The functional responsibilities of general practitioners (family doctors) (GPs) have changed significantly over the past decade. The number of GP functions has expanded. Despite the increasingly complex professional activities of GPs, there is no scientific evidence for the qualification characteristics of GPs expressed in knowledge, skills, abilities, and competencies in the theory and practice in training. In this regard, a study was conducted to determine the priority of GP competencies that make up the qualification characteristics of a specialist. Aim. To analyze, generalize and rationale the research results, as well as to develop preliminary guidelines for GP training. Material and methods. The information base for the study was the results of ranking competencies according to their importance in the professional activities of GPs in Russia. It was obtained during the ascertaining experiment, implemented using the Delphi method as a method of expert assessment and strategic planning of training specialists. Conclusion. The analysis of competencies developed and agreed upon by experts showed its compliance with the job functions of GPs, the requirements of the Federal State Educational Standard for the General Medical Practice (Family Medicine) and the WONCA guidelines. A summary of the study results to determine the priority of competence in GP activities showed the following: — all competencies (25) were defined as necessary and constitutive of GP qualification; — 21 competencies were considered significant and highly significant for GPs; — 4 competencies were considered as of moderate significance and below moderate significance. The analysis of the priority of competences revealed insufficient methodological support for GP training in accordance with the social order. The results obtained showed the need to continue the study within the project "Quality Management of Training of General Practitioners (Family Doctors)".

Aim. To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.Material and methods. The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%).Results. A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.Conclusion. IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the “aggressiveness” of therapy.

Биологический возраст в последние годы привлекает всё большее внимание исследований, и, прежде всего, при изучении процессов старения для дифференциации видов или типов старения по количественным величинам. Поэтому изучение ассоциации биологического возраста с ДР при СД 2-го типа актуально. Цель исследования – изучение корреляционных связей биологического и хронологического возраста с диабетической ретинопатией. Исследование проведено среди пациентов 45-59 лет с ДР при СД 2-го типа, проходивших стационарное обследование и лечение. У включенных в исследование 435 пациентов фиксировался хронологический возраст, а затем рассчитывался биологический возраст по методике Войтенко В.П. и др. с учётом гендерной принадлежности. При корреляционном анализе соотношения биологического возраста и параметров хронологического возраста в группе пациентов зрелого возраста с наличием ДР вследствие СД 2-го типа выявлена средняя корреляционная связь – r=+0,428 (p<0,01) с репрезентативным 95% доверительным интервалом. Между параметрами биологического возраста представителей с диабетическим осложнением со стороны органа зрения в зрелом возрасте и должного биологического возраста коэффициент корреляции составил r=-0,476 (p<0,05). При изучении соотношения между календарным возрастом и параметром должного биологического возраста корреляционным методом выявлено, что оно характеризуется слабой обратной и недостоверной корреляцией с коэффициентом корреляции, равным r=-0,114 (p>0,05) среди пациентов с развившимся диабетическим осложнением со стороны органа зрения Biological age has attracted increasing research attention in recent years, and, above all, in the study of aging processes to differentiate the types or types of aging by quantitative values. Therefore, the study of the association of biological age with DR in type 2 diabetes is relevant. The aim of the study is to study the correlations of biological and chronological age with diabetic retinopathy. The study was conducted among patients aged 45-59 years with DR in type 2 diabetes who underwent inpatient examination and treatment. The chronological age was recorded in 435 patients included in the study, and then the biological age was calculated according to the Voitenko V.P. et al. method, taking into account gender. The correlation analysis of the ratio of biological age and chronological age parameters in the group of mature patients with the presence of DR due to type 2 diabetes revealed an average correlation - r=+0.428 (p<0.01) with a representative 95% confidence interval. The correlation coefficient between the parameters of the biological age of representatives with diabetic complications from the organ of vision in adulthood and the proper biological age was r=-0.476 (p<0.05). When studying the relationship between calendar age and the parameter of proper biological age, the correlation method revealed that it is characterized by a weak inverse and unreliable correlation with a correlation coefficient equal to r=-0.114 (p>0.05) among patients with a developed diabetic complication from the organ of vision

