Introduction: The prevalence of chronic autoimmune thyroiditis (AIT) is more than 5% of the world's population. Despite this, the tactics and methods of treating AIT have not undergone innovations in terms of therapy for many years, while the modern trend in the treatment of other autopathologies is to use monoclonal antibodies. However, it was noted that with the use of some immune checkpoint inhibitors for the treatment of oncopathology, various autoimmune diseases debuted in patients. This fact opens up the prospect of studying new links in the pathogenesis of AIT.
Aim: determination of the level of sCD25, s4-1BB, sTim-3, sLAG-3, sGalectin-9 molecules in individuals suffering from various forms of AIT.
Material and methods: The study involved 31 subjects aged 18 to 40 years, divided into four groups: I Healthy (n = 10); II Carriers of antibodies to thyroid peroxidase (ATkTPO) (n = 11); III Subclinical form of hypothyroidism AIT (n = 6); IV AIT with hypothyroidism, medically compensated (n = 4). Venous blood was collected to determine the ATkTPO level by ELISA, the concentration of thyroid-stimulating hormone and free thyroxine by immunochemiluminescence, the level of CD25, 4-1BB, Tim-3, LAG-3, Galectin-9 by flow cytofluorimetry. Statistical processing was performed using the Kruskal-Wallis one-way analysis of variance. Results: The sCD25 level decreased by almost 85% (P = 0,001) from the control 19,2 pg/ml (2,20; 29,9) in groups: II 2.83 pg/ml (2,24; 3,17), III 3,23 pg/ml (2,69; 45,8), and IV 3,05 pg/ml (2,31; 7,37). The concentration of 4-1BB increased threefold (P = 0,001) in groups: II 35,0 pg/ml (15,5; 39,8), III 31,9 (27,8; 44,4) from the control 11,8 pg/ml (4,96; 14,0). sTim-3 decreased by more than 98% (P = 0,001) from group I 280 pg/ml (13,7; 321) when compared with groups: II 5,22 pg/ml (2,13; 6,34), III 4,10 pg/ml (3,36; 5,34), IV 1,26 pg/ml (0,362; 2,45). The content of LAG-3 decreased by 66% (P = 0,001) when comparing group, I 51,1 pg/ml (20,1; 60,1) with II 20,1 pg/ml (2,23; 41,6). The concentration of Galectin-9 in group II 277 pg/ml (196; 378) is 5 times lower than in I 1377 pg/ml (1140; 1910) (P = 0,001).
Conclusion: With the development of AIT, the concentration of CD25, Tim-3, LAG-3, Galectin-9 decreases, and the level of 4-1BB increases.

The aim of the research. To determine the biochemical and morphological features of various GDM subtypes in pregnant rats.
Materials and methods. A prospective study was conducted on white nonlinear rats: 50 females and 15 males. After confirmation, female rats were divided into 3 groups: group I – 15 pregnant rats (control), group II – 12 pregnant rats (subtype model with pancreatic β-cell dysfunction); group III – 12 pregnant rats (subtype model with IR). All rats underwent determination of glucose, insulin, adiponectin, leptin, omentin, interleukin-6, C-peptide and C-reactive protein levels in venous blood, as well as histomorphological studies of pancreatic tissue.
Results. According to the data obtained, the subjects in group III were characterized by lower levels of adiponectin [245 (225; 290) ng/ml; p < 0,001], higher levels of leptin [8,45 (6,1; 12) ng/ml; p < 0,001] and C-reactive protein [1678 (1550; 1818 ng/ml; p < 0,001], and a high level of C-peptide was also detected [5448 (3852; 6861) pg/ml; p<0.001]. Histological examination of the endocrine part showed signs of fullness and expansion of the capillary walls, dystrophy of alpha cells, as well as swelling and detachment of cell groups from the capsule. For those studied in group II, a lower level of C-peptide was detected [1907 (1560; 2082) pg/ml; p = 0,01], which is typical for patients with pancreatic β-cell dysfunction. Histological examination revealed signs of deformation of the pancreatic lobules and necrobiotic changes both in the exocrine part of the organ and in the islets of Langerhans.
Conclusion. We characterized the biochemical and morphological features of various GDM subtypes in pregnant rats, which allowed us to form prospective pathogenetic models of these subtypes. The presented models can be used in scientific and then clinical practice to verify the pathogenetic subtype of GDM.

