Interventional oncology is a rapidly evolving field of cancer treatment. Minimally invasive techniques, such as transarterial embolization with chemotherapeutic and radioactive agents, are common treatments and are found in many guidelines for the treatment of primary and metastatic liver lesions. It is known that the growth and development of a malignant neoplasm is primarily determined by angiogenesis. Rapid growth is ensured where the formation is directly related to the arterial bed. Therefore, when the drug is injected into the target vessel and providing tissue ischemia, it is possible to achieve a high degree of tumor pathomorphosis. This technique has an advantage for patients who, in some cases, cannot be treated surgically, and also increases the effectiveness of the chemotherapeutic effect. With the advent of necessary equipment in hospitals and the accumulation of experience in the use of minimally invasive interventions, it became possible to implement a new method of treating tumors of various localizations. In this review, we consider the results of domestic and foreign authors on the topic of intra-arterial chemoembolization before surgical treatment in patients with rectal cancer. It is noted that the analysis of the literature revealed a small number of works devoted to the chosen topic, despite the relevance of this problem for modern oncology.

The human body, a marvel of complexity, operates through a network of interconnected systems that extend beyond the conventional confines of organs and tissues. Among the most intriguing and dynamic of these networks is the gut- brain axis (GBA), it was considered only for digestion, but in recent years GBA has evolved dramatically, uncovering its profound implications for both physical and mental well-being. Background: As scientific research continues to delve into the intricacies of this bidirectional pathway, a deeper understanding emerges of how the GBA impacts not only digestion and metabolism but also mental health and obesity. Material and methods. This article conducts a systematic review of current scientific literature to explore the intricate mechanisms and profound implications of the GBA on mental health and obesity. Results. Components of the GBA, including the enteric nervous system, vagus nerve, neurotransmitters, gut hormones, and gut microbiota, collectively orchestrate digestion, metabolism, mood, cognition, and behavior. Recent research elucidates the role of the GBA in neurotransmitter production, microbiota composition, immune function, stress response, and vagus nerve communication, highlighting its significance in mental well-being. Moreover, disruptions in the GBA contribute to alterations in appetite regulation, metabolism, and gut microbiota composition, linking it to the development and exacerbation of obesity. Conclusions. Understanding the intricate connections within the GBA provides a foundation for developing targeted interventions to promote holistic health and well-being. By recognizing the multifaceted nature of the GBA, individuals and healthcare professionals can explore innovative approaches to address mental health disorders, life style modification and obesity effectively.

Currently, there is no common understanding of the bioelement status of obese children and adolescents. In this regard, we have summarized the available data on open access and presented information on the role and content of bioelements involved in the regulation of free radical homeostasis in the genesis of childhood obesity. The literature review revealed modern ideas about obesity as a metabolic pathology. The multifactorial nature of the development of oxidative stress in obesity, including in children and adolescents, is considered, the role of bioelements in the regulation of free radical homeostasis is revealed and it is shown that they can act as cofactors of antioxidant enzymes and/or be initiators of oxidative reactions. The most significant bioelements involved in the regulation of free radical processes are copper, zinc, manganese, selenium and iron. The analysis of the literature shows that children and adolescents with obesity experience changes in the metabolism of the main bioelements involved in the regulation of redox homeostasis. The content of copper, zinc, selenium, manganese and iron may vary depending on the gender and age of the subjects, as well as the type of biomaterial being studied.

Allergic rhinitis (AR) occupies a leading position among the causes of morbidity throughout the world, to date, it has been diagnosed in 400 million people. In the formation and progression of AR, a significant role is assigned to cytokines associated with the second type of immune response, in particular, IL-4, IL-5, IL-9, IL-13, IL-25, IL-33, thymic stromal lymphopoietin (TSLP). This literature review provides information on the influence of the listed mediators on the structural cells of the nasal cavity and blood immune cells (T- and B-lymphocytes, eosinophils, macrophages, dendritic cells), and discusses their association with the manifestation of AR symptoms and the severity of the disease. The results of studies aimed at establishing the level of IL-4, IL-5, IL-9, IL-13, IL-25, IL-33 and TSLP in biological fluids (blood serum, nasal lavage) and their expression in nasal epithelial cells in patients with AR compared to healthy people are assessed.

