In the practice of an obstetrician-gynecologist, the problem of pelvic organ prolapse is increasingly being raised. Symptoms of pelvic organ prolapse are noted from a young age, gradually progressing and reducing the patient’s quality of life. Various surgical methods of treatment also don’t solve the problem of prolapse. The recurrence rate after correction of prolapse with own tissues reaches 40%, and operations using mesh implants have a number of specific complications, the fight against which sometimes becomes more difficult than primary intervention. Despite the steady increase in the prevalence of the disease, effective methods of dealing with it have not yet been developed. Also, the tactics of managing patients at the initial stage of prolapse, when there are complaints, but they are not given enough attention, both by the doctor and the patient, are not defined. The main risk factors for the disease are: perineal ruptures during childbirth, episiotomy, menopause, repeated pregnancies and childbirth, polyhydramnios, multiple pregnancy, fetal macrosomia, conditions accompanied by a chronic increase in intraabdominal pressure, heavy physical labor, impaired innervation and circulation of the pelvic floor, genetic predisposition, hysterectomy and connective tissue dysplasia. The review is devoted to the causes and methods of prevention of pelvic organ prolapse at the present stage. Methods such as pelvic floor muscles training, including in the biofeedback mode using vaginal simulators, electrical impulse stimulation, high-intensity focused electromagnetic stimulation, and non-ablative Er:YAG laser therapy are considered. A systematic literature search was carried out using Scopus, web of Science, MedLine, PubMed and eLibrary data base system.

Despite scientific progress, there is currently no sigle opinion about the cause of the occurrence and recurrence of uterine fibroids, but due to the high level of molecular medicine, progress is being made in the hormonal and molecular genetic mechanisms of initiation, formation and growth of the fibroisds. The issue of pathogenetic treatment and prevention of recurrence of uterine fibroids in reproductive age remains relevant. The aims of the review. The aim of this review is to summarize current data about microRNA in biology of uterine leiomyoma (LM). This information can improve our understanding of the broad molecular interaction of signaling pathways in the formation of LM, and further maintaining epigenetic regulation as an important mechanism in the pathogenesis of uterine leiomyoma. In leiomyomas, the expression of a number of non-proteincoding genes is altered, such as microRNAs (miRNAs), which target genes that code protein. Material and research methods. Original and review articles, book chapters in the PubMed database related to the study of the pathogenesis of uterine fibroids in the period from 2004 to 2022 were found and analyzed. Results and discussions. Based on an analytical review of the literature, it becomes obvious that as evidence should be considered: 1. Abnormal myometrial and fibroid stem cells show an increased response to estrogen and progesterone exposure, stimulating processes such as cell proliferation, inhibition of apoptosis, and extracellular matrix (ECM) formation. 2. A number of tumor suppressor genes are abnormally hypermethylated in the LM when compared to normal myometrium, genes that form and regulate collagen, and a subset of estrogen receptor genes. 3. Multiple studies using microarray analysis or sequencing have demonstrated the existence of dysregulation of a number of protein-coding genes involved in cell proliferation and apoptosis, which are critical for the growth and progression of uterine fibroids. There are no reliable evidence base and do not provide an opportunity for practical application of clinically significant risk factors, the possibility of mathematical prediction of the growth of uterine fibroids in women of reproductive age. Data on the effect of the expression of a number of microRNAs on the growth of uterine fibroids in vivo are rather contradictory. The epigenetic processes of regulation and pathogenesis of the growth of leiofibromyomas in reproductive age have not been fully studied and substantiated. There are practically no data on predicting the growth of uterine fibroids in reproductive age, which will allow us to assess the risk of growth and determine further treatment tactics. Conclusion. Further work on the identification of specific genes, miRNAs, that are involved in the pathogenesis of LM may inspire the creation of new pathogenetic treatments. Such treatment is especially relevant for those groups of patients of reproductive age for whom surgical treatment may be ineffective. Targeted treatment can also prevent the recurrence of uterine fibroids, hence the need for repeat surgery.

