Stroke in patients with HIV infection is a significant medical problem associated with a number of specific risk factors and increased prevalence compared to the general population. In recent decades, improvements in antiretroviral therapy have significantly increased the life expectancy of HIV patients, which has led to an increase in chronic diseases, including cardiovascular and cerebrovascular. The prevalence of stroke in HIV patients is significantly higher, which is due to the multifactorial nature of stroke, including both HIV­specific mechanisms and traditional risk factors. Risk factors for stroke in HIV patients include age, duration of infection, high viral load, low CD4 cell count, the presence of concomitant diseases such as hypertension and diabetes mellitus, and smoking. In addition, certain types of antiretroviral therapy may increase the risk. To reduce the risk of stroke in HIV patients, a comprehensive approach is needed, including control of viral load, regular monitoring of cardiovascular health, lifestyle changes and correction of risk factors such as hypertension, hyperlipidemia and diabetes. Objective: to review the current literature on the problem of stroke in HIV infection in terms of prevalence and risk factors.

The article presents generalized literature data on the relevance of the problem of myocardial revascularization in patients with angina pectoris. Various methods of surgical treatment of this pathology that currently exist are described, their positive and negative sides are clarified. The effectiveness of open surgical and endovascular interventions in patients with chronic coronary syndrome was compared. It is indicated that the most promising method of treating multivessel lesions in hig-hrisk patients is a hybrid intervention combining the advantages of open and endovascular interventions. The hemodynamic significance of borderline stenosis should be determined by evaluating the functional reserve of coronary blood flow. The peculiarities of choosing one or another method of revascularization based on the generally accepted scale of coronary artery lesion Suntax Score are emphasized. The disadvantages of the existing criteria are indicated and justified

This article examines the effect of the drug Esmya, the active substance of which is ulipristal acetate (UA). Currently, UA is used for the conservative treatment of benign uterine tumors – leiomyoma. This medication belongs to a group of drugs that selectively modify progesterone hormone receptors, which makes it possible to influence many processes genetically programmed by the female body. It has been established that ulipristal acetate has a positive effect not only on the course of a benign tumor process – uterine fibroids, but in most cases helps to reduce the size of the organ and the volume of uterine nodes, which as a result significantly improves the quality of life of patients, leveling a number of depressing symptoms characteristic of this pathology: hemorrhages, pain, and most importantly, in some cases, UA allows both to reduce the volume of surgical interventions and not to resort to invasive surgical treatment methods at all. UA works for organ conservation, giving a chance for continued fertility without suppressing the reproductive function of women. The presented literature review provides a comparative description of the medicinal action of a group of drugs: gonadotropin-releasing hormone (GnRH) agonists and selective modifiers of progesterone receptors, in particular UA. The clinical effect associated with a decrease in estrogenic effects and the incidence of side effects showed a high safety profile and a lower degree of intoxication from the hepatobiliary system when using the drug UA. In addition, the possibility of using this medication in the treatment of combined pathologies – uterine fibroids and endometriosis – was noted.

Aim. To identify increase epicardial fat thickness (EAT) predictors in stable coronary artery disease (CAD) patients with borderline coronary arteries stenosis. Material and methods. 201 stable CAD pts with borderline CA stenosis participated at the study. Patients underwent a physical examination, clinical and biochemical blood tests, assessment of systemic inflammation markers and atherosclerotic plaque stability, genetic markers, instrumental studies (ECG, ultrasound of the heart, neck vessels, coronary angiography, determination of instrumental markers of stiffness, cognitive functions and the presence of early vascular aging syndrome (EVAS) were assessed. Statistical calculations were performed in the RStudio program. Multivariate regression models were built using the forward and backward step methods of minimizing the Akaike information criterion (AIC). ROC analysis methods for risk formulas of multivariate models the best risk threshold based on the sum of sensitivity and specificity was calculated, and 95% CI was estimated.

