Aim. To compare the expression of genes involved in energy metabolism in different types of endothelial cells (ECs) modeling the components of coronary artery bypass system (the grafted artery, arterial conduit, and venous conduit). Materials and Methods. We conducted a whole transcriptome sequencing of intact primary human coronary artery endothelial cells (HCAEC), human internal thoracic artery endothelial cells (HITAEC), and human saphenous vein endothelial cells HSaVEC) (n = 4 cultures per EC type) following 24-hour culture in a serum-free medium). Bioinformatic analysis was conducted using the Gene Ontology (GO) database for the following molecular categories: cellular car bohydrate metabolic process (GO:0044262), carbohydrate catabolic process (GO:0016052), ribonucleoside monophosphate biosynthetic process (GO:0009156), Purine ribonucleotide catabolic process (GO:0009154), mitochondrial outer membrane (GO:0005741), aldehyde dehydrogenase (NAD+) activity (GO:0004029), proton-transporting ATP synthase activity, rotational mechanism (GO:0046961), tricarboxylic acid cycle (GO:0006099), and oxidative phosphorylation (GO:0006119). Fold changes in gene expression were calculated for HCAEC, HITAEC, and HSaVEC relative to each other. Results. HCAEC and HITAEC had sig nificantly higher expression (fold change ≥ 2,00) of PPP1CB, HPRT1, ACAT1, CYP27B1, MTX3, MTX2, CYB5A, ALDH7A1, ATP6V1C1, SDHD, NDUFA1, COX6C, COX4I1, and NDUFB5 genes and signifi cantly lower (fold change ≤ 0,50) expression of FBP1, PFKFB2, AL DOC, NDUFS8, and NDUFB11 genes in comparison with HSaVEC. HCAEC had significantly higher expression of OGDH, NDUFS8, and NDUFB11 genes and significantly lower expression of PPP1CB, MTX3, MTX2, CYB5A, SDHD, COX6C, COX4I1, and NDUFB5 genes in comparison with HITAEC. HCAEC had significantly higher expression of FBP1, PFKFB2, ALDOC, and CYP27B1 genes in comparison with HI TAEC and HSaVEC. Conclusion. Expression of genes involved in energy metabolism signaling pathways significantly differs among HCAEC, HITAEC, and HSaVEC, which represent model components of coronary artery bypass system. This reflects endothelial heterogeneity not only be tween HITAEC and HSaVEC (modeling arterial and venous conduits) but also between HCAEC (modeling the endothelium of the grafted artery) and HITAEC (modeling the endothelium of the arterial conduit).

Currently, research into the pathogenesis of bronchial asthma focuses primarily on immune inflammation and airway remodeling. Both the immune and nervous systems are involved in the development of airway inflammation. Neurotrophic factors, particularly neurotrophins, are expressed by both neuronal and non-neuronal cells. In the lungs, neuro trophins are expressed by epithelial cells, alveolar and interstitial macrophages, eosinophils, and lymphocytes. Disruption of the relationship between nerve, epithelial, and immune cells in the lungs may play a significant role in the pathophysiological changes associated with bronchi al asthma. Aim. The aim of this study is to systematize current knowledge about the neuroimmune mechanisms of bronchial asthma and the role of neurotrophins in mediating the interactions between immune, epithelial cells, and neurons involved in the development of bronchi al hyperreactivity, eosinophilic inflammation, and airway remodeling. Materials and Methods. A narrative literature review was per formed, encompassing 97 publications from 2016 to 2025, to examine the interactions between neurotrophins, immune cells, epithelial cells, and neurons in asthma. Results. Both allergic and non-allergic asthma share an identical inflammatory response mechanism, which is driven by the production of leukocyte-derived, epithelial-derived, and neuro genic mediators and ultimately leads to airway remodelling. The paper discusses the interplay between airway immune inflammation and nervous system activity in a feedback-loop manner. On the one hand, parasympathetic, sympathetic, and sensory neurons act via ILC2-expressed receptors to induce contraction or relaxation of bronchial smooth muscle cells and to trigger or suppress Th2-type inflammation. On the oth er hand, mediators secreted by immune cells stimulate neurons to produce neurotrophins and neuropeptides. Cell survival capacity depends on the number and profile of receptors for neurotrophic factors. The article outlines the currently known pathways of neurotrophin interactions with the nervous and immune systems. Conclusion. The need for further research to elucidate the possibility of regulating neuroimmune disorders is substantiated.

