The work studied the magnetic resonance imaging (MRI) anatomy of the pudendal nerves in mature men who underwent surgery on pelvic organs. The study included 75 patients (30 patients in the first period of adulthood and 45 patients in the second period of adulthood). Thirty-seven patients underwent prostatectomy and 38 respondents underwent rectal resection. The single-trunk nature of the branching of the nerve, in which the pudendal nerve passes under the sacrospinous ligament, was found in the majority of patients (65.3%). The sources of formation of the pudendal nerves in 45 (60.0%) cases were the roots S2, S3 and S4, in 19 (25.3%) respondents the pudendal nerves were formed from the roots S2 and S4 and in 11 (14.6%) of respondents, the nerves originated from the S3 and S4 roots. The genital canals originate 22.5±3.2 mm below the ischial tuberosity and lie 39.8±9.5 mm anterior to it, the canals end at the level of the lower edge of the pubic symphysis 24.4±10.9 mm behind it. The average cross-sectional area of the genitals was 27.9±9.2 mm2. The average diameters of the pudendal nerve trunks at a level of 2 cm distal to the piriformis muscle were 4.63 mm, 1.85 mm, and 1.64 mm for the first, second, and third trunks, respectively. The average length of the pudendal nerve trunks before division into terminal branches was 25.23 mm. A comparison of the skeletotopic characteristics of the genital canals between patients with a conditional norm and patients after surgery on the pelvic organs demonstrated the presence of significant differences (p=0.023).

Variants of the anatomical structure of the bile ducts were studied based on endobiliary cholangiography performed in 150 patients who were treated in surgical clinics with a diagnosis of obstructive jaundice of non-tumor etiology, and a retrospective and prospective analysis of the results of their treatment was carried out. The study included the sequence of treatment and diagnostic techniques, the content of preoperative preparation and the alternation of various minimally invasive endobiliary operations. The patients were divided into control and main groups. The control group consisted of 30 patients who were operated on immediately after short-term preoperative preparation; they underwent cholecystectomy, choledocholithotomy with external drainage of the common bile duct. The main group included 120 patients who, along with special preoperative preparation, underwent two- or three-stage surgical interventions on the biliary tract. Various variants of the structure of both extrahepatic and intrahepatic bile ducts were identified, which were taken into account during the surgery and the formation of endobiliary approaches. Decompression of the biliary tract was carried out on the second or third day against the background of active infusion therapy, which continued in the postoperative period. The use of the method of percutaneous transhepatic decompression of the biliary tract using external-internal drainage is possible for any type of bile duct structure. This technique allows to reduce the percentage of postoperative complications from 46% to 23% and reduces the number of deaths from 34% to 11.7%. The use of preoperative preparation and endobiliary drainage methods stabilizes the condition of patients in the preoperative period, relieves the phenomena of cholestasis and cholangitis and allows surgical intervention to be performed under more favorable conditions.

This study is devoted to the morphofunctional substantiation of the model of male hypogonadism and the establishment of the effectiveness of its substitution therapy using morphological methods. There were 6 groups of adult male rats (4 individuals in each) studied. Four groups of rats were experimental. Under anesthesia, the left and right spermatic cords with the vascular bundle were tied with a temporary ligature, inducing hypogonadism. In the first two experimental groups of rats, the ligature was applied for 30 and 60 minutes (respectively). Animals of the other two experimental groups received substitution therapy by introducing kisspeptin K6. Animals of the third experimental group began to receive kisspeptin a few minutes after restoration of testicular blood flow (ex tempore), and the rats of the fourth group — after 3 days. The duration of substitution therapy was 7 days. In the right and left histological sections of the testis (n = 8), the number of viable and dying interstitial endocrine cells was counted (under the control of the ongoing immunohistochemical reaction with caspase 3), the percentage of these cell types from their total number was calculated, and the area of viable endocrinocytes was determined. The significance of differences in the median, upper and lower quartiles of the compared parameters was determined using the nonparametric Mann–Whitney test. It has been established that the modeling of male hypogonadism by applying a double-sided ligature to the vessels of the spermatic cord for 60 minutes and experiencing it by the animals for the next 10 days induces pronounced reactive changes and death of some interstitial cells, inhibition and cessation of spermatogenesis. Kisspeptin KS6, administered ex tempore and regularly after acute ischemia, has a protective effect on interstitial endocrinocytes, including anti-apoptotic, restoring spermatogenesis, probably through activation of the central links of the hypothalamic-pituitary-testicular axis.

