Background. Obstetric pessary comprises one of the methods for treatment of isthmic-cervical insufficiency. Despite the variety of pessaries produced, the common purpose of their use consists in preventing premature birth. Various types of pessaries correct different cervical parameters, which is not always taken into account by doctors when choosing a pessary and reduces their potential effectiveness. Objective. To substantiate a differentiated approach to the selection of pessary type for correcting isthmic-cervical insufficiency and preventing preterm birth based on the evaluation of cervical parameters. Methods. A randomized prospective study enrolled 90 pregnant women diagnosed with isthmic-cervical insufficiency (ICD-10 code — О.34.3) at 19–24 weeks of gestation. Of these, 41 women underwent correction of isthmic-cervical insufficiency with an obstetric unloading pessary and 49 women — with a perforated cervical pessary. Transvaginal ultrasound cervicometry evaluated the parameters of the cervix before correcting isthmic-cervical insufficiency and in dynamics (once every 4 weeks) after inserting various types of pessaries. Statistical data processing was carried out using Statistica 10.0 (StatSoft, Tulsa, USA) and MedCalc 10.2.0.0 (MedCalc, Mariakerke, Belgium). The differences were considered to be statistically significant at p <0.05. Results. Inserting an obstetric unloading pessary in isthmic-cervical insufficiency decreased the uterocervical angle from 115 (110; 130)° to 100 (90; 115)° (p = 0.021). A decrease in the uterocervical angle was observed during 16-week-use of obstetric unloading pessary. After insertion of perforated cervical pessaries, the length of the closed part of the cervical region increased from 23 (21; 24) mm to 25 (21; 27) mm (p = 0.009) for a period of 4 weeks with a subsequent decrease in this parameter. The effectiveness of both types of pessaries in preventing preterm birth was found to be identical. Urgent delivery occurred in 61% of cases of using an obstetric unloading pessary and in 64.7% of cases of using a perforated cervical pessary (p = 0.993). The gestational age at preterm birth against the background of the use of obstetric unloading pessaries and perforated cervical pessaries was found comparable and amounted to 247 (230; 253) days and 245 (225; 254) days, respectively (p = 0.870). Conclusion. A differentiated approach to selecting a type of pessary for the prevention of premature birth in isthmic-cervical insufficiency is determined by the initial ultrasound parameters of the cervix. Thus, an increase in the uterocervical angle serves as an indication for an obstetric unloading pessary, while a shortened part of the cervical region without an increase in the utero-cervical angle determines the use of a perforated cervical pessary. Additional dynamic ultrasound control after inserting pessaries of any type allows such complications as pessary displacement, cervical edema, amniotic fluid sludge, prolapse of fetal membranes in the vagina, and increased myometrial tone to be timely diagnosed and corrected, thereby increasing the effectiveness of using pessaries.

Background. Angiogenesis plays a crucial role in the progression of breast cancer. Identifying and investigating the key components of this process, focused on phenotype as well as microenvironment of the tumor, is considered highly relevant for understanding tumor biology. Studies into the expression of angiogenesis-related factors by means of immunohistochemical methods appear valuable for both assessing conventional chemotherapy options and identifying new targets in targeted therapy for breast cancer. Objectives. To investigate angiogenesis in breast ductal carcinoma by assessing the expression of vascular endothelial growth factor, angiopoietin-2, and hypoxia-inducible factor alpha in the context of various therapeutic strategies. Methods. An observational cohort study was conducted using biopsy samples from female patients with confirmed diagnoses of “fibroadenoma” and “ductal carcinoma of the breast,” residents of the Republic of Crimea, who applied to oncological hospitals in Simferopol from January 2021 to January 2023. Examination involved histological sections of breast tumor tissue from 68 patients with verified diagnoses of “ductal carcinoma” and “fibroadenoma” (the mean age of the patients was 65 ± 5). The following cohorts were formed in the study: control group, consisting of patients with breast fibroadenoma (n = 20); two subgroups of patients with ductal carcinoma of the breast (n = 48), including Group I — patients with ductal carcinoma of the breast who had not received chemotherapy (n = 23), Group II — patients with ductal carcinoma of the breast, who underwent surgery following one or more courses of chemotherapy (n = 25). The study involved examining the tumor tissue sections obtained from paraffin blocks, assessing the expression of angiogenesis markers via immunohistochemistry using primary antibodies against vascular endothelial growth factor, angiopoietin 2, and hypoxia-inducible factor alpha. Statistical analysis was carried out using Statistica 10.0 (StatSoft, USA). Differences were considered significant at error probability p ≤ 0.05. The value of p < 0.05 was deemed statistically significant for all types of analysis. Results. The expression of hypoxia-inducible and vascular growth factors differed significantly between both groups with breast ductal carcinoma as well as when compared to the control group. The hypoxia-inducible factor having