This article provides a comprehensive overview of modern approaches to the diagnosis and treatment of osteosarcoma of the mandible. The current methods of instrumental and laboratory diagnostics, including the latest imaging technologies and molecular genetic studies, are considered. Special attention is paid to a multidisciplinary approach to treatment combining surgery with neo- and adjuvant chemotherapy. Modern methods of reconstructive surgery and protocols of postoperative rehabilitation are described in detail. The issues of nutritional support at all stages of treatment, including the peculiarities of enteral nutrition and the specifics of diet therapy for various concomitant diseases of the gastrointestinal tract, are covered in detail. Algorithms for the management of patients in the early and late postoperative period are presented, as well as recommendations for long-term follow-up and prevention of complications. Based on the analysis of modern scientific literature and clinical experience, practical recommendations for optimizing the therapeutic and diagnostic process and improving the effectiveness of rehabilitation measures are formulated.

Introduction. Glioblastoma is the most common primary malignant brain tumor with an aggressive course. Despite two decades of relentless search for new therapeutic approaches in the treatment of glioblastomas, there has been limited progress in improving patient survival outcomes. Numerous obstacles hinder the effective treatment of these patients, including the immunosuppressive tumor microenvironment, the blood-brain barrier, and extensive tumor heterogeneity. Despite these challenges, immunotherapy is emerging as a promising avenue that may provide new hope for the treatment of this malignancy.
Objective. To evaluate the efficacy and long-term results of using a dendritic cell vaccine in patients with brain glioblastomas, in comparison with the results of treatment of patients who did not receive immunotherapy.
Material and methods. A single-center, prospective, cohort study included 100 patients with a pathologically established diagnosis of glioblastoma, of different sexes and ages. The main group included 50 patients, in whose treatment, in addition to the standard (surgical treatment, radiation therapy and chemotherapy), antitumor immunotherapy with a dendritic cell vaccine was used. The comparison group also included 50 patients with standard treatment, but without immunotherapy. The vaccine was manufactured at the immunology laboratory and the substrate for its preparation was the tissue of the glioblastoma tumor of a specific patient and his blood. The vaccine was administered intradermally, paravertebrally. Subsequently, overall and relapse-free survival, as well as the immunological status of the patient were assessed according to laboratory blood tests.
Results. The median overall survival (OS) in the immunotherapy group was 21.3 months (95 % CI 4–37 months), in the group without immunotherapy it was 15.8 months (95 % CI 3–22 months) (p = 0.002). Free progression survival (FPS) in patients in the immunotherapy group was 13.1 months (95 % CI 1–20 months). In patients in the group without immunotherapy it was 7.9 months (95 % CI 1–12 months) (p = 0.003). Overall survival in patients who received three or more courses of immunotherapy was statistically significantly higher than in patients in the group who received 1 or 2 courses. When studying the level of 6 cytokines (IL-6, IL-8, IL-10, TNF-α, IFN-α, IFN-γ) in venous blood during the immunotherapy courses, a change in the average level of 4 cytokines (IL-6, IL-8, IL-10, TNF-α) above the initial average values was noted. The population of immune cells temporarily increased, and this increase coincided with 3 courses of immunotherapy during the observation period.
Conclusion. Overall, in our study, the clinical use of immunotherapy in the structure of complex treatment in patients with glioblastoma demonstrated a measurable immunological response. An increase in the median overall and free progression survival was also noted in patients of the study group and the comparison group. Data were also obtained that the number of courses of immunotherapy affects life expectancy. Further study of the possibilities of immunotherapy will allow this method to be included in the standards of complex treatment of patients with glioblastoma.

The clinical picture of degenerative-dystrophic diseases of the cervical spine, although directly related to the level of involvement in the pathological process of functionally significant structures of the cervical spine, but also largely depends on the patient’s personalized data and comorbid status. Modern diagnostic methods cannot reliably demonstrate the involvement of these structures in the pathological process. In this regard, continuous research and development of new diagnostic methods for degenerative-dystrophic diseases of the cervical spine is required. Thus, the aim of the study is to identify various clinical and pathogenetic forms of the clinical course degenerative-dystrophic diseases of the cervical spine with myelopathic syndrome. The work is based on the study of clinical manifestations and magnetic resonance imaging of the cervical spine in 158 patients with degenerative-dystrophic diseases of the cervical spine aged 23 to 65 years. Among the patients, women predominated — 59.3 % (93 observations), men accounted for 40.7 % (65 observations). The complex of examination of patients included general clinical, neurological and neuroimaging studies using MRI of the cervical spine.
Damage to one of the functionally significant anatomical structures of the cervical spine occurred in 48.4 % (76 observations). Simultaneous involvement of two or more of these structures in the pathological process was diagnosed in 51.6 % (81 observations). Comparison of neurological symptoms of the disease with magnetic resonance imaging data of the cervical spine makes it possible to diagnose 3 forms of degenerative-dystrophic diseases of the cervical spine: myelic (1.5 %), combined myelo-radicular (38.1 %), combined myelo-radiculo-angiocerebral (6.1 %).
Due to the combination of neurological complications with impaired conduction of the spinal cord with symptoms of compression or irritation of the spinal cord roots and vertebral artery, the clinical manifestations of the disease acquire a significant variety of symptoms, which is always associated with difficulties in diagnosing degenerative-dystrophic diseases of the cervical spine. The identified clinical and radiological criteria of myelic, combined myelo-radicular and combined myelo-radiculo-angiocerebral forms of the course of this pathology The identified clinical and radiological criteria of myelic, combined myelo-radicular and combined myelo-radiculo-angiocerebral forms of the course of this pathology.

