Due to the increased effectiveness of oncology treatments, cardiovascular disease, including chronic heart failure, is a major cause of morbidity and mortality in cancer survivors, limiting their life expectancy. Screening of 4700 literary sources from the databases "Scopus", "Web of Science", "PubMed / MedLine", "The CochraneLibrary" was carried out for the keywords "anthracycline-induced cardiotoxicity", "cardiooncology", "cancer therapy-related cardiac dysfunction", "sacubitril/valsartan" for the last 10 years. The review, based on the analysis of highly cited articles, outlines the current understanding of the cardiotoxicity of anthracyclines, its mechanisms and possibilities for correction, including the use of sacubitril/valsartan.

Over the past four decades, non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease, believed to affect more than 25% of adults worldwide. Unless specific testing is done to detect NAFLD, the disease is typically silent until advanced and potentially irreversible liver impairment occurs. NAFLD is associated with a higher risk of cardiovascular and kidney dysfunction, independent of obesity, type 2 diabetes, and other common risk factors. However, the mechanisms underlying this association remain largely unexplored. An increase in the incidence of NAFLD among young individuals is emphasized. However, despite the global prevalence of NAFLD throughout the world, prevalence among young remains unclear. The purpose of this review is to analyze the main cardiometabolic risk factors and NAFLD and association with cardiovascular disease and kidney dysfunction in young adults.

Inflammatory bowel diseases represent a heterogeneous group of chronic diseases occurring as a result of disruption of interaction processes between the mucosal immune system and the colon commensal ecosystem. The key role of the intestinal microbiota in the pathogenesis of ulcerative colitis, as well as its definition as a deterministic factor influencing the status of immune activation and the severity of the disease, is confirmed in many studies. Accumulating evidence suggests that non-antibacterial drugs are able to modulate the composition of the intestinal microbiota, which in turn may determine the effectiveness of pharmacological therapy and the clinical outcome. The article presents a review of literature on the impact of drugs used in the treatment of ulcerative colitis on the bacterial community of the colon.

This review presents recently available information on the properties of endogenous and exogenous cannabinoids, their possible mechanisms of action and effects. The article reflects foreign experience in the use of cannabinoid preparations for the recommended indications, as well as possible promising effects for the expansion of their clinical use.

When analyzing pharmacoeconomic studies of the skin melanoma treatment conducted in various countries, the combinations of vemurafenib + cobimetinib and encorafenib + binimetinib are the most acceptable therapy options in terms of increasing life expectancy with adjustments for quality, but, according to the clinical guidelines of the National Joint Oncology Network (NCCN), USA, version 2.2023 – “Melanoma: Cutaneous”, not for adjuvant therapy. At the same time, social networks can be a valuable asset of information about patient’s quality of the life. For the patients with advanced melanoma with a BRAF mutation, the combination of atezolizumab + vemurafenib + cobimetinib indicated the highest clinical effectiveness and can be recommended for pharmacotherapy under condition of drug price reduction.Comparison various drugs combinations with monotherapy for patients with unresectable or metastatic melanoma with a positive BRAF V600 mutation indicated that nivolumab + ipilimumab therapy is not cost-effective in comparison with nivolumab monotherapy, but combination of dabrafenib + trametinib, on the contrary, increases the patient's life expectancy compared to vemurafenib and it’s more cost-effective. It was shown that Pembrolizumab to increase life expectancy but it’s associated with increased costs compared to ipilimumab when comparing different monotherapy options. The assumed additional cost-effectiveness factor is acceptable for most European countries, because it does not exceed the “willingness to pay” threshold. It is necessary to conduct large-scale pharma-economic studies in order to identify the most cost-effective treatment for Russia for various variants of the course of melanoma, both of various combined regimens with each other, and their comparison with monotherapy. It is important to take into account also the costs of correcting undesirable adverse drug reactions, since they have a significant impact to the structure of direct costs. The development of innovative drugs for the treatment of melanoma is proceeding rapidly, however, access to these drugs is limited due to their high cost. Patient-centred drug development and reimbursement options need to be found.

Objective: comparison of peripheral and central blood pressure, vascular wall stiffness and glomerular filtration rate in patients divided into salt-sensitive and salt-resistant based on the dynamics of blood pressure during night time after salt loading.

Materials and methods: the study included 180 patients with arterial hypertension: 96 men (53%) and 84 (47%) women, median age 59 (56-64) years. Salt sensitivity was assessed according to the method of V.I. Kharchenko with distribution into groups according to the results of blood pressure dynamics at night. Peripheral and central blood pressure, vascular stiffness, and glomerular filtration rate were compared.

Results: in 61% of salt resistant patients, there was a sufficient decrease in blood pressure during nocturnal sleep — the “dipper” profile, while in the group of salt sensitive patients, the decrease in blood pressure was sufficient only in 48%. Glomerular filtration rate was also higher in salt resistant patients compared to salt sensitive: 76,5 ml/min./1.73m² versus 68 ml/min./1,73m².