Results. The 1st group consisted of pts with phenotype stable CAD without diabetes mellitus (DM) and obesity (71 (35.3%) patients), the 2st group consisted of pts with phenotype stable CAD and type 2 DM (51 (25.4%) patients), the 3st group consisted of pts with phenotype stable CAD and metabolically unhealthy obesity phenotype (MUOF) (79 (39.3%) patients). In patients with stable coronary artery disease without DM and MUOF, the most significant predictor of increased EAT was the age of hypertension manifestation younger than 44.5 years (56 [11.58; 388.56], p < 0.001). The multivariate logistic regression model included following factors increased the odds of increased EAT in patients with stable CAD and DM: age at onset of hypertension younger than 44 years (59.92 [7.34; 1792.85], p = 0.002), fasting blood glucose level > 8.3 mmol/l (33.4 [3.92; 998.67], p = 0.007), and TNF-alpha level > 0.42 pg/ml (11.46 [1.17; 315.34], p = 0.069). In the group of patients with phenotype of CAD with MUOF, it was found that an increase of anti-inflammatory IL-10 level reduced the chances of an increase in EAT (p = 0.101), as well as taking the main groups of drugs affecting CAD prognosis during preceding year (p = 0.020). At the same time, the presence of more than 22.5 points on the MMSE scale increased the chances of an increase in EAT (p = 0.043).

Conclusion. Predictors of an increase EAT varied depending on the clinical phenotype of CAD and mainly consisted of indicators characteristic of EVAS, namely, the early hypertension debut and systemic inflammation markers activated our data once again indicate a close relationship between increase EAT, as an important predictor of the development of CVD in general, and CAD in particular, and EVAS, which is one of the fundamental factors in CVD development in young people.

Despite the advances in interventional cardiology, the problem of coronary restenosis remains relevant. An important factor in the pathogenesis of restenosis is the inflammatory process in the vascular intima. The aim of the study is to evaluate the relationship between the platelet-to-lymphocyte ratio (PLR), clinical and laboratory parameters in patients with repeat myocardial revascularization, and to analyze its prognostic value for clinical outcomes.

Material and methods. A crosssectional study included 931 patients who underwent repeat myocardial revascularization between May 2020 and May 2023. In-stent restenosis was detected in 420 patients in the main group, of which 162 patients previously had COVID-19. The control group included 511 patients without in-stent restenosis (107 patients previously had COVID-19). All registered events were verified by the hospital's electronic records in the Integrated Medical Information System.

Results. The regression analysis showed a statistically significant association of PLR with neutrophil and creatinine levels in both study groups, as well as with AST in the main group. PLR is not a significant predictor of myocardial infarction with coronary artery restenosis (OR = 1.0). Also, no relationship was found between the survival of patients with repeat revascularization and PLR.

Conclusion. An association of PLR with some laboratory parameters was determined, but its prognostic value for myocardial infarction with coronary artery restenosis was not found.

The purpose of this study is to determine the possibility of using the level of C-reactive protein (CRP) as a quantitative criterion for injury during open-heart surgery using a cardiopulmonary bypass machine, as well as to evaluate the correlation of CRP and the time of cardiopulmonary bypass (CPB), the time of myocardial ischemia.

Material and methods. A prospective nonrandomized cohort study was conducted to determine CRP at 4 stages of inpatient treatment and the correlation of CRP, cardiopulmonary bypass time and myocardial ischemia time was assessed in 108 patients who underwent open-heart surgery.

Results. In the postoperative period, the content of CRP in the blood serum of cardiac surgery patients statistically significantly increases after 24 hours, reaching maximum values on the 3rd day after surgery. When analyzing the correlation between the level of CRP 24 hours after surgery, the time of cardiopulmonary bypass and the time of myocardial ischemia, no statistically significant results were obtained.

Conclusion. In patients who underwent open-heart surgery using a cardiopulmonary bypass apparatus, an increase in CRP levels was noted from 2.7 (1.2; 5.82) to 174.5 (109.9; 253.3) mg/l after 68–72 hours after surgery. The dynamics of CRP content in patients undergoing cardiac surgery can be considered as a laboratory criterion for the morbidity of surgical intervention. There is no correlation between the level of CRP 24 hours after surgery, the time of cardiopulmonary bypass and the time of myocardial ischemia.

