The aim of this work was to study the conformational changes of lactate dehydrogenase under the influence of different concentrations of intermediates (pyruvate, oxaloacetate) in the temperature gradient with the  subsequent building of a mathematical model.

Materials and methods. Thermolability of lactate dehydrogenase was studied using the method of differential scanning fluorimetry to determine the change in endogenous fluorescence of tryptophan and tyrosine under the conditions of stable concentration of lactate dehydrogenase and changing concentrations of pyruvate and oxaloacetate. Further, a mathematical model was developed for a more in-depth consideration of the behavior of the catalytic protein.

Results. We found that pyruvate and oxaloacetate in low concentrations have a thermostabilizing effect on lactate dehydrogenase conformation; the effect of pyruvate is statistically more significant in comparison with oxaloacetate (p < 0.05). The studied ligands in high concentrations reduce the thermal stability of lactate dehydrogenase.

Conclusion. Understanding the role of small molecules in the regulation of biological and catalytic processes has long remained in the background of scientific interest, but today the work in this direction is reaching a new level. The data obtained indicate the possibility of small molecules acting as ligands when interacting with enzymes.  

Aim. To study platelet adhesion to a-C:H:SiOx film on titanium in an in vitro experiment to evaluate its antithrombogenic potential.

Materials and methods. Thin (less than 1 μm) a-C:H:SiOx films were deposited on VT-6 titanium plates with a size of 10 × 10 mm2 and a thickness of 0.2 mm using a vacuum ion-plasma unit using pulsed bipolar bias. The surface roughness was evaluated according to GOST 2789-73 using an atomic force microscope. The test samples were cultured at 37 °C for 30 min in platelet-rich human blood plasma, prepared for scanning electron microscopy, after which the distribution density of blood plates adhering to the test coating was calculated.

Results. With the same roughness index of the studied a-C:H:SiOx samples, the film decreased 116 times (in comparison with untreated titanium) the platelet count per 1 mm2 of the surface.

Conclusion. The deposition of a-C:H:SiOx thin film on the surface of VT-6 titanium alloy by PACVD method using pulsed bipolar bias significantly reduces the distribution density of platelets in comparison with an untreated metal surface. In vitro data suggest a significant antithrombogenic potential of this type of coating on the surface of devices in contact with blood.

Aim. To describe the CNA (Copy Number Aberration) landscape of luminal B breast tumor before treatment.

Materials and methods. The study included 100 patients with breast cancer (BC) of luminal B subtype for which a biopsy of the tumor material was performed prior to neoadjuvant chemotherapy (NAC). The tumor DNA was examined using a CytoScan HD Array microarray (Affymetrix, USA). The obtained microarray data were correlated with NAC efficacy.

Results. The study showed that loci 1q32.1-32.3, 1q41-42.2, and 8q24.21 had the highest frequency of  amplifications (in more than 65% of patients). The highest deletion frequency (in more than 60% of patients) was found in loci 16q21, 16q22.1, 16q23.1-24.1, 17p13.1, and 17p12. Trisomy was most often observed in chromosomes 7, 8, 12, and 17, and monosomy in chromosomes 3, 4, 9, 11, 18, and X-chromosomes. The CNA landscape of luminal B subtype breast tumors is different from triple-negative breast cancer. The largest difference in the frequency of amplifications between patients with an objective response to NAC and patients with no response to NAC was shown in 1q24.2-42.2 loci (46%), and the largest difference in the frequency of deletions (more than 30%) between groups was in regions 6q16. 3, 11p15.4, 11q23.1, and 16q22.2-22.3. These loci can be considered potential predictive markers.

Conclusion. The research determined loci with the highest amplification and deletion frequencies for luminal B breast cancer. Potential predictive markers for the given molecular subtype were identified.

Purpose. The aim of this study was to ascertain the characteristics of major salivary glands endocrine effect on
spermatogenesis.

