The problem of breastfeeding and an increase in its prevalence are examined at three possible levels of influence on the mechanisms for implementing breastfeeding: state, health care system, and personal. The study reviewed the literature on managing issues of implementation and prevalence of breastfeeding programs, the lactation period, approaches to forming lactation dominants, lactation challenges, and the need for prelactation preparation for pregnant women in order to increase breastfeeding adherence. The study also examined the issues that prevent breastfeeding from overcoming its low barrier.

The article examines history of fundamental discoveries, methods and clinical achievements in neuroimaging, their contribution to the development of diagnosing, treatment and understanding of epilepsy etiology, also as part of International League Against Epilepsy’s research. In the early stages of its development, neuroimaging had advanced rapidly in the areas of cancer detection, pneumoencephalography, pneumomiography, ventriculography, linear tomography and selective angiography. The development of epileptology was greatly influenced by the use of computed tomography and magnetic resonance imaging, which made it possible to identify pathological lesions in a large number of patients with cryptogenic epilepsy, expand the indications for surgical treatment and improve understanding of the pathogenesis of pathological processes in the brain associated with seizure activity. In recent years, functional magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography and single-photon emission computed tomography have become the focus of attention of researchers, which revealed a huge number of different structural changes of the brain tissue, which lie at the basis of the formation of the epileptic focus and lead to the development of focal epilepsy.

The article reviews Russian and foreign literature on the treatment of patients with acute pancreatitis according to the relevance, as well as increase in disease frequency, high mortality rate, and persistent disability of patients with severe pancreatitis. Pancreatic duct stenting is one of the most promising treatments for pancreatic necrosis, and it can help improve the treatment of such patients with a severe disease.

The success of standard therapy for alcoholic liver disease in terms of forecasting the risks of an adverse outcome is now assessed using the degree of decrease in the activity of laboratory markers of cytolysis and cholestasis. The study aims to examine a lipid profile through comparing of laboratory parameters in 28 patients aged forty to sixty with alcoholic liver disease before and after standard treatment in terms of mortality risks. When compared to the mortal risks before and after standard treatment in the group of patients with an achieved total cholesterol level of more than 5 mmol/L, the mortality risk was significantly reduced in patients with an achieved total cholesterol level of less than 5 mmol/L. It has been demonstrated that, in the presence of significant fluctuations in cholestasis indicators, a total cholesterol level in the blood serum of less than 5 mmol/L can be used as a criterion for reducing the mortality risk in patients after standard therapy for alcoholic liver disease.

Modern diagnosing of kidney diseases is based on a complex of clinical, laboratory, and instrumental studies, among which kidney biopsy occupies an important place. The study aims to assess the diagnostic value of kidney biopsy in patients with nephrological pathology. The study included 70 patients (n = 70) who underwent percutaneous puncture kidney biopsy from 2019 to 2022 for the following causes: nephrotic syndrome (42 %), chronic nephritic syndrome (35 %), and acute kidney injury of unclear etiology (23 %). The morphological examination revealed that two-thirds of all patients with kidney diseases (60 %) (p = 0,05) had glomerulopathy. Among glomerular diseases, IgA-nephropathy prevails (26 %) (p < 0,05), as well as membranous nephropathy (14 %). Amyloidosis (AA/Al) is registered in every seventh patient (14 %), while diabetic nephropathy – in every tenth (10 %). Complications of kidney biopsy develop in a quarter of cases (26 %). Anti-neutrophil cytoplasmic antibody-associated vasculitis, thrombotic microangiopathies and tubulointerstitial nephritis manifest more often in the form of acute kidney injury, IgA-nephropathy manifests itself in the onset of the disease with nephritic syndrome, while diabetic nephropathy, membranous nephropathy, focal segmental glomerulosclerosis, amyloidosis start with nephrotic syndrome in most cases. Kidney biopsy often has a significant impact on patient management tactics: according to the results of the morphological study, active pathogenetic therapy was initiated or corrected, and the vector of diagnostic search was also changed in 83 % of patients (p = 0,005). The data obtained confirm the need for the widespread introduction of kidney biopsy in order to optimize the quality of medical care provided to patients with a nephrological profile.

