Introduction. Previously, it was shown that the “classic” phenotypes of polycystic ovarian syndrome (PCOS) are associated with significant decrease in gut microbiota alpha diversity as compared with healthy women.

The aim of the study. To establish cut-off points for alpha diversity indices, significant in polycystic ovarian syndrome with hyperandrogenism.

Material and methods. The manuscript presents a sub-study of Eastern Siberia PCOS Epidemiology and Phenotype Study, conducted in Eastern Siberia (Russia) from 2016 to 2019. All participants (175 women of reproductive age: 26 women with PCOS (according to Rotterdam criteria (2003)) and hyperandrogenemia (increased levels of total testosterone (TT) and/or free androgenindex(FAI), and/ordehydroepiandrosterone sulphate (DHEAS)), 149 – without hyperandrogenemia) were recruited during the annual employment medical assessment. Methods included a questionnaire survey, anthropometry and modified Ferriman – Gallwey score, gynecological examination, pelvic ultrasound, and blood serum tests for TT, DHEAS, sex hormone-binding globulin, FAI, prolactin, thyroid-stimulating hormone, and 17-hydroxyprogesterone. Five indices of alpha diversity (amplicon sequencing variant, Shannon index, Simpson index, Chao index, and abundance-based coverage Index) were estimated for the gut microbiota using amplicon metasequencing. Statistical analysis included ROC-analysis for development of cut-off points for the indices, associated with hyperandrogenism in women of reproductive age with PCOS.

Results. According to results of ROC-analysis, the greatest sensitivity with moderate specificity, with a high area under the curve was established for the Shannon and Simpson indices with cut-off points classifying women with or without hyperandrogenemia – 5.84 and 0.97, respectively.

Conclusions. The developed criteria for assessing alpha diversity using cut-off points for the most significant indices can be useful for monitoring the results of different therapeutic interventions (prebiotics, probiotics, etc.) in hyperandrogenic phenotypes of PCOS.

The aim of the study. To assess the characteristics of the menstrual cycle and ovulation disorders in girls aged 15–17 years.

Materials and methods. The study was carried out in 2022–2023 in the Murmansk region in Apatity. A total of 225 girls with average age of 16.5 ± 0.03 years took part in the study. The characteristics of the menstrual cycle and ovulation disorders were studied according to the guidelines of the International Federation of Gynecology and Obstetrics.

Results of the study. In the study group, the onset of menarche (13.1 years) is observed at a later age compared to the girls living in other regions of Russia and neighboring countries (12.6–12.9 years). Every seventh girl has an irregular menstrual cycle, every fifth girl has a cycle duration of more than 38 days. Heavy menstruation occurs in every third girl, intermenstrual uterine bleeding – in every thirteenth girl. Half of the girls have painful periods (dysmenorrhea). Among ovulation disorders, the most common is abnormal uterine bleeding – 34.7 %. Also, intermenstrual uterine bleeding (8.0 %), primary amenorrhea (2.7 %) and polycystic ovary syndrome (1.3 %) are registered. Among gynecological pathology, in addition to ovulation disorders, we registered vulvovaginal candidiasis and paraurethral cyst.

Conclusion. The analysis of the obtained results showed that only 20.4 % of girls do not have gynecological pathology, which to a certain extent indicates a low level of reproductive health of girls. Asaresult, it is necessary to diagnose and treat diseases which can cause the development of ovulation disorders more carefully and at earlier stages of sexual development. The work was carried out as part of the research topic No. FMEZ-2022-0012.

Background. Uterine fibroids is a benign monoclonal tumor originating from the smooth muscle layer of the uterus. Non-modifiable risk factors for the development of uterine fibroids, such as age, ethnicity, age at menarche, etc, have been studied quite extensively, while the role of many controllable factors remains debatable.

The aim of the study. To identify the main modifiable factors associated with uterine fibroids in women of reproductive age living in the Baikal region, including certain ethnic groups.

Materials and methods. We carried out a multicenter cross-sectional study in 2016–2019 in institutions of Irkutsk and Bokhan (Irkutsk region) and Ulan-Ude (Republic of Buryatia). The subjects of the study were women to have annual workplace medical examination. The study included 1,347 participants of reproductive age (34.33 ± 6.37 years) who met the inclusion criteria. Among all women included in the study, there were 867 (64.37 %) Caucasians, 361 (26.80 %) Asians, and 119 (8.83%) women of mixed (Caucasian-Asian), ethnicity. The research methods included a questionnaire, general clinical and gynecological examination, and pelvic ultrasound examination.

Results. According to our study, the main non-modifiable factors associated with the presence of uterine fibroids were: Asian ethnicity; age at menarche 12–13 years; age of the study participant 40–44 years; menopausal symptoms; adenomyosis. The “controllable” factors included: city residency; body mass index over 40 kg/m2; history of abortions and miscarriages; metabolic syndrome; using combined oral contraceptives; lack of sexual activity; smoking; presence of anumber of occupational hazards.

Conclusion. Our study identified the main controllable factors associated with the presence of uterine fibroids in a multiethnic population of women of reproductive age.

Most tests assess physiology at rest, whereas many symptoms occur with physical exertion, and physical activity is an integral part of healthy functioning and quality of life of a person. Today, cardiopulmonary exercise testing is considered the standard for identifying exercise limitations and differentiating their causes.

Cardiopulmonary exercise testing is widely used in both basic and the latest research from cardiology and pulmonology to neurology and hematology and has great prognostic value. Cardiopulmonary exercise testing is considered the gold standard for non-invasive assessment of the cardiopulmonary system and physical performance. This study has become even more relevant and in demand due to the COVID-19 outbreak; now it plays an important role in the clinical assessment of recovering patients who have had COVID-19.

