosis of tuberculosis in 171 patients (90.47%), of which tuberculosis was observed in 111 (58.73%) patients, fibrous-cavernous tuberculosis (FCT) in 7 (4.1%), focal tuberculosis in 16 (9.4%), cavernous tuberculosis in 8 (4.6%). cirrhotic tuberculosis – in 1 (0.5%), tuberculous pleurisy (pleural caseoma) – in 9 (5.3%), tuberculous inflammation without specifying the form – in 19 (11.1%). During PCR examination of the surgical material, MBT DNA was detected in 132 (69.84%) patients, of which 21.69% of cases (using the SYNTHOL method) showed resistance of the pathogen to PTP. Histological examination revealed a phase of progression of tuberculous inflammation in the majority of patients – in 51.3% of cases.
Conclusion. The study of the surgical material allows not only etiologically verifying the diagnosis of tuberculosis and determining the activity of the tuberculosis process, but also individualizing the selection of an anti-tuberculosis therapy regimen based on the data of the drug sensitivity of the pathogen.

Objective. To compare the safety and efficacy of percutaneous liver biopsy using standard (strict) and extended patient selection checklists in a short-stay hospital (SSH) setting.
Materials and methods. Retrospective, single-center comparative study. The study included 543 patients with focal liver lesions who underwent percutaneous liver biopsy at the Botkin Medical Research Center between 2022 and 2026. In the first stage (2022–2024), the standard checklist was used (n=121). In the second stage, a modified extended checklist was used (n=422). The biopsy was performed in the operating room under ultrasound guidance (18G needle, Logic E convex transducer) with mandatory 4-hour post-procedure observation (blood pressure, pulse, complete blood count, and liver and abdominal ultrasound). Complications were classified as minor or clinically significant. Statistical processing included comparative analysis with determination of the significance of differences (p<0.05).
Results. The groups were comparable in terms of age, gender, ECOG performance status, and primary tumor site. The incidence of minor complications was 6.6% in both groups, while the incidence of clinically significant complications was 2.5% (standard checklist) and 2.4% (extended checklist). Differences in all types of complications (pain, bleeding from a skin wound, hemoperitoneum, subcapsular hematoma, anesthetic reaction) were statistically insignificant (p>0.05). Diagnostic efficacy was maintained: in 24–25.5% of cases, biopsy allowed for verification of the process in the absence of a detected primary tumor. Expanding the criteria (Hb≥90 g/L, platelets ≥100×10⁹/L, INR≤2.0, anticoagulant withdrawal for ≥ 3 days, minimal ascites) with unchanged ultrasound puncture criteria did not affect the safety or informativeness of the procedure.
Conclusion. Expanding the patient selection criteria for percutaneous liver biopsy in a short-stay hospital setting is feasible, safe, and does not increase the complication rate while maintaining high diagnostic efficacy. The use of an expanded checklist significantly increases patient flow and optimizes hospital resource utilization.

Aim. To summarise current concepts of the etiopathogenesis, diagnosis, and treatment of Mondor's disease and to illustrate them with the authors' own clinical observations.
Material and methods. A review of the literature on Mondor's disease was performed; three original clinical observations of the thoracic form are presented.
Main points. Mondor's disease is a rare benign superficial thrombophlebitis of the subcutaneous veins of the anterolateral chest wall, breast, abdomen, axilla, and penis. The thoracic form predominates in women aged 30–50 years, the penile form in young men. Leading factors are mechanical trauma, iatrogenic procedures (mastectomy, biopsy, mammoplasty), and hypercoagulability; up to 11–12% of cases are associated with breast cancer, and paraneoplastic variants have been described. The diagnostic gold standard is ultrasound with colour Doppler mapping (a hypoechoic, non-compressible vein without flow); in women, mammography is mandatory to exclude breast cancer. Treatment is mainly symptomatic (NSAIDs, warm compresses, heparin ointments); systemic anticoagulants are given on indication, and surgery (thrombectomy, vein resection) is rarely required.
Conclusion. The prognosis is favourable, with spontaneous resolution within 4–8 weeks. The clinician's key tasks are to avoid unnecessary treatment and not to miss a malignancy.

