The objective of the review is to systematize current information on the prevalence of viral hepatitis B and C, the risks of hepatocellular carcinoma (HCC) against their background and methods of its treatment and prevention.

   The highest prevalence of HCC is observed in the countries of Southeast Asia, which agrees with the prevalence of viral hepatitis B and C in these regions, as well as with the peculiarities of nutrition. It has been noted that increased alcohol consumption and metabolic syndrome are also risk factors for HCC in patients with viral hepatitis B or C. When diagnosed in early stages, HCC is treatable with locoregional techniques including surgical resection, radiofrequency ablation, transarterial chemoembolization, or liver transplantation. Methods for preventing HCC development include a healthy lifestyle, avoidance of bad habits, monitoring of liver condition if the patient has viral hepatitis. Timely vaccination against hepatitis B and correct treatment of hepatitis C are expected to reduce the number of patients with HCC. Universal screening for hepatitis B virus infection among adults aged 18–69 years is cost-effective. Standardization of HCC diagnosis and implementation of surveillance programs for at-risk individuals are critical for earlier diagnosis. Future efforts should focus on expanding our knowledge of the causes of HCC, identifying highly specific biomarkers, preventing HCC, and developing more effective treatments.

   Key biomolecular targets involved in regulating neuronal excitability are discussed, and recent findings on benzimidazole derivatives exhibiting anticonvulsant activity are presented. The relationship between their structure and anticonvulsant activity is closely analyzed. The literature review revealed that benzimidazoles possess diverse biological activities and significant potential for modulating ion channels, receptors, and other targets implicated in epileptogenesis, making them a promising scaffold for the development of novel antiepileptic drugs; can enhance GABAergic neurotransmission,
showing strong anticonvulsant properties in various experimental models of epilepsy; antagonize NMDA receptors, which helps reduce neuronal hyperexcitability and provides neuroprotective effects; modulate T-type calcium channels and TRPM7 channels, which are important targets for treating absence epilepsy and preventing relapses of status epilepticus. Selective kappa opioid receptor agonists also demonstrate anticonvulsant effects and the ability to block excitotoxicity. Ligands that act on peroxisome proliferator-activated receptors gamma, KV7 channels, and purine P2X3 receptors are also considered. Continued research in this field may lead to the discovery of effective and well-tolerated medications for managing epilepsy.

   The article is devoted to anxiety disorders in patients with infertility. Along with the physical aspects of this condition, many patients are experiencing significant emotional and psychological suffering. Women often experience feelings of loss, guilt, and loneliness. Unsuccessful trying to get pregnant can be a source of constant stress, affecting quality of life and relationships with partners and loved ones. The literature review presents modern data on the classification of infertility, symptoms of anxiety disorder, its etiology, the role of physiological, psychological and social factors, and the diagnosis of anxiety disorder using clinical and psychometric methods. The methods of treatment used are described, including psychopharmacological methods and psychotherapy. Anxiety disorders are a frequent companion of infertility, but they can and should be fought. A comprehensive approach including psychotherapy, medical treatment and support from loved ones helps many women to cope with anxiety and restore psycho-emotional balance.

   Entheses are vulnerable to acute trauma under excessive loads, and are also the main target organ in a number of rheumatic conditions.

   Aim of the study was to investigate the features of the microscopic structure of the entheses of the fifth metatarsal bone in humans.

   Material and methods. The feet of 56 male cadavers aged 21–35 years were studied. On micropreparations of the fifth metatarsal bone with its ligamentous apparatus, the thickness of the fibrocartilaginous enthesis zones was measured, the location of collagen fibers was described, and their percentage content per unit area in the zones of calcified and mineralized fibrous cartilage of the enthesis was calculated, followed by a comparative analysis of the data obtained.

   Results and discussion. It was found that the connections of all four ligaments and the tendon to the V metatarsal bone are fibrocartilaginous entheses with four separate zones in their histological structure. A reliable predominance of the thickness of the calcified fibrous cartilage zone over the thickness of the mineralized fibrous cartilage zone of the entheses of the tendon of the short peroneus muscle, metatarsal plantar and collateral ligaments with a parallel arrangement of convoluted collagen fibers and single mature chondrocytes and their isogenic groups was revealed. The maximum thickness of the calcified fibrous cartilage zone is noted for the enthesis of the deep transverse metatarsal ligament with a direct arrangement of collagen fibers and multiple isogenic groups of chondrocytes, the minimum ‒ for the tarsometatarsal and long plantar ligaments with chaotically intertwined collagen fibers and many mature chondrocytes and their isogenic groups. The serrated basophilic line of enthesis of the tendon of the peroneus brevis muscle is characterized by the greatest thickness and amplitude of the serrations. A decrease in the proportion of collagen fibers from the calcified to the mineralized zone was revealed at the entheses of the tendon of the short peroneus muscle and the complex of the tarsometatarsal and long plantar ligaments; an increase in the proportion of collagen towards the mineralized zone at the enthesis of the deep transverse metatarsal ligament and its equal proportion at the entheses of the metatarsal plantar and collateral ligaments.

