Dear readers of the "Baikal Medical Journal"!
We present to your attention the autumn issue of the "Baikal Medical Journal".

Relevance. Fibrinolysis is an important and integral part of the hemostasis system. Acting in parallel and together, the blood coagulation and fibrinolysis systems protect the body from excessive thrombus formation and vascular occlusion, on the one hand, and help maintain homeostasis by preventing excessive blood loss. On the other hand, as a result of imbalance between the coagulation and fibrinolysis processes, pathological processes such as hemorrhagic syndromes or thrombophilia occur. The fibrinolysis system includes not only plasmin, which directly breaks down the fibrin clot, but also a system of proteins that control plasmin activity: activators and inhibitors of this process.

Aim. To examine modern concepts of the processes of fibrin clot destruction, mechanisms of fibrinolysis control, types of disorders of these mechanisms and manifestations of these disorders, to describe the main tests for determining the activity of various proteins and fibrinolysis products.

Results. The review examines the sequence of reactions of fibrin and fibrinogen cleavage. The main plasminogen activators and plasmin inhibitors are given. The properties of the components participating in fibrinolysis are described. The review also shows the main fibrinolysis disorders: hypo- and hyperfibrinolytic conditions with examples. At the end of the review, the main laboratory tests are given that allow assessing the activity of the fibrinolysis system.

Conclusion. Fibrinolysis is an integral component of the hemostasis system. Fibrinolysis prevents obstruction of blood vessels by fibrin thrombi, recanalizes blood vessels and restores normal blood flow, and participates in the pathogenesis of cardiovascular and other diseases. Understanding the clinical significance of fibrinolysis is important for the diagnosis and treatment of various diseases and conditions associated with disorders in the blood coagulation and thrombus formation system. At the same time, it should be taken into account that laboratory diagnostics of fibrinolytic system disorders is carried out in combination with the study of pro- and anticoagulants, as well as platelets.

Background. Takotsubo syndrome is a stress-induced cardiomyopathy characterized by reversible myocardial damage with transient left ventricular dysfunction and electrocardiogram changes similar to acute coronary syndrome. The observed increase in reported cases of this syndrome The growing number of reported cases determines the need to increase awareness of this condition, the possibilities of diagnostic methods for differential diagnosis with acute coronary syndrome, and treatment.

The aim of the work. To present modern data of the pathogenesis of takotsubo syndrome, diagnostic criteria, the role of various diagnostic methods and differential diagnosis with acute coronary syndrome, and treatment features.

Results. The review presents recent literature data on the epidemiology, pathogenesis, and diagnosis of takotsubo syndrome. Possible pathophysiological mechanisms of the disease are discussed. Modern diagnostic criteria, the role of various diagnostic methods, and the possibility of coexistence takotsubo syndrome with coronary artery stenotic lesions are described. Complications such as acute heart failure, cardiogenic shock, and rhythm disturbances are discussed. The criteria of an unfavorable prognosis are given. Data on recurrence and possible factors that increase the likelihood of recurrent events are discussed. Currently, there are no evidence-based recommendations for the treatment of takotsubo syndrome. Indications for beta-blockers, levosimendan, and the role of mechanical support in patients with cardiogenic shock are discussed.

Conclusion. Takotsubo syndrome is not a very rare disease. The use of modern diagnostic methods makes it possible to establish a diagnosis. The course and prognosis of the disease vary, and it is necessary to identify high-risk patients. Treatment in the acute phase depends on the presence of complications. Randomized trials are needed to prove the effectiveness of various drugs both in the acute phase and in long-term treatment.

Relevance. Connective tissue development disorders are characterized by a wide polymorphism of clinical manifestations. Complications that develop on their basis often have severe consequences and significantly worsen the patient's quality of life. Clinical diagnostics of hereditary connective tissue dysplasias is quite a complex task, due to the wide range of clinical manifestations, but also an important part of successful diagnostics. One of the common variants of connective tissue dysplasia is collagenopathies.

Objective: to analyze the molecular genetic causes of collagenopathies and determine the features of their clinical manifestation.

Results. The molecular genetic basis for the development of collagenopathies is analyzed. Modern concepts of the structure of connective tissue, its functions and the formation of collagen fibers are considered. Clinical features of various variants of syndromic collagenopathies, their molecular genetic causes and functions of 28 types of collagen are shown. The main non-syndromic types of collagenopathies are given.

Conclusion. Diagnosis of hereditary pathology, in particular, variants of collagen fiber structure disorder, is a rather complex task, and the final diagnosis is determined using expensive DNA diagnostics. In this regard, understanding the clinical features and molecular genetic basis of hereditary collagenopathies, as well as their systematization for successful diagnosis and timely effective treatment, is of particular importance.

Relevance. Traumatic brain injury remains one of the leading causes of disability and mortality in modern society, while existing treatment methods demonstrate limited effectiveness in preventing the development of secondary brain damage and the occurrence of delayed neurological complications. The lack of drugs with a complex multitarget effect on the main pathogenetic mechanisms of traumatic brain injury necessitates the search for new therapeutic approaches.

