Dear readers of the "Baikal Medical Journal"!
A new issue of the "Baikal Medical Journal" has been published. In this issue of the journal, we have published many rare clinical observations, fundamental lectures and reviews on the main scientific areas of our publication.

The review presents current literature data on the prevalence, etiology, and role of sarcomere gene mutations in the pathogenesis of hypertrophic cardiomyopathy, and pathogenetic mechanisms of myocardial hypertrophy. The review discusses the variants of the phenotype, the possible relationship between causative genes and the phenotype. The data on the pathophysiology of left ventricular outflow obstruction, diastolic dysfunction, myocardial ischemia, and rhythm disturbances are presented. The role of non-invasive imaging modalities, the limitations of echocardiography, the advantages of magnetic resonance imaging of the heart, its role in the differential diagnosis of hypertrophic cardiomyopathy and left ventricular hypertrophy in hypertension, in athletes, patients with phenocopies of hypertrophic cardiomyopathy (Anderson-Fabry disease, amyloidosis of the heart) is determined. The criteria for a worse prognosis and a high risk of sudden death are described. Options for drug treatment are discussed, as well as modern therapy with the cardiac myosin-ATP-ase inhibitor mavakamten, which acts by reducing the formation of actin-myosin bridges, reduces contractility and pressure gradient in the left ventricular outflow tract. Invasive interventions (septal myectomy or alcoholic septal ablation) are indicated in patients with ineffective drug therapy. Estimation of risk factors for sudden death is necessary to determine the indications for implantation of a cardioverter defibrillator.

The article is devoted to the history of the Irkutsk scientific cardiological schools formation and development, the founders of which were Academician of the Russian Academy of Medical Sciences K.R. Sedov and Corresponding Member of the Russian Academy of Sciences A.A. Dzizinsky. The biography of K.R. Sedov and A.A. Dzizinsky is presented. Their invaluable contribution to the organization and development of Irkutsk regional cardiology service, as well as cardiologists training is reflected. Particular attention is paid to the role of these outstanding scientists in the development of cardiology as a fundamental and clinical science. The modern achievements and development paths of the Irkutsk cardiological school are described. Data is provided about its current representatives – students and followers of K.R. Sedov and A.A. Dzizinsky

Relevance. Patients with long-standing discogenic low back pain who do not show clinical improvement after conservative treatment are referred for surgical treatments such as lumbar fusion or total disc arthroplasty.

The purpose –– to evaluate the long-term effectiveness and safety of total intervertebral disc arthroplasty (TDA) and lumbar interbody fusion (LIF) in patients with degenerative lumbar intervertebral disk disease.

Material and methods. A comprehensive literature search strategy was developed in the PubMed/Medline and Cochrane Central Register of Randomized Controlled Trials databases. Studies were searched between January 2005 and May 2024 without restrictions on level of evidence or publication status. Both English-language articles and domestic publications were analyzed.

Results. The systematic review included four randomized controlled trials covering the long-term outcomes of surgical treatment of 1325 patients with degenerative lumbar intervertebral disk disease. There are no differences in the operating time in the total intervertebral disc arthroplasty and lumbar interbody fusion groups. In the lumbar interbody fusion group, the volume of blood loss exceeded that in the total intervertebral disc arthroplasty group of intervertebral disks. There were no differences between the total intervertebral disc arthroplasty and lumbar interbody fusion groups in the severity of low back pain on the visual analogue scale. In the total intervertebral disc arthroplasty group, the level of patient disability according to the Oswestry Disability Index is on average 9 % higher than in the lumbar interbody fusion group. The percentage of satisfaction with the operation in the group of patients after total intervertebral disc arthroplasty exceeds this indicator in the group of patients who underwent lumbar interbody fusion. The analysis of the incidence of complications demonstrated the absence of differences between the compared techniques. The frequency of reoperations in the total intervertebral disc arthroplasty group of intervertebral disks at the lumbar level is 48 % less than that in the lumbar interbody fusion group.

Conclusion. The obtained clinical results of total intervertebral disc arthroplasty of intervertebral disks at the lumbar level with preservation of the range of motion of the operated segment and the entire lumbar spine suggest that this technique is a promising alternative to lumbar interbody fusion.