Objective. To establish the features and interrelations of concentrations of endothelin-1, biologically active vasomotor amines and hormones in the blood of residents of the northern territories.

Material and methods. 499 practically healthy people aged 25–55 years living in the Arkhangelsk, Murmansk regions; Nenets Autonomous Okrug, Komi Republic (Svetlogorsk) and the Svalbard archipelago (Barentsburg settlement) were examined. Serum concentrations of endothelin-1, serotonin, norepinephrine, adrenaline, dopamine, adrenocorticotropic hormone (ACTH), thyroxine, cortisol, thyrotropin (TSH), somatotropic hormone (STH) were determined by enzyme immunoassay.

Results. In practically healthy residents of the Arctic, compared with people living in territories equated to the regions of the Far North, a high frequency of registration of elevated blood concentrations of endothelin-1 (55.79 and 35.34%), serotonin (28.76 and 19.55%), norepinephrine (30.04 and 16.92%), as well as significant levels of elevated concentrations was established dopamine (13.30 and 9.77%;), adrenaline (6.44 and  3.02%), ACTH (9.76 and 5.79%), cortisol (8.13 and 4.96%) and STH (10.57 and 5.79%); p < 0.01–0.001.

Conclusion. Serotonin, initiating vascular reactions together with endothelin-1, determines the direction of its further development, supporting synaptic excitation or providing inhibition. The high level of coincidence of elevated concentrations of serotonin and norepinephrine in 81 out of 115 people (70.43%) indicates that norepinephrine supports the regulation of the vascular bed caused by serotonin, prolonging or enhancing it. An increase in the concentration of adrenaline against the background of increased concentrations of norepinephrine (in 8 out of 115 people; 6.96%) causes the risk of an increase in total peripheral vascular resistance and vascular resistance in the kidneys. An increase in the concentration of dopamine above physiological limits is an expression of the need for processes to inhibit the mechanisms of regulation of hemodynamic reactions. Simultaneous increased concentrations of catecholamines and cortisol increase the tension of regulatory mechanisms with the formation of a state of readiness for stress (allostasis). Increases in ACTH, STH, and cortisol in the blood reflect metabolic changes that require both correction and control.

The choice of surgical treatment for patients with Zenker's diverticulum has been the subject of heated debate for many decades. Currently, the main method of radical treatment in Russia remains open surgery – diverticulectomy with myotomy of the lower portion of the cricopharyngeal muscle and esophageal myotomy. The purpose of the study was to improve the results of treatment of Zenker's diverticulum by improving surgical tactics. The results of examination and treatment of patients with Zenker's diverticulum who were operated on with open diverticulectomy with cricopharyngeal myotomy (21 cases) and transoral esophagodiverticulostomy (19 cases) were subjected to comparative analysis. Were analyzed: age of patients at the time of the time of diagnosis and the time of surgery, complaints, number and kind of concomitant pathology, size of the diverticulum pouch, complications of the main disease, hospital length of stay, preoperative and postoperative periods, results (outcomes, relapses in the long-term postoperative period). We demonstrated that transoral esophagodiverticulostomy is same effective like open classical surgery is a low-traumatic technique with a minimal risk of intra- and postoperative complications, and can be used in patients with recurrent diverticula and after spinal surgery from an anterior approach.

The aim of the study was to determine the indications for hybrid operations on the arteries of the lower extremities using the APACHE II and SAPS II multiorgan insufficiency risk assessment scales.

