COMPARATIVE CHARACTERISTICS OF THE PARAMETERS OF THE CEREBELLUM OF MEN AT A YOUNG AND OLD AGE ACCORDING TO MAGNETIC RESONANCE TOMOGRAPHY

Investigation which devoted to the study of the age characteristics of the human body are becoming increasingly important. Magnetic resonance tomography is the most informative diagnostic method for intravital visualization of tissues and structures of the brain. It also allows you to more accurately see the picture of morphological features with age-associated changes. The aim of the study was to carry out a comparative analysis of the age-related morphometric characteristics of the cerebellum in male with mesocranic type of cranium in young and old age according to the data of magnetic resonance tomography. The analysis of the results of a morphometric study of the cerebellum on tomograms of 91 men examined for medical reasons was carried out. Depending on the age, the subjects were divided into two groups. Group I included 52 young men (22–27 years old, inclusive), group II included 39 elderly men (from 78 to 83 years old, inclusive). The transverse, longitudinal and vertical dimensions of the cerebellum were determined. When comparing the parameters of the linear dimensions of the cerebellum in the studied age groups of men, a statistically significant decrease in all indicators in old age compared with young age was revealed (p=0.042). There was no statistically significant difference between the parameters of the longitudinal and vertical sizes of the cerebellar hemispheres in individuals of each age group (p>0.05); there is a tendency for these sizes to prevail in the right cerebellar hemisphere. The results obtained can serve as the equivalent of the age-related anatomical norm of the cerebellum in young and old men, which will make it possible to use these data in basic and clinical research, as well as in medical practice.

THE HISTORY, OPPORTUNITIES AND PROSPECTS OF TIME-LAPSE TECHNOLOGIES IN THE STUDY OF EARLY HUMAN EMBRYONIC DEVELOPMENT

Despite advances in assisted reproductive technologies, the high failure rate of existing stimulation protocols remains a key industry challenge. One of the leading reasons for this is the limited ability to assess the biological potential of the embryo and its chances of implantation. Over the past ten years, the focus of attention in reproductive technologies has significantly shifted from the patient to the embryo, since the need to improve their effectiveness stimulates the need to understand the deep processes of early development of the embryo. In order to increase the effectiveness of in vitro fertilization procedures in clinical embryology, high-tech methods of culturing and evaluating embryos are being introduced and improved. The purpose of the review is to demonstrate the history, possibilities and prospects in the study of early human embryonic development of time-lapse imaging technology. The active study and use of the capabilities of the time-lapse slow-motion technology allowed not only to expand the understanding of the processes of early development of the embryo, but also at the current moment allows us to assess its potential from the point of view of both biological and clinical perspectives. The main advantages of this method are the possibility of morphological assessment during the continuous cultivation of embryos in closed-type incubators without their extraction, as well as the determination of the exact time intervals of key events of the stages of embryo development with special attention to those moments that are not available for observation and fixation under conditions of traditional cultivation. clinical practice. The main point of growth for the development of time-lapse imaging technology was the creation and validation of the so-called morphokinetic criteria and algorithms for assessing the quality of developing embryos. The key perspective of the method is its use in combination with elements of artificial intelligence in order to predict the most potential embryo for transfer into the uterine cavity. Modern directions of research using the method of time-lapse shooting are the continuation of the development of morphokinetic algorithms and their effective criteria, the introduction of the technology of self-learning computer programs and the adaptation of these tools in clinical practice, the search and assessment of possible factors influencing the morphokinetics of embryos, quality control of the work of embryological laboratories. The future development of such technologies is presented in combination not only with the capabilities of artificial intelligence, but also in combination with the use of non-invasive genetic screening, the assessment of metabolomics and proteomics of developing embryos.

REVIEW ON THE TEXTBOOK OF THE AUTHOR GAIVORONSKY I.V. "NORMAL ANATOMY OF HUMAN", IN 2 VOLUMES, OF THE "SPEC-LIT" PUBLISHER, 2020, 10TH EDITION, REVISED AND SUPPLEMENTED

In general, the reviewed work is one of the best textbooks on the discipline of (human) anatomy, not only in the Russian Federation, but also in some CIS countries, in which it is actively used in the educational process and received of positive responses. It is in demand not only by students, but also by medical practitioners. It should be emphasized once again that this is a thoroughly revised, supplemented reissue. It retains the traditional form and method of presenting the material, familiar to many generations of former students, and now doctors, focuses on the heading of sections, supplemented the illustrative series, created summarizing tables on blood supply and innervation, highlighted the most important information necessary for the subsequent study of clinical disciplines. All changes and additions made by the author will facilitate preparation for the exam and are very important for subsequent practice. The main advantage of the reviewed textbook is the originality of the presentation of the material. The author managed to comply with the modern requirements of state educational standards of the third generation and in an accessible form to present the material, which is the basis for the subsequent study of a number of theoretical and all clinical disciplines. The information presented is accurate, reliable and scientifically proven, anatomical terms are given in accordance with the international anatomical nomenclature TA-1 (1999). In such a large work, some inaccuracies and typos cannot be avoided; some classifications proposed in the textbook are controversial. The point of view presented by the author is traditional for the morphological school of the Military Medical Academy, it is supported by a number of prominent anatomists and has a right to exist.

