The main representative of the vaginal biocenosis of adolescent girls after menarche and during the reproductive period of life is obligate-anaerobic lactobacilli. Qualitative and quantitative changes in the composition of the vaginal biocenosis occur under the influence of various exogenous and endogenous factors and can contribute to the development of the vulvar and vaginal inflammatory diseases.

The  aim of  the review. To  analyze modern literary data on  the  peculiarities of the vaginal biocenosis of adolescent girls, its formation in the age aspect, changes under the influence of adverse factors and in the presence of comorbid diseases. Two hundred fifty foreign and Russian literature sources indexed in RSCI, PubMed, Scopus, SSCI were analyzed, mainly from 2014 to 2024. Sixty-nine sources were used for the article, 23 of them published in the last 5 years.

Results. Most studies emphasize the fact that it is necessary to carefully examine adolescent girls with identified risk factors for violations of vaginal biocenosis, including comorbid diseases.

Background. Rheumatoid arthritis (RA) is a long-term autoimmune disease characterized by  a  systemic immuno-inflammatory reaction leading to  joint edema, synovial hyperplasia, damage to cartilage and bone tissue. There is currently no effective treatment for this disease.

The aim of the literature review. To analyze the mechanisms described to date that underlie the effects of mesenchymal stem cells (MSC) and extracellular vesicles (EV) on the pathogenetic links of rheumatoid arthritis.

Materials and methods. PubMed and eLibrary databases for the period 2011–2023 were analyzed using keywords: rheumatoid arthritis, hematopoietic stem cells, mesenchymal stem cells, rheumatoid factor, extracellular vesicles, cell therapy.

Results and discussion. The  review describes current aspects of  the  etiology and pathogenesis of  rheumatoid arthritis, its potential biomarkers and currently known therapeutic strategies. The effect of MSC on T and B lymphocytes, as well as  other cellular participants in  the  disease, has been studied in  experimental and clinical studies. The  review expands the  understanding of  the  mechanisms of therapeutic effects of postnatal progenitor cells and their extracellular vesicles in  the  treatment of  rheumatoid arthritis, which, in  terms of  comparison, reveals the advantages and disadvantages of each method. It can be concluded that MSC and EV are a promising direction in the treatment of rheumatoid arthritis, however, further studies of the interactions of molecules affecting the links of the pathogenesis of RA are needed. Additional studies based on a pathogenetically ranked approach to the treatment of the disease are also necessary, which allows to identify the patterns of  effects of  each method with subsequent recommendation in  choosing the use of progenitor cells or, mainly, their secretome in personalized RA therapy, and a more detailed study of the dosage, time and method of their administration is also necessary.

Asthma is the most important medical and social problem of our time due to its widespread prevalence, chronic course and heterogeneity, which determines the complexity of  treating this disease. Chronic inflammation, characteristic of  asthma, is accompanied by the development of an imbalance between pro-inflammatory and pro-resolving lipid mediators produced by omega-3 (ω-3) and omega-6 (ω-6) polyunsaturated fatty acids (PUFAs).

The  aim of  the  study. To  summarize modern ideas about the  role of  lipid mediators of inflammation resolution – lipoxins in the pathogenesis of asthma based on an analysis of articles published in English until 2023 in the PubMed database. These mediators are formed in very small quantities and are quite unstable in comparison with other lipid mediators of inflammation resolution, so the difficulty of their detection limits the study of the role of lipoxins as mediators of inflammation resolution, including in asthma. At the same time, a significant number of works have been published describing the anti-inflammatory and pro-resolving properties of lipoxins. To block the inflammatory response and trigger the processes of its resolution, lipoxins interact with the N-formyl peptide receptor type 2 and the nuclear receptor for aromatic hydrocarbons.

This review discusses the controversy surrounding the role of lipoxins as pro-resolving mediators and the potential therapeutic benefits oftargeting lipoxin receptors.

Background. Fabry disease is a genetically determined disease in which deficiency or complete absence of α-galactosidase A (GLA/AGAL) activity is formed. Diagnosis of this pathology is difficult, especially in late onset, with predominant cardiac involvement.

The aim. Evaluation of specially designed screening algorithms for Fabry disease in real clinical practice. Materials and methods. The analysis was conducted retrospectively on the basis of medical documentation. 91 848 medical reports were analyzed. Two algorithms have been developed for the creation of the database. The first algorithm included patients aged 25–60  years with a  left ventricle wall thickness of  13  mm or  more, as indicated by echocardiography and magnetic resonance imaging, and exhibiting disturbances in cardiac rhythm, cardiac conduction, or a reduction in the PQ interval, as determined by echocardiography. Exclusion criteria included hypertension, aortic aneurysm, cardiac amyloidosis, and Gaucher disease. The second algorithm included patients aged 25–60 years with a left ventricle wall thickness of 13 mm or more, in conjunction with hypertension, disturbances in cardiac rhythm, cardiac conduction, or reduction of PQ interval. The exclusion criteria were cardiac amyloidosis and Gaucher disease.

Results. As a result of applying two algorithms, the following groups were formed: Group 1 – 46 patients, including 17 patients with cardiac rhythm or conduction disorders; Group 2 – 31 patients, including 24 patients with cardiac rhythm or conduction disorders. Patients were invited to an appointment for genetic testing and measurement of α-D-galactose activity. All patients tested had α-D-galactose enzyme activity levels within normal limits and the genetic test was negative.

