The morphological structure of the bile ducts was studied in 78 cadavers of people of different ages and sexes, including the topography of organs, vascular-nerve bundles and cellular spaces of the hepatobiliary zone, and body composition features. Age characteristics, anatomical structure and histology of the bile ducts in normal conditions and in benign cholestasis were studied. Clinical data of 130 patients with cholestasis, treated in specialized departments of Veliky Novgorod, were analyzed. A large number of variations in the anatomical structure and location of the bile ducts have been identified. A dependence of duct topography on the shape of the duodenum and the patient's age has been observed, which may be of great importance in diagnosis and surgical interventions. Histological analysis revealed a correlation between the severity of destructive lesions and fibrous tissue proliferation and the duration of cholestasis. Active proliferation of the bile ducts occurs at 7–10 days, followed by their destruction and cirrhosis. The identified duct morphology features should be considered when choosing treatment strategies for cholestasis.

The article examines selected morphological aspects of cardiac changes in experimental animals following aspiration of acidin-pepsin into the respiratory tract. Outbred white rats were used as the study subjects and were allocated according to the matched–pairs principle into experimental and control groups. On day 21, the animals were withdrawn from the experiment. Histological sections were prepared using a rotary microtome (paraffin sections 5–7 μm thick), followed by hematoxylin and eosin staining, mounting in a low-viscosity acrylic mounting medium (Vitrogel), and microscopic examination. All rats exhibited damage to the bronchial and bronchiolar mucosa, inflammatory cellular infiltration, circulatory disturbances, and the development of atelectasis, distelectasis, and emphysema. Against the background of aspiration pneumonia, 8% of experimental animals showed pronounced changes in the valvular apparatus; signs of cardiomyocyte hypertrophy with interstitial edema were detected in 24% of cases; and 20% of rats demonstrated signs of myocardial dystrophy in combination with stromal alterations and microcirculatory disorders. Histological examination revealed inflammatory reactions of varying severity in all layers of the heart in 46% of the experimental animals. The release of inflammatory mediators following acidin-pepsin aspiration may lead to damage to the endocardium, cardiac valve apparatus, myocardial tissue, as well as disturbances in the microcirculatory system.

In this paper we present an analysis of current literature on neonatal hepatitis, with a particular focus on giant cell hepatitis, and examines epidemiological data on these diseases, including statistics from the Russian Federation. A clinical case of liver involvement in an infant is presented, describing the course of the disease and the pathomorphological features of organ tissues, including the liver. Based on the obtained data, the diagnostic challenges of giant cell hepatitis are substantiated; in this case, they were associated with the rapidly deteriorating condition of the child, as well as the significant contribution of a competing disease to the development of an unfavorable outcome. The presented histological images demonstrate liver damage resulting from an unspecified intrauterine infection. It is important to note that studying this pathology helps ensure timely medical care, improve preventive measures, and increase the likelihood of favorable outcomes in early childhood liver diseases.

The aim of the study was to clarify the morphological criteria for diagnosing Waterhouse-Friderichsen syndrome, infectious toxic shock, and cerebral edema in generalized forms of meningococcal infection. The study was based on a morphological analysis of 35 archived fatal cases of patients with meningococcal infection. According to the study results, the morphological criterion of Waterhouse-Friderichsen syndrome as an immediate cause of death in generalized forms of meningococcal infection is the presence of hemorrhages involving more than 30% of the adrenal cortex. The morphological criterion of infectious toxic shock as an immediate cause of death in generalized forms of meningococcal infection is the presence of congested capillaries occupying more than 40% of the volume of the interalveolar septa of the lungs. The presence in patients with generalized forms of meningococcal infection of adrenal hemorrhages involving more than 30% of the adrenal cortex and congested capillaries occupying more than 40% of the volume of the interalveolar septa of the lungs indicates that the immediate cause of death is a combination of Waterhouse–Friderichsen syndrome and infectious toxic shock. Cerebral edema as an immediate cause of death is considered an independent cause in patients with generalized forms of meningococcal infection when the patient presents with a strangulation groove, bradycardia, adrenal hemorrhages involving less than 30% of the adrenal cortex, and a capillary volume fraction in the lungs ranging from 25% to 40%.

