Background. The novel coronavirus infection, besides its variable course ranging from asymptomatic to severe forms, may persist after the acute phase of the disease. Research aimed at identifying factors associated with the likelihood of developing post-COVID syndrome remains highly relevant.

Objective – to determine the role of peripheral microcirculation in the development of post-COVID syndrome.

Material and methods. This prospective study included 127 patients with different clinical courses of novel coronavirus infection. The control group comprised 50 practically healthy volunteers. Laser Doppler flowmetry was used to assess peripheral microcirculation within the first 72 hours from disease onset, as well as at 2 weeks, 3 months, and 12 months, to determine the type of blood flow. At 3 and 12 months after disease onset, patients completed a primary self-rated health questionnaire to identify signs of post-COVID syndrome.

Results. A congestive-stasis hemodynamic type was registered in 22 (68.75%) patients with communityacquired pneumonia and in 20 (71.43%) patients without lower respiratory tract involvement, who subsequently developed post-COVID syndrome.

Conclusion. According to the results of the occlusion test, the vast majority of patients who later experienced post-COVID syndrome exhibited a congestive-stasis hemodynamic type. Since this type indicates reduced blood flow velocity and pronounced stasis at the level of postcapillaries and venules, it can be considered one of the predictors for the development of post-COVID syndrome.

Background. According to Russian and European clinical guidelines, in patients who have experienced a primary acute cerebrovascular accident (CVA), and in the absence of contraindications, it is recommended to perform surgical treatment for symptomatic stenosis (50–99%) of the internal carotid artery as soon as possible — preferably within 3–14 days after the event. This is an important aspect of secondary prevention of a recurrent CVA (I, A). However, most Russian vascular surgeons have a negative attitude towards this clinical practice, recommending that carotid endarterectomy (CEA) be performed 3 months or more after the index event.

The aim of the study is to evaluate the effectiveness and safety of performing CEA on days 3–14 after an acute cerebrovascular event within the framework of the work of a regional vascular center.

Material and methods. The retrospective clinical study included 964 patients: the observation group consisted of 432 (45.1%) patients who underwent CEA between the 5th and 14th day inclusive after an acute cerebrovascular event; the control group consisted of 532 (54.9%) patients who were operated on between 15 and 180 days after the event. The primary endpoints included the composite endpoint of major adverse cardiovascular events (MACE): acute myocardial infarction, stroke, death from cardiovascular causes, and hemorrhagic transformation. Secondary endpoints: operational criteria, neurological assessment, and long‑term outcomes.

Results. No statistically significant differences were found for the combined primary endpoint – 14 (3.2%) and 11 (2.1%), p=0.266. The subanalysis revealed statistically significant differences according to the criterion of small cancer – 4 (0.9%) and 0, p=0.027. In the separated follow–up period, for up to 3 years, statistically significant differences were obtained between the groups according to the criterion of mortality from any cause + cancer – 5 (1.4%) out of 345 and 27 (5.8%) out of 460, p=0.004.

Conclusion. Performing CEA on days 1–14 after an acute ischemic stroke without contraindications is effective and safe, and is also justified in the long‑term period as an important aspect of primary prevention of recurrent ischemic stroke.

Background. The development of new modifications of biodegradable tissue-engineered products (BTEP) for the treatment of deep frostbite remains highly relevant in the field of critical temperature medicine. One of the key regulators of cell proliferation, migration, tissue remodeling, fibrogenesis, and regeneration is transforming growth factor beta-1 (TGF-β1).

Objective: to perform histological and immunohistochemical (IHC) assessment of wound defect healing after deep skin frostbite in an experiment using standard therapy and in combination with BTEP implantation.

Material and methods. The study was conducted on 50 male Wistar rats. Deep contact frostbite of the dorsal skin (grade III) was modeled in rats of the control and experimental groups, after which the control group received standard frostbite therapy, while the experimental group additionally received BTEP implantation. The animals were removed from the experiment on days 7 and 14. The morphology of the wound defect in skin specimens was assessed using hematoxylin-eosin staining. TGF-β1 expression was evaluated by the IHC method as the percentage of protein-expressing dermal cells.

