Dear readers of the "Baikal Medical Journal"!

We present to your attention the summer issue of the "Baikal Medical Journal", in which we publish the most significant works of our colleagues.

Relevance. Cellular aging is a major contributor to age-related diseases, and understanding its mechanisms opens avenues for anti-aging strategies.

The aim of this review is to systematically analyze the literature data on the role of the AP2A1 protein in the processes of cellular aging and rejuvenation.

Results. Recent studies have identified AP2A1 (Adaptor Protein 2 Alpha 1 subunit), previously known for its role in endocytosis, as a crucial regulator of the senescent cell phenotype. In aged cells, AP2A1 localizes along actin stress fibers, interacts with integrin β1, and promotes strong adhesion to the extracellular matrix. These changes allow senescent cells to maintain their enlarged size and sustain cell cycle arrest. Experimental data show that AP2A1 knockdown leads to partial rejuvenation, characterized by reduced cell size, decreased senescence markers (p53, p21, SA-β-gal), and weakened adhesion. Conversely, AP2A1 overexpression in young cells accelerates senescence. These findings suggest that AP2A1 is not merely a biomarker of aging but an active regulator of cellular state. Targeting AP2A1 could offer a novel anti-aging therapeutic approach, aiming to modify senescent cell adhesion properties, mitigate their impact on tissues, and potentially induce partial rejuvenation.

Conclusion: This review provides a systematic analysis of AP2A1’s role in cellular aging, its link to integrin pathways, and the therapeutic potential of its modulation in biomedicine.

Background. Ocular metastases from prostate cancer are extremely rare, accounting for less than 1 % of all orbital tumors. Despite their rarity, these lesions are clinically significant due to the risk of vision loss and pain, and they often indicate advanced systemic disease.

Objective. To review the current literature on the clinical features, diagnostic methods, treatment strategies, and prognosis of ocular metastases from prostate cancer.

Results. Common manifestations include proptosis, visual acuity decline, diplopia, and orbital pain. Metastases typically involve the orbit or choroid. Diagnosis requires a high degree of clinical suspicion and includes orbital magnetic resonance imaging, PSMA positron emission tomography/computed tomography, ophthalmoscopy, and histopathological confirmation via biopsy. Elevated prostate-specific antigen levels with ocular symptoms strongly suggest metastatic prostate cancer. Treatment is mainly palliative and involves systemic androgen deprivation therapy, chemotherapy, and local radiotherapy. In some cases, regression of ocular lesions and symptom relief can be achieved, particularly if therapy is initiated early. Nevertheless, the median survival after diagnosis of ocular metastases is generally limited to 7–24 months.

Conclusion. Ocular involvement in prostate cancer represents a rare but serious metastatic manifestation. Early detection and a multidisciplinary therapeutic approach are essential to reduce symptom burden and improve quality of life. Further research and accumulation of clinical data are necessary to develop optimal management strategies for this uncommon complication.

Relevance. The hemostasis system is a complex multi-level mechanism that, on the one hand, prevents blood loss when a vessel is damaged, and on the other hand, maintains the blood in a liquid state, preventing excessive thrombi formation. It is implemented with the participation of blood cells, endothelial cells and other cells, as well as several sequentially and mutually activated enzyme systems. There are two types of hemostasis: primary and secondary. As a result of activation of primary hemostasis, a platelet thrombus is formed, secondary hemostasis results in the formation of a fibrin clot. Hemostasis disorders lead to either bleeding or thrombosis, which is one of the most important causes of mortality and morbidity in the world.

Aim. To consider modern concepts of the mechanisms of fibrin clot formation in norm and pathology, to provide screening tests for evaluation the pathology of coagulation hemostasis.

Results. The review examines the sequence of activation of coagulation hemostasis factors from the standpoint of cellular theory. A description and characteristics of most of the participants in the coagulation hemostasis process are separately provided. The most common causes, mechanisms and manifestations of hypo- and hypercoagulation are described. At the end, the most common screening tests for analyzing the state of coagulation hemostasis are described.

Conclusion. According to the cellular model, hemostasis occurs in four overlapping phases (initiation, amplification, propagation, and termination) and occurs on different cell surfaces. Specifically, coagulation is initiated in cells expressing tissue factor, amplifies and propagates on the phospholipid surface of fully activated platelets. Hemostasis involves complex biochemical mechanisms and interactions between the vascular endothelium, coagulation factors, and cellular (mainly platelets) blood components.

Relevance. Сhronic heart failure is a widespread pathology due to the high incidence of hypertension and coronary artery disease. Several million new cases of heart failure are reported in India every year. However, non-ischemic CHF is an even more difficult medical and social task due to the huge variety of causes of its causation and insufficient control by the Indian practical healthcare system.