Relevance. In this article we will talk about rare case of strangulated hiatal hernia after esophagectomy.

Case descriptions.The patient was hospitalized in the surgical department with a hiatal hernia and adhesive disease. The 9 months ago this patient has a treatment in regional oncological hospital by esophageal carcinoma. The esophagectomy with plastic by Lewis it is normal operation from the patients with esophageal cancer. The patient has a complaint on pain in the chest, vomiting and constipation during two days. The differential diagnosis was between cardiac ischemia, pneumonia, adhesive disease and acute pancreatitis. The blood analysis are don’t have a symptoms of acute inflammation. The contrast intestinal examination multispiral computed tomography scan was revealed the hiatal hernia. The clinical picture of intestinal obstruction has place on next day. The surgery was done. The cause of intestinal obstruction is the strangulated hiatal hernia with prolapse small intestine in left pleural cavity. The  resection of necrotic intestin, entero-enteroanastomosis and diaphragm plastic was done. The patient is recovered.

Conclusion. The stomach is strangulated in hiatal hernia more often. The strangulated hiatal hernia after Lewis esophagectomy is rare case (no more 4 %). The small intestine in the hernial sac can be rare also (no more 20 % from all cases).

Relevance. Differential diagnostics of volumetric formations of peripheral nerves and their semiotics using magnetic resonance imaging is one of the most complex sections in neurosurgery. A rare cause of compression-ischemic neuropathy of peripheral nerves are intraneural ganglionic cysts.

Case descriptions. The manuscript presents a rare case of an intraneural ganglion cyst of the ulnar nerve, which caused compression-ischemic neuropathy of the ulnar nerve with a lesion level in the cubital canal. After a detailed comprehensive clinical and instrumental examination, preoperative planning was carried out. Given the presence of a clear dissection plane, the use of microsurgical techniques made it possible to perform total tumor removal without compromising the integrity of the ulnar nerve with complete regression of compression-ischemic neuropathy. An intraneural ganglion cyst was histologically confirmed.

Conclusion. If clinical manifestations of compression-ischemic neuropathy of the ulnar nerve at the level of the cubital canal are detected in a patient, in addition to ultrasound examination and electroneuromyography, magnetic resonance imaging is necessary to exclude a space-occupying formation in this area. Microsurgical removal of a ganglion cyst is a highly effective treatment method that allows you to preserve the integrity of the peripheral nerve and its sheaths, as well as achieve complete regression of symptoms.

Relevance. Regular physical activity is one of the key principles of a healthy lifestyle, which has been proven to prolong life in both healthy people and people with cardiovascular diseases. However, there is a lot of data on the potential adverse effects of intense physical activity required to participate in professional or amateur sports.

Case descriptions. The work describes a clinical case of severe coronary atherosclerosis of a mature-aged athlete. The clinical, laboratory, and instrumental data of the patient are presented, as well as detailed management tactics taking into account the current state of the issue. Possible mechanisms of increased calcification of the coronary bed in people involved in intensive training are discussed.

Conclusion. It is necessary to understand the features of the course of coronary heart disease in athletes of older age groups: high tolerance to physical activity, often subclinical course of the disease, which implies more active questioning and the use of stress visualization techniques. Low-symptom nature of clinical manifestations, hemodynamic features require careful selection of antianginal therapy. Treatment of ischemic heart disease in this cohort of individuals should be carried out in accordance with current clinical guidelines, while the doctor's recommendations regarding the intensity of physical activity should be strictly individual and based on the results of stress tests.

Relevance. One of the main causes of death according to the World Health Organization is cardiovascular diseases. It is well known that dysregulation and/or overexpression of elements of the renin-angiotensin system leads to many negative vascular effects, thereby contributing to the development of cardiovascular diseases and pathological processes, including hypertension, aneurysms, congestive heart failure, stroke, coronary heart disease and endothelial dysfunction.

Aim. To consider the main angiotensins and the mechanisms of their action on vascular tone, endothelial functioning, and myocardial function. To demonstrate the participation of the renin-angiotensin system in the formation of the main types of cardiovascular pathology.