Numerous indicators recorded at each stage of the study, taken together, allow us to obtain a complete picture of the work of the cardiovascular, respiratory and muscular systems, as well as to study the characteristics of the metabolic response to stress.

This article contains a review of the literature on the history of the application and development of the cardiopulmonary exercise testing, its physiological characteristics and a study of the literature concerning application of studied method in medicine over the past 5 years. The search and analysis of articles were carried out using the scientometric databases PubMed, ScienceDirect, Google Academia.

The presented article may be useful for young specialists working in functional diagnostics, cardiology and pulmonology, as well as for researchers and postgraduates whose work involves application of the cardiopulmonary exercise testing method.

The leptin gene (LEP) is considered as a potential candidate gene affecting metabolic disorders associated with predisposition to overweight and obesity.

The aim of the study. To search for single nucleotide polymorphisms (SNP) of the leptin gene and to assess their relationship with anthropometric and biochemical parameters in Russian and Buryat adolescents with different weight status.

Materials and methods. The study included adolescents of two ethnic groups – Caucasoid (Russians) and Mongoloids (Buryats) – aged 11–17 years (mean age 14.8 ± 0.45 years) with different weight status. We assessed anthropometric parameters, determined biochemical parameters and leptin level in the blood plasma, and sequenced the leptin gene fragment localized in the 128253475–128255334 region (1859 bp) of this gene using the Sanger method.

Results. The sequencing of the leptin gene fragment identified 10 single nucleotide substitutions (rs28954118, rs3828942, rs759854910, rs199893150, rs7788818, rs144755411, rs917105894, chr7:128255051, chr7:128255092, chr7:128254681), two of them (rs28954118, rs144755411) had a correlation with biochemical and anthropometric parameters. In the group of Russian adolescents with overweight and/or obesity, the carriers of the AT variant of rs28954118 had statistically significantly higher levels of triglycerides (TG), very low density lipoprotein (VLDL) cholesterol, skin fold thickness on the abdomen and fat mass percentage compared with carriers of the AA genotype. In the control group of Buryat adolescents, the parameters of waist width, skin fold thickness on the hip and waist width/height ratio are statistically significantly lower in carriers of the CT variant of rs144755411 compared with carriers of the CC genotype.

Conclusion. AT genotype of rs28954118 was identified only in Russian adolescents with overweight and/or obesity, and was accompanied with statistically significantly high values of TG, VLDL cholesterol, skin fold thickness on the abdomen and fat mass percentage. The SNPs we identified do not affect the concentration of leptin.

Background. Within the framework of the regional pilot project on selective exome screening of newborn children, which is carried out on the basis of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, we conducted molecular genetic testing of children who meet the criteria for inclusion in the increased group of hereditary diseases. We examine not only children with suspected genetic etiology of the condition, but also children with borderline clinical and laboratory manifestations and minor developmental anomalies.

The aim of the study. To describe the clinical and phenotypic features of a patient with a previously undescribed Xq12q13.2 duplication detected in the neonatal period.

Materials and methods. The child was examined within the framework of a regional pilot project on selective exome screening of newborn children. DNA was isolated from a biological sample of venous blood of the newborn, and whole exome sequencing and chromosomal microarray analysis were performed. Signed informed voluntary consent for the publication of the examination data and a photograph of the child were obtained from the legal representatives of the proband.

Results. Data in favor of the presence of a previously undescribed Xq12q13.2 duplication, confirmed by the reference method were obtained in a patient included in the project in accordance with the clinical criteria for the formation of a risk group according to the data of the conducted whole exome sequencing. Discussion. Xq12q13.2 duplication was detected in the proband from the present clinical observation with non-specific clinical manifestations in the neonatal period. Similar duplications have been described in the literature in three patients with congenital malformations, epilepsy and psychomotor retardation. Early diagnosis of such a copy number variation disorder before the appearance of severe clinical signs of the disease will allow determining the prognosis and tactics of observation and treatment of the patient.

Conclusion. The described case of Xq12q13.2 duplication in a patient demonstrates the importance of timely genetic analysis to optimize medical genetic counseling, reduce diagnostic search and improve prognosis for patients.

Background. Autoimmune thyroiditis (AIT) affects more than 5 % of the world’s population.

The aim. To determine the level of sPD-1, sPD-L1, sCTLA-4 and sB7.2 molecules in individuals suffering from various forms of autoimmune thyroiditis.

Methods. The study included 31 individuals aged 18 to 40 years. They were divided into four groups: group I – healthy individuals (n = 10); group II – carriers of antibodies to thyroid peroxidase (n = 11); group III – individuals with AIT accompanied with subclinical form of hypothyroidism (n = 6); group IV – individuals with AIT complicated by compensated hypothyroidism (n = 4). Venous blood was collected to determine the level of antibodies to thyroid peroxidase using enzyme immunoassay, the concentration of thyroid stimulating hormone and free thyroxine – using chemiluminescence immunoassay, and the levels of sPD-1, sPD-1L, sCTLA-4, and sB7.2 – using flow cytofluorometry. Statistical processing was performed using the Kruskal – Wallis one-way analysis of variance.