Materials and methods. Mature white outbred male rats (2 months, 153 ± 18 g) consisted of the following groups (each containing 30 rats): intact, control, and group of rats subjected to multiple amputation of incisors. To achieve hypertrophy of major salivary glands multiple amputation of incisors was performed: incisors were cut to a level of 1-2 mm above the gingival margin under ether anesthesia once every 3 days within 2 weeks. Animals of the control group were anesthetized with ether at the same time. Rats were sacrificed by CO2 asphyxia after 2, 3, 4, 6, 8 and 10 weeks after the first amputation of incisors. Fragments of the rat testes were examined on a JEM-1400 “JEOL” (Japan) transmission electron microscope. On electron microscopy images the specific vacuolization of the cytoplasm of Sertoli cells, spermatogonia, spermatocytes and spermatids (standard units) was analyzed by the point counting method. In spermatogenic cells the proportion of mitochondria (%) with morphological signs of swelling was assessed.

Results. Transient ultrastructural changes of Sertoli and spermatogenic cells develop in the rats convoluted seminiferous tubules as a result of multiple amputation of the incisors, such as phagosomes and pronounced vacuolization in the Sertoli cells cytoplasm, cytoplasm vacuolization and mitochondrial swelling in spermatogenic cells. Sporadic spermatogenic cells with signs of nuclear (chromatin fragmentation, its condensation on the periphery of the nucleus) and cytoplasm (destruction of membrane organelles) destruction appeared as a result of multiple incisors’ amputation. Ultrastructural changes of Sertoli and spermatogenic cells are most pronounced at 2-3 weeks, decrease at 4 week and are completely leveled by the 6th week of the experiment.

Conclusion. Hypertrophy of major salivary glands, caused by multiple amputations of incisors, has similar to sialoadenectomy effect on the spermatogenic epithelium. Multiple incisors’ amputation cause transient  depression of granular convoluted cells function. Probably submandibular gland granular convoluted tubules cells endocrine factors make the greatest contribution to the regulation of spermatogenesis in rats. 

Aim. To assess the association of clinical and therapeutic parameters with the severity of the neurocognitive deficits in patients with schizophrenia.

Materials and methods. We examined 118 patients with schizophrenia, aged 34 [29; 41] years, and with a disease duration of 10 [4; 16] years. 33 patients (28%) received conventional antipsychotic drugs (CAD), and 85 (72%) patients received atypical antipsychotic drugs (AAD). As concomitant therapy, 58 people (49.1%) took trihexyphenidyl, 60 people did not take it (50.9%). Assessment of cognitive functions was carried out for all patients using the Brief Assessment of Cognition in Schizophrenia (BACS), and clinical psychopathological symptomatology was evaluated using the Positive and Negative Syndrome Scale (PANSS). Statistical analysis of the data was performed using the Kruskal-Wallis test ANOVA with the multiple comparison procedure, the Pearson’s chi-squared test, and K-means cluster analysis.

Results. Neurocognitive deficits formed three clusters of disturbances that differ in clinical severity: 1) mild, 2) moderate, 3) severe. According to the subscale of positive PANSS symptoms, patients with mild neurocognitive deficits had a lower average total score compared to patients with severe neurocognitive deficits (p = 0.011), who, in turn, received significantly longer antipsychotic therapy compared with patients with moderate (p = 0.014) and mild (p = 0.01) neurocognitive deficits. Herewith, the duration of CAD treatment did not differ between clusters; consequently, the obtained results on antipsychotics as a whole were obtained due to AAD (p = 0.005 and p = 0.001, respectively). Trihexyphenidyl did not affect the severity of neurocognitive deficits.

Conclusion. The severity of positive symptoms of schizophrenia was lower in patients with mild neurocognitive deficits. The most pronounced neurocognitive deficits are observed in patients receiving AAD. 

Despite the emergence of new groups of drugs for the treatment of type 2 diabetes mellitus (DM2), the issue of optimal adherence to treatment remains of interest.

The aim of this study was to investigate the factors that influence the adherence to treatment with sodium glucose co-transporter type 2 inhibitor, empagliflozin (Jardiance, Boehringer Ingelheim, Germany), in patients with DM2.

Materials and methods. The study included 102 patients with DM2 (58 of them were women); the observation time was 24 weeks. The mean age was 58.3 ± 10.4 years.

Results. Patients without cognitive impairment had a lower level of glycated hemoglobin (HbA1c) (7.76%, 6.18–9.34) than patients with mild dementia (8.51%, 7.02–10; p = 0.032). In the group of patients who noted the impossibility of purchasing even a part of the drugs, the level of HbA1c was 9.73% (8.95–10.51), while patients who had no difficulties in purchasing drugs HbA1c was 8.83% (7.85–9.81; p = 0.036). Empagliflozin was discontinued in 38.2% of patients for the following reasons: cost of the drug (16.6%), development of side effects (10.7%), lack of effectiveness (7.8%), other reasons (2.9%).