Small supernumerary marker chromosomes (sSMCs) are structurally abnormal chromosomes that cannot be clearly identified or characterized by traditional karyotyping. They can appear in a variety of forms, including rings, centric fragments, and other structural abnormalities, and are often detected during prenatal diagnosis. sSMCs occur in approximately 0.075 % of unselected prenatal cases and can be associated with a wide range of phenotypic presentations, from normal development to severe congenital malformations and syndromes. Understanding and interpreting the clinical significance of sSMCs remains challenging in genetic counseling due to their high heterogeneity and potential impact on fetal phenotype. Advances in the field of molecular cytogenetics, including techniques such as fluorescence in situ hybridization (FISH), as well as microarray comparative genomic hybridization (aCGH) and next-generation sequencing (NGS), have significantly improved the ability to accurately characterize sSMCs. These methods can determine their origin, size and genetic content, which is critical for risk assessment and decision-making during pregnancy. Thus, modern molecular cytogenetics techniques play a key role in the identification and characterization of sSMC, allowing for more accurate genetic counseling and helping to make informed pregnancy decisions. However, despite technological advances, sSMCs continue to pose a challenge for prenatal diagnosis due to their complexity and potential impact on fetal development. In this article, we aim to provide a general overview of sSMCs and of their impact on prenatal diagnosis, as well as consider the clinical significance and potential impact of sSMCs on pregnancy outcome.

A search and analysis of scientific articles presented in the databases PubMed, ScienceDirect, Elsevier, eLibrary for 2000–2024 was carried out. The selection criterion was the presence in the articles of information on the concentration of extracellular ATP in normal and pathological tissues, the mechanisms of purinergic regulation of cell functioning, and the expression of CD73 and CD39 ectonucleotidases on cells, which regulate proinflammatory extracellular ATP catabolism to immunosuppressive adenosine. Modern data are presented on the role of extracellular ATP in the regulation of cell functioning under normal and pathological conditions, during inflammation and the formation of cellular and humoral immune responses, as well as on the study of the mechanisms of purinergic signaling from extracellular ATP in the development of targeted drugs for various diseases, including neoplasms, neurodegenerative and autoimmune pathologies.

ENT diseases are widespread diseases in the general population of adults and children. They significantly reduce the quality of life of patients and increase costs of the healthcare system. This stimulates the improvement of legal regulation in this area and the organization of medical care. The aim of the study was to suggest ways to improve the quality of medical care for patients with ENT diseases based on an analysis of literature data, regulatory documents in otorhinolaryngology. Material and methods. The search for sources was conducted in the Scopus, Wеb of Sciеnce, PubMеd, MеdLine, CybеrLeninka, eLIBRАRY.RU databases etc., as well as in the «ConsultantPlus» reference as information database. Results and discussion. An analysis of literature data was carried out from the point of view of the possibility of improving the provision of medical care to patients with ENT diseases. Some aspects of the use of an interdisciplinary approach in otolaryngology in clinical practice are demonstrated, as well as other important areas that contribute to improving the quality of medical care for patients with the above-mentioned pathology. Pоssible ways for imprоving clinical recоmmendations, stаndards and prоcedures for providing medical care are dеmonstrated. Conclusions. Imprоving the quаlity and еfficiеncy of mеdical cаre in otorhinolaryngology is оne of the mоst impоrtant strаtegic dirеctions in publiс hеalth and hеalthcare, because of increasing of prevalence, morbidity and mortality from acute and chronic ENT diseases. The dеvelopment of nеw sciеntific and mеthodological аpproaches cоuld imprоve the quаlity lifе of pаtients with disеases of the еar, nоse and thrоat, rеduce the numbеr of cоmplications frоm this pаthology, rеduce the cоst of the pаthology diagnоsing and trеatment, increase the efficiency and quality of health care delivery.

Aim of the study was to carry out a comparative analysis of the height of the maxillary sinuses, the thickness of their upper wall and bone plate in the first period of adulthood and old age using 3D digital technologies. Material and methods. The work is based on the results of a 3D study of the facial part of the skull of 92 people with a normal maxillary sinus structure who were treated at a dental clinic in Perm. All patients were mesocrans, right-handed. The subjects were divided by gender and age into two groups. The first group consisted of 21 women and 27 men of the first period of adulthood (from 22 to 35 years old), the second group was represented by 23 men and 21 women of senile age (from 75 to 86 years old). The 3D study consisted in measuring the height of the maxillary sinuses and determining the thickness of their upper wall and bone plate. The height of the sinus was considered to be its largest vertical size on the frontal section. The thickness of the upper sinus wall was determined as the widest part of the orbital surface of the maxillary bone at its most prominent point. The thickness of the bone graft was calculated as the distance from the periosteum of the roots of six teeth (from the canine to the third molar) to the deepest point of the bottom of the maxillary sinus in the projection of these teeth. Results. There is a decrease in sinus height in old age compared to the first period of adulthood (p < 0.01). The dynamics of the maxillary sinuses size indicators is manifested in thinning of the upper wall and bone lamina by old age (p < 0.01). Both in the first period of adulthood and in old age there is a tendency to anatomical asymmetry of maxillary sinuses with predominance of parameters on the right side (p > 0.05). Conclusions. The data of a lifetime comparative analysis of the linear dimensions of the right and left sinuses in patients of the first adult and infantile ages, allow us to form an idea about the 