cytoplasmic localization was detected in the control group with benign processes, whereas the nuclear expression was noted in the breast ductal carcinoma groups. Significant differences in the nuclear expression of hypoxia-inducible factor have been established among groups of patients with confirmed ductal carcinoma of the breast: in Group II, which underwent chemotherapy, expression was notably higher in both the tumor stroma and in the stroma of tumor-free areas. The hypoxia-inducible factor expression was significantly greater at the demarcation zone than that observed in samples from surgically treated women in Group I (p = 0.033; p = 0.034, p < 0.001, respectively). In the tumor epithelium of patients with breast ductal carcinoma, vascular endothelial growth factor was expressed significantly more intensively in the group who did not receive chemotherapy compared to the other group (p < 0.001). Conversely, in the tumor stroma, angiopoietin exhibited significantly higher expression levels among patients who underwent chemotherapy compared to those who received no treatment; this was observed in both the tumor areas due to endothelial cell involvement (p = 0.004) and in conditionally healthy regions of the breast (p < 0.001). In the control group represented by fibroadenoma patients, the expression of the studied factors is more pronounced than in the groups with ductal carcinoma of the breast. Conclusion. The obtained data indicate the activation of angiogenesis processes in the group of patients after chemotherapy, as evidenced by the increased expression of hypoxia-inducible factor, vascular endothelial growth factor, and angiopoietin. This result is associated with the high prevalence of resistant forms of breast ductal carcinoma in Group II. The study of the signaling pathways of angiogenesis and its components provides valuable insights into patterns of occurrence and strategies to overcome chemotherapy resistance in ductal carcinoma of the breast.

Background. Pathogenesis of cardiac contusion involves primary traumatic and secondary hypoxic mechanisms of myocardial contractile function depression as well as body reactions aimed at adapting to altered environment. A significant part of these reactions is realized in the context of stress. The intensity of the stress component in myocardial dysfunction is largely determined by the individual stress reactivity of the body. Objectives. To assess the contractile function and functional reserves of the myocardium of rats with a high and low level of stress resistance in the post-traumatic period of cardiac contusion. Methods. A preclinical experimental randomized trial involved 134 white mature nonlinear male rats weighing about 270 g. The animals were divided by sequentially performed Open Field and Porsolt Forced Swim tests into 2 groups: group 1 — animals with low stress resistance, group 2 — animals with high stress resistance. Within each group, the animals were randomized into control and experimental subgroups. In the experimental subgroups, 6, 12 and 24 hours after simulating cardiac contusion, the force and rate indicators of myocardial contractility were evaluated using the Fallen isolated heart model. The summary measures of the study included assessing the contractile force and rate of isolated hearts of rats with low and high stress resistance, particularly under conditions of high-frequency rhythm load (ranging from 4.0 to 8.3 Hz) during the post-traumatic period of cardiac contusion. Data analysis was performed using software packages MS Office 2013 (Microsoft Corporation, USA) and Statistica, v. 10 (StatSoft, USA). The differences were considered to be statistically significant at p < 0.05. Results. 6, 12 and 24 hours after simulating a cardiac contusion, contractile force and rate of isolated hearts decreased in group 1 and group 2. In low stress-resistant animals, immediately following the stabilization period and during high-frequency rhythm test, the contractility force and rate in isolated hearts were statistically significantly lower (p = 0.0008) compared to those recorded in highly stress-resistant individuals. During the stimulation of a high-frequency rhythm, isolated hearts in the experimental group revealed diastolic dysfunction at all time points. In highly stress-resistant animals, diastolic dysfunction occurred at a heart rate of 300 min^-1 and above, whereas in low stress-resistant animals, it manifested at a heart rate of 240 min^-1 and above. At the same heart rate, diastolic dysfunction in low stress-resistant animals was statistically significantly greater (p = 0.0008) compared to that of highly resistant animals. Conclusion. The post-traumatic period following experimental myocardial contusion is characterized by a reduction in the force and rate of myocardial contractility, as well as a decrease in functional reserves of the myocardium, regardless of stress resistance. High stress resistance is associated with better preservation of cardiac contractile function and contractility reserves, whereas low stress resistance correlates with a more pronounced degree of myocardial dysfunction and a significant reduction in functional reserves of the contused heart. Differences in the severity of contractile dysfunction under conditions of high and low body resistance to stress can be attributed to varying degrees of secondary myocardial damage in the contused area, resulting from the misbalance between stress-activating and stress-limiting mechanisms involved in the development of secondary damage.