Conclusion. The incidence of Fabry disease in the cardiac population is low. However, the use of specialized algorithms for screening patients with this pathology will allow identifying patients at early stages of the disease for timely initiation of therapy.

Background. The  study of  recombination processes in  the  CRISPR-Cas loci of Salmonella enterica can help investigate the fundamental evolutionary mechanisms of  the  CRISPR-Cas system to  better understand the  acquisition of  phage resistance.

The aim of the study. To investigate the recombination processes in the proteincoding regions of CRISPR-Cas loci in the genomes of Salmonella enterica serovars Enteritidis, Infantis, and Typhimurium using in silico methods.

Materials and  methods. The  genomic sequences of  the  Salmonella serovars Enteritidis, Infantis, and  Typhimurium were  downloaded from the  NCBI  GenBank database. The  coding sequences of  cas genes were  extracted from the  genomes and  aligned according to  codon position. Recombination events were  identified in the resulting alignment using multiple algorithms. Verification of recombination events was performed.

Results. A  total of  7683  potential recombination events were  identified. Among these, 810 (10.54 %) were verified, and 45 (0.59 %) were recognized as results of convergent evolution. Recombination events are  detected more frequently between strains belonging to different serovariants than between those of the same serovariant. All serovariants can recombine with each other; however, recombination primarily occurs between Enteritidis and Infantis strains, as well as between Typhimurium and  Infantis strains. Infantis and  Typhimurium serovariants also exhibit recombination within themselves. No recombination events were found between strains of the Enteritidis serovariant. The events of convergent adaptive evolution were mainly found in the effector module genes: cas5, cas6, cas7.

Conclusion. It  has  been shown that  homologous recombination often occurs in the S. enterica genome in the region of the cas genes. Bioinformatic algorithms detect more recombination events between evolutionarily more distant strains, which are inconsistent with known in vitro studies.

Background. Evaluation of hereditary diseases is a difficult task due to the large number of nosologic forms, rare occurrence of each disease, which can lead to a long diagnostic search for the patient. Different methods of molecular genetics, including full-exome sequencing, are actively introducing into the complex of examination of newborns with general pathology and lead to better diagnosis and prognosis for children and their families.

The aim of the study. To estimate the frequency of occurrence of genetic disorders in newborns with somatic and surgical pathology during selective screening using whole exome sequencing.

Materials and methods. 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 estimated the results of genetic evaluation of 80 newborns who were treated in the neonatal departments of the Ivano-Matreninskaya City Children’s Clinical Hospital from February to October 2024.

Results. Eighty children were examined. Genetic findings of varying significance were detected in  31.2  % of  the  examined children. Pathogenic and likely pathogenic gene variants were detected in 16.2 % of cases, and chromosomal aberrations in  2.5  % of  patients. Genetic findings of  varying significance were found in  52  % of those examined for nervous system damage and in 18 % of patients with congenital malformations. By the time of description, the genetic diagnosis was confirmed in 16.2 % of patients with genetic findings. The diagnosis was based on the complete correspondence of the child’s existing phenotype with the identified gene variant.

Conclusions. The results of this study indicate a possible high incidence of exome abnormalities in neonatal pathology, as well as the high efficiency of whole exome sequencing in their diagnosis.

Background. COVID-19 during pregnancy affects the  development of  inflammatory reactions in the fetus. However, data on the impact of maternal COVID-19 on the phenotypic composition of umbilical blood monocytes in newborns are insufficiently presented.

The aim. To investigate the phenotypic composition of umbilical blood monocytes in newborns and assess their health status in cases of COVID-19 in the third trimester of pregnancy.

Materials and methods. A comparative study was conducted involving 62 full-term newborns from  mothers with  COVID-19 in  the  third trimester of  pregnancy (main group) and 30 newborns from mothers not infected with SARS-CoV-2 (control group). Expression of CD14, HLA-DR, CD206, CD32, TNFR1, TNFR2, IL17R, and TRAIL on umbilical blood monocytes was determined using flow cytometry.

Results. According to the results, the number of monocytes in the umbilical blood of newborns in the main group expressing CD14, HLA-DR, and TNFR2 was reduced by 1.54, 1.41, and 2.36 times respectively (p < 0.001) compared to the control group. The expression levels of CD206, CD32, TNFR1, IL17R, and TRAIL were increased by 3.02 (p < 0.001), 1.1 (p < 0.01), 1.3 (p < 0.001), 17.68 (p < 0.001), and 3.6 times (p < 0.001), respectively. Birth weight (p  =  0.021) and  height (p  =  0.006) at  birth were lower in newborns compared to the control group. In the evaluation using the Apgar score, no differences were found between the study groups at the first minute (p = 0.170). At  the  fifth minute, the  values were  lower than in  the  control group (p  =  0.001). Regression analysis identified a  dependence of  increased morbidity in  newborns on the number of umbilical blood monocytes expressing TNFR1 and TRAIL. Newborns in  the  main group had  an  increased risk of  developing cerebral ischemia, motor disorder syndrome, and persistent fetal circulation.