The aim of the research is to study the features of manifestation and outcomes of childbirth in early development of preeclampsia in singleton pregnancies. The retrospective analysis included 150 pregnant women diagnosed with early preeclampsia manifested at 34 weeks + 0 days for the period 2017–2019. The average age of pregnant women was 31 years (26–35) (Me, Q₁–Q₃), of which 81 (53,64%) were repeat births. The median gestation period at which clinical manifestations occurred was 31,4 weeks. The most common primary clinical symptom was edema 142 (94,7%). At the time of the manifestation, 122 (81,3%) moderate and 28 (18,67%) severe early preeclampsia were detected. Of 123 observations, moderate early preeclampsia in 31 (20,67%) cases progressed to severe. Thus, in 39,33% of cases, the early preeclampsia reaches a severe degree. The majority of patients required an early 32,4 weeks (30,4–34,0) surgical delivery. Nosologies based on endothelial dysfunction were common: 30 (19,9%) chronic arterial hypertension and 19 (12,6%) type 2 diabetes mellitus cases. The frequency of premature detachment of the normally located placenta was 10 (6,67%) cases. The average hospital stay for children was 33 (23–48) days. A high frequency of adverse outcomes for newborns with early preeclampsia was revealed. 7 children died antenatally (46,7%), of which 4 were associated with premature detachment of the normally located placenta, 2 children died on 55 and 93 days of life.

Oxidative stress is a key component in the pathogenesis of inflammatory bowel diseas. Melatonin is an endogenous regulator of homeostasis with pleiotropic properties, including antioxidant effects; rectal formulations of melatonin are not registered in the Russian Federation. The aim of research was to study the effect of melatonin incorporated into original rectal suppositories on oxidative stress parameters in experimental colitis induced by 2,4,6-trinitrobenzenesulfonic acid (TNBS colitis). Sixty-four Wistar rats were divided into four groups: intact; TNBS colitis; TNBS colitis + rectal suppositories with melatonin; TNBS colitis + rectal suppositories without active component (placebo). The TNBS colitis model was reproduced by weekly rectal administration of TNBS in increasing doses (15–60 mg/kg) for 6 weeks. The disease activity index, fecal calprotectin concentration, levels of lipid peroxidation products, and total antioxidant status in the colonic mucosa at the site of injury were assessed. The TNBS colitis model in rats reproduces clinical and laboratory manifestations of inflammatory bowel disease. It was found that the use of rectal suppositories with melatonin in TNBS colitis led to a decrease in disease activity index and fecal calprotectin concentration, a decrease in the content of lipid peroxidation products, and an increase in total antioxidant status compared with the TNBS colitis and TNBS colitis groups with rectal suppositories without an active component. The obtained data demonstrate the efficacy of melatonin in rectal suppositories in TNBS colitis and provide a rationale for further studies, as well as for the potential use of melatonin–containing rectal suppositories as part of combination therapy for inflammatory bowel disease.

Endometriosis is a highly prevalent gynecological disease that is often associated with impaired fertility, one of its underlying mechanisms being altered endometrial receptivity. The aim of this study was to systematically assess the relationship between transcriptomic changes in endometriosis and the molecular processes determining the receptive state of the endometrium. For a hypothesis-free, system-level comparison, principal component analysis was applied, followed by evaluation of the predictive significance of the resulting components for endometrial receptivity status using machine learning methods and their biological interpretation through enrichment analysis. Differential expression analysis revealed limited similarity between the conditions at the level of individual genes, whereas the system-level machine learning approach identified three principal components as the most informative for predicting endometrial receptivity. Enrichment analysis demonstrated that these components are associated with biological processes critical for implantation, including extracellular matrix remodeling, focal adhesions, Wnt signaling, immune response, and ciliary function. Modeling results indicate that this approach not only confirms known mechanisms involved in the establishment of endometrial receptivity but also enables the identification of novel factors associated with both receptivity and endometriosis.

