Over time, patients with heart failure experience a significant change in the geometric parameters of the heart and a decrease in exercise tolerance.
The aim of the study. To analyze the relationship between the structural characteristics of the heart and exercise tolerance with body mass index (BMI) in patients with chronic heart failure (CHF) with low ejection fraction (EF) of left ventricle (LV).
Material and methods. Echocardioscopic phenotyping was performed in 78 patients with NYHA type II-III CHF with LV EF less than 40% (53 men and 25 women, average age 66.3±7.9 years old), as well as assessment of exercise tolerance before and after therapy.
Results. Initially, the best indicators of the structural and geometric characteristics of the left ventricle, as well as parameters of exercise tolerance, were recorded in patients with a normal BMI. Against the background of CHF therapy, the greatest positive dynamics in the form of improved structural and geometric characteristics of the heart, as well as increased exercise tolerance, was also noted in the cohort of patients with normal body weight.

The purpose of the work ‒ to investigate the health of premature infants conceived both naturally and through in vitro fertilization (IVF).
Material and methods. Our study involved 189 premature babies born after IVF and conceived naturally. All children conceived by IVF were included in the main group, which was divided into 2 subgroups: the 1st subgroup included infants weighing 1000–1500 g (n=52), these are children with very low body weight (VLBW), and The 2nd subgroup included children weighing less than 1000 g (n=49), that is, with extremely low body weight (ELBW). Children conceived naturally were included in the comparison group, which was also divided into 2 subgroups: the first (n=46) – patients with VLBW, the second subgroup (n=42) – patients with ELBW.
Results. When assessing the health status of premature infants conceived in various ways, it was found that children with ONMT and ENMT in the IVF group are prone to respiratory diseases, delayed neuropsychiatric development, iron deficiency anemia and allergic dermatitis (p<0.05). It was revealed that delayed speech development and psycho-emotional lability were the predominant pathologies in children with ONMI born by IVF. When children were divided into health groups, it was found that children conceived by natural pregnancy had more often health group II (p=0.006), and children born after IVF had more often health group III (p=0.005).
Conclusion. The health of premature VLBW and ELBW infants born using the IVF method is characterized by a tendency to respiratory diseases, delayed neuropsychic development, the development of anemia of prematurity, and allergic dermatitis, which allows them to be classified as “frequently ill children” (p < 0.05).

Objective. Тo assess the functional state of the kidneys in patients operated on by various techniques for purulent pyelonephritis.
Material and methods. The clinical study included 89 patients with an established diagnosis of acute purulent pyelonephritis. All patients were hospitalized and treated in the urology department No2 of the Regional Clinical Hospital (Barnaul) from 2016 to 2024. The patients were divided into two groups depending on the method of treatment. The main group consists of 38 patients operated on using a hybrid organ-preserving technique. The study was approved by the local ethics committee of the BSMU of the Ministry of Health of Russia (protocol dated 04/20/2022). All patients underwent Doppler ultrasound and excretory urography. These studies were performed 12 and 60 months after surgery.
Results. The data of the functional state of the kidneys in patients obtained during the follow-up period (from one to five years) made it possible to reveal that more pronounced functional disorders associated with the development of nephroangiosclerosis were observed after open surgical interventions, in contrast to minimally invasive ones.
Conclusion. The study of the results obtained allows us to conclude that minimally invasive surgical methods in the treatment of patients with purulent pyelonephritis contributes to a significant reduction in the risk of complications in the form of nephroangiosclerosis.