Due to the total aging of the population, within the framework of the concept of “active longevity”, age-related aspects of women’s health have been paid close attention in the last decade. The physiological features of the menopausal period of life are due to the consequences of estrogen deficiency, while the protective effect of menopausal hormone therapy (MHT) in relation to diseases associated with age and aging leaves no doubt. At the same time, in the context of the ongoing COVID-19 pandemic, there are many open questions related to the appointment of MHT, both in terms of possible additional mechanisms for protecting the vascular wall, and in terms of risks, including against the background of changes in the state of immunity and the coagulation system. New realities require the development and justification of often fundamentally different approaches to the management of patients in gynecological practice, both in connection with coronavirus infection and in the postcovid period. That is why the organization of gynecological care during a pandemic requires a personalized approach to the management of patients with hormone-dependent diseases and the risk of unplanned pregnancy, as well as the development of clear algorithms that can be relied on in the daily work of both a practitioner and health care organizers.

Objective: to identify informative markers of the progression of cervical intraepithelial lesions of low degree.
Materials and methods: the dynamics of the results of the cytological study of cervical epithelium, genotyping of human papilloma viruses of high carcinogenic risk (HPV) with an assessment of the viral load, an immunocytochemical study of the expression of protein p16 (p16INK4α), serum folic acid in 90 HPV-positive patients of reproductive age was analyzed. 43 of the 90 patients (47.8%) who made up group I had regression of the disease. Group II included 30 of 90 patients (33.3%) with disease persistence - no significant changes in the results of laboratory and instrumental research methods. Group III was 17 out of 90 patients (18.9%) with disease progression. Statistical processing of the results was carried out using parametric and non-parametric analysis methods using IBM SPSS Statistics 28.0.1.1 (developed by IBM Corporation), STATISTICA 13.5.0.17 (developed by StatSoft.Inc) and MedCalc 20.027.
Results: factors that significantly distinguish patients with persistence or progression of low grade cervical intraepithelial lesions from women with regression of the disease are: earlier age of sexual onset, detection of atypical changes in low grade cervical epithelium, clinically significant HPV viral load, detection of p16INK4a protein expression, serum folic acid below 3.1 ng/ml.
Conclusions: deficiency of serum folic acid in HPV of positive patients should be considered as a pathogenetically significant risk factor for the implementation of infection into the clinical form of the disease, which is confirmed by its correlation with the cytological detection of LSIL, progressive increase in the copy of HPV, and p16INKα expression. The patient management strategy, which provides a personalized assessment of the risk of progression of cervical intraepithelial lesions, expands the monitoring of patients with cervical neoplasias associated with HPV.

Objective: to assess the significance of clinical and anamnestic characteristics of women as risk factors for the development of symphysiopathy during pregnancy.
Materials and methods: a retrospective analysis of 26 birth histories of patients with a diagnosis of symphysiopathy/symphysitis delivered in the GUZ «Clinical Maternity Hospital No. 2» in Volgograd at 38–39 weeks of pregnancy from 2016 to 2020. All patients diagnosed symphysiopathy was made at the management of pregnancy in the antenatal clinic on the basis of complaints, the data of physical examination and by ultrasound. The data of all pregnant women were ordered, encoded and entered into tables in the program MS Excel. Statistical analysis was performed with the SPSS program for windows 16.0.
Results: clinically, symphysiopathy was manifested by pain in the area of the pubic in 100% of cases. According to the medical cards, only two cases (7.7%) were treated with physical therapy. The conducted statistical analysis showed that such risk factors for the development of symphysiopathy as age, parity and body mass index (BMI) do not have statistical significance as possible factors affecting the course of symphysiopathy. A statistical analysis of the possible effect of weight gain on the width of the diastasis was carried out, according to which the compared groups have a statistical difference in the width of the diastasis (p=0.007).
Conclusion: the study shows that there is no significance of such clinical and anamnestic factors as age, parity, BMI for the manifestation of symphysiopathy during pregnancy. In this study, the only statistically significant criterion affecting the course of symphysiopathy is increased overall weight gain during pregnancy.