Results. On day 7, the experimental group showed active ingrowth of dermal fibers into the BTEP implantation zone and the formation of a moderate perifocal vascular network with signs of spasm. By day 14, a branched microcirculatory bed had formed without signs of congestive insufficiency. According to IHC analysis, the TGF-β1 expression level in the comparison group on days 7 and 14 was 5.84-fold (p=0.012) and 5.56-fold higher (p=0.025), respectively, than in the intact group. In the experimental group, the protein level was elevated on day 7 (3.38-fold, p=0.028), whereas no significant differences were detected on day 14 (p=0.116). TGF-β1 expression in the experimental group was significantly lower than in the comparison group both on day 7 (1.73-fold, p=0.024) and on day 14 (5.13-fold, p=0.017). Moreover, in the experimental group, the protein level decreased 3.12-fold by day 14 relative to day 7 (p=0.031), whereas in the comparison group there was no dynamics (p=0.213).

Conclusion. The use of BTEP not only ensures structural replacement of the defect but also regulates the molecular mechanisms of the wound process in deep frostbite, preventing the formation of a coarse scar through the control of TGF-β1 expression.

Background. Minimally invasive surgery has become one of the most rapidly developing fields of modern medicine over the past two decades. Laparoscopic interventions are the method of choice in the treatment of many abdominal diseases due to reduced surgical trauma, less postoperative pain, shorter hospital stays, and faster patient recovery.

Objective – to evaluate the effectiveness of a stepwise simulation training model in developing practical skills in laparoscopic surgery and to determine its educational value for the training of specialists with different levels of professional experience.

Material and methods. A prospective interventional study was conducted at the Training and Simulation Center of Urgench State Medical Institute (Republic of Uzbekistan) in 2024–2025. The study included 265 trainees with varying levels of practical experience in laparoscopic surgery. Training was conducted in stages using three simulation platforms: a box trainer (iModels), an analytical simulator (LAPARO Analytic), and a high-fidelity simulation complex (LAPARO APEX). In the final stage, laparoscopic cholecystectomy, appendectomy, TAPP hernioplasty, fundoplication, and sleeve gastrectomy were simulated. Training effectiveness was assessed by task completion time, number of technical errors, manipulation accuracy, instrument trajectory, and the integral rating automatically calculated by the simulators. Statistical analysis was performed using parametric methods, with statistical significance set at p<0.05.

Results. Upon completion of the training program, all groups demonstrated significant improvement in practical performance. For trainees with no prior experience in laparoscopic interventions, task completion time decreased by 38.6%, and the number of technical errors dropped by 42.1% (p<0.001). Participants with intermediate training showed a 29–33% improvement in movement accuracy and performance efficiency in complex simulation scenarios (p<0.01). Trainees with initial independent laparoscopic practice demonstrated statistically significant improvement in movement coordination, dissection quality, and operative timing (p<0.05). The most pronounced improvement was observed in novice surgeons, confirming the high effectiveness of the sequential training model.

Conclusion. The stepwise simulation training model ensures the sequential development of the technical and cognitive competencies required for the safe performance of laparoscopic interventions. The consecutive use of a basic box trainer, an analytical platform, and a high-fidelity simulator allows for objective monitoring of skill acquisition and enhances the quality of surgical training. The results support the widespread implementation of this model in the educational process of medical universities, simulation centers, and postgraduate professional education systems.

Background. Professional burnout among healthcare workers, particularly in emergency specialties such as anesthesiology, critical care, surgery, neonatology, and obstetrics, represents one of the most pressing issues in modern healthcare. In professions where the primary "tool" is the specialist's personality and the cost of error is maximal, burnout syndrome takes on the character of a professional epidemic.

Objective – to comprehensively study and analyze the current level of professional burnout, its structure, and its main determinants among physicians in the Amur Region.

Material and methods. A cross-sectional study was conducted involving 66 physicians from the Amur Region, including 39 (59.1%) anesthesiologists-intensivists and 9 (13.6%) neonatologists. The sample also included pediatricians (n=6), surgeons (n=5), internists (n=4), ophthalmologists (n=2), and neurologists (n=1). Professional burnout was assessed using the adapted Russian-language version of the Maslach Burnout Inventory (MBI). Descriptive statistics, Pearson's correlation coefficient (r), Student's t-test, and ANOVA were used for group comparisons. Statistical significance was set at p<0.05.