MORPHOMETRIC PARAMETERS AND FEATURES OF THE TOPOGRAPHY OF HUMAN PERINEAL BODY

In modern specialized literature, there is practically no information about the shape, size and topography of one of the most important formations of the perineum - of the perineal body. Knowledge of the anatomical aspects of the structure and location of the perineal center would allow in the future to reduce the postoperative complications associated with unintentional damage. The question of the morphology of the perineal body and associated muscles in clinical practice in obstetric traumatism remains relevant. The aim of the study was to study the morphometric parameters and features of the topography of the human perineal body. The objects of the study were 50 autopsy cases of people aged 60-87 years, 25 of each sex, who died from causes not related to the pathology of the pelvic organs. In each case, the perineal body, location of its center and associated muscles were identified. Methods of classical anatomical preparation, description and statistical analysis were used in the work. As a result of the work, five forms of the perineal body were identified: cruciform, «hourglass», triangular, round, polygonal. There were also cases where it was not possible to determine the shape of the intersection of the fibers. For men, the most common triangular shape, for women - the shape of an «hourglass». In most cases in which the shape of the intersection of the fibers was determined, there were clearly identifiable tendon fibers, that is, the tendinal center of the perineal body was present. The average area of ​​the tendinal center of the perineal body in women was 0.99±0.47 cm², and in men 0.94±0.32 cm². The ratio of cases of displacement of the tendinal center towards the right or left ischial tuberosities is almost equal to 10 cases towards the right ischial tuberosity and 11 cases towards the left. When evaluating the pubo-coccygeal asymmetry, in most cases with a triangular shape, there is a sharp displacement towards the apex of the coccyx. Also, the authors found that the average area of ​​the tendinal center of the perineal body is larger in women than in men. Thus, the human perineal body has a variety of forms, according to the authors, associated not only with the embryological features of the development of the muscles of the perineum, but also with the lifestyle, a history of diseases and surgical interventions in the area of ​​the tendinal center of the perineal body.

ANATOMICAL AND FUNCTIONAL CHARACTERISTICS OF THE LEVEL OF PHYSICAL DEVELOPMENT AND THE COMPONENT COMPOSITION OF THE BODY OF STUDENTS IN MORDOVIA REPUBLIC OF YOUTHFUL AGE

The study of the basic laws of the formation of students' physical health is of great importance for the state not only as an economic, but also as a labor and defense potential of the country. The study of age dynamics is necessary also for the development of regional standards of physical development, physical fitness of population of young people, as well as for improving the system of health-saving technologies in the organization and conduct of the educational process in educational institutions. The aim of the study was to study the level of physical development and body composition of 1612 young men aged 17-21 living in the Republic of Mordovia. In the course of the work, 48 absolute anthropometric indicators were analyzed, characterizing the anatomical and functional characteristics of an individual. It was found that among young people a normosthenic type of constitution with a proportional chest, with a medium-sized head and andromorph body type is widespread. In the population of student’s males, the prevalence of persons with an average level of physical development, an average value of the vital index is characteristic, however, the strength index of the hand in most of the studied had an indicator below normal. The majority of students showed a normal body mass index with an average level of body density, with an increased relative mass of fat and muscle components and a reduced mass of the bone component, which is possibly a consequence of the body's response to the negative influences of environmental factors, as well as reduced motor activity and insufficient physical activity.