   Conclusions. The conducted study with the discovery of the features of the microstructure of the entheses of the fifth metatarsal bone testifies to the existence of age, sex, and possibly constitutional patterns of their structure and predisposition to mechanical injury.

   The aim of the study was to establish age and gender patterns of topographic anatomy of the spleen in children and adolescents based on intravital imaging data.

   Material and methods. Computed tomograms of the abdominal cavity of 88 children and adolescents without visible pathology of the abdominal organs were analyzed. The subjects were divided into 4 age groups: early, first and second childhood, and adolescence. The distance from the spleen to the median sagittal plane, the distance from the spleen to the abdominal organs, the skeletotopy of the spleen and the distance from the spleen to the surface of the body were determined.

   Results and discussion. A significant increase in the distance from the spleen to the median sagittal plane with age was found. In the first three age groups, the value of the indicator was higher for girls compared to boys, and lower in adolescence. A significant increase in the distance from the spleen to the liver, pancreas, aorta, inferior vena cava, and loops of the jejunum and ileum was determined from early childhood to adolescence; in individuals of the first and early childhood ages, the distance to the liver, pancreas, aorta, and inferior vena cava was the same, while in adolescents it was greater than in those examined in the second childhood. Within one group, no differences were found between the indicators for girls and boys. Skeletotopically, the spleen tended to be located lower with age. The upper pole of the spleen in the overwhelming majority of cases descended from ThIX to the intervertebral disc ThX–ThXI, the hilum of the spleen ‒ from ThXII to the intervertebral disc ThXII–LI, the lower pole ‒ from LI to the intervertebral disc LI–LII. The distance from the spleen to the body surface significantly increased from early childhood to adolescence along the anterior median, left middle axillary and left scapular lines; in individuals of the first and early childhood ages it was the same, in children of the second childhood and adolescence it increased in comparison with previous age periods. In the adolescent group, the indicator was higher among boys than among girls along the anterior median, left middle axillary and left scapular lines.

   Conclusions. The article presents the topographic and anatomical characteristics of the spleen in children and adolescents and establishes patterns of change taking into account the sex and age of the subjects.

   The aim of this study was to predict, using molecular docking, the formation of complexes between cholera toxin subunit B (CTB) and lipid raft components – gangliosides GM1 and GM3, lactosylceramide (LacCer), and cholesterol.

   Material and methods. The study involved modeling the three-dimensional structure of the lipid raft–CTB complex to obtain information on ligand coordinates and binding energy, analysis of the amino acid sequences of the CTB D-chain, and molecular docking.

   Results. Three-dimensional structures of the complexes were obtained using molecular docking. The topology of ligands GM1, GM3, and cholesterol in the molecular pocket of the CTB D-chain was proposed. It was shown that the conformations of CTB with GM1, GM3, and cholesterol ligands exhibited negative binding energy, indicating the potential formation of stable complexes. LacCer was an exception, as its chemical characteristics, associated with the formation of unstable conformers, rendered it unsuitable for docking analysis.

   Conclusions. The proposed algorithms lay a scientific foundation for solving important applied problems in bioinformatics and pharmacology, specifically in the study of the pathogenesis and treatment of diseases related to lipid raft dysfunction.

   The aim of this work was to obtain and study antiviral properties of a drug for intranasal use containing yeast double-stranded RNA (dsRNA) and recombinant human interferon alpha-2b (IFN-α2b) incorporated into a delivery system (molecular construct).

   Material and methods. Molecular constructs carrying IFN-α2b and dsRNA were obtained by our original method. For present study, the samples of intranasal dosage forms of three formulations were chosen: 50 µg of dsRNA and 10, 50 or 100 IU of IFN-α2b per one dose. The in vitro antiviral activity of the composition preparations was determined by inhibition of cytopathic effect (CPE) of murine encephalomyocarditis virus (EMCV), Columbia strain, in mouse L929 and L-68 cell cultures. The in vivo protective properties of the preparations were studied in white outbred ICR male mice intranasally infected with 10 lethal dose, 50 %, of influenza virus strain A/Aichi/2/68 (H3N2). The protection coefficient was calculated by average life expectancy and death of animals.

