The article provides information on historical issues — the discovery of blood clotting factors, anticoagulant and thrombolytic therapy, on modern understanding, diagnosis and treatment of arterial and venous thrombosis, atherothrombosis, venous thromboembolism, intravascular microthrombosis syndrome, hemophilias and immunothrombosis. Assumptions about the development of atherosclerosis are presented.

Thyrotoxicosis most often occurs due to autoimmune diseases of the thyroid gland or a multi-nodular toxic goiter, but it can also be caused by TSH-secreting pituitary adenomas. In the presence of these adenomas, the levels of circulating free T3 and T4 increase in the absence of suppression, even with elevated TSH levels. Incorrect interpretation of results from studies that only measure TSH can lead to erroneous diagnoses and management strategies for patients, including unnecessary surgery or radioactive iodine therapy. This can contribute to the growth of pituitary tumors. Various tests have been used to try to diagnose them, but none have proven to be eff ective. Only laboratory tests in combination with MRI of the pituitary can accurately diagnose and prescribe treatment. When choosing a treatment for TSH-producing pituitary adenomas, preference is given to the surgical method of transsphenoidal adenomectomy. If surgery is not possible or eff ective, the method used to normalize TSH levels is to prescribe somatostatin analogs. In some cases, it is possible to use somatostatin analog therapy before neurosurgery. In exceptional circumstances, radiation therapy may be used, as with other types of adenomas.

The gut microbiome is of undeniable contribution to the functioning of numerous human organ systems, including higher nervous activity and behavioral reactions, and largely determines the activity of the immune system. To date, a large amount of knowledge has been accumulated about the importance of the composition, diversity and functional properties of the gut microbiota both for maintaining the human body in a state of health and for the development of pathology. Changes in the human organism are inevitably accompanied by changes in species composition and microbiome diversity. Certain patterns of changes in the human gut microbiome throughout life, as well as changes in its functional activity under the infl uence of external factors and food preferences. This research is based on search results in databases and electronic libraries PubMed (MEDLINE), Embase, Cochrane Library, Google Scholar, eLibrary in the period from 2012 to 2023. The review is devoted to the analysis of gut microbiome as a marker and predictor of chronic socially signifi cant non-communicable diseases, as well as an integral component of health gain in the context of a personalized approach of modern therapeutic strategies.  

The review presents a modern understanding of the pathophysiology and mechanisms leading to thrombocytopenia, as well as emerging treatment methods for.

The article provides a systematic review of data from domestic and international literature on the issue of hemorrhagic complications that can occur during emergency endovascular interventions. It provides a generalized classifi cation of these complications and highlights the frequency of major and minor hemorrhages in diff erent locations, depending on their underlying cause. Various factors, causes, and mechanisms related to the development of hemorrhaging are discussed, including those associated with surgical access, vessel dissection, rupture, anticoagulation, anti-platelet therapy, and thrombolysis. Methods for preventing and treating these complications following endovascular procedures are also described in detail.

Aortic valve replacement has long been recognized as the “gold standard” in the treatment of aortic valve disease. However, an increasing number of patients require combined surgical interventions in addition to aortic valve replacement. Currently, operative mortality in isolated aortic stenosis ranges from 3-8% in low-risk patients younger than 70 years and between 5 and 11% in “elderly patients”, reaching 15% in cases of combined heart interventions. The use of sutureless valves for open implantation requires careful analysis of the short-term and long-term outcomes of their use and comparison with the results of standard prosthetic methods. Material and methods. The study design is a comparative prospective-retrospective study evaluating interventions using diff erent types of biological prostheses for aortic valve disease in combination with associated cardiac pathology and without it. The study included patients over 65 years old with aortic stenosis who underwent aortic valve replacement using sutureless biological prostheses. Key surgical treatment outcomes were compared with data from patients implanted with sewn biological valves. Comparison was made based on intraoperative parameters, the number and nature of postoperative complications, survival, freedom from reoperation, dynamics of transaortic gradient, hemodynamic characteristics throughout the observation period. Results. In the group of patients with implanted sutureless valves, there was a low number of postoperative complications, faster recovery, signifi cantly lower mortality rates, higher freedom from valve-related complications in both short-term and long-term postoperative periods. Conclusions. The use of sutureless prostheses is justifi ed for aortic valve replacement and is safer compared to standard sewn prostheses in the absence of contraindications. Surgical treatment of patients with aortic stenosis using sutureless valves led to signifi cant clinical improvement in most cases, with signifi cantly lower rates of typical complications. The simplicity and reproducibility of the procedure, rapid learning process can undoubtedly contribute to a wider and more active implementation of this technology in clinical practice.