Conclusion. Maternal infection in the third trimester of pregnancy caused by SARSCoV-2 leads to the development of a fetal inflammatory response, increasing the risk of neonatal complications.

The aim of the study. To conduct preclinical diagnosis of ischemic heart disease and to identify latent coronary insufficiency in persons involved in traffic safety in railway transport.

Materials and methods. A cross-sectional study of 108 working male railway workers whose duty is ensuring the safety of railway traffic was conducted. These patients were selected as having high-grade arrhythmias (56.2 %) or non-specific disorders of repolarization processes on the ECG (43.8 %), which was an indication for coronary angiography. All patients underwent echocardiography, ECG, Holter monitoring with the study of heart rate variability, lipid spectrum and coronary angiography. Statistical processing was carried out in the Statistica 10 program.

Results and discussion. During coronary angiography, coronary artery stenosis of various severity were detected in 57 (52.8 %) patients. In the group of patients with  stenosis, total cholesterol was 9.7 % higher (p = 0.0054), left ventricular myocardial mass index was 18.6 % higher compared to the group without stenosis (p = 0.0012). In the presence of stenosis, standard deviation of normal heartbeat index was 103.3 ± 31.3 ms, without stenosis – 134.0 ± 48.2 ms (p = 0.0019). The duration of arterial hypertension in the group with stenosis was two times longer (p = 0.0036).

Conclusion. 52.8 % of the examined patients had coronary artery stenoses, more than half of these stenoses were hemodynamically significant. Positive correlations were found between the presence of coronary artery stenosis and the duration of hypertension, the presence of hypertrophy and diastolic dysfunction of the left ventricle, left ventricular myocardial mass index, and complaints of shortness of breath during exercise.

Based on  the  analysis of  publications of  the  last ten years this article discusses the problem of renal and splenic infarcts resulting from acute visceral artery emboli as one of the potential causes of abdominal pain in patients with atrial fibrillation. It has been shown that atrial fibrillation is the  main etiological factor of  visceral embolisms. The results of a series of observations of visceral infarction are summarized, which, given the rarity of this pathology, allows us to form a complete picture of this pathology. The authors emphasize the interdisciplinary nature of this problem, focusing on the fact that it may be encountered by specialists from different medical fields – surgeons, cardiologists, and neurologists. The clinical manifestations of visceral infarction are described as highly variable and nonspecific, with pain, laboratory markers of  inflammation, and elevation of  lactate dehydrogenase and D-dimer levels being the most common. The authors emphasize the importance of high-resolution methods of radiation diagnostics, such as computed tomography with intravenous contrast and magnetic resonance imaging, to clarify the diagnosis. Particular attention is paid to the need for early diagnosis to enable revascularization and  preservation of  the  function of  the  affected organ, while late diagnosis emphasizes the prevention of recurrent cardioemboli and symptomatic treatment. The analyzed literature sources did not contain information about the development of  complications of  visceral infarction which would require surgical treatment. The  analysis of  the  late outcomes of  renal infarction showed the  development of chronic renal failure and malignant arterial hypertension in half of the patients. There have been no reports of the development of any complications and mortality directly related to spleen infarction in the analyzed articles. The article also addresses the issues of prognosis, effective prevention and treatment of cardioembolic visceral infarcts, emphasizing the need for further research in this area.

Heart failure is the leading cause of death, frequent hospitalizations, and poor quality of life. The fundamental mechanisms involved in the occurrence and progression of heart failure are currently not precisely defined. Mitochondria play a key role in the processes of cellular metabolism, performing many biological functions. The  functional activity of mitochondria is inextricably linked to their  structure. In  cardiovascular diseases, in conditions of repeated hypoxia/reoxygenation of tissues, as  well  as under the influence of subclinical inflammation processes, pathological restructuring of the cardiomyocyte mitochondriome occurs. Studies conducted to  date suggest that mitochondria may be the key to understanding the onset and progression of chronic heart failure (CHF). An analysis of the literature demonstrates that the study of mitochondria in patients with CHF is an urgent topic, and the number of publications in the PubMed/MEDLINE system concerning research in this area is progressively increasing, 100 publications on this topic have been found in the eLibrary system. In this review, we reviewed modern methods for evaluating the  structure and  function of mitochondria in experimental and  clinical studies and analyzed the possibility of using these research methods in patients with cardiovascular diseases. It is shown that, despite a fairly wide range of possibilities for studying the structural and functional state of mitochondria of cardiomyocytes in CHF, the estimated indirect signs of mitochondrial dysfunction are surrogate markers, the degree of informativity of which must be studied in comparison with the actual state of the cardiomyocytes mitochondrial ultrastructure, the clinical picture of  the  disease and the prognosis of patients. The necessity of conducting clinical studies aimed at studying the association of direct ultrastructural characteristics of  cardiomyocytes mitochondria with indirect signs of mitochondrial dysfunction with the clinical course and outcomes of CHF is actualized, which will allow us to obtain fundamentally new fundamental knowledge about the mechanisms of development and progression of the pathophysiological phenomenon of CHF, to assess the  degree of informativeness of markers of mitochondrial dysfunction in patients with CHF, which will serve as the basis for the widespread introduction of these diagnostic methods into real clinical practice.