This review presents a systematic analysis of current data on the epidemiology and pathogenesis of urolithiasis from the perspective of integrative pathophysiology. It is demonstrated that urolithiasis has lost its status as an isolated renal pathology and is now considered a multidisciplinary syndrome, the development of which is determined by the synergistic interaction of climatic, nutritional, infectious, and metabolic factors. At the global level, a steady increase in morbidity, the blurring of gender differences, and the rejuvenation of the pathology have been recorded, correlating with the pandemic of metabolic syndrome and insulin resistance. In the Russian Federation, the average annual increase in prevalence is 2–3%, with two polar endemic types identified: hyperthermic (arid) in the south and cold (arctic) in the Far North, each characterized by specific lithogenesis mechanisms – from dehydration-induced hypercalciuria to cold diuretic syndrome and osteoporosisinduced resorptive hypercalciuria.
From a pathophysiological standpoint, focal tubulointerstitial injury and oxidative stress of nephrons, triggering epithelial apoptosis and the formation of an organic matrix for heterogeneous nucleation of salts, are recognized as the key link in stone formation. The central substrate of local damage is subepithelial Randall's plaques – interstitial calcium phosphate deposits that serve as the anatomical foundation for the epitaxial growth of calcium oxalate calculi. Metabolic syndrome and insulin resistance, by blocking renal ammoniogenesis, cause persistent urine acidification (pH<5.5), inducing urate and mixed lithogenesis, which neutralizes the traditional estrogen-dependent protection in women and explains the rapid convergence of gender ratios.
Special attention is paid to infectious lithogenesis: it is shown that uropathogenic strains (Proteus mirabilis, Klebsiella pneumoniae) form biofilms through quorum sensing systems, while urease-mediated urea hydrolysis shifts pH towards the alkaline side (pH>7.2), triggering struvite stone formation. At the same time, the concrement itself functions as a "biological container," shielding bacteria from antibiotics and the immune response, which explains the discordance between sterile urine and the infected core of the stone.
The necessity of transitioning from a symptomatic approach to precision metaphylaxis strategies based on elemental analysis of calculi and assessment of systemic metabolic disorders is substantiated. In-depth study of biochemical markers of lithogenesis in the male population, taking into account the androgen-dependent specificity of metabolic syndrome, is recognized as a priority direction.

Aim. The aim of the study was to conduct a detailed statistical analysis of patients’ access to primary specialized trauma care at a trauma centre in a large city, specifically Barnaul, during 2023–2025. Special attention was paid to the structure of trauma by injury type, localization, and the distribution of patients by sex, age, and social status.
Materials and Methods. This retrospective study was based on outpatient records of patients who sought trauma care at the trauma centre located at the Regional Clinical Emergency Hospital No. 2. The analysis covered the period from 2023 to 2025. Demographic, social, and clinical-statistical characteristics of the visits, as well as the structure of injuries and treatment methods, were assessed.
Results. A total of 58,450 patients aged 18 to 84 years were included in the study; the mean age was 39 years. Men accounted for 74.33% of all patients. The highest number of visits was recorded among persons aged 36–45 years, which corresponds to the economically active population. The majority of patients were able to continue treatment on an outpatient basis; hospitalization was required only in a small proportion of cases.
Conclusion. Trauma remains a major public health issue in large urban settings. The findings emphasize the need to improve outpatient trauma services, ensure accessibility of specialized care, and strengthen preventive strategies aimed at reducing trauma incidence.

The increased detection rate of pulmonary embolism (PE) and reduced in-hospital mortality have led to a growing number of patients with postthromboembolic syndrome (PTES), characterized by decreased functional status, reduced quality of life, and a high rate of rehospitalization. Traditional cardiac rehabilitation programs have limited accessibility and low patient adherence.
Objective. To summarize current data on the potential of telemonitoring and digital cardiac rehabilitation programs in the management of patients with PTES, and to evaluate their impact on functional status and quality of life.
Material and Methods. An analysis of the literature was conducted, including results from randomized clinical trials, systematic reviews, and ongoing study protocols (REVAMP, NCT06362382, NCT04777448) concerning the use of telemedicine in pulmonary hypertension and the consequences of PE.
Results. Telemonitoring using wearable devices (pulse oximeters, accelerometers, portable ECG recorders) and mobile applications enables continuous monitoring of physiological parameters, provides feedback, and allows for the adjustment of rehabilitation programs. Available data indicate improvements in functional status (increased 6-minute walk distance, higher peak oxygen consumption), reduced NT‑proBNP levels, decreased rehospitalization rates, and improved quality of life. Safety is ensured by clear selection criteria (functional class I–II, stable hemodynamics) and real-time monitoring of SpO₂ and heart rate.
Conclusion. Digital cardiac rehabilitation programs with telemonitoring are effective and safe tools for managing patients with PTES. Further research and the development of a regulatory framework are necessary for widespread implementation.

