The aim of the study was to describe morphometric characteristics of the posterior parts of the nasal cavity in different periods of childhood and to specify the age-related norm for improving surgical treatment options of choanal atresia and providing an optimal access to the anterior part of the skull base.

Material and methods. The study included 87 children aged 1-21 who were exposed to craniometry of the nasal cavity structures.

Results. The age-related variability of the linear dimensions and shape of the choanae, their relationship with the dimensions of the pyriform aperture and the height of the nasal cavity in the posterior part were defined in the study. The increase in the height of the choanae and the height of the nasal cavity at the back starts from 2– 3 years of age, and the width – from 8–12 years of age. The height and width of the pyriform aperture are equal to the age of 8–12; these parameters increase in older children's groups with a predominance of the height over the width. The height of the nasal cavity at the back increases in all age periods. The growth of the studied structures of the nasal cavity is completed by adolescence. In infancy, the height of the choanae is less than the height of the nasal cavity at the back by 45%, and less than the height of the pyriform aperture by 20%; in adolescence, these ratios are 42% and 23%, respectively. In infancy the choanal width is less than the width of the pyriform aperture by 49%, and in adolescence – by 40%. In infancy and early childhood, the choanae are typically small in height and width. Their shape is round in 25% of cases, however, ovoid shape is also found. The height and width of the pyriform-shaped aperture at these age periods are similar and do not exceed 17–18 mm; the height of the nasal cavity at the back is 25–27 mm.

Conclusion. The authors have described age-related morphometric features of the posterior structures of the nasal cavity. These features should be taken into account by otorhinolaryngologists and neurosurgeons when planning endoscopic intranasal surgical access in children. The younger the child is, the more difficult it is to perform a surgery due to the significant restriction of the access resulted from the small size of the piriform opening and the nasal cavity, and the obstinacy of the nasal septum. When performing choanotomy for atresia, it is necessary to form the choana comparing it in shape and size with the age-related norm

The article highlights peculiarities of localization of myocardial bridges. It is believed that the coronary arteries and their branches are located in the subepicardial tissue. However, some researchers describe cases of intramural localization of their sections. Myocardial bridges – a set of fibers of the ventricular myocardium located over a certain area of the subepicardial branch of the coronary artery - represent variants of such localization.

The aim of the study was to establish the patterns of macroscopic anatomy and topography of myocardial bridges investigating anatomical sections of the human heart in the adult and elderly people.

Material and methods. The study involved 65 formalin-fixed sample preparations of the human heart of the adult and elderly people who died of conditions that were not associated with heart diseases. The authors measured transverse and longitudinal dimensions of the ventricular complex of the heart, and calculated the transverse-longitudinal index. Subepicardial vessels were prepared without prior injection. The number of myocardial bridges over the main branches of the coronary arteries was counted and their length was measured. The type of blood supply to the heart was determined according to a three-member classification, depending on the source of discharge of the posterior interventricular branch.

Results. Myocardial bridges were observed on 44 (67.6%) sample preparations. As a rule, they were located over the branches of the left coronary artery (91.5%). They were typically located in the proximal half of the anterior interventricular sulcus. The length of the bridges ranged from 2.5 to 64 mm (Me = 13 mm). A direct positive correlation was found between the length of the ventricular complex of the heart and the length of the bridges. The relationship between the type of blood supply to the heart and the presence of bridges was not revealed. In 26 preparations, a cone artery departed from the right coronary sinus of the aorta, in addition to the right coronary artery, and bridges were observed in 17 sample preparations.

Conclusion. Myocardial bridges are more typical for the branches of the left coronary artery compared to the right. They are typically localized in the proximal third of the anterior interventricular sulcus. There is a dependence between the length of the bridges and the length of the ventricular complex of the heart. The distribution and number of myocardial bridges does not depend on the type of blood supply to the heart, but is associated with the independent discharge of the cone artery from the aorta.

The aim of the study is to define the features of organogenesis and histogenesis of sacral vertebrae in human embryos, which predetermine the anatomical structure of the sacrum in postnatal ontogenesis.

Material and methods. The authors studied human embryo serial sections at 17–23 stages from the Carnegie virtual embryological collection, total preparations and serial sections of the lumbosacral region of the fetal spine at 8–20 weeks of gestation without visible developmental anomalies. Histological sections were stained with hematoxylin and eosin; total preparations were stained with alizarin red and alcian blue. In addition, the study included 19 adult sacra from the anatomical collection of the Belarusian State Medical University.

Results. It was found that consolidation of the anlages of the upper sacral vertebrae starts at the early stages of embryogenesis by the fusion of their costal-transverse processes. During the first half of intrauterine development, the arch and articular processes of the adjacent vertebrae remain separate from each other. In contrast to other segments of the spinal column, five primary centers of ossification are formed in the anlages of the upper sacral vertebrae

The aim of the study is to investigate changes in the renal topography in the supine and lateral position of the patient in order to further improve the preoperative planning of laparoscopic operations in kidney masses.

