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Rationale: Peripheral artery disease (PAD) is common among the elderly and increases the risk of cardiovascular events, disability and death. PAD course and outcomes depend not only on the condition of macrovasculature but also on the tissue perfusion. We have previously shown that Type 2 diabetic patients with lower extremity ischemia have significantly lower perfusion than healthy volunteers, and the ratio of basal perfusion in the arm and leg (BP1/BP3) measured by incoherent optical fluctuation flowmetry (IOFF) allows to identify hemodynamically significant stenoses. Aim: To analyze associations between perfusion parameters registered by IOFF and the severity of vascular involvement in PAD patients. Methods: This single center cross-sectional study included 38 PAD patients admitted to the Department of Vascular Surgery and Coronary Artery Disease. The arteries were assessed with duplex Doppler ultrasonography (DDU), according to the results of which the PAD severity score and ankle-brachial index (ABI) were calculated. Skin microhemodynamic parameters were recorded by IOFF. The basal perfusion on the arm (BP1), the dorsal foot surface and the toe (BP2 and BP3), the ratio BP1/BP3, local thermal hyperemia (LTH2 and LTH3) and an increase in perfusion after heating on two leg zones (LTH2-BP2, LTH3-BP3) were evaluated and expressed in perfusion units (PU). BP1, BP3, and BP1/BP3 values were additionally measured with laser Doppler flowmetry (LDF). The analysis was performed depending on the degree of arterial involvement determined by DDU for each limb separately (n = 73). There were ≥ 50% stenoses in 15 extremities (Group 1), occlusion of one of the major arteries in 42 (Group 2) and ≥ 2 occlusions in 16 lower extremities (Group 3). Results: In the groups 1, 2 and 3, the values of most parameters estimated by IOFF decreased with an increase in severity of limb lesions. As an example, the respective perfusion parameters for the big toe in the study groups were as follows: BP3 4.0 [2.0; 9.8], 2.2 [0.9; 3.7] and 1.1 [0.7; 2.6] PU (p = 0.007); LTH3 10.0 [6.4; 14.9], 5.0 [1.5; 7.8] and 2.5 [1.4; 4.5] PU (p 0.001), and LTH3-BP3 3.8 [2.6; 7.8], 2.4 [0.6; 4.3] and 1.2 [0.4; 1.5] PU (p = 0.001). The BP1/BP3 ratio in the above mentioned group increased: 1.8 [0.8; 7.7], 7.2 [3.4; 21.3] and 14.2 [6.6; 18.3] (p = 0.004), respectively. No similar trend was found for this parameter registered by LDF. There were significant correlations between the lower extremities perfusion parameters measured by IOFF and ABI, with the correlation coefficients ranging from 0.365 to 0.717 (p 0.05). Conclusion: The functional parameters of the skin microhemodynamics vary with different PAD severity. In addition, they correlate with clinical indicators of atherosclerosis. The IOFF technique can be promising as an additional quantitative method for assessment of microvascular blood flow in patients with PAD.

Chronic constipation is a global medical, social, and economic problem due to its negative impact on patients’ quality of life and increased risk of colorectal cancer, cardiovascular and cerebrovascular disorders. The gut microbiota plays an important role in the pathophysiology of constipation through its interplay with the immune system, enteral and central nervous system, representing a promising therapeutic target. Gut dysbiosis in patients with constipation is characterized by reduced relative numbers of bacteria producing lactate (Lactobacillaceae, Bifidobacteriaceae) and butyrate (Lachnospiraceae, Oscillospiraceae), as well as with increased numbers of those producing hydrogen sulfide (Desulfovibrionaceae) and methanogenic archaea (Methanobacteriaceae). The leading pathogenetic mechanism related to intestinal dysbiosis in chronic constipation, can be microbial metabolic abnormalities (metabolic dysbiosis) characterized by altered production of short-chain fatty acid, methane, hydrogen sulfide, tryptophan metabolites and by abnormal bile acid biotransformation. It has been proven that dysbiotic abnormalities of the intestinal microbiome play a role in the pathophysiology of constipation, which allows for the use of prebiotics, probiotics, and synbiotics for effective microbiome-modulating therapy in patients with chronic constipation. The proven role of dysbiotic abnormalities of the intestinal microbiome in the pathophysiology of chronic constipation determines the effectiveness of microbiome-modulating therapy (prebiotics, probiotics, synbiotics) in patients with this syndrome. Inulin is the most studied preboitic; it is a soluble food fiber that markedly contributes to the regulation of intestinal microbiota, stimulates the growth of beneficial bacteria, and production of anti-inflammatory metabolites. Inulin normalized the intestinal function in patients with chronic constipation increasing the stool frequency, softening the stool, and reducing the intestinal transit time. In addition, inulin modulates the immune response and impacts the absorption of minerals, appetite, and satiety. Treatment with probiotics is also associated with reduced intestinal transit time, compared to controls. According to a systematic review and meta-analysis of 30 randomized controlled trials, only Bifidobacterium lactis strains (but not other probiotics) significantly increase stool frequencies in chronic constipation in adults. Clinical studies have shown that the targeted probiotic Bifidobacterium lactis HN019 can significantly increase the stool frequencies in patients with low (≤ 3 per week) stool frequency up to 4.7–5.0 per week, reduce the intestinal transit time and the rate of functional gastroenterological symptoms in adults with constipation. Beyond its clinical effects, Bifidobacterium lactis HN019 leads to beneficial changes in intestinal microbiota, significantly increasing the bifidobacteria and decreasing the enterobacteria numbers. The results of trials confirm the importance of synbiotic correction of dysbiotic microbiota in all patients with constipation to increase stool frequencies and improve fecal consistency, as well as to prevent the chronic disorders associated with constipation. Synbiotics, such as a combination of Bifidobacterium lactis HN019 and inulin, with the properties of both complementary and synergic synbiotic, may have the greatest microbiome-modulating and functional potential to significantly improve clinical outcomes in patients with chronic constipation compared to probiotics or prebiotics used alone.