Part of Russia's territory is located in cold and temperate climate zones, where people are constantly exposed to the risk of hypothermia and cryotrauma. When exposed to cold, general metabolic processes in the body are inhibited, leading to disruption of the central nervous system, respiratory and other vital functions of the body. Studies by many authors have shown that not a single functional system remains intact during acute hypothermia.
Purpose of the study. To identify patterns of changes in central hemodynamics, cardiac activity, vascular parameters depending on the severity and period of general unintentional hypothermia.
Research methods. The study included 26 patients of both genders, aged from 18 to 50 years – 2 groups of 13 patients – with mild and moderate (group 1) and with severe (group 2) degree of unintentional hypotermia. Results. In patients with severe hypothermia, a decrease in pulse arterial pressure was recorded from admission to day 7 of observation, compared to patients with mild hypothermia. A decrease in cardiac output was also recorded on the first day of severe hypothermia. Stroke volume and ejection rate were higher in patients with severe hypothermia compared to those with mild and moderate hypothermia. In patients with mild hypothermia, an increase in pulse wave velocity was observed on days 3 and 7 of observation, compared to day 1.
Conclusion. The increase in stroke arterial pressure corresponds to adaptive changes in hemodynamics in the post-hypothermic period of general cold injury. In severe hypothermia, pulse pressure and cardiac output are lower, while stroke volume and ejection rate are higher, compared to mild hypothermia. Over time, an increase in pulse wave velocity was observed in patients with mild hypothermia.

The aim of the study: to conduct a comparative analysis of the frequency of postoperative complications after video-assisted thoracoscopic surgeries and open lobectomies.
Material and methods of the study. A retrospective analysis of 404 cases (276 video-assisted thoracoscopic and 128 open surgeries) was conducted at the Sakhalin Regional Clinical Oncology Dispensary (2018– 2024). The incidence of pneumothorax, hemothorax, chylothorax, pneumonia, myocardial infarction, and pulmonary embolism was assessed.
Results of the study and their discussion. The incidence of postoperative complications was comparable between the groups. No statistically significant differences were found in any of the analyzed parameters. At the same time, in the group of video-assisted thoracoscopic surgeries, there was a tendency towards a decrease in the incidence of chylothorax (0% versus 2,3% in the open surgery group, p = 0,056), hemothorax (0,7% versus 1,6%; OR 0,46, 95% CI 0,07–3,25) and systemic complications (myocardial infarction: 0,4% versus 1,6%; pulmonary embolism: 0,7% versus 1,6%). The incidence of pneumothorax was almost identical (6,2% versus 6,3%).
Conclusions. Video-assisted thoracoscopic lobectomy demonstrates a postoperative complication profile comparable to that of open surgery. The observed reduction in the incidence of certain complications supports the safety and potential advantages of this minimally invasive approach, supporting its widespread adoption in clinical practice.