Results. When comparing the level of sPD-1L in groups I (54.1 (28.7; 67.6) pg/ml) and II (4.36 (2.36; 18.0) pg/ml), the decreased in this indicator was 91.94 % (p = 0.001). When comparing the sPD-1 level in the group of healthy individuals (16.6 (13.6; 37.2) pg/ml) and group IV (7.28 (5.18; 11.1) pg/ml), werecorded a decrease of 56.14 % (p = 0.001). The sB7.2 concentration decreased by 65.03 % in group II (16.4 (15.6; 32.7) pg/ml) compared to the control group (46.9 (39.3; 54.4) pg/ml) (p = 0.001). In group III, the sCTLA-4 level was 3.22 (3.06; 3.33) pg/ml and decreased by 88.66% compared to the control group (p = 0.001).

Conclusion. The development of autoimmune thyroiditis is accompanied with the decrease in the concentration of sPD-1, sPD-1L, sCTLA-4 and sB7.2.

Respiratory failure is known to be the main clinical manifestation of COVID-19. However, the mechanism of its development has not been sufficiently studied. The originality of the study is that for the first time, coagulation, fibrinolysis and endothelial dysfunction indicators were studied depending on the SpO₂/FiO₂ index in patients with COVID-19.

The aim of the work. To assess the role of impaired activity of the blood coagulation system and the development of endothelial dysfunction in patients with COVID-19 in the pathogenesis of respiratory failure.

Methods. The study included 134 patients infected with SARS-CoV-2 virus having varying severity of the clinical picture. They were divided into three groups according to the SpO₂/FiO₂ index. We determined the number of venous blood cells and studied the level of transferrin (TF), D-dimer, tissue-type plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), inter-cellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) in the blood serum.

Results. The study revealed that the tissue factor content increased by 24 % in patients of the third group compared to the first. The PAI-1 level was high in the second group and significantly decreased in the third (p < 0.001). An increase in the D-dimer level was recorded in the second and third groups. The levels of ICAM-1 and VCAM-1 molecules increased significantly in the third group of patients (p = 0.021 and p = 0.028, respectively). A moderate positive correlation was found between the SpO2/FiO2 index and the VCAM-1 level (p < 0.001), a weak positive correlation with PAI-1 (p = 0.012), and a weak negative correlation with TF (p = 0.027).

Conclusion. Respiratory failure in patients with COVID-19 is caused by disorders in the hemostasis and fibrinolysis systems, as evidenced by an increase in the level of tissue factor and D-dimer, “consumption” of tissue activator and plasminogen activator inhibitor. Developing endothelial dysfunction, accompanied by increased secretion of adhesion molecules, aggravates the pathogenesis of respiratory failure.

Background. Currently, the pathophysiological mechanisms of acute damage to organs and systems caused by coronavirus infection have been studied quite fully, but the mechanisms underlying the clinical manifestations of long COVID have not yet been accurately described. The mechanisms of persistence of a number of symptoms in patients who have had COVID-19 and the role of systemic inflammation and endotoxemia markers in it remain a understudied aspect and a promising direction for further studying.

The aim of the study. To assess the markers of systemic inflammation, endotoxin-releasing systems, intestinal permeability and endothelial dysfunction in patients with long COVID at the stage of health resort treatment.

Methods. The study included 32 patients who had recovered from coronavirus infection and were undergoing health resort treatment in the pulmonology department of the I.M. Sechenov Academic Research Institute for Physical Therapy, Medical Climatology and Rehabilitation. We also selected a control group (n = 20). All patients underwent peripheral blood analysis to detect the levels of markers of systemic inflammation, endotoxin-releasing systems, intestinal permeability, endothelial dysfunction and vasoconstrictor agents: C-reactive protein (CRP), lipopolysaccharide-binding protein (LPB), tissue-type plasminogen activator (tPA), zonulin, bactericidal/ permeability-increasing protein (BPI), vasopressors of angiotensin 2 and endothelin (EDN1).

Results. Patients who had recovered from coronavirus infection had a statistically significant increase in the levels of CRP (3.4 [2.56; 4.0] mg/l), LBP (18.46 [14.0; 25.5] ng/ml), tPA (0.07 [0.02; 0.32] ng/ml), angiotensin 2 (133.3 [63.0; 503.7] pg/ml) and a decrease in the level of BPI (1576 [276; 3588] pg/ml) (p < 0.05).

Conclusion. A statistically significant increase in markers of systemic inflammation, endotoxinemia, and vasoconstrictor agents in patients with long COVID indicates an imbalance in endotoxin-binding and endotoxin-releasing systems in patients who have had coronavirus infection. Further study of the described markers is necessary to improve approaches to long-term personalized therapy for this category of patients.

Background. Tooth extraction is considered the most frequently performed operation in surgical dentistry, which can often cause inflammatory complications. Modern research has come a long way in terms of developing methods for the prevention, diagnosis and treatment of these complications, but the search for their early laboratory markers remains an urgent task to this day.

The aim of the study. To determine prognostic laboratory criteria for the development of local inflammatory complications of third mandibular molar extraction.

Methods. The study included 35 people who underwent extraction of a third mandibular (semi-impacted) molar. Before the surgery, immediately after the surgery, 1, 2, 3 and 4 days after the surgery, we assessed the objective status of the patients and collected oral fluid from the oral cavity, in which we determined the concentrations of cytokines using enzyme-linked immunosorbent assay. After the surgery, patients were divided into a control group and a group with complications with determination of their cytokine status.

Results. Immediately after the surgery, patients from the group with complications, compared with patients from the control group, had significantly higher levels of proinflammatory cytokines – interleukin (IL) 1, IL-8 and comparable levels of tumor necrosis factor α and anti-inflammatory cytokines IL-4 and IL-10. Integral cytokine indices in both groups showed a sharp shift towards pro-inflammatory direction in patients with complications. This fact determines the protracted or progressive nature of the inflammatory process after the surgery.

