Tver State Medical University

Aim . To assess regulatory changes affecting primary health care (PHC) management in the Russian Federation from August to October 2025 was conducted. Material and methods . A content analysis of Russian regulatory legal acts was conducted for the period from August to October 2025, including the new Compulsory Health Insurance (CHI) rules, amendments to the State Guarantee Program for Free Medical Care for 2025 and 2026-2027, and others. The analysis identified systemic transformations in the organizational, financial, and legal frameworks of the PHC system. Results . The study shows that the legislative changes create institutional preconditions for PHC system optimization, creating conditions for strengthening public health and improving the healthcare. Key innovations include the digitalization of administrative processes, more detailed financial mechanisms for the CHI system, expanded rights for insured persons, and the development of a multi-­tiered support system. The implementation of these regulatory changes will contribute to improved efficiency in healthcare resource management, patient protection, and accessibility of care. Conclusion . An analysis of legislative changes from August to October 2025 demonstrates their significant impact on the transformation of the primary health care system in the Russian Federation. Key organizational and legal innovations are aimed at ensuring accessibility and continuity of care, introducing digital technologies into document flow and information sharing, and increasing the transparency and manageability of financial flows in CHI system. The implementation of these measures will create the institutional preconditions for the modernization of health facilities, improving standards of care, and increasing patient satisfaction. This will be the basis for the progressive development of Russian healthcare.

29 Background: Colorectal cancer (CRC) remains as a leading cause of cancer-related morbidity as well as mortality worldwide. Effective screening strategies are needed for early detection of CRC and also for its precursors in the form of advanced neoplasia (AN). Fecal immunochemical testing (FIT) is widely used for non-invasive screening, but its diagnostic accuracy for CRC and especially advanced neoplasia (AN) remains variable across studies. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane Library were searched from inception to July 2025 for studies comparing FIT against colonoscopy in average-risk, asymptomatic adults aged >50 years. After deduplication, 231 articles were screened, of which 11 met eligibility criteria. Data were extracted into 2×2 tables and pooled using a bivariate random-effects model to estimate sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR) with 95% confidence intervals. Study quality was appraised using the QUADAS-2 tool. Results: Across 11 Studies, FIT detected CRC with a pooled sensitivity of 0.74 (95% CI, 0.63–0.83) and specificity of 0.93 (95% CI, 0.88–0.96), corresponding to a positive likelihood ratio (LR+) of 10.10 and DOR of 36.54. For CRC+AN , sensitivity fell to 0.29 (95% CI, 0.23–0.37) with specificity of 0.94 (95% CI, 0.91–0.97). These findings indicate strong ability to confirm CRC when FIT is positive but limited capacity to exclude advanced neoplasia. Assay threshold reduction improved sensitivity at the expense of specificity, while increasing threshold improved specificity, but more AN cases were missed. Conclusions: FIT demonstrates high specificity but only moderate sensitivity for detecting CRC, which supports its role in population based screening and functioning as an effective triage tool that reduces unnecessary colonoscopies. Nonetheless, because of single-sample FIT’s low sensitivity in detecting AN carries the risk of under-detecting AN. Strategies such as repeated annual testing/ multiple-sample FITs, or integration with validated clinical risk models may enhance diagnostic yield. Overall, FIT remains a cornerstone of CRC screening but its limited sensitivity for precancerous lesions underscores the need for optimization, with screening programs required to balance improved detection yield against increased colonoscopy demand. Outcomes CRC only CRC + AN Sensitivity (95% CI) 0.74 (0.63–0.83) 0.29 (0.23–0.37) Specificity (95% CI) 0.93 (0.88–0.96) 0.94 (0.91–0.97) LR+ (95% CI) 10.10 (6.48–15.72) 5.15 (3.86–6.89) LR– (95% CI) 0.28 (0.19–0.41) 0.75 (0.70–0.81) DOR (95% CI) 36.54 (21.34–62.57) 6.87 (5.27–8.95)