The study aims to examine blood pressure indicators in men with arterial hypertension, their dependance on psoriasis, and identification of endothelium dysfunction, with vascular endothelial growth factor in combination of these diseases. The study included 168 male patients who were on outpatient treatment for stage 2 hypertension, of which 86 patients had a progressive stage of moderate severity. All patients underwent daily blood pressure monitoring and a blood test for the content of vascular endothelial growth factor. It was revealed that the level of vascular endothelial growth factor was statistically significantly higher (160.3 ± 49.9 pg/ml, p = 0.0002) in patients with a combination of hypertension and psoriasis than in those with hypertension without psoriasis. In patients with hypertension and psoriasis, statistically significantly (p < 0.05) higher variability of systolic arterial hypertension in the daytime and at night, as well as the rate of morning rise in systolic and diastolic blood pressure were noted. Also, in patients with hypertension and psoriasis, the normal daily blood pressure rhythm (dipper) was recorded more rarely (χ2 = 3.97, p = 0.046) – in 30.2 % of cases, while in patients with hypertension, the dipper daily rhythm was registered in 45 % of cases. The presence of psoriasis aggravates the course of arterial hypertension, a patient with hypertension and psoriasis requires more attention from a general physician, cardiologist and dermatovenerologist.

The study aims to conduct a comparative assessment of the clinical and economic efficiency of laparoscopic cholecystectomy and mini-access cholecystectomy in 116 patients with acute calculous cholecystitis who have undergone treatment. The clinical efficiency was substantiated by the shorter time of surgery, duration of in-hospital treatment, number of clinical and laboratory examinations, and duration of analgesic and anticoagulant therapy prescriptions. In acute calculous cholecystitis, laparoscopic cholecystectomy was 5 144.1 rubles less expensive than mini-access, while in acute gangrenous calculous cholecystitis it cost 28 881.0 rubles less. The use of less expensive surgical technology makes it possible to save money and therefore treat by 5 and 25 % more patients with acute catarrhal calculous cholecystitis and acute gangrenous calculous cholecystitis, respectively, using the budget

According to the studies, there is a high probability of gigantomastia development in juvenile with obesity, and mammary gland reduction may help decrease weight in such patients due to the improvement of hormones level in the organism. The article presents the results of a comparative analysis of reduction mammoplasty in patients with and without obesity. The study aims to examine the influence of obesity on short- and long-term results of performing a standard surgery with an author’s modification of reduction mammoplasty from 2010 to 2023 in 32 female patients with gigantomastia. The patients from 19 to 62 y. o. (34.5 ± 1.8) were divided into two groups: 23 women with obesity and 9 without. Performing reduction mammoplasty contributed to weight loss in the long-term postoperative period, while the recovery process itself after surgery in patients with obesity was much more difficult than in those without it. Obesity is an aggravating factor when performing reduction mammoplasty. The presence of excess body weight not only increases the severity of pain and blood loss, but can have a negative impact on the aesthetic result of surgery.

Pilon fractures are intra-articular fractures of the distal tibial metaepiphysis account for about 1 % of all lower extremity fractures. A typical sign of a pilon fracture is a large number of fragments of bone structures in the injured area as a result of the impact of the talus on the tibia. The study aims to assess antiinflammatory and antibacterial therapy, timely pain relief for an injured patient, prevention of thromboembolic complications, aseptic dressings, and the patient’s movement as soon as feasible before the suture material is removed. The assessment was based on the data from the medical documentation of the trauma hospital, instrumental research, and the results of dynamic observation of surgery on open reduction of a comminuted intra-articular fracture of the tibia of the left leg, osteosynthesis with a titanium plate and screws performed under regional spinal anesthesia. In the early postoperative period, an integrated approach to rehabilitation therapy was used. Intra-articular injuries of the distal metaepiphysis of the tibia are one of the most burning issues in traumatology. This type of injury requires the active implementation of modern diagnostic methods and surgical treatment through the use of metal osteosynthesis techniques in various variations.

The study aims to comparatively assess long-term results of surgical treatment of burns aftereffects using local tissues and free flaps from 2005 to 2022. The surgical treatment was performed on 84 patients with aftereffects of lower limbs burns. The mean age of the patients was 9.2 ± 1.7 years. The patients were divided into two clinical groups: group I included 51 patients (60.7 %) with local tissue grafting, group II included 33 patients (39.3 %) with the author’s method of free flap grafting using tissue from the groin area, which allowed for reducing the occurrence of relapses to a minimum. Two patients who repeatedly underwent unsuccessful surgeries required an additional surgical intervention. Moreover, it can be considered successful, given that prior to the surgical intervention, there were practically no movements in the joints. Thus, the available data show the effectiveness of plastics with a free flap of defects remaining during excision of postburn tightening scars in the lower limbs. However, in individuals under 18 years of age, future bone growth should be taken into account, as well as the proximity of the lesion to the joints, in order to avoid tension and the need for reoperations.

