The study of the molecular mechanisms of metabolic syndrome (MS) and its complications are among the most acute problems of modern endocrinology. Functional changes in the expression, activity, and regulatory properties of neuronal NO synthase (nNOS), which catalyzes the formation of the most important secondary mediator, nitric oxide (NO), and its dependent NO/cGMP signaling pathways in the brain, myocardium, and skeletal muscles, play a key role among the molecular causes of MS. In the brain, nNOS is associated with NMDA receptors, the hyperactivation of which in MS leads to excessive stimulation of nNOS and hyperproduction of NO, which leads to NO-induced damage to neurons and disruption of the central regulation of physiological processes and neurodegeneration. In the myocardium with MS, there are changes in the expression and localization of nNOS, as well as its functional interaction with cytoskeletal proteins, which leads to disorders of myocardial contraction and hypertrophy. In skeletal muscles, nNOS controls their contraction, oxidative metabolism, is involved in the regulation of vascular relaxation, and also participates in the regulation of glucose transport. A decrease in the expression and activity of nNOS, as well as dysregulation of its activity in MS, cause disturbances of these processes and make a significant contribution to the development of insulin resistance and deterioration of glucose homeostasis. Thus, nNOS can be considered an important therapeutic target in the treatment of MS and other metabolic disorders, as well as to prevent their complications from the nervous and cardiovascular systems and the musculoskeletal system.

Idiopathic scoliosis is a common disease of the musculoskeletal system, affecting 2–3% of children and adolescents worldwide. The etiology and pathogenesis of scoliotic spinal deformity have not yet been disclosed, despite numerous long-term studies. Animal modeling of scoliosis can become the basis for studying possible etiological factors and pathogenetic mechanisms of the formation of the pathology in question and the prospects for possible treatment of scoliosis in the future. To date, many different types of models of scoliotic disease have been created and studied. The purpose of this review was to analyze the literature data on animal modeling of scoliosis in order to understand the etiological factor of idiopathic scoliosis in humans. Material and methods. The review was carried out using databases of electronic information resources PubMed (MEDLINE), Scopus, eLibrary.ru. The analysis of scientific literature was carried out according to the search words: “idiopathic scoliosis”, “experimental model of scoliosis”, “animal model of scoliosis”, “mechanical models of scoliosis”, “pineal gland resection models”, “genetic models of scoliosis”. Results. The analysis of scientific literature data confirms the high importance of experimental animal models of scoliosis for the study of the etiology of idiopathic scoliosis. The review summarizes and analyzes data on the main directions of modeling scoliotic deformity: mechanical, neuroendocrine and genetic models. Conclusions. The models of scoliosis presented in the literature have been implemented with varying degrees of success and have not been able to clarify the etiology of spinal pathology, but they are a useful tool for testing interventions aimed at correcting and preventing deformity. The development of an optimal experimental model of scoliosis in animals will further overcome the existing limitations in determining the etiological factor of idiopathic scoliosis and describe the processes of disease development characteristic of humans.

According to current statistics worldwide, congenital orthopedic pathologies rank second quantitatively after congenital diseases of the nervous system. Congenital dislocation of the hip is one of the most common and severe pathologies of the musculoskeletal system in children and adolescents. The theories of its development and etiological factors are not only of historical interest but also create prerequisites for determining the true cause of this complex process. The problem of predicting the development of hip dysplasia remains relevant. The practical significance lies in determining the etiological factor (predisposing or risk factors) of the disease onset or manifestation. Analysis of the literature suggests that hip dysplasia is based on a genetic substrate as an etiological factor. Predisposing factors only increase the risk of pathology manifestation. Further studies to determine the etiological factor will make it possible to formulate more specific recommendations for the management of patients with hip dysplasia and possibly expand the methods of prevention and conservative treatment.