The liver size is important to take into account when it is necessary to assess the course and severity of various diseases, including infectious, malignant and systemic diseases. The liver linear dimensions of the same patient depend on the method of examination (palpation, percussion, sonography, computed tomography, magnetic resonance imaging). The objective of this investigation was to compare the linear diameters of the liver according to ultrasound data of cadavers before autopsy and liver linear diameters after extraction of it from the abdominal cavity. Material and methods. All data were obtained in the pathology department of the Regional Clinical Hospital of the Kaliningrad Region. We examined 25 cadavers (12 females and 13 males). Before the autopsy we performed the ultrasound examination with measuring of the linear diameters of the functional left and right lobes with a convex transducer of a portable S6 ultrasound system (SonoScape, China). After the autopsy we did 3 sagitally oriented incisions for maximum linear measurements similar to previous ultrasound ones. Results and discussion. After extraction of the liver from the abdominal cavity the anteroposterior diameters of both lobes decreased on average by half after autopsy (p < 0.001), the craniocaudal diameters of the left and right lobes, on the contrary, increased on average 2 times and 1.25–1.35 times respectively (p < 0.001). The oblique craniocaudal maximum diameter of the right lobe increased (“stretches”) by an average of 1.11–1.15 times (p = 0.002). Conclusions. After extraction of the liver from the abdominal cavity all the linear diameters changed. The oblique craniocaudal maximum diameter of the right lobe is the most “stable”, due to which it possible to imagine the intravital diameter of the liver.

The aim of the work is to compare the reaction of the pituitary-gonadal system and the cortisol content in two types of dopaminergic system reactions in male residents of Arkhangelsk at the change of the photoperiod during the year. Material and methods. During one year, a four-time examination was conducted (in March, June, September, December) of 20 practically healthy males in Arkhangelsk (average age 33.3 ± 5.3 years). The concentration of dopamine was determined in blood plasma, the components of the pituitary-gonadal system and cortisol level were studied in serum. Based on the analysis of individual reactions, the sample was divided into two groups: 1 – the concentration of dopamine in the subjects increases in December compared with September (n = 10); 2 – the concentration of dopamine decreases or does not change in December compared with September (n = 10). Results. In group 1, a decrease in testosterone levels was revealed: both total (18.16 nmol/l in December and 25.20 nmol/l in September) and free (3.77 and 4.29 pg/ml, respectively) fractions. At the same time, a higher cortisol content was noted in December in the first group compared with the second (574.22 and 502.69 nmol/l, respectively). In group 2, there was a significant decrease in estradiol levels (0.13 nmol/L in December versus 0.31 nmol/L in September) with an increase in the testosterone/estradiol index (173.82 and 54.01 units, respectively). Conclusions. The individual-typological variability of the dopaminergic system in the replacement of photoperiods in males living in the European North may have an indirect effect on the pituitary-gonadal axis through parallel activation of the adrenal cortex and increased aromatase activity. We assume that an increase in dopamine content during the period of minimum daylight hours plays a significant role in the compensatory adaptive increase in estradiol levels in the male population of the North.

The liver has a big potential for self-healing, but the activity of regeneration decreases with age. Changes are occurring, including in the functional activity of various liver cell populations, the study of the characteristics of which can become the basis for the development of new therapeutic approaches to the liver diseases treatment at older people. The aim of this research was to study the level of stem and progenitor cells and the functional activity of the healthy liver from age- different rats. Material and methods. Experiments were carried out on Wistar rats aged 6 and 12 months. Ultrasound and histological examination of the liver from rats was used to assess morphological changes. The lipid profile of blood serum was evaluated by biochemical methods. Cytometric methods were used to study the surface and intracellular antigens of stem and progenitor cells isolated from the bone marrow, arterial blood and liver of rats. Results and discussion. In 12-month-old male Wistar rats, compared with 6-month-old rats, excessive formation of extracellular matrix components, disruption of tissue architecture, development of portal hypertension, as well as an increase in the concentration of cholesterol, triglycerides, high- and low-density lipoproteins were revealed. We identified age- related differences in the content of hematopoietic and mesenchymal stem cells, epithelial cells (CD45–CD326+) in the bone marrow, blood and liver of rats. In the liver parenchyma, the populations of hepatocyte precursors (CD45– CD326+CD133+), oval cells (CD45–CD326+CD133+CD90+). At the same time, the level of all cell populations in the liver parenchyma of rats expressing the intracellular marker Sox9 was higher in one-year-old animals compared to younger ones, regardless of the cell phenotype. Conclusions. In the liver of 12-month-old rats, compared to 6-month-old rats, the number of cells expressing Sox9, lymphocytes with an inflammatory phenotype increases, the number of stem cells and various populations of epithelial and endothelial cells decreases, which leads to a decrease in the regenerative capacity of the liver, disruption of the tissue architecture of the organ and changes in lipid metabolism. These changes largely determine the increased susceptibility with age to the development of chronic liver diseases.