Aim of the study: to investigate the dynamics of glutathione metabolite concentrations in the blood of patients during the acute phase of coronavirus infection, as well as their dependencies on each other, on NAD⁺ metabolites, the severity of the infl ammatory response, and pre-existing conditions. Materials and methods. Changes in the concentration of oxidized and reduced forms of glutathione and their ratio, as well as clinical and biochemical parameters, including NAD⁺ and NADPH⁺ metabolites, were analyzed in patients with new coronavirus infection COVID-19 during the acute phase. Results. A signifi cant decrease in the concentration of both reduced and oxidized forms of glutathione and an increase in the ratio of reduced to oxidized forms compared to the control were demonstrated. A positive correlation was noted between the severity of respiratory failure and the oxidized form of glutathione and NADPH⁺. The reduced form of glutathione had a positive correlation with the concentration of NAD⁺ and NADPH⁺ and a negative correlation with the presence of obesity and ferritin concentration. Conclusion. For the fi rst time, a decrease in the concentration of key components of the cell’s antioxidant defense system — glutathione system — has been shown in patients with COVID-19, opening up prospects for the development of treatment methods for patients in the active phase using sulfhydryl group donors.

Despite the success in the treatment of cardiovascular diseases, the number of complications associated with arterial hypertension (AH) does not decrease. Against the background of high blood pressure, the functioning of the central nervous system (CNS) changes and personalized and more active antihypertensive therapy is required to achieve the target blood pressure. Aim. To determine the level of oxygen utilization by tissues, strength and endurance of the hand, as well as the minute volume of blood and the level of complications in high- and low-anxiety patients with stage II hypertension (AH) with a predominance of excitatory or inhibitory processes in the central nervous system taking an empirical and personalized version of antihypertensive therapy, as well as to determine the most effective treatment approach. Material and methods. Design: outpatient, single-center, cohort, prospective, controlled, non-randomized, long-term clinical trial. From 2011 to 2018 patients with stage II AH, degree 2, risk 3 (n = 328) and healthy (n = 164) men (54.6 ± 0.6 years) were divided by type of higher nervous activity into equal groups with a predominance of excitatory (sympathicotonia) or inhibitory (parasympathicotonia and activation of the renin-angiotensin-aldosterone system in the central nervous system) processes with high and low anxiety. Reactive and personal anxiety, the coefficient of oxygen utilization by tissues, the coefficient of endurance and maximum hand strength, as well as the level of complications of hypertension were determined. Some groups of high- and low—anxiety patients took the empirical option, while others of the same groups of the corresponding activity of the central nervous system and departments of the autonomic nervous system took a personalized version of antihypertensive therapy. It included correction of sympathicotonia in people with a predominance of excitatory processes, and blockade of mineralocorticoid receptors in those with a predominance of inhibitory processes. Results and discussion. In contrast to the empirical one, against the background of personalized therapy, the value of the oxygen utilization coefficient by tissues, the coefficient of endurance of the hand and the maximum strength of the hand were higher, and the minute volume of blood fl ow was lower. The values of the indicators against the background of personalized antihypertensive therapy were the same as in healthy individuals with the corresponding activity of the central nervous system and departments of the autonomic nervous system. The level of hypertension complications due to acute cerebral blood f ow disorder in the groups of patients taking the personalized therapy option was significantly lower than in the groups taking the empirical option. Conclusion. The equality of values with healthy individuals in terms of the coeffi cient of oxygen utilization by tissues, the coefficient of endurance of the hand and the maximum strength of the hand, as well as the low level of complications of hypertension, compared with the empirical treatment option, indicate the effectiveness of a personalized approach to pharmacotherapy of hypertension.

Contralateral occlusion of the internal carotid artery (ICA) has often been considered a predictor of adverse outcomes in surgical interventions in the carotid basin. Analysis of the results of major international studies (NASCET and ACAS) confi rms this association. However, the number of patients with contralateral occlusion in the aforementioned studies was relatively small. Recently, specialists in endovascular surgery have been evaluating radiological surgical techniques (stenting, angioplasty) of the internal carotid artery as the safest methods of surgical treatment for patients with contralateral ICA occlusion. The aim of this study is to compare and analyze the results of carotid endarterectomy and ICA stenting in patients with contralateral occlusion, as well as to evaluate the impact of concomitant factors and medical history on the outcomes of surgical intervention.