Background. Patients with short bowel syndrome and high small bowel fistulas represent one of the most challenging categories in abdominal surgery. The prevalence of the syndrome among adults in Russia is unknown owing to the absence of a registry, and national clinical guidelines are lacking, which results in divergent approaches among surgeons, intensivists and gastroenterologists. The highest postoperative mortality is recorded for reconstructive procedures performed within the first month after fistula formation.
Objective. To present the outcome of treatment of a patient with a high small bowel fistula complicated by extensive purulent wounds of the anterior abdominal wall and intestinal failure.
Material and Methods. A clinical observation of patient G., 28 years old, admitted to the surgical department of the V.D. Seredavin Samara Regional Clinical Hospital on 3 May 2023 after appendectomy, early adhesive small bowel obstruction and progressive peritonitis. A two-stage approach was applied: stage one comprised sanitation procedures, resection of the fistula-bearing small bowel segment with formation of an end jejunostomy 70 cm from the ligament of Treitz, negative-pressure wound therapy (Vivano device) and nutritional and metabolic support through an implanted intravenous port system; stage two comprised reconstruction of the intestinal tract.
Results. On 8 May 2023 multiple small bowel perforations were identified and resection with end jejunostomy was performed. From 19 May 2023, because of fixed evisceration of small bowel loops into the purulent midline wound, vacuum-assisted therapy was started; the dressing was removed on 1 July 2023 after substantial reduction of the wound defects. Daily jejunostomy output reached 8 L with oral intake of up to 10 L. Body weight fell from 96 kg on admission to 67 kg by day 60, with subsequent stabilisation under nutritional support. The patient was discharged on day 148 of treatment. On 11 November 2023 the reconstructive stage with entero-enteric anastomosis was performed; the postoperative period was uneventful and the patient was discharged on day 14. Since February 2024 the patient has returned to work with no impairment of gastrointestinal transit.
Conclusions. Management of a patient with a high small bowel fistula complicated by extensive purulent wounds of the anterior abdominal wall and intestinal failure requires a multimodal approach and coordinated work of a multidisciplinary team. Negative-pressure therapy converts an uncontrolled fistula into a controlled one and permits reliable assessment of the volume and character of the discharge. Reconstructive surgery should be performed after nutritional rehabilitation has been achieved and the inflammatory process has resolved; the minimum preparation period may reach three months.

Cardiovascular toxicity following high-dose chemotherapy and autologous hematopoietic stem cell transplantation is a complication characterized by a wide spectrum of clinical manifestations. This article presents two clinical cases that illustrate distinct pathogenetic variants of hypotensive cardiovascular toxicity in the early post-transplant period. The report describes two patients with lymphoproliferative disorders who received different conditioning regimens, both of which included high-dose melphalan. The first case involves a 52-year-old male with multiple myeloma who developed refractory hypotension due to vascular atony, with preserved left ventricular systolic function and normal levels of cardiac-specific biomarkers. In the second case, a 46-year-old female with Hodgkin lymphoma, previously treated with anthracycline antibiotics, received BEAM conditioning and developed hypotension accompanied by a reduction in left ventricular global longitudinal strain, elevated troponin T and C-reactive protein, indicating combined myocardial and vascular injury. These observations highlight the heterogeneous pathogenetic mechanisms underlying hypotensive cardiovascular toxicity. Routine assessment of left ventricular ejection fraction has limited diagnostic value in such settings. Extended monitoring, including speckle-tracking echocardiography and analysis of myocardial injury biomarkers, is warranted to ensure timely diagnosis and a differentiated treatment approach.