Conclusion. Determining the level of individual cytokines and cytokine indices in the oral fluid after the extraction of a third mandibular molar allows us to identify early markers for the chronicity of the inflammatory process, to predict its further course and to take appropriate measures to prevent the development of expected complications.

Background. Chronic lymphocytic leukemia (CLL) is the second most common hematological malignancy without a trend towards a decrease in its incidence. 66 % of patients with CLL experience bone fractures as a result of osteoporosis in all age groups, and the detection frequency is no more than 15 %. Insufficient understanding of the osteoporosis pathogenesis in CLL leads to problems in diagnosis, prevention and therapy.

The aim of the study. To analyze modern data on the features of the osteoporosis pathogenesis in chronic lymphocytic leukemia.

Results and discussion. Osteoporosis is formed when osteoresorption prevails over osteosynthesis due to intercellular interactions of bone tissue and the immune system, dysregulation of intracellular signaling pathways RANKL/RANK/OPG, Wnt, FoxO, RUNX2, initiated by cytokines, growth factors, prostaglandins, and hormones. The degree of osteoresorption in CLL is associated with the severity of the clinical course, chemotherapy and hormonal deprivation. The osteoporosis pathogenesis in CLL is considered as part of a complex set of events, including, firstly, the interaction between leukemic cells (overexpression of PTHrP, RANKL) and bone cells (synthesis of growth factors), which forms a vicious circle of osteoresorption and tumor growth. Secondly, pro-inflammatory markers in CLL (tumor necrosis factor α, interleukin (IL) 1β, IL-6, IL-8, IL-11, granulocyte-macrophage colony-stimulating factor, macrophage colony-stimulating factor, transforming growth factor β, prostaglandin E2) limit osteoblast-induced osteosynthesis and stimulate the expansion of osteoclasts from monocytic suppressor cells of myeloid origin with or without the participation of the RANKL/RANK system. Thirdly, oxidative stress in CLL and impaired efficiency of antioxidant protection with the participation of fibroblast growth factor 23, transcription factor Nrf-2 with activation of JNK, ERK1/2, NF-κB, and also an increase in the RANKL/OPG ratio lead to inhibition of osteoblastogenesis.

Conclusion. Analyzing and systematizing data on the osteoporosis pathogenesis in CLL are instrumental for the development of diagnostic criteria for osteoporosis in chronic lymphocytic leukemia that are much-needed in clinical practice and for the improvement of therapeutic tactics.

Background. Blepharitis is one of the most common eye diseases: it accounts for 23.3 % of the total number of patients with inflammatory eye diseases worldwide. 40.2 % of these patients seek outpatient care. The incidence of blepharitis is 1.5–2 times higher in women than in men. The leading factors in the development of blepharitis are both general (gastrointestinal tract diseases, diabetes mellitus, hypertension, systemic use of corticosteroids, etc.) and local (atopic and seborrheic dermatitis or rosacea). The main causative agents of this disease are Staphylococcus spp. (S. aureus, S. epidermidis). As a rule, the disease manifests itself in patients aged 30–50 years, while in women aged 40 to 45 years, 80 % of blepharitis are of staphylococcal origin. Currently, there are reports in the literature about apotential link between Helicobacter pylori infection and the development of chronic blepharitis, but the data are very contradictory.

The aim of the study. To analyze the features of the relationship between Helicobacter pylori and inflammatory eyelid diseases.

Materials and methods. We conducted a search and analysis of literary sources in the Web of Science, PubMed and Google Scholar databases, as well as in the Russian Science Citation Index database for the period from 2000 to 2022.

Conclusion. The review analyzes and summarizes the pathogenic mechanisms of the relationship between chronic blepharitis and Helicobacter pylori. We carried out an analysis of numerous studies, which give grounds to assume a possible role of Helicobacter pylori infection in the development and course of inflammatory eyelid diseases (blepharitis). The main pathogenic aspects in these studies are: chronic inflammation of the eyelids and gastrointestinal tract (antigenic mimicry); excretion of toxic substances from the oral cavity (ammonia, hydrogen nitrite, hydrogen cyanide and other substances causing indirect inflammation of the conjunctiva and eyelid cartilage); the presence of Helicobacter pylori in tears.

Background. Body dissatisfaction is widely spread among the population. It negatively affects human health, contributing to the development of eating disorders, anxiety and depressive disorders, and the formation of unhealthy eating patterns and lifestyle. Determining the factors associated with body dissatisfaction in adolescents may be important for the prevention of the above mentioned disorders.

The aim of the work. To describe the prevalence, characteristics and factors associated with body dissatisfaction among urban school students.

Materials and methods. Tenth-grade school students (n = 440) underwent anthropometry and also filled out questionnaires including socio-demographic factors and lifestyle factors. Collins scales were used to assess body dissatisfaction, and the Russian version of the Paediatric Quality of Life Inventory (PedsQL 4.0; Lyon, France) was used to assess health-related quality of life.

Results. 60.2 % of school students reported a desire to have body figures different from the actual one. 42.7 % of adolescents experienced mild body dissatisfaction, 17.5 % experienced moderate and severe body dissatisfaction. The frequency of body dissatisfaction was comparable among both male and female adolescents, but it was more pronounced among girls compared to boys (Z = 2.2; p = 0.029). Boys were significantly more likely than girls to strive for larger body figures than what they felt they had (38.8 % vs. 8.1 %). In contrast, girls were significantly more likely than boys to want to lose weight (55.4 % vs. 12.3 %). Statistically significant associations with moderate/severe body dissatisfaction are shown for overweight/ obesity and for the time spent by schoolchildren watching TV, on social networks, and in the Internet. Sports activities demonstrated a protective role in relation to body dissatisfaction. The presence of body dissatisfaction significantly reduced all aspects of adolescents’ quality of life.