Background: Insulinoma is a neuroendocrine tumor (NET), with its main clinical manifestation being the hypoglycemic syndrome. The symptoms of hypoglycemia are nonspecific, and therefore, in most cases, the diagnosis is made untimely. The Russian clinical guidelines for the diagnosis and treatment of NET suggest as a diagnostic test that the universal circulating marker of all NET, chromogranin A (CgA) be determined. However, the literature data on the sensitivity of CgA in the diagnosis of insulinoma are contradictory. Aim: To evaluate the diagnostic effectiveness of the CgA test in the diagnosis of insulinoma. Materials and methods: This was a hospital-based single-center, cross-sectional comparative (first step) and prospective non-comparative (second step) study conducted from 2016 to 2022. During the first part of the study, we determined serum CgA in 120 patients with suspected non-diabetic hypoglycemia and compared its levels in the patients with and without confirmed insulinoma (n = 87 and n = 33, respectively). During the second study step, CgA was measured in the insulinoma patients at 6 [4.0; 7.0] months after surgery. The CgA levels at baseline and post-surgery were analyzed in 74 patients (those with recurring non-diabetic hypoglycemia were excluded from the analysis). Results: In the study subjects without insulinoma, the median CgA level was 0.7 [0.5; 1.1] (range, 0.1 to 2.0) nmol/l and the difference (with Bonferroni adjustment) from its levels in the patients with insulinoma before surgery was non-significant (1.0 [0.7; 1.4], range, 0.1 to 8.5 nmol/l, р = 0.045). The CgA concentration in the insulinoma patients after surgery was 0.9 [0.7; 1.2], range, 0 to 1.9 nmol/l and significantly differed from that at baseline (1.0 [0.7; 1.4], range, 0.1 to 8.5 nmol/l, p = 0.012, Wilcoxon test). In the patients with insulinoma before surgery the CgA levels exceeding the generally accepted reference range ( 2 nmol/l) was found in 11.5% (n = 10), with its median level of 2.5 [2.3; 4.1], range 2.3 to 8.5 nmol/l. There were no significant associations between the CgA levels and localization, tumor numbers, their size and malignization grade, insulin and proinsulin values, and duration of fasting. The sensitivity and specificity of the CgA test were 12% [95% confidence interval [CI]: 6%–20%] and 100% [95% CI: 97%–100%], respectively. The prognostic value of a positive result (PVPR) was 100% [95% CI: 69%–100%] and the prognostic value of a negative result (PVNR) 30% [95% CI: 28%–32%]. Conclusion: As a diagnostic test, CgA has high specificity and prognostic value of a positive result. However, the uncertainty of the prognostic value of a negative result is unacceptably high. A special study is required to clarify the operational characteristics of CgA in insulinoma.

Background: New chemotherapy regimens (gemcitabine / nab-paclitaxel, FOLFIRINOX) have improved overall survival rates in ductal carcinoma, which has renewed the interest in surgical treatment for isolated liver metastases. Aim: To identify the role of surgery in ductal carcinoma of the pancreatic head with liver oligometastases. Methods: We retrospectively analyzed the data from 490 patients with morphologically verified ductal carcinoma of the pancreatic head in two specialized centers, who had undergone pancreatoduodenectomy (PD) from January 2011 to April 2024. In 21 patients, PD was performed simultaneously with liver resection (liver oligometastases were found during the surgery). Results: In the postoperative period after PD with liver resection, compared to that after PD without liver resection, intra-abdominal abscesses were more frequent (4/21 (19.0%) versus 10/469 (2.2%), p = 0.002) and relaparotomy was performed more often by 9.8% [95 confidence interval (CI, Miettinen-Nurminen score method) 0.21–30.3] (3/21 (14.3%) versus 21/469 (4.5%), p = 0.077). The postoperative death rates were comparable (1/21 (4.8%) versus 19/469 (4.1%), p = 0.8). The median overall survival of the patients after PD with liver resection was 11 (95% CI: 6–16) months, and overall 1-, 2-, and 3-year survival rates were 39.2, 16.8 and 7.2%, respectively. In the patients after PD with liver resection without any adjuvant chemotherapy (n = 5), the median overall survival was 6 (95% CI: 5–7) months, and in those with chemotherapy, 13 (95% CI: 6–16) months (p = 0.006). The overall three-year survival of the patients after PD with liver resection and adjuvant chemotherapy was 11.5%. In the patients after PD with liver resection R0, the median overall survival was 13 (95% CI: 6–32) months, with R1 resection 6 (95% CI: 6–7), and with R2 resection 6 (95% CI: 6–7) months (p = 0.021). The median overall survival of patients after PD with liver resection for G1 tumors was 17 (95% CI: 6–32) months. Conclusion: Surgery as a component of combination therapy for oligometastatic pancreatic head cancer can be considered in a certain category of patients with high tumor differentiation grade and mandatory preliminary assessment of the feasibility of R0 surgery and systemic chemotherapy.

We present a case of a rare lymphoproliferative disease diagnosed while differentiating between the causes of exudative-constrictive pericarditis. An 83-year old man was hospitalized with shortness of breath, edema and newly diagnosed atrial fibrillation (AF). Initially, the signs and symptoms were interpreted as manifestations of heart failure due to old myocardial infarction, arterial hypertension and AF. However, no significant systolic or diastolic dysfunction of the left ventricle and valve disease were identified and natriuretic peptide level was normal. Despite treatment, dyspnea and edema persisted, and pleural effusion (requiring drainage) and pericardial effusion increased. Repeated echocardiography showed signs of exudative-constrictive pericarditis. We consequently excluded the infectious (tuberculosis) and non-infectious (electrolyte disorders, hypothyroidism, solid tumors) etiologies of effusion. Taking into account the long-standing mediastinal lymphadenopathy (the patient had been previously examined, but the cause not identified), anemia, episodes of low-grade fever, weight loss, and polyneuropathy, a lymphoproliferative disease was suspected. Serum protein electrophoresis identified an M spike in the gamma globulin region. Immunophenotyping of peripheral blood lymphocytes and immunohistochemical examination of bone marrow confirmed the diagnosis of mantle cell lymphoma. The patient was referred for specialized treatment. At 5 months of the follow-up, the therapy was successful, the patient was stable with no cardiac complaints, no edema, and no new AF episodes. The case demonstrates the need to strictly follow differential diagnostic algorithms to identify the causes of nonspecific symptoms beyond one medical specialty.