The aim of the study was to analyze the frequency and risk factors of acute kidney injury (AKI) in patients with ST-segment elevation acute coronary syndrome (STE-ACS) and concomitant metabolic syndrome (MS) under the pharmacoinvasive treatment strategy.
Material and Methods. The study covered 78 patients divided into two groups: group 1 – STE-ACS patients with concomitant MS (n = 36); group 2 – STE-ACS patients without MS (n = 42).
Results. The study established statistically valid differences between the two groups of STE-ACS patients by a number of indicators. In particular, there were differences in baseline values of the body mass index (BMI) (p = 0,001) and total cholesterol concentration (TC) (р < 0,001), triglycerides (TG) (р = 0,007), triglycerideglucose index (TyG) (р < 0,001), and the creatinine level: on day 1 (р < 0,006), on days 2 and 3 (p < 0,001). On day 2, the glomerular filtration rate (GFR) averaged in group 1 to 66,7 ± 12,2, and in group 2 – to 57,3 ± 8,7 ml/min/1,73m2 (p < 0,001). AKI signs were observed in group 1 in 8 (22,2%) patients, in group 2 – in 2 (4,8%) patients. Along with AKI, the group 1 patients experienced other complications more frequently: cardiac rhythm disorder (р < 0,04) and pulmonary edema (р < 0,034). There were also established valid differences in the treatment duration: the group 1 patients stayed longer in the intensive care unit (ICU) (р = 0,042) and hospital (р = 0,035).
Conclusion. The STE-ACS patients with concomitant MS demonstrated signs of AKI 5,7 times more often than the patients without MS. The study revealed the following factors associated with the AKI development: high BMI (р < 0,001), increased TC in blood (р = 0,01), TG (р = 0,007), TyG (р = 0,036).

The aim of the research. Analysis of the results of Helicobacter pylori (H. pylori) treatment with the firstline regimen and bismuth in residents of the Transbaikal region depending on gender, age and medical activity.
Materials and methods. H. pylori eradication was performed using a first-line regimen (proton pump inhibitor, clarithromycin, amoxicillin) and bismuth tripotassium dicitrate at recommended doses for 14 days in 116 people. Of these, 82 were women and 34 were men, 59 were aged 20–50 years and 57 were aged 51– 65 years, 52 were medical staff and 64 were non-medical. Eradication control was performed 6–8 weeks after treatment with H. pylori antigen in feces using immunochromatographic analysis. During treatment, adverse events (AE) were analyzed.
Statistical methods: descriptive statistics, x2-test, odds ratio (OR) (biostatistics). Results. The efficiency of H. pylori eradication in the study group was 71,5%, among medical staff – 57,7%, among non-medical – 82,8% (p = 0,003). More successful treatment was observed among female non-medical (92,1%), in contrast to male non-medical (69,2%, p = 0,018) and female medical staff (52,3%, p < 0,001).
Non-medical aged 20–50 demonstrated the best eradication results – 93,3%, patients aged 51–65 nonmedical – 73,5% (p = 0,037), medical staff aged 20–50 – 58,6% (p = 0,002). There were no gender or age differences in the group of medical staff. AE were registered in 64 people (55,2%): 35 (67,3%) medical staff and 29 (45,3%) non-medical. AE were 2,5 times more common in male medical staff than in men in other specialties (p = 0,009).
Conclusion. Probability of H. pylori eradication is higher in women under 50 years of age who are not medically active. H. pylori eradication is less common in medical staff with-out gender or age differences, with a higher incidence of AE, especially in men.

The aim of the research. A comparative analysis of quality of life in conditionally healthy individuals and patients with arterial hypertension using the SF-36 questionnaire.
Materials and methods. The exploration included 525 respondents (349 women and 176 men) aged 18 to 89 years, residing in the Sakhalin Oblast between 2022 and 2023. Among them were 318 conditionally healthy individuals and 207 patients with arterial hypertension. The methodological novelty consisted in the combined application of the SF-36 questionnaire and the Myunsterberg test, which enabled a comprehensive assessment of both physical and mental health, as well as attention concentration levels. Statistical analysis was performed using RStudio, with the Mann–Whitney U test, Kruskal–Wallis test, and Bonferroni correction. Spearman’s rank correlation was used to analyze relationships between variables.
Results. The comparative analysis revealed statistically significant differences between conditionally healthy people and patients with arterial hypertension in terms of physical and psychological components of health (p = 0,045 and p = 0,005, respectively). Patients with hypertension had higher pain intensity (p = 0,0041) and decreased concentration (p = 0,016). In women with hypertension, the indicators of physical and emotional functioning were lower than in men (p < 0,05). No significant sex differences were found in the group of healthy individuals. Correlations between health components have also been established, which differ in men and women with hypertension.
Conclusion. The conducted exploration demonstrated that arterial hypertension adversely affects quality of life, impairing both physical and psychological parameters, particularly in women. The identified differences underscore the importance of comprehensive health assessment accounting for gender-specific characteristics. The application of the SF-36 questionnaire enabled precise documentation of key changes related to pain, physical limitations, and emotional status. These findings hold practical value for individualizing treatment approaches, developing prevention strategies, and designing targeted programs aimed at enhancing quality of life and improving health outcomes in patients with arterial hypertension.