Introduction. Langerhans Cell Histiocytosis (LCH) is a rare clonal disorder characterized by the infiltration of organs with CD1a+/CD207+ cells. The pulmonary variant predominantly affects adult smokers and often mimics COPD or interstitial lung diseases.
Aim. To demonstrate a clinical case of multisystem LCH (lungs, skull bones, pituitary gland) presenting with respiratory symptoms and to highlight the difficulties of its differential diagnosis in outpatient practice.
Materials and Methods. A retrospective analysis of clinical and laboratory data from a 48-year-old female patient was performed, including spirometry, chest CT, brain MRI, and video-assisted thoracoscopic lung biopsy results.
Results. In a patient with a long history of smoking, COPD was diagnosed without effect from basic therapy. Further examination revealed cystic restructuring of lung tissue, diabetes insipidus, and tooth loss. The diagnosis was morphologically verified via VATS biopsy. Stabilization of the process was achieved under immunosuppressive therapy.
Conclusion. The latent course and lack of pathognomonic signs of LCH require high oncological vigilance. Surgical lung biopsy remains the "gold standard" for diagnosis. Timely initiation of pathogenetic therapy ensures a favorable prognosis.

The vascular system is highly variable, which affects not only the vessels that are involved in peripheral blood circulation, but also large vessels, including the aorta, as well as its branches. The aim of the work was to describe a case of variant anatomy of aortic arch branching and aberrant right common carotid artery. The data on the variability of the branching of the arch and carotid arteries were obtained during multi-slice spiral computed tomography. The data analysis was carried out on the computer workstation of a radiologist. The man is 72 years old, the bifurcation of the common carotid artery in a typical place (C3-C4) was not detected. The external carotid artery was a direct extension of the common carotid artery. At the level of 1,5 cm up from the mandibular angle, it was divided into two branches: 1) the trunk extends outwards and anteriorly, which after 5 mm was divided into the facial artery and an upward artery, from which the maxillary, hypoplastic superficial temporal artery and the posterior auricular, occipital arteries branched off; 2) the internal carotid artery extended upward, from which, in turn, the ascending pharyngeal artery also separated. The left common carotid artery extended from the brachiocephalic trunk, and its bifurcation was typically located. The course and branching of the left external and internal carotid arteries in the neck and head were typical. The described case complements the existing information on the variant anatomy of the vessels of the head and neck, which is of practical importance for surgeons and doctors of X-ray endovascular diagnostics in terms of improving the safety of surgical procedures, reducing the frequency of postoperative complications and improving the prognosis of patients.

Background. Curriculum implementation in clinical medicine is a crucial stage in medical education, as it determines the development of clinical knowledge, practical skills, and professional competencies among future healthcare providers.
Objective. To assess the process of implementing the clinical medicine curriculum in medical training institutions in Kericho County, Kenya.
Methods. This study used a descriptive cross-sectional design with both quantitative and qualitative approaches. Data were collected using structured questionnaires, surveys, and guided interviews. Students from three institutions and clinical medicine lecturers selected purposively were included in the study. Quantitative data were analyzed using descriptive and inferential statistics, with significance set at p<0.05.
Results. The curriculum implementation process was generally perceived as well structured and organized. However, important challenges were identified, including insufficient faculty training, staff shortages, limited resources, and non-compliance with required standards in some training facilities. Teaching was reported to rely mainly on traditional teacher-centered methods, while e-learning was used only to a limited extent. Overall, both lecturers and students expressed mixed, and in some cases negative, perceptions of the teaching process.
Conclusion. The implementation of the clinical medicine curriculum in Kericho County medical training institutions is generally acceptable, but it requires stronger regulatory compliance, improved faculty capacity building, and better allocation of educational resources.

Background. Passive wireless monitoring (Wi-Fi Sensing) allows a patient's motor activity and physiological parameters to be tracked without wearable devices, which makes it attractive for personalised medicine and neurorehabilitation. The same physical basis of the method — analysis of radio signal distortions (RSSI, CSI, ToF/TDoA) — creates a vulnerability surface and gives rise to ethical problems that have not so far been systematised.
Objective. To conduct a comprehensive analysis of the ethical aspects and security issues of Wi-Fi Sensing in personalised medicine and neurorehabilitation, to systematise vulnerabilities and to propose an approach to selecting protective countermeasures that accounts for both technical constraints and ethical imperatives.
Material and Methods. The work draws on three data sources: a systematic patent analysis of 14,253 documents for 2020–2025, a critical review of current scientific literature, and a mathematical framework for the optimisation-based selection of countermeasures allowing for synergistic effects.
Results. Three groups of ethical problems were identified: informed consent and third-party privacy; irreversible compromise of biometric templates (accuracy of personal identification from individual gait patterns reaches 95.4 %); and psychological distress in the form of a digital panopticon. Active and passive attacks and physical-layer vulnerabilities were systematised. A mathematical framework was developed that permits selection of an optimal set of countermeasures accounting for synergy and antagonism under budget constraints and performance requirements.
Conclusions. A protocol for the ethically responsible use of Wi-Fi Sensing in neurorehabilitation is proposed, comprising five requirements: informed consent with periodic reaffirmation, protection of third-party data, technical measures at the physical layer, ethical review of algorithms, and quantitative justification of countermeasure selection.

