Introduction. Gestational diabetes mellitus (GDM) is heterogeneous disease that includes several subtypes: subtype with predominant insulin resistance (IR) and subtype with predominant dysfunction of β-cell of pancreas. It was revealed that pancreatic cells express a gap junction protein, connexin 36, and gap junctions containing this protein normally coordinate the pulsating dynamics of Ca ²⁺ and the release of insulin, and disruption of this process may be one of the pathogenetic mechanisms of GDM.

The aim of work was to study distribution of connexin 36 in pancreatic tissue when modeling various subtypes of GDM in rats.

Materials and methods. Prospective study was conducted on white nonlinear rats: 50 females and 15 males. Female rats were divided into 3 groups: I — 15 pregnant rats (control); II — 12 pregnant rats (pancreatic β-cell dysfunction); III — 12 pregnant rats (IR). All rats underwent histomorphological examination on paraffin sections using primary rabbit polyclonal antibodies to connexin 36 (Invitrogen, USA).

Results. In study of pancreatic samples of group III, a sharp decrease in level of connexin 36 expression was noted. In samples of group II, it was revealed that in endocrine regions of gland, membrane reaction between cells is negative. Morphometric examination revealed a significant decrease in both the specific density of immune complexes and their average area in groups III and II (p < 0.050).

Discussion. An immunohistochemical study of the distribution of connexin 36 indicates a decrease in electrotonic connectivity through gap contacts both in model of GDM subtype with predominant IR and pancreatic beta-cell dysfunction.

Conclusion. Results obtained suggest that reduction of connexin 36 may accompany development of pathogenetic mechanisms of GDM.

Introduction. The cause of muscle contractures in patients with cerebral palsy is not fully understood.

The aim of the study was to study the pathomorphological changes in the gracilis muscle (musculus gracilis) to determine the most effective strategy for treating contractures depending on the level of movement disorders in patients with cerebral palsy.

Materials and methods. Patients (n = 24) were divided into three groups according to the Gross Motor Function Classification System (GMFCS) scale. Histological examination of m. gracilis was performed, morphometric parameters were assessed.

Results. Myopathy of varying severity was detected in patients. In GMFCS II–III, an inverse statistical relationship was found between the percentage of muscle tissue in micropreparations and the Quetelet body mass index. In children of GMFCS IV and V, a negative correlation was recorded between the proportions of contractile and connective tissue in histological sections.

Discussion. Changes in m. gracilis are due to spastic syndrome. Interventions on the tendon-muscle apparatus do not affect the functional abilities of children with cerebral palsy.

Conclusions. The pathomorphological picture of the sections of m. gracilis corresponds to myopathy, the severity of which depends on the severity of motor limitations of children with cerebral palsy. Shortening of sarcomeres in myofibrils of m. gracilis is one of the reasons for the formation of adduction contractures of the hip joints in patients with cerebral palsy. Therapeutic and surgical interventions on the tendon-muscle system do not increase the muscle strength of children with cerebral palsy and do not affect their functional abilities.

Justification. Colonoscopy and polypectomy significantly reduce the risk of colon cancer. A follow-up colonoscopy performed after a polypectomy is an important method of monitoring patients with colorectal polyps.

The aim of the study was to evaluate the role of a district therapist in the prevention of colon neoplasms based on the results of a study of groups of patients who were examined as part of a follow-up.

Materials and methods. 322 patients underwent colonoscopy, of which 200 patients underwent follow-up colonoscopy.

Results. In the group with colon polyps (n = 148), a control colonoscopy was performed in 52/93 (55.91 %) patients after polypectomy — in 15/52 (28.85 %) colorectal polyps were found again; 41/55 (74.55 %) in the patient who refused polypectomy — in all 41/41 (100 %) polyps were found (p < 0.001). In patients after polypectomy, new localization of colon polyps was significantly more common and their morphological pattern changed significantly more common than in those who refused surgery (p = 0.017 and p = 0.031, respectively).

Conclusion. A follow-up colonoscopy is an important stage in the follow-up of patients with colon polyps. Dynamic colonoscopy is necessary for patients both after polypectomy and without surgical treatment of colon polyps for their early diagnosis and removal, as well as, as a result, the prevention of colorectal cancer.

Introduction. The number of people with severe multicomminuted fractures of the distal humerus is increasing every year. This trend has a negative impact on the outcomes of treatment of such fractures, which confirms the urgency of the problem of providing care to patients with intra-articular fractures of the distal shoulder.