Conclusion. Thus, the main factors influencing the adherence to treatment were the cost of the drug, development of adverse events, and lack of effectiveness from the therapy. At the same time, the opportunity of purchasing all the necessary drugs was associated with both better glycemic control and a higher quality of life.

The aim of the study was (a) to establish ethnicity-specific differences in such morphological parameters of the proximal phalanges (PP) as the bone length and the width of diaphysis in male children and adolescents from Tajikistan and Western India and (b) to develop regression equations for determining their age based on the size of the PP.

Materials and methods. Three hundred and sixty-two X-ray images of the right hand of male subjects were examined. All subjects originated from Tajikistan and Mumbai, India, and aged from 6 to 17 years. The  relationship between the subjects’ age and the length of the PP (LPP) and the width of the diaphysis of the PP (WPP) was investigated using a simple linear regression and correlation analysis. The LPP and WPP dependence on age was determined using one-way ANOVA and the Kruskal–Wallis test followed by post-hoc analysis by age groups.

Results. LPP and WPP of the subjects from Tajikistan and India correlated with age, with the correlation  coefficient exceeding 0.5. In both ethnic groups, the correlation coefficients for LPP vs. age was greater than  0.8. The correlation coefficient for WPP vs age ranged from 0.68 to 0.77 in Tajiks and from 0.58 to 0.69 in Indians. Simple linear regression models were developed to predict the age from LPP (R2 > 0.6), except for LPP 5 for Tajiks. The LPP 5 values in Tajiks and the WPP values in both ethnic groups showed weak R2, which ranged from 0.35 to 0.53. Eleven significant differences were identified between the ethnic groups of the same age with respect to LPP and WPP.

Conclusion. PP length was a better age predictor than the diaphysis width. The most reliable predictor for both ethnic groups was LPP 2. The PP parameters did not change uniformly over time. The PP demonstrated especially intensive growth between 12 and 15 years. The most significant differences in LPP and WPP between two ethnic groups were found for the ages of 8 and 15–16 years, with LPP and WPP in Tajiks exceeding those in Indians.

Aim. To assess the results of endovascular treatment in patients with multiple intracranial aneurysms (MIA) in the late postoperative period according to health-related quality of life (HRQoL) concept.

Materials and methods. 172 cases of patients having undergone endovascular MIA repair were examined. The evaluation of patient health-related quality of life was carried out using the SF-36 (The Short Form (36) Health Survey), the ICF (the International Classification of Functioning), and the modified Rankin Scale (mRS).

Results. The complication of subarachnoid hemorrhage (SAH) appears in approximately 1,2% of cases in the late postoperative period. When assessing the health-related quality of life according to the SF-36 domains in patients with Subarachnoid hemorrhage (SAH), the QoL showed a decrease in “Social Functioning” (p = 0.03). In patients with pseudotumor cerebri (PTC) a decrease was seen in “Role-Physical Functioning” (RP) (p = 0.004), while “General Health” (GH) (p = 0.049), “Social Functioning” (SF) (p = 0.005) and “Mental Health” (MH) (p = 0.009) subscales also saw decreases. Having more than two inpatient surgical procedures is also associated with the health-related quality of life of patients (p < 0.05). Assessment of activity with ICF showed the intensity of irregularities on the d4501 domain – “walking short distance” – depended on the existing SAH (p < 0.05). Procedural complications affected the patient’s daily activities on the domains d4501 — “walking long distance” (p = 0.03), and d640 — “doing household chores” (p = 0.01).

Conclusion. The assessment with ICF allows the specification of patient activity and participation in public life. The SF-36 scale provides additional information on the patients’ subjective perception of their condition. Considering the quality of life in the late postoperative period is not completely restored in all patients, ongoing rehabilitation measures, diagnostic cerebral angiographies and improvements in the surgery techniques are required.  

The aim of this study was to determine the general patterns of pathogenetic changes in the blood coagulation system and in non-specific proteinases and their inhibitors during the development of experimental  ischemiareperfusion injury.