Introduction: Sydnonimines are a promising group of drugs for development of novel substances with predominant cerebral vasodilatory activity. One of them is experimental compound with laboratory code BBP20233. The mechanism of action of BBP2023 compound is tied to its metabolites. This study aims for identification of biotransformation products of BBP2023 using HPLC-MS/MS method. Materials and Methods: Identification of BBP2023 biotransformation products was performed in male rats and male rabbits after intragastric administration of BBP2023 in form of oil emulsion. Blood samples were collected before and 1 and 8 hours after administration. Urine samples from rats were collected before and 24 hours after administration. Additionally, complete liver isolation was performed in another group of rats to investigate liver’s role in BBP2023 metabolism. Identification of products was performed using HPLC-MS/MS method as well as UHR-TOF method. Results and Discussion: Analysis of rat plasma samples collected 1 hour after administration revealed the presence of parent compound, active metabolite SIN, geranamine and various isomers of OH-derivatives. Analysis of rat urine samples collected 24 hours after administration showed the presence of glucuronic acid conjugates of SIN and parent compound. Similar results were obtained from rabbit plasma samples, although with less variety of hydroxylated derivative isomers. Conclusion: Investigated features of BBP2023 biotransformation require detailed analysis of pharmacokinetics for both BBP2023 and its metabolites to determine their role in therapeutic effect and possible adverse effects.

Introduction. Currently, the practical interest of researchers is aimed at studying the biomedical potential of secondary plant metabolites in order to create new drugs. Flavonoids are a large class of natural phenolic compounds with a wide range of biological activity. Particular attention is paid to the ability of some flavones (apigenin and luteolin, their glycoside apigetrin) to suppress the growth of malignant tumors. However, low concentrations of these polyphenols in plant matrices do not allow reliable assessment of pharmacokinetics in the human body. In this regard, an urgent bioanalytical task is the development of accurate and reproducible methods using high-tech hybrid methods of analysis. Purpose of the study. Development and validation of chromato-mass-spectrometric methodology of the quantitative determination of apigenin, apietrin andlLutheololin in the blood plasma of mice. Material and methods. To develop the methodology of quantitatively determined flavones, a highly effective liquid chromatograph Agilent Technolo-gies 1260 Infinity II and the mass spectrometer Ab Sciex Qtrap 3200 MD was used. The chromatographic separation was carried out on the analytical column Agilent Infinitylab Poroshell 120 EC-C18 with a gradient mobile phase containing 0.1 % of ant and acetonitril. For detecting, analytes and the in-ternal standard warfarin were ionized by electrical exposure in the mode of negative ions using multiple reactions monitoring. The sampling of plasma of the blood of mice was precipitating with methanol. Results. The optimal conditions of the convertible-phase chromatographic separation of apigenin, apigerin, lutheololin and varfarin with times of reten-tion from 5,3 to 7,8 minutes were selected. Each compound in optimal conditions of electrical ionization is protoned with the formation of the composi-tion of the composition [М–Н]- and fragmentation on two characteristic ion-products. The methodology of simultaneous quantitative HPLC-MS/MS de-termination of flavones in the plasma of mice, characterized by a linearity in a wide range of concentrations and a low limit of quantitative determina-tion of 1.0 ng/ml, values of the degree of extraction of analyts in the range of 90,8-100,4 %. The validation characteristics of the methodology satisfy the relevant regulatory requirements of selectivity, the influence of the matrix effect, intraulinary accuracy and precision. Conclusion. The results of validation tests indicate the suitability of the developed express and rather accurate bioanalytic methodology of the quanti-tative determination of the three structurally related flavons in the joint presence of mice in the blood plasma. The metrological characteristics of the methodology allow you to use it to conduct the analytical part of pharmacokinetic studies of drugs containing both individual flavonoids and plant ex-tracts

Rationale. The aim of the study is to analyze the associations of regional characteristics with the individual risk of comorbidity in the elderly population in the subjects of the Russian Federation. Materials and methods. The material of the cross-sectional study «Epidemiology of cardiovascular diseases in the regions of the Russian Federation» (ESSE-RF-3), conducted in 2020—2022, was used as individual data. The analysis included 10535 men and women aged 60—74 years. The presence of comorbid conditions was assessed using 4 methodological approaches: 1 — according to the Order of the Ministry of Health of the Russian Federation dated 07/01/2021 No. 698n.; 2 — according to the Eurasian guidelines; 3 — according to the Charlson index; 4 — in accordance with the recommendations on the organization of prioritization of patients in the framework of follow-up. To describe the regional living conditions, an integral index assessment was used, which was previously performed using the principal component method. The association of comorbidity with regional indices was assessed using logistic regression analysis, with the calculation of odds ratios (OR) and a 95% confidence interval. Results. The deterioration of economic living conditions and the shift in the age structure of the region’s population towards older age is associated with comorbidity, regardless of the method of its assessment. An increase in the industrial development of the region is associated with a decrease in the probability of comorbidity, calculated according to the «Charlson index» OR=0.93 (0.90—0.97) and according to the «Methodological Recommendations» OR=0.94 (0.90—0.97). Conclusion. The conducted study demonstrated the influence of economic, industrial and demographic regional living conditions on the individual probability of comorbidity.