The article presents up-to-date clinical and epidemiological features of acute respiratory infection (ARI) in young patients in the Khabarovsk Territory. The study was conducted at the Federal State Budgetary Institution «301 Military Clinical Hospital of the Ministry of Defense» in Khabarovsk for the period 2019-2021.
The purpose of the study to provide a general clinical and laboratory characteristic of ARI depending on the etiology in young people.
Material and methods. A study of 120 patients (90+30) of young age (18 to 30 years old) was conducted, of which 90 people were patients with ARI of various etiologies and 30 were healthy young people. Detection of the etiology of infections was carried out by the polymerase chain reaction method in real time. The concentration of interleukins and transcription factors in the blood serum of the examined patients was determined by the enzyme immunoassay method.
Results. The maximum of chemokine levels was noted in rhinovirus and metapneumovirus infections. The IL-8 level in all ARIs was within the normal range with a tendency to decrease (P-level - 0.0005), which indicates a slow response of immune system of the macroorganism and the absence of a risk of bacterial flora overlay (P-level - 0.0005). The distribution of erythrocyte shapes relative to blood volume (RDW) tended to decrease in hospitalized patients with metapneumovirus and rhinovirus infections 12.03±1.02% (P-level - 0.0209).
Conclusion. Our study showed that ARI followed the classical development of clinical and laboratory criteria with the formation of signs of immune dysregulation in young patients. Immune dysregulation was formed due to the change of residence and the crowded location of conscripts.

Aim. To evaluate the urinary sodium concentration in COVID-19 patients with acute kidney injury.
Material and methods. The study, conducted at the Republican Clinical Infectious Diseases Hospital in Izhevsk in 2020-2021, included 52 patients with COVID-19: 24 people without clinical and laboratory signs of acute kidney injury, 14 with prerenal acute kidney injury, 14 with renal acute kidney injury. Sodium concentration in urine was determined on days 3-5 after hospitalization. The control group included 11 healthy people not infected with SARS-CoV-2.
Results. An increase in urinary sodium concentration compared to the control group was observed not only in COVID-19 patients with acute kidney injury, but also in patients with COVID-19 without signs of nephropathy (p<0.001). There were no differences in urinary sodium concentrations between the subgroups of patients with prerenal and renal acute kidney injury, as well as without overt nephropathy.
Conclusion. The diagnostic value of determining the concentration of sodium in urine for the differential diagnosis of prerenal and renal acute kidney injury in patients with COVID-19 has not been identified. An increased concentration of sodium in urine in patients with coronavirus infection without signs of acute kidney damage compared to healthy individuals may indicate the probable development of subclinical damage to the proximal tubules.

The purpose of the study. To study the functional state of the liver using the iLivTouch device to assess the degree of steatosis and liver fibrosis in patients with biliary tract pathology in combination with excess body weight.
Material and methods. We have examined 48 people with chronic acalculous cholecystitis (CAC) with normal body weight (group 1), 66 people with chronic acalculous cholecystitis (CAC) and overweight (BMI) (group 2) aged 18-44 years old in accordance with clinical recommendations for diagnosis and treatment of chronic cholecystitis. The control group included 36 individuals who did not have diseases of the biliary system and were overweight. These groups were comparable by gender and age, the comparison groups were comparable by the degree of changes in the biliary system. For a comprehensive study of the functional state of liver, the iLivTouch device (Wuxi Hisky Medical Co., Ltd. (HISKY MED), China) was used to conduct transient elastography. For statistical analysis the following programs were used: Statistica, MS Excel, SPSS.
Results. During a comprehensive study of the functional state of the liver using liver elastometry, the body mass index (BMI) in the examined population was 26.1±0.3 kg/m2. The degree of liver fibrosis is 7.0±0.1 kPa (n<7.3 kPa), the degree of liver steatosis is 259.4±2.4 dB/m (n<240). According to correlation analysis, BMI, steatosis and liver fibrosis increase with age, p = 0.001; 0.002 respectively. With increasing BMI, the likelihood of developing steatosis and liver fibrosis increases, p = 0.0001. With an increase in the incidence of liver steatosis, the likelihood of developing liver fibrosis increases, p = 0.0001.
Conclusions. The data obtained indicate the need to take into account the state of liver function in CAC with BMI. The use of transient elastography helps to improve the algorithm to searching for clinical and functional disorders in patients with biliary pathology and overweight.