Recent investigations have demonstrated the involvement of neutrophils and neutrophil extracellular traps (NETs) in the initiation and progression of autoimmune inflammation in rheumatoid arthritis (RA) patients. Simultaneously, macrophages/monocytes, which are the main antigen-presenting cells, play a key role in the immune response as a result of disruption of antigen processing and presentation. Studying the role of monocytes and monocyte extracellular traps (METs) in RA pathogenesis is promising and is of particular interest. The aim of the research was to study the features of the main parameters of monocyte extracellular generation traps in RA patients depending on the stage of autoimmune inflammation. Material and methods. 37 RA patients and 30 healthy individuals were enrolled in study. Circulating monocytes were purified with centrifugation procedure using iohexol with a 1068 kg/m3 density gradient. Cells were identified histochemically, and the extent of monocyte activation was assessed using common nitroblue tetrazolium test. The generation of METs was stimulated by phorbol-12-myristate-13-acetate (PMA), and visualized using fluorescence microscopy with SYBR green. Results and discussion. In patients with inactive RA, the number of monocytes in a state of generating both spontaneous and PMA-induced METs is higher compared to the reference group. The transformation of autoimmune inflammation from remission to the active phase was accompanied by a further increase in the proportion of monocytes that form METs spontaneously and in the presence of PMA (by 114.7 % and 44.2 %, respectively, relative to the comparison group). The growth rate of spontaneous METs formation is 2.6 times higher than induced METs; RA activation is evidenced by an increase in the number of monocytes in the process of spontaneous formation of METs by more than 17.8 %. Conclusions. The obtained data suggest METs participation in the initiation and maintenance of RA autoimmune inflammation along with NETs presumably through exhibition their citrulline neoepitopes. METs could probably be considered as a new potential diagnostic biomarker.

The aim of the research was to investigate the effect of argon plasma coagulation on the wall of the gastrointestinal tract in experiment. Material and methods. A method of endoscopic argon plasma coagulation in a liquid medium was developed to eliminate the shortcomings of the standard technology. Rabbits, divided into two groups, were used as experimental animals; the developed technology of argon plasma coagulation in a liquid medium was applied in the treatment group, while the standard technology of argon plasma coagulation was used in the control group. Gastroscopy, with focal application of argon plasma coagulation followed by morphological examination of the coagulation zones after 1 hour, 1 day, 3 days, and 5 days, was performed. Results. Analysis of morphological sections indicates that when using argon plasma coagulation in a liquid medium, the depth of coagulation impact on biological tissues decreases, as well as the severity of inflammatory changes, resulting in faster reparative changes. The obtained results may be of interest for further clinical-experimental research and implementation into clinical practice of modifications of endoscopic argon plasma coagulation.

The aim of the study was to compare scenarios of numerical modeling of the operation of a heart valve bioprosthesis, identifying their advantages and limitations. Material and methods. Numerical modeling was conducted in the Abaqus/ CAE (Dassault Systèmes, France) engineering analysis environment, simulating two cycles of the valve apparatus’s operation. In total, three different computer models were studied, each providing different levels of detail and complexity of the “UniLine” bioprosthesis. Model No.1 was the most simplified and considered only the geometry of the flap; Model No. 2 incorporated elastic connectors with variable stiffness; Model No. 3 included a composite support frame. Qualitative validation of the modeling results was conducted by comparing with the bench tests data obtained on the hydrodynamic stand (ViVitro Labs, Canada) during tests of the corresponding clinical model of the “UniLine” bioprosthesis. Results. One of the setups, Model No. 2, displayed an artificial stress concentration according to Von Mises in the connector attachment area, reaching 2.695 MPa, which is close to the material’s strength limit. Other setups showed a more moderate stress distribution – up to 0.803 and 0.529 MPa. Moreover, it was demonstrated that only Model No. 2 and Model No. 3 reproduce the key effect of the bioprosthesis operation, the mobility of the commissural posts, ensuring a qualitative match with the work in bench conditions. Conclusions. A methodology is proposed that may be useful for conducting further in silico studies of heart valve bioprostheses. Boundary conditions, methods for linking prosthetic components, and opportunities for large-scale “exploratory” studies based on using simplified models are described. The study results confirm the necessity of including all prosthesis components in the numerical model for a more comprehensive and realistic representation of its biomechanics. Such detail contributes to a more accurate safety and effectiveness assessment of the device and can also serve as a foundation for its further optimization.