   Results and discussion. All the composition preparations used in this study demonstrated the ability to inhibit the destructive effect of the test virus and increase the number of viable cells in L929 and L-68 cultures. The enhancement of the protective effect was observed with increasing IFN-α2b content in the drug formulation. The greatest antiviral activity was shown for the preparation containing 50 µg of dsRNA and 100 IU of IFN-α2b per dose. A composition preparation of the same formulation, administered intranasally three times at a dose of (2.5 mg dsRNA and 5000 IU IFN-α2b)/kg according to the therapeutic and prophylactic regimen, protected 50 % of animals from death, which was not observed in a group administered with dsRNA alone. IFN-α2b used at a dose equivalent to its content in the composition preparation had a similar but less pronounced effect.

   Conclusions. The results of the in vitro and in vivo experiments have confirmed the fact that combining interferon and its inducer enhances the antiviral effect of the composition drug compared to that of its components used separately. The data obtained testify to the prospects for the development of intranasal forms of antiviral drugs using a combination of interferon and dsRNA incorporated in a delivery system.

   Skin wounds are common and represent a major public health and economic problem due to the risk of complications and significant negative impact on patients’ quality of life. The wound healing process involves the interaction of multiple skin cells, immune cells, blood cellular components, growth factors and cytokines. However, external factors such as the skin microbiota may also play an important role in wound healing. Recent studies have shown interactions between different types of microorganisms, as well as between microorganisms and the host immune system in the wound environment.

   The aim of the study: to analyze the microbiota and determine its correlation with the pH of the wound environment using an experimental infected wound as an example.

   Material and methods. In an experiment on 60 Wistar rats, in which an infected wound was modeled, its microbiota was studied by mass spectrometry of microbial markers using a gas chromatograph with a «Maestro» mass-selective detector, the pH of the wound surface was also measured.

   Results and discussion. The microbiota of the infected wound consisted of an association of 26 genera and individual species of microorganisms. Gram-positive bacteria remained dominant throughout the entire experiment; more than 70 % of the total number of microorganisms were strict anaerobes. A strong positive correlation was found between 18 genera of microorganisms, as well as a relationship between the pH of the wound environment and the level of wound contamination.

   Conclusions. When choosing agents for local treatment of infected wounds, it should be taken into account that the wound microbiota includes gram-positive and gram-negative aerobic and anaerobic bacteria, as well as microscopic fungi. Therefore, drugs not only should have a bactericidal effect on aerobic bacteria, as the most common cause of wound infection, but also be effective against anaerobic bacteria and exhibit fungicidal activity. The data regarding the correlation between pH and the level of wound contamination can be used to monitor the wound process.

   Paracetamol is one of the five most common drugs causing fatal hepatotoxicity. The mouse model of paracetamol hepatotoxicity adequately reflects the mechanism of drug poisoning in humans. However, there are many controversies associated with understanding the pathogenetic mechanisms of process.

   Aim of the study was to reveal the signs of systemic damage of various organs on the basis of estimation of haematological and biochemical indices of peripheral blood of experimental animals after administration of a half-year dose of paracetamol.

   Material and methods. Male C57Bl/6 mice aged 10 weeks were given a single intraperitoneal injection of a paracetamol solution at a concentration of 14 mg/ml at a dose of 600 mg/kg body weight or saline in an equivalent volume, after 6, 12, 24 and 48 hours, blood was collected and haematological and biochemical analysis were performed.

   Results and discussion. Paracetamol administration causes in mice an increase in alanine and aspartate aminotransferase activity, decrease in total protein, albumin, globulin content. There is an increase in the urea and creatinine level. Transient monocytopenia, lympho- and thrombocytopenia, granulocytosis are observed in peripheral blood.

   Conclusions. After administration of paracetamol at a dose of 600 mg/kg body weight, signs of liver (change of alanine and aspartate aminotransferase activity, total protein and urea content) and kidney (creatinine level) dysfunction were detected in mice. In peripheral blood, the classic picture of inflammatory response is determined (lymphopenia and granulocytosis) with signs of impaired haemostasis in the form of thrombocytopenia. No generalized changes affecting all organs were detected, which determines the need to use more sensitive and specific methods to detect signs of systemic inflammation.

   The unsatisfactory quality of drinking water has a significant impact on the health of the population, mainly living in rural settlements. Due to natural features, the quality of groundwater in the region is characterized by severe mineralization, hardness, alkalinity, increased iron, boron, manganese, sodium concentration and fluoride deficiency, which makes them unsuitable for drinking water supply without preliminary water treatment and may be risk factor for the pathology of the digestive and genitourinary systems.