The dynamics of cytokine content with urinary tract infection in patients with type 2 diabetes mellitus against the background of immunocorrection was studied.
Material and methods. 155 patients were divided into 5 groups. Group 1 – 35 almost healthy volunteers, Group 2 – 30 people with type 2 diabetes mellitus, Group 3 – 30 people with type 2 diabetes mellitus who received traditional basic therapy in accordance with the standards for the treatment of urinary tract infections, Group 4 – 30 people with type 2 diabetes mellitus who received the immunomodulator cycloferon along with the standard therapy, Group 5 – 30 patients with type 2 diabetes mellitus who received the immunomodulator imunofan along with the standard therapy. The main parameters studied were the content of cytokines IL-4, IL-6, IL-1β and TNF-α in the venous blood of patients in the dynamics of urinary tract infection and outside the infectious process.
Results. In patients with type 2 diabetes mellitus, the content of all the studied cytokines was increased, which indicates the presence of chronic immune inflammation in the absence of an infectious process. Against the background of basic therapy for urinary tract infections, the levels of IL-1β, TNF-α and IL-6 did not change even after 8 weeks during the resolution of the infectious process. The inclusion of imunofan in the treatment allowed us to reduce the levels of TNF-α and IL-1β, and the use of cycloferon - IL-6.
Conclusion. The results of the study indicate the advisability of including immunomodulators imunofan and cycloferon in the complex therapy of patients with type 2 diabetes mellitus and urinary tract infection.

The purpose of the study was to compare the microcirculation parameters of the macular region of the retina using optical coherence tomography with angiography (OCTA) in patients with stage II newly diagnosed low-tension glaucoma (LTG) and the hypertensive form of primary open-angle glaucoma (POAG).
Material and methods. In the dispensary and outpatient department of eye microsurgery of the State Budgetary Healthcare Institution of the Republic of Bashkortostan, Clinical Hospital 8, Ufa, 3 groups of patients aged 45 to 65 years old were examined. The first group consisted of 30 patients (30 eyes) with an advanced stage of newly diagnosed low-tension glaucoma. The second group included 45 patients (45 eyes) with stage II hypertensive form of POAG (hereinafter referred to as POAG). The control (third) group consisted of 50 relatively healthy people without glaucoma and concomitant ophthalmopathology (50 eyes). All patients were comparable by gender and age. The ophthalmological examination included OCTA of the macular area with measurement of vascular density using an Optovue XR Avanti device with the AngioVue function (Optovue, USA).
Results. According to the study, statically significant differences in retinal vascular density in patients with LTG and POAG were recorded in the superficial choroid plexus of the Parafovea region, while microcirculation disorders in both the superficial and deep vascular plexuses of the macula were more pronounced in the group of patients with POAG. In patients with stage II LTG, the indicator of vascular density of the superficial choroid plexus had a positive correlation of weak strength in Fovea with the thickness of the retina in this area (r=0.464*, p<0.05), and in the Parafovea region - a negative correlation of medium strength with the level global loss of the retinal ganglion cell complex (r=-0.528*, p<0.05). The results obtained indicate the possibility of using OCTA to assess the degree of damage to the macular region of the retina in glaucomatous optic neuro-opticopathy in patients with an advanced stage of both low-tension glaucoma and the hypertensive form of the disease.

According to the IV Universal Definition of Myocardial Infarction, there are 5 types of the disease, with 3 subtypes in type 4. In pathologoanatomic practice, there are difficulties in differentiating myocardial infarction of type 1 and type 2 when there is no acute coronary injury during autopsy. Now pathologic anatomy has a large stock of techniques and methods, including the use of computational technology and statistical data processing. The introduction of computational programs for retrospective assessment of the circulatory state will help to increase the level and evidence of pathological anatomical studies.
The aim of the work is to analyze autopsy cases of acute myocardial infarction using computational programs.
Material and methods. The computational program “Quantitative assessment of heart failure in the postmortem period” developed by the authors and based on the database “Patients with heart failure in the terminal period” was used in the work. The program calculates the cardiac index according to Y. Starr, Baevsky adaptation index and classifies variants of functional circulatory failure.
Results. According to the IV universal definition of myocardial infarction the observations were distributed as follows: myocardial infarction type 1 (MI1T) - 34, MI2T - 29, MI4aT - 6, MI4bT - 6 and MI5T - 2 cases. Myocardial infarctions of types 3 and 4c were categorized as clinical concepts and were not included in the study. Within our analysis, IM2T was found to have the smallest area of cardiac necrosis (Me 4.0 (3.0-12.5)) and significantly smaller compared to IM1T (p=0.0137). Application of the computer program revealed the 1st and 2nd variants of functional circulatory disturbance only in MI2T, which in turn indicates an extracardiac effect on the heart and thus can be considered as a complication of other underlying pathology. To verify the accuracy of the computer program, the sensitivity and specificity of the test were calculated. Acute heart failure was taken as a criterion, characterized by Y. Starr as moderate, severe, and critical, corresponding to options 3, 4, and 5 of the FCD classification.
Conclusion. The proposed computational program, as an additional method, helps to qualitatively analyze hemodynamic disturbances in the heart without making a hard and long autopsy. The computer program calculates indices of acute heart failure occurring during myocardial infarction, is characterized by high accuracy of the test, and sensitivity and specificity are 94.57% and 100%, respectively.