Methods. In the experiment, 30 white mature rats were divided into 5 groups: Group 1 — control, Group 2 and Group 3 — rats exposed to tartrazine at the rate of 750 and 1500 mg/kg for 60 days. In the Group 4 and Group 5, mexidol was injected intramuscularly at the rate of 50 mg/kg against the background of the conditions of the Group 2 and Group 3. Electron microscopic examination of the adrenal glands was performed according to the standard protocol. Results. In the Group 2, epithelial cells of the glomerular and fascicular zones have a round or oval nucleus with uneven contours. The nucleus contains accumulations of heterochromatin under the karyolemma and in the karyoplasm. Large mitochondria with vesicular cristae are observed in the cytoplasm. The cisterns of the smooth endoplasmic reticulum are poorly developed. Lipid inclusions are located in groups or singly. In the Group 3, mitochondria with partially destroyed cristae were detected in the cytoplasm of endocrinocytes of the zona glomerulosa, and in the epithelial cells of the zona fasciculata, loosely packed lamellar structures were detected in the center or periphery of mitochondria, as well as cells with apoptosis. Endocrinocytes of the zona reticularis have a small size, an oval nucleus with slightly tortuous contours and accumulations of heterochromatin in the karyoplasm in the rats of the Group 2. Mitochondria were large and medium in size with spherical cristae in cross section, the cisterns of the smooth endoplasmic reticulum are unevenly expanded and fill the gaps between mitochondria. In the Group 3, almost half of the large mitochondria have densely packed lamellar structures along the periphery or in the center. Conclusion. The above-established ultramicroscopic features of endocrinocytes of the adrenal cortex after 60 days of exposure to tartrazine indicate a decrease in their secretory activity, which depends on the dose of the supplement administered. The introduction of mexidol against this background helps to restore the disturbed ultramicroscopic picture of cells to control values, which is more pronounced in the Group 4.

The article is devoted to the study of the variant anatomy of the arteries of the forearm. The study was carried out on photorealistic copies of four corpses (two Mongoloids and two Caucasoids) based on the use of the anatomical table "Anatomage Table EDU 6.0.2". Variants of branching of the radial and ulnar arteries were identified, differing from the description in classical anatomy. The results obtained can be useful for developing a student's understanding of the importance of an individual approach to the patient, as well as have practical significance for doctors when performing medical manipulations and planning access for surgical intervention.

Aim: to evaluate the effect of adrenergic and purinergic signaling in platelets (PLT) during COX inhibition on the severity of hematuria in women with nephrolithiasis (NLT). Material and Methods. The study was prospective and included 60 patients with imaging evidence of urinary tract stones, who were treated with high doses of non-selective non-steroidal anti-inflammatory drugs (NSAIDs) as part of lithokinetic therapy (LKT) for analgesia. The study included 30 women who had reproducible TP-receptor hyporeactivity (<45%) after 72h of LKT with non-selective NSAIDs. The severity of hematuria was assessed at the time of hospitalization and for 7 days of LCT. The activity of the TP receptor, α2-adrenergic receptor, purine P2X1- and P2Y-receptors (P2Y1, P2Y12) was studied by turbidimetric method on a ChronoLog analyzer (USA). Agonists (arachidonic acid, epinephrine, ATP and ADP) were used at EC50 and EC10 concentrations. Statistical analysis was performed using the MedCalc package. Results. After 72 hours of LCT, the activity of the TP receptor, α2-adrenergic receptor and purine P2-receptors of PLT decreased and reached the level of hyporeactivity. Recovery of the activity of P2X1- and P2Y-receptors to the level of normoreactivity was registered after 5 days, while the activity of the α2-adrenergic receptor remained in the range of hyporeactivity. On day 7, α2-adrenergic receptor and P2X1-receptor hyperreactivity developed and P2Y- receptor normoreactivity remained. The effectiveness of compensatory reactions of PLT aimed at limiting hematuria depended on the synergism of functionally active receptors. Conclusion. In women with nephrolithiasis during the administration of non-selective NSAIDs, the spontaneous increase in α2- adrenoreceptor activity is indicative of the lability of the sympathoadrenal system caused by the trafficking of stones in the urinary tract. The limitation of hematuria observed in this case is associated with increased pro- aggregation activity of platelet hemostasis due to synergism of α2-adrenoreceptor and P2-receptors.