Results. The findings of a study confirm a high level of professional burnout among physicians working under conditions of increased workload and stress, consistent with national and international studies. Frequent or very frequent symptoms of emotional exhaustion were reported by 32.3% of physicians, morning fatigue by 29.2%, high effort expenditure by 26.2%, and depletion of emotional resources by 23.1%. Hospital-based work increased the risk of professional burnout compared to outpatient practice (r=0.45, p<0.01).

Conclusion. Among all medical specialties, the most vulnerable are anesthesiologists-intensivists, surgeons, neonatologists, and emergency physicians – those who work under chronic stress, with irregular schedules, frequent night shifts, and constant exposure to critical conditions and fatal outcomes. There is a need to rethink risk factors and develop adaptive prevention strategies.

Background. Sleep disturbances and evening screen activity are considered significant factors contributing to cognitive decline in students. The use of electronic devices before bedtime is accompanied by sensory and emotional hyperstimulation, circadian rhythm disruption, and suppression of melatonin secretion, which can negatively affect memory consolidation, attention, and emotional regulation. Given the high academic load, the issue of sleep neurohygiene is particularly relevant for the student population.

Objective – to study the relationship between evening use of screen devices, sleep quality, and subjective cognitive impairment among medical university students.

Material and methods. An anonymous online survey was conducted among 265 third- to fifth-year students at Amur State Medical Academy, aged 18 to 23 years. The questionnaire included items on evening screen activity, sleep quality and duration, difficulties falling asleep, night awakenings, as well as subjective assessment of memory and attention. Descriptive statistics and Spearman's correlation analysis were used for data processing.

Results. It was found that 93.9% of students regularly use electronic devices in the evening, and 72% use them immediately before sleep. The average sleep duration was 6.3±1.1 hours, which is below the recommended physiological norm for young adults. Frequent engagement with social networks instead of resting was reported by 61% of respondents. Subjective deterioration of memory and attention was reported by 51% of students, with 47% reporting memory decline even when attempting to concentrate. Correlation analysis revealed a statistically significant positive relationship between evening screen activity and subjective deterioration of memory and attention among female students (r=0.42; p<0.001).

Conclusion. The high prevalence of evening gadget use among students is associated with reduced sleep duration and subjective decline in memory and attention. The findings highlight the need to implement sleep neurohygiene practices within the educational environment.

Background. Multiple endocrine neoplasia syndrome (MEN) is a hereditary disease with an autosomal dominant mode of inheritance, characterized by the development of tumors in several endocrine organs against the background of germline mutations in tumor suppressor genes. Despite the presence of characteristic clinical and genetic markers, the diagnosis of type 1 MEN is often delayed. Cases with non‑classical manifestation present particular challenges.

Description of a clinical case. Patient P., 29 years old, with verified MEN type 1 syndrome. Has been under dynamic monitoring by an endocrinologist at her place of residence since 2022. The development of endocrine pathology was gradual, demonstrating a typical evolution of the disease with sequential involvement of the parathyroid glands, the adenohypophysis, and the pancreas. The disease manifested as primary hyperparathyroidism with laboratory‑confirmed hypercalcemia (total calcium – 2.74 mmol/L) and elevated parathyroid hormone levels (up to 28.09 pmol/L). Subsequently, a mammosomatotropinoma of the pituitary gland was diagnosed, accompanied by clinically significant hyperprolactinemia (prolactin levels up to 1226 mU/L, monomeric prolactin up to 402 mU/L), laboratory signs of acromegaly (growth hormone – 13.2 ng/mL, somatomedin‑C – 451 ng/mL), and characteristic clinical manifestations (increased foot size, galactorrhea). During instrumental examination, multiple solid masses in the pancreas were additionally identified; they were assessed as neuroendocrine tumors, and calculi were found in both kidneys. The patient underwent subtotal parathyroidectomy (on 24.10.2025) and endoscopic transsphenoidal removal of a mammosomatotropinoma at the V.A. Almazov National Medical Research Center (on 22.12.2025), with normalization of hormonal parameters in the postoperative period.