The transformations of domestic healthcare carried out in the last three decades have not led to the planned results, and in some areas the consequences have turned out to be negative. Rural healthcare suffered the most significantly. The aim of the study was based on the analysis of the situation in the rural health care of the country to propose measures to improve it. Material and methods. The statistical data of the Ministry of Health of Russia, Rosstat, Central Research Institute of Organization and Informatization of Healthcare, as well as data on the Siberian Federal District for the period from 1990 to 2020 were used. Scientific publications on the problem under consideration have been studied. Results and their discussion. The course taken in the early 90s of the last century towards the commercialization of medicine remains. So for the period from 2005 to 2018 in the structure of the country’s medical personnel, the number of people employed in the public sector decreased from 93.6 to 86.8 % (by 237 000), whereas in private medical organizations it increased by 2.3 times. In 2020, 38.4 % of medical organizations were already private. The most significant changes have occurred in rural healthcare. The number of paramedic and obstetric stations decreased by 21.1 %, the provision of beds in hospitals is 2 times lower than the national average, and doctors are 3 times fewer than in cities. In the age structure, the share of doctors over the age of 60 increased from 13.5 % (2017) to 18.1 % (2020). The implementation of the programs “Zemsky Doctor” and “Zemsky paramedic” did not lead to an increase in the provision of medical workers in rural areas. Today, medical care is geographically available only to 49 % of villagers, for 40 % it is difficult to access, and 9 % is practically inaccessible (2 % of respondents could not answer the question). This has led to the fact that the average life expectancy of the villagers is 1.5 years lower than that of the townspeople, and the total mortality is 1.2 % higher than the national average. Conclusion. The problem of accessibility of medical care to the rural population has worsened in the last three decades. The implemented programs aimed at improving its accessibility and quality, including for rural residents, have not led to a significant positive result.

Overestimation of medical consequences of low-dose exposures to ionizing radiation contributes to the strangulation of nuclear energy production. Several examples of the overestimation are discussed here: the Chernobyl accident, East Urals Radioactive Trace and Semipalatinsk Nuclear Test Site. Results of certain studies of Chernobyl-related malignancies should be reassessed taking into account that some cases, classified as aggressive radiogenic cancers, were in fact late-stage malignancies. Associations of various markers with the tumor progression can become a field for future research and re-interpretation of data obtained in studies comparing malignancies from different regions. Reported correlations between low-dose exposures and non-malignant diseases call in question the cause-effect character of such correlations for cancer reported by the same and other researchers. The correlations may have been caused or influenced by bias, in particular, the dose-dependent selection and self-selection: individuals with higher dose estimates would be on average more motivated to undergo medical checkups and given more attention. Therefore, diagnostics tend to be more efficient in people with higher doses. Lifelong animal experiments are a promising approach to the research of dose-response relationships.

Knowledge of the position of lung fissures is necessary for the appreciation of lobar anatomy and thus locating the bronchopulmonary segments. The study aimed to investigate the patterns of fissures and lobes of the lungs and their variations in Andhra Pradesh, India and to find their clinical implications and compare them with the previous studies. Methods: The patterns of lobes, fissures, and hilar anatomy of lungs and its variations of 47 lungs by dissection method of embalmed cadavers was performed in the Department of Anatomy, Narayana Medical College (Nellore, India). The specimens were macroscopically observed for gross morphology of fissures and lobes. Results. The study showed oblique fissure in 33 % (grade 1), 26 % (grade 2), 24 % (grade 3) and 14 % (grade 4) of right lungs and 27 % (grade 1), 31 % (grade 2), 12 % (grade 3) and 12 % (grade 4) of left lungs. The incomplete horizontal fissure was seen in 38 % of right-sided lungs (grade 1). 19 % of right lungs and 10 % of left lungs had accessory lung fissures. Conclusions. Awareness of the variations in the lobes and fissures of the lungs is important for radiologists while interpreting magnetic resonance imaging and computed tomography scans. Also, we believe that the data from the present study certainly adds an important reference in the medical literature to thoracic surgeons in performing pneumonectomy and segmental resection.

Aim. To study the spectrum of variants in the PRL, PRLR, PRLHR genes in women of reproductive age with non-tumor hyperprolactinemia. Material and methods. In women with non-tumor hyperprolactinemia (n = 15), targeted high-throughput sequencing of the PRL, PRLR, and PRLHR genes was performed. The target panel of genes included coding regions and adjacent splicing sites. Results. When analyzing the PRL, PRLR, PRLHR genes, a number of rare and common variants were identified. The common variant rs1205955 was found in the PRL gene (MAF А = 0.279). For the PRLR gene, a rare variant rs185353023 was identified in the 3’UTR (MAF А/С = 0.003) and 12 common variants. For the PRLHR gene, 10 common variants have been identified. The maximum number of variants was localized in the 3’UTR region and introns. Conclusions. For the first time in Russia, targeted high-throughput sequencing of the PRL, PRLR, PRLHR genes was performed, the results of which did not reveal obvious pathological variants in the studied genes in women with high prolactin content of non-tumor origin. The discovered polymorphism in these genes makes it possible to further study its association with impaired function of the prolactin link of hormonal regulation.

