Relevance. Minimally invasive interventions under ultrasound control are a promising method for treating thyroid nodules with proven clinical effects. Indications for the use of minimally invasive methods are constantly changing and being supplemented. It is of practical interest to expand the indications for interstitial laser photocoagulation of thyroid nodes as experience accumulates. The purpose of the study: to study the changes in indications for performing interstitial laser photocoagulation of thyroid nodes over 15 years.

Materials and methods. Based on the experience of treating 876 patients with colloidal goiter using interstitial laser photocoagulation, the dynamics of indications for this technique were studied. The treatment data were analyzed in two-time groups: group 1 — the initial stage of the introduction of the technique, and group 2 — the stage of widespread use of the technique. With the accumulation of experience, the adjustment of photocoagulation and ultrasound modes was carried out. The control of the treatment was evaluated in dynamics by reducing the volume of nodes.

Results and conclusions. During the study, it was found that in both groups of patients, it was possible to achieve regression and decrease in the size of the nodes, depending on the pathology and size of the nodes. This made it possible to expand the indications at the expense of patients with large nodes (more than 30 mm in diameter). With recurrent nodular goiter, good results were also obtained. It has been established that interstitial laser photocoagulation is a safe, predictable method of treatment with the possibility of selecting individual regimens, well tolerated by patients. Indications for the use of the method are wide and are set individually based on the predicted risk/effectiveness ratio. The method does not negatively affect the quality of life of patients. When selecting patients, the opinion of both the doctor and patient should be taken into account.

Relevance. The problem of mechanical jaundice is the most urgent in abdominal surgery. This is primarily because the frequency of this pathology is steadily increasing, and the mortality rate does not have a distinct downward trend. Surgical tactics in case of mechanical jaundice remains multivariate, and a differentiated approach is needed for treating this contingent of patients, which is decisive in improving the results of surgical aids.

The aim of the study. To improve the results of treatment of patients with mechanical jaundice of calculous etiology.

Materials and methods. The analysis of the results of treatment and specially conducted studies in 554 patients with mechanical jaundice of calculous etiology was carried out. The patients underwent ultrasound, CT, and MRI. The concentration of adrenaline, norepinephrine, dopamine, 11-oxycorticosteroids, histamine, and serotonin, as well as toxic metabolic products were determined. The state of the autonomic nervous system was assessed by determining the autonomic index and mathematical analysis of the heart rate using variational pulsometry.

Results. All the patients were operated on. Priority was given to stage-by-stage surgical tactics combining endoscopic decompression of the biliary tract with endoscopic papillosphincterotomy in the early stages of hospitalization and open surgical treatment after cupping the clinic of mechanical jaundice. There was a 3-fold increase in the number of endoscopic interventions. The mortality rate for the entire period decreased by 2.1 times. The reason for the results obtained is the degree of trauma of the operation. The parameters of the musculoskeletal, autonomic nervous, and sympathoadrenal systems were determined in patients divided into three groups. In the first group, primary open surgery on the biliary tract was performed, in the second — endoscopic papillosphincterotomy and abdominal surgery on the biliary tract, in the third — only endoscopic papillosphincterotomy. Endoscopic papillosphincterotomy had the most sparing effect on the functioning of the cardiovascular system and normalization of vegetative homeostasis. The volume of the surgical aid for mechanical jaundice affects the content of the sympathoadrenal system and biologically active substances in the blood plasma. When performing abdominal operations, compared with minimally invasive ones, the concentration of adrenaline, norepinephrine, serotonin, histamine, and 11-oxycorticosteroids in the blood increased by 1.5–2.5 times.

Conclusion. The effectiveness and priority of minimally invasive operations for treating mechanical jaundice have been confirmed. The use of endoscopic resolution of biliary hypertension makes it possible to reduce the mortality rate against the background of a steady trend toward normalization of the indicators of the sympathoadrenal system and variational pulsometry.

Low-invasive ultrasound-controlled interventions are promising methods for treating primary hyperparathyroidism (PHPT) with proven clinical effects. In the presence of objective advantages of low-invasive ultrasound-controlled staged parathyroidectomy, indications for its implementation are not fully formed, and there is no consensus on the criteria for selecting patients. The study formed the criteria for selecting patients with primary hyperparathyroidism to perform staged parathyroidectomy. In 2012–2020, staged parathyroidectomy was performed in 61 patients. Staged parathyroidectomy was performed according to the original technique (patent RU No. 2392898 "Method of treatment of primary and secondary hyperparathyroidism"). Indications for the surgical treatment of PHPT were determined using Russian clinical guidelines. According to the results obtained during the long-term postoperative period, the effectiveness of staged parathyroidectomy was 90.2%. This indicator was achieved because of other things and strict selection of patients. Based on the analysis of the results obtained, the criteria for selecting patients and contraindications for performing staged parathyroidectomy were formed.