Material and methods. The study included 35 patients with a simple renal cyst, who underwent computed tomography in the supine position and on the healthy side (operating position). To assess the topography, the authors have proposed the following coordinate system: on axial computed tomograms performed with the patient in the supine and lateral position, the OY axis was drawn across the spinous process and the middle of the vertebral body, the OX axis was perpendicular, and went across the most posterior point of the spinal foramen. CT-grams were assessed using RadiAnt DICOM Viewer program.

Results. The study defined morphometric features of the renal displacement medially and anteriorly, as well as cranially or caudally. There was a greater mobility of the left kidney compared with the right kidney. The least mobile was the upper third of the kidney on each side, the middle third of the kidney was more mobile at the level of the hilum, and the greatest displacement was noted in the lower third of the kidney. When patients being in the lateral position, the left kidney was more often displaced downward (caudally) – in 83% of cases, the right kidney was equally often displaced cranially (53% of cases) and caudally - 47%. In all cases of the patient's lateral position, the displacement of the kidney was accompanied by deformation of its vascular pedicle.

Conclusion. The data obtained must be taken into account in preoperative planning, when performing laparoscopic kidney surgery.

The article discusses features of morphometric parameters of the thyroid gland based on results of ultrasound examination. The need to study development of the thyroid gland in the fetus is due to the high prevalence of thyroid pathology and the possibility of its early prenatal diagnostics.

The aim of the study was to characterize morphometric parameters of the fetal thyroid gland at 20–24 weeks of gestation using ultrasound examination.

Material and methods. In the study the thyroid glands of 70 fetuses, both male and female, at the age of 20-24 weeks, were exposed to ultrasound examination. During ultrasound examination, the authors evaluated linear parameters, an organ perimeter, thyroid volume, and growth rate.

Results. Ultrasound examination of fetuses aged 20–24 weeks demonstrated that all anatomical structures of the thyroid gland were well visualized on the images. The period from the 20th to the 24th week of the fetal intrauterine development was accompanied by an increase in the studied parameters of the thyroid gland, the growth intensity ranged from 3% (width of the left lobe) to 37% (thyroid volume). In female fetuses, the lobe sizes of the thyroid gland and the index of the thyroid volume prevailed. This period was also characterized by a low (up to 14%) growth intensity of certain linear parameters in male and female fetuses in different age subgroups.

Conclusion. Starting from the 20th week of intrauterine development, ultrasound examination allows detecting features of the topography, quantitative anatomy and growth intensity of the fetal thyroid gland. The data obtained evidence the possibility of assessing the state of the thyroid gland during ultrasound screening of a fetus.

The aim of the study was to detect morphofunctional features of the retina of WAG/Rij rats during postnatal development from the 1st to the 360th day after birth.

Material and methods. The study included retina of the inbred WAG/Rij rats (60 eyeballs from 30 rats totally) from the 1st to the 360th day of life. Standard histological studies were performed on paraffin sections stained with hematoxylin and eosin. Immunohistochemical method was used to determine the expression of acidic glial fibrillar protein GFAP in the rat retina. Mouse monoclonal antibodies (Santa Cruz Biotechnology) and a universal secondary detection system (NovocastraTM) were used for imaging. The degree of protein expression in the retina of WAG/Rij rats was compared in different age groups.

Results. It was found that after birth, the retina of rat models of the WAG/Rij line is formed in the same way as the retina of rats of other strains and acquires a definitive structure only by the end of the second week (correlates with the opening of the eyes). On the 20th day, the first signs of dystrophic and destructive processes appear in the retina of WAG / Rij rats progressing as they grow older and leading to retinal gliosis. The increase in the expression of acidic glial fibrillar protein GFAP begins from the 30th day and increases with age as destructive processes in the retina increase.

Conclusion. The early postnatal development of the retina of the WAG/Rij rats, which correlates in character with the postnatal retina development of rats of other strains, is interrupted by the launch of destructive processes in the retina soon after its complete differentiation. The further intensifying cascade of degeneration over time leads to the death of retinal neurons and their replacement by glial cells.

The aim of the study is to determine the features of the skin area in Kyrgyz women population in view of their constitutional groups and somatotypes.

Material and methods. We studied the physical status of 1028 Kyrgyz women of different age groups – the juvenile age group (n=310), the 1st adulthood age group (n=310), and the 2nd adulthood age group (n=410) living in Osh and its neighborhood applying anthropometric and bioimpedance methods. Statistical data processing was performed by statistical programs Microsoft Excel and the package STATISTICA 6.0. The differences between the two compared values were determined by the Student's criterion and they were considered significant at p<0.05.