Objective: to study the microbiota of the vagina, myomatous nodes, their bed in patients with fibroids.
Materials and methods: a comprehensive examination of 83 patients aged 26 to 50 years with diagnosed interstitial, interstitial-subserous uterine myoma was carried out. By age, all women are divided into 3 groups. Standard clinical and clinical laboratory studies, colposcopy, microbiological examination of the detachable posterior vaginal fornix, biopsy specimens of myomatous nodes and their bed, as well as morphological examination of biopsy specimens of myomatous nodes and their bed were performed.
Results: in the structure of clinical manifestations of uterine fibroids, pain syndrome was the leading one (p<0.05). The number of myoma nodes in patients varied from 1 to 22. The duration of the operation and the amount of blood loss did not differ significantly (p>0.05). According to the results of a bacteriological study of the detachable posterior vaginal fornix in patients in the 2^nd group, a decrease in the frequency of detection and the number of lactobacilli was revealed compared to the 1^st group, and in women in the 3^rd group, these microorganisms were absent. Among the anaerobic microorganisms in the 1^st and 2^nd groups, Eubacterium spp. dominated, in the 3^rd — Peptostreptococcus spp. In patients of group 3, the frequency of detection of Bacteroides spp. was significantly increased (p<0.05). Among the aerobic spectrum of microorganisms in all groups, coagulasenegative staphylococci predominated. In a bacteriological study of biopsy specimens, the absence of growth of microorganisms in myomatous nodes was observed in 7.2% of cases, in the tissue of the bed of myomatous nodes in 17.7%. The microbiota of myomatous nodes and their bed in most cases was represented by anaerobic taxa. According to the results of a morphological study of biopsy specimens, no inflammatory reaction of tissues was detected.
Conclusions: In women with uterine myoma of different age groups, multidirectional changes in the vaginal microbiota were revealed. In most cases, the myomatous node (92.8%) and its bed (82.3%) are not sterile with the dominance of anaerobic microbiota taxa. Identified significant correlations in the loci «vagina – myomatous node – myomatous node bed» indicate their relationship. The detection of various taxa of microorganisms in the myomatous node and its bed, according to morphological studies, is not associated with the presence of infectious and inflammatory processes in the tissues.

Purpose: comparative study of the structure of infertility and outcomes of ART programs among patients of different age groups.
Materials and methods: the case histories of 180 patients with infertility were studied: Group I ≥ 35 years old; Group II <35 years old. Laboratory and immunohistochemical studies were carried out, and the outcomes of ART were assessed.
Results: in group I, a shortened menstrual cycle was determined in comparison with group II (27,15 ± 3,39 days vs 29,57 ± 2,38 days, p = 0,001). Also, in group I, the following were more often found: inflammatory diseases (p = 0,05); history of unilateral tubectomy (p = 0,019); increased FSH levels (9,73 ± 2,43 vs 8,74 ± 2,50); decrease in the concentration of LH, progesterone, AMH (p <0,05). In the cells of the aspirate of the uterine cavity in patients of group I, there was an increased content of progesterone receptors and a decreased concentration of estrogen receptors (p <0,05). Patients of group I received a smaller number of oocytes (8,34 ± 3,51 vs 10,78 ± 4,37) and quality embryos by the 5th day of cultivation (82,7% vs 87,97%; p <0,05). The number of pregnancies in groups I and II was 22,22% and 36,67%, respectively, and live births – 14,44% and 27,78% (p <0,05). Patients who gave birth had increased progesterone levels, greater endometrial thickness, more oocytes with transvaginal puncture, and high-quality embryos.
Conclusion: the factors that reduce fertility were: genital pathology, inhibition of ovarian function, depletion of the follicular reserve. Fewer live births are associated with defects in embryonic and implantation factors.