Aim. To assess the dynamics of regression of post-stroke aphasia and dysarthria and their impact on the rehabilitation process in patients in the acute period of stroke. Materials and methods. 718 patients (median age 68.5 (61.0; 76.0)) in the acute phase of stroke were examined. Upon admission and discharge from the hospital, assessments were made using the Wasserman, Barthel, Rankin, and NIHSS scales, the increase in scores from the first day after the onset of stroke to discharge was determined, the duration of inpatient treatment was as sessed. Results. The patients were divided into 3 groups: 246 without speech disorders, 226 with aphasia and 246 with dysar thria. The increase in the Wasserman scale score during the period of hospitalization was higher in cases of dysarthria, while aphasia demonstrated a slower regression (р = 0,0001). The lowest level of NIHSS score increase was observed in patients with aphasia, the highest – with normal speech (p = 0.001). In the group with dysarthria, there were no statistically significant dif ferences when compared with the group without speech pathology (p = 0.241). The increase in the Barthel scale scores in patients with aphasia was significantly lower than the data for the other groups: p = 0.001 when compared with patients without speech disorders and p = 0.007 when compared with the dysarthria group. When comparing the score increase in patients with out speech disorders and with dysarthria, statistically significant differences in the Barthel index were not revealed (p = 0.116). The highest increase in Rankin scores was observed in patients with normal speech, slightly higher in patients with dysarthria, and the lowest increase in patients with aphasia (p = 0.0001). Patients with aphasia had the longest hospitalization periods, while patients without speech pathology spent the shortest time in hospital. In patients with dysarthria, hospitalization periods were al so prolonged, but less significantly than in those with aphasia (p = 0.0001). Conclusion. Speech dysfunction in post-stroke dysarthria regresses faster compared to aphasia. Post-stroke dysarthria and aphasia negatively impact the rehabilitation pro cess, reducing the patient's functional capabilities and prolong ing hospital stays. The presence of aphasia hinders the expan sion of daily activities and delays the recovery of neurological impairments during the acute phase of stroke. Dysarthria does not significantly impact the recovery dynamics as measured by the NIHSS and Barthel scales.

Aim. To assess lipid profile disorders in obese individuals working in the coal mining industry. Materials and methods. A study was conducted involving 209 male miners, divided into groups based on the presence and severity of obesity. Key cardiovascular risk factors (CVRF) were studied, including lipid metabolism disorders and ceramide profile. Dyslipidemia (DLP) refers to conditions in which the concentration of blood lipids and lipoproteins is higher or lower than reference values. Obesity was assessed using the body mass index (BMI). To study the features of ceramide metabolism, the levels of 15 ceramides (Cer d18:1) with different carbon chain lengths of the fatty acid fragment were compared. Results. The prevalence of obesity was 24.9 % and was represented by grade I (80.8 %) and grade II (19.2 %). DLP was verified in 64.1%. Individuals with obesity demonstrated a significantly unfavorable clinical profile, having a statistically higher level of systolic and diastolic blood pressure (p = 0.002), higher blood glucose concentration (p < 0.001), higher incidence of arterial hypertension (63.5 % vs. 36.9 %, p < 0.001) and hyperglycemia (32.7 % vs. 15.3 %, p = 0.006), as well as statistically significant deviations in the lipid spectrum due to higher concentrations of total cholesterol (TC) (p = 0.002), triglycerides (TG) (p = 0.041), very low-density lipoprotein cholesterol (VLDL-C) level (p = 0.041), a higher proportion of individuals with hypercholesterolemia (HC) (p = 0.023) and elevated levels of apolipoprotein B (ApoB) (p = 0.014). Other indicators also showed an unfavorable profile in individuals with obesity when assessing lipid concentrations and the incidence of DLP, although the differences did not reach statistical significance. Comparative analysis of ceramide concentrations showed a significantly lower concentration of Cer d18:1/17:0 in individuals with obesity (p = 0.043). Correlation analysis revealed an association between BMI and the level of TC, ApoB, TG, VLDL-C, lipoprotein (a) and high-density lipoprotein cholesterol (HDL-C). Principal component analysis confirmed the association of obesity not only with age, but also with the duration of work in the profession of respondents with various variants of DLP. Conclusion. Obesity and DLP are common CVRF among miners. HC and elevated ApoB levels are the most common variants of DLP. A statistically significant decrease in the concentration of Cer d18:1/17:0 was found in individuals with obesity. The most unfavorable clinical and lipid profile was observed among individuals with obesity compared to respondents without obesity. The results of the principal component analysis demonstrated the association of obesity with lipid metabolism disorders in coal industry workers, taking into account not only the age of the respondents, but also the length of service in the profession.

