The aim of the research. To identify clinical and laboratory predictors of in-hospital mortality in patients with acute ischemic stroke and to assess their prognostic value.

Materials and methods. A single-center retrospective study included 230 patients with acute ischemic stroke. Neurological status, comorbid conditions, hemostatic parameters, antithrombotic therapy, and ABO blood group were analyzed. The prognostic value of the studied factors was assessed using ROC analysis and binary logistic regression.

Results. The NIHSS score demonstrated the highest discriminative ability for predicting in-hospital mortality (AUC = 0,937). Independent predictors of in-hospital mortality included elevated fibrinogen levels and absence of antiplatelet and anticoagulant therapy at the prehospital stage. Atrial fibrillation was associated with mortality in univariate analysis. No significant association was observed for D-dimer levels. No association was found between ABO blood group and in-hospital mortality.

Conclusion. The findings confirm the importance of the NIHSS score and hemostatic parameters for assessing the risk of in-hospital mortality in patients with acute ischemic stroke. The use of clinical and laboratory indicators may improve the accuracy of early prognostic assessment of adverse in-hospital outcomes.

The aim of the research: Was to determine the nature of changes in functional parameters of the cardiovascular system and microcirculation in obese female patients undergoing liposuction under the influence of systemic epinephrine absorption during general anesthesia.

Materials and methods. A prospective randomized study was conducted in 60 obese female patients with grade II–III obesity who underwent liposuction of more than 4000 mL. Three methods of maintaining general anesthesia were used: sevoflurane, desflurane, and propofol-based anesthesia. During the intraoperative period, systemic cardiovascular responses, including heart rate (HR) and mean arterial pressure, were assessed. Continuous microcirculation monitoring was performed using laser Doppler flowmetry. The study was carried out in three phases: before anesthesia (T₁), after solution infiltration (T₂), and during lipoaspiration (T₃). Intraoperative blood loss was determined based on the hemoglobin concentration in the liquid fraction of the lipoaspirate. Statistical analysis was performed using nonparametric methods. The results are presented as tables, box-and-whisker diagrams, and correlation plots generated with IBM SPSS Statistics 23.0.

Results. Systemic epinephrine absorption during liposuction is accompanied by a phased microcirculatory response with an increase in the pulsatile component of blood flow. At the stage of subcutaneous adipose tissue infiltration with tumescent solution, a significant increase in the microcirculation index (M) and heart rate (HR) was recorded, which was most pronounced during inhalational anesthesia. The increase in M was associated with an enhanced influence of the cardiac regulatory mechanism and a decrease in the endothelial component contributing to the index. A direct correlation was found between HR and the volume of intraoperative blood loss. When HR was ≥ 90 bpm, blood loss exceeded 500 mL; when HR was ≥ 100 bpm, blood loss exceeded 800 mL. M values exceeding 25 arbitrary units were associated with marked hyperperfusion and a 30% increase in blood loss. Inhalational anesthetics potentiated the observed changes, whereas propofol reduced the severity of these manifestations.

Conclusion. Systemic epinephrine absorption during tumescent infiltration is accompanied by pronounced phasic changes in microcirculation and functional parameters of the cardiovascular system, manifesting as tachycardia, increased tissue perfusion, and predominance of the cardiac mechanism in the regulation of microvascular blood flow. The degree of these reactions correlates with the volume of intraoperative blood loss and depends on the anesthesia method. The identified patterns should be taken into account when selecting anesthetic management, and heart rate monitoring should be used as a modifiable factor for the prevention of blood loss during liposuction.

Objective. To evaluate the clinical and functional features of GERD and OSAS comorbidity.

Materials and methods. The study included 144 patients with verified GERD. All participants underwent medical history taking, anthropometry, questionnaire surveys (GERDQ, Berlin Questionnaire for apnea), esophagogastroduodenoscopy and 24-hour esophageal pH-impedance monitoring. Patients identified as high risk for OSAS by the questionnaire underwent cardiorespiratory monitoring to confirm the diagnosis. Using multivariate discriminant analysis, we identified a set of features and developed a mathematical model to determine the probability of reflux-associated sleep apnea in patients with GERD. To confirm the results of discriminant analysis and adjust for initial differences in anthropometric parameters, multivariate logistic regression analysis was additionally applied.