The aim of the study is to establish the significance of SNP of the IL-4 (C589T) and TNFα (G308A) gene in the pathogenesis of periprosthetic infection in patients after endoprosthetics of large joints with primary osteoarthritis.
Materials and methods. The study included 182 unrelated patients of middle (45–59) and elderly (60–74) age with primary osteoarthritis of large joints stage III who underwent total joint arthroplasty. Group 1 (n = 92) – patients with uncomplicated course. Group 2 (n = 90) – patients with development of periprosthetic infection. Control group – 92 practically healthy individuals. Research methods: clinical; laboratory (immunological – determination of IL-4, TNF-α; genetic – polymorphism of the gene IL-4 (C589T), TNFα (G308A)); instrumental (radiography). Statistical processing of the study results was performed using the IBM SPSS Statistics Version 25.0 software package (IBM, USA).
Results. In patients with an uncomplicated postoperative period after endoprosthetics of large joints for primary osteoarthritis, a predominance of the -589C- allele, -589C/C genotype of the IL-4 gene and the -308G- allele, -308G/G genotype of the TNFα gene was revealed. An increase in the level of IL-4 and TNFα on the 10th day of the postoperative period was established in the first and second groups relative to the control values, and no differences were found between the clinical groups. Carriage of the mutant genotype of the IL-4 gene (C589T) contributes to a decrease in the content of the encoded protein, and carriage of the mutant genotype of the TNFα gene (G308A) is characterized by an increase in the concentration of TNF-α.
Conclusion. The -589T- allele, -589T/T genotype of the IL-4 gene, and the -308A- allele and -308A/A genotype of the TNFα gene are associated with the development of periprosthetic joint infection in patients after endoprosthetics for primary osteoarthritis. In patients, elevated IL-4 and TNFα concentrations are recorded on the tenth postoperative day compared to control values. Carriers of the -589T/T genotype of the IL-4 gene are characterized by decreased IL-4 levels in the blood serum, while carriers of the -308A/A genotype of the TNFα gene are characterized by elevated TNF-α levels.

The central link in the cell's energy metabolism are the substrates and enzymes of the Krebs cycle, as well as the electron transport chain of the mitochondria. Metabolites of the Krebs cycle are also present in the bloodstream and perform important functions outside the cycle. The aim of this review is to establish new concepts on the mechanisms of action of succinate in stress situations, taking into account the mechanism of substrate phosphorylation.
To study scientific achievements in the field of energy metabolism, such methods as system-structural and comparative were used. The use of the designated methods allowed us to present the author's scheme, displaying the general patterns of metabolic changes in succinate during hypoxia, inflammation and tumor growth.
Molecular mechanisms of succinate action associated with the development of pathological conditions have been identified. The features of the action of the enzyme succinate dehydrogenase are considered. It has been established that energy-dependent processes dominate in maintaining the main functional systems of the body. Potential molecular markers that reflect real value in monitoring the dynamics of the pathological process have been identified.
A conclusion is formulated about the need for further study of the role of succinate in cellular energy homeostasis for both fundamental science and clinical medicine.