Background. Carbohydrate metabolism disorders, including post-transplant diabetes mellitus (PTDM), are among the most frequent metabolic complications after kidney transplantation and are associated with worse outcomes. Reported PTDM prevalence ranges from 10 % to 40 %, reflecting population heterogeneity, differing immunosuppressive protocols and the absence of uniform diagnostic criteria. Transient glycaemic disturbances of the early post-transplant period are often excluded from analysis, which leads to underestimation of the true frequency of these disorders and of their prognostic role.
Objective. To determine the incidence and risk factors of carbohydrate metabolism disorders in kidney transplant recipients based on clinical, laboratory and therapeutic data.
Material and Methods. A multicentre combined retrospective–prospective cohort study involving at least four medical organisations (A.I. Burnazyan FMBC, Moscow; B.V. Petrovsky Russian Research Centre of Surgery, Moscow; Federal Siberian Research and Clinical Centre, Krasnoyarsk; Orenburg Regional Clinical Centre of Surgery and Transplantation). The design comprises four consecutive stages: assembly of the initial sample by inclusion criteria (age over 18 years, graft survival exceeding 30 days, availability of medical records); refinement of the sample by exclusion, data-invalidity and drop-out criteria; allocation into cohorts with and without carbohydrate metabolism disorders based on assessment on days 30–45 after transplantation; and comprehensive characterisation of the cohorts with analysis of immunosuppressive regimens, modifiable and non-modifiable risk factors, the early glycaemic profile and cardiovascular risk factors. The protocol was approved by the local ethics committee (No. 127 of 17 October 2025).
Expected results. The study will yield protocol-consistent data on the frequency of carbohydrate metabolism disorders in kidney recipients and on the contribution of demographic, metabolic, infectious and iatrogenic (immunosuppression-related) factors, including assessment of the prognostic role of transient glycaemic disturbances in the early post-transplant period.
Conclusion. Implementation of the protocol will make it possible to identify both general and organ-specific predictors of carbohydrate metabolism disorders and to optimise monitoring and immunosuppression strategies in kidney transplant recipients.

Objective. To develop a simple and reproducible scoring system for assessing the risk of hepatic artery thrombosis (HAT) after liver transplantation, incorporating the anatomical and technical features of arterial reconstruction, and to evaluate its practical value.
Materials and methods. A retrospective analysis was performed on 1,237 consecutive orthotopic liver transplantations. The endpoint was hepatic artery thrombosis. Based on vascular anatomy, the number and method of anastomoses, back-table reconstructions, and the use of conduits, a 0–10-point scoring system—the Hepatic Artery Complexity Score (HACS)—was developed. The optimal stratification threshold was determined by analyzing the observed thrombosis rates for each score value. The score was supplemented by a one-dimensional model of arterial hemodynamics. The results were validated in a prospective cohort of 80 patients.
Results. Hepatic artery thrombosis developed in 36 of 1,237 recipients (2.9%). Binary stratification with a threshold of 8 points was optimal: the thrombosis rate was 2.2% (24/1,068) for HACS 0–7 and 7.1% (12/169) for HACS 8–10; the relative risk was 3.16 (95% CI, 1.61–6.20), χ²=12.16, p<0.001 (Fisher’s exact test, p=0.002). Each additional HACS point increased the odds of thrombosis by 15% (OR 1.15; 95% CI, 1.02–1.29; p=0.027). The specificity of the score was 86.9%, and its negative predictive value was 97.8%.
Conclusion. HACS is a simple bedside tool that, at a threshold of 8 points, identifies a group with more than a threefold higher risk of thrombosis and reliably excludes thrombosis in the remaining patients (NPV, 97.8%). Combined with hemodynamic assessment, the score supports riskadapted reconstruction and postoperative monitoring strategies. External validation in independent cohorts is required.