Multiple sclerosis (MS) is a demyelinating disease affecting the myelin sheath of nerve fibers. In most patients, against the background of primary damage to the white matter of the spinal cord, signs of damage to the motor system come to the fore. There is not enough information about morphological changes in the brain matter and manifestations of damage to the white matter of the hemispheres in MS.
The purpose of this study was to characterize the morphological changes in the brain substance in the clinical variant of multiple sclerosis with a predominance of psychoorganic syndrome.
Material and methods. Clinical data and results of morphological examination of the brain were analyzed in 6 cases of autopsy observations of multiple sclerosis in patients with a predominance of psychoorganic syndrome at the onset.
Results. During the study of medical records in the studied group of patients, all of them were female with an average age at the time of development of fatal complications of 53.4±3.3 years old. In the clinical picture, against the background of damage to the cerebral hemispheres, namely a decrease in intelligence, impaired concentration, exhaustion, mild changes in the motor system were noted. The study revealed extensive foci of damage at different stages. Histological examination reveals signs of vasculitis, destruction and demyelination of nerve fibers, proliferation of astrocytes near the injury, as well as destruction of interastrocytic connections.
Conclusion. The clinical variant of rapidly progressive multiple sclerosis with a predominance of psychoorganic syndrome is typical for middle-aged females with pronounced morphological stage changes in the white matter of the brain, multiple foci of demyelination against the background of progressive edema.

The present study aimed to substantiate the clinical significance of ultrasound diagnostics as a reliable method for assessing the morphometric characteristics of the gum and the condition of the periodontium.
Material and methods. The gums of 30 healthy volunteers aged 18-25 years old with different biotypes (thin, n = 18; thick, n = 12) were examined.
Results. The results demonstrate high accuracy and reproducibility of this method in measuring key gingival parameters, including the thickness of the free gingiva, the thickness of the gingiva in the alveolar ridge area and the height of the free gingiva. It was found that the difference in the average thickness at the alveolar ridge level can reach 0.42 mm, and in the free gingiva area up to 0.19 mm compared to the thin biotype. While the height of the free gingiva did not have statistically significant differences between the biotypes. Thus, ultrasound examination allows for reliable differentiation between thin and thick gum biotypes, which is important for planning dental treatment and expected results.

Rosacea is a common chronic dermatosis affecting the central part of the face. Recently, there has been an increase in morbidity associated with the nature of the course, duration, frequent relapses, short episodes of remission and resistance to classical therapies.
Aim. To assess the effectiveness of therapy of the papulopustular rosacea using complex antioxidant and oxidative system parameters.
Material and methods. The study included 45 patients with the papulo-pustular subtype of rosacea, who were under observation at the Republican Dermatovenerologic Dispensary in Ufa. During therapy, the total antioxidant activity and total oxidative capability of blood serum were determined in patients on day 1 and on day 30 [14]. The ratios of the first indicator to the second were calculated before and on the 30th day of treatment, after which the difference between the second and first ratios was calculated. With a difference of 0.5 or more, the treatment was evaluated as effective, with a difference of less than 0.5 – as ineffective.
Results. In 35 patients, the therapy was considered effective, which correlated with the dynamics of the clinical response from the skin. For the remaining 10 patients, in whom the initial therapy regimen was considered ineffective, monitoring the indicators of the antioxidant and oxidative systems allowed timely correction of the therapy.
Conclusion. Indicators of the antioxidant and oxidative system are convenient tools for assessing the effectiveness of rosacea treatment and allow correcting irrational treatment regimens for a faster clinical response from the skin.