Materials and methods. The study was conducted on 48 male Wistar rats (180–200 g). We used a model of ischemia-reperfusion injury achieved by applying rubber tourniquets to both hind limbs at the inguinal fold level for 6 hours. Revascularization was performed for 6, 12, or 24 hours following the application of tourniquets, after which we examined the state of the internal and external blood coagulation pathways and the activity of nonspecific proteinases and their inhibitors.

Results. Indicators of blood coagulation system change show the development of blood hypocoagulation changes as the reperfusion time increases. By the 6th hour of reperfusion, the prothrombin time (PT) was lengthened by 112.0% (p = 0.0142) and the activated partial thromboplastin time (APTT) by 170.0% (p = 0.0147) compared with values in the control group. By the 12th reperfusion hour, the PT was lengthened by 174.2% (p = 0.0389), and the APTT increased 4.9-fold (p = 0.0002). When the reperfusion period was increased to 24 hours, it was characterized by lengthened PT and APTT, accompanied by an increase in antithrombin III by 11.5% (p = 0.0371) and a decrease in protein C by 71.4% (p = 0.0071). Changes in the non-specific proteinases and their inhibitors were characterized by a 2.8-fold increase in the trypsin-like proteinase activity (p < 0.001) relative to the control, as well as a 2.2-fold decrease in antitrypsin activity and acid-stable inhibitors (p < 0.001), which reached a maximum after 24 hours of reperfusion. A direct correlation was found between indicators characterizing the deficiency of coagulation system factors and a decrease in antiproteinase potential.

Conclusion. Hemostatic system disorders are characterized by the development of hypocoagulation during ischemia-reperfusion injury as the result of an increase in the trypsin-like proteinase activity and a decrease in the levels of inhibitors. The established changes may be associated with the deficiency of coagulation factors and proteinase inhibitors and share common pathogenic mechanisms. 

The aim of the study was to characterize the features of the subpopulation composition and cytokine-secretory activity of T lymphocytes (Th1, Th17 and Treg) in relation to the concentration of galectin-1 and galectin-3 in the blood of patients with colon cancer.

Materials and methods. A total of 26 patients diagnosed with colon cancer were examined. The study material included whole peripheral blood, blood plasma, and supernatants of suspension cultures of mononuclear leukocytes. Lymphocytes isolated from blood were typed by flow cytometry using monoclonal  antibodies. The content of galectin-1 and galectin-3 (in blood plasma) and IFNγ, IL-17A, and TGFβ (in supernatants of mononuclear leukocyte culture in vitro) were determined by enzyme-linked immunosorbent assay. The results obtained were analyzed by statistical methods.

Results. In patients with colon cancer, a significant increase in the concentration of galectin-1 and galectin-3 in the blood plasma was found, which was associated with a decrease in the content of CD4+T-bet+ Th1 lymphocytes, CD4+RORC2+ Th17 lymphocytes in the blood and in vitro hyposecretion of IL-17. At the same time, positive correlations were revealed between the concentration of galectin-1 and galectin-3, the content of CD4+FoxP3+ Treg cells in the blood, and the secretion of TGFβ by mononuclear leukocytes in vitro.

Conclusion. In colon cancer, increased levels of galectin-1 and galectin-3 in the blood are associated with quantitative deficiency and inhibited secretory activity of effector T lymphocytes and activation of the immunosuppressive functions of regulatory T cells. These results suggest a negative role of galectin 1 and galectin 3 in the mechanisms of regulation of the T cell immune response in colon cancer.

Aim. To study the level of activity of lysosomal cysteine proteases (cathepsins H, B, L) in blood plasma and fractionated leukocytes (polymorphonuclear and mononuclear) in patients with Alzheimer’s disease in comparison with similar indicators in persons without signs of neurodegeneration as a possible marker of Alzheimer’s disease development and diagnosis.

Materials and methods. The spectrofluorimetric study of cathepsins B, L, H activity level in plasma and fractionated leukocytes was conducted in 22 patients diagnosed with Alzheimer’s disease in comparison with the same indicators in 22 patients matched by sex, age and associated diseases with patients of the observation group, but having no signs of neurodegeneration.

