The article focuses on new approaches to anticoagulation: abelacimab, a modern, highly selective factor XI inhibitor, and the Boston Scientifi c EKOS minimally invasive clot dissolution system. This paper analyzes the unique mechanisms of action of abelacimab, revealing its therapeutic potential compared to traditional anticoagulants, and its potential applications in clinical practice. The drug's pharmacokinetic properties are discussed in detail, particularly its rapid onset of action (within 30 minutes) and exceptional duration of action (over 30 days). Particular attention is paid to the clinical indications for abelacimab, as well as its pharmacokinetic characteristics and administration routes, which are important aspects for its practical application. The second part of the article discusses the potential use of the Boston Scientifi c EKOS ultrasound endovascular thrombectomy system for minimally invasive thrombolysis, which can be combined with the eff ectiveness of abelacimab. A clinical example of the successful use of the EKOS system in a patient with occlusive deep vein thrombosis of the lower extremity is presented. 

Relevance. Chronic combat stress (CCS) is a special form of long-term stress exposure associated with the formation of initially borderline functional states, subsequently remote mental and somatic disorders in war veterans. Current data indicate the systemic nature of these disorders in the form of the formation of pre-clinical manifestations and going beyond isolated mental pathology.

Objective. Systematic analysis and meta-analytic evaluation of longitudinal studies devoted to the remote mental and somatic consequences of chronic combat stress from the standpoint of the allostatic load concept.

Material and methods. A systematic review and meta-analysis of longitudinal cohort studies published in 2010–2025 were performed. The search was conducted in the PubMed/MEDLINE and Scopus databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The analysis included studies with a quantitative assessment of combat exposure and mental or somatic outcomes. The meta-analytic synthesis was performed using the random eff ects model; Heterogeneity was assessed using the I² and τ² statistics.

Results. Forty-two studies were included in the fi nal analysis. CСS is associated with an increased risk of developing posttraumatic stress disorder (PTSD), depressive and anxiety disorders, as well as cardiovascular diseases, metabolic and endocrine disorders. Signs of persistent autonomic, neuroendocrine, and immune dysregulation were identifi ed. Genetically informed studies confi rm a partial commonality of the biological determinants of mental and cardiovascular disorders.

Conclusions. CСS should be considered as a multilevel pathogenetic factor in the formation of remote mental and somatic consequences, which justifi es the need for an interdisciplinary approach to the management of this category of patients.

Cardiovascular diseases (CVD) are the leading cause of death in the world. This review analyzes the role of vitamin D deficiency as a risk factor for CVD, including hypertension, coronary heart disease, heart failure, and stroke. Vitamin D defi ciency (25(OH) D < 30 ng/ml) occurs in 30–50% of the population, especially in regions with low insolation. Epidemiological data confi rm a 1.5–2-fold increase in the risk of CVD with low vitamin D levels. Pathophysiological mechanisms include endothelial dysfunction, infl ammation, dyslipidemia, and activation of the renin-angiotensin-aldosterone system. Clinical studies (VITAL, D-Health) show contradictory results: taking vitamin D is eff ective only in groups with severe deficiency. Further research is needed to develop personalized approaches to CVD prevention.

Material and methods. A review of the scientific literature (2014–2025) was conducted based on a search in the PubMed, Scopus, and eLibrary databases. Data from meta-analyses, large cohort studies (Framingham, Rotterdam), and randomized controlled trials (VITAL, D-Health) were analyzed. The sources were selected based on the criteria of relevance, design quality, and evidence.

Objective. To investigate the relationship between serum uric acid levels and echocardiographic (EchoCG) parameters, and to assess the association of hyperuricemia with cardiovascular and renal abnormalities in patients with chronic kidney disease (CKD).

Material and methods. A cross-sectional retrospective study included clinical, instrumental, laboratory, and EchoCG data from 473 patients (307 men and 166 women) with a confi rmed diagnosis of CKD. The mean age of the study participants was 38.5 ± 12.7 years. Hyperuricemia was defi ned as serum uric acid ≥ 0.42 mmol/L in men and ≥ 0.36 mmol/L in women. Patients were divided into subgroups: CKD with hyperuricemia (n = 199) and CKD without hyperuricemia (n = 274).