Background. Maintaining and restoring skin microcirculation in surgical flaps, as well as accelerating rehabilitation after skin flap transplantation, in order to mitigate the consequences of burns and injuries, remain a pressing issue. In addition to various timings and techniques for plastic surgery, physiotherapeutic approaches prove to be efficient and include low-intensity electromagnetic radiation in millimeter waves as their prominent techniques. In recent years, experts have paid an increasing attention to the application of low-intensity electromagnetic radiation across different frequency ranges for the enhancement of microcirculation in patients after surgical correction of burn consequences. However, this approach is yet to be further validated. Objective. To investigate the effect of different combinations of ultrahigh frequency electromagnetic radiation with ozone therapy on the oxidative metabolism of blood in rats using a model of ischemic skin flaps. Methods. A preclinical experimental randomized study was conducted on 100 adult male Wistar rats weighing between 200 and 250 grams. Five equal-sized groups of animals were formed in the study: Group 1: intact (no interventions), and Groups 2, 3, 4, and 5: after surgical intervention (modeling of ischemic skin flaps). Animals in Group 2 (control group) received no therapeutic procedures. Rats in Groups 3 and 5 underwent a 10-minute course of electromagnetic radiation exposure with a dose of 0.06 mJ for seven days. Animals in Group 3 were exposed to electromagnetic radiation of ultrahigh frequency with a range of 53–78 GHz. Animals in Group 4 received injections of ozonized saline solution (with a saturating ozone concentration in the ozonized oxygen mixture of 3000 µg/L) daily for 7 days, administered intraperitoneally at a volume of 1 mL. Group 5 underwent a combined treatment: daily exposure to ultrahigh frequency electromagnetic radiation along with intraperitoneal ozone therapy (the application modalities of these treatments were similar to those used in Groups 3 and 4, respectively). The intensity of lipid peroxidation, peroxide resistance in erythrocytes, and overall antioxidant system activity were assessed in order to investigate the balance of pro- and antioxidant systems in plasma and erythrocytes. Additionally, the study involved determination of the level of malondialdehyde content and evaluation of the activity of superoxide dismutase and catalase in erythrocytes. The obtained date were analyzed, using MS Office 2013 (Microsoft Corporation, USA) and Statistica 10 (StatSoft, USA). Results. The conducted analysis revealed an antioxidant effect from ultrahigh frequency electromagnetic radiation, with this effect being enhanced by ozone therapy. In addition, the study detected the inhibition of free radical oxidation under the ultrahigh frequency electromagnetic radiation and ozone therapy. Conclusion. Thus, the positive effects of the studied therapeutic factors manifest at the systemic level, as evidenced by the optimization of biochemical parameters and indicators of oxidative metabolism in the plasma of animal blood. It has been established that ultrahigh frequency electromagnetic radiation, administered in a noise mode, exerts a regulatory effect on pro- and antioxidant systems in the body, as demonstrated in a model of transplanted skin flap. This intervention leads to a reduction in the severity of oxidative stress and an enhancement of antioxidant reserves in the blood. The observed effect is further amplified with the additional application of ozone therapy.

Background. All types of alopecia fall into two main categories: scarring and non-scarring alopecias. Among these, certain types frequently pose challenges in differential diagnosis due to their similar clinical manifestations, thus necessitating specific examinations to be made for confirmation of the diagnosis. For instance, trichotillomania may be easily confused with alopecia areata. Description of clinical cases. The paper presents three clinical observations of patients with both scarring and non-scarring alopecia and highlights the challenges in establishing a definitive diagnosis due to the similarities in clinical presentations. The study emphasized the importance of thorough examination and close attention to patients with long-standing areas of hair thinning, along with the necessity for meticulous differential diagnostic efforts. In addition, the significance of pathological examination is considered as an indispensable tool for the evaluation of most similar cases of scarring and non-scarring alopecias. Conclusion. Early verification of the diagnosis and timely initiation of therapy for hair disorders appear crucial, both for the potential restoration of hair growth and for the prevention of further hair loss.