Results. The activity of all three enzymes, and especially cathepsin H, increased significantly in blood plasma.  A significant increase is also noted in the activity of cathepsins H, B, and L in homogenates of fractionated  leukocytes. At the same time, in both polymorphonuclear and mononuclear leukocytes the greatest degree of changes is demonstrated by the activity of cathepsin B, and the least is the activity of cathepsin L. Given the available data on an increased cathepsin B activity in the cerebrospinal fluid of patients with Alzheimer’s disease, we can assume a correlation between the state of lysosomal proteases activity in the Central nervous system and in the peripheral blood cells.

Conclusion. Alzheimer’s disease is associated with increased activity of cysteine cathepsins in plasma, polymorphonuclear and mononuclear leukocytes of peripheral blood, which can be considered as one of the possible markers of development and diagnosis of the disease.  

Sternal wound infections are a terrible complication that require long and complex treatment.

The aim of the study was to evaluate the results of using the modified method of vacuum therapy to treat purulentseptic complications of post-sternotomy wounds in clinical practice.

Materials and methods. According to the applied method of vacuum therapy, all patients with infectious complications of post-sternotomy wounds were divided into two groups (n = 25, average age 56.6 years). The classical vacuum therapy was used in the first group consisting of 12 patients. In the second group, 13 patients were treated with the help of the modified method of vacuum therapy.

Results. In the first group, 1 patient (8.3%) experienced osteomyelitis of the sternum, following a partial resection of bone plates; 1 patient (8.3%) developed sternal fistulas, which required long-term treatment; 1 patient (8.3%) had bleeding due to the injury of the left brachiocephalic venous trunk because of the direct contact of the polyurethane pad with the blood vessel wall. The bleeding was eliminated by fixing the damaged area of the vascular wall with U-shaped sutures using polytetrafluoroethylene pads. In the second group, no complications of this nature were observed. The modified method of vacuum therapy allows for the effective evacuation of the hemorrhagic discharge of the wound surface, the reduction of the degree of pathogen contamination in the adjacent tissues, and the elimination of bleeding risk .

Conclusion. The modified method of vacuum therapy in combination with effective algorithms for treating purulent-septic complications of post-sternotomy wounds allows physicians to avoid fatal complications and achieve good clinical results.

The aim of this study was to assess the features of disturbed food intake and find ways to optimize rehabilitation and resocialization processes for patients with acquired defects and deformities of the oropharyngeal zone.

Materials and methods. The study included 86 patients of a surgical hospital with defects and deformities of the oropharyngeal zone: 59 men and 27 women. The degree of dysphagia was assessed using clinical scales: volumeviscosity swallow test (V-VST) and swallowing disability scale (SDS). Rehabilitation measures to normalize swallowing were performed in the experimental group (I), which consisted of 42 patients. The control group (II) consisted of 40 patients and was not included in the restorative effect. The groups were balanced according to the severity of the disorder, sex and age. Comparative analysis of the severity of impaired swallowing before and after rehabilitation and evaluation of its effectiveness were conducted.

Results. Data from the study of the dysphagia degree on the SDS scale for the whole sample (n = 82) suggest that the degree of disorder manifestation depends on the location and extent of anatomical defect. Moreover, comparative analysis suggests that the presence of a combined defect exacerbates the severity of dysphagia. Step-by-step speech therapy in the control group aimed at overcoming swallowing disorders included adaptive, compensatory and restorative strategies used in various combinations depending on the location of the defect and the severity of dysphagia. The comparison of the repeated assessment data on dysphagia severity in two groups of patients (I and II) showed that the rehabilitation measures had a positive impact.

Conclusion. Thus, we can state that speech therapy, which is a non-drug and non-invasive rehabilitation method, allows patients to successfully normalize eating process, helps in preventing cachexia-anorexia and dehydration, which is important for a successful postoperative period, as well as for improving the life quality of patients.

Aim. To evaluate the functional annotation of genes associated with rheumatoid arthritis with different parameters of the ClueGO Cytoscape tool.

Materials and methods. Genes of susceptibility to rheumatoid arthritis were extracted from publicly available database GWAS (catalog of associations of single nucleotide polymorphisms with diseases). The Gene Ontology (GO), the functional annotation of genes, was performed using Cytoscape ClueGO. The features of the functional annotation using the plugin ClueGO Cytoscape were analyzed.

Results. Depending on the initial parameters specified in the plugin, the grouping of terms according to the gene ontology was carried out with a different degree of generalization. A smaller minimum number of genes in a group allows to form a larger number of groups, which makes it possible to obtain more detailed functional characteristics.