The article presents the results of the subject-content analysis of the assessment scales of palliative status in patients with cervical cancer. The study was conducted on the basis of a four-stage review of domestic and foreign literature. Among the most considered by researchers indicators for determining the prognostic status are: the use of data on tumor localization, the presence of metastases, the assessment of the state according to ECOG or Karnovsky, the presence of certain clinical triggers and screening of symptoms with targeted early palliative care. The spread of most indicators across the study matrix indicates a significant diversity of approaches among different scientists to forming an assessment of the palliative status of patients with cervical cancer and the absence of uniform, unified principles for predicting risks in this category of patients. It was found that despite the increased interest in palliative status assessment tools for the purpose of timely referral to a set of palliative care measures, a limited number of studies have been conducted on this topic with different results of referral to palliative care. It has been stated that future prognostic models should reflect the treatment goal and, perhaps more importantly, social tactics for these categories of patients at later stages.

This article examines current aspects of cardioembolic stroke (CES) as an acute cerebrovascular accident, focusing on its epidemiology, etiopathogenesis, and clinical manifestations. Statistical data on stroke incidence and mortality are presented, highlighting significant regional differences, with a particularly high incidence in Eastern Europe and Russia. It is noted that stroke has traditionally been perceived as a problem of the elderly; however, in recent decades, an increase in cases has been recorded among young people, due to the increasing prevalence of cardiovascular risk factors and improved diagnostic methods. Furthermore, the article examines in detail the relationship between atrial fibrillation and the development of CES, and describes the mechanisms leading to ischemic stroke, including embolization. The economic consequences of stroke, such as disability and the high cost of rehabilitation, are discussed, which negatively impact the social and economic aspects of society. In conclusion, the need for early diagnosis, effective treatment and rehabilitation of patients, as well as the implementation of a comprehensive approach to stroke management, is noted in order to reduce disability and improve quality of life.

Diabetes mellitus (DM) is a common endocrine disorder that can lead to various complications, including cardiovascular diseases, nephropathy, and neuropathy. These complications are associated with damage to the endothelial glycocalyx (EG), which is a layer of carbohydrates that covers the surface of endothelial cells and plays an important role in maintaining vascular integrity and regulating inflammation. In recent years, researchers have shown interest in targeting EG as a potential treatment for DM complications. This article will discuss existing approaches and medications that can affect EG, based on recent studies.

Coronary heart disease (CHD) remains one of the leading causes of death and disability worldwide, which makes it an urgent topic for study and discussion. The modern view of the problem of coronary heart disease suggests an integrated approach to understanding the risk factors that contribute to the development of this disease. Traditionally, the main risk factors were hypertension, dyslipidemia, smoking, diabetes mellitus, and obesity. However, recent research shows that other aspects should be added to this list: genetic predisposition and stress levels.
An analysis of the studies presented in this review shows that dyslipoproteinemia (ApoV/ApoA1), smoking, psychosocial factors, diabetes mellitus, hypertension, abdominal obesity, alcohol, low physical activity, and insufficient fruit intake are the most significant risk factors for coronary heart disease. Recently, special attention has been paid to psychoemotional/psychosocial factors that require careful consideration in the framework of prevention, treatment and rehabilitation of patients.