Results. Patients with GERD and OSAS comorbidity had significantly higher BMI, waist circumference, and a higher prevalence of otolaryngological pathology. According to pH-impedance monitoring, this group showed statistically significant differences: higher total AET, a higher number of proximal mixed weakly acidic reflux episodes, longer bolus exposure time in the supine position, as well as lower index PSPW and MNBI in the proximal esophagus. Multivariate discriminant analysis identified 8 key predictive features and developed two functions (F₁ > F₂). The method demonstrated a sensitivity of 98,43% and specificity of 97,44%. Multivariate logistic regression analysis adjusted for BMI and waist circumference confirmed the preservation of significant differences in key reflux parameters between the groups.

Conclusion. The obtained data confirm the potential significance of impaired volume and chemical esophageal clearance (decreased PSPW index, increased bolus exposure time), disrupted epithelial barrier integrity in the proximal esophagus (decreased proximal MNBI), and the predominance of proximal weakly acidic nocturnal reflux in GERD and OSAS comorbidity.

The aim of the research. Тo research muscle mass indicators of computed tomography such as skeletal muscle area and index, as diagnostic markers of nutritional deficiency in cancer patients.

Materials and methods. A prospective study was performed on a sample of cancer patients. Group 1 –with nutritional deficiency (n = 105), group 2 – without nutritional deficiency (n = 96). The groups were balanced by location of the primary tumor (p > 0,05), age (p > 0,05), gender (p > 0,05). Research methods: survey using the Nutritional Risk Screening-2002 questionnaire; anthropometry; study of muscle strength using a dynamometer, testing the speed of five consecutive rises from a chair; measurement of muscle mass by defining of skeletal muscle area, skeletal muscle mass index based on the findings to computed tomography using the program the RadiAnt DICOM VIEWER 2023.1; studying functional capabilities by of the “4-meter walk” test. Statistical processing was performed using IBM SPSS Statistics Version 25.0.

Results. All anthropometric indicators, muscle strength, functional capabilities were decreased in cancer patients with nutritional deficiency. Skeletal muscle area and mass index taking into account gender differences were decreased in cancer patients with nutritional deficiency. Skeletal muscle area value was decreased for 45,8% of patients with a negative result of nutritional screening. The functional capabilities in these patients had no different to the values of patients with confirmed nutritional deficiency. The correlations between Skeletal muscle area and markers of nutritional deficiency have been identified.

Conclusion. Given the widespread use of computed tomography, the area of skeletal muscles can be recommended as an additional objective diagnostic criterion for nutritional deficiency.

Objective. This study assessed the outcomes of intensive sepsis therapy using extracorporeal blood purification techniques using hemodiafiltration and selective hemosorption.

Materials and Methods. Two comparable groups were recruited. In the study group, standard sepsis therapy according to the hospital-approved protocol was supplemented with extracorporeal detoxification using selective hemosorption with hemodiafiltration (SHS+HDF Group). The control group, recruited using a stratified selection method (stratified by age, gender, presence of comorbidities, and severity of condition) from retrospective clinical cases, received a standard treatment protocol with hemodiafiltration (HDF Group). Hemodynamic parameters, inflammatory markers, patient mortality on days 7, 14, and 28, and the severity of the patient's condition using the SOFA, MODS, and LODS scales were assessed.

Results. Extracorporeal detoxification using the method of selective hemosorption with hemodiafiltration has been found to demonstrate the best clinical and laboratory parameters in dynamics and statistically significantly improves the prognosis of survival in sepsis. In particular, the analysis of the hospital survival rate of patients with sepsis demonstrates the significant advantages of the "GHS+GDF" strategy (survival by day 28 was 84% versus 76% with pronounced curve divergence after day 14 of follow-up. At the same time, the level of statistical significance when comparing the curves using the log-rank method was 0,028).

Conclusions. Larger studies using randomized methods are needed for a more detailed analysis of this treatment strategy. Furthermore, a clearer definition of the indications for selective hemosorption is needed.

The aim of the research. To study the effect of adaptation status on microcirculation parameters measured by dynamic light scattering (mDLS) in healthy volunteers, patients with confirmed chronic pathologies and athletes.

