This scientific review examines such a pathological condition as antiphospholipid syndrome. We note that this syndrome remains a relevant problem
not only for obstetricians and gynaecologists, but also for doctors of various specialties. The article discusses etiological aspects of antiphospholipid syndrome
and provides data on the prevalence of the syndrome by age and gender. The pathogenetic aspects of the development of antiphospholipid syndrome in
general and during pregnancy are touched upon. Much attention is paid to the presence of this pathology precisely during the preconception period and the
period of pregnancy at various stages of gestation. We have analysed the literature to describe clinical manifestations of the disease during pregnancy, and
have also described the possible outcomes of pregnancy with this syndrome. Much attention is paid to the diagnosis of antiphospholipid syndrome, as well as
to the treatment of this pathology, depending on the clinical situation.

Cystic fibrosis is a hereditary disease, manifested by clinical polymorphism, severe course and prognosis. In Russia, there has been an increase in
the number of patients diagnosed with cystic fibrosis (since 2011, the number of patients has increased by 4 times). The purpose of the review is to determine
the modern principles of cystic fibrosis therapy in order to identify the methods of treatment most promising for further development. A review of scientific
publications presented in the electronic databases PubMed, eLibrary, Cochrane Library, Google Scholar for the period 2017-2023 was carried out. Improving
the quality and life expectancy of patients with cystic fibrosis at the present stage is provided through early intervention, a comprehensive and personalised
approach to therapy with continuous therapeutic measures. The method most promising for further development is exerting impact on the etiopathogenetic
mechanisms of the development of cystic fibrosis.

Community-acquired pneumonia (CAP) morbidity and mortality continues to pose a major challenge to health systems worldwide. Identification
of risk factors for severe disease and death may facilitate early identification of patients at high risk for the development of potential complications and
poor outcome of CAP. A search was conducted using PubMed, Scopus, eLibrary, WoS, Cochrane databases for literatures published from 1997 to 2022. The
importance of individual factors that may be associated with a higher risk of death is considered, including sociodemographic parameters, comorbidities,
invasive and non-invasive ventilation, as well as a number of laboratory biomarkers. Based on the results of the literature analysis, it is not possible to identify
a single unique marker; each of the studied parameters has its own limitations regarding the predictive ability of death in patients with CAP

The aim of the research. To determine the relationship between the content of calcium and magnesium in drinking water sources and the incidence of
essential hypertension (EH).
Material and methods. The content of calcium and magnesium in the drinking waters of the Kazbekov district of the Republic of Dagestan was determined by the
AAS method in the flame atomisation mode on the contrAA 700 spectrometer (Analytik Jena AG, Germany) at the Department of Analytical and Pharmaceutical Chemistry of the FSBEI HE DSU. The study covered the population fit for work (a cohort of men and women aged 30-59 years). Data on the morbidity of the EH
population were obtained in the Kazbekov central district hospital (reporting form 12). Statistical data processing was carried out using Microsoft Excel 2013 and
Statistica 6.0 programs. The arithmetic mean (M) and standard deviation (SD) were determined. The type of data distribution was determined using the ShapiroWilk criterion. The Pearson correlation coefficient was used to determine the significance of the relationship between the parameters with normal distribution
(the incidence EH in the population, the content of calcium and magnesium in the waters). The critical significance level is assumed to be p <0.05.
Results. Indicators of calcium, magnesium, water hardness and the incidence of EH among the population in all 12 settlements of the Kazbekov district has
revealed an inverse correlation of moderate, noticeable and high strength on the Chaddock scale: for calcium, magnesium and water hardness: for men, r =
-0.403; -0.691; -0.506; for women, r = -0.462; -0.818; -0.585.
Conclusion. The role of calcium, magnesium and water hardness in the pathology of the EH in the population of the Kazbekov district of the Republic of
Dagestan has been determined. The correlation coefficient indicators determined the following pattern: the lower the content of calcium and magnesium in
natural waters leads to the higher the incidence of EH of the population and, conversely, an increase in the content of these macronutrients reduces the growth
of pathology. Data on the calcium and magnesium status of the environment can be used to establish regional sanitary standards for the territory.