Conclusions. The results of the study justify the approach to body dissatisfaction as an independent problem that requires active diagnostics and targeted exporure, and determine possible directions for preventive measures among adolescents.

Background. In the conditions of an Arctic expedition, people’s physical and mental health are affected not only by extreme climatic and geographical factors, but also by social and living conditions caused by group isolation. Comfort psychological atmosphere in an isolated team, its group cohesion and motivation are an environmental resource for expedition participants and contribute to maintaining optimal functional state throughout the entire shift period.

The aim of the work. To identify and to describe group cohesion, group motivation and psychological atmosphere in the team as the parameters of group dynamics of "Arctic Floating University – 2023" expedition participants in connection with changes in their functional state during the shift period.

Methods. We used V.A. Rozanova’s "Group motivation", C.E. Seashore’s "Group Cohesion Index", and A.F. Fiedler’s "Team’s psychological atmosphere" questionnaires; psychophysiological testing on the UPFT-1/30 "Psychophysiologist" device (variational cardiologic intervalometry, complex eye-hand reaction); M. Lüscher color test; statistical methods: descriptive statistics and correlation analysis using the Spearman coefficient. Follow-up monitoring of the functional state and group dynamics parameters of the expedition participants was carried out once every two days during the entire expedition period. 42 participants of the "Arctic Floating University – 2023" project took part in the study.

Results. The functional state of the participants in the maritime Arctic expedition during the entire expedition period was characterized by acceptable and nearoptimal values, a sufficient level of performance efficiency, an average level of physical condition, the absence of signs of severe stress, and an average level of subjective comfort. Group cohesion, group motivation, and the psychological atmosphere in the team increase from the beginning to the end of the expedition period, and on the days 21–22, they have the highest levels compared to all days of the expedition. Mostly direct correlations were revealed between group processes and changes in the functional state of expedition participants.

Conclusion. A positive relationship was established between group cohesion, group motivation and psychological atmosphere in the team and the parameters of the functional state of the expedition participants.

Background. The issues of early diagnostics and prevention of schizophrenia, despite more than a century of their study, remain relevant. In recent decades, there has been an increase in interest in the study of depersonalization-derealization symptom complex in the context of verification of the initial manifestations of the disease. Meanwhile, ICD-10 does not include symptoms of depersonalization and derealization in the rank of diagnostically important symptoms for this pathology, and they are traditionally considered as manifestations of schizotypal disorders. The existing contradictions suggest the need for further study of depersonalization and derealization in the clinic of manifest forms of schizophrenia.

The aim of the study. To assess the prevalence and clinical manifestations of depersonalization-derealization in paroxysmal forms of schizophrenia.

Materials and methods. The study included 40 patients with depersonalization-derealization symptoms in the clinical picture of manifest forms of schizophrenia. Typological groups were represented by paranoid schizophrenia with an attack-like or continuous course (18 people) and schizoaffective disorder (22 people). We used such research methods as clinical follow-up, clinical and anamnestic, clinical and psychopathological, and also the Cambridge Depersonalization Scale.

Results. Manifestations of depersonalization-derealization at the pre-manifest stage of the disease were observed in 82.5 % of the study cohort. In most cases, mild and moderate severity was detected – in 37.5 and 42.5 %, respectively; severe form was found only in 20 % of patients. In 17.5 % of cases, manifestations of depersonalization and derealization were periodic, and in the majority (65 %) of patients they were persistent. Almost 1/3 of patients had total depersonalization, 22.5 % had only autopsychic and allopsychic depersonalization, and 17.5 % of cases had isolated somatopsychic depersonalization. An association was found between the severity of depersonalization-derealization and paranoid syndrome. During the disease, as negative disorders increase, the manifestations of depersonalization-derealization are reduced.

Conclusion. The obtained data demonstrate the need for further studying depersonalization symptom complex in the clinic of manifest forms of schizophrenia in the aspect of prognosis of the clinical course of the disease.

Background. Currently, researchers are aiming to establish the relationship between neurocognitive disorder and other clinical manifestations of endogenous diseases and functional indicators of the patient’s adaptation to social life. According to some data, the development of cognitive disorders is associated with the severity of catatonic disorders in the clinical picture of various diseases, in particular the presence of  catatonic symptoms determines the  worst indicators of  cognitive functioning in the case of schizophrenia.

The aim. To study the clinical and psychopathological features of catatonic syndrome in connection with schizophrenia spectrum disorders, as well as its connection with neurocognitive disorder manifestations among patients with endogenous disorders.

Methods. From September 2022 to March 2024, we conducted a prospective, multicenter study of patients (n = 69) suffering from paroxysmal schizophrenia with primary catatonic symptoms in  the  structure of  attacks. Mental status, the  severity of catatonic symptoms using Bush – Francis Catatonia Rating Scale, neurocognitive profile using a number of validated scales (Montreal Cognitive Scale, Brief Assessment of Cognition in Schizophrenia, Frontal Assessment Battery) were assessed.

Results. Neurocognitive disorder was revealed in all cases studied. It has been noted that, depending on the presence/absence of affective symptoms, various domains of the neurocognitive profile are affected. Thus, in patients without severe affective symptoms, auditory and verbal memory, attention, processing speed, and motor skills are impaired. In patients with pronounced affective disorders, processing speed, motor skills, and problem-solving behavior are affected.