Цель исследования. Оценить изменения показателей кислотно-щелочного состояния у пациентов с ишемической болезнью сердца в интраоперационном периоде при проведении коронарного шунтирования в условиях искусственного кровообращения (ИК) при применении экстракорпоральной аутогемомагнитотерапии (ЭАГ-МТ). Рассмотреть наличие отрицательного эффекта данной методики на показатели кислотно-щелочного баланса. Изучить возможную взаимосвязь между полиморфизмом гена рецептора ангиотензина-1 (AGTR1 A1166C), эндотелина-1 (EDN1 Lys 198 Asn), эндотелиальной синтазы оксида азота (NOS3 C786T) и изменением исследуемых показателей кислотно-щелочного состояния. Материал и методы. Группа 1 включала стандартное анестезилогическое пособие при коронарном шунтировании в условиях ИК без применения ЭАГМТ (60 пациентов). Группа 2 включала стандартное анестезиологическое пособие при коронарном шунтировании в условиях ИК с примененением ЭАГМТ (63 пациента). Оценивались показатели кислотно-щелочного состава артериальной крови: водородный показатель, лактат, дефицит оснований, калий, натрий, гемоглобин, гематокрит. Всем пациентам обеих групп интраоперационно был выполнен забор венозной крови из центрального венозного катетера. Далее методом полимеразной цепной реакции выполнено исследование генотипов полиморфизма гена рецептора ангиотензина-1 (AGTR1 A1166C), эндотелина-1 (EDN1 Lys 198 Asn), эндотелиальной синтазы оксида азота (NOS3 C786T). Результаты. На втором этапе исследования в двух группах выявлено уменьшение водородного показателя артериальной крови, гемоглобина, гематокрита, дефицита оснований. Получено статистически значимое увеличение лактата, калия в обеих исследуемых группах. Между полиморфизмом гена рецептора ангиотензина-1 (AGTR1 A1166C), эндотелина-1 (EDN1 Lys 198 Asn), эндотелиальной синтазы оксида азота (NOS3 C786T) и показателями кислотно-щелочного состояния артериальной крови не выявлено. Выводы. Применение ЭАГМТ не оказывает отрицательного действия на электролитный баланс и кислотно-щелочной состав крови. Наличие полиморфизма гена AGTR1 A1166C (rs 5186), гена EDN1 Lys 198 Asn (rs5370), гена NOS3 C786T (rs 2070744) не влияет на изменение кислотно-щелочного состояния артериальной крови.

Введение. Аллергический ринит и атопический дерматит – распространенные аллергические заболеваниям у детей. Анализ заболеваемости и тенденций развития аллергических заболеваний необходим для успешного решения проблемы заболеваемости, помощи детскому населению на региональном уровне, прогнозирования и контроля. Цель исследования. Изучить многолетнюю динамику основных эпидемиологических показателей общей и первичной заболеваемости аллергическим ринитом и атопическим дерматитом детского населения Гродненской области. Материал и методы. Ретроспективный анализ показателей заболеваемости аллергическим ринитом и атопическим дерматитом детского населения Гродненской области за период 1999-2023 гг. – дети 0-14 лет, 2008-2023 гг. – дети 15-17 лет. Результаты. Среднемноголетний стандартизованный по возрасту показатель общей заболеваемости аллергическим ринитом детей 0-14 лет составил 266,89 (95% ДИ: 238,33-295,47), первичной заболеваемости – 67,67 (95% ДИ: 57,36-77,98) на 100 000 детского населения соответствующего возраста. Среднемноголетний показатель общей заболеваемости аллергическим ринитом детей 15-17 лет (2008-2023 гг.) составил 791,97 (95% ДИ: 680,79-903,14), первичной – 113,73 (95% ДИ: 92,84-134,61) на 100 000 детского населения этого возраста. Среднемноголетний стандартизованный по возрасту показатель общей заболеваемости атопическим дерматитом детей 0-14 лет составил 872,89 (95% ДИ: 825,27-919,782) на 100 000 детского населения соответствующего возраста, первичной заболеваемости – 459,1 (95% ДИ: 399,96-518,24) на 100 000 детского населения соответствующего возраста. Среднемноголетний показатель общей заболеваемости атопическим дерматитом детей 15-17 лет составил 415,68 (95% ДИ: 377,63-453,73), первичной – 143,88 (95% ДИ: 120,53-167,23) на 100 000 детского населения этого возраста. Многолетняя эпидемическая динамика аллергического ринита характеризуется умеренно выраженной тенденцией к росту показателя общей заболеваемости детей 0-14 лет (темп прироста (убыли) средний = +2,4%) и 15-17 лет (темп прироста (убыли) средний = +3,62%), стабилизацией показателя первичной заболеваемости детей 0-14 лет (темп прироста (убыли) средний = -0,67%) и 15-17 лет (темп прироста (убыли) средний = +0,72%). Многолетняя эпидемическая динамика атопического дерматита характеризуется умеренно выраженной тенденцией к снижению показателя общей заболеваемости детей 0-14 лет (темп прироста (убыли) средний = -1,57%) и росту показателя заболеваемости детей 15-17 лет (темп прироста (убыли) средний = +2,1%), выраженной тенденцией к снижению показателя первичной заболеваемости детей 0-14 лет (темп прироста (убыли) средний = -5,42%) и детей 15-17 лет (темп прироста (убыли) средний = -5,89%). Представлены картограммы территориального распределения показателей заболеваемости аллергическим ринитом и атопическим дерматитом детского населения Гродненской области в период 1999-2023 гг. (0-14 лет) и 2008-2023 г. (15-17 лет). Выводы. Причины установленных закономерностей изменения показателей заболеваемости аллергическими болезнями детского населения разных возрастных групп, а также проживающих на разных территориях, по всей вероятности, обусловлены воздействием средовых и социально-экономических факторов. Представленные картограммы дают возможность наглядной визуализации показателей заболеваемости аллергическим ринитом и атопическим дерматитом в отдельных территориально-административных регионах области.

Цель исследования. Определение состояния структур головного мозга и параметров кровотока в желудочковой системе у новорожденных, матери которых страдали фетоплацентарной недостаточностью, с помощью нейросонографии и допплерографии. Материал и методы. В исследовании участвовали 96 новорожденных от матерей с фетоплацентарной недостаточностью (основная группа) и 30 здоровых новорожденных (контрольная группа). Диагностический комплекс включал нейросонографическое исследование передней и средней черепной ямок, а также допплерографию передней и средней мозговых артерий, вены Галена с оценкой скоростей кровотока, систоло-диастолического соотношения (S/D), индекса резистентности (Ri) и пульсационного индекса (Pi). Результаты. Сравнительный анализ показателей кровотока в передней мозговой артерии и вене Галена не выявил статистически значимых различий между основной и контрольной группами. При исследовании средней мозговой артерии, несмотря на отсутствие статистически значимых различий в скоростях кровотока по сравнению с контрольной группой, индекс резистентности (Ri), пульсационный индекс (Pi) и систоло-диастолическое соотношение (S/D) демонстрировали статистически значимые различия. Это указывает на повышенное сосудистое сопротивление у новорожденных из основной группы. Выводы. Для объективной оценки состояния центральной нервной системы новорожденных от матерей с фетоплацентарной недостаточностью необходимо комбинировать допплерографию и нейросонографию. Исследование выявило нарушение гемодинамики в бассейне средних мозговых артерий у новорожденных из основной группы. Для оценки церебральной гемодинамики предпочтительнее использовать индексы Ri, Pi и S/D.

В данной статье приводится клинический случай идентификации образования надпочечника с развитием первичного гиперальдостеронизма у пациента, госпитализированного в эндокринологическое отделение учреждения здравоохранения «Гродненская университетская клиника». Коллективом авторов изложена тактика диагностического поиска для установления диагноза и назначения адекватного лечения при подозрении на первичный гиперальдостеронизм у пациента с артериальной гипертензией.