   Aim of the study was to investigate changes in the macro- and microelement composition in the blood, as well as their associations with increased general hardness of drinking water and some therapeutic diseases in rural and urban residents of the Novosibirsk region.

   Material and methods. The study included 185 people, urban and rural residents of the Novosibirsk region, who underwent screening at the Research Institute of Internal and Preventive Medicine – Branch of the Federal Research Center Institute of Cytology and Genetics SB RAS. Anamnestic and socio-demographic data were collected in all patients, and blood was taken for biochemical examination. Serum level of calcium, phosphorus, magnesium, iron and creatinine were determined. A physicochemical analysis of tap water was carried out in the places of residence of the subjects.

   Results and discussion. A comparative analysis of the chemical parameters of water revealed differences in the levels of calcium, magnesium, manganese, copper and total hardness. The blood level of calcium, iron and creatinine in were statistically significantly higher than in the control group; among the main group patients, chronic kidney disease (2.4 times, p = 0.006) and urolithiasis (1.6 times, p = 0.051) were more common.

   Conclusions. Regional differences in the mineral composition of tap water and blood parameters of residents of these settlements are described. The level of creatinine and micro- and macronutrients such as iron and calcium in the blood of rural residents is higher.

   Avian influenza A virus subtype H5 is widespread in the bird population, and there is a risk of its transmission to humans, therefore, it is necessary to develop an effective vaccine to prevent virus spread.

   The aim of the work was to develop prototypes of DNA vaccines encoding modified variants of the hemagglutinin trimer of highly pathogenic avian influenza A virus (H5N8) and its fragment (stem) and to study their immunogenic properties.

   Material and methods. DNA constructs were designed, produced and purified, their expression was analyzed in eukaryotic cells using reverse transcription PCR and Western blot analysis. Laboratory animals (Syrian hamsters) were immunized with experimental DNA vaccines using the jet injection method, the antibody titer in their sera was determined using ELISA. The sera were also tested in the virus neutralization reaction in MDCK cell culture.

   Results and discussion. Expression of target genes in experimental DNA vaccines was confirmed at the transcription and translation levels. Immunogenicity analysis showed that immunization of Syrian hamsters with pVAX-H5 and pVAX-H5 delT4 constructs encoding hemagglutinin ectodomain variants with and without the fibritin trimerizing domain of bacteriophage T4 using jet injection resulted in the formation of specific antibodies (average titer 1:3×104 and 1:5×103, respectively) with virus-neutralizing activity (average 50 % neutralizing titer 1:40). At the same time, specific antibodies were not detected in the group of animals immunized with the DNA vaccine encoding the hemagglutinin stalk.

   Conclusions. In the course of the work, DNA vaccines encoding variants of the hemagglutinin trimer of the influenza virus subtype A (H5N8) and its fragment (stem) were designed and obtained. A comparison of the immunogenicity of experimental DNA vaccines was conducted and the most promising variant of the design – pVAX-H5, encoding a modified trimer of the hemagglutinin of the influenza virus with a trimerizing domain of the fibritin of the bacteriophage T4 – was established.

   The assessment of the influence of occupational factors on the state of internal organs in model conditions is becoming increasingly relevant to establish the initial manifestations of pathology at the stage of examination of the connection between the disease and the occupation of workers in harmful production conditions.

   The aim of the study was to assess the influence of occupational factors (at the level of 1.5 MPC, MPD) on the state of internal organs in Wistar rats under model conditions of a 180-day experiment, depending on the type and duration of their exposure.

   Materials and methods. In assessing the 180-day dynamics (from 0 days – 6 months (background) to 60–120–180 days – 8–10–12 months) of the impact of production factors on the morphological state of tissues and organs of Wistar rats, generally accepted and unified methods were used. Animals (n = 72) of both sexes were distributed in equal numbers (18 individuals each) into the comparison group (not exposed to production factors) and 3 experimental groups (exposure to vibration, noise, chemical exposure). Additionally, 10 individuals who were sacrificed on day 0 – 6 months (background) were allocated to the comparison group for background analysis. Every 60 days (in 180-day dynamics) after exposure to production factors, animals were euthanized with chloroform (3 ml of chloroform was injected into the desiccator with a syringe and the time from the moment of administration to the moment of onset of narcotic sleep was noted, the procedure was repeated with 5 and 10 ml of chloroform), and necropsied with organ extraction for histopathological studies. The sections were stained with hematoxylin and eosin.