To date, nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver pathology and already at the stage of steatosis causes a high risk of developing cardiovascular diseases (CVD). Convincing evidence has been obtained that CVD is the most common cause of death in patients with NAFLD. Common risk factors (insulin resistance, abdominal obesity, dyslipidemia, hyperuricemia, chronic kidney disease and type 2 diabetes mellitus) and similar pathophysiological mechanisms (endothelial dysfunction, changes in lipid metabolism, systemic inflammation, plaque formation/instability, oxidative stress) of NAFLD and CVD, allow us to consider NAFLD not only as a key risk factor for the development of CVD, but also as a co-factor in the progression of cardiac pathology. The progression of NAFLD itself leads to a more severe course of CVD.

Amiodarone is currently the most effective drug for life-threatening arrhythmias, however, the instructions for its use indicate thyroid dysfunction (hypothyroidism, hyper thyroidism) as contraindications. Due to the high iodine content, amiodarone can cause damage to the thyroid gland (with the development of hypothyroidism or thyrotoxicosis) in 15–20 % of patients. Before starting amiodarone therapy, it is necessary to assess the pa tient's thyroid status with mandatory determination of thyroid-stimulating hormone. In cases where amiodarone is prescribed for primary or secondary prevention of fatal ventricular arrhythmias or when discontinuation of the drug is impossible for other reasons (any form of arrhythmias that occurs with severe clinical symptoms that cannot be eliminated by other means of antiarrhythmic therapy), compensation for impaired thyroid function is carried out while continuing amiodarone intake.

The review presents the data on cardiac damage in patients with thyroid dysfunction (hyper- and hypothyroidism). The features of cardiovascular pathology in patients with hyperthyroidism and the possibility of using certain groups of drugs (beta blockers, antiplatelet agents, anticoagulants) are described. The association of hypothyroidism (including subclinical) with atherosclerosis and diastolic arterial hypertension, an increased risk of developing ischemic heart disease and myocardial infarction, heart failure and cardiovascular mortality, regardless of gender, age and previous cardiovascular diseases, has been shown. Available facts indicate the need to determine thyroid hormones in patients with cardiovascular pathology and mandatory assessment of the state of the cardiovascular system in patients with thyroid pathology.

Aim. To investigate the prevalence and characteristics of polyvascular disease in the Eurasian region's population with one or more previously established locations of atherosclerotic arterial damage, and to evaluate the diagnostic importance of the ankle-brachial index (ABI) as a marker for polyvascular disease (PVD).Material and methods. A total of 1837 patients were included in the main branch of the KAMMA registry (patients with PVD), among which 91,6% had coronary artery disease (CAD) (n=1683). For further analysis, the group of patients with CAD was combined with 1222 patients included in the second branch of the registry — KAMMA-cardio, forming a patient population (n=2905), in which all patients had verified CAD. The mean age of patients was 66,0 [59,0; 72,0] years, with 60,3% being male. Peripheral arteries was assessed using ultrasound examination.Results. PVD was present in 95,6% of patients with coronary atherosclerosis: dual-region involvement was observed in 51,3% of patients, three-region involvement in 37,1%, four-region involvement in 3,4%, and five-region involvement in 2,0%. Stenoses of the common carotid artery were observed in 71% of patients, internal carotid artery — in 68%, lower limb artery — in 52%, and renal and mesenteric artery — in 8,3%. There were following diagnostic effectiveness of the ABI for detecting patients with lower limb artery stenosis was: sensitivity — 58,0%, specificity — 83,6%. The quality of antithrombotic and lipid-lowering therapy was insufficient.Conclusion. In the overwhelming majority (95,6%) of patients with CAD in the KAMMA registry, PVD was revealed, with nearly half of the patients having involvement in three or more arterial zones. In the patient population with CAD, there should be an active effort to identify patients with PVD, using at least the ABI determination and active modern antithrombotic and lipid-lowering therapy according to current clinical guidelines.