Objective: the purpose of this publication is to present the establishment of the implantation zone of the fetal egg during ultrasound diagnostics at 5-7 weeks to differentiate the types of cicatricial and isthmian pregnancies in women with a scar on the uterus after cesarean section.
Materials and methods: the study included 11 women with low implantation of the fetal egg in the presence of a scar on the uterus. All underwent ultrasound with transabdominal and transvaginal approaches at 5–7 weeks of pregnancy to establish the place of implantation of the fetal egg relative to the scar on the uterus.
Results: according to the results of ultrasound evaluation of the implantation zone of the fetal egg in 5–7 weeks were differentiated: type 1 of scar pregnancy (1 case); type 2 of scar pregnancy (7 cases) and low implantation along the posterior wall of the uterus at the level of the scar intact from it (2 cases).
Conclusions: ultrasound at 5–7 weeks is a necessary method of examination in women with a scar on the uterus for the diagnosis of scar pregnancy. The establishment of the implantation zone of the fetal egg is a tool that allows differentiating the types of cicatricial and isthmic pregnancies.

A case of early prenatal diagnosis of diastrophic dysplasia at 13 weeks 2 days of gestation is described. During ultrasound screening of the first trimester, fetal changes characteristic of this form of systemic skeletal dysplasia were revealed – micrognathia, micromelia, flexion contracture in the elbow and knee joints, pathognomonic abduction of the thumb of the hands and feet for diastrophic dysplasia (hitchhiker thumb), varus deviation and postaxial polydactyly of the feet, in combination with by a significant increase in the nuchal translucency. Pregnancy was interrupted for medical reasons. The possibilities of ultrasound diagnostics of diastrophic dysplasia by two- and three-dimensional ultrasound using are shown.

Childless marriages remain an important medical and social problem at present, both in our country and around the world. Infertility is a violation of the reproductive system, which has a wide range of conditions that affect one of the most important human functions – the ability to reproduce. The uterine factor of infertility occupies one of the leading positions in the formation of both primary and secondary infertility. Given the growth of acquired forms of uterine infertility, it is impossible not to turn to such a disease as intrauterine adhesions. Intrauterine synechiae is an acquired uterine disease that occurs after an injury to the endometrial mucosa. In the modern world, the prevalence of intrauterine adhesions in women of the reproductive period is increasing every year. However, it should be noted that despite modern technologies, it is impossible to accurately determine the number of women who have intrauterine adhesions. Taking into account the multifactorial development of intrauterine adhesions, as well as the low effectiveness of treatment methods, this problem occupies one of the leading positions in the structure of gynecological diseases and remains relevant. The asymptomatic course of the adhesive process leads to difficulty in diagnosis, and therefore the clinician needs to be aware of the risk factors for the development of intrauterine synechiae. The review presents risk factors for the formation of intrauterine synechiae.

Personalized management of children with chronic inflammatory non-communicable diseases, including bronchial asthma, have been extremely elaborated last decade. Highly informative biomarkers exploring is one of important conditions of this management. Testing aim, molecule’s pathogeneticrole, adequate biomaterial choice and test validity determine possibility and effectiveness of biomarker application. The paper represents key features of most perspective asthma biomarkers and discuss advantages and disadvantages of their using in pediatric practice. with rational biomarkers implementation nowadays one can separate patients with asthma development risk, provide a rational prevention, confirm the diagnosis and evaluate severity in some cases, optimize anti-inflammatory treatment, prognose the treatment response, evaluate future exacerbation probability, devote children with severe asthma in-time to initiate and conduct biological therapy for them.