Fetal distress is the most common cause of stillbirth, hypoxic ischemic encephalopathy, cerebral palsy, and neonatal mortality. Fetal distress requires emergency operative delivery, which may be accompanied by an increase in obstetric complications. Aim. To evaluate the prognostic value of the comprehensive assessment of standard parameters from the first screening and amniotic fluid volume at 11–13+6 weeks of pregnancy for risk stratification of emergency operative delivery due to fetal distress. Materials and methods. The pilot observational study of 103 pregnant women was conducted, beginning at 11–13+6 weeks of gestation and ending immediately after delivery. The study was observational and included not only standard first trimester screening but also amniotic fluid volume assessment. Two groups were formed based on the delivery outcome: 82 pregnant women were assigned to the control group, while 21 patients in the study group underwent operative delivery due to fetal distress. Binary logistic regression was used for risk stratification. The predictive ability of the model was assessed using ROC analysis and the Hosmer-Lemeshow test. Results. Univariate analysis revealed the trend toward differences between the study groups at 11–13+6 weeks of gestation for the following parameters: nuchal translucency thickness (p = 0.17), standardized amniotic fluid volume (p = 0.1), and free beta-subunit human chorionic gonadotropin level (p = 0.22). The binary logistic regression model including these potentially significant parameters demonstrated significant statistical significance (ROC-AUC = 0.722 ± 0.067 [95 % CI 0.591–0.854], Se = 68.4 %, Sp = 72.5 %, p = 0.003). Conclusion. The model integrating assessment of fetal nuchal translucency, free beta human chorionic gonadotropin levels, and the ratio of amniotic fluid volume to gestational age during the first screening has sufficient prognostic value and can be used to stratify the risk of emergency cesarean delivery in patients with fetal distress.

A systemic inflammatory response plays a significant role in the pathogenesis of preeclampsia, with endotoxin, a lipopoly saccharide produced by gram-negative microorganisms, being the putative trigger. Gram-negative microflora of the intestine, urinary tract, and oral cavity may be the source of endotox in. Aim. To assess urinary endotoxin levels and their relation ship with bacterial counts and proteinuria in pregnant women with varying degrees of preeclampsia severity. Materials and methods. A cross-sectional cohort study was conducted, including 105 pregnant women: 30 with severe preeclampsia, 35 with moderate preeclampsia, and 40 without hypertensive syndrome. All women delivered by cesarean section for obstetric and medical indications. Urinary endotoxin levels were as sessed by their activity in the LAL assay using a chromogenic endpoint method. Urine cultures were performed on Uriselect-4 Agar, Columbia Agar with 5% Blood, Sabouraud Agar, Yolk Salt Agar, and Thioglycollate Medium. Species identification of the isolated bacteria was based on the morphological, cultural, and biochemical properties of the isolated strains and confirmed by mass spectrometry. Statistical analysis was performed using StatTech v. 4.10.2 (developed by StatTech LLC, Russia). Results. Endotoxinuria levels significantly correlated with the severity of preeclampsia: the highest endotoxin activity was found in pregnant women with severe preeclampsia (0.21 EU/ml, p < 0.001), while the lowest was found in pregnant women with out hypertensive syndrome (0 EU/ml). A significant correlation was found between proteinuria levels and urinary endotoxin activity (ρ = 0.572, p < 0.001), which can be explained by a direct damaging effect on the kidneys. No correlation was found between endotoxinuria levels and urinary bacterial counts, in cluding gram-negative bacteria: bacterial growth was noted in 25% of samples from pregnant women with severe preeclampsia. Conclusion. Endotoxin likely plays a role in the pathogen esis of preeclampsia, given that endotoxinuria levels correlate with preeclampsia severity. Moreover, the source of endotoxin is not gram-negative bacteria in the urinary tract.