Background. The  pathogenetic mechanism of  the  development of  a  prolonged systemic inflammatory process in patients who have suffered a new coronavirus infection remains an  urgent problem. One of  the  proposed mechanisms leading to  hyperinflammation in  COVID-19 is  the  involvement of  the  inflammasome of NOD-like receptor protein 3 (NLRP3), gasdermin D protein (GSDMD), which are effector molecules of pyroptosis, in  triggering the  continuous production of  an  increased number of inflammatory markers due to activation by the SARS-CoV-2 virus.

The aim. To evaluate the inflammatory response in convalescents of a new coronavirus infection in the catamnesis based on the dynamics of pyroptosis, interleukin response and indicators of the vascular link of hemostasis.

Materials and methods. The blood of 41 patients in the recovery period was examined; one month, three and six months after the infection. The cellular composition of  peripheral blood, the  level of  ESR, CRP, ferritin, D-dimer were determined by classical methods; and the concentration of interleukins (IL) -1β, IL-6, IL-18, NLRP3 inflammasomes, and gasdermine D (GSDMD) was determined by ELISA methods.

Results. It was revealed that for all the parameters studied, there is a slow decrease in the level of values by six months. Despite the improvement in the morphological picture, altered cells are found in the peripheral blood after six months. The levels of  GSDMD, platelets, IL-1β, D-dimer, ESR, IL-18, NLRP3 do  not reach the  values of the control group after six months, which indicates a stable hyperinflammatory response of the immune system.

Conclusion. Dysregulation of the NLRP3 inflammasome and gasdermine D can lead to an inadequate immune response of the body to infection, which contributes to  the  maintenance of  the  hyperinflammatory process and  long-term recovery. Further study of triggers and inducers involved in the pathophysiological processes of inflammation triggered by COVID-19 will allow us to develop an approach to personalized treatment and rehabilitation of patients.

Introduction. Functional unloading of  muscles is  accompanied by  slow-to-fast transformation of muscle myosin phenotype, an increase in acid sphingomyelinase (ASM) activity, ceramide, reactive oxygen species (ROS), and  advanced glycation end products (AGEs). The association of sphingolipids, AGEs-associated processes and muscle plasticity has not been studied.

The aim. To  assess the  relationship of ASM and ceramide-associated increase in ROS to the AGEs-dependent pathway regulating the expression of various myosin heavy chains (MyHC) isoforms during 7-day functional unloading of rat m. soleus, and to evaluate the efficacy of the FIASMA drug in preventing muscle phenotype change.

Methods. White male rats were subjected to  7-day hindlimb suspension (HS) combined with administration of  the  acid sphingomyelinase inhibitor amitriptyline. Fluorescence microscopy was used to  detect the  levels of  ASM, ceramide, MyHC isoforms, ROS, NADPH oxidase 2 (NOX2), MyoD1 (myoblast determination protein 1), AGEs and their receptors (RAGE, receptor for advanced glycation endproducts) in the soleus muscle. Western blotting was used for detection of NOX2, RAGE and AGEs-modified proteins in muscle homogenates. The changes in MyoD1 level in myonuclei were studied ex vivo by incubating the muscle with exogenous AGEs.

Results. Unloading led to a decrease in the muscle mass and fiber diameter, transformation of myosin phenotype, an increase in ASM, ceramide, ROS, NOX2, AGEs, RAGE and nuclear MyoD1 content. NOX2 and AGEs-modified proteins did not change. Amitriptyline mitigated the loss of muscle mass and fiber diameter reduction, decreased fast to slow shift. It also decreased ASM, ceramide, ROS, RAGE, and mionuclear MyoD1. Muscle incubation with exogenous AGEs increased in MyoD1 in myonuclei.

Conclusion. ASM activation during soleus muscle unloading contributes to  the  MyoD1-related slow-to-fast myosin transformation associated with ROS overproduction and RAGE signaling.

Background. The problem of a personalized approach to patients with ischemic stroke does not lose its relevance. Research is being conducted aimed at searching for points of application in the pathogenesis of cerebral infarction and the possibility of influencing them in order to have a positive impact on the recovery prognosis of patients.

The aim of the work. To study the level of fractalkine (FKN) in the blood serum of patients with ischemic stroke (atherothrombotic subtype) in dynamics. The data obtained in the future can serve as the basis for the possible use of fractalkine as one of the treatment options for patients with acute cerebral ischemia.

Materials and methods. Sixty people took part in the study. Group I (control) – healthy people; Group II – patients with hypertensive crisis without signs of acute changes in target organs; Group III – patients with atherothrombotic pathogenetic subtype of ischemic stroke on the background of hypertensive crisis.

Results. It was revealed that the level of fractalkine in patients with hypertensive crisis, and in patients on the first day after the development of ischemic stroke, was 3.2 times higher than in the control group (p < 0.001). The fractalkine content in the blood serum of patients with ischemic stroke remained high for ten days. The highest level was recorded on days 4–5 from the onset of the disease and exceeded the initial level by 27.5 % (p < 0.001). Positive correlations were established between fractalkine indicators and indicators of the NIHSS (National Institutes of Health Stroke Scale) and Rankin scales, and blood pressure (p < 0.001).