The aim: to evaluate the frequency of concomitant pathology and outcomes of chronic heart failure of various etiologies in patients of the southern region of India

Materials and methods. A prospective study was conducted on 145 patients with chronic heart failure due to ischemic heart disease and 100 patients with chronic heart failure due to other causes, who were observed at the Kerala Institute of Medical Sciences. Comparative analysis of comorbidities and prospective two-year monitoring of each patient were conducted. The frequency of hospitalizations and the outcome of chronic heart failure during the specified period and statistical associations of events with comorbidities were assessed. Data processing was performed in the Statistica 12 program.

Results. In the group of patients with ischemic heart disease, a statistically significant predominance of cases of diabetes mellitus was revealed (84 vs. 15.3%), hypertension (74.4 vs. 25.4%), dyslipidemia (73.3 vs. 26.1%), chronic kidney disease (78 vs. 22%), anemia (72.1 vs. 27.3%), hyperuricemia (36.2 vs. 13%) compared with patients with non-ischemic etiology of heart failure. Also, in the group of patients with ischemic etiology of chronic heart failure, a predominance of cases of hospitalization during the observed period was revealed: 40 and 32.3%, respectively (p=0.001). The concomitant conditions described earlier were associated with hospitalization in the group of patients with ischemic etiology of chronic heart failure. However, in the group of patients with non-ischemic etiology, a significantly higher incidence of death was observed: 34 and 40%, respectively, which had a statistical association with atrial fibrillation.

Conclusion. Patients with chronic heart failure of non-ischemic etiology have a higher mortality rate compared to patients with chronic heart failure due to ischemic heart disease. This is probably due to insufficient control of this group. A higher prevalence of rhythm disturbances associated with mortality was also noted in this group.

Relevance. Suicidal poisonings occupy a special place among chemical poisonings, which occurs against the background of a previous psychotraumatic situation. To date, it has not been clarified how stress conditions affect the nature of acute poisoning, and how the adrenal glands react to chemical aggression. There are no studies devoted to the study of morpho-functional changes of the adrenal glands in suicides caused by various chemicals. Understanding the mechanisms of toxic effects can have significant clinical and experimental implications for understanding adaptive processes in the body.

The aim of the work is to study changes in the structure of the adrenal glands of rats during experimental modeling of suicidal poisoning.

Materials and methods. The experiment was performed on 135 mongrel male rats. Acetic acid poisoning was modeled on two groups of animals. The first group was previously subjected to acute (6-hour) stress, the second – to chronic (14-day) stress. A 30 % solution of acetic acid was used as a toxicant, which was administered once in an amount of 0.5 ml. The observation period ranged from 1 to 15 days. The stress level and morphofunctional state of the adrenal glands were determined by the content of corticosterone, prolactin, hydroperoxides and lipids. The weight of the gland, the width of the cortical substance and its zones, the degree of damage and the change in the structure of the cortical substance were determined. The statistical significance of the differences between the studied groups was assessed using the nonparametric Mann–Whitney test.

Results. The premorbid state significantly changed the adrenal glands response to chemical aggression. Acute stress causes an increase in the adrenal glands mass; it lowers the reserves of plastic material in corticocytes. At the same time, there is an increase in the content of corticosterone and prolactin in blood plasma. Acetic acid poisoning after 14 days of stress causes severe damage to the adrenal cortex.

Conclusion. The depth of damage to the adrenal glands in suicidal poisoning is directly associated with premorbid stress. The greatest structural changes in the adrenal cortex are observed when poisoning is combined with chronic premorbid stress. Acute premorbid stress preceding suicidal poisoning increases the body's resistance to the toxicant.

Background. Damage and biomechanical disorders of the patella-femoral articulation significantly worsen the general functional state of the knee joint.

Aim. To evaluate the effectiveness of known methods of surgical treatment of persistent and recurrent patellar dislocations and to clarify the indications for their use depending on the type of chronic instability.

Materials and methods. Surgical treatment was performed on 24 patients with patellar instability, which were divided into 4 groups according to the Blumensaat classification: 1. persistent habitual subluxations 2. persistent habitual dislocations 3. recurrent post-traumatic dislocations 4. persistent permanent dislocations.

Clinical, radiological, magnetic resonance and arthroscopic methods were used.

Results. In 10 patients with persistent habitual subluxations of the patella, a percutaneous suture of the medial retinaculum according to Yamamoto and release of the lateral retinaculum were performed.

In 8 patients with persistent habitual dislocations of the patella, a release of the lateral retinaculum and an anchor suture of the patellafemoral ligament to the inner edge of the patella were performed, using two titanium Fastin fixators.