Premature rupture of membranes (PROM) is defined as the rupture of the amniotic sac before the onset of labor and occurs in approximately 8% of pregnancies worldwide. Despite its high prevalence, the etiology of this condition remains unclear. The leading etiological theory currently implicates infection. Risk factors for PROM at full term have been assessed in numerous studies; however, they vary depending on the population studied. This article examines the risk factors for PROM in a population of women living in a large industrial city. Aim. To study risk factors for premature rupture of membranes in women with a gestational age of more than 37 weeks. Materials and Methods. A retrospective case-control study was conducted involving 200 women. The first group consisted of 100 women who gave birth to preterm premature rupture of membranes at 37-41+6 weeks' gestation, while the second group consisted of 100 women who delivered normally and with timely rupture of membranes. The study was conducted using data extracted from birth records and individual patient records. Statistical analysis was performed using StatTech v. 4.10.4 (developed by StatTech LLC, Russia). Differences were considered statistically significant at p < 0.05. Results. The study identified 18 reliable risk factors for premature rupture of membranes. The most significant risk factors for premature rupture of membranes were infectious (acute respiratory viral infections in the first trimester, vaginal infections before 12 weeks, and a history of STIs), anamnestic (infertility, history of intrauterine surgery), and obstetric complications of pregnancy (threatened miscarriage, gestational anemia, gestational diabetes, preeclampsia). Conclusion. The analysis demonstrates that the risk factors identified in the study are characterized by significant heterogeneity and cannot be explained within a single etiopathogenetic framework. Current scientific research predominantly emphasizes the infectious theory in the development of premature rupture of membranes. However, clinical conditions such as gestational anemia, gestational diabetes mellitus, and preeclampsia cannot be fully explained by this theory alone. Therefore, the pathogenesis of premature rupture of membranes remains unclear and requires further comprehensive interdisciplinary research.

Couvelaire's uterus (uteroplacental apoplexy) is a rare but life-threatening complication of premature placental abruption, characterized by diffuse blood permeation of the myometrium and a high risk of massive obstetric hemorrhage. A clinical case of a 20-year-old female patient with antenatal fetal death at 33 weeks of gestation due to premature placental abruption is presented. Ultrasound revealed a retroplacental hematoma. An emergency cesarean section was performed. Couvelaire's uterus was diagnosed intraoperatively: blood permeation of the anterior uterine wall with petechial hemorrhages was noted. Despite significant morphological changes, myometrial contractility was preserved, bleeding was controlled, allowing for organ-preserving treatment using compression sutures and balloon tamponade. Postoperatively, the patient was diagnosed with severe preeclampsia, requiring intensive care, including blood transfusion. Following treatment, her condition stabilized. She was discharged in satisfactory condition with preserved reproductive function. This clinical case demonstrates that even in the presence of a couvelaire uterus, organ-preserving interventions are possible, provided hemodynamic stability and preserved uterine contractility are maintained. An individualized approach, timely diagnosis, and multidisciplinary management are key factors in achieving a successful outcome. Avoiding routine hysterectomy in such situations reduces surgical morbidity and preserves the reproductive potential of patients.

