The article presents a generalized material of the historical establishment of laboratory medicine at the Pavlov First Saint Petersburg State Medical University (University), based on a survey of graduates and employees of the laboratory service of the University. 40 years ago, the Rector’s office of the First Medical Institute of Leningrad named after akad. I. P. Pavlov decided to introduce the academic discipline «laboratory diagnostics» as a variable part of the general training program for a medical doctor. The students demonstrated the gain knowledge at the final examination with microscopy of a blood preparation, performing a urine test strip, followed by a discussion of the plan for laboratory diagnostics of a specific situational task. Further, training of specialists for work in the laboratory service of the country (internship, residency, postgraduate studies) was also started. Many people keep in touch with Alma mater and the analysis of the «feedback» with graduates of our University allows to formulate a short historical essay and make some suggestions about the further development of this block of educational activities of the University.

The objective of the study was the analysis of the main clinical characteristics identified in patients with malignant neoplasms of the pancreas, who received medical care in healthcare institutions of St. Petersburg in the period from 2015 to 2020.

Methods and materials. A continuous study of clinical and statistical data of patients with pancreatic cancer receiving medical care in healthcare institutions of St. Petersburg (of federal and city subordination) for the period from 01.2015 to 02.2020 was carried out. In total, the study included depersonalized medical cards of 2141 patients diagnosed with pancreatic cancer.

Results. During the studied period, more than half of the patients diagnosed with cancer of the pancreas received medical care in specialized oncological institutions of city subordination, a third – in federal institutions, 11.3 % – in multidisciplinary city hospitals. The maximum number of cases was in patients of older age groups: 41.7 % – 70 years and over, including 15.4 % – 80 years and over. The majority (39.7 %) of new patients with pancreatic cancer hospitalized in medical institutions of St. Petersburg were diagnosed with stage IV of the disease. The disease, according to examinations, was represented by stage III in 29.7 % of patients at the time of initial hospitalization. The pancreatic cancer was presented with stage III in 20 % of the patients. The disease was registered in 4.4 % of patients at stage I. Stage 0 or carcinoma in situ was diagnosed at initial presentation in 4.7 % of patients. The stage of the disease was not determined in 1.4 % of patients. The tumor was located in the head of the pancreas in 64.4 % of patients. The most common histological type of pancreatic cancer is ductal adenocarcinoma, which was verified in 72.0 % of patients. Type 2 diabetes mellitus was registered in 37 % of patients as concomitant disease.

Conclusion. The results of the analysis of clinical and statistical data of patients with pancreatic cancer may become a background for conducting research on the early detection of this neoplasm.

Surgical treatment of acute biliary pancreatitis over the past decades have been improved from realization of open traumatic surgical interventions to the use of minimally invasive technologies. However, despite the progress in the treatment of this pathology, the question of the timing of cholecystectomy after endoscopic papillosphincterotomy with lithoextraction remains unresolved. In some cases, after the endoscopic papillosphincterotomy, a recurrence of the disease occurs, as well as other various biliary complications, such as: acute calculous cholecystitis, choledocholithiasis, cholangitis, associated with the fact that the main etiological factor – the gallstone disease – has not been eliminated, specifically, cholecystectomy was not performed.

The objective of this study was to analyze the evolution of surgical tactics in the treatment of acute biliary pancreatitis with combined cholecystocholedocholithiasis.

The objective was to conduct a comparative analysis of the dynamics of biomarkers of apoptosis and autophagy in the eripheral blood of patients in the acute period of ischemic stroke (IS) and compare it with the dynamics of the severity of neurological deficit according to the NIHSS (National Institutes of Health Stroke Scale) and the volume of the brain lesion according to the results of magnetic resonance imaging (MRI). To assess the role of the studied parameters in the prognosis of the outcome of the acute period of the disease.

Methods and material. We examined 56 patients in the acute period of newly developed atherothrombotic IS. The control group consisted of 29 healthy donors. Patients underwent a dynamic clinical and neurological examination on the 1st, 7th and 14th days from the onset of the disease. At the same time intervals, the dynamics of the expression of biomarkers of apoptosis and autophagy in peripheral blood was evaluated by flow cytometry and compared with neurological status indicators on the 1st, 7th, and 14th  days, respectively, using correlation analysis.