Analysis of morphological processes accompanying aging in the hippocampus is one of the urgent problems of the present time.
Purpose. To assess morphofunctional state of pyramidal neurons in the hippocampus of nonlinear white rats.
Material and methods. Using histological and morphometric methods, we have studied autopsy material (70 hippocampi) obtained from animals of both sexes of 3 age categories.
Results. The results of the study showed the presence of signs of dystrophic changes in the pyramidal neurons of the main fields of the hippocampus in adult animals. However, in animals of the older age group, the number of degenerative changes in neurons increased. This statement was also supported by a significant decrease in the area of pyramidal cell bodies in the CA1, CA3 and CA4 fields of the hippocampus in old rats when compared with group II (adult animals), which was confirmed by morphometry (р < 0,05). In addition, cell sizes in old animals in all hippocampal fields corresponded to the sizes of neurons in 14-day-old animals.

The cubic epithelium of the kidney is an indispensable and widespread in vitro model for studying the physiology of mammalian cells. These cells play a key role in blood filtration, nutrient reabsorption and waste disposal, so their behavior directly affects kidney function. The use of renal epithelial cells in research makes it possible to study pathological processes at the cellular level, for example, the effect of toxins, drugs or genetic mutations on kidney function.
The aim of our work was to obtain a primary line of epithelial cells from a rabbit kidney.
Materials and methods. Primal cells were isolated through tissue dissociation in collagenase type 1, followed by cultivation in the media enriched with growth factors: human insulin, transferrin, dexamethasone and epidermal growth factor. The obtained cell subculture was verified by the immunocytochemical method. Anti-alpha 1 Sodium Potassium ATPase and N-cadherin were selected as tissue–specific markers of the cubic epithelium of the kidney, and alpha-SMA is a marker of smooth muscle cells and fibroblasts, was selected as a negative control. The enzyme Na+/K+-ATPase plays an important role in blood filtration and elimination of toxins in mammalian kidneys. N-cadherin is a protein that is involved in the formation of dense contacts of epithelial tissues.
Results: the isolated cells actively proliferated in a specialized culture medium and demonstrated morphological characteristics that are typical for epithelial phenotype. The results of immunofluorescence microscopy confirmed the epithelial origin of the cells. As a result, a primary stable line of the rabbit kidney epithelium was obtained, suitable for further experimental work in vitro.

Purporse. To establish the influence of natural, temperature and cold fermentation on the content of hydroxycinnamic acids in purple coneflower herb.
Material and methods. The object of the study is fresh purple coneflower herb of industrial series and harvested from cultivated forms.
The effect of the following types of fermentation on the content of hydroxycinnamic acids and the activity of polyphenol oxidase was studied: temperature, cold, natural, as well as thermal and ultrasonic pre-treatment, natural drying. The content of hydroxycinnamic acids was determined by the spectrophotometric method with Arnov's reagent, the activity of polyphenol oxidase – by the spectrophotometric method according to A.N. Boyarkin.
Results. Fermentation at 40 ºС for 2 hours increased the content of hydroxycinnamic acids by 64.8%, at 60 ºС the content of hydroxycinnamic acids and the activity of polyphenol oxidase were lower. Natural fermentation increased the content by 26.5%, which corresponded to the minimum activity of the enzyme. Temperature pre-treatment of fresh herb increased the content by 2.3 times with a sharp drop in the activity of polyphenol oxidase. Thermal inactivation of the enzyme in all the studied methods of preliminary pre-treatment led to a decrease in the content of hydroxycinnamic acids. Temperature and cold fermentation of dried herb reduced or did not affect the content of substances.
Conclusions. Among all the studied methods of pre-treatment of fresh purple coneflower, the highest increase in the content of hydroxycinnamic herbal acids was determined during heat pre-treatment, which led to a sharp drop in polyphenol oxidase activity.