Introduction. One of the angina causes in intact coronary arteries may be vasospasm. Despite the stenosis absence, vasospastic angina is characterized by a recurrent course, can progress to myocardial infarction (MI) and cause life-threatening arrhythmias.Short description. A case of vasospastic angina in a 69-year-old man, confirmed by 24-hour electrocardiographic monitoring, is presented. Long-term vasospasm first led to acute coronary syndrome on November 11, 2022 without myocardial damage. Standard therapy is recommended. Calcium antagonists were not included in the prescriptions. Then, on December 23, 2022, frequent and longer-lasting attacks of angina with extensive irradiation and shortness of breath appeared. On December 29, 2022, acute MI developed. Both cardiovascular events were caused by vasospasm in the right coronary artery.Discussion. Currently, there is no exact data the frequency of vasospastic angina in Russia. There are no definitive guidelines regarding the rationale of endovascular intervention. High doses of calcium channel blockers are usually suggested. In case of insufficient effect of monotherapy, dihydropyridine and non-dihydropyridine calcium antagonists simultaneously or add long-acting nitrates should be used. Nicorandil is used as second-line drugs. The positive effect of statins has been proven. However, complete solution of the problem of recurrent MI against the background of vasospasm was not possible. The presented case highlights the recurrent nature of the disease and the importance of selecting optimal therapy aimed at preventing vasospasm in order to reduce the risk of myocardial damage in this category of patients.

Журнал для непрерывного медицинского образования врачей В ПОМОЩЬ ПРАКТИКУЮЩЕМУ ВРАЧУ Персонифицированный подход к ведению больного COVID-19 с осложненным коморбидным фоном* 1 Федеральное государственное бюджетное образовательное учреждение высшего образования «Ростовский государственный медицинский университет» Министерства здравоохранения Российской Федерации, 344022, г.Ростов-на-Дону, Российская Федерация 2 Государственное бюджетное учреждение Ростовской области «Ростовская областная клиническая больница», 344015, г

Combined cardiological and ophthalmological pathology has a high prevalence in older age groups of the population and common pathogenetic mechanisms, among which, of course, is a violation of the cytokine profile. However, the cytokine profile of the blood was practically not analyzed in elderly patients with combined ischemic heart disease with glaucoma. The aim of the study was to study the cytokine profile in patients with combined cardio- and ophthalmopathology. The study was performed at the S.N. Fedorov National Medical Research Center “MNTK Eye Microsurgery”, in two groups: patients with combined coronary heart disease with glaucoma (n = 58 people), and patients with coronary heart disease (n = 49 people), who in both cases have the same age of 60-74 years. The diagnosis of glaucoma was carried out in accordance with the criteria of the “National Glaucoma Guidelines”. Electrocardiographic, echocardiographic, radiographic, and enzyme studies were performed to diagnose coronary heart disease. The determination of cytokines in blood plasma was carried out on the device “Becton Dickinson FACS Canto 2 (USA)” using a special set of CBA (BD Biosciences, USA). Among the patients of the compared groups of the same age, significant differences in most cytokines were revealed, namely, a predominant increase in patients with combined cardio- and ophthalmopathology relative to the group with coronary heart disease. The content of IL-5, IL-12, IFNγ, TNFα in the blood plasma of patients with coronary heart disease combined with glaucoma increased with a significant difference compared to patients with coronary heart disease. However, the highest increase among the cytokines under consideration is characteristic of IL-6 and IL-17, which amounted to 23.8±1.1 pg/mL and 20.2±1.7 pg/mL in patients with combined cardio- and ophthalmopathology versus 6.3±0.3 pg/mL and 7.9±0.5 pg/mL, respectively, in patients with coronary heart disease. At the same time, the level of IL-4 and IL-10 decreased significantly to 2.2±0.2 pg/mL and 6.4±0.4 pg/mL versus 4.8±0.3 pg/mL and 11.9±0.6 pg/mL. The use of logistic regression made it possible to determine the relative risk values of the studied blood cytokines and to develop uncorrected and adjusted models, according to which the closest association with the risk of developing combined coronary heart disease with glaucoma was established for IL-6 and IL-17, with the relative risk values in the uncorrected model of 2.87 and 2.71, respectively (p < 0.001). However, in the adjusted model, the association of IL-6 with combined coronary heart disease with glaucoma increased to 2.92 (CI 2.80-3.27, p = 0.004), and IL-17 decreased to 2.64 (CI 2.51-2.85, p = 0.003). There was also a significant association of IL-4, IL-5, IL-12, IFNγ and TNFα with combined coronary heart disease with glaucoma. The study demonstrated new associations of systemic cytokines with the risk of developing combined coronary heart disease associated with glaucoma.

