Diseases of the sinoatrial node (SАN) are characterized by its inability to perform the function of the dominant pacemaker. This review presents data from recent studies of the anatomy and physiology of the SАN, which demonstrate the presence of structural and functional heterogeneity of the SAN and its components, describes the structure and function of the conducting intra-nodal pathways, the “novel paranodal area”, and also discusses the phenomenon of a shift in the site of excitation generation and the presence of a “non-firing mode” of cardiomyocytes. The authors critically discussed the genetic mechanisms of the development of sick sinus node syndrome (SSS), justified a multidisciplinary approach and further anatomical, morphological and physiological studies that play a fundamental role in the development of therapy and diagnosis of related diseases.

Risk factors are constitutional peculiarity and human behavior that infl uence the disease development and / or pathological condition in the future. With regard to certain nosological units, including cardiovascular diseases, modifi able and nonmodifi able risk factors are distinguished. Non-modifi able risk factors for the development and progression of cardiovascular diseases include age, gender, and genetic predisposition, which are used to develop risk stratifi cation systems. These risk factors cannot be adjusted, ie. modifi ed, and can only be taken into account when determining the level of risk of diseases development. On the contrary, modifi able risk factors can undergo changes and be subdivided into behavioral and biological ones. Behavioral risk factors include: smoking, unhealthy diet, low physical activity, excessive alcohol consumption, chronic psycho-emotional stress. These behavioral risk factors in the lifestyle of a modern person are becoming more common in the conditions of urbanization, and contribute to the development of cardiovascular diseases. It should be noted that with longterm exposure to behavioral risk factors on the human body, biological risk factors are also formed: arterial hypertension, dyslipidemia, overweight, obesity, diabetes mellitus, chronic kidney disease.This review discusses the contribution of chronic kidney disease as a risk factor, as well as the mechanisms of formation and progression of cardiovascular diseases in kidney dysfunction.

The review describes the evolution of surgical and medical methods of treatment regarding a new nosological formpostoperative sternomediastinitis, which develops against the background of cardiac surgery tremendous upgrowth. The effectiveness of integration a surgical approach with the combined use of vacuum therapy and bacteriophages in the cleansing of the poststernotomy wound, as well as antibiotics and bacteriophages combination in order to control antibiotic-resistant pathogenic flora of the purulent-septic process in the anterior mediastinum, has been shown. Our own material included the treatment of 88 patients with deep sternal infection. The method proposed by the authors made it possible to reduce the duration of treatment and hospital mortality to 5%.

The review focuses on prelupus, a condition that is not classified as “definite” systemic lupus erythematosus according to modern criteria, but has an incomplete number of signs characteristic of this disease. The purpose of the review is to acquaint readers with the diagnosis, terminology, state of the disease, and advisability of incomplete systemic lupus erythematosus.

Objective. Identification of the ratio of the content of signaling molecules extracellular pool and the activity of intercellular blood contacts in practically healthy people and in pathology.

Material and methods. The results of immunological examination of 840 people aged 21–55, 672 women and 168 men living in Arkhangelsk, including 256 practically healthy people at the time of examination and 584 patients with diagnoses of coronary heart disease, hypertension, staphylococcal bronchitis, Crohn’s colitis, autoimmune thyroiditis are presented. The study included the determination of erythrocytes, platelets, neutrophil granulocytes, lymphocytes aggregation, as well as the study of a hemogram, and immunoassay.

Results. In pathological processes, the levels of blood cells aggregation are 2–9 times higher than those in practically healthy individuals. The highest are the levels of the relative content of aggregated erythrocytes and platelets (2–4 times higher) compared to the proportion of aggregated granulocytes and lymphocytes. In the presence of an autoimmune component, considerably more activity of lymphocyte aggregation is recorded, compared to that of granulocytes. An increase in the activity of erythrocyte and platelet aggregation is associated with an increase in the activity of vasoconstriction reactions-vasodilation by endothelin-1 and the nitric oxide cycle, as well as with an increase in serum concentrations of transferrin, sCD71, IgE, CIC and adhesion molecules with a decrease in the concentration of adrenaline. Higher levels of leukocyte aggregation are associated with cortisol, TNF-α, IgE, CIC and free transferrin receptor, as well as adhesion molecules increase in the blood content.

Conclusion. The combination of high level of neutrophil granulocytes and IgE aggregation causes the formation of irreversible aggregates of leukocytes and can be considered as an unfavorable prognostic sign of the pathological process course. The systemic effect of cytokines in their hyperproduction is an extreme measure to normalize the levels of aggregation of cells in the circulating pool and reflects the risk of developing pathological consequences of excessive aggregation.

The article deals with an issue of the day, the effect of antioxidant therapy on the temporal organization of external respiration in patients with chronic obstructive pulmonary disease. Data on diurnal rhythm, circaseptane and circasemiseptane rhythms of external respiration parameters in patients suffering from chronic obstructive pulmonary disease under the influence of antioxidant therapy using Eltacin are represented.