Background. The study of explanted heart valve bioprostheses is a valuable source of information about the destructive processes in their components that develop as a result of prolonged contact with the recipient’s body. An analysis of the morphology, staging and degree of involvement of various valve prosthesis materials in the prevalence of pathological processes – calcification, mechanical damage, growth of the connective tissue capsule, is the basis for developing potential methods for increasing the service life of these products and reducing the risk of re-interventions. The aim of the study was to evaluate the potential of computed microtomography to analyze the internal structure of a biological prosthetic heart valve explanted due to dysfunction. Material and methods. In this work, we investigated the prevalence of pathological mineralization of the PeriCor bioprosthesis, explanted as a result of the developed dysfunction of the leaflet apparatus with a clinical picture of grade 2B prosthetic insufficiency. The material was described macroscopically, after which it was subjected to high-resolution computed microtomography. In the structure of the sample, X-ray dense areas of pathological mineralization were identified and described, and the volume of the material involved in calcification was assessed. Results. It was shown that the main pathological changes that led to prosthetic dysfunction were degenerative changes in the biomaterial with signs of calcification, thickening and rupture of the leaflets. It was quantitatively determined that the areas of radiologically dense inclusions (calcifications) occupy 11.1 % of the volume of the material. It has been established that the described areas are associated with the sheathing of the frame and with the elements of the suture material used in the production of this bioprosthesis. Conclusion. The method of non-destructive analysis of the internal structure of altered materials of a biological prosthesis studied in this work has demonstrated the possibility of а qualitative and quantitative assessment of areas of pathological mineralization, their distribution and connection with other processes leading to the development of prosthetic dysfunction. The method makes it possible to visualize macro- and microsites of calcification and can become a valuable tool to complement existing approaches to the study of explanted bioprostheses.

There is a high risk of suicidal attempts in patients with psychiatric problems. This risk varies according to the sociodemographic status and clinical presentation. Periodic systematic profiling of suicidal risk factors in developing countries is an established need. Objectives. The objective was to study the sociodemographic data, psychiatric disorder, precipitating events, mode of attempt, and intent of attempt in suicide attempted patients. Material and methods. During the 1.5 years, 150 referrals were screened for the presence of suicide attempters in consultation-liaison services. Those who fulfilled the criteria for suicide attempters were evaluated by using semistructured pro forma containing sociodemographic data, precipitating events, mode of attempt, psychiatric diagnosis by using ICD-10 and intent of the attempt. Results. Adult age, rural background, housewives and students, unemployed, below matriculation educated were more represented in this study. Gender wise more females are represented. More than 80 % of all attempters had a psychiatric disorder. The majority had a precipitating event before the suicide attempt. The most common method of attempt was by use of insecticide poison. Many have moderate intent in the attempt. Conclusions. The majority of suicide attempt patients had a mental illness. Early identification and treatment of these disorders would have prevented morbidity and mortality associated with this.

Sarcopenia is a special condition that develops in older people. Sarcopenia represents a loss of muscle strength and mass in the elderly and is a common disease and is also associated with several adverse health effects. Due to the impact of sarcopenia on quality of life, disability and mortality, greater awareness is needed to correctly identify this condition and in particular its biological immunoendocrine markers. The purpose of the study was to study the characteristics of metabolism in sarcopenia in elderly people at the molecular, cellular and organizational levels. Material and methods. The study included 402 elderly people (199 men and 203 women, average age 68.9 ± 1.2 years), who are divided into three groups depending on the presence or absence of arterial hypertension and sarcopenia. The state of adipose and muscle tissue was studied using anthropometric measurements, bioimpedansometry and dynamometry. Results and discussion. The present study revealed a significant increase in energy exchange tension in patients with arterial hypertension, expressed in the increase in ADP content, but it was not enough to maintain the ATP/ADP ratio at the proper level. In patients with arterial hypertension and sarcopenia, a pronounced deficiency in ATP and ADP content, as well as ATP/ADP ratio was observed. The energy deficiency can also be explained by increase in lactate dehydrogenase activity in patients with arterial hypertension to compensate for energy deficiency by enhancing glycolysis processes. However, when sarcopenia was attached, this sanogenetic compensatory mechanism no longer worked. Conclusions. Dysfunction of adipose tissue in patients with arterial hypertension precedes the development of sarcopenia, while there is an increase in tension in energy exchange, expressed in elevation of ADP content, but when sarcopenia joins, there is a pronounced deficiency in both ATP and ADP content, as well as ATP/ADP ratio.