Введение. В статье приводится клинический случай развития дилатационной кардиомиопатии на фоне приема противоопухолевой терапии. Пациентка С., 41 года, обратилась на прием к кардиологу 02.12.21 г. с жалобами на одышку при ходьбе, отечность ног. Какой-либо связи с инфекционными заболеваниями и появлением одышки не отмечает. Перед этим проходила лечение в онкодиспансере с диагнозом рак яичника Т3сN1М1, стадия IV, метастазы в загрудинные и забрюшинные лимфоузлы. После 6 курсов неоадъювантной аутолимфохимиотерапии карбоплатином и паклитакселем выполнена полная циторедуктивная экстирпация матки с придатками, оменэктомия, холецистэктомия 11.04.2018 г. Затем было проведено 6 курсов адъювантной полихимиотерапии карбоплатином и паклитакселем. Цель исследования. Выявить связь между развитием дилатационной кардиомиопатии у пациентки и проведенной химиотерапией. Материал и методы. Эхокардиография, МРТ сердца с контрастным усилением. Результаты. По данным эхокардиографии от 02.12.21 г., выявлена дилатация левого предсердия до 44 × 48 мм, правого желудочка — 26 мм, правого предсердия — 45 × 40 мм, левого желудочка. Конечный диастолический объем левого желудочка 255 мл, фракция выброса левого желудочка 25-28 %. По данным магнитно-резонансной томографии сердца, выявлено интрамуральное накопление и замедленное выведение контраста в межжелудочковой перегородке и в области её соединения со свободной стенкой правого желудочка, что свидетельствовало о повреждении миокарда. Через 3 мес. после терапии препаратами: метопролола сукцинат, сакубитрил/валсартан, ацетилсалициловая кислота, спиронолактон, торасемид, эмпаглифлозин, наряду с клиническим улучшением отмечается положительная динамика: уменьшение камер левого предсердия до 40 × 43 мм, правого желудочка — до 25 мм, правого предсердия — до 41 × 33 мм, конечного диастолического объема левого желудочка — до 190 мл, увеличение фракции выброса левого желудочка до 44-46 %. Заключение. Таким образом, ключевым элементом для пациентов из группы высокого риска являются профилактические меры, направленные на предупреждение возможного кардиотоксического действия химиопрепаратов, а также поиск оптимальной терапии, направленной на устранение негативных последствий химиотерапии.

According to the literature, exudative pleurisy and pericarditis are considered rare complications of the new coronavirus infection. This estimation can be explained by the fact that statistical studies cover mainly the hospital treatment of this disease. The true frequency of these complications and their consequences are not fully understood.Aim. The study of late complications of the new coronavirus infection in the form of pleurisy and pericarditis.Conclusion. In our case, a 62-year-old patient with the new coronavirus infection confirmed by polymerase chain reaction, severe bilateral polysegmental viral pneumonia, CT3, 60% on day 43 after the onset of clinical symptoms, was found to have manifestations of pleurisy and pericarditis during outpatient treatment. Cardiac MRI is the most informative method for detecting small pericardial and pleural effusions. The diagnostic capabilities of this method are superior to ultrasounography of the heart and pleural cavities and computed tomography of the lungs. Administration of colchicine 1.0 g per day for 1 month allowed not only to the elimination of pericarditis and pleurisy, but also the reduction of pressure in the right ventricle, probably by reducing the damage to the pulmonary parenchyma.

Introduction . Right atrial (RA) masses have a very different origin. They may be clots. Most often, thrombi from the inferior vena cava migrate to RA. At the same time, an isolated thrombus in RA is a rare finding. Brief description . The article presents a case of detection of a round mass in RA in combination with an atrial septal defect. The mass was discovered by chance during a cardiac ultrasound in a 71-year-old female patient who applied due to hypertension. Accurate determination of the mass structure was possible only after its removal and histological analysis. It turned out to be an organized thrombus with cystic degeneration. Discussion . When a volumetric formation in the RA cavity is detected, a differential diagnosis of a thrombus with primary benign (myxoma or fibroelastoma) and malignant (sarcoma, lymphoma) tumors, metastases, which are found much more often than with primary cardiac tumors. The case is of interest due to thrombus location in RA region without inferior vena cava thrombosis, in combination with an atrial septal defect. This could contribute not only to pulmonary artery embolism, but also cause a paradoxical embolism in systemic circulation vessels.