The resistance of microorganisms to antimicrobials is an important cause of adverse outcomes of infectious diseases. It is important to study various aspects of the epidemic process of the spread of resistant strains of microorganisms. Аim. To evaluate the possible role of various patient-related factors in the development of Streptococcus pneumoniaе resistance to groups of antibacterial drugs in adult patients with community-acquired pneumococcal pneumonia. Materials and methods. The design is "case-control" study. The antibacterial drug resistance profile for Streptococcus pneumoniae isolates isolated from the sputum of 311 adult patients with community-acquired pneumonia caused by Streptococcus pneumoniae was evaluated from September 1, 2020 to April 06, 2025 in Kazan.  The association with the isolation of antibiotic resistant strains was analyzed for the following factors: patient's gender, age over 65 years, presence of concomitant chronic diseases, indications of surgery and hospitalization during the 1 year preceding this disease, taking inhaled glucocorticosteroids and/or systemic glucocorticosteroids and/or chemotherapy, presence of a harmful chemical factor at work, activity related to contacts with a large number of people at the place of work or study, the presence of cohabiting,  selection of biological material from the patient on the 2nd day of hospitalization and later, a month of analysis selection, residence in a certain area of Kazan. Regression analysis (univariate and multifactorial) was performed with the calculation of the odds ratio (OR) and 95 % confidence intervals. Results. According to the results of a multifactorial analysis, the male sex of the patient (aOR = 0.11, 95 % CI 0.02−0.89, p = 0.02) and the presence of cohabitation with the patient (aOR = 0.1, 95 % CI 0.01−0.95, p = 0.045) were associated with a lower risk of isolation of levofloxacin resistant Streptococcus pneumoniae strains. Examination on the 2nd day of hospitalization and later significantly increased the probability of detecting penicillin-resistant (aOR = 3.27, 95% CI 1.32−8.09, p = 0.01) and erythromycin-resistant (aOR = 3.3, 95 % CI 1.28−8.54, p = 0.014) strains of pneumococcus. Our study did not reveal a relationship between age, concomitant diseases, previous hospitalizations, and occupational characteristics with the presence of resistance of pneumococcal strains isolated from patients with community-acquired pneumonia to antimicrobial agents. Conclusion. Significant factors of pneumococcal resistance to certain groups of drugs were: the time of taking the material for examination (day of hospitalization), gender, the absence of cohabitants.

Aim. Improving the system of HAI prevention in patients with ACA. Materials and methods. A descriptive, comprehensive, single-center, retrospective analytical epidemiological case-control study was conducted at a specialized medical care center for patients (n = 1240) with circulatory system diseases (CSD) over the period from 2019 to 2025. To assess the effectiveness of the implemented preventive measures, an analysis of checklists was carried out (n = 344); 31 parameters were analyzed in each checklist. Results. During the study, the algorithm for preventive measures aimed at reducing the risk of HAIs in patients with ACA was modified and optimized. The preventive measures were systematized into an integrated model across three key areas of medical technology safety: prevention of lower respiratory tract infections (LRTIs), prevention of skin and soft tissue infections (11 measures in each category), and prevention of catheter-associated urinary tract infections (CAUTI) – 9 measures. The total volume of the preventive measures package amounted to 31 items. The audit and effectiveness evaluation of the implemented system demonstrated a statistically significant reduction in HAI incidence by 41.12 % (OR = 5.15; 95 % CI [3.63–7.39], p < 0.0001). Positive changes were evident in every HAI category; the magnitude of reduction varied between 1,26- and 7,76-fold. Conclusion. The demonstrated high efficiency of the improved HAI prevention system in ACA patients makes it possible to recommend its implementation as a standard of preventive measures in specialized healthcare settings.

Despite advances in expanding access to antiretroviral therapy, the rate of decline in new HIV infections globally and in the Russian Federation remains insufficient to eliminate the epidemic by 2030. Pre-exposure prophylaxis (PrEP) is recognized by the WHO as a key component of combination prevention. Aim. To conduct an analytical review of current pre-exposure prophylaxis (PrEP) strategies for HIV infection based on meta-analyses, clinical trials, and Russian Federation sanitary legislation requirements for the period 2010–2025. Materials and methods. A systematic literature search was conducted in PubMed, Scopus, the Cochrane Library, and eLibrary, according to relevant inclusion criteria (relevance and methodological completeness). A systematic review, content analysis, and comparative data assessment were used in accordance with PRISMA guidelines. Content analysis and comparative assessment methods were applied. Results. Meta analyses confirm the high efficacy of oral PrEP (tenofovir/ emtricitabine): a 62–99 % reduction in the risk of HIV infection, depending on adherence (OR 0.38; 95 % CI 0.26–0.56). The analysis demonstrated high efficacy (up to 99%) of oral PrEP with high adherence. In 2025, the key trend was the introduction of modern injectable PrEP agents (cabotegravir, lenacapavir), which, alongside oral formulations, significantly improve treatment adherence and address low compliance. The main barriers in the Russian Federation are stigma and insufficient awareness among primary care physicians about the possibilities of using PrEP. Conclusion. Integrating PrEP into national HIV prevention programs requires improving the regulatory framework, ensuring drug availability, training healthcare professionals, and raising public awareness. The projected economic impact of preventing new HIV infections is many times greater than the cost of prevention. It should be noted that PrEP is not a universal preventive measure: without adherence to the dosing regimen, its efficacy may significantly decrease, requiring a comprehensive patient support approach.