Results. Among all patients with CKD (n = 473), hyperuricemia was observed in 199 cases (42.0%). Compared with patients without hyperuricemia, those with CKD and hyperuricemia had signifi cantly higher mean age, body mass index, systolic and diastolic blood pressure the size of cardiac structures according to ECHOCG data and serum creatinine levels were statistically significantly higher. In contrast, hemoglobin concentration, red blood cell count, and estimated glomerular fi ltration rate (eGFR) were significantly lower. Signifi cant correlations of serum uric acid were found with systolic and diastolic blood pressure, eGFR, left atrial anteroposterior diameter, left ventricular end-systolic and end-diastolic diameter, interventricular septum thickness, posterior wall thickness of the left ventricle, left ventricular ejection fraction, and venous blood glucose.

Conclusion. The study demonstrated a signifi cant contribution of hyperuricemia to alterations in the geometry of the left heart chambers and a decline in renal filtration function.

Cardiovascular diseases (CVDs) continue to be the leading cause of mortality in Russia. Over the past three decades, effective preventive measures have led to a one-third reduction in morbidity rates. However, there remains a significant risk of mortality among patients under 50 years of age who experience acute myocardial infarction (AMI). This highlights the need to identify additional predictors, including radiological features, to enhance prognostic models for CVD. There is an approach suggesting that incorporating low-correlation pairs of features may yield more informative model predictions.

Aim. To evaluate the hypothesis that patients under 50 years of age with AMI exhibit distinct low-correlation pairs of characteristics, as identifi ed by chest computed tomography (CT), compared to patients over 50 years of age with AMI.

Material and methods. This was a retrospective study involving patients who experienced their first AMI and had undergone chest CT 6–12 months prior to the cardiovascular event. Correlation matrices were created for patients under 50 years of age and those over 50. Subsequently, pairs of features with low correlation that were common to all patients were removed from the set of feature pairs for the younger group.

Results. The study included 59 patients, with 12 under the age of 50 and 47 over 50. The groups diff ered in the prevalence of multivessel lesions, the presence of osteoporosis and hydrothorax as assessed by chest CT, and the average aortic size. By constructing correlation matrices and eliminating common feature pairs with weak correlations, we identified 12 unique feature pairs that could enhance existing risk models.

Conclusion. Utilizing radiological markers to improve CVD prognosis shows promise, but further prospective cohort studies with larger sample sizes are necessary to validate these findings.

Periprosthetic infection (PJI) is a serious problem in orthopedic practice. In the case of an unknown pathogen, empirical antibiotic therapy is based on local epidemiological data.

The aim of this study is to calculate the expected effectiveness of empirical antibiotic therapy based on microbiological monitoring of PJI pathogens using mathematical modeling.

Material and methods. A retrospective analysis of 379 bacterial isolates isolated in the PJI of the hip, knee and shoulder joints (2018–2024) was carried out. Microbiological identification and sensitivity testing were performed using standard methods. The indicator of expected empirical eff ectiveness (IEEE) of antibiotics was calculated.

Results. The incidence of coagulase-negative staphylococci (CoNS) was 39.6%, Staphylococcus aureus was 28.5%, gram-negative bacteria was 10.3%, Streptococcus was 8.7%, and Enterococcus was 5.3%. Antibiotics with consistently high IEEE (≥ 80% in all periods) were identifi ed: vancomycin, linezolid, and tigecycline; with an average IEEE (50–79%) — include ciprofl oxacin/levofl oxacin, clindamycin, tetracycline, rifampicin, aminoglycosides, trimethoprim-sulfamethoxazole, and meropenem; with a low IEEE (≤ 49%) — include erythromycin, aztreonam, and tobramycin. A negative trend of decreasing the sensitivity of CoNS to fl uoroquinolones (from 70.0 to 47.3%; p =0.014), co-trimoxazole (from 82.0 to 55.9%; p =0.007) was revealed. The optimal combination for the starting empiric therapy is the scheme «vancomycin+meropenem» with the estimated calculated effi ciency ≥ 87.4% against more than 90% of the pathogens of PJI.

Сonclusion. Mathematical modeling of the effectiveness of antibiotic therapy based on local data on pathogens and their sensitivity is a promising tool for optimizing empiric therapy for PJI.

Enteropathogenic infection caused by Escherichia coli, complicated by hemolytic uremic syndrome (HUS), is rare in adults and is associated with a high risk of severe complications and mortality. We present a clinical case of a 25-year-old patient with acute gastroenteritis complicated by infectious-toxic shock, disseminated intravascular coagulation syndrome, acute kidney injury with anuria, and hemolytic uremic syndrome. The etiological diagnosis was confi rmed by bacteriological stool culture with isolation of enteropathogenic Escherichia coli; tests for salmonellosis and shigellosis were negative. The patient received intensive therapy, including antibacterial treatment, infusion therapy, renal replacement therapy, and correction of coagulopathy. Against the background of comprehensive treatment, gradual recovery of renal function and regression of multiple organ failure were observed. The patient was discharged in satisfactory condition. This case highlights the importance of early diagnosis of hemolytic uremic syndrome in adult patients with severe gastroenteritis and the timely initiation of intensive pathogenetic therapy.