Внутрибрюшное давление редко измеряется по умолчанию у пациентов отделения интенсивной терапии. Внутрибрюшная гипертензия и абдоминальный компартмент-синдром вносят значительный вклад в развитие мультиорганной недостаточности у пациентов в критическом состоянии, связаны со значительной заболеваемостью и смертностью. В данной статье рассмотрены и проанализированы причины, особенности механизмов патофизиологии повышения внутрибрюшного давления, а также современные аспекты диагностики и лечения пациентов с абдоминальным компартмент-синдромом.

Введение. Ишемическая болезнь сердца (ИБС) – одна из основных причин смертности и инвалидности в мире. Современные методы лечения, такие как чрескожное коронарное вмешательство (ЧКВ), значительно улучшили прогноз пациентов. Однако риск развития рестеноза стента остается значимой проблемой. Цель исследования. Определить уровень биохимических маркеров (Р-селектина и интегрина-β3) в плазме крови у пациентов с ИБС, после ЧКВ, а также оценить эффективность разных моделей прогнозирования рецидива стеноза в стенте. Материал и методы. В исследовании приняли участие 209 пациентов с ИБС, которых разделили на четыре группы: здоровые лица, пациенты с хроническим течением ИБС без показаний к инвазивной коронарографии, пациенты с ИБС, которым выполнено плановое ЧКВ, и пациенты с рестенозом в стенте. Уровни Р-селектина и интегрина-β3 в плазме крови измерялись методом иммуноферментного анализа. Результаты. Рестеноз в стенте возник у 12 пациентов (8,05%) после планового ЧКВ. Анализ показал, что показатели Р-селектина и интегрина-β3 не имели статистически значимых различий между группами пациентов. Модель прогнозирования, включающая индекс массы тела (ИМТ), желудочковую экстрасистолию (ЖЭ), количество стентов, сахарный диабет (СД) и мультифокальное атеросклеротическое поражение коронарных артерий (МФАПКА), продемонстрировала наилучшую эффективность по большинству ключевых метрик. Выводы. Показатели Р-селектина и интегрина-β3 не показали значительных различий у пациентов с рестенозом. Модель, включающая ИМТ, ЖЭ, количество стентов, СД и МФАПКА, наиболее эффективна для прогнозирования рецидива стеноза в стенте.

Гипотиреоз вызван дефицитом гормонов щитовидной железы, демонстрирует множественные клинические проявления. Кроме таких симптомов, как непереносимость холода, усталость, запоры, брадикардия, депрессия, сонливость, осиплость голоса, нарастание веса, следует отметить возможность развития отека тканей. Слизистый отек (микседема) и формирование изолированных выпотов в полостях (брюшной, плевральной и полости перикарда) характерны для гипотиреоза. Данные проявления вызваны повышенной проницаемостью сосудов и транссудацией жидкости и альбумина в интерстициальное и другие пространства (околосердечную сумку, плевру), неадекватной секрецией антидиуретического гормона, накоплением гидрофильных гликозаминогликанов в межклеточном веществе дермы и в разных тканях. Множественные выпоты в полостях тела и отек тканей одновременно встречаются редко, неспецифический характер этих симптомов требует дифференциального диагноза, в котором гипотиреоз не всегда учтен, это приводит к его поздней диагностике и несвоевременному назначению терапии, особенно у коморбидных пациентов. В обсуждении данного случая хочется обратить внимание на необходимость тщательного анализа полученных клинических данных и использования простых алгоритмов дифференциальной диагностики.

Введение. На данный момент не установлен уровень С-реактивного белка (СРБ), который может быть допустим у доноров с травматическими и нетравматическими повреждениями головного мозга, а также не изучена его динамика у пациентов при наступлении смерти мозга (СМ). Цель данного исследования – изучить динамику уровня СРБ у пациентов с тяжелым необратимым повреждением головного мозга, которое в последующем приводит к смерти мозга Материал и методы. В проспективное исследование были включены 106 пациентов с тяжелым повреждением головного мозга, у которых, несмотря на проводимое лечение, была констатирована СМ. Пациентам определялся уровень СРБ в 1-10-е сутки проведения интенсивной терапии. Результаты. Уровень СРБ при поступлении в ОАиР был равен 13,3 (3,86; 29,1) мг/л. СРБ в пределах нормальных значений был только у 14 (13,2%) пациентов. На 2-е сутки интенсивной терапии уровень СРБ был статистически значимо выше – 85 (45,4; 140,6) мг/л, р=0,00004 vs 1 cутки. На 3-и сутки интенсивной терапии уровень СРБ был также статистически значимо выше – 135,3 (73,6; 238,2) мг/л, р=0,00001 vs 2 cутки. Уровень СРБ у всех пациентов был выше референтных значений. На 4-е сутки у пациентов уровень СРБ стал равен 219,7 (112,7; 326,4) мг/л (р=0,00006 vs 3 cутки) и в последующие сутки статистически значимо не изменялся. Выводы. Динамика уровня СРБ у пациентов с тяжелым повреждением головного мозга может использоваться как предиктор неблагоприятного исхода интенсивной терапии и наступления смерти мозга.

Введение. Исследование гетерогенности и пластичности астроцитов в головном мозге, в частности в перитуморозной зоне, на разных этапах роста новообразования поможет понять их значение в прогрессировании глиальных опухолей. Цель. Морфометрическая оценка астроцитов в головном мозге грызунов при прогрессировании глиальной опухоли. Материал и методы. Моделирование глиальной опухоли головного мозга грызунов с помощью имплантации клеток глиомы С6 с последующей иммуногистохимической оценкой GFAP+-астроцитов в перитуморозной зоне в правом полушарии и аналогичной зоне левого полушария головного мозга грызунов в разные сроки эксперимента. Результаты. На ранних сроках роста глиальной опухоли отмечено статистически значимое преобладание клеточной плотности и различие морфометрических параметров клеток астроцитов в перитуморозной зоне правого полушария головного мозга крыс по сравнению с аналогичной зоной левого полушария. Прогрессирование глиальной опухоли сопровождалось достоверным снижением клеточной плотности астроцитов в перитуморозной зоне с нарастанием реактивных изменений астроцитов в аналогичной зоне контрлатерального полушария. Выводы. Развитие опухолевых процессов в головном мозге грызунов сопровождается активацией астроцитов с приобретением клетками реактивного фенотипа в перитуморозной зоне. Вместе с тем дальнейшее прогрессирование новообразования подавляет активную пролиферацию астроцитов.