Materials and methods. The experimental study involved 149 individuals of both sexes, aged 21 ± 4 years. The subjects were divided into three groups based on their fitness level: 96 somatically healthy subjects, 25 subjects with chronic somatic pathology, and 28 subjects who regularly exercised. The mDLS study included four stages: rest, recording of parameters, physical activity (10 squats), and recording of parameters. Each recording consisted of five phases with alternating blood flow occlusion.

Results. Under control conditions, baseline microcirculation parameters were comparable between groups. Under stress, pronounced microcirculation activation was observed in all groups, with the most noticeable changes in healthy and sick subjects. Athletes demonstrate increased stability. Post-occlusive hyperemia enhances the effects of stress, especially in healthy individuals. Group differences are confirmed by parameter correlations and visualized in graphs.

Conclusion. The hemodynamic index matrix is an effective tool for noninvasively assessing the functional state of the microcirculatory bed and the degree of cardiovascular adaptation under the influence of stress and adaptation. The identified hyperreactivity of the endothelial component can serve as a prognostic marker for depletion of adaptive reserves in pathology. The microcirculation pattern characteristic of athletes can be considered a target for rehabilitation measures.

The purpose of the study. To compare the prognostic significance of cytomegalovirus (CMV) activity indicators and molecular biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), soluble ST2, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β)) in assessing the risk of developing adverse cardiovascular events in patients with chronic heart failure (CHF) over 24 months of observation.

Material and Methods. The study included 151 patients with functional classes II–IV CHF, aged 50–70 years, with subsequent prospective observation for 24 months. The endpoint was a composite defined as hospitalization for CHF decompensation and the occurrence of adverse clinical events (cardiovascular death, nonfatal myocardial infarction or acute cerebrovascular accident, and pulmonary embolism) during the 24-month observation period. Blood cytomegalovirus DNA was detected using polymerase chain reaction at study entry. NT-proBNP levels were determined by immunochemiluminescent analysis, and soluble ST2, TNF-α, and IL-1β levels were determined by solid-phase enzyme-linked immunosorbent assay.

Results. The highest risk of death (OR = 8,57; 95% CI = 1,98-37,1; p = 0,004) and the occurrence of a combined endpoint event (OR = 3,17; 95% CI = 1,78–5,64; p < 0,001) was observed in CMV-seropositive patients. Other markers demonstrated a lower hazard ratio for developing a fatal outcome within 24 months from 1,14 (95% CI = 1,06–1,24; p < 0,001) for IL-1β to 1,42 (95% CI = 1,21–1,66; p < 0,001) for soluble ST2; for the combined endpoint – from 1,1 for IL-1β (95% CI = 1,05–1,15; p < 0,001) to 1,30 for soluble ST2 (95% CI = 1,18–1,42; p<0,001). Multivariate analysis revealed an increased risk of death (OR = 1,24; 95% CI = 1,12–1,38; p < 0,001) and the occurrence of a composite endpoint event (OR = 1,12; 95% CI = 1,07–1,18; p < 0,001) with each 100 copies/mL increase in CMV DNA. Viral load had a greater predictive power than factors such as gender, age, atrial fibrillation, CHF functional class, and TNF-α and IL-1β levels.

Conclusion. The presence of CMV DNA and the level of CMV viral load are significant markers in predicting the development of cardiovascular events in patients with CHF within 24 months, which allows us to recommend their determination for early risk stratification of the unfavorable course of cardiac dysfunction.

Objective: to assess the detection rate of monogenic disorders in neonates with encephalopathy using whole-exome sequencing.

Materials and Methods. A cohort descriptive study was conducted at the Ural Research Institute for Maternal and Child Health in 2024–2025. Whole-exome sequencing (WES) results from 41 neonates with neonatal encephalopathy (NE) at a gestational age greater than 28 weeks were analyzed. The phenotype was characterized using "major" and "minor" risk criteria for genetic pathology. Congenital malformations were identified in 11 (27%) infants.

Results: Genetic variants of varying significance were detected in 7 (17,07%) children included in the study, in 8 genes (PRD1, DNAH5, DOCK7, SDHA, SLC45A2, RS1, KMT2D, TUBA1A). An association of the finding with the clinical phenotype was confirmed in 75% of cases. In 3 (37,5%) patients, the variants were classified as having uncertain clinical significance. In full-term newborns, the frequency of findings was 22,58%, while in premature infants, no significant variants were identified. In children with congenital malformations, the effectiveness of WES was 36,36% versus 10% in those without congenital malformations (p = 0,069).