Corrosive stricture of the common bile duct complicated by obstructive jaundice, is a serious life-threatening disease. The stricture associated with chronic pancreatitis is difficult to treat due to fibrosis, scarring of the bile duct wall in the distal region. Preference is given to minimally invasive methods of eliminating stricture to restore the bile outflow. The presented rare long-term clinical observation of the complex treatment of corrosive stricture of the common bile duct terminal section complicated by obstructive jaundice, purulent cholangitis, coagulopathy, hemobilia, demonstrates the complexity of managing such patients, the effectiveness of the use of minimally invasive technologies.

From the latest WHO classification of neuroendocrine neoplasms (NENs), the term MiNENs refers to mixed neuroendocrinenon-neuroendocrine tumors. A neuroendocrine component coexists with a non-neuroendocrine one in them. They are morphologically and/or immunohistochemically validated. The non-neuroendocrine component implicates adenocarcinoma, apart from other histological subtypes of carcinomas, such as squamous cell carcinoma. The neuroendocrine component can be represented by a high-grade tumour (HGNEC) in addition to neuroendocrine cancer. Gastric NENs also have subgroups of MiNENs such as mixed adenoneuroendocrine carcinoma (Mixed-adenocarcinoma-NEC), which includes both, small or large cell type, neuroendocrine carcinoma (NEC) and mixed adenoneuroendocrine tumor (Mixed-adenocarcinoma-NET). Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) is a rare disease. Based on the available data, neuroendocrine component has a highly aggressive biological behaviour represented by a low-differentiated neuroendocrine tumor in the majority of MiNENs cases. The treatment is based on the principles of neuroendocrine tumour therapy. The foregoing shows that it is not possible to provide precise epidemiological data, prognosis and approve treatment strategies.

A 46-year-old patient consulted a cardiologist complaining of discomfort behind the sternum, which manifested itself in 3 weeks after a mild COVID-19 recovery and had been persisting for about 4 months by the time she consulted the doctor. Echocardiography did not reveal any disturbances in regional and global contractility. It was thickening and hyperechogenicity of the pericardium of the lower-lateral, and lateral areas of the left ventricle without any signs of pathological exudation that attracted attention. A chest X-ray and a test with physical activity were performed. Blood tests did not reveal any abnormality, an increase in C-reactive protein was observed. The patient was diagnosed with chronic non-exudative form of pericarditis associated with COVID-19. A successful treatment was carried out: colchicine 0.5 mg/day, ibuprofen 600 mg 3 times a day. Next time the patient consulted a doctor 3 months later. Against the background of ARVI, typical episodes of low-intensity chest pain repullulated. Echocardiography showed regional exudation and initial signs of impaired diastolic function. A compulsory vaccination with Gam-COVID-Vac was carried out in 4 weeks. The post-vaccination period was accompanied by low-grade pyrexia for 2 days, after which the patient noted the complete disappearance of the heart pain. Echocardiography recorded pericardial layers separation and some improvement in diastolic function. The treatment was not carried out for various reasons. Over the next months, cardialgia did not recur. Check study 3 months after showed no visible exudation into the pericardial cavity, a decrease in hyperechogenicity compared to the records of previous studies was noted. In 8 months after vaccination, the patient suffered another mild COVID-19 with exudative pericarditis recurrence and the involvement of the pleura. Blood tests taken during the 1st week of the disease revealed a characteristic cellular shift (lymphocytosis 38%), as well as an increase in ERS up to 26 mm/h, D-dimer up to 1166 μg/l. CRP was normal. Additional analysis for cardiolipin antibodies, antinuclear factor, rheumatoid factor, cyclic citrullinated peptide antibodies, b2 glycoprotein I antibodies did not reveal any pathology. Transient low-grade pyrexia had been persisting for 3 weeks in evening hours, in spite of the fact that she kept taking 800 mg of ibuprofen per day. By now, the patient continues receiving colchicine according to the planned 6-months course of administration.

Two clinical cases are described. The information about long-term febrile patients who had lymphadenopathy and splenomegaly is given. A large-scale and lengthy diagnostic search was carried out. During examination, hematological and rheumatological diseases were excluded. Diagnosis by exclusion showed that the clinical picture was associated with previous multiple vaccinations. In both cases, a post-vaccination reaction with systemic inflammatory response syndrome was diagnosed.

The article presents data on the doctors of the 2nd Pacific Squadron during the sea passage from Kronstadt to the Far East. Data on the fate of the squadron ships, the results of the Battle of Tsushima, medical losses and fatality are presented.

The article presents historical data about the events of the beginning of the Civil War in Russia and military doctors of the Voluntary Army. They performed their professional duty during the period of hostilities. The personal data of some doctors, the facts of their further fate in Russia and life in emigration are given.

The article presents brief characteristics of outstanding therapists of the Central Medical Refresher Institute who held senior military-medical positions during the Great Patriotic War.