Conclusion. Based on  the  results of  processing the  material, it  was revealed that the most pronounced neurocognitive disorders were found in case of the manifestation of  paroxysmal paranoid schizophrenia in  male patients with a  relatively early onset of the disease and hypokinetic catatonic disorders. In the future, we are planning to compare these results with the results of control group of patients with endogenous diseases and without catatonia.

Background. The article reviews the problem of testing the in-person version of the burnout reduction program "OsNOVA" for health workers.

The aim of the work. To present the results of the program immediately after its completion and to study the sustainability of the effect.

Materials and methods. As part of the program testing, 49 doctors and nurses were interviewed. The following methods were used: Maslach Burnout Inventory; Lazarus and Folkman Inventory of Coping Strategies; Beck Depression Inventory; Perceived Stress Scale 10; Short Form 12 questionnaire; mindfulness questionnaires.

Results. It was found that when implementing a program to reduce the level of professional burnout in medical workers, held in-person, there is a statistically significant decrease in those subjects whose burnout was initially high. This is accompanied by an increase in mindfulness (primarily such components as Non-judgmentalism, Observation and Awareness of Actions), productive coping strategies. Health workers with a relatively low level of burnout had an improvement in a number of indicators reflecting the burnout level, as well as an increase in the quality of life. The effect achieved by the program persisted for at least three months after the end of its active part.

Conclusion. The "OsNOVA" program in an in-person format can be used to prevent professional burnout of health workers. Additional work is planned for its further improvement.

Background. The prevalence of obesity among children is increasing, which is a serious healthcare problem. In healthcare, the problem of motivation affects an important area that reflects its effectiveness – patient motivation for treatment. A decrease in treatment motivation reduces therapeutic effect, increases the complication rate of the underlying disease, reduces the quality of life of patients and increases treatment costs.

The aim of the work. To identify the differences in treatment motivation in adolescent girls with obesity.

Materials and methods. The pilot study was carried out at the clinic of the Scientific Centre for Family Health and Human Reproduction Problems. The study included 40 girls aged 14–16 years suffering from grade 1 obesity. To study treatment motivation, we used the following methods: J. Nuttin’s, D. McClelland’s, S.R. Panteleev’s, J.K. Collins’, method of the self-conception research, the “Type of Attitude Towards the Disease” method; attitude towards the disease.

Results. The study showed that the adolescents who were admitted into hospital for the first time had higher treatment motivation during the study than the adolescents who were readmitted into hospital. The adolescents who were readmitted into hospital felt guilty remorse, anxious suspiciousness, and fear of failure. The dominant type of treatment motivation in both groups consisted of the following attitudes: achieving symptomatic improvement; receiving a “secondary gain” from the disease; other motivation (passive position).

Conclusion. The obtained data from the study of treatment motivation in adolescent girls with obesity can be used to optimize the process of therapy of such patients in a hospital setting.

Background. Local antibacterial therapy in the treatment of osteomyelitis significantly increases the effectiveness of surgical debridement.

The aim of the work. To assess in an in vivo experiment the dynamics of perifocal tissue reactions to the application of an original polyvinylpyrrolidone-based antimicrobial gel in a one-stage treatment of implant-associated infection in the hip joint in rabbits.

Methods. Implant-associated infection was modeled by inserting Staphylococcus aureus-infected wires into the medullary canal of the femur of rabbits (n = 12). On the day 14, we removed the wire and performed radical surgical treatment of the suppurative focus and hip replacement. The animals were divided into two groups: experimental group – with application of the original antimicrobial gel at the stage of hip replacement (n = 6); comparison group – without gel application (n = 6). For morphological studies, animals were sacrificed on the days 10, 45 and 90 after hip replacement, changes in soft tissues and the bone marrow canal were assessed, and cell populations were counted with statistical data processing.

Results. The application of the original antimicrobial gel causes statistically significant decrease in the number of neutrophils in the soft tissues surrounding the implant in the comparison group at all stages. Moreover, in the experimental group, at early stages the number of lymphocytes, plasmacytes and macrophages was statistically significantly higher; on the day 45, a statistically significantly larger number of lymphocytes was registered, and on the day 90 – a statistically significantly larger number of multinucleated and epithelioid cells.

Conclusion. The experiment histologically confirmed the effectiveness of application of the original antimicrobial gel to stop infectious inflammation in soft tissues and the bone marrow canal during surgical debridement of an osteomyelitic lesion followed by hip replacement. A pronounced giant cell reaction aimed at removing the polyvinylpyrrolidone-based gel requires further research in terms of its outcomes.

Background. The effect of sleeve gastrectomy (SG) and mini-gastric bypass (MGB) are still being studied; there is a reason to believe that these methods are completely comparable in terms of achieving good bariatric results and metabolic effects.

The aim of the study. To assess the effectiveness of laparoscopic sleeve gastrectomy and one-anastomosis gastric bypass in patients with morbid obesity and type 2 diabetes mellitus by conducting a comparative analysis.

Methods. We carried out retrospective cohort study. From August 2019 to May 2023, we operated 55 patients with morbid obesity and type 2 diabetes mellitus (DM): 23 patients – in the MGB group, 32 patients – in the SG group. Median follow-up was 21 and 15 months, average age 47.6 ± 9.6 and 47.6 ± 10.7 years, body mass index (BMI) – 51.4 ± 7.8 and 50.8 ± 7.7 kg/m2, median duration of type 2 DM – 36 and 17 months, respectively. Fasting blood glucose was 7.16 ± 1.5 and 8.61 ± 2.95 mmol/l (U = 249; p = 0.022), and glycosylated hemoglobin (%HbA1c) – 6.66 ± 1.04 and 7.35 ± 1.86 % (U = 296; p = 0.222), respectively.