Background. Acute pancreatitis is recognized as a common disease, occasionally accompanied by the development of local complications that require surgical debridement. Rare complications of pancreatitis may occur in clinical practice, which is one of the reasons for their untimely diagnosis and treatment. Pancreaticopleural fistula and high small bowel obstruction develop in less than 1% of acute pancreatitis cases. Therefore, possible options for management of these complications are considered valuable. Description of clinical cases. The clinical examples, provided in the present paper, describe pancreaticopleural fistula and high small bowel obstruction that develop against the peripancreatic mass in the abdominal cavity. Patient K., 44, was hospitalized to the Regional Clinical Hospital of Emergency Medical Care, Krasnodar Krai, and preliminary diagnosed with bilateral hydrothorax and type II respiratory failure; pleural puncture was performed. Following the extended examination, a clinical diagnosis was made as follows: “Acute necrotic pancreatitis spreading to a pancreatic tail cyst. Reactive double pleurisy”. The postoperative period was indicated with repeated recurrence of right hydrothorax, and pancreaticopleural fistula (diagnosed by measuring amylase activity in the brown fluid effused from the right pleural cavity, which appeared to be 41216 IU/l (not normally determined)). The right pleural cavity and pseudocyst of the pancreatic tail were drained, resulting in obliteration of the pancreatbcopleural fistula. Patient V., 50, was hospitalized and transferred to the surgical department of the Regional Clinical Hospital No. 2, Krasnodar Krai, and diagnosed with “pancreonecrosis, extensive purulent-necrotic peripancreatitis.” The patient underwent puncture-drainage treatment. The postoperative period was complicated by acute small bowel obstruction. Surgical treatment involved Braun enteroesterostomy. The patient recovered. Conclusion. Pancreaticopleural fistula refers to a rare complication of acute pancreatitis, manifested by hydrothorax. Its diagnosis is based on the determination of amylase activity in the effusion. Drainage of the pleural cavity and pancreatic pseudocyst contributes to obliteration of the fistula. The intestinal obstruction, another complication of pancreatitis, requires open surgical treatment when a conservative therapy appears ineffective.

Background. The article discusses the problem of the impact of epidemic diseases on ethnogenesis. As an ancient agricultural ethnic group in contact with nomadic and Mediterranean populations, the Adyghe were formed during periods of frequent epidemics of dangerous diseases caused by the process of animal domestication and subsequent impact of anthropogenic factors. The devastating effect of smallpox and measles pandemics was felt following the establishment of intensive trade exchange during the 2nd century CE by the Roman and the Han empires. The first plague pandemic (beginning with the “Justinianic Plague”, 542–543) mostly affected the Balkans and the Eastern Mediterranean. The second plague pandemic, the so-called “Black Death” (1346–1353), which appeared in the center of the Mongol Empire, quickly spread via caravan routes across most of Eurasia. The scale of the epidemic was influenced by the pathogenic complex that had developed by the 14th century, which included humans, the bacterial pathogenic agent itself, and its carriers (large rodents especially black rats, fleas). Factors such as famine caused by overpopulation, low standards of personal and public hygiene, the prevalence of wooden buildings in cities and towns, the fur trade, etc., also had contributory effects. Objectives. The study set out to identify the natural and the socio-cultural factors that influenced the spread of the plague and the smallpox epidemics in the North-West Caucasus. Methods. The data on which this study is based are formed from collections of narrative sources (Russian, Arabic-Persian, European), archaeological and historical-anthropological works, medical and genetic studies (electronic platforms: eLIBRARY.RU, Academia.edu, CyberLeninka, J-STAGE [Japan Science Technology Information Aggregator, Electronic]). Research methods: historical and comparative, on which basis a comparative analysis of the impact of the plague pandemic of the mid-14th century centering on contact between on nomadic and sedentary ethnic groups (Mongols and Russians, Mongols and Circassians) was carried out; the individualizing comparison method, which was used to identify the specific means by which the Circassian ethnic group overcame the Black Death pandemic; the systems analysis method, on which basis the roles of pathogenic complex and anthropogenic factors in the course of epidemics were compared. Results. The results of the analysis show that the population of the North-West Caucasus were affected by the Black Death plague of the mid-14th century to a significantly lesser extent than the urban centers of the Golden Horde, Rus’ and Europe. The serendipitous failure of the pathogenic complex in the former region was due to the following natural and anthropogenic factors: (1) the North-West Caucasus (more precisely, the entire area to the west of the Teberda River) was naturally bereft of effective carriers of the plague bacillus (marmots, gophers, etc.); (2) Matrega and Copa, the two contemporaneous Circassian towns serving as ports for the shipment of grain and other agricultural products, were located on the periphery of the Adyghe settlement area; (3) the dispersed, farmstead way of life among the estuaries and the complex network of peninsulas of the Kuban Delta, mountains and forests of the NWC contributed to the rapid adoption of quarantine measures; (4) a reliable vitamin-rich nutrition system (sturgeon and their caviar, goat meat and cheese, fruit, honey, etc.); (5) a well-developed system of hygiene and disease prevention (smallpox, malaria), whose existence was retrospectively established based on sources from the 17th–19th centuries. Conclusion. The plague pandemic that took place within the unified space of Mongol imperial communications had a huge impact on the historical fate of the Adyghe ethnic group, which was manifested in their paradoxical numerical growth against the backdrop of general depopulation. Against the backdrop of frequent epidemics, Adyghe developed strict and quite effective rules for preserving life and health, covering disease prevention, personal and public hygiene. Some particularly impressive practices, if not created by Adyghe folk medicine, then preserved there and later transmitted to Ottoman Turkey and Western Europe, was manifested in the original practice of smallpox inoculation.