Введение. В развитии и прогрессировании артериальной гипертензии (АГ) важная роль отводится влиянию полиморфных вариантов генов. Полиморфизмы С(-509)Т, T869C, G915С гена трансформирующего фактора роста β1 (TGFB1), А110186299G и С110196387T гена α1 цепи коллагена IV типа (COL4A1), G5665T гена эндотелина-1 (EDN1) могут способствовать ремоделированию артериальной стенки. Цель. Оценить распространение полиморфных вариантов С(-509)Т, T869C, G915С гена TGFB1, А110186299G, С110196387T гена COL4A1, G5665T гена EDN1 у пациентов мужского пола 30-49 лет с АГ, проживающих в Гродненском регионе. Материал и методы. В исследование включены 204 мужчины (65 здоровых лиц и 139 пациентов с АГ 1 и 2 степени). Данные обследований (общеклинических, генотипирования методом полимеразной цепной реакции) проанализированы с использованием программы STATISTICA 10.0. Результаты. У пациентов с АГ и у здоровых лиц, соответственно, частота встречаемости аллельного варианта Т полиморфизма G5665T составила 16,8 и 13,9% (р=0,45), аллельного варианта Т полиморфизма С(-509) Т – 34,2 и 36,9% (р=0,66), аллельного варианта Т полиморфизма Т869С – 41,4 и 40,8% (p=0,99), аллельного варианта С полиморфизма G915C – 7,9 и 6,9% (р=0,84), аллельного варианта А полиморфизма А110186299G – 35,6 и 37,7% (р=0,74), аллельного варианта Т полиморфизма С110196387T – 46,4 и 43,8% (р=0,63). Выводы. Частота встречаемости генотипов и аллелей исследуемых полиморфных вариантов сопоставима среди пациентов мужского пола с АГ 1-2 степени и практически здоровых лиц.

Введение. Зуд – один из наиболее частых симптомов, сопровождающих псориаз. Пациенты с зудом сообщают об ухудшении качества жизни, депрессии, тревожности и дисморфических проблемах, а также о сниженной эффективности от проводимого лечения. Цель исследования. Изучить интенсивность кожного зуда и уровень нейропептидов в сыворотке крови у пациентов с псориазом, ассоциированным с психическими расстройствами. Материал и методы. Основными методами обследования 110 пациентов с псориазом были клинико-анамнестический, клинико-лабораторный, клинико-психопатологический. Результаты. У пациентов с сочетанным вариантом псориаза и психических расстройств установлена статистически значимо большая частота встречаемости зуда кожи (р

Пациенты с наличием фибрилляции предсердий, (ФП) особенно с частыми пароксизмами, имеют высокий риск сердечно-сосудистых осложнений. ФП ассоциируется с увеличением смертности, частоты инсульта и других тромбоэмболических осложнений, госпитализаций, развитием сердечной недостаточности, ухудшением качества жизни, снижением переносимости физической нагрузки и дисфункцией левого желудочка. В статье представлены возможности восстановления и удержания синусового ритма у пациентов с пароксизмальной формой ФП.

Актуальность. Экспертно-реабилитационная оценка у недоношенных детей в неонатальном периоде и первые месяцы жизни представляет собой большие трудности, с этих позиций обоснованно и целесообразно для категории недоношенных детей ввести термин «абилитационный прогноз». Цель исследования. Обосновать и разработать показатели абилитационного прогноза и абилитационного потенциала недоношенных детей. Материалы и методы. Выполнено проспективное исследование. В исследование включено 212 недоношенных новорожденных (n=212), данные которых были статистически обработаны. Сформировано две группы: 1-я группа медицинской абилитации МА(+) n=89 пациентов, которым мероприятия МА выполнялись в соответствии с основными направлениями разработанной методики в полном объеме. Другая часть детей составила 2-ю группу МА(-) n=123 пациентов, которым МА в соответствии с разработанной методикой не проводились. Постконцептуальный возраст детей, в котором начиналась МА недоношенным составлял от 32 недель до 3-х месяцев. Результаты. На основании качественных значений реабилитационного прогноза (благоприятный, сомнительный, неблагоприятный) разработан количественный интегрированный показатель «абилитационный потенциал неврологического развития для недоношенных детей» – АПтН (в диапазоне значений от 7 до 35 баллов). Для установления четких границ, разделяющих значения благоприятного, сомнительного и неблагоприятного уровня, выполнен ROC-анализ. В ходе исследования установлено, что оптимальными точками разделения являются: 11 (площадь под ROC-кривой (AUC) AUC=0,8613 95ДИ [0,8101-0,9124]) и соответственно границей установления благоприятного АПтН от 7 до 11 (из 35 максимально возможных), p

Липиды и частицы липопротеинов обуславливают развитие атеросклероза и определяют риск сердечно-сосудистых заболеваний. Помимо общего холестерина, липопротеинов низкой и высокой плотности (ЛПНП, ЛПВП), также другие липидные медиаторы способствуют сердечно-сосудистому риску. Липопротеин(а) (Лп(a)) – один из них. В настоящее время рекомендации и консенсусные заявления рекомендуют измерение Лп(а) у всех взрослых хотя бы один раз в жизни. Лп(а) состоит из ЛПНП-подобной частицы, в которой апобелок(а) посредством одной дисульфидной связи ковалентно связан с апобелком В100. Уровень Лп(а) – генетически обусловленная особенность. Цель. Провести анализ литературы по клиническому значению липопротеин(а) в развитии сердечно-сосудистых заболеваний. Материал и методы. Проанализировано 46 литературных источников. Выводы. Учитывая четкие литературные данные, указывающие на связь Лп(а) с сердечно-сосудистыми заболеваниями в качестве независимых факторов атерогенеза и тромбогенеза, несомненный интерес вызывает изучение роли Лп(а) в развитии сердечно-сосудистых событий.

Статья посвящена юбилею выдающегося ученого, высококвалифицированного специалиста и настоящего профессионала в области кардиологии, любимого всеми наставника и просто прекрасного человека профессора 1-й кафедры внутренних болезней учреждения образования «Гродненский государственный медицинский университет», доктора медицинских наук, профессора, член-корреспондента НАН Беларуси В. А. Снежицкого.