The article analyzes the clinical and laboratory features of young men and women with abdominal obesity and metabolic syndrome. The study was carried out on 173 patients of both sexes aged 18-45 years. The patients were divided into 3 groups: group 1 – isolated abdominal obesity (AO); group 2 – combination of abdominal obesity with 1 of the metabolic syndrome components (AO+1); group 3 – metabolic syndrome (MetS). It was found that in young men, the values of carbohydrate (glucose, insulin) and lipid metabolism (HDL cholesterol, LDL cholesterol, triglycerides), insulin resistance indices (HOMA-IR, TyG) in the AO and AO+1 groups were homogeneous. However, the ratio of TG/HDL in the AO+1 group exceeded the value of the AO group. Women in the AO+1 group showed changes relative to the group of women with isolated AO that are hyperglycemia, increased LDL cholesterol, insulin resistance (increased TG/HDL) and dysfunction of visceral adipose tissue (increased VAI). Young men with MetS are characterized by excess body weight, hyperglycemia, dyslipidemia (increased LDL cholesterol and triglycerides), insulin resistance (as measured by TyG and TG/HDL), and dysfunction of visceral adipose tissue. The gender feature of women is the development of MetS on the background of obesity, dysfunction of visceral adipose tissue and insulin resistance in combination with deeper changes in lipid metabolism (increased LDL cholesterol and triglycerides, as well as a decrease in HDL cholesterol).

The purpose of the work is to clarify the criteria for the diagnosis of acute adrenal insufficiency and infectious-toxic shock as the direct causes of death in meningococcal infection. The study is based on a clinical and morphological analysis of 27 archival cases of fatal outcomes of patients with meningococcal infection. Histological examination of the archival preparations stained with hematoxylin and eosin was carried out. The specific volume of capillaries in the lungs, hemorrhages in the medullary and cortical substance of the adrenal glands, necrosis in the cortical and medullary layer of the adrenal glands, as well as preserved adrenal cells were studied quantitatively. According to the results of the study, in Waterhouse- Friderichsen syndrome, hemorrhages involving more than 1/3 of the adrenal cortex lead to fatal cases. In meningococcal infection with the development of infectious-toxic shock, capillaries occupy more than ½ of the volume of the interalveolar septa of the lung. The analysis of specific volumes of hemorrhages in the cortical substance of the adrenal glands and capillaries in the interalveolar septa of the lungs can be used during clinical and anatomical analysis for differential diagnosis of Waterhouse-Friderichsen syndrome and infectious-toxic shock.

 The article discusses the issues of diagnosing autoimmune hepatitis and the importance of timely liver biopsy with histological examination. Due to the lack of specific diagnostic markers and vast heterogeneity of clinical, laboratory and histological features, and also considering relatively rare incidence of the disease, the diagnosis of autoimmune hepatitis can be difficult. Therefore, this review summarises the etiopathogenesis, clinical, serological and histological manifestations of autoimmune hepatitis. Special attention is paid to the different specificity of morphological features such as portal hepatitis, centrilobular necroses, rosette formation, emperipolesis and their significance depending on the presence of laboratory signs of autoimmune hepatitis. Visual examples of morphological manifestations are presented. The article also emphasises the importance of a comprehensive approach to signs and symptoms for the detection of autoimmune hepatitis and differential diagnosis with other liver pathologies: viral hepatitis, drug-induced liver injury, primary cholangitis, and Wilson's disease. Consideration of all available data is crucial in the diagnosis of autoimmune hepatitis.

Analgesic narcotic analgesics are the basis for the treatment of pain syndromes. Russia is undergoing import substitution processes for the production of narcotic analgesics, and appropriate actions are being taken to ensure the growth of the production base of the pharmaceutical industry. The results of a study of the range of opioid analgesics on the Russian market, as well as in the Novgorod region, are presented. The period of regulation based on prohibitions, restrictions, additional responsibilities, which caused certain problems in the quality of pain therapy, is being replaced by a period of greater concern for the needs of patients. The article shows the processes of a significant increase in the release of narcotic analgesics in sufficient quantities and in various dosage forms. The Novgorod region has a sufficient range of analgesic narcotic analgesics in modern dosage forms.

The authors set their goal to study adjuvant therapy in the complex treatment of phthisiopulmonology patients based on the principles of domestic integrative physiology. At the forefront, there are both the physiological issue of the homeodynamic optimum of pro- and antioxidant balance and the issue of existing sulfur-containing antioxidant agents, based on which molecular sulfur shows its ambivalent abilities, namely, to act as a physiologically active donor and acceptor of free electrons. At the same time, the issue of imbalance becomes relevant as the leading cause of redox homeostasis disorders. In the approach taken, the authors discover grounds for putting forward the concept of meso-oxidants. The latter have as their main function the retaining of physiological redox homeostasis, through the constant maintenance of pro- and antioxidant equilibrium. In support of this conclusion, the authors make pharmacodynamic analysis of sulfur medicinal compounds; from the standpoint of integrative science, they provide physiological analogies; and (in relation to sulfur) they attract data from the history of medicine. The final conclusion and solution of the planned task is the recognition of the pharmacological substance acetylcysteine as a leading sulfur-containing meso-(anti)oxidant; and that aims the authors to carry out the second part of the plan that is experimental testing of the put forward scientific hypothesis.