Objective: to study the features of the blood lipid profile in obese children and adolescents, depending on the presence of insulin resistance, endothelial dysfunction and minimal diastolic dysfunction of the left ventricle.
Materials and methods: the study involved 370 obese children and adolescents from 7 to 17 years of age (the main group) with a body mass index BMI > 30, the control group consisted of 123 children of the same age without obesity. Methods: clinical, paraclinical (biochemical blood test, blood pressure measurement, functional diagnosis of endothelial dysfunction, assessment of minimal diastolic dysfunction).
Results: cardiometabolic disorders in obesity in childhood and adolescence are accompanied, first of all, by hypertriglyceridemia, which entails further violations of the lipid profile. There was also a positive correlation between changes in insulin and triglyceride levels in children and adolescents with obesity and endothelial dysfunction, as well as in patients with HOMA IR 3.2 and a combination of endothelial dysfunction and minimal dysfunction.
Conclusions: based on the study of the nature of lipid spectrum disorders in obese children and adolescents and the presence of signs of endothelial dysfunction and/or minimal left ventricular dysfunction, it was concluded that obesity at this age is more often accompanied by minimal left ventricular diastolic dysfunction or a combination of endothelial dysfunction and left ventricular dysfunction. The development of insulin resistance leads to an increase in the combined pathology (ED and MDLj). Hypertriglyceridemia, which is associated with high levels of insulin and presumably determines the development of insulin resistance, plays an important role in the development of cardiometabolic disorders in obesity in childhood and adolescence.

Objective: to investigate correlation between thymic stromal lymphopoietin and bronchial asthma course and control in patients of different age groups.
Materials and methods: one hundred and four patients were included in 1-year long open prospective study. There were three age groups: children (6 –11 y.o., n=38), adolescents (14–17 y.o., n=35) and adults (25 –50 y.o., n=31). we used asthma duration ≥12 months, uncontrolled asthma and acute respiratory infection absence for ≥14 days as inclusion criteria. Clinical history, validated questionnaires, spirometry, common blood count, serum and nasal material to evaluate thymic stromal lymphopoietin were obtained during first visit. Patient were consequently examined twice with 6 months intervals. Statistical analyses included ANOVA (Kruskal-wallis test) and Pearson’s correlation (r). Differences accepted significant with р<0,05.
Resuts: prevalence of main risk factors of asthma control lost (poor compliance, obesity, non-atopic phenotype, fixed airway obstruction) was different in age groups. we didn’t find any thymic stromal lymphopoietin in nasal material. Thymic stromal lymphopoietin concentration correlate significantly with duration of uncontrolled asthma in previous 12 months (r=0,74). we have found greater serum thymic stromal lymphopoietin concentration in patients who demonstrated FEV1 below normal at Visit 3.
Conclusion. Serum thymic stromal lymphopoietin level can be used as risk factor of asthma future exacerbation and spirometry results decline.

Objective: to develop a system for predicting the probability of developing damage of the central nervous
system (CNS) in the neonatal period in children who was born prematurely.
Materials and methods: the main group of the study is premature newborns with gestational age (GA) less than 36 weeks inclusive (n = 60), the control group – fullterm newborns (n = 35). In the process of dynamic observation, the main group was divided into subgroups depending on the diagnosed CNS injury in the neonatal period, according to the neurosonography (intraventricular hemorrhages (IVH), periventricular leukomalacia (PVL): subgroup 1 (prematurity babies with CNS injury) – 25 people, subgroup 2 (premature babies without CNS injury) – 35 people. we estimated clinical and anamnestic, laboratory and instrumental data of children at birth and in dynamics, indicators of antioxidant protection (manganese-containing superoxide dismutase (Mn-SOD), copper, zinc-containing superoxide dismutase (Cu, Zn-SOD), reduced glutathione (GSH), oxidized glutathione (GSSG), total antioxidant capacity of blood (TAS/TAC), oxidative stress (TOS/TOC), 4 polymorphisms of Mn-SOD gene.
Results: we designed two prognostic models which can determine the probability of developing IVH and PVL in the neonatal period in premature newborns. This models are included GA, Apgar scores at 1 and 5 minutes of life, presence of respiratory failure at birth, invasive mechanical ventilation in the neonatal period, presence of intrauterine infection in the neonatal period and indicators of antioxidant protection (GSH, TAS/TAC; model 2).
Conclusions: a comprehensive assessment of the clinical and anamnestic data of premature newborns at birth, as well as the determination of indicators that take into account the level of antioxidant protection, will make it possible to identify a premature baby at the risk for organic injury of the CNS and to correct the therapeutic strategies in the neonatal period.