EXPERIMENTAL MODELS OF THE HYPOTHYROIDISM

Hypothyroidism is a systemic chronic disease that occurs as a result of a deficiency of thyroid hormones (thyroid hormones): triiodothyronine and tetraiodothyronine (thyroxine). Targets of thyroid hormones are almost all organs and tissues of the human body, which explains the variety of clinical manifestations that occur when these hormones are deficient. Recently, basic research through the use of experimental models has become more relevant and allowed us to obtain a number of new morphological and functional changes that occur in hypothyroidism. This review discusses the main experimental models of hypothyroidism: surgical, radioactive, dietary, anti-thyroid administration and genetics’ model. The main principle of the surgical model of hypothyroidism is to remove the thyroid gland. The radioactive model is based on the introduction of a radioactive isotope of iodine to laboratory animals. The dietary model is based on the use of a special diet with a limited amount of iodine. The drug model is based on the introduction of antithyroid drugs - methylimidazole and propylthiouracil. The principle of the genetic model consists in special genetic manipulations with the genome of laboratory animals. The advantages and disadvantages of each model are discussed. The use of sophisticated equipment has brought specialists closer to a more complete and holistic understanding of the morphological and functional manifestations of hypothyroidism. Researching of experimental models is an important tool in relation to the studying of the mechanisms underlying hypothyroidism and, as a result, in improving prevention and treatment-diagnostic strategies.

MEDICAL MORPHOLOGY AND DIGITAL LEARNING TECHNOLOGIES

On November 19, 2020, within the framework of the XI National Congress with international participation «Ecology and human health in the North», the All-Russian workshop «Medical morphology and digital learning technologies» was held at the videoconference. The meeting was attended by teachers-morphologists of medical universities and faculties of cities located in territories with especial ecological and geographical conditions of residence and education of students (Yakutsk, Saint-Petersburg, Perm, Omsk, Krasnoyarsk). The current situation in the world, caused by the Covid-19 virus infection pandemic, posed an unprecedented challenge to many social institutions of modern society, including the system of higher medical education and training of medical personnel. She accelerated the controversial, largely uncertain and not painless transition to digitalization of education as part of the implementation of the national digital economy program. Medical higher education, starting from the first courses, is extremely practical in its essence. The existing electronic platforms and digital instruments, despite all their effectiveness, still cannot be an adequate replacement for those technologies that have traditionally served as the educational and methodological base of preclinical disciplines for many decades, while anatomy is the basic practical discipline for all clinical specialties. This situation is not specific only for individual countries, it is the same for the entire medical higher school around the world. The result of the exchange of experience of the anatomical departments of medical universities at the meeting was the conclusion that the weakest link of distance technologies - digital proctoring of practical anatomical knowledge should be organizationally supported in the form of appropriate scientific and pedagogical seminars and conferences, widely published and recommended, are determined its limits, possibilities and use. It is necessary to analyze and revise the existing work programs of disciplines in order to determine the structural sections of the programs of disciplines and the volume of their transfer to digital platforms, partially or completely, or technologically unchanged at all. It is also mandatory to develop new training, retraining and advanced training programs for morphologists who carry out educational activities using an intermediary language and digital technologies. It is recommended that teachers of morphological departments of medical universities and faculties practically master and bring the relevant professional competencies in the field of mastering the tools of the electronic information educational environment to the level of documented professional excellence. At the same time, when creating educational literature, digital tutorials and gadgets on human anatomy, one should strictly adhere to the international anatomical terminology TA-2 (London, 2019) to eliminate the confusion and variety of terms used to denote the same anatomical structures.

MYOCARDIAL BRIDGE - A VARIANT OF NORMAL ANATOMY OR PATHOLOGY? CASE REPORT

Myocardial (muscle) bridges are considered a variant of the normal anatomy of the coronary arteries, but there are some reports of their clinical significance: their presence is associated with angina pectoris, myocardial infarction, ventricular tachycardia, and sudden cardiac death. In this study, using a clinical case as an example, the significance of the problem, approaches to assessing perioperative risk and methods for identifying risk factors at the preoperative stage in a patient with abnormal coronary arteries are presented. At stydiyng clinical case according to the results of coronary angiography in the 7th segment of the anterior interventricular artery, a myocardial bridge with stenosis in systole up to 95% was revealed, which, against the background of hemorrhagic shock, could provoke the development of acute coronary syndrome. An analysis of a clinical case, a review of the literature on assessing the risks of patients with myocardial bridges demonstrates an insufficient assessment of this morphological feature for patients with a non-cardiac surgery profile. In the studied case, the patient underwent elective orthopedic surgery and emergency surgery aimed at stopping bleeding. Surgery with concomitant trauma, systemic inflammatory response, anesthesia and analgesia, pain, hypothermia, bleeding, anemia, and nutritional deficiencies is similar to an extreme stress test. The combination of these factors provokes inflammatory, hypercoagulable, stressful and hypoxic conditions, which are associated with a perioperative increase in troponin levels, arterial thrombosis and, as a consequence, a high risk of mortality. The authors suggest that current clinical guidelines for assessing perioperative risks need to be improved. With such a refinement, it is necessary to rely not only on the existing international recommendations, but also on the results of the latest meta-analyzes devoted to the prognostic role of preventive myocardial recanalization before surgery. Thus, in summary, it can be noted that the existing clinical guidelines and risk assessment scales do not contain ready-made solutions for all clinical cases, but can only be the basis for making decisions in specific situations and do not provide sufficient guarantees of the success of surgical interventions.