One of the rare variants of uterine smooth muscle tumors is mitotically active leiomyoma, histological characteristics of which are defined by a high number of mitoses in the absence of necrosis and cellular atypia. Despite the presence of mitotic activity, this tumor process is benign. Mitotically active leiomyoma of the uterus is usually diagnosed in patients in the perimenopausal period and its size typically does not exceed 10 cm. This article presents a rare clinical case of a giant-sized mitotically active leiomyoma of the uterus in a woman of reproductive age. Attention is drawn to the challenges in clinical diagnosis and the difficulties in differentiation from malignant neoplasms. The primary treatment method for mitotically active leiomyoma of the uterus is surgical (myomectomy or hysterectomy as indicated). According to several publications, no recurrence of this pathology was observed during patient follow-up after surgical treatment ranging from 6 months to 15 years. Considering the clinical and macroscopic similarity of mitotically active leiomyoma with leiomyosarcoma, careful histological verification of the diagnosis is necessary to determine the correct management strategy.

Aim. Informing readers about the achievements of genetics, molecular biology, as well as the development of non-genetic diagnostic criteria for tuberous sclerosis, which reliably allow for a correct and timely diagnosis. Materials and methods. A retrospective analysis of our own 10-year observation of a girl suff ering from tuberous sclerosis is presented. Anamnestic data, conclusions of laboratory and neuroimaging methods of research, diagnostic criteria from 2012 (TSC Clinical Consensus Conference) were used to confi rm the diagnosis. Results and discussion. The clinical observation conducted represents a case of tuberous sclerosis, a rare genetically determined disease from the group of phacomatoses, observed for 10 years. The diagnosis was facilitated by the presence of speech and psychomotor development delay, pyramidal symptoms, and frequent seizures. The detected mutation in the gene (TSC1 or TSC2) with an autosomal dominant inheritance phenotype without fl uctuations would confi rm the established diagnosis, however, the patient’s mother refused examination. It was necessary to resort to another, no less reliable option to confi rm this diagnosis: the recommendations of the TSC Clinical Consensus Conference 2012 and based on the identifi ed primary (facial angiofi bromas, hypopigmented spots, cortical nodes, brain tubers, subependymal nodes) and secondary (numerous enamel pits in teeth, multiple kidney cysts) clinical signs present in our patient to establish the diagnosis. Conclusions. The presented clinical observation indicates the possibility of diagnosing tuberous sclerosis without genetic testing.

The work is dedicated to the features of the clinic, diagnosis, and treatment of acute appendicitis (AA) in patients with the new coronavirus infection (COVID-19). An analysis of 73 cases of diagnosis and treatment of AA in patients with COVID-19 in an infectious diseases hospital was conducted. In patients with COVID-19, immunopathological reactions, disturbances of consciousness, and the administration of antibacterial and anti-inflammatory therapy complicated the diagnosis of concurrent AA, leading to a smoothing or complete absence of local pain symptoms, an inability to fully collect complaints and medical history, and the presence of leukopenia. In patients with severe COVID-19 with disturbances of consciousness according to the Glasgow Coma Scale up to 9–13 points, CT grade 4, and respiratory failure of the 3rd degree, the basis for targeted diagnostic search for acute surgical pathology of the abdominal cavity of an inflammatory nature was the progressive increase in leukocytosis in the complete blood count, refractory to the administered antibacterial and anti-inflammatory therapy, in combination with values of CRP and procalcitonin (PCT) exceeding their average values in the group of patients with COVID-19. With an increase in the severity of COVID-19, the final diagnosis of AA was possible only when using additional instrumental diagnostic methods and performing diagnostic laparotomies (laparoscopies). A direct correlation was found between the severity of COVID-19 and an increase in the frequency of gangrenous forms of AA and secondary AA. The number of postoperative complications in AA was directly correlated with the severity of COVID-19. Fatal outcomes occurred only in patients with severe COVID-19 due to the progression of multiorgan failure.

Despite the fact that it has been almost 50 years since the first description of aldosterone-cortisol-producing adrenal adenomas (Connshing syndrome), there are still many unresolved issues regarding the diagnosis and treatment of this condition. The presented clinical case confirms the complexity of recognizing this disease due to the frequent absence of its manifesting clinical symptoms and the lack of information acquired from standard laboratory tests. In these cases, the method of comparative selective venous blood sampling from the adrenal glands plays a significant role in the differential diagnosis of rare forms of primary hyperaldosteronism. Analysis of clinical cases presented in the scientific literature from 2000 to 2023 showed that partial adrenalectomy is the method of choice for surgical treatment of this pathology, which is associated with minimal risk of postoperative complications.

This article presents the life and creative path of a prominent Russian scientist, one of the founders of the theory of hematopoiesis, Doctor of Medicine, Professor Alexander Alexandrovich Maximov.