Activation of the body’s regulatory systems provides adaptation to the impact of pathogenic factors. Prolonged exposure to extreme factors during combat operations can lead to the formation of a focus of pathologically increased exaltation in the central nervous system. The study aims to comparatively assess the tension of central regulatory structures in victims with battle and peacetime traumas in the acute period to develop criteria for indicating the severity of functional disorders of the central nervous system and pathogenetic treatment. Twenty servicemen who received mine-explosive trauma as a result of combat operations, twenty victims of domestic trauma, and twenty healthy males were examined. Neurophysiological and ultrasound methods of research were used to assess the functional state of the central nervous and cardiovascular systems: electroencephalography with quantitative analysis, transcranial Doppler with functional tests, electrocardiography with assessment of heart rate variability: The study assessed the index of spectral power of rhythms in alpha/theta ranges, indices of spectral power of heart rhythm (index of vagosympathetic balance; index of centralization; index of activation of subcortical structures), indices of vasodilatation/vasoconstriction reflecting reactivity of cerebral vessels to tests with hyper/hypocapnia. The following statistically significant differences were revealed between peacetime and wartime traumas: a decrease in vasodilation reserves for hypercapnia, and in some cases, their absence during battle trauma; increasing indices of centralization and activation of subcortical structures during battle trauma; decrease in the index of spectral power of rhythms in the alpha/theta ranges due to an increase in the power of the theta range during battle trauma. Based on this set of indicators, a scale of quantitative assessment of the degree of tension of regulatory subcortical structures in points was developed for early detection of patients with excessive activation of the central regulatory circuit leading to maladjustment and unfavorable course of the post-traumatic period.

The study aims to present a clinical case of a rare pathology such as obstetric hemolytic uremic syndrome associated with infection during pregnancy, and complicated by massive bleeding, a critical obstetric condition, and a high risk of maternal mortality in a near-miss case. The study analyzes changes in causes of maternal mortality rate in the Russian Federation, including changes towards extragenital diseases; indirect causes and embolisms; preeclampsia, obstetric bleeding, and sepsis despite their decrease in the causes of maternal mortality rate; and such diseases as thrombotic microangiopathy, which is considered a probable life-threatening maternal condition and named a critical obstetric condition, that can be diagnosed in a highinformation laboratory with an instrumental basis. Thrombotic microangiopathy is attributed to many diseases, therefore, there are many unclear and controversial issues in diagnosing such a disease during pregnancy. Its clinical symptoms include hemolytic microangiopathic anemia, thrombocytopenia, thrombosis of the terminal arterioles and capillaries of the microvascular bed, and multiple organ dysfunction.

The study aims to evaluate the efficacy of xenon inhalation at various concentrations on neurological and cognitive impairments when simulating open traumatic brain injury (TBI) in rats. Tests were performed on 35 male Wistar rats weighing from 250 to 350 g. After simulating an open traumatic brain injury, the animals received inhalation with a mixture of gases: 5 sham operated animals received only anesthesia without traumatic brain injury and inhalations, a control group with traumatic brain injury + inhalation N₂ 70 % / O₂ 30 % (group “TBI”, n = 10); an experimental group with traumatic brain injury + inhalation of xenon-oxygen 70 % / O₂ 30 % (group “TBI + iXe70”, n = 10), an experimental group with traumatic brain injury + inhalation of xenon-oxygen and nitrogen – Xe 35 % / O₂ 30 %, nitrogen 35 % (group “TBI + iXe + N₂”, n = 10) for 60 minutes. After gas inhalation, the animals were observed for 14 days. On the 3rd, 7th and 14th days, the neurological limb placement test was carried out. The preservation of cognitive functions, such as learning and spatial memory, was assessed using the Morris water maze test with control testing on the 14th day. After testing, on the 14th day of observation, euthanasia was performed, and the brain was collected for research. It was found that the selected xenon concentrations in doses of 0.25 and 0.5 MAC statistically significantly reduced the severity of both neurological deficit and cognitive impairment in 7 and 14 days, whereas increasing the xenon concentration did not significantly enhance the neuroprotective effect.