This article examines digital culture as a special environment that has a formative influence on society. Interactive behavior and hypertextuality in digital culture form clip perception, prompting the emergence of new patterns of thinking. The result of this phenomenon may be a deep gap between cultural codes.

Relevance. In this article, we consider the possibilities of a psychodynamic psychotherapeutic approach in the diagnosis and treatment of gender dysphoria on the example of a clinical case. Gender dysphoria refers to the distress that may accompany a mismatch with the patient's biological sex and assigned gender. In the past few years, there has been an increase in the number of patients requesting the restoration of congenital anatomical sex characteristics due to regret after genderaffirmation surgery (GAS). Recent studies have shown that one of the key regrets after GAS is inadequate psychological and psychiatric evaluation in determining whether GAS is an indication.

Case study. In this article, we explored how psychodynamic psychotherapy can be used to diagnose and treat disorders associated with gender dysphoria in the case of a 21-year-old man who presented with symptoms that met the diagnostic criteria for two conditions: unspecified gender dysphoria 302.85 (F64.1) and transvestic disorder with autogynephy 302.3 (F65.1) according to DSM-5. The main symptom appeared when the patient was at pre-school age and has been a constant concern ever since. The symptoms disappeared after psychodynamic psychotherapy, which lasted 11 months. Evaluation of psychotherapeutic effects 2 years after the completion of psychotherapy showed the stability of the results achieved.

Conclusion. Based on our analysis, we concluded that the use of psychodynamic psychotherapy for patients with gender dysphoria helps recognize neurotic conflicts that may underlie transgender symptoms, and thereby reduce the likelihood of a diagnostic error in determining the presence of indications for GAS. Looking at cases of gender dysphoria in Balint groups can also be of great help in understanding the etiology of gender dysphoria symptoms.

Fatigue, mood disturbances, lack of performance, and gastrointestinal disturbances are common among athletes during training and competition. Psychosocial and physical demands during intense exercise can initiate a stress response that activates the sympathoadrenal and hypothalamic-pituitary-adrenal axes, resulting in the release of stress and catabolic hormones, inflammatory cytokines, and microbial molecules. The gut is home to trillions of microorganisms that play fundamental roles in many aspects of human biology, including metabolism, neuroendocrine, and immune function. The microbiome and its influence on host behavior, the gut barrier, and immunity is a critical aspect of the gut-brain axis. Data have been obtained showing a high correlation between physical and emotional stress during exercise and changes in the composition of the gastrointestinal microbiota. Modifications to the composition of the microbiota in professional athletes can improve training efficiency, improve athletic performance and shorten the recovery period after intense physical exertion.

The article presents the features of bioelectrical processes in the myocardium of premature babies with different gestational age in the neonatal period. The analysis of quantitative electrocardiographic indicators revealed the features of the parameters of the terminal part of the ventricular complex associated with the degree of maturity and age of newborns. At the same time, it was found that during the first month of life in very premature babies significant changes in homeostasis and morphofunctional state of various vital organs and systems occur.

Relevance. Autism spectrum disorders (ASD) are a problem that is not talked too much. It is important to form alertness in pediatricians for early detection of children with "autism".

The aim of the study: to identify symptoms characteristic of children with ASD, as well as concomitant diseases, to increase alertness.

Materials and methods. A survey of 52 parents with children with ASD. Data processing was carried out using the Microsoft Excel program.

Results and conclusions. The first signs of ASD that the district pediatrician should pay attention to are the absence of eye contact, the absence of an index gesture, the absence of speech, stereotypes, alienation, and lack of response to his name. The presence of allergopathology, constipation, a limited diet with a limited drinking regime, combined with a delay in impaired mental function, when manifesting up to 1–2 years is an excuse to show the child to a psychiatrist to exclude ASD.

Relevance. In connection with the trend toward an increase in life expectancy and aging of the population, the issue of timely detection and treatment of geriatric disorders in elderly and senile patients becomes relevant. The aim of the study is to analyze cognitive impairment in hospitalized elderly and senile patients.

Materials and methods. The study involved 93 patients older than 75 years, namely 63 women (80,2±5,0 years) and 30 men (80,2±6,4 years). All patients underwent a brief geriatric examination. The probability of frailty syndrome was assessed using the "Age is not a barrier" questionnaire, the risk of falls was assessed using the Morse scale. Cognitive status was determined using the MINI-COG questionnaire and the Mini-Mental State Examination (MMSE) scale. The data of biochemical blood tests (creatinine, uric acid, glucose, total cholesterol and lipid spectrum, K, Na) were also taken into account.