ANATOMICAL VARIANTS OF INFERIOR MESENTERIC VEIN ACCORDING ON THE DATA OF MULTISPIRAL COMPUTED TOMOGRAPHY

Knowledge of the variants of the anatomical variability of the liver vascular bed can be of critical importance in liver resection, liver transplantation, laparoscopic operations, resection of the pancreas, surgical treatment of portal hypertension The main vessels of the hepatic portal vein system are characterized by pronounced anatomical variability in the formation of the portal vein trunk, the greatest variability is characterized by inferior mesenteric vein. The aim of the investigation was to study the variant anatomy of the inferior mesenteric vein according to multispiral computed tomography. The material was 100 multispiral computed tomograms of the abdominal organs from the archive of the clinics of the Samara State Medical University for 2018-2019. For mathematical modeling and the creation of three-dimensional models based on tomograms of the vascular bed, plugins were used in the programs «Luch» and «Autoplan». Variants of the portal vein formation, the angle of inflow of the inferior mesenteric vein into the superior mesenteric and splenic veins, the distance from the point of confluence of the inferior mesenteric vein to the point of confluence with the portal vein were studied. The study revealed that the inferior mesenteric vein in 40% of cases flows into the splenic vein, in 39% - into the angle of confluence of the superior mesenteric and splenic veins, in 16% - into the superior mesenteric vein. In 5% of cases, the absence of the inferior mesenteric vein was revealed. The angle of fusion of the inferior mesenteric vein with the superior mesenteric vein was statistically significantly greater than the angle of fusion of the inferior mesenteric vein with the splenic vein. The angles were 76.36 ± 1.53 ° and 64.89 ± 3.52 °, respectively (p = 0.004). The length of the common trunk of the inferior mesenteric and splenic veins was significantly greater than the common trunk of the mesenteric veins and amounted to 16.98 ± 1.09 mm and 9.37 ± 0.65 mm (p = 0.001), respectively. Thus, the study showed a high degree of anatomical variability of the inferior mesenteric vein.

THE DEVELOPMENT OF EXTRA-ARTICULAR LIGAMENTS OF THE HIP JOINT DETERMINE ANGULAR VALUES OF THE PROXIMAL FEMUR

There are practically no data on the quantitative aspects of prenatal morphogenesis and the growth rates of the ligaments of the hip joint in humans, as well as information on the correspondence of the shape and structure of the ligaments to the bones forming the joint. The aim of the study was to reveal the features of the growth of the extra-articular ligaments of the hip joint in the prenatal period and to establish correlations between the structure of the ligaments and the structures of the proximal end of the femur. The material of the study is based on the analysis of 175 cases without pathology of the musculoskeletal system. The dimensions of the ilio-femoral, pubic-femoral, ischio-femoral ligaments and the cervico-diaphyseal angle and angle of rotation of the femoral neck in relation to the distal epiphysis of the bone were studied. As a result of the study, it was found that in the process of prenatal development with increasing age, the distance between the distal fixation points and the angle between the parts of the ilio-femoral ligament increases. Both legs have fibers that are woven into the fibrous membrane of the joint capsule. A correlation was found between the growth of morphometric parameters of the ilio-femoral ligament and the angular values ​​of the proximal femur. In contrast to the ilio-femoral ligament, the pubo-femoral and ischio-femoral ligaments show low signs of differentiation at different stages of prenatal ontogenesis. The pubo-femoral ligament becomes available for macroscopic examination from the beginning of the second half of the prenatal period. It is defined as a thickening of the medial fibrous membrane of the joint capsule, has its origin on the superior branch of the pubic bone and the iliac part of the acetabulum and is attached to the intertrochanteric line in the medial segment. The sciatic-femoral ligament is macroscopically defined as a thickening of the posterior part of the joint capsule. The ligament has a triangular shape, with a base in the region of the ischial part of the acetabulum and the ischial tubercle, its apex facing the trochanteric fossa at the antero-inner edge of the greater trochanter. It was found that the growth rate of morphometric parameters of different parts of the hip joint ligaments at different stages is not the same, which determines the change in the shape of the ligaments. The greatest transformations occur in the ilio-femoral ligament, the smallest in the pubic-femoral and sciatic-femoral ligaments. There is a correlation between the anatomical structure of the extra-articular ligaments of the hip joint and the corresponding angular values ​​of the proximal femur.