The contribution of immunoregulatory cytokines to the formation of cold airway hyperresponsiveness in asthma patients is important for understanding approaches to therapy. Aim of the study was to investigate the interaction of tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ) with bronchial phagocytes in non-allergic asthma patients depending on the airway response to cold air. Material and methods. In 41 patients with asthma, standard monitoring of clinical symptoms of the disease was performed with assessment of the level of asthma control using the Asthma Control Test (ACT) questionnaire, basic spirometry, collection of induced and spontaneously produced sputum, as well as exhaled breath condensate (EBC), and a bronchoprovocation test of isocapnic hyperventilation with cold (–20 ºС) air (IHCA), the content of TNF-α, IFN-γ in EBC and cellular composition of sputum. Results. Cold airway hyperresponsiveness was revealed in 15 patients (group 1), and in 26 patients (group 2) bronchial reaction to IHCA was absent. There were no intergroup differences in the level of asthma control (17.1 ± 0.89 and 18.7 ± 0.63 ACT points, respectively; p > 0.05) and indices of lung function (FEV1 91.2 ± 4.07 and 98.8 ± 2.61 %, respectively; p > 0.05). In response to IHCA in sputum of group 1 patients, the number of neutrophils significantly increased, the number of macrophages, structurally integral epithelial cells decreased, proportionally to this, the level of IFN-γ increased significantly in EBC, TNF-α content did not change. Conclusions. The response to isocapnic hyperventilation with cold air in non-allergic asthma patients with cold airway hyperresponsiveness is characterized by an increase in the level of IFN-γ in the exhaled breath condensate with no significant changes in the content of TNF-α. The increase in the proportion of neutrophils in sputum under the influence of cold stimulus is accompanied by a decrease in the number of macrophages and structurally integral epithelial cells because of inflammatory damage, destruction and cytolysis.

The widespread use of testicular hyaluronidase preparations determines the particular interest in the development of oral dosage form. The drug under development, which is hyaluronidase pegylated using electron beam immobilization technology (PEG-GIAL), requires an assessment of its safety. Identification of possible neurotoxic action, as well as the influence on cardiac function seems to be very relevant. Aim of the study was to investigate the effect of PEG- GIAL on behavioural reactions and electrical activity of the heart of experimental animals. Material and methods. Eight hundred of white outbred rats (male and female) were used as experimental animals. The effect of PEG-GIAL on the central nervous system was determined using the «open field with holes» test, examining such characteristics as emotional reactions and orientation-research behaviour. The functional state of the cardiovascular system was assessed by electrocardiography data. Results. PEG-GIAL administration in all studied doses does not lead to changes in the functional activity of CNS, does not have a pronounced effect on the indices of orientation-research behaviour and emotional reactions in laboratory animals. No statistically significant changes in the cardiogram of rats were revealed, including no intersex differences. Conclusions. PEG-GIAL administration in all studied doses has no toxic effect on the electrical activity of the heart and has no pronounced effect on changes in the functional activity of the CNS and behavioural reactions.