BACKGROUND: Chronic cardiac failure belongs to the most threatening and delayed manifestations of cardiotoxicity in oncology patients receiving the treatment with antitumor medicines. As of today, only two groups of drugs were proven to have significant cardioprotective effects in these categories of patients: angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-adrenergic blockers. Recently, the first data were published on the successful use of sodium-glucose cotransporter type 2 inhibitors in patients with chronic cardiac failure, receiving anthracycline therapy. AIM: optimization of cardioprotective therapy in the treatment of chronic cardiac failure in oncology patients receiving cardiotoxic chemotherapy. METHODS: A prospective observational open-label research was carried out with an enrollment of 116 oncology patients with verified chronic cardiac failure, which were receiving cardiotoxic chemotherapy, of which 60 patients of the control group were receiving double cardioprotective therapy (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) and the 56 patients of the test group were receiving similar therapy with an addition of Dapagliflozin at a dosage of 10 mg once daily in the morning. The controls of the results were conducted in 6 months by means of laboratory and instrumental examinations, as well as by using additional methods of controlling the results. RESULTS: The groups compared did not differ by the combined primary clinical endpoint (the rate of hospitalizations due to cardio-vascular reasons, the refusal to undergo chemotherapy for the reason of chronic cardiac failure progression and the safety of using the drug products: the presence of urinary tract infections and sepsis), but they differed by the surrogate clinical endpoints that included the dynamic trend of the levels of the groups compared did not differ by the combined primary clinical endpoint (the rate of hospitalizations due to cardio-vascular reasons, the refusal to undergo chemotherapy for the reason of chronic cardiac failure progression and the safety of using the drug products: the presence of urinary tract infections and sepsis), but they differed by the surrogate clinical endpoints that included the dynamic trend of the levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and the global longitudinal strain (GLS) of the left ventricle, determined within the timeframes established for the research — before the initiation of chemotherapy and in 6 months. The patients that have passed all the control tests (n=47), after the end of the 6 months period, underwent a comparison of the levels of troponin Т, left ventricle ejection fraction (LVEF), NT-proBNP and GLS. It was found that the dynamic changes of troponin T levels in both groups did not significantly differ (p=0,260), as well as the LVEF indicator (p=0.340), while the NT-proBNP level was significantly decreasing in the test group — by 7.8% comparing to the control group (p=0.006). Comparable data were obtained for the GLS (the decrease in the test group by 6.5% in relative values) comparing to the control group (p=0.008). In 22/47 (46,8%) patients, chronic cardiac failure was diagnosed before the initiation of chemotherapy, in 25/47 (53,2%), chronic cardiac failure was developing during the antitumor medication therapy. In both groups, a total of 17 (16%) fatal outcomes were registered, none of which was caused by the cardiac failure. CONCLUSION: We suppose that the decrease in the levels of the cardiac failure marker and the less intensive impairment of the left ventricle longitudinal strain with a background of adding sodium-glucose cotransporter type 2 inhibitors to baseline therapy for chronic cardiac failure in oncology patients receiving cardiotoxic chemotherapy, reflects their cardioprotective potential. Thus, the sodium-glucose cotransporter type 2 inhibitor Dapagliflozin slows down the progression of chronic cardiac failure in oncology patients receiving cardiotoxic chemotherapy.

Keratoconus is an ectatic corneal disease, resulting in loss of visual functions in young population. Diagnosis of the disease at a moderate stage with a typical progressive clinical course is not particularly difficult; however, the diagnosis verification in a few cases is rather troublesome. This literature review systematizes modern conceptions to the keratoconus diagnosis, outlines current approaches to patients examining and diagnostics results assessing. The clinical manifestations (complaints, anamnesis data, visometry and autorefractokeratometry results) at the early stages of keratoconus with its non-progressive course are similar to ordinary myopia and regular myopic astigmatism; as a result, it is quite difficult to suspect the disease in such cases. With progressive keratoconus course, as corneal protrusion develops, the disease acquires features specific for gradual irregular corneal myopic astigmatism growth. Currently valuable pathognomonic slit-lamp signs of keratoconus are Fleischer’s ring, stromal Vogt’s striae and focal thinning of the cornea in the ectasia apex. Nowadays the gold standard of keratoconus diagnosis and screening is comprehensive examination of the cornea by means of modern computer optical scanning (Scheimpflug camera in particular) keratoanalyzers, combining keratoscopy (Placido’s disc) and keratotomography. The keratoanalyzers original software generates maps and calculates irregularity indices of the cornea shape (keratotopography), refractive power (keratometry) and thickness (keratopachimetry), as well as values the probability and stage of corneal protrusion. Such diagnostic platforms provide differential diagnosis and verification of keratoconus at the earliest signs of the topographic stage of the disease; to date, there are no effective methods, that can reliably confirm or exclude ultrastructural changes at the pretopographic stage of keratoconus.

BACKGROUND: Migraine is a chronic neurovascular disease with high incidence rate and medical-social significance. Despite more than half a century of studying the disease, the pathogenesis of migraine is not yet completely clear. The results of separate research works demonstrate the inter-relation of migraine with the presence of patent foramen ovale and circulation shunting from the right side to the left one. AIM: Detailing the incidence rates and the clinical characteristics of migraine, as well as the effects of endovascular installation of the occluding device into the patent foramen ovale in terms of migraine course in a cohort of patients that had an ischemic stroke episode according to the mechanism of paradoxical embolism due to having a functionally significant patent foramen ovale. METHODS: The examined population included 97 patients aged from 18 to 50 years old (mean age 32.29±2.19 years; 70.8% females), undergoing examination procedures at the Research Center of Neurology from January 2018 until October 2023. All the patients previously had an ischemic stroke that had involved the mechanism of paradoxical embolism, associated with the presence of patent foramen ovale and high functional significance shunting. All the patients underwent an assessment of their conditions associated with the presence of a patent foramen ovale — migraine with or without aura, other procedures included the detailing of headache characteristics and of the effects of migraine on social adaptation. The endovascular intervention was performed in 61 patients. Dynamic follow-up data were obtained for 36 patients, of which 24 migraine patients had an assessment of headache characteristics before and after the foramen ovale closure. RESULTS: Within the cohort of patients with patent foramen ovale accompanied with functionally significant shunting and with a previous episode of ischemic stroke, the incidence of migraine was 39.2% (no aura — 21 patients or 55%; with aura — 17, or 45%), while the proportions of women and men being 1.9:1. The rate of headache attacks was 4 [1; 7] days per month. In 6 months after the installation of the foramen ovale occluder, migraine patients were showing a significant decrease in the rate of headache onsets from 4 [2; 24] to 2 [1; 5] days a month (р=0.009); a decrease was reported for pain intensity from 7 [7; 9] to 3 [3; 7] points of the visual analogue scale for pain (р=0.0001) along with a decrease in the degree of migraine affecting the patients’ everyday activity from 20 [6; 89] to 17 [2; 26] points (р=0.019) of the MIDAS questionnaire. CONCLUSION: The present research has confirmed the high incidence found in a cohort of patients with patent foramen ovale. Installation of the occluder resulted in a decrease in the rate and intensity of headache along with a decrease of migraine affecting the social adaptation. The research limitations were a small number of patients and the absence of data on the residual shunting circulation.