The aim of the research. To assess the contribution of concomitant pathology in hematological patients to the course and outcomes of the new
COVID-19 coronavirus infection.
Material and methods. Data analysis of 221 patients of Primorsky Krai with malignant (tumor) (group 1, n=173 (84%)) and benign (non-tumor)
(group 2, n=48 (16%)) diseases of the blood system aged 18 to 90 years hospitalized with COVID-19 since April 2020 to September 2022. The
frequency of occurrence of endpoints was analyzed according to the goal: 1st – fatal outcome (mortality from any cause); 2nd – combined point,
including hospitalization in the ICU and the need for a ventilator; and 3rd point – assessment of the condition of patients who survived treatment in
intensive care units for COVID-19.
Results. Patients with malignant blood diseases and COVID-19 are significantly more likely to have a fatal outcome compared to non-tumor blood
diseases. In hematological patients with polymorbidity, the risk of fatal events in COVID-19 increased. Only diabetes mellitus had the greatest
significance in the risk of mortality in COVID-19 and hospitalization in the ICU, especially for patients with non-tumor blood diseases. The presence
of cardiovascular pathology increases the risk of hospitalization in the ICU/ventilator only for patients with non-tumor blood diseases. Among the
patients hospitalized in the ICU, only 4 or 5.8% of patients with blood tumor diseases were discharged from the hospital.
Conclusion. Hematological patients with the addition of COVID-19 need correction of concomitant general therapeutic pathology to improve the
outcomes of coronavirus infection and require follow-up

The aim of the research. To study the dynamics of uromodulin during surgeries in the retroperitoneal space using laparoscopic and retroperitoneal approach.
Material and methods. The content of uromodulin was studied in 162 patients before and after surgery for renal cysts, under different gas pressure modes
and duration of pneumo- and retropneumoperitoneum.
Results. It has been established that in the condition of maintaining the pressure of insufflated gas above 12 mmHg and its greater exposure, there is a
significant increase (4-5 times) in the content of uromodulin in the urine on the first day after surgery. In blood serum, the opposite dynamics is observed: a
decrease in uromodulin (2-2.5 times). Three days after surgery, all parameters returned to their original values.
Conclusion. With the laparoscopic approach, changes in uromodulin levels are more pronounced in comparison to retropneumoperitoneum, which possibly
attests to a higher level of surgical aggression and reflects a greater risk of renal dysfunction. The main factor influencing the uromodulin content is the higher
(over 12 mmHg) pressure level used for pneumo- and retro-pneumoperitoneum. A less significant factor is the duration of the operation.

The aim of the research. To evaluate the indicators of the quality of life in schoolchildren with abdominal pain in native and non-native populations of the
Republic of Tyva.
Material and methods. Schoolchildren aged 7-18 from the ethnic populations of the Republic of Tyva (379 Mongoloids (Tuvans) and 163 Caucasians) were
examined by the cross-sectional method. We used a standard questionnaire to identify gastroenterological complaints and a parental (CHQ-PF28) adapted
Russian version of the Child Health Questionnaire (CHQ) to assess the quality of life of children. The calculation of indicators was carried out according
to the sections characterising various areas of the child’s life, according to a 100-point system. The study was approved by the ethics committee and was
conducted after obtaining the written consent of the examined. Statistical analysis was carried out using the χ2 and Mann-Whitney tests.
Results. A decrease in quality of life indicators on a number of scales of the questionnaire was found in schoolchildren with abdominal pain compared with
children who had no complaints, regardless of ethnicity, gender and age. However, Caucasians have lower quality of life scores on such scales as “bodily pain
and discomfort”; “behaviour disorder”; “mental health” reflecting the state of physical and mental health of children and was accompanied by an increase in
persistent feelings of anxiety and depression.
Conclusion. In schoolchildren of the Republic of Tyva with abdominal pain, the features of quality of life parameters in ethnic populations have been
established, which can be considered a manifestation and severity of psychosocial distress in children formed with the participation of genetic and socioeconomic factors