To date, mortality from a complex pelvic injury remains high. It is noted that the total mortality from pelvic injury is 4.7 %. It is recognized that diagnostic imaging plays a leading role in the treatment of pelvic fractures, and image quality helps to reduce the morbidity and mortality of patients with injuries. The aim of the study was to evaluate the role of CT with three-dimensional reconstruction in the diagnosis of pelvic bone fractures. Material and methods. During the 36-month period, 76 patients of both sexes (54 (71.0 %) men and 22 (29.0 %) women) were examined. The Young-Burgess classification system was used to assess the nature of pelvic fractures. A spiral computed tomograph Aquilion 16 Model TSX-101A (Toshiba, Japan) was used. All patients are scanned in a supine position with no movement during the examination. The scan was started from the top of the iliac crest and continued through the level of the sciatic tubercles. The thickness of the cut and the step of the tomography is 10 mm, the table feed is 15 mm per tube revolution, the pitch is 1.5:1, the scanning time is 20–30 seconds. Results. The average age of the patients was 35.2 ± 1.77 years. The largest share was road injuries – 86.9 %: road accidents – 30.3 %, collisions with a pedestrian – 32.9 %, motorcycle and bicycle accidents – 23.7 %, falling from a height – 13.1 % of patients. Pelvic organ radiography diagnosed a sacral fracture in 33 (43.4 %) patients. Anteroposterior compression (AS) was recorded in 9.2 % of cases, of which AS-I in 7.89 %, AS-II – 1.31 %. Lateral compression was observed in 73.68 % of cases: LC-I – 57.89 %, LC-II – 10.53 %, LC-III – 5.26 %. Vertical shift and mixed mechanical injury were detected in 7.89 and in 7.89 % of cases, respectively. The unclassified fracture was detected in 1.31 % of cases. Pelvic ring fractures were associated with sacral fractures (69 (90.8 %) patients) and with acetabular fractures (63 (82.9 %) cases), in 6 (7.9 %) patients – not associated. Conclusions. In combined injuries, lateral compression injuries of the pelvis were more common, which, in comparison with traditional radiographs, were statistically significantly recognized on CT images (p < 0.001), which confirmed the fact that pelvic fractures are more common in lateral compression injuries than in anteroposterior injuries. For a complete assessment of the pelvic ring, in addition to the pelvic view, a CT scan of the lateral part of the sacrum is required.

To create a systematic database on the presence of metals in the environment and the human body, it is necessary to conduct local studies in different regions of the Russian Federation. A comprehensive analysis of the content of cadmium and lead in different coenotic links, including the human body, has not been carried out in the Altai Republic. The aim of the study was to reveal the level of lead and cadmium accumulation in the solid and finely dispersed phases of snow and hair of the population of Gorno-Altaisk. Material and methods. The content of lead and cadmium in the snow and hair of the population of Gorno-Altaisk was estimated by the atomic absorption method. Snow samples were taken in the areas of 10 central coal boilers, hair samples were taken from 122 volunteers permanently residing in the city. Results. The concentration of metals in snow water exceeded the maximum allowable concentrations: for cadmium (0.004–0.008 mg/kg) by 3.8–8.2 times; for lead (0.008–0.469 mg/kg) by 2–15.6 times. In the solid phases of snow, the content of metals exceeded the permissible level by about 3 times. The average value of the concentration of cadmium in the hair of the population was 0.16 mg/kg, which did not exceed the all-Russian reference value (0.25 mg/kg), the proportion of excess among the population was 6.5 %. The lead content (3.18 mg/kg) approximately corresponded to the all-Russian values (3.0 mg/kg), the excess was found among 43 % of the population. Conclusion. As a result of the widespread use of solid fuels, the presence of cadmium and lead in the environment increases, which is confirmed by the accumulation of these metals in the snow cover and the accumulation of the analyzed microelements in the hair of the population of Gorno-Altaisk.