The rehabilitation of pediatric patients with oncology diseases localized in the maxillofacial area is a complex and long-term process. Most frequently, the resection area involves the maxilla or the mandible, which, in turn, impairs the functioning of the whole dentofacial system. The restoration of the integrity of the facial structures is the key task in the treatment of such patients. One of the main materials used for reconstructing the jaws is the titanium alloy. However, despite its beneficial properties and characteristics, there is a high risk of inflammation, encapsulation or failure of the endoprosthesis. The aim of the research was to analyze the data available up to date on the methods of perfecting the surfaces of titanium endoprostheses based on the published research works. After analyzing the articles devoted to the modification of the surface of titanium constructions used for endoprosthetics, for the period from 2008 until 2022 (n=41), we came to a conclusion that the modification of the surface of titanium endoprostheses results in an increase in its osteointegration, which decreases the risks of failure for the constructions.

BACKGROUND: Distraction arthroplasty of the ankle joint is the treatment method used for the cases of terminal osteoarthritis of the ankle joint that allows for delaying the arthrodesis or the total endoprosthesis replacement. The therapeutic effect is being achieved due to the separation of the articular surfaces (arthrodiastasis) with using the Ilizarov frame (or other devices for external fixation) for a period of 8–12 weeks. Only one research was described with the patients undergoing repeated arthroscopy of the ankle joint after the distraction arthroplasty in a combination with microfracturing of the cartilage defects, or repeated arthroscopy at the moment of removing the external fixation device (after 3 months). АIM: To study the changes in the articular surfaces according to the Outerbridge before and after the distraction arthroplasty of the ankle joint using the repeated arthroscopy of the ankle joint. METHODS: A total of 17 distraction arthroplasty surgical interventions of the ankle joint were performed (7 [41.2%] females and 10 [58.8%] males; the mean age of the patients was 48.5±13.57 years). Repeated arthroscopy of the ankle joint due to the recurrence of anterior impingement-syndrome after the distraction arthroplasty of the ankle joint within up to 12 months from the moment of removing the Ilizarov frame was carried out in 4 patients. For the evaluation of the treatment results, the Foot and Ankle Ability Measure (FAAM) scales were used, with an evaluation of pain, functions, deformity and the alignment of the foot and of the ankle joint (АОFAS Ankle-hindfoot scale), with subjective evaluation of pain (VAS); the status of the cartilage tissue in the ankle joint was evaluated using the modified Outerbridge scale. RESULTS: In all the patients, a statistically significant improvement of the functional result was found in 12 months from the moment of surgery when using the FAAM (р=0.0006) and АОFAS Ankle-hindfoot scales, as well as after removing the Ilizarov frame in 1, 3 and 6 months. The pain intensity according to the VAS scale has decreased from 6.17±1.32 cm before surgery to 2 cm (1.4; 2.1) (p=0.00002) in 12 months. The arthroscopic findings upon the repeated interventions demonstrate the development of the massive arthrofibrosis with its further degradation to the end of 6 months, also showing the restoration of the cartilage defects from Outerbridge grade IV to grade II–III. CONCLUSION: Upon the repeated arthroscopy, including the one performed at the end of 12 months after the distraction arthroplasty of the ankle joint, signs of regeneration were observed in the cartilage tissue defects with further defect coverage with a cartilage-like tissue, which, probably, determines the analgesic effect of the distraction arthroplasty of the ankle joint.

Deep vein thrombosis and pulmonary artery thromboembolism are the most commonly occurring cardio-vascular complications of oncological diseases, which may develop at any stage of the oncological process. These life-threatening complications take the leading positions within the structure of mortality among cancer patients, giving place only to the oncology disease itself. It is important to note that the patients with cancer-associated thromboses are the most difficult group of patients, in which the development of thromboses and thromboembolisms may not only delay the vitally important treatment of the main disease, but also to completely cease the treatment due to the lack of possibility for its adequate performing. This is an important social and economic task, taking into consideration the costs for the healthcare system required to treat the disease itself and its concomitant complications. Thus, there is a criticality factor of not only the treatment itself, but also of the prevention of oncology-associated thromboses and thromboembolisms. Currently, due to the wide spreading of the said complications, the therapy and the prevention of them undergo significant changes. The traditionally used warfarin is being switched to low molecular weight heparin. At the present moment, oral anticoagulants are used more and more often. The analysis of special scientific literature has allowed for evaluating the novel principles of treatment in cases of oncology-associated thromboses and thromboembolisms depending on the location of the process, on its stage, on the severity of the patient status, as well as to define the risk factors of oncology-associated thromboses, the practicability and possible methods of its prevention in various groups of patients.

BACKGROUND: Bariatric surgery represents an actively developing surgery field. With this, thanks to using modern automated methods of dissecting and suturing the tissues, a significant decrease is observed in the number of postoperative complications. At the same time, the problem of surgical suture incompetence remains topical even at the present times. The traditional methods of intraoperative diagnostics of incompetence are the provocative tests: the methylene blue test and the air leak test. One of the promising methods for intraoperative control during surgery is the use of fluorescent visualization in the near infrared range using the indocyanine green (ICG). AIM: Evaluate the informativity of intraoperative diagnostics of machine suture incompetence during the longitudinal gastric resection using fluorescent visualization with indocyanine green (ICG) by using the pig model to imitate various reasons of incompetence and to control surgical complications using morphological tests. METHODS: The research was carried out with using 20 pigs, each of which underwent the longitudinal gastric resection. The animals were distributed into the following experimental groups: the control group with performing standard longitudinal gastric resection (n=4) and the tests groups with longitudinal gastric resection and modeling of two variants of mechanical reasons of incompetence (n=12), as well as the local ischemia group (n=4). Intraoperationally, the gastric lumen was filled with a solution containing methylene blue and indocyanine green, after which, an evaluation was performed of the developed staining or Indocyanine green fluorescence visualization. Besides, in the ischemia group, ICG was administered intravenously. On Day 7 after surgery, samples were taken for histological examination. RESULTS: In 10 out of 11 experiments with the mechanical factor of modeling used to stimulate the machine suture incompetence, ICG visualization was found, with the ingress of methylene blue found in two cases out of 11, respectively. In 90% of the cases, the transudation of ICG corresponded to significant signs of inflammation, with the ingress of methylene blue being found only in 20% of the cases. CONCLUSION: The method of intraluminal administration of Indocyanine green in “mechanical” models of machine suture incompetence upon longitudinal gastric resection is more informative comparing to the introduction of methylene blue. Data from fluorescent ICG-angiography completely correspond to the location of ischemia modeling area.