Conclusion. Studying the role of fractalkine in the pathogenesis of cerebral infarction remains a promising direction. The results obtained with further research in this area may become the basis for the subsequent development of fundamentally new approaches in the treatment of patients with acute cerebral events.

Background. Of particular importance in the repair process for cephalohematomas is the pathological remodeling of the bones of the cranial vault. Local changes in the bones of the skull are accompanied by the processes of osteolysis and osteogenesis and have uncertain dynamics. Changes in the state of bone tissue in cephalohematomas can be monitored based on determining the concentration of markers of osteolysis and osteogenesis in the blood of newborns.

The  aim. To  define the  level of  markers of  osteolysis (beta-CrossLaps) and osteogenesis (N-osteocalcin, vascular endothelial growth factor receptor 1 (VEGFR1)) in  the  venous blood serum of  newborns with cephalohematomas and evaluate the dynamics of local bone changes.

Methods. There were 90 newborns under observation, 30 patients with medium and large cephalohematomas (the cephalohematoma was punctured), 30 patients with small cephalohematomas (the puncture was not performed) and 30 healthy children. The level of markers of osteolysis and osteogenesis in the blood was determined by photometry using an enzyme-linked immunosorbent assay. Registration of local bone changes was carried out using ultrasonography and craniometry.

Results. The level of beta-CrossLaps in patients from the first group was 2.57 times higher, and in patients from the second group 4.45 times higher, than in healthy newborns on day 10 (p < 0.001). The concentration of N-Osteocalcin on day 10 in the second group was 1.43 times higher than in the first group (p < 0.001). The concentration of VEGFR1 in patients from the first group was 1.9 times higher, and in patients from the second group 3.01 times higher than in the control group (p < 0.001). Local osteolytic changes in the skull predominated in patients of the first group on day 10, and ossification in the second group on day 28 of observation (p < 0.001).

Conclusion. Reparation for cephalohematomas is associated with the phenomena of  resorption of  the  bones of  the  cranial vault and pathological ossification of hemorrhage in the zone of periosteum separation. Changes in the level of markers of osteogenesis and osteolysis in venous blood serum in patients with cephalohematomas may reflect the dynamics and direction of the pathophysiological process of remodeling of the bones of the cranial vault.

The occurrence of combined sensorimotor disorders of spinal cord function in combination with disorders of the autonomic nervous system after surgical correction of spinal deformity requires studying the mechanisms of the relationship between the sensorimotor and autonomic nervous systems in conditions of iatrogenic disorders.

The aim. To identify possible connections and their nature between the thresholds of heat perception and the amplitude of electrical activity of muscles at their maximal voluntary tension in patients with scoliosis for further use as a clinical model for studying the relationship between sensorimotor and autonomic nervous systems.

Materials and methods. Eighty-seven patients aged 6–43 years with spinal deformities of various etiologies were examined by electromyography and esthesiometry before and after its surgical correction.

Results. Based on the comparison of the electromyogram amplitude at the maximal voluntary tension of the anterior tibial muscle and the thresholds of heat perception, the presence of a reflex apparatus of conjugating the sensitivity to heat of the skin receptive field and voluntary activation of the muscle during localization of its motor neuron pool in the same segment of the spinal cord was established. This reflex mechanism can be used as a basic physiological model to study the nature of the interaction of spinal motor and autonomic centers in conditions of ischemic spinal cord injury during surgical correction of spinal deformity. It is possible to create diagnostic tests on its basis to assess the degree of violations of the interaction of the sensorimotor and autonomic systems in conditions of iatrogenic spinal cord injuries.

A critical analysis of the literature on the factors contributing to the excessive accumulation of iron in the structures of the substantia nigra of the brain in Parkinson’s disease is presented. This morphological feature, along with such signs as the accumulation of an abnormal form of presynaptic protein alpha-synuclein in dopamine neurons, their rapid death and gliosis in the substantia nigra of the brain, is one of the most important in the pathomorphological picture of the disease.

It is shown that the excess of iron in the substantia nigra may be due to the influence of such factors as the effects of toxic metals (aluminum, mercury and lead) on the brain, impaired permeability of the blood-brain barrier, changes in the expression of metal-containing proteins and genetic mutations. At the same time, the role of factors such as the consumption of large amounts of iron with food and dietary supplements, and mitochondrial dysfunction in the formation of this morphological sign of Parkinson’s disease remains not fully understood.

Continuation of the study of the causes of accumulation of excess iron in the structures of the midbrain in Parkinson's disease and those consequences that may be caused by excessive accumulation of iron in these structures remain relevant for modern neurology.

The literature search was conducted in the databases PubMed and eLibrary.

Background. Breast reconstruction with allo- and/or autologous materials is becoming the most popular surgical treatment option for breast cancer patients.

The aim of the study. To evaluate the efficacy of reconstructions in breast cancer patients depending on the technique of reintervention.