Results. BMI at the follow-up was 33.8 ± 6.5 kg/m2 in the MGB group and 35.5 ± 5.2 kg/m2 in the SG group (p = 0.147). Excess weight loss percentage was 68.4 ± 16.4 and 59.8 ± 14.4 (p = 0.040); total weight loss percentage – 34.1 ± 8.6 and 29.7 ± 8.0 (p = 0.109), respectively. Fasting blood glucose was 5.48 ± 1.84 and 5.39 ± 0.59 (p = 0.247), %HbA1c level – 5.3 ± 0.5 and 5.44 ± 0.58 (p = 0.230), respectively. All patients in the SG group and 22 patients in the MGB group were normoglycemic with target values of %HbA1c achieved after the surgery within a period from 3 to 12 months. There were no statistically significant differences in the number of complications (according to Clavien – Dindo II).

Conclusion. Sleeve gastrectomy and mini-gastric bypass in patients with morbid obesity and type 2 diabetes demonstrate almost similar bariatric results in the medium term. Both methods make it possible to achieve compensation for type 2 diabetes mellitus with equal efficiency within a period from 3 to 12 months after surgery.

Increase in life expectancy in the world leads to an increase in the number of patients with multimorbidity who will require surgical intervention and anesthesia in the future. The desire of specialists to meet the high standards of clinical guidelines when performing medical interventions is often associated with the risk of complications, especially when providing emergency medical care. Complications during surgical interventions and anesthesia can be observed in institutions of any level and when providing care by any specialists.

The aim. To assess the main risk factors that can cause complications when providing anesthesia.

Materials and methods. The study was conducted in accordance with international reporting requirements for reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was performed in PubMed and Cochrane Controlled Clinical Trials Register. The method of searching by references was used to select the articles. The search strategy did not include limitations of the language, type and date of the article. Inclusion criteria: full-text publications devoted to the influence of risk factors on the incidence of complications when providing anesthesia care. Exclusion criteria: brief summaries; abstracts without a full-text version; publications without key words.

Results. The review assessed the most common risk factors causing complications during anesthesia and ways to reduce them.

To the present day, many links in the pathogenesis of rheumatoid arthritis remain unclear, which leads to unsatisfactory results in its therapy.

The aim. To study the cells involved in immune reactions and tryptophan metabolites in the joint capsule in rheumatoid arthritis.

Materials and methods. The experiments were carried out on 40 Wistar rats. Rheumatoid arthritis was induced by intraperitoneal injection of a solution of type 2 collagen (Chondrex Inc., USA) in incomplete Freund’s adjuvant. On the days 7, 14 and 21, the content of tryptophan, kynurenine, 3-hydrokenurinine, L-5-hydrotryptophan in the joint capsule was determined using high-performance liquid chromatography. Cells with CD3, CD20 and CD68 in joint tissues were studied at the same time using the streptavidin-biotin-peroxidase method. We used enzyme-linked immunosorbent method to determine antibodies to citrulline-containing peptide. Statistical analysis was performed using the Jamovi, version 2.3 software.

Results. The content of cells carrying CD3, CD20 and CD68 markers in the joint was high in experimental rheumatoid arthritis. In joint tissues, the content of tryptophan metabolites along the kynurenine pathway also increases and the concentration of metabolites along the serotonin pathway decreases. Direct positive correlations of cells carrying CD3, CD20 and CD68 differential clusters with the content of tryptophan metabolites along the kynurenine pathway and negative correlations with metabolites of the serotonin pathway were established.

Conclusions. Cells carrying CD3, CD20 and CD68 markers and tryptophan metabolites – kynurenine and L-5-hydrotryptophan – play an important role in the pathogenesis of rheumatoid arthritis.

Background. Polysaccharides are known to possess adjuvant properties, they are biodegradable, safe, and are of low-labor production. In this regard, the development of polysaccharide-based adjuvants is an urgent task.

The aim. To develop a method for obtaining mannans from the cell walls of Saccharomyces cerevisiae yeast and to study their adjuvant properties using subunit vaccine model.

Materials and methods. The preparation of mannans was obtained from the Saccharomyces cerevisiae yeast by enzymatic and alkaline hydrolysis. Its adjuvant properties were assessed in BALB/c mice immunized with the recombinant receptor-binding domain (RBD) of the SARS-CoV-2 (S) protein (Delta (B.1.617.2)). The titers of specific antibodies in the blood sera were determined by ELISA assays using the recombinant RBD (Wuhan-Hu-1 and Delta), and the recombinant (S) protein (Wuhan-Hu-1, Delta and Omicron) as antigens. The titers of virus-neutralizing antibodies were determined using virus-neutralization tests with the SARS-CoV-2 virus strains Wuhan – hCoV19/Australia/VIC01/2020 (Wuhan-Hu-1), Delta – hCoV-19/Russia/PSK-2804/2021 (Delta (B.1.617.2)), and Omicron 1 – hCoV-19/Russia/Moscow171619-031221/2021 (Omicron (B.1.1.529)).

Results. The developed scheme allowed for obtaining up to 200 mg of mannans from 10 g of yeast cell debris. Double, with a two-week interval, immunization with RBD (50 μg) in combination with mannans (40 μg and 10 μg) induced the production of specific antibodies in titers from 1:2477330 to 1:188360. The titer of virus-neutralizing antibodies to the Delta – hCoV-19/Russia/PSK-2804/2021 was 1:485 (40 μg of mannans per mouse).

Conclusions. We developed a scheme for obtaining a low-toxic preparation of mannans from the Saccharomyces cerevisiae yeast. The highest adjuvant activity was achieved when using mannans at the dose of 40 µg per mouse. Blood sera obtained from the immunized animals neutralized both homologous and heterologous SARS-CoV-2 strains.