In recent years, there has been an increase in the incidence of fungal infections, including deep mycoses. Key risk factors for developing fungal infections include chemotherapy and immunosuppression; decompensated diabetes mellitus; renal failure; septicemia in immunocompromised patients; dehydration, such as severe diarrhea and vomiting; alcoholic cirrhosis of the liver; cancer; and HIV infection. Treatment for complications of COVID-19 has contributed to the growth of drug resistance in bacteria and fungi. The Mucorales species are characterized by high level resistance to most currently available antifungal drugs. The emergence of severe deep mycoses with high mortality rates necessitates a focus on antifungal resistance, as fungi can become resistant to drugs designed to kill them. The objective of this study was to review the current state of treatment for antifungal infections, identify risk factors for invasive mycoses. 
When this was used method of the review of the literature. A list of antifungal drugs available on the Russian pharmaceutical market is provided. The most common form of mucormycosis is the rhinocerebral form, with a mortality rate reaching 80%. The main treatment includes radical removal of necrotic soft and bone tissue in the lesion, systemic antifungal therapy with liposomal amphotericin B (intravenously) and symptomatic therapy. It is shown that the pharmaceutical market has a limited range of dosage forms and a limited range of antifungal agents. 

In contemporary medical practice, an increasing body of evidence highlights the consequences of infection with SARS-CoV-2, pointing to a wide range of extrapulmonary clinical and laboratory abnormalities, some of which are characteristic of autoimmune and autoinflammatory diseases. This article presents a clinical case of post-COVID syndrome in COVID-associated limbic encephalitis, in which the diagnosis of a post-infectious autoimmune encephalitis required a more detailed retrospective analysis of nonspecific clinical and dynamic data combined with a comparison of instrumental study results. Analysis of the presented clinical case indicates the need for long-term follow-up of patients with limbic encephalitis (for at least three years with electroencephalographic monitoring), along with appropriately adjusted retrospective therapy. Particular emphasis should also be placed, during medical history taking in patients with sequelae of SARS-CoV-2 infection, on identifying a history of limbic encephalitis when patients consult various medical specialists, especially when presenting with a set of nonspecific complaints associated with limbic system involvement that persistently reduce quality of life. By examining the cause-and-effect relationship, it can be concluded that a structural trace is formed within the functional immune system that was involved in adaptation to a specific environmental stressor – the SARS-CoV-2 pathogen – which subsequently led to pathological changes in other systems and, consequently, to dysregulation of vital processes. A stepwise selection of psychopharmacotherapy based on the pathophysiological mechanisms underlying the development of dysregulatory disorders is substantiated. The article presents the process of selecting optimal therapy taking into account the patient’s social status, justifies rehabilitation measures, and traces the clinical follow-up over a three-year period.

To investigate the frequency of single nucleotide polymorphisms in genes of the hemostatic system and the folate cycle, as well as their intergenic interactions, in patients with antenatally diagnosed fetal growth restriction with and without clinical manifestations of preeclampsia. The study included 255 delivery records. The first (control) group consisted of 70 cases of normal deliveries in conditionally healthy pregnant women. The second group comprised 90 cases of deliveries complicated by fetal growth restriction without clinical signs of preeclampsia. The third group included 95 cases of deliveries with diagnosed early–onset preeclampsia and fetal growth restriction at a gestational age of 20–34 weeks. In patients from all groups, genetic polymorphisms associated with the hemostatic system and folate metabolism were determined using real-time polymerase chain reaction. Epistasis analysis was performed using the Generalized Multifactor Dimensionality Reduction (GMDR) v. 0,7 method. Predictive models of varying complexity were constructed. For the group with fetal growth restriction without clinical preeclampsia, the three-locus model. For the group with fetal growth restriction accompanied by preeclampsia, the most effective was the five–locus model. Specific high-risk genotypic profiles were identified for each form of the pathology. Distinct variants of the genetic architecture underlying isolated fetal growth restriction and fetal growth restriction associated with preeclampsia were identified. Combined analysis of polymorphisms in hemostasis- and folate cycle related genes enables early prediction and risk stratification of placental disorders.