Materials and methods. The object of the study was a group of 70 female patients who underwent repeat reconstruction using endoprosthesis, flap autografting, and/o r a combination of these methods, between 2016 and 2023. The age of the patients ranged from 25 to 68 years. The mean age was 46.8 ± 8.6 years. Body mass index (BMI) > 25 was in 56 % (n = 37) of patients, BMI < 25 – in 44 % (n = 33). Regarding the reconstructive option, the patients were divided into three groups: 1) reconstruction with endoprosthesis (tissue expander or silicone endoprosthesis) (n = 30; 42.8 %); 2) reconstruction with deep inferior epigastric artery perforator (DIEP) or transverse rectus abdominis myocutaneous (TRAM) flap (n = 20; 28.5 %); 3) combination of thoracodorsal flap (TDF) and endoprosthesis (n = 20; 28.5 %).

Results. According to the data of the BREAST-Q questionnaire there was a significant increase of psychosocial and sexual well-being in the postoperative period in all groups. In the group of endoprosthesis reconstruction there was a pronounced dynamics of the growth of satisfaction with the mammary gland (before the operation – 50.3 points according to Rasch, after the operation – 84 points), despite several repeated operations. In case of TRAM-flap reconstruction (n = 5/20; 25 %) the patients noted a slight discomfort, difficulty in performing household physical activity during 6 months after the surgical treatment (before the operation – 46 points according to Rasch, after – 49 points). Among the interviewed patients, on average (11 points according to Rasch), an increase in satisfaction with the state of the anterior abdominal wall was noted. In the group of TDF + endoprosthesis reconstruction none of the interviewed patients noted discomfort, limitation and inability to perform everyday physical activity (preoperatively – 46 points according to Rasch, after – 49 points).

Conclusion. The data of our study are comparable with the world results, both in terms of the approach to the choice of repeat reconstruction and the overall satisfaction of the patients.

Background. Etiology and pathogenesis research of such a corneal disease as keratoconus is rather difficult due to the impossibility to study the underlying ultrastructural and molecular cornea changes in vivo and in animal models.

The aim. To evaluate zinc relevance in the biomechanical properties of the corneal stroma – by means of in vitro keratoconus cell model.

Materials and methods. In this experimental study, normal and keratoconic cell models of the corneal stroma were exampled – three-dimensional tissue-engineered structures of corneal fibrocytes obtained from healthy donors keratocytes and grown on standard and zinc-depleted nutrient media, respectively. The biomechanical properties of tissue-engineered structures modeling the normal and keratoconic corneal stroma were evaluated by means of the atomic force microscope nanoindentation. Additionally, histological assessment of the obtained cell models and immunohistochemical analysis of type I collagen were performed.

Results. According to the study of five samples of each of the corneal stroma models, a  statistically significant difference in  viscoplastic biomechanical properties was shown: the effective Young’s modulus of the normal and keratoconic models was 9.9 [5.4; 15.6] and 10.3 [6.1; 14.8] kPa, respectively. The in “healthy” group cell cultures thickness was 17.67 ± 1.32 and 18.10 ± 1.22 microns for two and four weeks of cultivation, respectively; in the “keratoconus” group, in a zinc depleted medium, the cell cultures thickness was 21.25 ± 8.39 and 25.55 ± 5.67 microns at the same time of cultivation, respectively. The extracellular component with an excess collagen fraction prevails in the structure of the latter.

Conclusion. The  data obtained confirms the  modern keratoconus etiology and pathogenesis concept – the biomechanical function deterioration of the keratoconic cornea is a consequence of copper, iron and zinc mineral dysmetabolism in its stroma.

Currently, due to the popularity of smart mobile devices, the frequency of calls from patients with signs of maladaptation of the binocular visual system has increased significantly.

The aim of the study. To assess the state of the binocular visual system in patients with esotropia and diplopia, as well as to search for effective methods of treating this pathology.

Material and methods. There were 20  patients aged 15 to  36  years (Me 24.5 [15.3; 30.3]) with complaints of permanent diplopia. The use time of smart devices in all patients was more than 6 hours per day (Me 7.8 [4.3; 11.3] hours). Refraction in all patients was myopic, and the corrected acuity of both eyes was 1.0. The angle of strabismus according to Hirschberg varied from +5 to +15° (Me 10 [5.5; 10]°). As a control group, 15 patients aged 15 to 36 (Ме 23.4 [16.3; 30.5]) years with moderate myopia without oculomotor disorders were examined. Along with the standard ophthalmological examination, the thickness of the extraocular muscles was additionally assessed in all patients according to ultrasound data. The algorithm for treating patients with esotropia included orthopto-diploptic treatment. If  the  measures were ineffective, surgical treatment was performed at the second stage.

Results. Comparing the thickness of the oculomotor muscles found that the internal rectus muscle in patients with esotropia has, on average, a significantly greater thickness than in patients in the control group (p = 0.02), and the thickness of the external rectus muscle is comparable on average (p = 0.33). A positive result after the first stage of treatment was obtained in 2 patients, in the remaining 18 patients, tenoscleroplasty of the internal rectus muscle with partial median myotomy was performed as the second stage of treatment. As a result of the treatment, all patients achieved binocular vision and stereo vision.

Conclusion. The  presented data demonstrate the  possibility of  the  formation of persistent violations of binocular functions in patients with myopia and impaired accommodation against the background of prolonged visual tension, which requires the use of a special algorithm of diagnostic and therapeutic measures.

Background. The effectiveness intraocular correction of corneal astigmatism on the target astigmatic axis in the online calculators toric IOL.