Conclusion: arterial hypertension is more severe in salt sensitive patients, which was reflected in the intergroup comparison of peripheral and central blood pressure, vascular stiffness, and excretory function of the kidneys. Assessment of salt sensitivity at night may be useful in identifying high-risk groups of patients requiring the most careful monitoring and “aggressive” antihypertensive therapy.

Objective: evaluation of gender differences in the antihypertensive effect after denervation of the renal arteries based on the results of office and daily measurements of blood pressure in resistant arterial hypertension in a 3-year follow-up.

Materials and methods: the study involved 80 patients with resistant arterial hypertension (RAH); Patients were divided by stratification randomization into the interventional treatment group, who continue to receive antihypertensive therapy (AHT) (RDN group) and the MT group (patients on drug therapy only. The study groups were comparable in terms of gender, age, duration of hypertension, the number of antihypertensive drugs taken, the presence of For 12 months, a comparative study was conducted between groups, further analysis of the effectiveness of surgical treatment of RDN PA was carried out at control points of 24 and 36 months, in which laboratory and instrumental examinations were performed.

Results: according to the office measurement of blood pressure within the RDN and MT study groups, both in men and women, it turned out to be similar. After 12 months of observation between the comparison groups, the women of the group showed a statistically significant negative dynamics of the office SBP (p<0.01) and office DBP (p<0.05) parameters. According to the analysis of average daily, average daily, average night SBP indicators, after 12 months in the RDN group, a decrease was observed in all main parameters (p<0.001). It is worth paying attention to the fact that in the MT group, among the average daily, average daily, average night ABPM indicators after 12 months, no statistically significant changes were detected. When conducting a gender analysis of ABPM indicators using the Friedman test and correcting the p value for multiple comparisons at visits of 24 and 36 months, a statistically significant decrease in the main average daily indicators in women was demonstrated, while in men such changes were not established.

Conclusions: the data obtained indicate a more pronounced antihypertensive effect after radiofrequency denervation of the renal arteries in resistant arterial hypertension in women.

Purpose: to evaluate the features of the course of complications in patients with BAV based on the results of a pathomorphological study.

Material and methods: a retrospective analysis of a register of 328 patients with AS and dilation of the ascending aorta (DAA), based on histological studies performed in 2010–2022 was carried out. 209 patients were diagnosed with BAV as a result of histological examination, and 119 patients were diagnosed with tricuspid aortic valve (TAV). The type of BAV was analyzed in 139 operated patients based on the results of the analysis of surgical protocols.

Results: according to the obtained results, the first type with fusion of the right and left coronary cusps prevailed among patients with BAV (78%), the smallest number of patients with BAV was with fusion of the right coronary and non-coronary cusps of the aortic valve (4%), while fusion of the left coronary with the non-coronary cusps of the aortic valve (AV) and patients with "true" BAV occurred in each case in 9% of patients. The formation of AS (75.6%), DAA (68.4%), and the combination of AS+DAA (81%) was more observed in the group of patients with the first type of BAV. According to the results of histology of the AV, there were no significant differences depending on the morphology of the valve. In particular, according to the results of AV histology, the frequency of calcification did not differ in groups of patients with BAV and TAV. Fibrosis with erasing of the layered histoarchitectonics of the AV of varying severity was detected in every second patient, regardless of the presence of congenital heart disease (CHD). According to the results of aortic histology, hemodynamic aneurysm in patients with BAV was much more common than in patients with TAV (p=0.0027). In addition, it was verified that in 39 patients out of 40 without pathomorphological changes in the aortic wall, aortic stenosis appeared in the diagnosis, of which 80% of patients had CHD: BAV. It was verified that 39 out of 40 patients without pathomorphological changes in the aortic wall had aortic stenosis in the diagnosis. Moreover, in 80% of patients, the main cause of aortic dilatation was identified as BAV.

Conclusions: the results of this study demonstrated that in the vast majority of cases, aortic dilatation and aortic stenosis are formed during fusion of the right and left coronary cusps. The absence of morphological changes in the aortic wall in almost every third patient with DAA and BAV, confirms the genetic contribution to the formation of aortic dilatation in this category of patients and requires further study.

Objective: to evaluate changes in the activity of markers of pro/antioxidant systems of liver tissue of animals carrying melanoma B16 with the introduction of dimethyltin bis (3,5-di-tert-butyl-4-hydroxyphenylthiolate) (Me-3) at different stages of the development of the tumor process.

Materials and methods: the study was conducted on mice of the C57Bl/6 line (females). 48 hours after the transplantation of tumor cells to female mice of the C57Bl/6 line, the studied compounds were administered intraperitoneally 1 time per day for 5 days according to the classical method used for screening compounds with a suspected antitumor effect. The tested compounds were administered at a total dose of 375 mg/kg. The animals were removed from the experiment on the 7th and 18th days after the transplantation of tumor cells.