Trigeminal neuralgia presents significant challenges in neurosurgery, with patients responding variably to Microvascular Decompression (MVD). Advanced neuroimaging techniques, specifically MRI using the Constructive Interference in Steady State (CISS) sequence and Diffusion Tensor Imaging (DTI), have emerged as promising tools in predicting the outcomes of MVD. Aim of the study was to determine neuroimaging predictors of successful microvascular decompression surgery in patients with classical trigeminal neuralgia. Material and methods. This retrospective study analyzed 58 patients who underwent microvascular decompression for classical trigeminal neuralgia at the Federal Neurosurgical Center in Novosibirsk, Russia, between January 2017 and December 2021. Outcomes were assessed by the Barrow Neurological Institution (BNI) scale. Preoperative neuroimaging with CISS and DTI was used to evaluate neurovascular conflict severity, nerve diffusion and other criteria. Results. 79.3 % (BNI I & II) of patients were practically free of pain postoperatively, in which 65.5 % (BNI I) had successfully completely recovered from the procedure with no pain, and 13.8 % (BNI II) had a good outcome. And the study found a significant correlation between favorable MVD outcomes and higher Sindou grades 2 and 3, indicating more severe neurovascular conflict (p < 0.001). Also significant differences were observed in outcomes based on fractional anisotropy values on symptomatic nerve (p = 0.029). Discussion. Anatomical factors which measured by MRI had limited impact on outcomes, while Sindou grading showed a significant correlation with surgical outcomes, and higher fractional anisotropy values were associated with poorer outcomes. Conclusions. The investigation of neuroimaging predictors for MVD surgery outcomes in patients with trigeminal neuralgia, received from CISS-sequence imaging and pre-treatment DTI, indicates the importance of estimation of severity of vascular compression in surgical planning and the predictive value of fractional anisotropy values from DTI for preoperative assessments.

Chronic heart failure (CHF) is a common complication of many cardiovascular diseases. It is important to study the clinical and functional features of CHF to clarify the further prognosis of this disease due to the unfavorable course and high mortality rate. Diagnosis and treatment of CHF is an issue for doctors of various specialties, in particular when it comes to geriatric patients with multiple concomitant diseases. Various physiological and morphological transformations in the aging population contribute to heart failure. The most common type of HF in older people is HF with preserved ejection fraction. Atypical clinical symptoms of CHF are much more common in elderly people than in young people. The prevalence of HF with age is associated with a longer period of influence of damaging factors on the heart, such as arterial hypertension, metabolic stress or ischemia-related damage. Due to the unfavorable course and high mortality rate, it is important to study the clinical and functional characteristics of CHF to clarify its prognosis. However, the data available on this issue vary significantly; the mechanisms, issues of diagnosis and treatment of patients with heart failure in different age groups have not been sufficiently studied, which determined the purpose of this study ‒ to investigate the features of the clinical and functional characteristics of CHF depending on age. Material and methods. The study included 90 male and female patients with diagnosed CHF stages I-IIB, NYHA functional class I-IV, aged 40–86 years, who underwent echocardiography, general and biochemical blood tests. The patients were divided into two groups: group 1 – patients of working age (women 16–54 years old and men 16–59 years old, n = 20), group 2 – patients older than working age (women 55 years and older, men 60 years and older, n = 70). Results and its discussion. According to the data obtained, the average age of all surveyed was 68.1 ± 9.8 years. The second stage of CHF prevailed in both the first and second groups of the studied categories of participants. Atypical symptoms prevailed, which creates difficulties in its diagnosis and treatment. The frequency of CHF decompensation in patients over working age, as well as the concentration of natriuretic peptide, is higher compared to the group of CHF patients of working age, which is probably due to the presence of comorbid pathology and cognitive deficit. The data obtained can be used to develop an approach to stratify the risk of CHF.

Complex network analysis is a relatively new method of analysis in medical research. It can be utilized in population- based study of different comorbidities. The aim of this study was to estimate the effectiveness of complex network methodology in analysis comorbidities in unruptured brain aneurysms patients. Material and methods. A comprehensive network analysis of a sample of 628,831 individuals was performed, after constructing bipartite networks all the connections between index diagnosis and revealed comorbidities were statistically validated. Results and discussion. Altogether, 1787 patients with unruptured aneurysm were identified (ICD code I67.1). After complex network analysis bipartite networks were established based on index diagnosis, there were 182 codes of comorbidities. Of those, 150 from 182 codes (82 %) were found in people aged from 40 to 70 years, men had 67 (37 %) codes and women had 115 (63 %). In addition to traditional discirculatory and heart diseases, analysis elucidated previously scarcely described comorbidities including chronic obstructive pulmonary disease in non-smokers women older than 60 years. Conclusion. Demonstrated data shows the effectiveness of network complex analysis in population-based research of comorbidities in unruptured aneurysm patients.