Conclusion. WES is an effective method for identifying the genetic causes of NE, especially in full-term newborns and in combination with congenital malformations. Timely genetic diagnosis is important for clarifying the prognosis for life and health, personalizing treatment.

The purpose of this analytical review is to study the relationship between the young age of teenage mothers under the age of 19 and the health status of their children. Newborns of young mothers have the highest incidence of neural tube defects, which researchers attribute to the lack of folic acid intake. The rate of exclusive breastfeeding at birth was around 80–90%, but decreased to 40% by the age of 4 months due to the use of water, cow's milk, or infant formula by young mothers for feeding purposes. The birth weight and length of young mothers' children were lower, which the authors attributed to the increased nutritional requirements of the teenage mother's body, which, in the context of inadequate and unbalanced nutrition combined with pregnancy and subsequent breastfeeding, leads to deficiencies in both the mother and the child. The mother's age had an indirect impact on the child's cognitive status, not only due to medical factors but also due to a variety of accompanying psychosocial factors. All authors agree that the negative consequences of early pregnancy can be minimized by providing high-quality prenatal care, active mother involvement in childcare, and comprehensive support from the healthcare system and family.

Carotid endarterectomy (CEAE) is the "gold standard" for stroke prevention in patients with hemodynamically significant carotid artery stenosis. The choice of anesthesia method — general (OA) or regional (RA) — remains a matter of debate, as it affects the risk of perioperative complications. This article analyzed 78 sources, including randomized controlled trials, prospective and retrospective cohorts, systematic reviews, and meta-analyses published through 2026. There was no statistically significant difference in the incidence of perioperative stroke between OA and RA. However, RA was associated with a significant reduction in the risk of myocardial infarction, especially in patients with heart failure. RA also correlated with shorter duration of surgery and hospitalization, but with more frequent hemodynamic fluctuations. The effectiveness of neuromonitoring (multimodal in OA and clinico-instrumental in RA) was a key factor determining neurological safety. Moderate hypothermia has shown potential in reducing postoperative cognitive impairment. Thus, the choice between OA and RA in CEAE should be personalized, based on the patient's dominant risk profile.

Aim. To summarize current data on tryptophan catabolism and the pathophysiological mechanisms involving tryptophan, its enzymes, and metabolites in tumor initiation and progression.

Materials and methods. A comprehensive search for scientific articles published between 2020 and 2026 was conducted using PubMed, eLIBRARY, and Google Scholar databases. The search used keywords in both Russian and English: «tryptophan metabolism», «kynurenine pathway», «serotonin pathway», «indole pathway», «IDO1», «TDO2», «immunosuppression», «carcinogenesis», «cancer». Inclusion criteria: publications containing data on metabolic, molecular and cellular mechanisms of tryptophan and its metabolites in cancer initiation and progression, as well as clinical studies evaluating the predictive and prognostic value of these substances in oncology. Exclusion criteria: articles in languages other than english and russian, reports, study protocols, duplicates and studies with incomplete data.A total of 37 sources were analyzed, including 3 russian publications, all published within the last 5 years.

Results. Tryptophan metabolic reprogramming is recognized as a hallmark biochemical feature of tumor cells. This review synthesizes current findings on the catabolic pathways of this amino acid and the mechanisms by which tryptophan and its metabolites contribute to the initiation and progression of malignant neoplasms. Particular emphasis is placed on the hyperactivation of the kynurenine pathway mediated by the enzymes IDO1 and TDO2, which leads to immunosuppression, chronic inflammation, and the stimulation of metastasis. Furthermore, the dysregulation of the serotonin and indole pathways and their subsequent impact on carcinogenesis and progression are addressed.

Conclusion. The literature analysis highlights the critical pathogenetic role of tryptophan metabolism disorders in tumor progression and immune evasion. Investigating the enzymatic components of the kynurenine cascade provides a strong rationale for developing novel therapeutic strategies aimed at inhibiting IDO1 and TDO2 activity in oncological practice.