Materials and methods. The results of treatment of 217 patients, 2001–2022: the control group was retrospective data of 137 cases with fractures of the humerus, the main group was 80 patients treated using innovative developments.

Results. Innovative developments in elbow joint surgery, including a new device for bone fragment reposition, an external fixation device for elbow joint, and a transosseous access method, have been introduced into clinical practice. These developments have improved the treatment outcome and reduced the number of complications during transosseous osteosynthesis from 16.67 % to 5.56 %.

Discussion. Factors affecting postoperative elbow joint functionality include fracture complexity, choice of fixation technique, and choice of surgical approach. The method allows to avoid total elbow joint endoprosthetics, providing clinical results without significant limitation of activity and to ensure anatomical restoration of the articular surface and functions. To reduce the risk of complications, an integrated approach has been developed, including optimization of diagnostics, treatment, and rehabilitation.

Conclusion. The use of advanced methods for optimizing surgical treatment of patients with fractures of the distal humerus allows to improve the results of medical rehabilitation, increasing the effectiveness of treatment and reducing the number of complications.

Introduction. The question of the effect of lipids on the risk of venous thromboembolism (VTE) currently remains open and debatable. The effect of dyslipidemia on the risk of arterial and venous thrombosis is currently being studied.

The aim of the work was to evaluate the parameters of the blood lipids of patients with pulmonary embolism (PE) in the acute period and 1 year after the episode.

Materials and methods. A prospective cohort study of lipids — total cholesterol (TCH), low-density lipoproteins (LDL-C), high-density lipoproteins (HDL-C), triglycerides (TG), apolipoproteins A1and B (ApoA1 and ApoB) — was conducted in patients in the acute period PE and after 1 year of follow-up.

Results. Patients with PE in the acute period have initially normal levels of THC, LDL-C, TG, ApoA1, ApoB, and low levels of HDL-C. After 1 year of follow-up, the levels of THC, LDL-C, TG, and ApoB exceed normal values, dyslipidemia is detected due to the predominance of LDL-C, and HDL-C levels return to normal.

Discussion. Determination of the blood lipids initially and over time allows monitoring changes in the concentration of lipids and correcting dyslipidemia to reduce cardiovascular risk.

Conclusion. In the acute period of PE, normal levels of THC, LDL-C, TG, ApoA1, ApoB are noted, but lower in comparison with patients without a history of VTE, low levels of HDL-C. After a year of follow-up, hypercholesterolemia, dyslipidemia due to LDL-C, TG, and ApoB are detected, which creates a cardiovascular risk in these patients and requires correction.

Introduction. Improving the medical care for parturients in different age groups, taking into account complications of pregnancy, childbirth and postpartum period is one of the main tasks of modern obstetrics within the framework of the “Midwifery 2030” program.

The aim of study is to identify and conduct a comparative analysis of the course’s features of pregnancy and childbirth in different age groups of women.

Materials and methods. The retrospective analysis of 400 womens’ histories of the Sverdlovsk Region aged 16– 49 years was conducted. The women were divided into 4 groups. The work included a comparative analysis of the following identified: 10 pregnancy, 9 childbirth complications and 6 additional parameters.

Results and discussion. A direct connection between specific complications and the patient’s age was established, mechanisms for the development of pathological processes were proposed taking into account age-related changes. There is an increase in the incidence of cesarean sections in the direct proportion to the patient’s age. Under 20 years, exacerbations of kidney pathologies during pregnancy, injuries of the genital tract during childbirth, predominate. Over 30 years, gestational diabetes mellitus and arterial hypertension predominate, childbirth often occurs with the development of bleeding. The age of 21–30 years is accompanied by lower percentage of complications and is the most favorable for pregnancy and childbirth.

Conclusion. The pregnancy and the childbirth at 20–30 years old is accompanied by the least number of complications. Complications typical for pregnant under 20 and over 30 years of age have a number of significant differences.

Introduction. In certain cases, pediatric hand fractures may require surgical intervention, including open reduction, which is associated with an elevated risk of postoperative scar formation.

The aim of the study is to substantiate the feasibility of incorporating anti-scar therapy with а gel containing cepalin, heparin, and allantoin into the comprehensive rehabilitation of pediatric patients following surgical treatment of hand fractures.