Relevance. Pneumonia complicated by sepsis remains one of the leading causes of mortality in intensive care units. Early recognition of life-threatening conditions and the implementation of modern therapeutic strategies are crucial for improving outcomes.
The aim of the research. To summarize current approaches to the diagnosis and intensive care management of community-acquired, hospital-acquired, and viral pneumonia complicated by sepsis, based on recent clinical guidelines.
Materials and Methods. A literature review was conducted covering publications from 2018 to 2024, including national clinical guidelines and international recommendations (IDSA, SSC), as well as clinical studies on novel antibacterial agents, biomarkers, and extracorporeal therapies.
Results. Current treatment strategies include personalized antibiotic therapy, use of prognostic and diagnostic biomarkers (PCT, MR-proADM, suPAR, presepsin), molecular diagnostics (NGS), selective hemoadsorption, and targeted immunotherapy (IL-6 and JAK/STAT inhibitors). Special attention is given to early risk stratification and timely therapeutic intervention.
Discussion. Key issues remain unresalved regarding patient selection for advanced therapies, optimal timing, and criteria for treatment effectiveness. Further research is needed to refine personalized treatment approaches.
Conclusion. Intensive care for pneumonia complicated by sepsis requires an integrated approach based on pathogen profile, disease severity, immune status, and prognostic markers. Incorporation of innovative treatment methods can reduce mortality and improve clinical outcomes.

Understanding the different types of migraines is essential for accurate diagnosis and effective treatment. Migraines are one of the most prevalent neurological disorders in the world, with an estimated 1.1 billion cases in 2019. The modern understanding of migraines combines neuronal, vascular, and neuroinflammatory mechanisms to explain its occurrence. The study of epidemiology, concomitant diseases and risk factors allows for a deeper interpretation of the pathophysiology of migraine and the development of more individualized methods for the prevention and treatment of seizures.
The aim of the research. To analyze literature on epidemiology, comorbidity, and various risk factors of migraine.
Materials and methods. Data from the PubMed Open Science Library were used. A search for literature was performed using keywords from a literature source from 2009 to 2025.
Results. An analysis of literary sources was conducted using keywords in the search for literary sources in such combinations as: "age and gender", "eating habits", "migraine and pregnancy", "hormonal imbalance and migraine", "genetic and epigenetic factors", "chronic fatigue syndrome", "eating disorders", "cardiovascular diseases", "epilepsy", "multiple sclerosis", "gut-brain axis", "rheumatoid arthritis", "psoriasis", "stress", "general anxiety disorder", "bipolar affective disorder", "alzheimer's disease", "parkinson's disease", "amyotrophic lateral sclerosis", "irritable bowel syndrome", "celiac disease"
Conclusions: migraine demonstrates overlapping pathophysiological pathways with multiple comorbid disorders, underscoring the need for expanded research to refine preventive approaches for these interconnected conditions.

The problem of nutritional support for children undergoing palliative care is very relevant, since such patients have pronounced health features that significantly affect the ability to receive and absorb the substances necessary for full life. This review is illustrated by two clinical cases that describe the features of the nutritional status in children depending on the chosen tactics regarding nutrition. A child with severe dysphagia, feeding independently, has a severe body weight deficit and an extremely unfavorable prognosis for life. In turn, a patient with the same neurological problems, but receiving nutrition through a gastrostomy, has nutritional status indicators within the normal range. Due to this, the child has a more favorable prognosis for life. We believe that when severe dysphagia is detected, a gastrostomy is the optimal method of feeding in patients with cerebral palsy, as the most effective and safe method of nutritional support.

Nutcracker syndrome is a rare condition caused by aortomesenteric compression leading to compression of the left renal vein and left-sided renal phlebohypertension. The main clinical manifestations include discomfort in the left hypochondrium, hematuria, proteinuria. Diagnosis of the syndrome is difficult due to the rarity and nonspecificity of the clinical picture. For the purpose of demonstration, a clinical case of a patient who was diagnosed with Nutcracker syndrome after a long diagnostic search is presented. The article focuses on the importance of an interdisciplinary approach in the diagnosis and treatment of this syndrome, emphasizing the need for an individual approach to each patient to achieve optimal clinical results.

Justification/Relevance: a review of the literature is presented with a clinical example of poisoning with a mixture of psychotropic substances such as: 4-chloromethcathinone (clephedrone), alphapyrrolidinovalerophenone (a derivative of the narcotic drug N-methylephedrone), tetrahydrocannabinol.