Abstract Background Cajal cells (interstitial pacemaker cells), due to spontaneous electrical activity, cause the contraction of smooth muscle cells, and regulate the motility of the gastrointestinal tract along with neuronal structures. Data on the number of these cells in the muscle lining of the esophagus in achalasia are few and contradictory. The aim of our study was to investigate the distribution of cells regulating motility in the muscular layer of the esophagus in patients with achalasia. Methods Seven patients with achalasia were included in this study. During the peroral endoscopic myotomy and the formation of a tunnel in the esophagus before dissection a biopsy of the muscle membrane was performed at the level of the upper, middle and lower third of the esophagus. An immunohistochemical reaction with CD117 antibodies (c-kit) was used to detect Cajal cells. The number of positive cells was counted at an increase of x500 in 5 random fields of vision. The detection of neuronal structures was carried out using an immunohistochemical reaction with antibodies to the S100 protein, followed by a semi-quantitative assessment. Results Histological examination in the upper third of the esophagus found small groups of striated muscle fibers among the bundles of smooth muscle cells. Cajal cells in the upper third of the esophagus were not numerous 2.2 [0–10]. Their number increased in the middle third of 6.8 [3–15] and reached a maximum in the lower third of the esophagus of 11.3 [10–25]. S100-positive neuronal structures among bundles of smooth muscle cells were rare, and in some cases were not detected at all. Conclusion The quantitative distribution of Cajal cells in the muscular layer of the esophagus in patients with achalasia is uneven with a significant increase in the lower third of the esophagus, against the background of a deficiency of neuronal structures in smooth muscle tissue.

Abstract Background The study of the prevalence of gastroesophageal reflux disease (GERD) was conducted in Moscow 20 years ago. Epidemiological criteria for GERD (heartburn and/or regurgitation at least once a week) were found in 23.6% of respondents. The aim of our study was to assess the current prevalence of GERD in Moscow. Methods A total of 4358 randomly selected individuals aged 18–80 years were studied in 2022–2025 using a specially designed questionnaire based on the Mayo Clinic Questionnaire. The questionnaire included typical clinical manifestations of GERD: heartburn, regurgitation, and their frequency of occurrence. ‘Frequent symptoms’ were defined as the main symptoms (heartburn and/or regurgitation) occurring at least once a week or more often. ‘Infrequent symptoms’ were defined as episodes of one of the main symptoms occurring less than once a week over the past 12 months. Patients were considered to have GERD if they reported frequent heartburn and/or regurgitation. Results The mean prevalence of frequent and infrequent GERD symptoms in Moscow was 15.5% and 42.6% for heartburn and 10.0% and 31.1% for regurgitation, respectively, over the past 12 months. The average prevalence of GERD (heartburn and/or regurgitation at least once a week) in Moscow was 19.2%. Conclusion This is the second population-based study of GERD prevalence using a questionnaire based on the Mayo Clinic Questionnaire conducted on 4358 people in Moscow in 2022–2025. The average prevalence of GERD in Moscow was 19.2% which is lower than in the first study 20 years ago (23.6%). The research is ongoing, it is planned to interview 5121 individuals.