Background. For historical reasons, the incidence of tuberculosis (TB) varies significantly across geographic areas of the Russian Federation. This situation may be associated with the spread of the dominant Beijing genotype of M. tuberculosis (MBT) and of its aggressive B0/W148 subtype in the human population. Establishing a relationship between these genetic variants of MBT and the incidence of tuberculosis will serve as evidence of their epidemiological significance and a reason for decisionmaking in the TB epidemiological surveillance system.

The aim of the study. To assess the relationship between the spread of the Beijing M. tuberculosis genotype and its B0/W148 subtype with the incidence of tuberculosis in the cumulative population of the European and Asian parts of the Russian Federation.

Materials and methods. An epidemiological study was conducted, including an analysis of the distribution data of the Beijing genotype of MBT and its B0/W148 subtype (meta-analysis) in Russia and a study of TB incidence rates in the same regions. To assess the relationship, we used the Pearson’s chi-square test (χ²); the significance level when testing statistical hypotheses (p) was taken as 0.05.

Results. In the European regions of the Russian Federation, a statistically significant relationship was found between the TB incidence and the prevalence of MBT Beijing genotype (χ² = 17.2; p = 0.009) and the absence of such a relationship with the B0/W148 subline (χ² = 9.9; p = 0.127). In the Asian part of the Russian Federation, a highly statistically significant association was found between the incidence of TB and both the incidence of MBT Beijing genotype (χ² = 25.4; p = 0.0001) and the incidence of its B0/W148 subtype (χ² = 29.6; p < 0.0001).

Conclusion. A statistically significant relationship was established between the incidence of TB in the general population and the incidence of MBT Beijing genotype, regardless of the value of the average long-term TB incidence rate. In areas with high TB prevalence, a stable association was determined between the incidence rate not only with MBT of the entire Beijing family, but also with its aggressive subtype B0/W148.

Background. Irkutsk region maintains a high incidence rate of multidrug-resistant (MDR) tuberculosis (TB). Detection of MDR-associated Mycobacterium tuberculosis strains in Irkutsk region requires dynamic assessment of the TB pathogen population, taking into account the emergence of a new resistant variant of Beijing Central Asian Outbreak (CAO).

The aim of the study. To assess changes in the genotypic structure of M. tuberculosis strains circulating in the Irkutsk region over a ten-year period.

Materials and methods. A total of 732 M. tuberculosis strains (196 strains for 2021– 2022, 536 strains for 2011–2015) were studied using MIRU-VNTR and SNP typing.

Results. The MDR level increased to 67.4 % with an increase of pre-extensive drug resistance (pre-XDR) (33.2 %) (p < 0.001). In the modern sample, the dominance of the Beijing genotype increased (83.7 %) due to an increase in the proportions of the B0/W148 (38.8 %) and CAO (12.8 %) subtypes with a stable overall level of Central Asian Russian (36.8 %) and other Beijing strains (8.2 %). Strains other than the Beijing genotype belonged mainly to the Euro-American lineage (Lineage 4): LAM (8.9 %), Ural (2.7 %), Haarlem (2.0 %), S (0.5 %) and L4-unclassified (5.3 %); 25 isolates were not classified. In the 2011–2015 sample, LAM was more common than in the modern sample (10.8 % vs. 3.6 %; p < 0.01). The increase in MDR and preXDR was statistically significant among Beijing B0/W148 strains (93.4 % vs. 66.1 %; p < 0.001).

Conclusion. Unfavorable trends of significant spread of MDR and pre-XDR of the Beijing genotype strains were revealed. Among the Beijing strains, not only B0/W148 but also the Beijing CAO subtype, which was previously rare in Siberia, are the most successful; they have the highest levels of MDR and pre-XDR and a tendency to widespread distribution in all groups of TB patients.

Background. The B0/W148 subtype belongs to the L2phylogenetic lineage of Mycobacterium tuberculosis and is most common in the former Soviet Union. Test systems capable of detecting genetic variants of the pathogen are needed for effective epidemiological surveillance. Studying the genetic diversity of B0/W148 strains and finding molecular markers suitable for their genotyping are key steps in the development of such diagnostic tools.

The aim of the work. To study the phylogenetic diversity of the B0/W148 subtype circulating in the territory of the Russian Federation and neighboring countries in order to identify unique clades and search for specific molecular markers suitable for their precise identification.

Materials and methods. The study used DNA samples of B0/W148 strains (n = 34) isolated in different regions of the Russian Federation, as well as genomic data obtained from the SRA NCBI (Sequence Read Archive of the National Center for Biotechnology Information) (n = 419). Phylogenetic analysis and principal component analysis (PCA) of whole genome sequencing (WGS) data were used to analyze genetic diversity and to identify molecular markers. An evolutionary reconstruction of the age of the identified clades was carried out.

Results. The analysis of the B0/W148 genomes (n = 453) revealed that they are divided into three phylogenetic clades: B – basal, M – minor and P – principal. It was found that specific mutations in the M and P clades allow for their differential diagnosis. The 4137219T>G mutation is unique for the M clade, and the 2241091C>T mutation is unique for the P clade. No characteristic mutations were found among the strains of B clade. In addition, unique mutation profiles in the genes responsible for drug resistance were identified for the clades.

Conclusion. The study showed that B0/W148 strains represent a genetically heterogeneous population divided into B, M and P clades. M and P Clades have unique mutations that allow for their identification. It was also found that all clades are characterized by the presence of specific mutation profiles in drug resistance genes.