Preeclampsia has long been a leading cause of maternal and infant morbidity and mortality worldwide, including in Russia. A history of preeclampsia, particularly in its severe forms, increases the risk of developing cardiovascular diseases, cerebrovascular complications, and peripartum cardiomyopathy, making prognosis and prevention crucial.

Over the past 20 years, a number of preeclampsia prognostic models have been proposed. Some are based solely on anamnestic risk factors and offer limited information. More modern models consider not only anamnestic risk but also various biometric indicators, such as uterine artery blood flow velocity, significantly increasing the informative value of the method and enabling dynamic prognostication.

This review presents current preeclampsia prognostic models used internationally and in the Russian Federation, along with data on their informative value.

Brain cell metabolism is characterized by numerous cellular and molecular mechanisms. Exposure of brain cells to damaging factors leads to mitochondrial dysfunction, the accumulation of reactive oxygen species, and the development of oxidative stress. Neuroprotection is a set of mechanisms aimed at protecting cells of the central nervous system. Endogenous cardiotonic steroids – ouabain and marinobufagenin – slow down oxidative, biochemical, and molecular signaling cascades in brain neurons exposed to stress factors.

The aim of this review is to establish new understanding of the mechanisms of action of cardiotonic steroids on neurons under physiological and pathophysiological conditions. To study scientific advances in the interactions between Na⁺/K⁺-ATPase and cardiotonic steroids, methods such as systems-structural and comparative analysis were used.

Using these methods, we presented a schematic diagram depicting the general patterns of metabolic changes in Na⁺/K⁺-ATPase in CNS pathologies. Based on literature review, the molecular mechanisms of action of cardiotonic steroids under physiological and pathological conditions are presented. Endogenous and exogenous representatives of the class of cardiotonic steroid metabolites are examined. It is established that the action of these hormone-like compounds is directly linked to Na⁺/, K+-ATPase, cytoplasmic, and membrane proteins. Potential molecular forms of cardiotonic steroids that correlate with the development of certain pathophysiological processes in the central nervous system are identified.

A conclusion is drawn regarding the need for further study of the mechanism of action of cardiotonic steroid metabolites for both fundamental neurobiology and clinical medicine.

Chronic obstructive pulmonary disease (COPD) is a complex disorder involving multiple contributing factors. COPD risk factors encompass various aspects of modern life. Special attention is given to environmental exposure, occupational hazards and socio-economic conditions. Tobacco smoke plays a pivotal role in disease development. The complex composition of tobacco smoke contains thousands of harmful substances that damage the airways and lung tissue. Comorbid conditions significantly impact the course of COPD. Considering all disease aspects is essential for a comprehensive treatment approach. Interdisciplinary collaboration among specialists from various fields is an essential prerequisite for successful disease management. The review examines contemporary aspects of multifactorial aspects and multimorbidity in COPD.

This review summarizes current data on the composition, functional state, and role of T-lymphocyte subpopulations engaged in the antitumour immune response in patients with colorectal carcinoma. The distinct functional states of CD8+, CD4+ T-cells, regulatory T-cells (Treg), tissue-resident memory T-cells (TRM) and unconventional lymphocyte populations- including invariant natural killer (iNKT) and γδ-T-cells- are examined within the colorectal tumour microenvironment. It has been shown that a prevalence of CD8+ and Th1 cells is associated with a favorable prognosis, whereas functional exhaustion of T cells with co-expression of PD-1, TIM-3, LAG-3, and TIGIT reflects immune dysfunction and may indicate disease progression. A context-dependent influence of Th2 and Th17 cells has been noted. The functional exhaustion of tissue-resident memory CD8+ Trm cells in the tumor microenvironment during disease progression is described.

This review demonstrates that the immune landscape of colorectal cancer is shaped by the interplay of diverse T-lymphocyte subpopulations driven by their functional and quantitative heterogeneity, thereby underscoring the significance of these characteristics for the development of prognostic biomarkers and personalized immunotherapeutic strategies.

The article analyzes the theoretical and experimental issues of referred somatic pain. To objectify the reflected pain syndrome, the use of the pain mapping method is justified.

The aim of the research. To conduct a substantive analysis of publications devoted to the study of angiotensin-converting enzyme 2 and its role in the development of endothelial dysfunction in COVID-19.

