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The most important component of cardio-oncology is the assessment of the risk of development and diagnosis of cardiovascular toxicity of the antitumor therapy, the detection of which is largely based on visualization of the cardiovascular system. The article addresses up-to-date methods of non-invasive visualization of the heart and blood vessels, according to the 2022 European Society of Cardiology Clinical Guidelines on cardio-oncology. Also, the article discusses promising cardiovascular imaging techniques that are not yet included in the guidelines: assessment of coronary calcium using multislice computed tomography and positron emission computed tomography with 18F-labeled 2-deoxy-2-fluoro-d-glucose.

Objective: Evaluation of the analgesic, opioid-sparing, anti-inflammatory and adverse effects of the diclofenac and orphenadrine (Neodolpasse) fixed combination for analgesia in the postoperative period of surgical cancer patients., Material and Methods: A randomized, single-center, prospective, comparative study evaluated two analgesic regimens in 40 cancer patients undergoing various open cavity surgeries, including extensive combined interventions associated with the resection of 3 or more organs. The study was conducted following the transfer from the ICU to the surgical department during the early activation period, within the first two postoperative days. In the first group N ( n =20), "Neodolpasse" (a fixed combination of 75 mg Diclofenac and 30 mg Orphenadrine) was administered as an infusion, twice daily. In the second group K ( n =20) analgesia was performed with ketoprofen as an intravenous infusion at a daily dose of 200 mg. Patients in both groups received scheduled prolonged epidural analgesia with 0.2% ropivacaine, and when the severity of pain in a visual analogue scale (VAS) increased to more than 40 mm, so an additional dose of 100 mg tramadol was administered intramuscularly. Daily measurments of blood creatinine level and C-reactive protein were taken, postoperative blood loss was accounted for, as well as postoperative complications according to the Clavien-Dindo classification., Results: The comparative analysis of the indicators of pain syndrome severity showed that the patients in group N exhibited a more pronounced analgesic effect, so on the second postoperative day 30% of patients reported moderate pain (from 50 to 60 mm on the pain scale), on the third day - 15%, and by the fourth day - all 100% of patients experienced pain of low intensity. The additional analgesia with tramadol in group N was required twice less than in the comparison group, and such adverse effects as nausea, drowsiness, and weakness were significantly more common in the ketoprofen group. In both groups, the average blood creatinine level did not exceed permissible values, and the C-reactive protein was elevated at all stages of the study but tended to decrease by the fourth day. The analysis of postoperative complications according to the Clavien-Dindo scale at the time of discharge did not reveal a direct correlation between the occurred complications and the use of NSAIDs. Adverse effects such as anastomotic failure, gastrointestinal complications, or other hemorrhagic manifestations were not recorded., Conclusion: The inclusion of Neodolpasse into multimodal analgesic regimens resulted in the most pronounced analgesic and opioid-sparing effects in surgical cancer patients using laparotomy access. Additionally, the application of short courses of nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with a favorable safety profile.

Prostate cancer (PCa) is one of the most common malignant neoplasms in middle-aged and elderly men. Transrectal ultrasound guided prostate biopsy is the standard method for diagnosing prostate cancer but is associated with a high incidence of infectious compli-cations. A review of the literature on optimizing the prevention of infectious complications when performing transrectal prostate biopsy is presented. The main risk factors and the common measures to prevent the development of complications are discussed, including a study of using fosfomycin trometamol as the preferred drug for antibacterial prophylaxis. Fosfomycin meets the requirements for empirical prophylaxis, but further clinical studies are needed.

In 2020, prostate cancer (PCa) ranked third in the structure of the most significant oncological diseases. In the Russian Federation, in terms of the frequency of detection among men, prostate cancer is second only to tumors of the upper respiratory tract and lungs, accounting for 14.9%. Radical prostatectomy (RP) in various modifications is still the most common treatment for localized prostate cancer, despite the existence of alternatives such as active surveillance, hormonal and radiation therapy, cryoablation, and others. And the technological pinnacle of the surgical treatment of prostate cancer at the moment is robot-assisted prostatectomy, the widespread use of which was marked by the publication of J. Binder back in 2002. This technology combined the advantages of minimally invasive laparoscopic RP with improved surgeon ergonomics and technical ease of vesicourethral anastomosis reconstruction and has now become the preferred minimally invasive approach. This article will consider the use of a robot-assisted technique in the stage of T3 prostate cancer.