The Republic of Tajikistan ranks first globally in mortality from cardiovascular diseases (CVD), underscoring the urgent importance of improving pharmaceutical access to high-quality and safe medications for its citizens.
This study aims to analyze Tajikistan's state policies on healthcare provision for patients with circulatory system disorders, to assess mortality data for this group of patients, and to review the legal framework for pharmaceutical supply to identify prerequisites for improving pharmaceutical support in medical care for cardiovascular disease patients, considering international practices.
Material and methods. The study analyzed statistical data from the Agency for Statistics of the Ministry of Health and Social Protection of the Republic of Tajikistan, as well as national legal regulations on healthcare for non-infection diseases and pharmaceutical activities. Methods of content analysis, systematization, generalization, and descriptive statistics, with MS Office Excel 2017 were used.
Results. The government of Tajikistan has developed and implemented a well-defined healthcare policy, including measures to combat non-infection diseases. From 2019 to 2023, circulatory system disorders have been the leading cause of mortality in Tajikistan, with ischemic heart disease (IHD) at the forefront, as in many other countries worldwide. There was an increase in mortality among patients with CVD over the past 5 years by 18.7% (15,026 people), and hospital mortality rates from IHD and hypertension also increased in the Khatlon and Gorno-Badakhshan regions of the Republic of Tajikistan. Among the effective measures to improve pharmaceutical support is the new edition of the Law of the Republic of Tajikistan «On Medicines, Medical Products, and Pharmaceutical Activities.»
Conclusions. An analysis of Tajikistan’s healthcare policies, implementation efforts, and legal framework has been conducted. It was found that in recent years, numerous organizational and managerial decisions have been made, with all National Programs for treating and preventing non-communicable diseases fully implemented, although no new programs have been introduced. The main prerequisites for improving the pharmaceutical component of medical care for patients with cardiovascular diseases have been identified, taking into account international experience: the lack of an up-to-date National Strategy for the Health of the Population of the Republic of Tajikistan and existing social National programs that take into account the challenges of the present, the country’s capabilities and international experience; outdated approaches to the functioning of the pharmaceutical healthcare sector of the Republic of Tajikistan (the principle of providing medicines rather than patient-oriented pharmaceutical care); limited range of drugs registered in the Republic of Tajikistan for the treatment of CVD, which reduces the population’s access to rational drug therapy.

Objective. The study aims to assess the status and issues of HR management automation in pharmaceutical manufacturing companies.
Material and methods. The research draws upon academic studies in HR management system automation within pharmaceutical manufacturing companies. The used methodology includes systemic analysis, socio-psychological surveys, and behavioral rating scale techniques.
Results. The implementation of automated HR management systems in pharmaceutical companies remains largely on early development stages. Analysis of key barriers to effective HR process automation revealed several challenges, including low overall digitalization levels and the use of non-optimal technological solutions, despite staff showing interest in automation. Current digital transformation trends in HR management necessitate the automation of professional development and qualification enhancement systems, as well as monitoring of socio-psychological, production, and business processes, considering industry specifics, enterprise characteristics, and workforce needs.

The aim of the work is to consider the main issues of pathogenesis, clinical picture, methods of diagnosis of aortic coarctation on the example of a clinical case.
In the presented observation, an aortic pathology was suspected for the first time in a patient aged 65 years old during an examination for unstable angina pectoris during routine fibroesophagogastroduodenoscopy. Subsequently, the diagnosis of aortic coarctation was confirmed using multispiral computed tomographic angiography.
Routine follow-up by primary care physicians of a patient with long-term aortic coarctation did not allow the diagnosis to be established at the early stages of the disease and led to multiple complications. An accidental finding during an endoscopic examination of the esophagus and an additional examination by radiation methods made it possible to make a diagnosis.
Сonclusion. This clinical example confirms that multispiral computed tomographic angiography has great diagnostic capabilities that should be used in case of suspected congenital heart defects and for detailing abnormalities of the cardiovascular system.