The aim of the research. To develop and test a technique for determining the length of the thoracodorsal nerve.
Material and methods. An anthropometric examination of 105 male and female corpses aged 36,100 years was carried out with the determination of height,
length of the upper limb, neck circumference and chest width. After anatomical dissection of the brachial plexus, the length of the thoracodorsal nerve was
measured. Correlation and regression analysis revealed the degree, significance and equations of conjugacy of the anthropometric indicators with the length
of the thoracodorsal nerve.
Results. The median length of the thoracodorsal nerve before entering the broadest muscle of the back is 12.5 cm with fluctuations from 11.5 to 14.3 cm
within the interquartile interval Q1, Q3, and 9.5 [8.3; 11.0] cm without the extramuscular branches. Significant correlations were established between the
neck circumference and the length of the thoracodorsal nerve. The revealed linear regression equations make it possible to accurately determine the length of
the thoracodorsal nerve in 83% of cases and make the right decision regarding the possibility of its transfer to the position of the damaged nerve. The quartile
distribution of people into 3 groups by height, the determination of five parameters (age, height, upper limb length, neck girth, chest width) and the use of
linear regression equations increases the accuracy of determining the length of the thoracodorsal nerve up to 94%.
Conclusion. The length of the thoracodorsal nerve is an important factor in the possibility of its transfer to the position of the damaged nerve. As an external biomarker of the length of the thoracodorsal nerve, it is advisable to use age, height, neck circumference, upper limb length and chest width.

The aim of the research. To study the cytokine and peroxidase profile of bronchial interstitial macrophages and the functional activity of bronchial epithelium
in bronchial asthma (BA) patients with different airway responses to the hyperosmolar stimulus.
Material and methods. In 70 BA patients, the degree of asthma control (ACT, points), external respiration function (FEV1, % predicted), airway response
(∆FEV1, %) to the bronchoprovocation test with ultrasonic inhalation of hypertonic (4.5%) sodium chloride solution (IHS), the collection and study of
exhaled breath condensate (EBC) and induced sputum (IS) was performed. In cytological smears, the cellular composition, myeloperoxidase (MPO) activity,
the degree of destruction of the bronchial epithelium were studied. The contents of IL-12 and IL-13 in EBC were measured. Group 1 (n=25) included subjects
with airway hyperresponsiveness to hyperosmolar stimulus, Group 2 (n=45) included subjects with absent hyperresponsiveness (∆FEV1 -18.5±2.8 and
-0.78±1.0%, respectively, p<0.001).
Results. Patients of both groups had no differences in ACT and FEV1, but in first group a lower value of FEF25-75 was recorded (55.3±3.9 and 69.2±4.4%,
respectively, p=0.023). The number of macrophages in IS was 34.9±5.1 and 49.8±4.6% in patients of the 1st and 2nd groups, respectively (p=0.039). The MPO
was 120 (120;180) and 60 (60;120) pixels (p=0.016), bronchial epithelial cells with total damage to the nucleus and cytoplasm were 40% (39;50) and 30%
(25;35) (p=0.007). In the 1st group, there was a significant decrease in IL-12 (p=0.0002) and IL-13 (p=0.043) in EBC after the IHS test, and a close relationship
was observed between the content of macrophages and MPO values (Rs=-0.79; p=0.007) in sputum, as well as between the baseline concentration of IL-12
and FEF25-75 (Rs=0.53; p=0.042).
Conclusion. Airway hyperresponsiveness to the hyperosmolar stimulus in BA patients is associated with production and consumption of IL-12, increased
production and exocytosis of MPO, more pronounced destruction and cytolysis of epithelial cells as well as worsening of the patency of small bronchi.