Conclusion. The results obtained with different grouping options can be useful for further studies of genetic mechanisms of rheumatoid arthritis.

The aim of the study was to identify general patterns and features of changes in the content of hypoxia-inducible factors-1 and -2 in association with an imbalance of cytokines (IL-10, IL-13, galectin-2 and -9, IFN-gamma) in the blood in diseases associated with hypoxia.

Materials and methods. We examined 25 patients with coronary heart disease (CHD) with heart failure II-III according to NYHA, 16 patients with chronic obstructive pulmonary disease (COPD) without exacerbation, 16 patients with infiltrative pulmonary tuberculosis (TB) before anti-TB therapy, and 18 relatively healthy donors. Plasma concentrations of HIF-1alpha, HIF-2alpha, IL-10, IL-13, galectins-2 and -9, and IFN-gamma were determined by enzyme-linked immunosorbent assay (ELISA).

Results. Positive outcomes of quantity determination of HIF-2alpha in the blood (24.00 ± 8.54 %, 75.00 ± 10.83%, 43.75 ± 12.40% of patients, respectively, against «zero» values in healthy donors) and also signs of immunosuppression at normal plasma concentrations of HIF-1alpha were determined in diseases associated  with chronic hypoxia (in patients with CHD, COPD, TB). Immunological insufficiency in CHD and TB is caused by a deficiency of IFN-gamma and galectin-2 in association with an excess of galectin-9 (in patients with CHD 1.10 [0.52; 2.60] pg/ml p = 0.038) or IL-13 (in patients with TB 0.81 [0.79; 1.40] pg/ml, p = 0.043), and in patients with COPD it is caused by a surplus of galectin-9 and IL-13 (8.50 [3.96; 15.00] pg/ml, p = 0.001 and 2.62 [1.20; 7.58] pg/ml, p = 0.002, respectively) at normal concentrations of IFN-gamma and galectin-2. The content of IL-10 in the blood tends to increase in CHD and COPD.

Conclusion. In patients with CHD, COPD and TB, chronic hypoxia is associated with immunosuppression mediated by an imbalance of IL-10, IL-13, IFN-gamma, galectins (2 and 9) in the blood and the secretion of HIF-2alpha, which has the property to stimulate the differentiation of M2-macrophages synthesizing anti-inflammatory cytokines.

The aim of the study was to develop ways to improve the diagnosis and treatment of systemic sclerosis (SSc)-ILD. Interstitial lung disease (ILD) is a common manifestation of SSc. In the territory of the Siberian Federal District (SFD), the number of patients with the progressive phenotype of SSc-ILD is approximately 750 people. When immunosuppressive therapy is ineffective and pulmonary fibrosis progresses, lung transplantation is indicated. The emergence of new possibilities of pathogenetic therapy currently requires studying the possibilities of their applications in real clinical practice on the territory of the SFD.

Discussion. The results of a discussion of diagnostics, therapy, and routing of a rheumatology patient during the interdisciplinary observation of SSc-ILD in the SFD are presented. The reason for this discussion was the new data on the use of nintedanib in this category of patients

Conclusion. To improve the efficiency of diagnosis and treatment of patients with SSc in the SFD, it is necessary to implement the principle of a multidisciplinary approach with the obligatory involvement of a pulmonologist and a radiologist (a specialist in CT diagnostics), and, if differential diagnosis is necessary in difficult clinical situations, of a pathomorphologist. An urgent task is the introduction of an algorithm for examining patients with SSc for the timely diagnosis of ILD in the territory of the Siberian Federal District. To improve the quality of medical care in the territory of the SFD for patients with ILD-SSc it is necessary to create a reference center in the city of Novosibirsk with the possibility of initiating anti-fibrosis therapy.