Materials and methods. We analyzed 24 Russian and international articles describing the structure and function of angiotensin-converting enzyme 2, as well as its role in the development of endothelial dysfunction in COVID-19, published over the past 5 years.

Results and discussion. Angiotensin-converting enzyme 2 molecules, located on the surface of endothelial cells, play a key role in the development of endothelial dysfunction and associated sepsis-induced coagulopathy and vasculopathy. They act as receptors that bind the SARS-CoV-2 coronavirus, thereby facilitating the pathogen's entry into the cell. The penetration of SARS-CoV-2 into endothelial cells and their damage under the influence of proinflammatory cytokines and activated innate immune cells induces the production of "endothelial dysfunction markers," which contributes to a shift in hemostasis toward hypercoagulability.

Conclusion. Angiotensin-converting enzyme 2 mediates SARS-CoV-2 penetration into cells and triggers a pathophysiological cascade leading to endothelial dysfunction, immunothrombosis, a "cytokine storm," and multiple organ failure.

Multiple sclerosis occupies one of the leading places among the causes of disability in young people. In the Trans-Baikal Territory, there is an increase in the incidence of multiple sclerosis among the child population, which attracts special attention from specialists. The diagnosis of multiple sclerosis in children has certain difficulties associated with the clinical features of the onset (atypical symptoms), differential diagnosis (similarity with other demyelinating diseases), and features of the MRI picture. The article discusses the features of epidemiology, clinical manifestations and course of multiple sclerosis in childhood. Possible risk factors for the development of the disease are discussed. The classic case of a patient with the onset of rapidly progressive multiple sclerosis is described.

CLIPPERS syndrome is a rare chronic inflammatory disease of the central nervous system, predominantly affecting the brainstem and cerebellum. Its pathognomonic radiological sign is multiple punctate and linear contrast-enhancing foci in the pons (the "salt-and-pepper" sign), detected on contrast-enhanced magnetic resonance imaging. Diagnosis is challenging due to the condition's rarity and low awareness among physicians. A key feature of the syndrome is its pronounced positive response to corticosteroid therapy. Presented clinical case ample emphasizes the importance of timely recognition of this treatable pathology for initiating effective treatment.

Intermediate–high-risk pulmonary embolism (PE) is characterized by preserved systemic hemodynamics in the presence of right ventricular (RV) dysfunction and elevated cardiac-specific biomarkers, which are associated with a risk of early clinical deterioration. The appropriateness of systemic thrombolytic therapy (TLT) in this patient population remains controversial, as it requires careful balancing of the potential reperfusion benefits against the risk of hemorrhagic complications. This review summarizes current evidence regarding anticoagulant therapy, systemic and catheter-directed reperfusion strategies, and discusses the potential role of non-immunogenic staphylokinase.

As a clinical illustration, we present a case of a patient with intermediate–high-risk PE who demonstrated clinical worsening despite anticoagulant therapy and was treated with systemic TLT using non-immunogenic staphylokinase, resulting in complete thrombus resolution, restoration of RV function, and absence of hemorrhagic complications. These findings highlight the need for further research to refine patient selection criteria and optimize treatment strategies.

This methodological article focuses on one of the earliest stages of planning biomedical research: a priori statistical power analysis. In the context of the scientific discourse on the problem of result reproducibility, empirical sample size calculation is giving way to rigorous mathematically justified approaches, which is consistent with the principles of evidence-based medicine, the requirements of bioethics, and the objectives of healthcare economics. The text details the probability theory behind hypothesis testing, examining the relationship between Type I and Type II errors. INEXT, the smallest effect size of interest (SESOI) is specified. Practical calculations force researchers to adjust for multiple comparisons and map out subgroup analyses. The text also covers how to handle groups of unequal sizes and what to do about expected patient dropouts. Later in the text, we review several software packages. We focused heavily on platforms with Russian interfaces because local doctors need tools they can easily navigate. We examine the open- source software Jamovi to show exactly how this works. We look at two of its modules to show the exact contrast. jPower targets only the standard parametric t-test. The jYS plugin, by contrast, handles much more complex tasks. It allows researchers to calculate a priori power for the multifactorial and non-parametric models that actually appear in real clinical datasets.