Objective: to evaluate the clinical efficacy of targeted therapy with omalizumab in children with moderate to severe uncontrolled bronchial asthma.
Materials and methods: 7 children receiving omalizumab therapy in a hospital and polyclinic of the Ufa City Children’s Clinical Hospital No. 17 were under observation. In accordance with the instructions for use, the monoclonal antibody drug omalizumab was administered subcutaneously every 2-4 weeks. The dosage of the drug was determined based on the child’s body weight and the initial level of serum IgE. The anamnesis of life and disease, the results of instrumental and laboratory research methods, the results of AST and c-AST tests were studied in all the children studied.
Results: against the background of therapy with omalizumab in children, there was a significant decrease in the frequency of daytime symptoms (p=0.0179), a decrease in the frequency of night symptoms (p=0.0233), increased physical activity (p=0.0179), a decrease in the need for bronchodilators (p=0.0179), an increase in FEV1 according to spirography (p=0.0431), a decrease in the volume of basic anti-inflammatory therapy with a decrease in the dose of IGCS in 71.43% of patients (p=0.0425), a significant increase in the number of AST and c–AST test scores: before treatment 12 [10; 13] points, against the background of treatment - 23 [20; 25] points, (p=0.0277). During the follow-up period of therapy with omalizumab, no serious adverse reactions were detected.
Conclusion: thus, targeted therapy using omalizumab is clinically effective in children with moderate to severe uncontrolled bronchial asthma.

Objective: present a clinical case of a rare autoinflammatory disease.
Materials and methods: an analysis of a clinical case of mevalonate kinase deficiency syndrome in an 8-year-old girl was carried out.
Results: mevalonate kinase deficiency syndrome (SDMC) is a rare autoinflammatory disease with an autosomal recessive inheritance mechanism. The severity of the disease correlates with the residual activity of the enzyme mevalonate kinase, which is involved in the biosynthesis of cholesterol and isoprenoids, which is necessary for the conversion of mevalonate into the final product. As a result, the body accumulates mevalonic acid, especially high levels of it are found in the urine. A relatively mild SDMC phenotype is distinguished: hyperimmunoglobulinemia syndrome D (first described as HIDS in 1984) and a severe variant – mevalonic aciduria. A little more than 300 patients with SDMC have been described in the world. The disease is manifested by intermittent fever, arthralgia, pharyngitis, cervical lymphadenitis, urticarial rash resembling urticaria, less often vasculitis-like manifestations in the form of petechial-purple elements. Diagnosis is based on the activity of the mevalonate kinase enzyme in the blood or skin cells, biochemical analysis of urine (high numbers of mevalonic acid), as well as genetic confirmation of a mutation in the mevalonate kinase gene. The main principles of therapy for autoinflammatory diseases are the control of clinical symptoms and inflammation in general, as well as the prevention of amyloidosis.
Conclusion: if an autoinflammatory process in the body is suspected, it is necessary to conduct a genetic study for timely diagnosis and the appointment of pathogenetic therapy to improve the quality of life and prevent complications.

The review article gives a modern definition of the concept of agoraphobia. Different classification approaches in the typing of agoraphobia are presented. Its role as a factor aggravating the course of non-psychotic mental disorders is shown. The features of its manifestation depending on the nosological affiliation are analyzed. It was revealed that agoraphobia is a predictor of an unfavorable outcome in people with panic disorder. In turn, panic disorder often causes the development of agoraphobia. At the same time, gender and age aspects are noted. The comorbidity of agoraphobia and somato-vegetative type of generalized anxiety disorder is shown. Agoraphobia increases the risk of suicidal behavior in depression, has a high correlation with the severity of personality disorders, especially of the avoidant and dependent type. At the same time, some researchers dispute the point of view that these types of personality disorders are predisposing factors for panic disorder and agoraphobia, based on retrospective data on the premorbid personality structure of patients with anxiety disorders. The relationship between PTSD and panic disorder is emphasized in connection with the emergence of a circular model of the development of feelings of fear, which postulates a similar etiology of anxiety disorders. There is a comorbidity of agoraphobia with disorders of the hypochondriac spectrum: from the degree of fixation to obsessive nature. reduces the effectiveness of therapy for schizophrenic spectrum disorders and the quality of life of patients. The picture of the panic disorder itself with agoraphobia becomes heavier if the patient has chronic alcoholism (in particular, the frequency of seizures increases), while the presence of agoraphobic symptoms leads to a relapse of alcoholic illness, which is explained by taking alcohol to relieve symptoms, and also increases the likelihood of developing dependence on tranquilizers.