Aim of the study: to analyze current and promising approaches to the treatment of the consequences of traumatic brain injury, to identify the most promising areas.

Methods: a systematic review of the scientific literature, analysis of the results of preclinical and clinical studies on the use of various therapeutic approaches in traumatic brain injury, including standard intensive care, experimental neuroprotective drugs and cell therapy.

Results: it was found that the standard existing therapy for the consequences of traumatic brain injury is aimed primarily at maintaining vital functions and controlling intracranial pressure, but does not affect the key mechanisms of secondary brain tissue damage. Most experimental neuroprotective drugs have not demonstrated significant clinical efficacy. One of the most promising approaches to stimulating brain tissue neuroprotection and preventing the development of its secondary damage after traumatic brain injury is therapy with stem cells or their secretion products. The secretome of mesenchymal stromal cells, containing a wide range of biologically active molecules and molecular complexes, has a unique ability to affect a wide range of pathogenetic mechanisms that occur after traumatic brain injury. Recent advances in molecular and cellular biology (in particular, obtaining cell lines with prolonged proliferative potential) open up opportunities for clinical translation of this technology.

Conclusion: existing therapy for the consequences of traumatic brain injury has limited effectiveness and does not allow for the prevention of delayed damage to brain tissue. One of the most promising approaches to preventing the development of undesirable consequences of traumatic brain injury is therapy with stem cells or products of their secretion.

Relevance. Benign prostatic hyperplasia is one of the most common urological conditions in elderly men, with both its prevalence and symptom severity increasing proportionally with age. At the same time, the effectiveness of conservative therapy is often limited, as many patients continue to experience significant lower urinary tract symptoms despite medical treatment. The standard surgical option — transurethral resection of the prostate— is associated with risks such as bleeding, hospitalization, and a high incidence of sexual dysfunction, with retrograde ejaculation occurring in 50–70% of patients. In this context, water vapor thermal therapy (Rezūm) represents a promising minimally invasive alternative. It provides durable relief of BPH-related symptoms with minimal invasiveness, allowing patients to avoid long-term pharmacotherapy and reduce the risk of surgical complications, while preserving the prostate gland and sexual function.

Aim. To evaluate the early clinical outcomes and safety of Rezūm water vapor thermal therapy in patients with benign prostatic hyperplasia.

Materials and Methods. A retrospective single-center analysis was conducted on the treatment outcomes of 9 men (aged 49–78 years; mean age 59.4 ± 9.1 years) presenting with severe lower urinary tract symptoms (IPSS ≥ 22) and moderate prostate enlargement (30.8–70.0 mL). All patients underwent Rezūm thermal ablation (4–6 vapor injections; mean procedure duration 7.8 ± 1.5 minutes). Follow-up at 3 months included assessment using the International Prostate Symptom Score, quality of life index related to symptoms, maximum urinary flow rate, post-void residual urine volume, prostate volume, and complication recording according to the Clavien–Dindo classification.

Results. By the 3-month follow-up, the total IPSS score had significantly decreased from 25.8 ± 2.9 to 5.9 ± 1.3 points (a 77% reduction; p < 0.01), and the QoL index improved from 5.0 ± 0.5 to 1.1 ± 0.3 (a 78% reduction; p < 0.01). Qmax increased from 6.6 ± 2.8 to 20.8 ± 2.8 mL/s (+215%; p < 0.01), while the PVR decreased from 128 ± 116 to 0 mL (p < 0.01). Prostate volume was reduced by 65% (from 53.3 ± 14.8 to 18.6 ± 2.9 mL; p < 0.01). Spontaneous voiding was restored in 100% of patients (median time: 7 days). Grade I–II complications were observed in 2 patients (11% macroscopic hematuria, 11% transient urinary retention). No complications of grade ≥ III, infections, or sexual dysfunctions were reported.

Conclusion. Rezūm water vapor thermal therapy provides a significant reduction in BPH-related symptoms, improves urodynamic parameters, and enables rapid recovery of spontaneous voiding with a minimal risk of complications. It may be considered an effective minimally invasive alternative to transurethral resection of the prostate.

Relevance. Currently, the use of tobacco and tobacco products has acquired the character of a global epidemic, and the number of diseases associated with this harmful habit is steadily growing. In the last 20 years, a trend has emerged worldwide to replace traditional cigarettes with electronic ones, positioned by marketers as less harmful. These devices, being fashionable and modern, have become especially popular among teenagers and young people. However, cases of severe lung pathology, including fatal ones, have been reported in users of electronic nicotine delivery systems.

Aim. To analyze and structure data on methods of electronic delivery of nicotine to the body, as well as on the pathogenesis of lung damage from various liquids for "vaping".