Results:  with the introduction of Me-3, there was a decrease in malondialdehyde as the main indicator of the activity of lipid peroxidation at all stages of the development of the tumor process.

Conclusions: the multidirectional effect of Me-3 on the enzymatic activity of the antioxidant system on days 7 and 18 of the development of melanoma B16 suggests some selectivity of action depending on the initial pro/antioxidant status of the cell, as well as the expediency of studying this group of compounds as a substrate for nanozymes with pro/antioxidant activity.

Objective: to study the rate of enrollment of patients for inclusion in clinical trial according to various parameters and its change under the influence of internal factors, to develop new parameters and indicators that could be sensitive for assessing the effect of the this factors.

Materials and methods: a retrospective analysis of phase II-III data from four phase II-III clinical trials in the field of oncology and hematology conducted from 2007 to 2017.

Results: the rate of recruitment of patients, other parameters of recruitment of patients and their derivatives, which were influenced by internal factors, were studied.

Conclusions: Patient recruitment is affected by internal factors. This impact can be multidirectional: can increase the number of patients or, conversely, reduce it. Knowing the direction of the influence of a certain factor, it is possible to predict the success of both the recruitment of patients and the success of the clinical trial in general.

Granulomatosis with polyangiitis (GPA, Wegener's granulomatosis) is a rare autoimmune disease, characterized by vasculitis of small and medium-sized vessels, as well as the formation of granulomas and the most frequent involvement of the upper respiratory tract, lungs, kidneys and eyes in the pathological process. In the absence of treatment, the disease progresses rapidly and is fatal. The onset of the disease is possible at any age. Pharmacotherapy is aimed at suppressing the immunopathological reactions underlying the disease in order to achieve complete remission associated with anti-neutrophil cytoplasmic antibodies of systemic vasculitis (ANCA-SV). The article deals with a difficult case for diagnosis of respiratory tract damage in GPA in a 60-year-old woman.

A case report of a rare disease associated with antibodies to the basement membrane of the glomeruli of the kidneys (Goodpasture's syndrome) in a young woman is presented. The case is characterized by a typical course of the disease with a high titer of antibodies to the basement membrane of the glomeruli, kidney damage with the formation of terminal renal failure and infiltrative lung damage. The starting point for the development of the disease was probably massive tissue damage after an intense long massage. The diagnosis was confirmed clinically and by immunological data. The patient underwent intensive therapy, including the use of genetic engineering therapy with the subsequent development of covid-19 infection, effectively treated with traditional methods. During the year of observation, stabilization of the autoimmune process was achieved against the background of combination therapy. The difficulty of curing patients with pneumo-renal autoimmune damage and the possibility of achieving a positive course of the disease on the background of multicomponent intensive therapy are emphasized.

Draw the attention of clinical therapists, gastroenterologists, surgeons, general practitioners to the problem of antibiotic-associated diarrhea caused by the irrational use of antibacterial drugs. To highlight the difficulties in diagnosing and managing patients with antibiotic-associated pseudomembranous colitis.

Werner's syndrome is a disease characterized by premature aging, including the earlier development of diseases of the cardiovascular system: generalized atherosclerosis, hypertension, ischemic heart disease, and the occurrence of fatal complications such as myocardial infarction, stroke, at a younger age. It is cardiovascular diseases are the main cause of death of patients with Werner syndrome, whose life expectancy does not exceed 50 years. Therefore, patients with this syndrome need regular monitoring for early detection of signs of cardiovascular diseases, an increase in the quality and duration of life.

Thrombocytosis (an increase in the level of platelets in the peripheral blood above 450×109/l) has different causes and mechanisms of formation: it can be familial, primary (clonal), secondary (reactive). The ability to interpret peripheral blood parameters, knowledge of the main differential diagnostic criteria for diseases accompanied by thrombocytosis, allow the doctor to conduct the necessary examination to determine the cause of an increase in the platelet count in the blood. Clarification of the nature of thrombocytosis is very important, since clonal thrombocytosis is more often accompanied by the development of thrombotic complications and requires more active therapeutic intervention, specific therapy. Timely diagnosis helps to prevent the development of thrombosis, improves the prognosis, quality of life and survival of patients.

Objective: to study various aspects of motivation for learning among senior students, residents and postgraduates of a medical university.

Materials and methods: a survey of 174 students at the department was conducted (150 students of the 5th and 6th courses, 24 residents and graduate students). An electronic survey form was used. The survey was conducted simultaneously and anonymously.

Results: the results of the survey made it possible to discuss the motives and factors that determined the choice of a future profession, to establish changes in ideas about the profession during training, the advantages and disadvantages of the educational process, the organization and quality of independent work, the role of teachers and assessments, the opportunities provided for self-realization and their use in the educational process.

Conclusion: the study of student motivation factors in the process of studying a clinical discipline is a necessary process for their awareness by the teaching staff of the department and the implementation of "feedback" — use in the educational process.