The aim of the research. To evaluate the influence of tobacco smoking and pulmonary tuberculosis on development of bronchial patency disorders.
Material and methods. The study group included 56 patients with pulmonary tuberculosis. Group 1 included 23 patients who had stopped smoking and,
along with tuberculosis chemotherapy, received treatment for nicotine addiction. Group 2 included 20 patients who continued to smoke tobacco and only
received tuberculosis chemotherapy. Group 3 included 13 patients who had never smoked and only received tuberculosis chemotherapy.
Results. The results of the study have shown a high prevalence of severe forms of tuberculosis among smokers. In all study groups, the presence of bronchial
hyperreactivity of varying degrees of severity was noted. Against the background of specific treatment and refusal of smoking in Group 1, relief of bronchial
hyperreactivity by the 4th month was noted. Among non-smokers, the presence of bronchial hyperreactivity by the 4th month of therapy was also not noted.
In the group of patients who continued to smoke tobacco, bronchial hyperreactivity remained at the same level. Also, in the group of smokers who had
stopped smoking, and in the group of non-smokers, there was an increase in the main indicators of the respiratory function (FEV1%, FVC%, Tiffeneau Index)
by the 4th month of treatment. In the group of smokers who continued to smoke tobacco, there was no increase in these indicators.
Conclusion. Early detection and treatment of bronchial hyperreactivity, including smoking cessation among smokers, will improve the condition of the
bronchopulmonary system of patients with tuberculosis and prevent further development of bronchial obstruction.

The aim of the research. To study the serum concentration of proinflammatory cytokines and adipokines in patients with chronic obstructive pulmonary
disease (COPD) with different body weights.
Material and methods. A cross-sectional observational case-control study was performed. A total of 122 subjects were examined and divided into 2 groups:
the main (n=102) and the comparison group (n=20). The main group included 102 patients with a previously established diagnosis of COPD. The comparison
group consisted of apparently healthy individuals. All examinations were carried out according to GOLD (2017). The concentrations of adiponectin (ng/ml),
leptin (ng/ml), interleukins 1β (IL-1β) 6 (IL-6) and tumour necrosis factor - alpha (TNF - alpha) (pg/ml) in blood serum were studied.
Results. The serum level of adiponectin in COPD patients with normal body weight and overweight is significantly higher than in COPD patients with
obesity (p1-3=0.025, p2-3=0.034) and healthy people (pcomp-1=0.0001, pcomp-2=0.001). The leptin level in overweight and obese COPD patients is 2 times
higher than in COPD patients with normal body weight (p1-2=0.0001, p1-3<0.0001). The concentration of IL-1b, 6 and TNF-alpha in all examined patients was
within the reference values. IL-1b was lower in healthy individuals than in patients with COPD (p<0.0001). The level of IL-6 is higher in healthy people and
in patients with COPD with normal body weight than in patients with COPD who are overweight and obese (p1-2=0.024, pcomp-2=0.0003, pcomp-3=0.002).
Conclusion. The serum level of adiponectin in COPD patients with normal body weight and overweight is significantly higher than in COPD patients with
obesity and healthy controls. Adiponectin concentrations are associated with indicators of COPD severity. As the body weight of COPD patients increases,
leptin values increase. The concentration of 1β, 6, TNF-alpha in patients with COPD receiving treatment is within the reference values. Moreover, the value
of IL-1β in patients with COPD is higher than in healthy people.

The aim of the research. Postoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery and it is important for the postoperative
recovery is to minimise POCD. It appears promising to use multimodal cognitive training for cognitive prevention and rehabilitation, which will help
activate different functional systems of the brain. Aim of the study. The approbation of the «RECOVERY» computer program for simultaneous multimodal
stimulation of cognitive domains to restore cognitive functions in patients with coronary artery disease (CAD) in the early postoperative period of coronary
artery bypass grafting (CABG).
Material and methods. The study enrolled 27 patients after elective CABG, median age 63 years [40; 77] and 30 apparently healthy subjects at the median
age of 20 years [18; 21]. A simultaneous stimulation of cognitive domains using the «RECOVERY» program (two tasks: a visual‐motor reaction of choice and
an open type task in verbal modality) was performed in the patients once, starting from 2-3 days after CABG. The comparison group also received one-time
training. All participants in the study were assessed indicators of psychomotor and executive functions, short-term memory and attention.
Results. Patients after CABG demonstrated comparable results while using the «RECOVERY» training program for cognitive stimulation in terms of reaction
time for correct and incorrect answers, as well as in the number of answers in the open task in comparison to the healthy subjects.
Conclusion. The study has shown that multimodal cognitive training using the «RECOVERY» program is a possible method for restoration of cognitive
functions in CAD patients in the early postoperative CABG period. However, to be able to include this type of cognitive rehabilitation in the postoperative
rehabilitation program in the cardiac patients, further studies are needed to substantiate the intensity and duration of the training course.