Aim of the study was to investigate quality of life indicators in children and adolescents with gastroesophageal reflux disease (GERD) in the Mongoloid and Caucasian populations of the Republic of Tyva. Material and Methods. Schoolchildren aged 7–18 years of the indigenous (25 Mongoloids – Tuvans with GERD and 354 practically healthy) and newcomers population Republic of Tyva (5 Caucasians with GERD and 158 practically healthy) were examined using a cross-sectional method. Gastroenterological complaints and demographic information were recorded. To assess the quality of life of children, adapted Russian parent (CHQ-PF28) and child (CHQ-PF45) versions of the Child Health Questionnaire (CHQ) were used. The questionnaire allows you to assess various areas of a child’s life. Results and discussion. A decrease in the quality of life was established in schoolchildren of both ethnic populations in the presence of GERD on a number of scales as assessed by the children themselves and their parents. However, unlike parents, children’s assessments tended to decrease in the “family cohesion” section (p = 0.068), which, to a certain extent, may reflect the presence of intrafamily problems that can have a traumatic effect on the child. According to parents’ assessments, in schoolchildren with GERD in the Caucasian population, the decrease in indicators concerned only the “physical activity” scale (p = 0.039). In the Tuvan population, more extensive deviations were noted ‒ in sections “general health assessment” (p = 0.041), “physical activity” (p = 0.024), “changes in health status” (p = 0.006), “pain/ discomfort” (p = 0.037). According to the assessment of children, Caucasians with GERD did not show a decrease in indicators, and Tuvans with GERD had fewer deviations on the scales than, according to their parents. Conclusions. Tyva schoolchildren with GERD showed a decrease in quality of life indicators, which was more pronounced among Mongoloids - Tuvans, and there were differences in its assessment by the children themselves and their parents.

An increase in the frequency of patients with arterial hypertension (AH) seeking medical care and its more severe course after a novel coronavirus infection (NCI), COVID-19, determines the need to study possible pathogenetic mechanisms of disease progression. Aim of the study was to investigate some features of lipid metabolism and changes in hemostasis in patients with AH after NCI COVID-19. Material and methods. An analysis of the most informative indicators of lipid metabolism and hemostasis was carried out in 104 patients with AH underwent (more than 2 months ago) NCI, in comparison with 117 patients with AH, with no history of COVID-19. The study included men and women aged from 30 to 75 years. Determination of the concentration of lipids in blood serum was carried out using the photometric method on a biochemical analyzer AU 480 (Beckman Coulter, США). Hemostatic parameters were determined by the chromogenic method using an automatic hemostasis analyzer Technology Solution 190 (USA). Results and discussion. It was found that patients with AH underwent NCI had significantly higher serum levels of total cholesterol, LDL cho- lesterol, triglycerides, D-dimers, platelets and lower activated partial thromboplastin and thrombin time compared with patients without COVID-19. Conclusions. The data obtained indicate a tendency to atherogenic changes in the blood lipid profile and increased coagulation processes in patients with AH in the long-term period (more than 2 months) after suffering a NCI COVID-19.

Infertility is a condition of the reproductive system, which is expressed in the absence of clinical pregnancy after 12 months of regular sexual activity without contraception. Despite the achievements of reproductive medicine, the problem of infertile marriage is far from being resolved. Restoring fertility in married couples requires rapid development of medical technologies in the field of reproductive medicine. Currently, cystectomies and myomectomies of various localizations are performed endoscopically. The undoubted advantages of laparoscopic operations are a decrease in the severity of pain syndrome, shortening the period of hospital stay after surgical treatment, and early activation of patients, as well as improvement the quality of care and increase the likelihood of spontaneous pregnancy. Aim of the study was to evaluate the effectiveness of endovideosurgical treatment of patients with various forms of infertility in a gynecological hospital. Material and methods. A statistical review of the medical documentation of the gynecological department of the Simferopol City Clinical Maternity Hospital No. 1 for 2020 was performed, data from 105 women of reproductive age (from 22 to 43 years) who underwent surgical treatment for infertility were analyzed. The patients were divided into six groups according to nosological units. The results and discussion. 47 women (44.76 %) became pregnant. In group 1 (N97.0, n = 20), 11 (55 %) became pregnant, in group 2 (n = 41), 18 (43.9 %) became pregnant. In group 3 (N97.2, n = 2), pregnancy did not occur (0 %). In group 4 (N97.3, n = 1), pregnancy did not occur after surgical treatment (0 %). In group 5 (N97.8, n = 8), two patients became pregnant (25 %). In group 6 (N97.8, n = 33), 16 (48.5 %) became pregnant. Conclusions. A positive relationship between surgical treatment of patients with various causes of infertility and the frequency of pregnancy in the natural cycle was revealed, which indicates the need for endoscopic diagnostic and therapeutic procedures to restore fertility.