   Results and discussion. In a chronic experiment, initial pathomorphological signs of damage in 2 or more organs were established on the 60^th day of exposure to production factors, and a large degree of organ tissue damage in rats was noted from the effects of chemical and physical factors (general vibration) on the 180^th day of the experiment, unlike the comparison group.

   Conclusions. Based on the conducted experiment on the impact of production factors (at the level of 1.5 maximum permissible concentration and maximum permissible level) on the state of the internal organs of experimental animals, it can be concluded that they develop morphofunctional disorders in 2 or more organs (biomarker of accelerated aging) on the 180th day of the experiment (with initial manifestations on the 60^th and 120^th days), which can provoke accelerated aging of the biological systems of animals and humans, and negatively affect their life expectancy.

   The work is devoted to the screening study of the psychotropic activity of regulatory peptides of a number of glyprolins and melanocortins in conditions of thyroid hyperfunction.

   Material and methods. The study was carried out on male rats divided into groups: I – intact rats (control); II – individuals with experimental hyperthyroidism; III, IV, V, VI, VII and VIII – animals with induced hyperthyroidism receiving Thr-Lys-Pro-Arg-Pro-Gly-Pro, ACTH(4-7)-Pro-Gly-Pro, ACTH(6-9)-Pro-Gly-Pro, Pro-Gly-Pro, Pro-Gly-Pro-Leu, Arg-Pro-Gly-Pro, Pro-Gly-Pro-Val and Met-Thr-Lys-Pro-Arg-Pro-Gly-Pro, respectively. The behavioural activity of rodents was studied using the «Open Field» test.

   Results and its discussion. It was found that in the group of rats with induced hyperthyroidism there was an increase in chaotic, disorderly motor activity against the background of a decrease in orienteering and exploratory (crossing the centre, examination of burrows) and an increase in the level of anxiety (defecation, grooming, freezing). The investigated melanocortin and glyproline compounds against the background of thyroid dysfunction had to a greater or lesser extent a corrective effect on the behavioural status of laboratory animals.

   Conclusions. The results of the screening study of psychotropic activity of glyproline and melanocortin peptides under conditions of thyroid hyperfunction testify to the fact that that the compounds Thr-Lys-Pro-Arg-Pro-Gly-Pro and Met-Thr-Lys-Pro-Arg-Pro-Gly-Pro show the most pronounced effect on behavioural parameters in the «Open Field» test at intraperitoneal administration at doses of 87 and 88 µg/kg/day equal to 1/10 of their molecular weight.

   Impaired cardiovascular function in metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) is not adequately studied, and data on changes in electrocardiogram (ECG) parameters, including in rodent models of MS and T2DM, are contradictory and ambiguous.

   Aim of the study was to investigate ECG parameters in models of MS and T2DM and to identify possible correlations between impaired glucose tolerance and the severity of changes in ECG parameters.

   Material and methods. Male Wistar rats were used in the experiments. MS was induced by a high-fat diet (HFD) for 17 weeks; T2DM was induced by a combination of HFD and streptozotocin injection (HFD + STZ): 11 weeks of HFD followed by an injection of streptozotocin and continued HFD for another 6 weeks. Control animals were kept on a standard diet.

   Results. The glucose tolerance test confirmed the development of impaired glucose tolerance to the prediabetic level in the HFD group and to the diabetic level in the HFD+STZ group. ECG changes were found only in the HFD+STZ group: a significant (compared to the control and HFD group) increase in the amplitude and area T wave on the ECG was shown.

   Conclusions. Pronounced ECG abnormalities develop only in the model of T2DM, but not in the MS model.

   The data on the prognostic significance and relationship of the prolonged QT syndrome with the risk of cardiac rhythm disturbances in liver cirrhosis are contradictory. One of the directions of further research in this area is to study the significance of other electrocardiographic parameters reflecting ventricular repolarization disturbance in patients with liver cirrhosis.

   Aim of the study was to investigate diagnostic and prognostic value of electrocardiographic parameters reflecting changes in heart electrical systole and heterogeneity of ventricular repolarization in relation to the presence of terminal liver cirrhosis and development of adverse outcomes in patients with established diagnosis of liver cirrhosis.

   Material and methods. The study included 35 patients with an established diagnosis of liver cirrhosis and 20 comparison group individuals matched by gender (p = 0.550) and age (p = 0.376). The severity of liver cirrhosis was assessed using the MELD and Child-Turcotte-Pugh scales. All patients had ECG recorded and analyzed on a Poli-Spectrum-8/E electrocardiograph (Neurosoft LLC, Ivanovo).