Materials and methods. The prospective non-randomize study included 28 pediatric patients aged 5 to 17 years who underwent open reduction and fixation for hand fractures. The participants were divided into two groups: the main group (n = 15) received topical scar therapy with а gel containing cepalin, heparin, and allantoin for a period of 6 months, while the control group (n = 13) underwent standard rehabilitation without any targeted scar treatment. The condition of post-operative scars was assessed using the Manchester Scar Scale (MSS) at 6 weeks, 3 months, and 6 months postoperatively.

Results. In the main group, positive dynamics were observed across all scar characteristics, with statistically significant changes recorded for the “tissue tension” parameter — from (1.20±0.68) points at week 6 of follow-up to (0.53±0.52) points after 6 months (p = 0.009). Differences between the main and control groups reached statistical significance at the 6-month mark for the parameters “surface relief ” (0.60 vs. 1.00; p = 0.038) and “tissue tension” (0.53 vs. 1.31; p = 0.001). The difference in the total MSS score between the groups also reached statistical significance after 6 months (3.93 vs. 5.62; p = 0.007).

Conclusion. The application of а gel containing cepalin, heparin, and allantoin is associated with a reduction in scar-related changes across multiple parameters, thereby supporting its integration into comprehensive rehabilitation protocols for pediatric patients following surgical treatment of hand fractures.

Introduction. Non-communicable diseases (NCDs) continue to be one of the leading causes of death and disability both in the world and in Russia, while occupying a significant share in the structure of mortality rates — 74 % and 80 %, respectively.

The aim of the study was to study the structure and dynamics of mortality rates of the population from priority groups of NCDs in Russia in a multi-year perspective for 2010–2022.

Materials and methods. For the epidemiological study we used data from various materials, Ministry of Health, Rospotrebnadzor and Rosstat on mortality and morbidity of NCDs by main classes, groups and socio-demographic indicators for 2010–2022.

Results. According to the values of mortality rates in the overall mortality structure of the population of Russia over a number of years (2010–2022), the main share was made up of NCDs, primarily diseases of the circulatory system, neoplasms, diseases of the digestive and respiratory organs.

Discussion. In 2022, 68.4 % of deaths were due to NCDs, most of which were related to diseases of the circulatory system (43.8 %) and neoplasms (14.8 %). The priority of the listed groups of NCDs was also observed in the long-term dynamics (2010–2022) of mortality rates in Russia: diseases of the circulatory system (38.3–56.8 % of all deaths), neoplasms (11.6–16.6 %), diseases of the digestive system (4.5–5.5 %) and respiratory diseases (3.3–4.7 %). In terms of gender, according to the mortality rate, men of working age died from NCDs 3.1–3.7 times more often than women.

Conclusion. NCDs remain the leading cause of death in Russia, primarily among the working-age population, requiring increased measures to prevent cardiovascular diseases, neoplasms, and diseases of the digestive and respiratory organs in particular.

Background. Hypertensive disorders during pregnancy remain one of the leading causes of maternal and perinatal morbidity and mortality. These conditions require timely diagnosis to prevent severe cerebral complications.

The aim of the study was to determine the nature of the relationship between the severity of hypertensive disorders in pregnant women and sonographic changes in optic nerve parameters.

Materials and methods. 80 pregnant women were examined, divided into 4 study groups: patients with normal pregnancy (n = 20), with gestational hypertension (n = 20), moderate (n = 25) and severe preeclampsia (n = 15). A comprehensive ophthalmological examination was performed, including ultrasound optic nerve examination with the determination of scleral canal diameter (SCD), optic disc height (ODH), optic nerve diameter (OND) and optic nerve sheath diameter (ONSD).

Results. А direct relationship of noticeable strength was found between ODH with OND, as well as with ONSD. An inverse correlation of noticeable strength between ODH and SCD has been revealed. With ODH >0.5 mm and OND >2.6 mm, the risk of developing severe preeclampsia increases by more than 2.5 times. With ONSD >5.7 mm, the risk of developing severe preeclampsia increases by more than 7 times.

Conclusion. A close relationship has been established between ultrasound parameters of the optic nerve and the risk of preeclampsia. ODH has a direct relationship with ONSD and OND. The discovered inverse relationship between ODH and SCD limits the isolated use of ultrasound values of ODH as an instrumental marker of preeclampsia severity.