Chronic pelvic pain resulting from varicose veins of the small pelvis is a multidisciplinary problem. A key cause of pelvic congestion is congenital or acquired gonadal valve failure. Ultrasound and Doppler examination for chronic pelvic pain allows in most cases to diagnose pelvic varicose veins. Multispiral computed tomography or magnetic resonance imaging details the nature and extent of the pathology. Selective phlebography is considered the gold standard for diagnosing varicose veins of the small pelvis. Conservative treatment with phlebotropic drugs is prescribed for limited pelvic varicose veins. Surgical treatments include open resection and retroperitoneal and transperitoneal laparoscopic gonadal vein excision or clipping. The most effective is minimally invasive endovascular occlusion of reflux veins using spiral technologies and sclerosants. The left ovarian vein is reduced more often. The decision on bilateral embolization of blood vessels depends on the severity of changes in veins and the intensity of blood reflux. A decrease in the intensity or disappearance of pain in the pelvic area is achieved in 80–100% of cases after the procedure. Diagnosis of this condition is difficult due to the fact that the appearance of pelvic varicose veins is nonspecific and includes symptoms of surgical, urological, gynecological and other diseases of the pelvic organs.

The authors of this article have analyzed the problem of diagnostic conclusion unification in patients with chronic heart failure (CHF). The root of this problematic situation in which practitioners find themselves is that, despite the large number of different regulatory documents, there is no consensus on what is considered correct and what is wrong when formulating a diagnostic conclusion in a patient with CHF. The many-faced syndrome is designated differently: CHF, congestive heart failure, chronic circulatory failure. There are difficulties in determining the stage of CHF in patients receiving optimal drug therapy or in those who are in a state of compensation after a successful surgical correction. When assessing the functional status in a patient with CHF, a distinct subjectivity should be taken into account in determining which limited physical activity is slight or, conversely, marked, as well as what kind of physical exertion is normal for the patient. This subjectivity naturally leads to low reproducibility of the assessment results of the CHF functional class in the same patient by different doctors. CHF should also be classified according to the value of a left ventricular ejection fraction. The diagnosis should also take into account the state characteristics of a diastolic function of the left ventricle (especially in patients with CHF and preserved left ventricular ejection fraction). The authors give examples of diagnostic conclusions, including cases of comorbid pathology.

This article provides a review of the phenomenon of entopy or local atopy from the viewpoint of allergic phenotypes and endotypes. A clinical form of the entopy endotype is local allergic rhinitis, which is still a fertile area for research. The exact mechanisms in the breakdown of allergen tolerance in entopy remain unclear. The  review focuses on the pathogenesis, diagnostic algorithm, and the choice of treatment strategies in local allergic rhinitis.

Regulatory T-lymphocytes play a central role in the immunological tolerance system. To date, existence of many different subpopulations of regulatory T-cells have been described. However, a number of questions related to the function, differentiation, and homeostasis of these subpopulations in a body remain unclear. Interactions between the previously discovered pairs of helper and regulatory T-lymphocytes require further study. The main topic is identification and establishment of the functions of regulatory memory cells. Interstitial migration of activated regulatory T-lymphocytes is also a promising direction. In this review, we summarized the main findings in multiple subsets of regulatory T-lymphocytes, discussed unclear data that will require further studies, and  showed an application for regulatory T-lymphocytes in medicine.

This article overviews and systemizes published data on the ways of implementing different methods of biofeedback, robotic devices, and brain-computer interfaces (BCI) for rehabilitation of children with cerebral palsy (CP).

Aim. To survey implementation practices and clinical outcomes of rehabilitation technologies and possible neurophysiological mechanisms underlying their efficacy in patients with CP. We searched PubMed, Web of Science and eLIBRARY.ru databases for relevant publications using specified keywords.

Results. The analysis of relevant literature has shown that robotic technologies and BCIs with biofeedback based on electroencephalography and electromyography parameters are rapidly developing and implemented for the rehabilitation of children with CP. The first evidence of effectiveness for such methods and approaches has been found. However, there is a lack of fully developed conventional standards for the use of such rehabilitation methods and protocols in children. Control groups comprising of children with CP are often absent in such studies. In many cases, the variations of neurophysiological and neurochemical parameters before and after a course of rehabilitation are not evaluated. Having such data would help clarify physiological mechanisms underlying effective rehabilitation of motor functions and then design more adequate rehabilitation procedures and medication protocols.