Aim. To develop and implement a digital trigger-based system for HAI surveillance integrated into a hospital information system of a multidisciplinary hospital and to evaluate its effectiveness. Materials and Methods. A retrospective single-center observational study was conducted in a multidisciplinary hospital (83 beds, including 11 intensive care unit beds). The analysis was based on data obtained from the operation of a digital epidemiological surveillance system during the period from January 1, 2025, to December 31, 2025. The development and implementation of the digital surveillance system had been completed before the beginning of the study period. The system was based on trigger-driven identification of potential healthcare-associated infection (HAI) cases using objective events recorded in the hospital information system, namely positive microbiological test results and the occurrence of surgical procedures. When a trigger event was detected, an electronic task was automatically generated for the attending physician to complete a standardized structured checklist without free-text entry. Case classification was performed according to standard case definitions using clinical, laboratory, and temporal criteria. To ensure completeness of case registration, the system incorporated mandatory confirmation of entered data, task completion monitoring, and selective case verifi cation by the hospital epidemiologist. Results. During the study period, 2,037 surgical procedures were performed. Device utilization metrics were: 2,969 central line-days, 2,321 urinary catheter-days, and 1,207 ventilator-days. HAI rates were: central line-associated bloodstream in fections (CLABSI) – 4.3 per 1,000 central line-days; catheter-associ ated urinary tract infections (CAUTI) – 2.1 per 1,000 catheter-days; ventilator-associated pneumonia (VAP) – 4.1 per 1,000 ventilator-days; surgical site infections (SSI) – 0.8 per 100 procedures. A total of 394 trigger events were registered, of which 43 cases (11.0 %) were clas sified as HAIs. All generated tasks were completed. In 10% of cases, data clarification was required during verification. No additional HAI cases not captured by the system were identified. Conclusion. The dig ital trigger-based surveillance system integrated into the hospital information system ensures standardized HAI detection and high case as certainment completeness. The use of automated algorithms, structured checklists, and multi-level control improves reproducibility of epidemi ological indicators and can be considered an effective tool for organizing epidemiological surveillance.

Background. The adaptation of student youth under conditions of migration and changing food environments presents significant challenges, compounded by insufficiently developed methodological approaches to cross-cultural nutrition research. Aim. To systematize current data on the hygienic assessment of nutrition, nutritional status, alimentary-dependent risks, and associated health disorders in international students, taking into account ethnic specificity. Materials and Methods. A search and analysis of scientific publications in Russian and English was conducted in the eLIBRARY.ru, CyberLeninka, PubMed, Google Scholar, Scopus, and Web of Science databases for the period 2014–2026, using keywords reflecting nutrition, nutritional status, and adaptation of international students. Results. Classical dietary assessment methods (food frequency questionnaire, 24-hour dietary recall, weighing) were found to have limitations when applied to different ethnic groups, requiring adaptation and cross-cultural validation. Universal anthropometric cut-offs (body mass index, waist circumference) cannot be directly used for all ethnicities without adjustment, whereas central obesity indicators (waist-to-hip ratio, waist to-height ratio) are more preferable as they demonstrate less ethnic dependence. Analysis of actual nutrition among Russian medical students revealed systemic disorders: macronutrient imbalance, irregular meal patterns, and low awareness of alimentary-dependent diseases. In international students, these issues are aggravated by dietary acculturation, physiological changes, and functional tension persisting until the third year of study, which is associated with an increased risk of adaptation failure and the development of alimentary-dependent disorders. Methodological limitations of current research were identified. Conclusion. To improve the effectiveness of hygienic nutrition assessment in international students, it is necessary to develop ethno-specific questionnaires, establish hygienic monitoring that accounts for structural and psychological factors of acculturation, and design scientifically grounded health-preserving programs for international students.