Material and methods. 36 patients participated in the study, all study participants were divided into two groups: group 1 (n = 18) – patients who had a low risk of developing multiple organ failure (APACHE II from 0 to 15 points, SAPS II – from 0 to 7 points) and associated mortality (APACHE II – 10.8%, SAPS II – 11–12%). Study group 2 (n = 18) – patients who had an average risk of developing multiple organ failure (APACHE II – from 15 to 29 points, SAPS II – from 7 to 15 points) and associated mortality (APACHE II – 21.3%, SAPS II – 22–34%). There were 2 subgroups in these groups: subgroup A – patients who underwent hybrid interventions, subgroup B – patients who underwent multi-storey reconstructions. The groups were homogeneous in terms of age, gender, and the spectrum of concomitant pathology. The follow-up period for patients was 30 days.

Results. The duration of the operation in the study groups did not depend on the option of its implementation, as well as on the initial severity of the operated patients. In the study group with a low risk of developing multiple organ failure and death, no complications were detected in the subgroup with more traumatic multilevel arterial reconstruction, while after hybrid interventions, one case of postoperative thrombosis was recorded. In subgroup 1B, there were also significantly better indicators of limb revascularization (p < 0.05). In patients of subgroup 2B of the study, who scored an average number of points on the integral risk scales of multiple organ failure, a significantly higher number of thrombotic complications was noted, regardless of the affected segment. It is important to note that in the second group of the study, the indicators of limb revascularization were comparable between subgroups A and B. During the 30-day follow-up period from the moment of discharge: in the first group of the study, restenoses, repeated hospitalizations and operations, including amputations, were not detected. In the second group of the study, the number of thrombotic complications, post-discharge reocclusions, as well as related emergency vascular revisions was significantly higher in subgroup B (p < 0.05). 15 minutes after blood collection and addition of heparin to the drug, the area of deposited erythrocytes was significantly higher in patients of group 2 (5.45 ± 0.22 mm²) compared with the 1st group of the study (2.13 ± 0.16 mm²; p < 0.05). It is necessary to note a strong direct correlation between the luminescence amplitude at a frequency of 450 nm and the area of the «coin» columns of erythrocytes formed in the smear (r = 0.86; at p < 0.05).

Conclusion. According to the results of the study, a direct relationship was revealed between the degree of risk of developing multiple organ failure and mortality, assessed on the APACHE II and SAPS II scales, and the results of hybrid and multilevel vascular reconstructions on the arteries of the lower extremities. Assessment of local hemorheology using luminescent spectroscopy is an important method in predicting the results of vascular reconstruction on the arteries of the lower extremities.

The treatment of patients with gunshot wounds remains an urgent problem in traumatology and orthopedics in modern conditions. Mine blast wounds lead to defects in various areas not only of soft tissues, but also of the bones of the lower extremities. Lower extremity injuries in mine blast wounds are the cause of prolonged treatment, rehabilitation and, in some cases, disability of patients. To eliminate soft tissue defects, free and non-free skin grafting methods are most often used. Extensive bone defects, obtained as a result of mine blast impact on the lower limbs, often make it impossible to close them simultaneously with the use of skin grafting methods with local tissues. This article presents several clinical observations of successful use of flaps of different muscle groups to close defects of the tibia and calcaneus. The method of muscle plasty of bone cavities makes it possible to close the wound defect in conditions of bone, muscle tissue and skin deficiency, which contributes to the reduction of treatment time for patients with gunshot wounds, reduction of post-traumatic complications and early return of servicemen to service.

The work presents key milestones in the life and scientific work of Professor V.R. Braitsev – a prominent oncologist surgeon and clinician, organizer of domestic medicine. Little-known facts from the life of the scientist are noted. It should be noted that he covered complex issues with such a long-range focus and depth that they are generally relevant for the modern Russian oncological surgical school. Whatever problems the inquisitive thought of Professor V.R. concerns. Braitsev, he constantly found creative ways to solve them. Moreover, this applied not only to coloproctology, but also to other localizations in abdominal surgery. Its theoretical foundations and vector of scientific research in the field of practical surgery and oncology are still used in modern research by scientists in this field. During his many years and eventful life, Vasily Romanovich provided the basis for the creation and development of practical Soviet healthcare.