Cystic fibrosis is a genetic disease with a wide range of clinical manifestations, in some cases accompanied by severe complications. In recent years, a significant increase in the number of adolescent patients with cystic fibrosis has been observed, which indicates an increase in life expectancy among children with this diagnosis. Previously, therapy for this disease was mainly based on the management of symptoms and was not always successful. At present, medications have become available that allow correction of defective protein structures involved in the pathological process of the disease. The article examines the current strategy of targeted therapy for this hereditary disorder, which involves the use of modern drugs aimed at restoring the structure and function of the abnormal CFTR protein by compensating for its defective structure. Using a clinical case of a child who has suffered from cystic fibrosis since birth over a 15-year period, the absence of an effect from a combined two-component drug is demonstrated. Despite favorable prognostic data, the therapy did not produce the expected effect, which may indicate its late initiation, as well as the presence of an already decompensated state in a number of organs and systems involved in the pathological process. This should be taken into account when using targeted therapy in patients with this pathology. As a rule, early and timely initiation of treatment yields good results, helps prolong the patient’s life, prevents a number of life-threatening conditions, and generally improves the quality of life of such patients.

The purpose of this study is to identify violations of the parameters of innate immunity in acute serous pyelonephritis depending on the trimester of gestation. The study included 110 women divided into groups. The main study groups (15 women in each) consisted of pregnant patients in the first, second and third trimesters with a verified diagnosis of "Acute gestational serous pyelonephritis". In the circulating peripheral blood, the parameters of innate immunity were studied: functional and metabolic activity of neutrophils, cytokine spectrum, the state of the complement system. In patients with acute pyelonephritis in the 1st-3rd trimesters of gestation, compared with the group of pregnant patients without renal pathology, suppression of the activity and phagocytic intensity, an increase in the oxygen-dependent activity of circulating blood neutrophils, an increase in the content of C₅, C_5a complement components in blood plasma, a decrease in the content of the C_3a component and inhibitors of the complement system (factor H and C₁-ing.), an increase in the cytokines TNF_α, IL-1β, IL-6, IL-8, IL-17, IFN_γ, IL-4 and IL-10 were revealed, which can be considered as immune inflammation at the systemic level, more pronounced in the 2nd and 3rd trimesters of pregnancy. The basic treatment of acute pyelonephritis does not normalize most of the studied altered parameters of innate immunity in these trimesters. The results of the studies complement the existing data on the immunopathogenesis of the development of acute pyelonephritis in each trimester of gestation and are the basis for revising the treatment protocols for acute pyelonephritis in pregnant women.

Adrenal neoplasms are the third most common cause of hemorrhages and hematomas in the paranephric space. Spontaneous adrenal hemorrhage is a rare, potentially life-threatening condition characterized by acute blood loss due to vascular rupture within the adrenal gland, accompanied by active bleeding and the formation of retroperitoneal hematomas. This article presents a clinical case of diagnosing a spontaneous rupture of a left adrenal tumor in a 38-year-old female patient. Contrast-enhanced multislice computed tomography revealed an extensive left-sided retroperitoneal hematoma with a volume of 1300 cm³. Owing to timely surgical management, including laparotomy, removal of the organized left retroperitoneal hematoma, left adrenalectomy, and careful postoperative monitoring, the patient was discharged on the tenth day of hospitalization without any complications.

Manual therapy in the rehabilitation of patients with degenerative-dystrophic spinal diseases is one of the most effective methods, allowing for rapid restoration of patient activity through non-surgical means. To develop a manual therapy method applicable for the rehabilitation treatment of most patients with degenerative-dystrophic spinal diseases, accounting for various clinical and morphological manifestations of the disease without risk of post-manipulation complications. Based on the analysis of the biomechanics of the musculoskeletal, vertebral, and extravertebral systems, a proprioceptive neuromuscular manual therapy method was developed. This method enables rehabilitation of most of these patients across different clinical and morphological presentations without post-manipulation complications. The method was applied in the rehabilitation of patients with vertebrogenic pain, musculo-tonic, tunnel, and irritative syndromes. The results demonstrate significant improvement in both clinical and subjective outcomes in degenerative dystrophic spine diseases patients using the developed proprioceptive neuromuscular manual therapy method. The proposed proprioceptive neuromuscular manual therapy method has shown high effectiveness and can be used in the rehabilitation of patients with degenerative-dystrophic spinal diseases across different clinical and morphological manifestations without a high risk of post-manipulation complications.