Results. The performed study revealed the constitutional and somatotypological features of the skin area in the juvenile and both periods of adulthood in the female population. The body surface area is minimal in women of leptosomic group and maximum in megalosomic one. Somatotypological specificity is determined by the minimum value of this indicator in women of asthenic and stenoplastic types and by the maximum value in representatives of the euriplastic tall type. There is the tendency to increase the body skin area from the juvenile to the 2nd period of adulthood, which is typical for women of all somatotypes and constitutional groups.

Conclusion. The area of the skin is one of the indicators of human physical development, which has somatotypological specificity in representatives of various constitutional groups of the studied women population. The presented materials on the constitutional and typological features of the women’s physical status in relative norm conditions can serve as one of the bases for further development of a personalized approach in clinical medicine.

The aim of the study was to characterize the immunomorphological processes in the spleen of patients with immune thrombocytopenia depending on the form of the disease and the response to splenectomy.

Material and methods. The study included the spleens of 50 patients with immune thrombocytopenia, including 32 women (64%) and 18 men (35%). The median age was 38.0 (22.8; 52.0) years. Depending on the form of the disease, all patients with immune thrombocytopenia were divided into three groups: first diagnosed disease (n=12); persistent form (n=20); and chronic form (n=18). All cases of immune thrombocytopenia were divided into two subgroups: 1 (n=32) – patients who were in remission after splenectomy; 2 (n=18) – people with refractory disease after splenectomy The comparison group was represented by spleens autopsy material of 20 people who had no history of blood system and liver diseases, or other pathology. The median age was 39 (27; 65) years. Histological, immunohistochemical, and morphometric methods were used to study the size of the red and white spleen pulps, as well as their cellular composition.

Results. In patients with immune thrombocytopenia who responded to splenectomy, the spleen morphology was characterized as corresponding to stages I–II of the immune response. In the subgroup with a refractory course of the disease and in patients with a persistent form, the condition of the spleen corresponded to stages II–III of the immune response, which indicated a longer or aggressive course of the disease. Reducing the size of the periarterial lymphoid muffs, regardless of the response to splenectomy in relation to the comparison group (p<0.05), reflects the pathogenesis of the disease and presents the effect of immunosuppressive therapy on T-cell area of white pulp. Changes in the cell composition of the spleen in patients with immune thrombocytopenia were characterized by an increase in the relative and absolute number of B and T lymphocytes in the white and red pulps, macrophages (CD68+) and dendritic cells (CD35+, S100+). An increase in the content of lymphoid elements expressing CD4+ in white and red pulps, as well as CD8+ T-lymphocytes in the red pulp indicates a multifactorial development of autoimmune disorders in this disease. A significant increase in the number of cytotoxic CD8+ T cells and CD68+ macrophages in the red pulp in patients with refractory course of immune thrombocytopenia compared to those who responded to splenectomy (p<0.05) indicates that cytotoxic T-lymphocytes along with macrophages are actively involved in the destruction of platelets in patients resistant to the surgical treatment of the disease. Morphometric criteria for unfavorable prognosis of immune thrombocytopenia after splenectomy were determined.

The aim of the study was to establish morphofunctional and immunohistochemical characteristics of large omentum in women with ovarian cancer.

Material and methods. The large omenta of 48 women with ovarian cancer (low-grade differentiated seropapillary adenocarcinoma of high-grade malignancy) of II stage (n=20) and III stage (n=28) were studied. Histological sections were stained with overview histological and immunohistochemical methods (to reveal ki67, P53, CD34, CD7, CD4, CD8, CD61 proteins expression).

Results. In patients, the size of the large omentum was characterized by high individual variability; in the presence of metastasis, the size of the omentum was reduced. Intensive development of blood vessels in the organ was noted, but in the presence of metastases stasis of blood corpuscles, leucocytic infiltration, and moderate edema of connective tissue were observed in the organ’s vessels. Areas of lymphoid tissue, both small lymphatic follicles and diffusely located lymphoid tissue, were revealed in the omentum. In most follicles, reactive centers were not marked, and the number of follicles was reduced in the presence of metastases in the omentum. The analysis of CD34+ cells distribution showed that they were identified both in the tumor and in the areas of the omentum adjacent to the tumor, which indicates a pronounced angiogenesis. An irregular distribution of CD7+ and CD8+ and CD4+ cells was revealed in the tumor tissues, as well as in the surroundings. Simultaneously with the expression of P53 protein, ki67 protein expression is revealed in the significant number of tumor cells (including endothelial cells of tumor blood vessels). The proportion of ki67+ cells in the tumor cell population was 60.1±3.3%. The presence of a large number of ki67+cells in the presence of P53 protein expression in them indicates the aggressiveness of the tumor, as well as a disturbance of apoptosis regulatory mechanisms in the cells. Ki67 expression was low in the omentum areas unaffected by metastases, and it was revealed in the certain areas of connective tissue in fibroblastic programmed differentiation cells.