Adrenocarcinoma is a rare adrenal disease with an unfavorable prognosis. Adrenocortical cancer therapy is characterized by insufficient effectiveness. This review covers the generally accepted adrenocortical carcinoma therapy methods -mitotane alone or in combination with chemotherapeutic agents. It also provides perspectives from the novel agents` studies in adrenocarcinoma patients. Information about the use of insulin-like growth factor inhibitors, multikinase inhibitors, anti-PD-1/PD-L1 is given.

Providing medical care to people with gender dysphoria is a complex multidisciplinary task, the success of which is determined by the close cooperation of specialists qualified in helping such patients, such as a psychiatrist, endocrinologist, and surgeon. In addition to diagnostic testing, patients with gender dysphoria require psychotherapy or psychological counseling, hormone replacement therapy, and, if necessary, gender confirmation surgery. Before prescribing hormone therapy, it is necessary to make sure that the patient meets the criteria for the diagnosis of gender dysphoria, to be sure that the patient’s desire to change gender is justified, all the consequences of therapy, including possible physical changes and the timing of their occurrence, are explained. Genital reconstruction procedures are possible only after at least one year of hormone therapy and life in the role of the chosen gender. The algorithms of medical care for persons with gender dysphoria developed to date describe in detail the mechanism of gender reassignment, the contribution of various specialists to this process, as well as possible risks and methods for their prevention. Only careful observance of the stages of diagnosis and treatment without violating their sequence can lead to the successful achievement of the result. while any deviations from the algorithms, due to objective and subjective reasons, entail serious life-threatening consequences, which is clearly demonstrated in the clinical cases presented in this article.

Type 1 autoimmune polyglandular syndrome (APS1) is a rare disease, with an unknown prevalence in the Russian population. Due to the low awareness of doctors, it takes more time to make the accurate diagnosis and provide correct medical care. This article describes classical features of APS1 and a clinical case of a patient, who did not have one of the most common first manifestation of the disease - mucocutaneous candidiasis. Hypocalcemia was detected much later than the first clinical manifestations in the form of generalized seizures occurred. Patient also suffers from tapetoretinal abiotrophy, he completely lost vision in childhood which made it difficult for the doctor and patient to interact in the treatment of the disease.

Objective: to study the dynamic changes in the content of monocytes expressing Toll-like receptors of type 2, 4 and 9 in military personnel under occupational stress.
Materiasl and methods: 37 servicemen (average age 37.3±4.8 years), who participated in special operations (service in areas with an unfavorable operational situation lasting 3 months) have been examined and divided into two groups: group I included military personnel (n=27) who had clinical manifestations of an infectious process of any etiology during participation in special operations and during 6 months of observation after returning from an area with an unfavorable operational situation; the criterion for inclusion in group II of observation was the absence of manifestation of the infectious process. Phenotyping of peripheral blood monocytes was performed by flow cytofluorimetry. Statistical data processing was carried out using the STATISTICA 12 software package (StatSoft InC., USA).
Results: during 6 months of follow-up, all the examined servicemen had a persistent significant decrease in the content of monocytes expressing Toll-like receptors of type 4 and no change in the content of monocytes expressing Toll-like receptors of type 9. In the group with the manifestation of the infectious syndrome, there was a significant decrease in the number of monocytes expressing Toll-like type 2 receptors, most pronounced by the 6th month of follow-up.
Conclusions: violation of antigenic recognition processes at the level of innate immunity structures in military personnel within six months after participating in special operations, allows these individuals to be classified as at risk of developing persistent immune dysfunction.