Conclusion. The presented clinical observation demonstrates the typical evolution of MEN type 1 syndrome – from the manifestation of primary hyperparathyroidism to the formation of a complete classical triad involving the adenohypophysis and the pancreas. A distinctive feature of this case was the combination of hyperprolactinemia and acromegaly within the framework of a mammosomatotrophinoma, which required a comprehensive assessment of the function of the anterior pituitary lobe. The presented case illustrates the need for doctors who treat young patients with combined endocrine pathology to develop syndromic clinical thinking.

Background. Severe perinatal asphyxia in newborns is often accompanied by a complex of interrelated disorders: congenital pneumonia, pneumothorax, metabolic instability, myocardial dysfunction, and seizures. The role of seizures as an independent factor affecting cerebral blood flow is systematically underestimated when interpreting neurosonography data.

Objective: to perform a systemic analysis of the influence of inflammation, pneumothorax, metabolic disturbances, and myocardial dysfunction on cerebral autoregulation in a newborn with severe asphyxia, with an assessment of seizures as a factor complicating the interpretation of the resistance index (RI).

Study design. Descriptive clinical case report with qualitative systemic analysis. Materials and methods. A clinical case of a full-term newborn with severe asphyxia, seizures in the first hour of life, congenital pneumonia, pneumothorax, hypoglycemia/hyperglycemia, and transient myocardial ischemia is presented. The dynamics of RI, laboratory markers, and brain magnetic resonance imaging (MRI) findings were analyzed.

Results. The patient demonstrated an increase in RI to 0.86 against the background of seizures, inflammation (C-reactive protein up to 5.99 mg/L), pneumothorax, glycemic fluctuations (2.4–12.9 mmol/L), and decreased cardiac output (168 mL/kg/min). Brain MRI revealed no structural changes, indicating a transient functional breakdown of cerebral autoregulation. Seizures are considered an independent factor hindering unambiguous interpretation of RI.

Conclusion. An increased RI in newborns with severe asphyxia is not a specific marker of irreversible ischemia. It may reflect a transient disintegration of autoregulation under the influence of a combination of factors. Normal MRI confirms the functional nature of the disturbances. All statements are hypothetical and require verification in prospective studies.

Background. Acute hemorrhoidal bleeding remains a common cause of emergency hospitalization. Treatment traditionally begins with conservative therapy; if ineffective, it progresses to minimally invasive surgical methods. However, in recent years, increasing evidence has accumulated in favor of superselective embolization of the superior rectal artery.

Objective – to substantiate the role of endovascular embolization as a key element of differential management in acute hemorrhoidal bleeding.

Material and methods. A systematic literature review on superior rectal artery embolization was conducted. The search spanned 12 years (2014–2026), with an emphasis on publications from the last 5 years. Searches were performed in PubMed, Scopus, Web of Science, Embase, Google Scholar, DOAJ, and eLibrary using the following keywords and their combinations: “superior rectal artery embolization”, “hemorrhoidal artery embolization”, “emborrhoid”, “rectal artery embolization”, “hemorrhoidal bleeding”, “acute hemorrhoidal bleeding”, “endovascular embolization hemorrhoids”, “minimally invasive hemorrhoid treatment”, “superior rectal artery anatomy”, “embolization outcomes hemorrhoids”, “rectal artery embolization complications”, “emborrhoid technique”, “hemorrhoidal disease interventional radiology”.

Results. Systematic reviews confirm the absence of severe ischemic complications and fatalities associated with superselective superior rectal artery embolization. One of the key advantages of the method is the preservation of anal canal and sphincter anatomy, which is particularly important for patients with pre-existing continence disorders or a high risk of developing them. The absence of the need for anesthesia in the anal canal area and the possibility of performing the procedure under local anesthesia via femoral or radial access make embolization attractive for elderly and frail patients.

Conclusion. Embolization is the method of choice for recurrent bleeding, contraindications to transrectal interventions, patients on anticoagulants, and those with high anesthetic risk. The inclusion of endovascular technologies in clinical guidelines and standards will optimize the management of the most complex category of patients with acute hemorrhoidal bleeding.