   Results. Patients with liver cirrhosis had significantly longer QTc interval durations than those in the comparison group (458.0 [432.5; 482.7] and 418.5 [405.0; 432.0] ms, respectively) (median [25^th percentile; 75^th percentile]) and smaller absolute and relative to QT interval Tpeak-Tend interval values. The severity of liver cirrhosis, as determined by the MELD scale, was directly correlated with QTc (r = 0.355; p = 0.0396), QTd (r = 0.389; p = 0.0228) and QTcd (r = 0.382; p = 0.0257) interval duration. The follow-up period was 3.96 [1.50; 8.59] months. Death from cirrhosis-related causes was recorded in 12 (34.3 %) patients. Among the electrocardiographic parameters investigated, the addition of QTc interval duration to the MELD scale in the prognostic model made it possible to increase the model performance and achieve statistical significance (area under the curve 0.763 (95 % confidence interval 0.633–0.894), p = 0.0088).

   Conclusions. Patients with liver had higher QTc values than those in the comparison group and lower Tpeak-Tend, Tpeak-Tend/QT and Tpeak-Tend/QTc values. The severity of liver cirrhosis, as determined by the MELD scale, was associated with an increase in QTc, QTd and QTcd duration. Adding QTc interval duration to the MELD scale allowed for the increase in the performance of the all-cause mortality prediction model.

   The urobiome is being actively studied, diagnostics are being improved and new markers of inflammatory diseases of the urinary tract are being searched for, despite the fact that most microorganisms are unidentified and their functions remain not fully understood.

   The aim of the study was to study the composition of the urinary tract microbiota (urobiota) in patients with liver cirrhosis, depending on the presence of urinary tract infection.

   Material and methods. A prospective cohort single-center study was conducted on 48 patients with liver cirrhosis (30 men, 18 women), who, in addition to standard studies, underwent metagenomic sequencing of urine and feces. The average age of the examined patients was 50.5 years, there were 16 and 32 patients with and without urinary tract infection, respectively. High-performance sequencing was performed using the MiSeq genetic analyzer (Illumina, USA) using a protocol based on the analysis of variable regions of the 16s rRNA gene. Data analysis was performed using the Kraken2 algorithm. The significance level of α is assumed to be 0.05. The study is registered in Clinicaltrials.gov (NCT05335213).

   The results and their discussion. The dominant phylotypes of the urobiota in patients with liver cirrhosis are Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, among which Proteobacteria predominate (more than 50 %). The beta diversity of the urinary tract microbiota has significant differences in patients without or with urinary tract infection (p = 0.001). Urinary tract infection increases the density of such taxa in urine as Gammaproteobacteria, including Escherichia, Klebsiella, Acinetobacter, Enterobacter, as well as Bacilli, Synergistia, Deltaproteobacteria, Epsilonproteobacteria, Acidithiobacillia and decreases the density of Prevotella, Clostridioides, Brevundimonas, Delftia, Stenotrophomonas, Streptococcus (p < 0.05).

   Conclusions. Microbiological identification based on the method of metagenomic sequencing made it possible to identify more than 1,000 types of microorganisms in the urine of patients with liver cirrhosis, including uncultivated ones, and a characteristic bacterial pattern of urinary tract infection, which expands the understanding of the pathogenesis and diagnostic possibilities of urinary tract infections and creates prerequisites for substantiating the directions of microbiota modulation and personalization of patient treatment.

   Hypertension is a chronic progressive disease, in the absence of correction of which, target organs are involved in the pathological process, with the disease worsening and the life expectancy deterioration. Chronic kidney disease (CKD) develops in about 30 % of patients with hypertension, causing the development of cardiovascular complications, including death. The prognostically unfavorable combinations of risk factors in men and women, which will inevitably lead to the development of CKD, have not been fully studied.

   Aim of the study was to build a model for predicting the risk of developing CKD in patients with stage II GB, depending on gender.

   Material and methods. 100 patients aged 60.5 [20.0] years (median [interquartile region]) with a diagnosis of stage II hypertension were examined. The main group included 50 patients with CKD (men – 21, women – 29, age 64.0 [19.1] years), the comparison group included 50 patients without CKD (men – 25, women – 25, age 58.5 [22.1]). The presence of metabolic syndrome was determined in all of them, systolic and diastolic blood pressure were measured, the salt sensitivity taste threshold, uric acid and blood creatinine content were estimated, the glomerular filtration rate was calculated, аn echocardiographic study was performed, and the severity of depression using the Beck scale was assessed.