Introduction. Biomedical implants in present time are under active research. Titanium nickelide (NiTi) is alloy widely uses for its properties. Despite the advantages of NiTi, its use is limited by the potential risks associated with abnormal tissue reaction. Therefore, significant efforts are being made to improve the biocompatibility of NiTi and reduce its toxicity.

The purpose of the study is to research potential changes in hematological parameters, to assess acute, subacute and chronic toxicity that may be associated with NiTi-silver (Ag) alloys.

Materials and methods. The study was conducted as part of an open, randomized, controlled experiment lasting 9 months. The object of study was samples of NiTi powder with Ag addition. NiTi powder without the addition of Ag was used as a control. The study of acute, subacute, subchronic, chronic toxicity and hematological profile in particular, were conducted.

Results. When assessing the condition of laboratory animals after conducting a test to determine acute systemic toxicity, animal deaths and adverse clinical signs were not recorded in any group of animals during the entire observation period. To study the potential for subacute toxicity, a general blood test was performed, and the potential anti-inflammatory activity of the implant was noted.

Conclusion. Assessment of acute, subacute, subchronic and chronic toxicity of NiTi revealed no signs of animal death or pronounced clinical symptoms indicating a general toxic effect after surgery. As a result of the dynamic assessment parameters of the blood, no changes characteristic of the toxic effect of the alloy on hematopoiesis were detected.

Background. One of the main criteria for the severity of the condition of patients with cystic fibrosis is the bacterial composition of bronchial secretions; in this regard, regular monitoring of the microbial landscape and rational use of antibacterial therapy in this category of patients are necessary.

The aim of the study is to assess the impact of CFTR modulators on the respiratory microbiome and the need for antibacterial therapy in children with cystic fibrosis.

Materials and methods. From November 2023 to May 2024, an open prospective study compared 46 children with cystic fibrosis (ages 2–17), including 26 on elexacaftor/tezacaftor/ivacaftor and 20 without CFTR modulators. Microbial composition and antibiotic therapy use were evaluated over 6-month pre- and post-study initiation.

Results. The use of CFTR modulator contributed to a decrease in the duration of ABT courses (p = 0.000), while the absence of therapy, on the contrary, led to an increase in the duration of ABT courses (p = 0.003). No significant differences in the frequency of detection of individual bacterial groups between the groups were found over time. A tendency toward an increase in the amount of bacterial DNA (p = 0.099) was found in patients who didn’t take the CFTR modulator. An increase in the concentration of Enterobacteriales was found in patients without targeted therapy during 6 months of observation (p = 0.005).

Conclusion. CFTR modulator therapy significantly reduced ABT needs in cystic fibrosis children. Although no major differences in microbial detection frequencies were found, PCR identified clinically relevant bacterial colonizations: Staphylococcus aureus, Pseudomonas aeruginosa, Haemophilus influenzae.

Introduction. Caudal anesthesia does not always provide satisfactory blockade and has contraindications, which sets goal of searching for new methods of inguinal canal zone blockades.

The aim of the study to assess effect of spermatic cord blockade on central hemodynamics, serum cortisol levels; to evaluate intraoperative and postoperative analgesia in children operated for orchidopexy.

Materials and methods. Prospective non-randomized study was conducted, which included 26 children aged 1 to 17 years, who underwent unilateral orchidopexy. Modified spermatic cord block was performed. Acid-base balance, serum cortisol, central hemodynamic parameters using bioimpedance rheography method, qNOX index using Conox monitor were examined. Postoperative pain syndrome was assessed by FLACC, Wong-Baker, and visual analogue scale depending on age.

Results. Significant decrease in cortisol levels was detected at the time of testicular traction (p < 0.050); according to acid-base balance analyses no significant changes were found. At each stage of surgical intervention statistically significant decreases were detected in mean arterial pressure, stroke volume, total peripheral vascular resistance, and oxygen delivery index (p < 0.050). qNOX index did not increase in response to pain stimulation. Score on postoperative analgesia scales did not exceed 2 [2; 4] points in patients after 1 hr., after 3 hr.— 2 [0; 4], after 6 hr.— 2 [0; 3]; after 12 and 24 hr. — 0 [0; 4] and 0 [0; 0].

Conclusion. Use of a modified spermatic cord block provides effective intraoperative analgesia, reduces body’s stress response to surgery and causes a moderate decrease in central hemodynamic parameters in patients.