The article describes a clinical case of cardiac rhabdomyoma first diagnosed in an 18-year-old girl. At the age of 12 months, the patient first developed generalized, prolonged convulsive seizure with the eyeballs rolling upward, tonic arm tension, and profuse salivation. From 1.5 to 2 years, according to her mother, the girl had frequent "freezing" with fixed stare. Anticonvulsant therapy was not administered. From the age of 2 years 8 months, the child began to experience episodes of drowsiness, lethargy, blurred speech, and repeated vomiting lasting up to 2 weeks. The patient was regularly treated at the neurological department. According to CT at the age of four, the patient showed characteristic alterations in the brain and was diagnosed with tuberous sclerosis, symptomatic generalized epilepsy, and psychoorganic syndrome. Only at the age of 18, cardiac ultrasound detected a 7x6 mm hyperechoic formation with endogenous growth buried in the myocardium of the left ventricular (LV) anterior-lateral wall and another one in the area of the LV lateral wall with endogenous growth of 2×4 mm. Magnetic resonance imaging (MRI) revealed multiple focal formations with clear, even contours in the area of the middle anterior septal segment (closely adjacent to papillary muscles) in the region of the apex, buried in the myocardium. The formation sizes were 9×7 mm, 8×13 mm, and 7.5×6 mm, respectively, and they moderately accumulated the contrast agent. Lesions with identical characteristics and a diameter up to 4.5 mm were visualized on the anterior wall in the region of the apex, in the depth of the myocardium. Due to the absence of arrhythmias and hemodynamic disorders, immunosuppressive therapy was not administered. Follow-up and dynamic MRI control of the heart were recommended. If signs of tumor growth are detected, consider immunosuppressive therapy with everolimus. The case is of interest for a long asymptomatic growth of rhabdomyoma. Generally, cardiac rhabdomyomas are diagnosed in the postnatal period and may be the earliest manifestation of tuberous sclerosis.

Introduction. An increase in bilirubin and liver enzyme activity may be one of the side effects of statin therapy, often occurring in patients after AMI and coronary artery stenting, or in high and very high risk individuals on high and moderate intensity statin therapy. The frequency of occurrence of increased transaminases and bilirubin is according to different authors. Therefore, in terms of differential diagnosis, the cardiologist should consider Gilbert’s syndrome as a possible cause of hyperbilirubinemia. Description of the clinical case. The article considers a clinical case of differential diagnosis of non-conjugated hyperbilirubinemia detected in a patient after coronary artery stenting. The level of hemoglobin, erythrocytes, reticulocytes did not differ from normal values and did not change over time. This made it possible to exclude the hemolytic genesis of hyperbilirubinemia. Genetic testing was used to establish the homozygous form of Gilbert’s syndrome. However, the presence of fibrotic changes in the liver, an increase in not only unconjugated, but also conjugated bilirubin, hypertriglyceridemia, dyslipidemia, and stenosing atherosclerosis of the coronary arteries did not allow us to state that the patient had only Gilbert’s syndrome. Discussion. According to recent studies, this disease is characterized by a benign course and reduces the risk of developing cardiovascular diseases due to the antioxidant effect of bilirubin. In addition to Gilbert’s syndrome, the patient was diagnosed with an erased form of non-alcoholic fatty liver disease associated with metabolic syndrome. Conclusion. The disease was caused by insulin resistance, a high-calorie diet, excess consumption of saturated fats, refined carbohydrates, and a sedentary lifestyle. The drugs of choice in this case are statins, ezetemibe, and ursodeoxycholic acid. Their appointment allows not only to reduce cardiovascular risk, but also to slow down the further progression of liver fibrosis.