Results. Normal cognitive status was recorded in women 2,5 times more often than in men. Patients with dementia were more likely to be obese than those without dementia (70% versus 35%; χ²=4,46; p=0,035). Cognitive impairment was accompanied by a decrease in physical functioning: the risk of falls on the Morse scale in the group of patients with dementia was 25% (p=0,038) higher, and the score on the "Age is not a barrier" test was 45% (p=0,009) worse than in patients without dementia. Patients with dementia tended to hyperuricemia and hypokalemia. Spearman's correlation analysis revealed inverse relationships between MMSE scores and the presence of arterial hypertension (r=–0,43; p<0,05) and type 2 diabetes (r=–0,33; p<0,05), with physical functioning ("Age is not a barrier": r=–0,49; p<0,05 / Morse: r=–0,41; p<0,05), with uric acid level (r=–0,61; p<0,05) and creatinine (r=–0,37; p<0,05). The presence of arterial hypertension and diabetes mellitus was combined with a more pronounced decrease in cognitive potential.

Conclusions. The share of elderly patients reached 80% of all hospitalized persons. Dementia is 25% more common in men than in women. The presence of arterial hypertension, type 2 diabetes, and obesity increased the risk of dementia. The presence of dementia limits the physical functioning of patients by 45% and increases the risk of falls by 25%.

The results and the degree of safety of various groups of hypoglycemic drugs are presented. The current work analyzes the safety of the use of glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl peptidase-4 (iDPP-4) inhibitors, insulins, and inhibitors of sodium glucose cotransporter type 2 (iSGLT-2) according to clinical studies published in the scientific literature. Macrovascular complications in diabetes mellitus (DM) develop much earlier than microvascular complications and are the cause of death in 75–80% of patients. The safety of ongoing hypoglycemic therapy is based on the stabilization of its cardiovascular effect. GLP type 1 receptor agonists (lixisenatide) and DPP-4 idiopathic agonists (alogliptin) demonstrated a positive effect on the prognosis of patients with cardiovascular diseases. In addition to metformin, selective sodium-glucose cotransporter type 2 inhibitors, in particular empagliflozin and GLP type 1 analogs, act as first-line drugs from the position of cardiovascular safety in the treatment of patients with type 2 diabetes with a very high cardiovascular risk (liraglutide). The action of iSGLT-2 is glucose-dependent, which leads to a lower risk of hypoglycemia and, accordingly, cardiovascular safety for this class of drugs. Empagliflozin prevents the progression of cardiovascular disease in patients with type 2 diabetes, with heart failure with reduced ejection fraction, regardless of the presence of diabetes, providing a holistic approach to the management of patients with a cardiac profile.

Relevance. Adjuvant hormonal therapy in postmenopausal women at an early-stage of estrogen-positive breast cancer (BC) includes anastrozole, letrozole, tamoxifen, toremifene, and exemestane, but the most effective drug is not known, and in this situation, the role of adjuvant hormonal therapy becomes especially debatable.

The purpose of the study. Conducting an indirect comparison of oestrogen antagonists and aromatase inhibitors used in postmenopausal women with early-stage estrogen-positive breast cancer through a systematic search and selection of transitive data from randomized controlled trials (RCTs), and their subsequent quantitative synthesis in a network meta-analysis.

Methods. We conducted a systematic review in two databases: MEDLINE and The Cochrane Central Register of Controlled Trials. Full-text versions of articles from RCTs were reviewed to evaluate the comparative efficacy of adjuvant hormonal monotherapy with toremifene, tamoxifen, anastrozole, letrozole, and exemestane in women with early-stage estrogen-positive postmenopausal breast cancer who had not previously received hormone therapy. Efficacy was assessed by overall survival (OS). A network meta-analysis was carried out using the NetMetaXL programme.

Results. As a result of a systematic search, we selected 8 RCTs involving 25167 patients. When performing a synthesis of the obtained data using a network meta-analysis, no statistically significant differences in 5-year OS were obtained between the comparators.

Conclusions. There are no clinically significant differences in 5-year OS between the compared drugs of adjuvant hormonal monotherapy in early-stage breast cancer.

Introduction. Until recently, simple cysts of the testicular parenchyma were considered extremely rare pathology. Recently, this condition has been diagnosed more often, which is largely due to the widespread use of ultrasound examination of the scrotum. To date, a unified approach to the management of patients with this nosology has not been developed, which served as the basis for a review of the literature on simple cysts of the testicular parenchyma.

Results. Simple cysts of the testicular parenchyma are observed in 8–10 % of patients. The etiology of simple intratesticular cysts remains unknown. Small cysts of the testicular parenchyma are most often asymptomatic, pain symptoms of a nature for large cysts larger than 2 cm. Asymptomatic single cysts of the testicular parenchyma do not require surgical treatment and probably need dynamic monitoring. In patients with symptomatic and multiple cysts, surgical treatment should be recommended. Preference should be given to organpreserving techniques in the form of cyst resection/enucleation. Orchiectomy for the treatment of simple intratesticular cysts should be considered in exceptional cases.