Myelodysplastic syndrome is a group of myeloid neoplasms that arise from the action of damaging factors on hematopoietic stem cells, which are based on somatic mutations, which leads to the formation of clonal hematopoiesis. we know from epidemiological data that old age, male gender, and smoking are in themselves independent risk factors for myelodysplastic syndrome. These factors can potentiate the occurrence of mutations in the genome. In young people and children, myelodysplastic syndrome is a direct consequence of genetic abnormalities. There is an assumption that epigenetic regulatory genes are subject to frequent mutations. The chromatin of malignant cells acquires epigenetic abnormalities affecting tumor resistance, which explains their response to treatment with epigenetic drugs in combination with other therapies The appearance of new mutations potentiates hematopoiesis, which is accompanied by the shutdown of apoptosis and the transformation of myelodysplastic syndrome into acute myeloid leukemia. It is suggested that mutations in the genes of epigenetic regulators have functional effects on pluripotent hemopoietic stem cells. Epigenetic profiling of patients had a significant impact on understanding the molecular basis of etiology, pathogenesis, and patterns of transformation of myelodysplastic syndrome into acute myeloid leukemia, but it is not known which genes are the most clinically significant for their final use in laboratory diagnostics and targeted hypomethylating therapy. Despite the multitude of mutations in epigenetic regulators in myelodysplastic syndrome, the creation of prognostic models based on them requires a detailed study that includes not only analysis of the frequency of such mutations, but also the establishment of a relationship with clinically significant outcomes. The aim of this review is to study the prevalence of the mutational status of epigenetic regulation in patients with myelodysplastic syndrome.

Objective: to study and compare the influence of such factors as: gender, age, family status, level of education and the frequency of determination of the international normalized ratio (INR) on the compliance of patients after mitral valve replacement (MC) with mechanical prostheses in dynamics - after 6 and 12 months.
Materials and methods: it were analyzed data of 260 patients after MC prosthetics with mechanical bicuspid prostheses. The Morisky-Green test was used to assess compliance.
Results: the most committed to treatment were female, middle-aged persons with secondary specialized and higher education, as well as married persons. Among patients who monitored INR on a monthly basis, the percentage of compliant patients was higher compared to patients where this indicator was determined less than once a month. The dynamics of a decrease in the number of compliant patients after 12 months of follow-up was established.
Conclusions: the data obtained indicate the need to carry out more active work on the formation of compliance with «vulnerable» categories of patients: with men, with elderly and young patients, with persons with secondary education, unmarried. The revealed tendency to decrease compliance after 12 months, regardless of the studied factor, indicates the importance of maintaining compliance in the long-term postoperative period. Also, the data obtained indicate the presence of a relationship between the multiplicity of INR control and compliance.

Objective: formation of a brief overview of data on the main historical stages of the formation and development of the sanitary and epidemiological service in the country as a whole and in the Don region, in particular, as well as on the contribution of Rospotrebnadzor bodies and organizations in the Rostov region to the common cause of ensuring the sanitary and epidemiological well-being of the country in different time periods.
Materials and methods: Analysis of archival materials, library collections of institutes and literary sources from databases of electronic libraries e-library, CyberLeninka, etc.
Results: The contribution of the Rostov-on-Don Research Anti-Plague Institute and the Rostov Research Institute of Microbiology and Parasitology to the common cause of ensuring the sanitary and epidemiological well-being of the country in different time periods is indicated. Special attention is paid to the issues of effective interaction of Rospotrebnadzor bodies and organizations among themselves and with other healthcare and scientific institutions.
Conclusion: Russia has developed a very efficient, operational system capable of effectively addressing issues of ensuring the sanitary and epidemiological well-being of the population.