Among married couples of childbearing age, the frequency of infertility in different regions of Russia and the world ranges from 10 to 21%. The effectiveness of the results of in vitro fertilization (IVF) and embryo transfer is determined by two factors: the functional completeness of the embryo at the blastocyst stage and the absence of intrauterine pathology. One of the main causes of imperfect or unsuccessful implantation is an impaired function and damaged endometrial structure, which is often caused by a chronic inflammatory process in the endometrium. 
Chronic endometritis (CE) is a condition associated with a violation of the coexistence between microorganisms and the immune system of a macroorganism in the endometrium. A majority of CE cases produce no noticeable clinical signs or mild symptoms and the CE prevalence rate is approximately 10% based on the histological findings of an endometrial biopsy.
The interconnection between СE and reproductive dysfunctions, such as implant damage and repeated miscarriage, has been studied by many researchers at the present stage. Chronic endometritis is common among patients with unexplained infertility. Diagnosis and treatment of chronic endometritis increase the frequency of spontaneous pregnancies and live births in such patients. The diagnosis of chronic endometritis is not simple, often contradictory, and, thus, requires close cooperation between the fertility specialist and the pathologist. In this study, we reviewed the literature on the pathophysiology of chronic endometritis and how it may be associated with infertility, as well as the literature regarding the diagnosis and treatment of CE, published at PubMed as on May 2019 in a version and contra-version format.

Aim. The problem of anaplastic astrocytomas is quite relevant today. The WHO classification distinguishes IDH1/IDH2 mutant anaplastic astrocytomas, anaplastic astrocytomas without IDH1/IDH2 mutations, and anaplastic astrocytomas not otherwise specified. The aim of this work was to cluster IDH1-mutant anaplastic astrocytomas based on their cytogenetic profile to select prognostically significant molecular subgroups, which can have both clinical and fundamental scientific value.

Materials and methods. In this work, we performed a cluster analysis of anaplastic astrocytomas according to their cytogenetic profiles based on available genetic databases of tumors and large cohort studies, as well as a comparison of Kaplan – Meyer survival curves for various molecular subgroups of patients.

Results. We studied the main genetic features of the inter-tumor heterogeneity of anaplastic astrocytomas and distinguished seven molecular subgroups based on the cytogenetic profile: embryo-like, inflammatory-like, deletion, matrix, cyclin, GATA3-dependent and tyrosine kinase. Moreover, each of these subgroups has not only distinctive molecular characteristics, but also important clinical features.

Conclusion. A detailed study of the molecular properties of anaplastic astrocytomas will not only optimize the process for predicting treatment outcomes, but also create innovative formats for targeted therapy within the framework of the concept of personalized medicine.

Adiponectin, the most common plasma adipocytokine, plays a crucial metabolic and anti-inflammatory role. With insulin resistance associated with obesity, an increase of adiponectin concentration, which leads to the activation of signaling pathways involved in the regulation of metabolism, occurs. Currently, adiponectin is being investigated as a potential therapeutic target for metabolic syndrome, although more research is required to understand the underlying mechanisms controlling its levels. In this review, we will examine the main mechanisms that control adiponectin levels in blood serum and its role in insulin-sensitizing effect, as well as evaluate the potential use of adiponectin and its receptors as a potential therapeutic target.

A case report of successful intravascular aspiration in a patient with acute cardioembolic stroke is presented. Non-occlusive critical thrombosis of the extracranial segment of the left internal carotid artery with distal total embolization of the medial cerebral artery was verified. During the intervention, the dislocation of thrombotic masses into the supraclinoid segment occurred.

The choice of immunosuppressive therapy is determined by the degree of sensitization to the histocompatibility gene complex on chromosome 6 (HLA). The risk of rejection in the early periods after surgery  increases for the patients with repeated kidney transplantation. Optimizing immunosuppressive therapy is the only  way to prolong the life of a patient with a terminal stage of chronic renal failure. имости на 6-й хромосоме (НLA). The analysis of a clinical case of a 47-year-old patient who was undergoing treatment at the N.V. Sklifosovsky Scientific Research Institute of Emergency Medicine after the third allotransplantation of a cadaveric kidney in 2016 was performed. The patient was diagnosed with chronic glomerulonephritis (IgA-nephropathy) chronic end-stage renal failure; in the early postoperative period, in addition to basic immunosuppression, anti-lymphocytic polyclonal antibodies were prescribed in combination with plasmapheresis sessions for the treatment and prevention of acute rejection crisis in the early postoperative period. For the first time, in order to prevent the development of an acute rejection crisis and minimize infectious complications of immunosuppressive therapy in the recipient after the third kidney transplant, plasmapheresis sessions were used using a plasmapheresis filter with a polymethylacrylate membrane in combination with a short course of polyclonal antibodies.