Glaucoma is one of the main causes of irreversible blindness worldwide. Up to 76% of the glaucoma cases are accompanied with complicated cataract. The issue of cataract treatment in glaucoma patients is a difficult task for any surgeon, for the surgical procedure itself can result in a number of complications. One of them is the loss of endothelial cells in the cornea. A decrease in the endothelial cell density in such patients occurs due to long-term use of various hypotensive drops, due to variations of intraocular pressure, as well as due to the surgical interventions themselves. Up to 16.9% of cataract removal cases with a background of glaucoma are accompanied by pronounced post-operative corneal swelling, which leads to an increased risk of losing corneal endothelial cells. The perspective branch of surgical treatment for cataract and glaucoma is the development of a unified algorithm taking into account the individual characteristics of the patient, such as the eye lens clouding, the glaucoma stage, the intraocular pressure, the past surgeries, the hypotensive therapy and the density of corneal endothelial cells.

Gliomas are the reason of fatal outcomes in an overwhelming number of patients with oncology diseases located in the central nervous system. The diagnostics of such neoplasms requires using stereotaxic biopsy, which cannot be performed in a certain percentage of the patients. Besides, this disease is characterized by high recurrence rates, despite the advances in developing resection and chemotherapy — based technologies. The early detection of oncological diseases located in the central nervous system and the differential diagnostics of tumor pseudo progression, not affecting the survival of the patient, represents a challenge for modern Medicine. Liquid biopsy is a minimally invasive diagnostic method based on the analysis of tumor derivatives (such as extracellular tumor DNA and RNA), contained within the biological fluids of the organism. For the purpose of defining the presence of the tumor component, the tests are used to detect the so-called hot-spot mutations and the patterns of epigenetic regulation, found in specific types of tumors. The technology can be used for detecting tumor recurrences and for the differential diagnostics of space-occupying mass lesions in patients, in which stereotaxic biopsy is contraindicated. The review contains a discussion on modern advances of fluid biopsy based on the analysis of the extracellular tumor DNA and RNA levels in blood plasma and in the cerebrospinal fluid of glioma patients.

BACKGROUND: Chronic generalized periodontitis takes the second place by the occurrence rate worldwide among the diseases of the maxillofacial area. High significance of preventing and early diagnostics for chronic generalized periodontitis is defined by the early tooth loss, by the decrease in chewing efficiency and by the development of chronic infection foci. It is known that the main etiology factor of chronic periodontitis is the microbial one, including the representative of the oral cavity microbiota — Tannerella forsythia, which is a Gram-negative, anaerobic bacterium. AIM: To verify the presence of T. forsythia in cases of chronic generalized periodontitis depending on the disease severity. METHODS: The research included 126 patients with chronic generalized periodontitis of various severity degree, for which, an analysis of the content of periodontal recess was carried out. In the control group, consisting of individuals with no periodontal tissue abnormalities (n=39), the content of gingival sulcus was analyzed. The samples were examined using the method of polymerase chain reaction following the real time mode by means of employing the DT-96 detection thermocycler (DNA-Tekhnologia NPO) and the «ParadontoScreen» test kit. RESULTS: The findings included a high direct correlation between the rate of detecting T. forsythia and the severity degree of the course of chronic periodontitis (the correlation coefficient value was found to be 0.997; p 0.05). A strong direct relation (0.948; p 0.05) was demonstrated between the concentration of T. forsythia genomic equivalent and the severity degree of chronic periodontitis. CONCLUSION: The conducted research has shown that the concentration of T. forsythia is a predictor for severity degree of chronic periodontitis.

BACKGROUND: The posterior dislocation of the humerus head occurs up to 4.5% of all cases of dislocated humerus. Low prevalence and difficulties in diagnosing this type of injury often lead to the formation of old shoulder dislocations. Old cases of back dislocation of the humerus head, especially with reversible bone defects, are accompanied by limitations of movement in the shoulder joint, expressed by pain syndrome. The presence of bone defects in the head of the humerus makes it necessary to replace the latter with bone or soft tissue structures, in surgical practice tendons of the subcutaneous and sub-carpal muscles are most often used. In old cases, scar post-traumatic rebirth is often impossible. CLINICAL CASE DESCRIPTION: The article presents a new method of operative treatment of the old clutch, in the framework of which the use of a new method of operative treatment of the reversal fracture of Hill-Sachs with a long-term stuck back dislocation of the shoulder is considered. The main goal, which is the operative treatment of reversible osteochondral defect up to 25% of the area of the humerus head, due to the deficiency of bone mass of the shoulder head. By moving the corrugated tendon of the long head of the bicep to the impaction zone and fixing it with anchor clamps in the defect zone, resulting in the stabilization of the shoulder joint. CONCLUSION: The outcome of this clinical case is restoration of the function of the shoulder joint and absence of clinical symptoms of instability in it in the late postoperative period. The use of the proposed method of operative treatment makes it possible to reduce the risks of developing postoperative restriction of movements in the joint, instability of the head of the humerus bone, especially in the long-term cases of dislocation of the head of the humerus.

BACKGROUND: Thoracoscopic thymectomy performed with using the lateral intercostal access in cases of non-invasive thymic tumors is the commonly used technique. Most frequently, the three-port and the single-port techniques are used. As the experience was accumulating, it became evident that the intercostal access has a number of disadvantages, such as unsatisfactory visualization of the nerve on the opposite side and of the cervical portion of the thymus, along with a probably of developing chronic pain syndrome. One of the possible solutions for this issue can include the use of sub-xyphoid access. AIM: An evaluation of direct results obtained when using the unified sub-xyphoid access during thoracoscopic thymectomy in patients with non-invasive epithelial thymic tumors. METHODS: An experience was analyzed that was gained after the treatment of 14 patients undergoing thoracoscopic thymectomy using the unified sub-xyphoid access for non-invasive epithelial tumors of the thymus. The age of the patients ranged from 24 to 70 years (median — 42 years); 9 of them were females (64.3%) and 5 were males (35.7%). In all the patients, at the moment of surgical treatment, stage I disease was diagnosed. The minimal dimension of the excised thymoma in this research was 15 mm with the maximal dimension being 65 mm, the median value was 38 mm. RESULTS: Two surgeries (14.3%) were accompanied with technical difficulties due to the presence of an adhesion process after a previous episode of pulmonary inflammation, which resulted in more significant intraoperative blood loss, which was 200 ml. The surgery duration varied from 60 to 180 minutes with the median of 82.5 minutes. In the majority of cases (97.6%), the pain syndrome level did not exceed 4 points of the visual analogue scale for pain. During the postoperative period, a single surgical complication was reported — the development of the retrosternal hematoma; no fatal outcomes were reported. CONCLUSION: The thoracoscopic thymectomy from the unified sub-xyphoid access is a justified option for cases of non-invasive epithelial thymic tumors. This method allows for performing the surgery in full range, not violating the oncology principles. It was proven that, for tumors measuring up to 65 mm, this method does not result in an increase in surgery duration or an increase in the rates of intraoperative complications.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.