The vaginal microflora plays a key role in maintaining a woman’s reproductive health. A violation of its composition, known as dysbiosis, can lead to the development of inflammatory processes, infections and infertility. This article examines current data on the role of vaginal microflora in the pathogenesis of infertility, including the mechanisms of dysbiosis’ influence on fertility, embryo implantation, and outcomes of assisted reproductive technologies (ART). Special attention is paid to the relationship between bacterial vaginosis (BV) and chronic inflammatory diseases of the pelvic organs, which can cause structural and functional disorders of the reproductive system. Modern methods for the diagnosis and correction of vaginal dysbiosis, including the use of antibiotics, probiotics, and personalized approaches, are also discussed. The article highlights the need for further research to understand the mechanisms of interaction between the microbiota and reproductive health, which may contribute to the development of new strategies for infertility treatment.

Background. The heterogeneity of fibromyalgia manifestations requires interdisciplinary study of clinical and psychological features and the patient’s ability to cope with stress load (coping intelligence), which influence adherence to treatment and preservation of health potential.
Objective: a pilot study of integrative medical and psychological analysis and presentation of clinical cases reflecting individual manifestations of coping intelligence in association with genetic factors and biochemical indicators in patients with fibromyalgia.
Design and methods. Complex stress load was simulated under experimental conditions. Baevsky’s Stress Index and the level of subjective comfort were recorded in patients with fibromyalgia. Laboratory diagnostics of such biochemical markers as cortisol, adrenaline, norepinephrine, serotonin, dopamine, Il-4, Il-6, and Il-10 are performed before and after the experiment. The presence of BDNF and COMT gene polymorphism was also studied. Psychodiagnostics included assessment of temperament and coping in patients. Three clinical cases of fibromyalgia reveal different clinical and psychological features in manifestations of coping intelligence.
Results. The study confirms the heterogeneity of patients with fibromyalgia. Three patients with severe hypochondria, reactive anxiety or personal anxiety were examined. Their temperamental emotionality varied, namely, low, medium, and high. Physical, mental, and communicative loads revealed the features of the regulatory systems of these patients. Regardless of phenotype, we found a decrease in cortisol and adrenaline levels in all patients after complex exercise. The concentration of serotonin in these patients remained virtually unchanged. While the change in dopamine levels was diverse. Noteworthy is the fourfold increase in the concentration of interleukin-4 in a patient with a high Baevsky’s Stress Index.
Conclusions. Comprehensive studies of the genesis of fibromyalgia reveal unique characteristics of the patient necessary for the selection of drug therapy and regulation the emotional state.

The article is devoted to the analysis of the current state of teaching artificial intelligence (AI) within higher medical education and the development of a multi-stage student-training model. It is shown that despite the high level of student interest, formal AI courses are still extremely limited in medical universities. A model is proposed that includes basic familiarization with AI in the early years, elective courses during the senior years, specialized training within residency programs, and continuing professional education modules. The connection between AI education and the objectives of personalized medicine is emphasized, along with the need to develop digital competencies among future physicians. The implementation of the proposed model is expected to contribute to the modernization of medical education and the preparation of healthcare professionals ready to effectively utilize AI technologies in clinical practice.

Contemporary society is witnessing a steady increase in e-cigarette use among youth. Numerous studies have confirmed the negative cardiovascular effects of vaping, including sudden cardiac death. In recent years, the scientific community has been actively investigating the impact of e-cigarettes on various body systems.
This article presents a unique clinical case of asystole due to sinus arrest in an adolescent who regularly used e-cigarettes. This case highlights the serious cardiac risks associated with vaping at a young age.

One of the causes of chronic hypoxemia is pulmonary arteriovenous malformations, the pathophysiological basis of which is the shunting of venous blood into the arterial blood flow without the stage of oxygen saturation. This pathology is rarely diagnosed in childhood due to the late onset of clinical symptoms, as well as the lack of alertness of pediatricians in the field of this rare pathology. This article presents a clinical case of a 16-year-old patient, confirming the importance of a thorough physical examination, the complexity of differential diagnosis of arteriovenous malformations with other diseases and the need for an interdisciplinary approach to the treatment of this group of patients.