Background. The peritoneum is an active serous membrane involved in barrier, transport, immune, and reparative functions. Inflammation significantly alters its morphofunctional properties, thereby influencing the course of peritonitis and the development of complications.
Objective. To summarize current knowledge on the anatomy and physiology of the peritoneum and its response to inflammation.
Materials and methods. A review of Russian and international literature was performed, focusing on peritoneal histology, microcirculation, lymphatic drainage, mesothelial function, and the pathophysiology of peritoneal inflammation.
Results. The peritoneum was shown to be a highly specialized organ with marked structural and functional heterogeneity. Mesothelial cells, the glycocalyx, submesothelial stroma, vascular and lymphatic networks provide barrier and fibrinolytic properties. During inflammation, exudation, leukocyte migration, expression of adhesion molecules and cytokines are activated, while the balance between fibrin formation and fibrinolysis is disrupted, promoting fibrin deposition, adhesions, and fibrosis.
Conclusion. The peritoneum should be regarded as a dynamic immunometabolic organ. Studying its response to inflammation is essential for understanding the pathogenesis of peritonitis and improving its treatment.

Objective. To study the diagnostic capabilities of contrast-enhanced ultrasound in patients with new-onset renal graft dysfunction.
Materials and Methods. A total of 63 patients were included in this planned, interventional, prospective, two-center study. A comparative analysis of anamnestic, anthropometric, demographic, and laboratory data, as well as quantitative parameters of contrast-enhanced ultrasound (CEUS) (time-intensity curve analysis) was performed in patients with stable renal graft function (group 1) and dysfunction (group 2), confirmed by laboratory data and renal biopsy results.
Results. A total of 57 patients were included in the final analysis. There were no statistically significant differences between the groups (group 1 (23 patients) vs. group 2 (34 patients)) in age, body mass index, and time from transplantation to study inclusion; The patients differed in gender (female 17 (74%) vs. 6 (17.7%), p<0.001), and serum creatinine level (90 (68–107) vs. 128 (100–150) μmol/L, p<0.001). Qualitative analysis of CEUS revealed parenchyma hypocontrast in 28 (82.4%) patients in Group II. Comparative analysis of a number of quantitative CEUS parameters characterizing the intensity of contrast in the cortical part of the parenchyma, the renal column zone, and the pyramids revealed their significant decrease in the dysfunction group. Comparative analysis of the time parameters of TIC curves revealed a slower penetration of the contrast agent into the cortical layer of the parenchyma, as well as a slower penetration and a faster elimination in the pyramid zone in the dysfunction group. Cutoff values for parameters demonstrating statistically significant differences were determined, as well as the test's operational characteristics—sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy.
Conclusion. CEUS has high potential for clinical application in recipients with parenchymal causes of graft dysfunction. Quantitative assessment of the time-intensity curve parameters during contrast-enhanced ultrasound examination of the renal graft is a promising method for noninvasive monitoring of renal graft perfusion in patients with normal function and allograft dysfunction.

Background. This study explored the use of blended mode of learning among students of medical imaging sciences in Kenya Medical Training College (KMTC) Campuses in the Western Kenyan region. Blended learning is defined as an approach that combined face-to-face instruction with e-learning experiences. The global COVID-19 pandemic rapidly increased the utilization of blended learning, generating a wealth of online digital resources. Consequently, understanding the role of blended learning in supporting and developing skills through field-based teaching is crucial in medical education.
Materials and Methods. The research adopted a descriptive cross-sectional research design to collect both qualitative and quantitative data. The study was conducted at KMTC Kisumu and Eldoret campuses, targeting all registered medical imaging science students. A sample size of 196 participants was determined using the hypergeometric distribution formula, with purposive sampling applied. 11 lecturers were interviewed. Data were collected using pretested questionnaires and interview schedules, and both qualitative and quantitative data were presented in tables and charts. Data analysis was performed using SPSS software version 25 for Windows.
Results. Findings revealed that medical imaging students at Kisumu and Eldoret KMTC campuses expressed high satisfaction, attention, confidence, and perceived relevance with blended learning, indicating effective integration of online and face-to-face instruction. Lecturers confirmed the active use of models such as flipped classrooms and modular designs improves learning.
Conclusion. The study concluded that blended learning enhances student engagement, practical readiness, and self-directed learning but requires infrastructural improvements and targeted technical support.