Conclusion. The results obtained indicate significant plasticity and reactivity of great omentum in the presence of tumor process in the body and confirm the important role of great omentum in protective reactions.

The ongoing coronavirus disease 2019 (COVID-19) pandemic dictates the need to study the molecular and cellular mechanisms of interaction between the pathogen and the human body. The manifestation of neurological symptoms in some patients with COVID-19 is a problem for neuroscientists due to the insufficiently understood pathomorphogenesis of the disease. This review systematizes the literature data reflecting the ways of penetration of SARS-CoV-2 into the brain, features of its interaction with neurons, neuroglia, and immune cells. It has been shown that the main mechanisms of SARS-CoV-2 neuroinvasion are presumably retrograde axonal transport along the fibers of the olfactory and vagus nerves; penetration through the damaged blood-brain barrier (BBB) or migration of immunocompetent cells containing viral particles through the intact BBB. It was found that virusinducible neuronal death is caused not only by a direct cytotoxic effect, but also due to dysregulation of the reninangiotensin system of the brain and the release of a large amount of inflammatory cytokines as a manifestation of a “cytokine storm”. The participation of neuroglial cells in the initiation and maintenance of neuroinflammatory and neurodegenerative processes due to the activation of their proinflammatory phenotype has been demonstrated. The role of mast cells in antiviral defense mechanisms and inflammatory reactions is discussed.

Reticuloendothelial system (RES) is considered one of the local immune response regulation centers. It takes part in most physiological and pathological processes, namely, in local homeostasis, in regulation of trophism and immunological responses of both primary and secondary immune responses. The main cell population of (RES) is a macrophage, which is a stationary cell that can move only within the tissue layer. Dendritic cells as representatives of (RES) as well are under direct control of macrophages. Up to 80% of all immunocompetent cells are concentrated in the intestinal mucosa. For adequate interaction with the intestinal microbiota and ensuring immunological tolerance to normal commensals, there is a lymphoid tissue associated with the intestinal mucosa (gut-associated lymphoid tissue – GALT), in which mononuclear phagocytes perform their most significant functions. When pathogenic microorganisms enter the mucosa, the network of resident macrophages as an immune barrier triggers an inflammatory response to further stabilize homeostasis. However, a pronounced microbial and antigenic load in the gut requires the mandatory presence of specific immune cells – lymphocytes, whose immature forms are located in GALT structures and specialize under the guidance of mononuclear phagocytes. After the final differentiation, lymphocytes expressing integrin α4β7 are able to return from the systemic bloodstream to the intestinal mucosa to perform highly specific functions. This phenomenon is called the homing effect. It was noted that in non-specific ulcerative colitis and Crohn's disease, both the number of regulatory T-lymphocytes and their expression of integrin α4β7 increases. The pathology of the homing effect, according to some researchers, explains the possibility of follow-up secondary lesions in chronic inflammatory bowel diseases with the development of systemic pathology.

The paper presents a novel histochemical approach for evaluation of tryptase expression in the mast cell population. To study the selective effect of mast cells (MC) on the parameters of a specific tissue microenvironment, it is necessary to detail the molecular composition of their secretome and analyze the pathways of degranulation. The developed method for combined immunomorphological and histochemical tryptase staining protocols contributes to a more objective determination of the integral level of specific protease expression in the skin MC population. Extra visualization potentials of cytological features and specific aspects of tryptase processing expand efficiency of morphological analysis in both normal and pathological conditions.

This article is the second of two articles on Nikolay Ivanovich Pirogov. In the first article “Highlights of the professional activities of Nikolay Ivanovich Pirogov before and after his professoriate in Saint Petersburg (1841–1860).” we discussed his early training and his professional development at the Dorpat University and abroad till his appointment in Saint Petersburg 1841. Also is discussed how during and after his professoriate in Saint Petersburg he developed management of mass war casualties. In this second article we highlight his professional career as an anatomist, surgeon and anaesthesiologist. The authors want to emphasize that these two articles are an extract from previously published extensive articles related to Nikolay Ivanovich Pirogov. You can find these articles in the reference list under the name of the first author [12–17].

The article is dedicated to the anniversary of Aleksndr Abramovich Stadnikov, Doctor of Biological Sciences, Professor, Honored Scientist of the Russian Federation, Honored Worker of Higher Education of the Russian Federation. The authors cover in detail the formation of A.A. Stadnikov as a teacher and scientist. Particular attention is paid to his scientific interests, contribution to the development of national science and higher medical education.