Thrombocytopenia is a condition in which the level of platelets in the blood decreases and becomes less than 150×109/L. This can lead to an increased risk of bleeding. One of the causes of thrombocytopenia may be medication; its association with the use of more than 300 drugs has now been documented. The pathogenesis of such, drug-induced thrombocytopenia (DITP), is described as a consequence of direct cytotoxic effects of drug on megakaryocytes, which leads to increased platelet destruction in the bloodstream or dysfunctional thrombopoiesis. In the diagnosis of DITP the leading role belongs to the clinical approach: first of all, it is carried out on the basis of data of drug history and a minimum set of laboratory tests, including counting the number of platelets in the blood and determining the clotting time. Since thrombocytopenia may be associated with the risk of serious bleeding, its timely diagnosis is of key importance for determining the tactics of therapeutic intervention. We present a clinical case of DITP, after the combined use of drugs of different groups – statin, xanthine oxidase inhibitor, cytostatic drug of antimetabolite group, non-selective beta- adrenoblocker and two non-steroidal anti-inflammatory drugs with different mechanism of action. The described case showed that to avoid polypharmacy in patients with DITP it is necessary to assess hemostatic potential by low-frequency piezotromboelastography, because even in conditions of insufficient platelet count they can provide preserved functional ability to maintain hemostasis.

A mucocele of the appendix is a cystic formation of the appendix, the lumen of which is filled with mucin of varying consistency. There are benign and malignant forms of the disease. Its pathogenesis varies depending on the etiology and has not yet been fully studied. The clinical picture of this disease is nonspecific and there are difficulties in preoperative diagnosis. The purpose of the study is to present a rare clinical case of mucocele of the appendix, as well as literature data on this pathology. Successful treatment of a patient with appendix mucocele, an atypical location of the tumor was demonstrated. Based on the results of intraoperative express biopsy, as well as postoperative pathomorphological examination, surgical intervention was carried out to the required extent and with a favorable prognosis for the patient’s future life. Choosing the right method of surgical treatment allows you to avoid dangerous complications, such as the development of mucinous cystadenocarcinoma and pseudomyxoma peritonei. When performing surgery, it is necessary to be guided by the principles of safety from the patient’s point of view and not be afraid of performing access conversion.

According to the epidemiological dictionary definition, environmental factors have a property of influence. However, the exposure doses of risk factors (RF) and their relation to the severity, prevalence of the harmful effect in the exposed population remains unknown. Aim of the study was to find out the exposure to predictors of cardiovascular diseases (CVD) in the group of employees of locomotive crews (ELC) of the Trans-Baikal Railway (TBR). Material and methods. Predictors of acute coronary syndrome, coronary heart disease, cerebral stroke and sudden cardiac death were determined using multivariate statistical analysis during the 2008–2013 study of 22 items of a natural group of initially healthy 7959 male employees of locomotive crews (ELC) of the Trans-Baikal Railway (TBR) aged 18–66 years old. The qualities of predictors as screening tests were assessed by the quality control method of a verifiable diagnostic test (VDT) with binary outcomes. Using this method the exposure doses in the observation group were found out by determining the sensitivity value of CVD predictors. Results. The studied CVDs had overlapping predictors that had different quantitative scores in terms of VDT indicators. Exposure to risk factors at the population level can be measured by the sensitivity index of VDT, which reflects the prevalence (accumulation) of risk factors among those individuals who have the final outcome. Conclusions. Risk factors in different exposures (concentration) form different CVDs. It is necessary to monitor RF in ELC to assess their exposures, predict CVD, and organize therapeutic and preventive measures and medical care.

Aim of the study was to assess the frequency of the symptoms of professional burnout, depression, anxiety and stress in nurses working in departments providing medical and rehabilitation services to patients with impaired functions of support and movement. Material and methods. We carried out an anonymous survey among the nurses working in two medical institutions in Novokuznetsk that provide medical rehabilitation services to patients with impaired neuromuscular, skeletal or movement-related functions. In order to detect the symptoms of burnout and to determine their severity we used the Maslach Burnout Inventory adapted by N.E. Vodopyanova. The extent of depression, anxiety and stress were assessed with the DASS-21. Results. The majority of the nurses showed symptoms of burnout varying from moderate to extremely high; psychoemotional exhaustion was present in 57.7 %, depersonalization in 76.9 % and reduced personal accomplishment in 57.7 %. The integral burnout index was moderate and high or extremely high in 69.3 % of the nurses. At the same time almost half (45.4 %) of the respondents had symptoms of depression and/or anxiety (stress) and their severity correlated with the extent of burnout. Conclusions. The nurses working in departments specializing in providing medical and rehabilitation services to patients with impaired neuromuscular, skeletal or movement-related functions belong to the groups of medical persons vulnerable to professional burnout, depression, anxiety and stress.