   Results and discussion. It turned out that in men with stage II hypertension, the risk of developing CKD is more determined by such combinations of risk factors as the threshold of taste sensitivity to table salt, blood uric acid content, and depression severity according to the Beck scale, in women it was metabolic syndrome presence, depression severity, systolic arterial pressure at admission.

   Conclusions. Models for predicting the risk of developing CKD in patients with stage II GB differ by gender, are easy to use, will allow the practitioner to accurately determine the probability of kidney damage in men and women with hypertension, optimize therapy considering the identified predictors and slow down the progression of hypertension stage of GB and related complications.

   Merkel cell carcinoma is a rare tumour characterized by a high potential for metastasis and local recurrence. The nonspecific clinical picture of the disease often leads to late diagnosis, which creates certain difficulties in the further management of patients. The predominant number of patients with Merkel cell carcinoma are elderly and senile persons, whose comorbid status requires a personalized approach to treatment. This article presents a clinical observation of successful treatment of an 84-year-old woman with Merkel cell carcinoma of the infraorbital region. The patient came to the clinic with complaints of a skin tumor in the infraorbital region on the right, which was verified at her place of residence as Merkel carcinoma. Computer tomography additionally found a focal mass in the right parotid gland. Additional examination revealed no contraindications to surgical treatment, after which the patient underwent wide excision of the skin tumor with a reconstructive plastic component, extended cervical lymph node dissection with resection of the parotid salivary gland on the right. Histological examination of postoperative material confirmed the diagnosis. Subsequently, the patient underwent a postoperative course of radiation therapy. No information on recurrence of the disease was received at the time of submission of data for publication. Treatment of Merkel cell carcinoma in elderly patients requires a multidisciplinary approach and can significantly improve the quality of life.

   Osteoarthritis is a common degenerative disease that causes pain and results in functional insufficiency of the joint, deterioration in the quality of life and its duration. Its treatment should be aimed at reducing pain, improving joints mobility and limiting functional disorders. A clinical case of total knee arthroplasty and multidisciplinary rehabilitation aimed at reducing pain, improving its function and quality of life is presented.

   Material and methods. A prospective analysis of the treatment and rehabilitation of a patient with the right knee joint osteoarthritis of the III radiological stage was carried out. The article presents the aspects of medical rehabilitation after knee arthroplasty in the settings of the Federal Center for Traumatology, Orthopedics and Endoprosthetics of Minzdrav of Russia, Cheboksary.

   Results. A year after the operation, movement in the right knee joint was fully restored, there is no pain syndrome. The patient leads an active lifestyle.

   Conclusions. Total knee arthroplasty improved patient’s quality of life and functioning. She has no pain syndrome when walking even long distances in a year after the surgery. A multidisciplinary approach to treatment has demonstrated substantial clinical benefits.

   Disappearing bone disease, or Gorham – Stoat syndrome, is a disease of massive osteolysis associated with the proliferation of hemangiotic tissue leading to bone resorption.

   Material and methods. The article presents a rare clinical case of Gorham – Stoat syndrome in a 19-year-old patient. The disease manifested at the age of 16 with a lesion of the thoracic vertebrae.

   Results. Against the background of the appearance of neurological disorders due to compression of the spinal cord and the development of myelopathy, the patient initially required surgical treatment on the spine. The diagnosis of massive osteolysis is based on anamnesis, X-ray data and histological conclusion. Subsequently, multiple lesions of the ribs, pelvic bones and skull were added. Quite rare in this case is a multi-focal lesion of the skull bones with compression of brain structures.

   Conclusions. In differential diagnosis against the background of multifocal resorption of skeletal and cranial bones, it is important to remember about etiological causes that are rarer than hematological and metastatic lesions, including idiopathic osteolysis.

   Introduction. Global trends in reducing cardiovascular mortality in the second decade of the 21st century, demonstratedin a number of studies, highlight another phenomenon - the increase in the prevalence of psychosocial risk factors for cardiovascular diseases associated with sleep quality, and in particular, such negative affective states as trait anxiety, depression and hostility.

   Aim of the study was to determine associations between the prevalence of psychosocial risk factors and sleep quality among women in an open urban population.

   Material and methods. A cross-sectional study with a response rate of 70.3% was conducted on a representative sample of women 25–64 years old in Tyumen (n = 1000). To determine the levels of trait anxiety, depression, hostility, and sleep quality, the standard WHO MONICA-MOPSY questionnaire was used.

   Results. The significant prevalence of negative affective states has been determined in the female population (more than 30 % of depression and more than 90 % of personal anxiety and hostility). Negative affective states in the female population prevailed in terms of high levels of personal anxiety and hostility. Age period 45–54 years among women in the open urban population was the most vulnerable category in relation to decreased sleep quality. In the presence of negative affective states, there were negative trends in sleep disturbance at high level of anxiety and depression, but an opposite positive trend – at high level of hostility.