Ganglioneuroma is a benign tumour consisting of elements of sympathetic nerve nodes that has secretory activity with synthesis of catecholamines
that cause an increase in patients’ blood pressure. The patients do not note other symptoms. The article presents a clinical observation of a patient with
retroperitoneal ganglioneuroma which caused secondary arterial hypertension complicated by haemorrhagic stroke. Intravital laboratory and instrumental
diagnostic methods did not detect the tumour. Therapy aimed at stabilising blood pressure was ineffective. Against the background of increasing multiple
organ failure, the patient died

The article presents a clinical case of a relatively rare pathological condition: oesophageal rupture-haemorrhagic syndrome (H. Boerhaave
syndrome). The description of the clinical case is preceded by a literary reference reflecting the main milestones in oesophageal surgery development as well
as the merits of the staff of the department and the clinic of hospital surgery (E.G. Salishchev, V.D. Dobromyslov, A.G. Savinykh). The description of a clinical
case of Boerhaave syndrome with a rupture localised in the lower third of the oesophagus illustrates the efficacy of routine radiological and endoscopic
studies of Boerhaave syndrome with mediastinal and pleural complications. We believe that early diagnosis and timely surgery were key to a favourable
outcome. During the operation, sagittal diaphragm crurotomy by A.G. Savinykh was used, which allowed effective and extrapleural drainage of the posterior mediastinum.

A rare clinical case of a phreno-pericardial fixed gastro-omental hernia complicated by high obstruction in the subcompensation stage in an
elderly woman is presented. The clinical symptoms were constant heartburn increasing in the horizontal position, signs of impaired passage through the
gastrointestinal tract: daily vomiting after eating, and the patient noted a decrease in body weight by 5kg. At the preoperative stage, the patient was examined:
fibroesophagogastroduodenoscopy, X-ray of the oesophagus, stomach and duodenum, ultrasound of the abdominal cavity. During the surgical intervention,
a defect in the diaphragm of 14 by 6 cm was revealed, into which the body, the antrum of the stomach and the bulb of the duodenum as well as the
omentum prolapse. Diaphragmochiatoplasty was performed using a mesh implant. The postoperative period proceeded without complications. Congenital
malformations of the diaphragm are extremely rare and their clinical manifestations are detected at an early age. In order to correctly understand the cause of
this type of pathology, it is necessary to know the embryogenesis of the fetus. The formation of the embryo’s diaphragm begins on the 22nd day, which involves
4 different structures: the transverse septum, pleuroperitoneal membranes, esophageal mesenchyme and parts of the trunk wall. In most cases, children with
congenital diaphragmatic hernia have concomitant malformations incompatible with life. In patients of the age group of this pathology with a pronounced
clinical picture, we have not met in the literature available to us.

The article presents a clinical case of surgical treatment of a patient with an echinococcal cyst of the spleen on the basis of the Regional State
Budgetary Healthcare institution «Krasnoyarsk Interdistrict Clinical Hospital No.20 named after I.S. Berzon», Krasnoyarsk. The patient’s case history is
presented. The results of the outpatient examination (ultrasound and MRI of the abdominal cavity) as well as additional examination in the hospital are
presented in detail. MSCT shows a splenic cyst measuring 20 × 20 cm, pushing aside the adjacent organs of the abdominal cavity and the retroperitoneal
space. During a planned surgical intervention, a giant splenic cyst was identified. A splenectomy for the cyst was performed. The patient was discharged from the hospital in a satisfactory condition. Timely surgical treatment of abdominal cysts requires their early diagnosis on an outpatient basis.