Results. A statistically significant increase in the expression of annexin V and caspase-3 compared with the control group was observed throughout the study in all populations of leukocytes with a maximum increase in the first 24 hours. Increased expression levels of annexin V and caspase-3 positively correlated with the severity of neurological deficit and the amount of brain damage on the 1st and 7th days. A direct correlation was found between increased values of autophagy biomarkers LC3, Cyto-ID, the amount of brain damage, and the severity of neurological deficit on the 7th day.

Conclusion. A statistically significant increase in biomarkers of apoptosis and autophagy in the peripheral blood in the acute period of IS correlates with the severity of clinical and neurological parameters. The role of a significant increase in caspase-3 as a predictor of adverse disease outcome requires further study.

Introduction. Vitamin D deficiency may be an independent predictor of coronary heart disease (CHD) and the severity of coronary atherosclerosis. The results of studies of the association of various polymorphisms of the vitamin D receptor (VDR) gene with the risk and severity of CHD are contradictory, which necessitates the study of genetic variants of the VDR gene and the characteristics of the clinical course of CHD in the Russian population.

The objective was to determine the distribution of genotypes of TaqI, BsmI and ApaI of polymorphic variants of the VDR gene and the level of vitamin D sufficiency in CHD patients with varying severity of CHD, residents of St. Petersburg.

Methods and materials. The study included 407 CHD patients and 318 patients without clinical signs of CHD of comparable age (p>0.05). All CHD patients underwent coronary angiography. Typing of the VDR gene variants was performed by polymerase chain reaction and subsequent restriction analysis. Determination of the level of 25(OH)D blood serum was carried out by enzyme immunoassay.

Results. Vitamin D deficiency was detected in 82 % of CHD patients, the content of 25(OH)D in blood serum was lower in CHD patients who had 2 or more myocardial infarctions (MI) than in those who had one MI (p=0.03). Vitamin D deficiency is associated with a 3.6-fold increased risk of multivessel disease (p=0.01). The presence of the aa genotype and the a allele (ApaI), the bb genotype and the b allele of the VDR gene (BsmI) is associated with an increased risk of CHD and the severity of atherosclerotic lesions of the coronary arteries.

Conclusion. Vitamin D deficiency is typical for CHD patients and is associated with the severity of coronary atherosclerosis. The presence of aa genotype and a allele (ApaI polymorphism), bb genotype and b allele of the VDR gene (BsmI polymorphism) is associated with an increased risk of CHD and the severity of atherosclerotic lesions of the coronary arteries. TaqI polymorphism of the VDR gene is not associated with the risk of CHD.

Introduction. The evaluation of the shape of the left atrial appendage into interconnection with the internal relief of its wall is of an importance for discovering anatomical patterns of the left atrium, which appears to be the most thrombogenic and are associated with a high thromboembolic risk from this chamber.

The objective was to study features of the internal relief of the walls of the left atrial appendage of the adult heart and to find the dependence of these features on the size and shape of the appendage.

Methods and material. We studied 68 left atrial silicone casts prepared from the hearts of 35–89 years men and women died from non-cardiac causes. By means a caliper, we measured the length and width of the cavity of the left atrial appendage, determined the shape, the number of lobes and intertrabecular spaces. With Image J program, we estimated the proportion of the area occupied by these spaces and pectinate muscles in pixels from photographs of the anterosuperior surface of the appendage. We used correlation analysis, Mann–Whitney U-test.

Results. We found two-lobed appendages commonly than single-lobed and three-lobed. The number of intertrabecular spaces was 4–41 (median 21), with one-lobed appendages having fewer than twoand three-lobed. The same parameter was higher in the «chicken wing» than in the «arrowhead» specimens (23 vs 18, p=0.004). The proportion of the area occupied by the pectinate muscles and intertrabecular spaces in the left atrial appendage was 47 % (16–83 %) and showed none association with the shape of the cavity and the number of lobes.

Conclusion. The number of intertrabecular spaces in the walls of the left atrial appendage correlated with its length and width and was the smallest in single-lobed specimens and in the appendages of the «arrowhead» shape. The abundant intertrabecular spaces were common for «chicken wing» variant of the left atrial appendage.

The objective of our study was to determine the reasons for not prescribing anticoagulant therapy (ACT) in the therapeutic department of university clinic for patients with atrial fibrillation (AF) and a high risk of stroke and to discuss the optimal management of these patients.