   Conclusions. Analysis of the definition of negative affective states in the female population in the age range of 45–54 years, the associations of their high level with sleep quality seems necessary to use in the formation of a preventive program to reduce high cardiovascular risk in an open urban population, focused primarily on the regulation of psychological parameters.

   Medical and social determinants of public health influence the state of health, risk of occurrence and outcomes of breast neoplasms in women.

   The aim of the study is a comparative analysis of medical and social characteristics of women with malignant and benign breast neoplasms.

   Material and Methods. The data of a survey of 600 female patients were used. The main group (women with malignant breast neoplasms) and the control group (women with benign breast neoplasms) were compared, the data were obtained during the survey and by copying data from medical records. The medico-social attributes were combined into groups.

   Results and discussion. Despite the fact that the groups are similar in social status and lifestyle, data on the presence of evidentiary differences between them in the main groups of characteristics (four groups of characteristics were taken into account: “Obstetric history”; “Morbidity”; “Social status”; “Lifestyle”) were obtained.   

   Conclusions. The social trait “loneliness” through obstetric history is associated with the incidence of breast malignancy. Screening in groups of women with malignant and benign breast neoplasms should be conducted separately, taking into account the social determinant – the social and economic conditions in which they live and are treated, and also in the context of the medical determinant, which includes consideration of the level of professional competence of medical personnel who diagnose and treat these diseases.

   Duchenne muscular dystrophy is a rare progressive neuromuscular disease that is diagnosed in early childhood and leads to a significant reduction in life expectancy. Based on clinical guidelines, the authors of this article developed a questionnaire for pediatricians to determine the knowledge of primary care physicians about early diagnosis and treatment of patients with this rare genetic disease.

   Material and methods. Using the method of quantitative sociological survey, we determined the awareness of pediatricians about a rare genetic disease. The basis for the quantitative analysis was data from an online survey with 609 respondents who were pediatricians.

   Results and its discussion. Less than half of the respondents (48 %) showed a high level of knowledge, were ready to diagnose the disease correctly, to carry out dispensary monitoring of patients. Every third respondent has knowledge that is insufficient to diagnose and manage patients with Duchenne muscular dystrophy. Also, during the survey, the authors of the article found out the opinion of pediatricians about the sufficiency and/or insufficiency of their knowledge in the management of patients, as well as their preferences in channels for obtaining new information about this disease.

   Conclusions. Pediatricians play a major role in the early diagnosis of Duchenne muscular dystrophy. In this regard, the training of pediatricians in accordance with the new clinical guidelines should be included in the training and improvement of doctors’ knowledge. Addressing this issue could lead to significant clinical and economic benefits.

   Thyroid diseases occupy one of the leading places in the world among all non-neoplastic diseases of the endocrine system. This problem is also relevant in the Russian Federation, their prevalence depending on the region ranges from 35 to 60 %.

   Aim of the study was to investigate the structure of morbidity and mortality from thyroid diseases in iodinedeficient regions located within the zone of radioactive contamination using the Penza region as an example.

   Material and methods. The data of the regional information and analytical medical system ProMed were analyzed. Overall morbidity was studied from January to April 2024, mortality – from 2019 to 2024.

   Results. 89.70 % of cases were registered in women of all age categories, and only 10.30 % in men. The thyroid diseases were mainly diagnosed in elderly people (36.41 % of cases). Their structure is specific for age categories: among persons under 18 years of age, “other specified thyroid diseases” were most often registered (31.67 % of cases), in the age group from 18 to 44 years – “unspecified thyroid disease” (25 %), among patients aged 45 to 90 years – nontoxic multinodular goiter (28.65 % of cases in middle-aged individuals, 35.2 % among the elderly and 29.55 % – among the seniors). Mortality from thyroid diseases is extremely rare, but in some cases, thyroid diseases were indicated in the “other important conditions” column of the death certificate, therefore, pathological conditions of the gland make a significant contribution to the development of thanatogenesis.

   Conclusions. The gender and age distribution of thyroid diseases was established; they predominate in women in all age categories, the elderly are at risk. Mortality due to this category of diseases is rare. At the same time, the development of both hypo- and hyperthyroidism negatively affects the functioning of a number of organs and systems of the body, which can make a significant contribution to the development of thanatogenesis. The number of registered cases of thyroid diseases in the region generally corresponds to the general statistical data for the Russian Federation.