In 4 patients with relapses after surgical treatment of habitual dislocations of the patella (suturing of the medial retinaculum according to Yamamoto), autoplasty of the medial patellafemoral ligament with the tendon of the semitendinosus muscle according to Schottle-Weiler in our modification was performed. In 2 patients with permanent persistent dislocation of the patella, the release of the lateral retinaculum with mobilization of the tendon of the straight head of the quadriceps and transposition of the tibia tuberosity with the patellar ligament (medialization and reduction) were performed.

When studying the remote results in periods from 6 to 7 years, all patients had no recurrence of dislocations and subluxations of the patella. The full range of motion in the knee joint was preserved.

Conclusion. The conducted study demonstrated that an individualized selection of surgical strategy, based on the Blumensaat classification and time elapsed since injury, combined with modified minimally invasive techniques, ensures reliable patellar stabilization and sustained functional outcomes in the long-term period.

Relevance. Cholelithiasis is one of the most common gastrointestinal diseases. In case of long-term stone carriage, some patients experience complications in the form of biliodigestive anastomoses. Incomplete fistulas are relatively rare and their diagnosis is sometimes difficult due to the diverse clinical picture.

Case descriptions.  The article presents a clinical observation of a rare complication of cholelithiasis - incomplete cholecystogastric fistula with simulation of a submucosal tumor of the antrum of the stomach. A 72-year-old female patient was admitted for planned surgical treatment for chronic calculous cholecystitis. The gallstone was detected more than 10 years ago, the next exacerbation of the disease occurred 1 month ago after eating fatty and fried foods. According to multispiral computed tomography, signs of a space-occupying lesion of the pyloric part of the stomach with signs of infiltrative growth into the wall of the gallbladder were obtained. During surgery, an incomplete cholecystogastric fistula was established. Cholecystectomy was performed. A defect in the wall of the antrum of the stomach was detected, where a calculus measuring 15x10x10 mm was found in the submucosal layer, simulating a space-occupying lesion of the antrum of the stomach. The defect in the wall of the stomach was sutured. The postoperative period was favorable. Wound healing by primary intention. The patient was discharged in satisfactory condition on the 8th day. During the control examination after 3 months, the condition was satisfactory.

Conclusion. The peculiarity of this clinical observation: difficulties in diagnosing a rare variant of biliodigestive anastomosis - an incomplete cholecystogastric fistula with a simulation of a submucosal tumor of the antrum of the stomach.

Background. Complications of chronic gastroduodenal ulcers remain a pressing issue despite the optimization of conservative treatment of gastric and duodenal ulcers. The almost complete rejection of planned surgical treatment and the development of complications of ulcer disease in some cases have led to an increase in the number of emergency surgeries, in which there is a high probability of unfavorable outcomes. The main tasks in solving this problem are still timely diagnostics of resistant cases of therapy and timely prescription of adequate surgical treatment. The combination of various complications of peptic ulcer disease, especially atypical ones, such as choledochoduodenal and cholecys-toduodenal fistulas, gives non-specific and diverse clinical manifestations. This has a significant impact on the disease course and diagnostics. The choice of treatment tactics for this category of patients is individual.
Case description. A rare clinical observation is presented – a combination of several complications, including atypical ones, of a chronic ulcer of the duodenal bulb. A 58-year-old man was admitted to the surgical department with back and epigastric pain, vomiting mucus, and had not been examined before. Endoscopic examination revealed a chronic ulcer of the duodenum complicated by bleeding, penetration, and duodenal fistula. Ultrasound examination and computed tomography allowed only to determine the signs of acute cholecystitis. According to absolute indica-tions, laparotomy was performed. During revision, the diagnosis was clarified, a chronic ulcer of the duodenal bulb with penetration into the hepatoduodenal ligament, two fistulas – cholecystoduodenal (between Hartmann’s pouch and the ulcer) and choledochoduodenal, acute cholecystitis were detected. 
Conclusion. The clinical example demonstrates a combination of several complications of chronic duodenal ulcer, including atypical ones. The chosen treatment tactics allowed the patient to recover.

Relevance. The development of cellular technologies is a very promising direction in the development of modern medicine, which allows developing methods that can overcome previously insoluble problems of medical care.

The aim of the study: to present the basic concepts and directions of development of modern cellular technologies in an accessible form.

Materials and methods. The basis of the lecture is the analysis of domestic and foreign sources over the past 15 years.

Results. It is shown that cellular technologies are a modern innovative basis for reparative therapy, are of great importance for the development of transplantology, pharmacology and other medical fields. The development of cellular technologies is closely related to the concept of stem cells. The lecture discusses the basic principles of their cultivation and application.

Conclusion. Cellular technologies are a promising method of modern regenerative medicine. The development of cell technologies and management of stem cell development open up a number of new areas of medical care, such as bioprinting, biobanking, replacement and regenerative therapy.