Introduction . Gastroesophageal reflux disease (GERD) can be accompanied by a triad of cardiac symptoms (arrhythmia, cardialgia, signs of autonomic dysfunction). This syndrome is called gastro-cardiac or Remheld syndrome. The most common rhythm disturbances in Remheld syndrome are atrial fibrillation, supraventricular extrasystole. In the clinical case we have described, a rare variant of Remheld’s syndrome is presented: paroxysmal ventricular tachycardia with GERD. Description of the clinical case . Patient V., 48 years old, applied to a cardiologist on 21.04.21 with complaints of attacks of sudden palpitations, disturbing for six months. From the anamnesis it is known that since 2017 he has been suffering from GERD, he does not take drugs for stopping reflux attacks for 6 months, canceling it on his own. According to Holter ECG monitoring from 03/20/21, paroxysmal ventricular tachycardia was revealed. According to echocardioscopy data from 04/26/21, no structural changes that could be the cause of this life-threatening rhythm disturbance were found. Video gastroscopy from 04/28/21: distal reflux esophagitis. Endoscopic signs of hiatal hernia. Lack of cardia 2 tbsp. Gastroesophageal prolapse. At the consultation with a gastroenterologist, the patient was prescribed both non-drug (lifestyle correction) and drug treatment: rabeprozole, clarithromycin, amoxicillin and others. In addition for the relief of paroxysmal ventricular tachycardia—amiodarone, telmisartan. Discussion . According to studies, one of the mechanisms of arrhythmia in GERD is associated with the excitation of the distal esophagus by refluctate with the development of viscero-visceral reflexes mediated through n. vagus. Increased activation of n. vagus creates an arrhythmogenic substrate for the re-entry mechanism, and thus increases the risk of arrhythmias. Antiarrhythmic therapy along with the treatment of GERD led to the elimination of VT paroxysms. Later, 2 months after the withdrawal of antiarrhythmic drugs against the background of ongoing GERD therapy, paroxysms of VT were not recorded. This was also a confirmation of the pathogenetic relationship between GERD and paroxysmal VT. Conclusion . The case is of interest to the development of a life-threatening rhythm disturbance: paroxysmal ventricular tachycardia against the background of GERD, which is a very rare variant of Remkheld’s syndrome and is not found in the available literature.

Federation Despite the increased interest of the scientific community in diseases associated with atherosclerosis, the widespread use and availability in clinical practice of diagnostic research methods (Doppler ultrasound, CT, MRI), allowing to visualize the vessels of the abdominal cavity, chronic mesenteric ischemia remains an underestimated, undiagnosed and insufficiently studied disease, mainly due to the lack of knowledge and awareness among doctors, which leads to delays in diagnosis and delayed treatment of patients, which significantly increases the risk of death. Currently, new recommendations for clinical, physical, laboratory and instrumental diagnostics of chronic mesenteric ischemia have been developed and are being implemented. These documents should help primary care physicians in early detection of this disease, optimization of treatment and reduction of mortality from this pathology. The lecture highlights the issues of etiology, pathogenesis, classification, clinical course, laboratory and instrumental diagnostics, as well as the possibilities of conservative and surgical treatment of chronic mesenteric ischemia.

In the last decade, facts related to the role of the microbiota in the pathogenesis of neurodegenerative diseases have been established and the concept of the gut-microbiota-brain axis has been formulated. The gut-microbiota-brain axis has been shown to be a sensitive pathological marker of Alzheimer's disease and Parkinson's disease. Numerous works of Russian and foreign scientists and summarized data in scientific reviews indicate that one of the key reasons for the development of these diseases is a change in the gut microbiota. A number of published studies have focused on the pathogenic effects of altered gut microbiota and its metabolites on the nervous, endocrine, and immune systems. On the other hand, a growing body of fundamental work points to the ability of the gut microbiota to regulate the function of the central nervous system through the gut-microbiota-brain axis, to influence brain development and the integrity of the blood-brain barrier. This article presents an analysis of a number of systematic reviews and results of clinical studies conducted mainly in animal models and in vitro, proving the relationship between the intestinal microbiota, neurotransmitters, and associated pathophysiology. The paper shows the need for further study of the influence of the gut microbiota on the central nervous system, which can play an important role in the early recognition, prevention, and treatment of neurodegenerative diseases.