Methods and materials. A retrospective analysis of 1307 case histories of AF patients admitted to a university therapeutic clinic from 2014 to 2018 presented. The reasons for not prescribing ACT to patients with AF and high risk of stroke and optimal ACT discussed.

Results. ACT was not prescribed to 109 (9.7 %) hospitalized patients out of 1128 patients with AF without prosthetic valves and mitral stenosis who had a high risk of stroke ((4.5±1.1) points on the CHA2DS2VASc scale). The risk of bleeding – (1.6±0.1) (HAS-BLED). The age of patients was (73.8±10.4) years. From 2014 to 2018, the frequency of unjustified non-prescribing ACT decreased by 3.7 times – from 47/205 (22.9 %) in 2014 to 11/178 (6.2 %) in 2018 (p=0.001). In general, over 5 years of observations, subjective reasons for not prescribing ACT were: lack of stroke risk assessment (78.0 %), senile age of patients and the presence of dementia (42.2 %), the first paroxysm of AF (22.9 %) during myocardial infarction and heart surgery, planned surgical treatment, effective radiofrequency ablation and patient refusal. Objective (usually transient) reasons for not prescribing ACT were: severe and moderate anemia (24.8 %), recent bleeding (11.9 %), gastrointestinal diseases predisposing to bleedings (9.2 %), oncology (12.8 %), end-stage chronic kidney disease (2.8 %), thrombocytopenia (2.8 %). Often various reasons for not prescribing ACT were combined.

Conclusion. In patients with AF and a high risk of stroke, the incidence of not prescribing ACT decreased by 3.7 times from 2014 to 2018. In 2014, the most common reasons for not prescribing ACT were the lack of stroke risk assessment and the senile age of patients, and in 2017–2018 senile age, the first paroxysm of AF, effective radiofrequency ablation, anemia, recent bleeding, and gastrointestinal diseases predisposing to bleedings.

Introduction. Melanoma is one of the most malignant human tumors, originating from melanin-forming tissue. Currently, among the risk factors for the development of malignant neoplasms, including melanoma, light pollution is considered – exposure to light at night. In turn, the violation of circadian rhythm under conditions of light pollution often leads to the occurrence of desynchronosis, which is the cause of the development of a number of diseases, including malignant neoplasms. As a rule, light pollution is accompanied by a decrease in the production of epiphyseal melatonin, which has oncostatic, antitumor and antioxidant effects.

The objective of study was to study the morphological features of transplanted B16 melanoma, to establish the micromorphometric indicators of tumor cells and circadian rhythms of some of them for further use as control indicators in the study of the effect of various light regimes and experimental therapy on the morphofunctional state of the body of animals with transplanted melanoma.

Methods and materials. The study was conducted on male hybrid mice of the BDF1 line. The animals were divided into 2 equal groups of 25 individuals. The first group served as an intact control, the mice of the second group were transplanted with B16/F10 melanoma. On the 15th day after tumor inoculation, the animals were withdrawn from the experiment at 9.00, 15.00, 21.00 and 3. The mass and volume of the tumor were determined, microscopic, including micromorphometric studies of tumors were performed. Glucose levels were determined in blood plasma. The daily dynamics of the studied parameters was assessed, and for the statistical calculation of the amplitude and acrophase of circadian rhythms, a cosinor analysis was performed.

Results. The study of the circadian rhythm of glucose made it possible to reveal its difference in animals with melanoma from that in the control. Changes in the daily rhythmicity of this metabolite, which comprehensively reflects the synchronization of many rhythms with each other, allows us to state a significant change in circadian rhythmostasis in animals with melanoma. As a result of the study, we have established micromorphometric indicators characteristic of B16 melanoma on the 14th day after transplantation. The circadian rhythm of the area of the nucleus and cells, the mitotic index and the absence of a clock for the NCR were established. The difference between the phase-amplitude features of the CR of the area of the nucleus of melanocyte cells from the normal ones was found.

Conclusion. The obtained data indicate a change in rhythmostasis in mice with experimental B16 melanoma. The features of the organization of the rhythmicity of the tumor itself can be used in its targeted experimental therapy, taking into account chronobiological features. The results of the study can be used for further studies of the effect of various lighting modes on the morphofunctional state of the animal organism in the pathology under study.