Summary. Acne is one of the most common dermal diseases which 96% of people are suffered from. However, there aren’t any up-dated findings about disease incidence and clinical features of acne in different age groups specifically young adults. The pathogenesis of the disease hasn’t been searched completely. AIMS: Evaluation of the prevalence rate, clinical and epidemiological traits of acne and morpho functional skin parameters of patients aged 18-25. MATERIALS AND METHODS: 655 people aged 18-25 were examined for suggestive clinical findings of acne. The Multiskin Test CenterMC 1000 software and hardware complex (Courage + Khazakaelectronic GmbH, Germany) was used for examination of morpho-functional skin health of patients with severe acne. Microbiome was examined by bacteriologic culture technique on enriched medium with follow-up colony count (lg КОЕ/ml). RESULTS: аn examination of 655 people aged 18-25 years revealed acne in 60.5%, the proportion of men among patients was 36.6%, women - 63.4%. Mild case of acne prevailed – 52.7% of the total number of patients; moderately severe condition was diagnosed in 33.3%, severe ones in 7.8% of cases. At the same time, mild and moderately severe conditions were common for women, and severe ones for men. Mild form of acne more often affects women and men aged 19 (28,4% and 29,3%) and 21 years old (30,6% and 28,0% respectively); moderate form at age 18 (21,7% and 20,0% respectively); at age 19 (36,8% and 34,0% respectively) and at 21 (women – 22,6%, men 24,0%); severe acne affects people aged 19 (54,5% and 30,0%) and 21 (27,3% and 20,0% respectively). In case of acne there are abnormalities of the morphofunctional state of the skin: anhydration, hyperactivity of the sebaceous glands, skin laxity, increased porosity and chromatosis. The skin microbiome of patients with acne changes characterized by an increase in the concentration of pathogenic germs (Staphylococcus aureus, Klebsiella, Enterobacter, Bacillus spp., Candida gem +) and a decrease of opportunistic pathogenic microflora, which favour the development and spread of the inflammatory process. CONCLUSIONS: An examination of 655 people aged 18-25 years revealed acne in 60.5%, the proportion of men among patients was 36.6%, and 63.4% of women. Progression of the acne was diverse and mild forms prevailed – 52.7% of the total number of patients; moderately severe conditions were diagnosed in 33.3%, severe in 7.8% of cases. In case of acne there are abnormalities of the morphofunctional state of the skin and microbiome changes with an increase in the concentration of pathogenic germs and a decrease of opportunistic pathogenic microflora.

Body temperature is one of the key indicators for diagnosing a variety of surgical and trauma-related conditions. Infrared thermography is one of the most relevant and widely used methods in modern clinical practice. This technique has not yet received general acceptance, and its use is currently underrepresented in the scientific community. The aim of this study was to analyze existing data on the practical significance and role of medical thermography in diagnosing and predicting postoperative complications in trauma patients. An analysis of both Russian and international publications was conducted to explore the potential and future prospects of medical thermography in current trauma practice. In orthopedic and trauma practice, infrared thermography is more commonly used to diagnose chronic musculoskeletal conditions such as scoliosis, osteoporosis, and osteochondrosis. In acute traumatic injuries, it is more commonly used for intraoperative and postoperative monitoring to prevent complications or enable their early detection, as treatment outcomes largely depend on timely and adequate diagnosis and identification of the primary injury. Opinions within the scientific community on the use of medical thermography remain divided. On the one hand, the vast majority of researchers studying the potential of medical thermography consider it a valuable supplement to conventional imaging methods. However, despite its numerous advantages and significant application potential, the technique has yet to be widely adopted. Infrared thermography is a promising diagnostic tool in modern medicine, especially in traumatology. Conducting more studies to explore its capabilities could help raise awareness and promote its integration into trauma care practice.

The production of powerful vasoconstrictors (endoperoxides, endothelins) and cytokines such as tumor necrosis factor alpha (TNF-α) that suppress nitric oxide (NO) synthesis play a key role in the development of endothelial dysfunction, which leads to disruption of vasorelaxation processes. To date, sufficient data have been accumulated showing that the development of endothelial dysfunction, caused, in particular, by quantitative and qualitative disruption of lipid homeostasis, is of paramount importance in the progression of systemic vascular pathology. The effect of oxidized low-density lipoproteins (oxy-LDL) on the vascular wall initiates the development of endothelial insufficiency and the formation of an atherosclerotic plaque. Oxy-LDL also mediates vasoconstriction of coronary vessels by reducing eNOS, inhibiting NO and increasing endothelin production. The development of hyperlipidemia initiates a proliferative response of endothelial cells with subsequent changes in their functional activity and expression of proteins of the “proinflammatory endothelial phenotype” that play an important role in regulating the local inflammatory process. At the same time, hyperexpression of cell adhesion molecules VCAM-1, ICAM-1 and E-selectin is a decisive step in increasing the adhesive activity of monocytes and their migration into the vascular wall. An important link in the formation of endothelial dysfunction in hyperlipidemia, according to many authors, is a change in the amount and activity of endothelial nitric oxide synthase (eNOS) and, as a consequence, a violation of NO production by the endothelium.