Results. The lecture discusses the cardiogenic and vascular effects of angiotensins II, 1-7, 1-9 and the role of these angiotensins in the development of atherosclerosis, coronary heart disease, heart failure, and arterial hypertension. The article presents the main principles of correction of the angiotensin system disorder and promising directions of research of this problem.

Conclusion. The concept of the classical renin-angiotensin system regulating arterial pressure and vascular tone has evolved into the understanding of this system as a complex network of mediators-anti-tensins and their receptors affecting many physiological pathways.

Although the main components of the renin-angiotensin system were discovered more than half a century ago, this system still attracts a large number of researches works in various fields. The renin-angiotensin-aldosterone system has a number of regulatory and counter-regulatory axes that have a significant impact on the course of many diseases. Among the numerous options for cardiovascular therapy used to treat hypertension and heart failure, drugs that affect the renin-angiotensin-aldosterone system play a significant therapeutic role.

Background. The high percentage of people with overweight and obesity is a social problem almost all over the world. 
The main cause of obesity is overeating. Understanding the pattern of gradual food intake, its expenditure and deposi-tion is the basis of rational nutrition.
Results. The lecture presents the order of macronutrient utilization in the process of abdominal and cellular digestion. 
It is shown that the utilization of proteins, lipids and polysaccharides occurs by changing sequential states: poly-mer ↔ monomer. The deposition of polymers and oxidation of monomers has organ specificity, while the deposition of glycogen is limited, and the deposition of fats is carried out proportionally to the excess of consumed macronutrients.
Under conditions of regular and frequent nutrition, the needs of the basal metabolism are provided by glycogenolysis and glycolysis. Under conditions of fasting and physical activity, fats become in demand, which through hydrolysis and subsequent oxidation of fatty acids, are converted into acetyl-CoA and are used in the tricarboxylic acid cycle. 
Under conditions of regular, excessive nutrition and low physical activity, adipocyte triglycerides are required by the body only for the basal metabolism.
The deposition of food organic by the human body ensures the continuous need of vital activity under conditions of peri-odic food intake. The deposited reserve guarantees the state of homeostasis. The volumes of carbohydrate deposition are strictly controlled, but the volumes of deposited fats can significantly exceed their reserve needs. Under conditions of frequent and abundant nutrition, adipocyte fats are practically not in demand by the body, and the excess of con-sumed proteins, lipids and carbohydrates are converted into fats.
The expenditure of nutrients consumed by a person is controlled by the basal metabolism, thermogenesis and psy-chophysical activity. People cannot control the basal metabolism. It ensures the very existence of a person (gas exchange, blood circulation, excretion, cellular homeostasis, etc.). A person can control the volume of food consump-tion and include expenditure on bursts of muscle activity – there are receptors for adrenaline in muscles. Adrenaline stimulates glycolysis in muscle cells and lipolysis in adipocytes. Increased physical activity and fasting are the only ways in which a person can “include” the expenditure of triglycerides.
Conclusion. When the body’s expenditure on basic metabolism, thermogenesis and psychophysical activity is satis-fied, the deposit system automatically, without our conscious participation, deposits triglycerides in volume of more than half of the dry body mass. There are simply no other ways to control food surpluses in the body. All food surpluses are deposited in fats.

An excellent teacher and mentor Galina Mikhailovna Globenko has been working at the Department of Human Anatomy, Operative Surgery and Forensic Medicine of Irkutsk State Medical University for more than half a century. Galina Mikhailovna was born on February 21, 1944 in the village of Tumanny, Srednekansky district, Khabarovsk Territory.

She spent her childhood and primary school years in Chukotka, in the city of Pevek and in the village of Bodaibo, where Galina Mikhailovna graduated from high school and in 1961 entered the Irkutsk State Medical Institute.

After graduating from medical institute, Galina Mikhailovna was invited to the department of normal human anatomy, where she proved herself to be a conscientious and responsible worker, actively participated in the work of the department’s team, continued her education in graduate school and soon defended her Ph.D. thesis.

During her career, Galina Mikhailovna went from assistant to associate professor of the department, was secretary of the Bureau of Rationalization and Invention, and worked in the dean’s office of the medical faculty of the medical university.