Endoscopic combined intrarenal surgery (ECIRS) was first performed in 2008 and consisted of simultaneous antegrade and retrograde approaches to the kidney. ECIRS combines two techniques: percutane nephrolithotripsy and retrograde intrarenal surgery.
We present the experience of treating a female patient with multiple concrements of the right kidney.
Objective. To evaluate the efficacy and safety of endoscopic combined intrarenal surgery (ECIRS) using a stone-free rate and complication rate by the Clavien-Dindo classification on the basis of the presented clinical study.
Material and methods. Patient B., 66 years old, was admitted to the Urology Unit No. 1 of the Regional Clinical Hospital No. 2 (Krasnodar, Russian Federation) with dragging pain in the lumbar region on the right side and a nephrostomy tube on the right. She underwent a complex of laboratory and imaging studies. The surgery was performed under spinal anesthesia. The patient was placed on the operating table in the Galdakao-modified supine Valdivia position and underwent ECIRS on the right side (percutaneous nephrolithotomy with stone extraction + retrograde intrarenal surgery) and nephrostomy and ureteral stenting on the right side. The postoperative period went smoothly, and the patient had no complications according to the Clavien-Dindo classification. Follow-up computed tomography showed no stones in the urinary system.
Conclusions. ECIRS is an updated, complete, and versatile version of percutaneous nephrolithotomy, which is a leading method in endourology and can be considered the new gold standard for treatment of patients with multiple kidney stones or staghorn nephrolithiasis. ECIRS allows for personalized stone management.

The most common problem during parotid surgery is unintentional damage to the facial nerve and its branches, which can subsequently lead to paralysis of the facial muscles. Intraoperative neuromonitoring (IONM) is now being widely used as an addition to the standard nerve identification procedure. Having information about the functional state of the nerve in real time, the surgeon can prevent its possible damage.
Material and methods. A clinical example of the use of IONM in the surgical treatment of pleomorphic adenoma of the parotid gland is described in the paper. During the operation, subtotal resection of the right parotid gland was performed, preserving the branches of the facial nerve using a test with a bipolar electrode.
Results. The postoperative period was without complications. The use of neuromonitoring made it possible to determine the location of the branches of the facial nerve, to assess their functional activity and, thereby, to ensure safe surgical intervention while preserving nerve function.

The aim of the study was to study the lymphovenous anastomosis in sphincter insufficiency.
Material and methods. Evisceration of the terminal portion of the thoracic lymphatic duct from 15 cadavers was performed. The inclusion criteria were edema and ascites, which were observed in patients who died from various diseases. The medical history was obtained after the autopsy. The isolation of the terminal part of the thoracic lymphatic duct was carried out according to a modified author's patented technique. Adipose tissue from the obtained biomaterial was cavitated with an ultrasound machine for better visualization of the vascular architecture and for identification of the lymphovenous junction with the sphincter apparatus zone.
Results. The study showed detected rare cases of thrombi in the lymphovenous anastomy, formed in the lumen of the lymphatic vessel, which leads to its obstruction and, as a result, imbalance of the lymphovenous anastomy. The article presents unique macro photos of the thrombus.

The prevalence of neuroendocrine tumors (NET) has increased over the past few decades, probably due to early diagnosis, increased alertness and widespread endoscopic and imaging studies in the diagnosis of diseases of the gastrointestinal tract (GIT). Neuroendocrine tumors that occur in the small intestine are considered rare malignancies. Despite this, both the incidence and prevalence of NET of the small intestine are gradually increasing. According to retrospective studies, the standardized incidence rate of small intestine NET was 1.46 per 100,000 populations in 2018, equaling the incidence of lung NET. To date, there are no statistics on the incidence of NET in the Russian Federation. This makes it difficult to analyze the results of treatment and to develop a diagnostic algorithm.
The work analyzes the data of newest publications on the clinical manifestations of NET of the small intestine, the main diagnostic and therapeutic methods used in this pathology and presents a clinical case of small intestine NET.
Conclusion. In the early stages of the disease, most patients have slight symptoms or none at all.