The aim. To establish the effectiveness of corneal astigmatism correction by toric IOLs calculated by various methods of astigmatic axis measurement.

Material and methods. Forty patients (60 eyes) with corneal astigmatism were analyzed. Keratometry parameters for calculations in 30 eyes were obtained using Wave Light Oculyzer II or Pentacam HR, the measurement of the toric astigmatic axis was carried out using the Kane formula. In 30 eyes, keratometric data for calculation were obtained using the Verion Measurement Module, the target axis was calculated using the Barett formula in Verion.

Results. Statistically significantly lower vector and centroid error was shown by calculations of the target astigmatic axis using the Kane formula with Oculyzer II or Pentacam HR keratometry compared with the results of calculations with kerat ometry and Barett in Verion (p < 0.05). The smallest centroid (0.05 dpt) and the smallest average absolute error (0.47 ± 0.51 dpt) of the residual astigmatism indicators in the Kane calculation group, the arithmetic difference of the calculated target axes of the toric orientation according to Verion and Kane revealed, in 70 % of the calculations of the second group, a difference of more than 5° in measuring the axis orientation. The percentage of eyes with a vector error of less than 0.5 dpt in the second group exceeded the indicator of the first group by 13.3 %, less than 1.0 dpt – by 23.3 %.

Conclusion. The calculation of the toric axis according to online formula using Oculyzer II or Pentacam HR keratometric indicators allows us to obtain a smaller average centroid error of 0.05 dpt compared with a centroid error of 0.25 with the orien tation of the toric axis according to keratometric measurements on Verion and the calculation on Verion.

The research is devoted to the study of the subjective assessment by young people and representatives of  the  older generation of  the  situation of  social exclusion of Russia in the space of international relations. The context of the lives of Russians is comprehended by the authors through the prism of the psychology of social stress and coping with it, which reflects the novelty of the study.

The aim. To identify the features of subjective assessment and cognitive-behavioral strategies for overcoming the stress of social exclusion among young people and the older generation.

Methods. The comparative study was conducted at the intersection of idiographic and nomothetic approaches. The sample consisted of 4 empirical groups of respondents of different ages, a total of 100 people (men and women) from 18 to 78 years old (M = 35.8; SD = 15.3). The methodological complex included: a semi-structured interview, methods “Cognitive assessment of a stressful situation” (Malenova A.Yu., 2015), “Scale of ethno-national attitudes” (Khukhlaev O.E., Kuznetsov I.M., Tkachenko N.V., 2018), “Methods for  diagnosing cognitive-behavioral strategies for  overcoming a stressful situation” (Sizova I.G., Filippchenkova S.I., 2002), “Questionnaire of personal changes” (Parfenova T.V., 2008).

Results. Assessing the  consequences of  alienation is  ambivalent, associated with a decline in the quality of life, limited opportunities, and integration at the national level. The dominant emotion is sadness, reflecting the uncertainty of the situation. It is more assessed as stressful by representatives of middle adulthood. Strategies for overcoming it are aimed at strengthening subjective control over the situation among young people. In youth, perception of reality without transferring aggression to other ethnic groups is possible in the case of less pronounced ethnic attitudes.

Conclusion. The main subjective criteria for the situation of social exclusion as social stress are the division of countries into “Ours” and “Strangers”; a prevailing negative assessment of  the  consequences of tension in  international relations; perception of subjective limitations of planning and self-realization in the future.

Background. Cardiovascular events are the main threat in the post-COVID period, and  their risk is  increased in  patients who have had a  new coronavirus infection (SARS-CoV-2). In this regard, the  direction of  studying the  correction of  already well-studied modifiable risk factors is of particular relevance. One of such factors is certainly dyslipidemia.

The aim. To study the level of blood lipids in patients after new coronavirus infection and the possibility of its correction during rehabilitation in sanatorium conditions with the additional use of the phytotherapy.

Materials and methods. The study included 50 people who, according to their medical history, had suffered from SARS-CoV-2 infection and were admitted to sanatorium treatment. All patients underwent a course of rehabilitation measures lasting 20 days. Before and after the course of rehabilitation, patients underwent laboratory analysis, which included the main biochemical parameters, including total cholesterol, lowdensity lipoproteins, high-density lipoproteins and triglycerides. The respondents were divided into two groups – experimental (group 1; n = 21) and control (group 2; n = 29). Patients from group 1 received tea from a phytocomposition in addition to standard measures.

Results. In  the  group receiving tea based on  herbal phytocomposition, there was a statistically significant decrease in total cholesterol from 6.91 ± 1.75 to  5.9  ±  1.64  mmol/l (p  =  0.04) and  low-density lipoproteins from 4.68  ±  1.65 to  3.78  ±  1.28  mmol/l (p  =  0.038). No  changes were detected in  these indicators, as well as in the level of triglycerides in group 2.

Conclusion. The  use of  the  phytocomposition presented in  the  study during the course allowed a statistically significant reduction in low-density lipoproteins levels in the blood of post-Covid patients by more than 0.9 ± 1.85 mmol/l. The use of phytopreparations in order to reduce the risk of cardiovascular events in patients who have undergone new coronavirus infection is a promising area that requires more detailed in-depth studies.