Primary hemochromatosis results from pathogenic variants in several genes that can lead to increased iron stores in the body, with excess iron deposited in various organs including the liver, pancreas, and heart. Primary hemochromatosis is associated with homozygosity for the HFE p.Cys282Tyr mutation in 80% of cases. However, rare cases of hemochromatosis (nonHFE hemochromatosis) can be caused by pathogenic variants in other genes (such as HJV, HAMP, TFR2, and SLC40A1). Deposition of excess iron in parenchymal tissues leads to cellular dysfunction and clinical manifestations of the disease. The most commonly aff ected organs are the liver, pancreas, joints, skin, pituitary gland, and heart. Iron-overload cardiomyopathy is systolic or diastolic dysfunction of the heart caused by excess iron deposition, resulting in chronic heart failure. The gold standard for diagnosing primary hemochromatosis is genetic testing, which should be performed in all patients suspected of having this pathology after excluding secondary causes of iron overload. The mainstay of hemochromatosis therapy is therapeutic phlebotomy and iron chelation. The article presents a clinical case of a patient with primary hemochromatosis and a history of very high serum ferritin levels, which led to iron accumulation in the heart.

Some progress has been made in the study of the pathogenesis of peripheral T-cell lymphomas, which account for 10–15% of all non-Hodgkin’s lymphomas; however, diagnosis is diffi  cult due to their rare occurrence and clinical and morphological diversity.

Aim. to present data on the clinical course of peripheral T-cell lymphoma using a clinical example of patient Z.

Material and methods. An analysis of literary sources was conducted and a case was presented demonstrating the difficulties in diagnosing non-Hodgkin’s T-cell lymphoma.

Results and discussion. Patient Z., 56 years old, treated in a multidisciplinary hospital with the diagnosis of “Acute toxicoderma. Stevens–Johnson syndrome?” had been under the care of a dermatologist for dermatitis for 10 years. One month prior to hospitalization, he developed a skin rash covering his entire body with blistering, soreness, severe weakness, fever, difficulty swallowing, and joint pain. Despite treatment (prednisolone, meropenem, linezolid, fluconazole), the patient’s condition worsened, leading to multiple organ failure and death. Postmortem biopsy revealed peripheral T-cell lymphoma of unspecifi ed type and exacerbation of chronic dermatosis.

Conclusions. This case confirms the aggressive course and poor prognosis of peripheral T-cell lymphoma, highlighting the unsatisfactory results of standard therapy. The disease’s onset, with hyperthermia, polyarthralgia, and skin changes, complicated the diagnosis of lymphoma, partly due to the lack of awareness and oncologic suspicion of oncohematological pathology among general practitioners and dermatologists. This case demonstrates the usefulness of immunohistochemical examination of the lesion biopsy, determining the extent of lymphoproliferative bone marrow lesions, and determining patient management strategies. 

The article provides information about the creation and operation of the Pharmacy Order, the main directions of its work. Information is provided on the structures that preceded the Pharmacy Order and were created based on it later. The names of the leaders of the Pharmaceutical Leprosy are given and some biographical information is provided.

This article presents the life story of Professor N.N. Petrov, an outstanding surgical oncologist and humanist of his time. Littleknown facts about the scientist are highlighted. Nikolai Nikolaevich was a highly versatile surgeon. The scientist’s universally recognized fame did not come overnight, but through persistent work and quest to resolve complex issues in surgical pathology. It has been noted that his successful resolution of these problems was facilitated not only by his sound training in anatomy and physiology, but also by his desire to work as a pr ac ticin g su rge on an d oncologist in challenging circumstances. He also played a significant role in the creation of the oncology service system in the USSR. In practical work, N.N. Petrov’s successes were facilitated by his natural talent, which developed into brilliant clinical thinking, keen observation, a sensitive and caring attitude toward patients, an ability to understand their psychology, perseverance in helping patients, preserving life at any cost, and a desire to avoid unnecessary risk to the patient. There are individuals whose role in the development of a particular fi eld of science is difficult to overestimate. For Russian oncology, such a figure was Academician N.N. Petrov of the USSR Academy of Medical Sciences. Nikolai Nikolaevich dedicated his entire life to a noble goal — the fight against disease and the alleviation of human suffering. As a true physician and humanist, saving the wounded and helping the sick was always a natural need, a fundamental duty, and a sacred obligation for him.