Results. Reusable devices have the most pathogenic effect on the body of users, especially when using liquids containing tetrahydrocannabinol, but even nicotine-free liquids are not harmless to health. More than 30 different substances with a potentially harmful effect on the body have been found in the aerosols of electronic liquids. In most cases, the picture of lung damage in "vapers" is represented by the development of diffuse alveolar damage, the pathogenesis of which involves both direct tissue damage by chemicals and a violation of the immune response and inflammatory mechanisms. E-cigarette users demonstrate a predominance of the pro-inflammatory phenotype of macrophages, an excess of pro-inflammatory cytokines and a lack of anti-inflammatory ones. Vapers using liquids based on tetrahydrocannabinol have foamy macrophages in the lung tissue and bronchoalveolar lavage that accumulate vitamin E acetate. Also, users of electronic nicotine delivery systems have been found to have multiple disturbances in gene expression by macrophages, as well as various damages to deoxyribonucleic acid in the epithelial cells of the oral mucosa, which may be an initiating factor in the development of malignant neoplasms and other types of pathology. In experiments on mice, it was shown that replacing conventional tobacco smoke with electronic aerosol does not improve the condition of the lung tissue in mice, and inhalation of aerosols containing nicotine is accompanied by an increase in platelet function.

Conclusion. Electronic nicotine delivery systems are not a safe replacement for regular cigarettes. Moreover, even nicotine-free fluids have a damaging effect.

Relevance. Pulmonary hemorrhage is a serious condition that requires attention in medical practice. It can occur for various reasons and manifest itself with varying intensity from hemoptysis to profuse bleeding and requires immediate hospitalization. The causes of pulmonary hemorrhage are varied: various diseases of the lungs and bronchi, cardiovascular system, hemostasis disorders. Arterial hypertension is a rare cause leading to this pathology.

Case descriptions.  The article presents a clinical case of hemoptysis in patient Z., 64 years old, with uncontrolled arterial hypertension. The examination revealed no pathology of the respiratory system (infection, cancer), heart disease, aortic pathology, no traumatic anamnesis, and coagulogram indices were within normal limits. The episode of hemoptysis, as well as an increase in blood pressure to high numbers (224/105 mm Hg, while the usual figures were 140-160/90-110 mm Hg) were detected for the first time. Pulmonary hemorrhage was stopped using endoscopic occlusion with a foam obturator and endovascular embolization; hemostatic and hypotensive therapy were also performed. Against the background of effective hypotensive therapy, the target blood pressure was achieved over 6 months of observation, and no recurrence of pulmonary hemorrhage was detected.

Conclusion. The absence of recurrence of pulmonary hemorrhage against the background of normalization of blood pressure, as well as another reason during the examination, allows us to associate this episode of hemoptysis with a marked increase in blood pressure.

Relevance. Lower extremity varicose vein disease is the most frequent reason patients seek consultation with a vascular surgeon. The primary treatment for this condition is surgical intervention. Complications of phlebectomy include lymphorrhea, damage to major blood vessels and nerves, thromboembolic complications as well as infectious complications. The incidence of surgical site infections following open vein surgery ranges from 1.5 % to 16 %. However, no reliable statistical data on the frequency of severe infectious complications after phlebectomy are available. Despite their low frequency rate, severe surgical site infections are clinically significant, as their development substantially prolongs hospitalization, necessitates additional therapy, and may adversely affect overall treatment outcomes.

Case descriptions.  This article presents a case of cellulitis that developed in a female patient with varicose vein disease of the lower limbs during the postoperative period following phlebectomy. The appropriately chosen surgical approach, combined with targeted antibiotic therapy based on microbiological test results, led to complete wound healing and full patient recovery.

Conclusion. Deep skin and soft tissue infections are rare complications of phlebectomy, yet they present diagnostic challenges, severe clinical course, and require prolonged treatment. When a deep subcutaneous infection is suspected in the surgical area, urgent additional investigations should be performed. The cornerstone of management involves early surgical intervention combined antibiotic therapy administered considering the results of microbiological tests.

Relevance. Facial pain (prosopalgia, orofacial pain) is one of the topical problems in clinical neurology. Complex anatomical, topographic and physiological characteristics of the facial area structure emphasize the need to understand their correlation when drawing up a clinical picture of individual nosological forms. In differential diagnostics and treatment of orofacial pain, the features of the pathogenetic mechanisms of pain are taken in to account. In addition to classical trigeminal neuralgia described in the first lecture, other variants of this pathology play an important role, as well as damage to other cranial nerves involved in the innervation of the facial area, such as the glossopharyngeal and vagus. Also in the international classification of orofacial pain (ICOP) a separate group is occupied by diseases associated with dysfunction of the temporomandibular joint, the causes of which can be arthralgia, myofascial pain in the face, reflected pain in case of damage to the cervical spine, neurostomatological syndromes, bruxism. The listed causes involve damage to various tissue structures: muscles, joints, ligaments, central and peripheral nervous system.

Conclusion. Differential diagnostics of facial lesions should be carried out taking in to account knowledge of the anatomy, physiology, pathophysiology of the face. Correlation of clinical manifestations is based on interdisciplinary interaction of doctors of different specialties: neurologists, dentists, traumatologists. Only combined knowledge of the structural features, functions and pathology of the orofacial region will provide an up-to-date and differentiated approach to the treatment of facial pain.