Background. Sacrococcygeal pilonidal sinus is a common condition in the natal cleft that typically requires surgical intervention. This study compares the outcomes of two surgical techniques for this condition: open excision and Limberg flap reconstruction.

The aim of the study. To conduct a comparative evaluation of the open excision versus Limberg flap inmanaging sacrococcygeal pilonidal sinus todetermine the relative advantages of the Limberg flap technique.

Materials and methods. This prospective study involved 70  randomly selected patients diagnosed with pilonidal sinus disease. Thirty-five patients underwent open excision, while 35 underwent Limberg flap reconstruction.

Results. The study found that the open excision method (1st method) had an average surgical duration of 33 minutes, while the Limberg flap method (2nd method) had an  average duration of  40  minutes. Patients in  the  1st method group recovered in 3–4 weeks, while those in the 2nd method group recovered in 12–15 days. The 1st method had two cases of wound infections and three recurrences, whereas the  2nd  method had one case of  seroma and no  recurrence. The  postoperative pain-free period ranged from 15–17  days for  the  1st  method and 12–15  days for the 2nd method.

Conclusion. The Limberg flap technique excels in managing the pilonidal sinus. It offers faster healing, lower pain scores, an earlier return to standard functions, and lower recurrence rates, making it an attractive choice for treating this condition. The study’s findings provide valuable insights into the comparative outcomes of these two surgical approaches, highlighting the advantages of the Limberg flap technique in managing the sacrococcygeal pilonidal sinus.

Background. Obesity, diabetes mellitus and metabolic dysfunction-associated fatty liver disease are some of the most pressing issues of our time. Melatonin has been shown to be effective in correcting a number of metabolic disorders, but there is insufficient data on its effect on morphological features of lipid metabolism in obesity and type 2 diabetes mellitus.

The aim. To study micro- and ultrastructural features of lipid metabolism in the liver of db/db mice with obesity and type 2 diabetes mellitus and to evaluate the effects of melatonin treatment on them.

Methods. Female db/db mice from 8 weeks of age were administered melatonin solution intragastrically (1 mg/kg in 200 μl of water) for 56 days. The comparison groups were intact (control) and placebo animals, which were injected with 200 μl of  dH2O according to  the  above scheme. Light-optical and  electron microscopic examinations of liver samples were performed.

Results. In control and placebo db/db mice, hepatocytes were characterized by vacuolar dystrophy and aberrant accumulation of small lipid inclusions, sometimes with the presence of giant lipid droplets (LDs). Also we revealed: endoplasmic reticulum stress; densification of the mitochondrial matrix with chaotically arranged cristae, or destruction of their ultrastructure; mitophagosomes; complexes of mitochondria with LDs; mass exocytosis of  LDs into the  interhepatocyte slits and Dysse spaces with stagnation of intercellular fluid. Treatment with melatonin resulted in a decrease in the relative number of hepatocytes with LDs, a decrease in the percentage of cells with small-droplet inclusions, and  an  increase in  the  percentage of  hepatocytes with medium and large, but not giant LDs. The mitochondria ultrastructure improved, and  the  formation of  complexes from  mitochondria with  large compartments of granular endoplasmic reticulum increased. Exocytosis of LDs into the interhepatocytic slits was not detected.

Conclusion. Melatonin can be considered as a promising agent in complex therapy of metabolic associated fatty liver disease in obesity and type 2 diabetes mellitus.

Background. Spinal cord injury (SCI) leads to partial or complete loss of sensory and/or  motor functions below the injury site due to neuron and glial cell death, axonal degeneration, and disruption of the blood-spinal cord barrier (BSCB). Motor rehabilitation presents a promising strategy for recovery after SCI, but its molecular and cellular mechanisms remain poorly understood, particularly in regions distant from the injury epicenter within the central pattern generator.

The  aim of  the  study. To assess structural and molecular changes occurring in regions proximal (Th9) and distal (L₂) to the epicenter of SCI in rats (Th₈) during rehabilitation motor load.

Materials and methods. SCI was induced in rats at the Th₈ level. Animals were divided into a control group (SCI) and a group subjected to motor rehabilitation (SCI + Rehab). Structural and molecular changes were evaluated in the thoracic (Th₉) and lumbar (L₂) regions. The number of preserved myelinated fibers was assessed using methylene blue staining, and BSCB disruption was evaluated through the epifluorescence of Evans blue dye. Quantitative PCR was used to analyze the mRNA expression of genes encoding proteins specific to perisynaptic astrocytic processes.

Results. In the lumbar region (L₂), motor rehabilitation led to a greater number of myelinated fibers in the corticospinal tract compared to the control group. Astrong negative correlation (r  = –0.761) was observed between Evans blue fluorescence and the area of preserved tissue in the Th₇–Th₉ region in rehabilitated animals; however, this relationship is not statistically significant. Molecular analysis revealed that rehabilitation did not affect astrocyte polarization into aneurotoxic phenotype or the alteration of perisynaptic processes in both proximal and distal regions.

Conclusion. Motor rehabilitation promotes the preservation of myelinated fibers in the lumbar region and reduces BSCB damage in the area proximal to the SCI. However, rehabilitation does not affect astrocyte polarization or the expression of mRNA genes encoding proteins characteristic of perisynaptic astrocyte processes.