Studying the key mechanisms of cardiovascular diseases has opened new possibilities for the pharmacological impact on the pathophysiological mechanisms of heart failure (HF). The signaling pathway, nitric oxide - soluble guanylate cyclase - cyclic guanosine monophosphate (NJ-sGC-cGMP), provides normal functioning of the cardiovascular system in healthy people and serves as a potential target for medicines in HF with reduced ejection fraction (HFrEF). In HFrEF progression, the sGC activity decreases due to endothelial dysfunction and oxidative stress. The increased synthesis of cGMP resulting from sGC stimulation can restrict myocardial fibrosis, reduce stiffness of the vascular wall and induce vasodilation; in this process, the mechanism of action of sGC stimulators does not overlap with other therapeutic targets. According to the results of the international randomized clinical study VICTORIA, the use of the sGC stimulator, vericiguat, in patients with HF, ejection fraction <45%, and a recent episode of decompensation in their history reduced the risk of repeated hospitalization and cardiovascular death. Also, this treatment was characterized by a favorable safety profile when added to standard therapy.

Introduction: A large number of both preclinical and clinical studies demonstrates the efficiency of bioregulatory peptides for the treatment of prostatitis and chronic pelvic pain syndrome (CPPS). A relatively new drug in this group is Prostatex, the active ingredient of which is bovine prostate extract., Aim: To evaluate the effect of taking Prostatex on the intensity of CPPS, the sexual function, and the results of microscopy of expressed prostate secretions and urinalysis., Materials and Methods: A cohort of patients aged 25-65 years with chronic abacterial prostatitis and complaints of chronic pelvic pain was analyzed. The abacterial type of prostatitis was confirmed by bacteriological examination of expressed prostate secretions. The patients received Prostatex for 30 days according to the following scheme: 1 suppository rectally 1 time per day. The follow-up was 30 days. Before starting the drug and at the end of the 30-day course, patients completed the Chronic Prostatitis Symptom Index (NIH-CPSI) and the sexual function questionnaire. In addition, urinalysis and microscopic study of expressed prostate secretions was performed., Results: A total of 1700 patients were included in the study. While taking the drug, there was a significant decrease in pain during digital rectal examination, as well as in the intensity of pain as a symptom of CPPS. The severity of symptoms after treatment was lower in all domains of NIH-CPSI. Microscopic study of the expressed prostate secretions during treatment showed a decrease in the number of patients with excessive number of leukocytes. The sexual function improved, while urinalysis and microscopy of expressed prostate secretions returned to the reference values., Conclusion: The use of Prostatex for the treatment of patients with CPPS reduces the severity of pain and other symptoms of chronic prostatitis, increases sexual function and normalizes the expressed prostate secretions and urinalysis. In order to obtain data of a higher level of evidence, it is necessary to carry out randomized, blind, placebo-controlled studies.

Objective: To analyze the results of redo reconstructions of lower limb arteries in patients with obliterating atherosclerosis, immediate and long-term results in patients who underwent reconstructive interventions with occlusion of previous reconstruction and preventive interventions., Material and Methods: The study included 43 patients. The main group (group 1) consisted of 18 patients who underwent preventive vascular reconstructions. The control group enrolled 25 patients who underwent redo interventions for occlusion of previous reconstructions. The control group was divided into 2 parts; 15 patients had chronic limb ischemia (group 2), 10 patients had acute limb ischemia (group 3). Mean age of patients was 56.8±8.2 years; there were 37 (86%) men and 6 (14%) women. Multifocal vascular atherosclerosis was noted in 41 (95.3%) patients, carotid artery lesion - 29 (70.7%), coronary artery disease - 34 (79%). Patients with type II diabetes mellitus were excluded., Results: We chose each surgical intervention considering preoperative diagnostic data. Open, endovascular and hybrid interventions were performed. There were no deaths and limb amputations in the 1 st group. Two (13.3%) amputations were registered in the 2 nd group, 3 (30%) amputations and 1 (10%) death were registered in the 3 rd group. The follow-up period was 24 months. An 18-month freedom from amputations was 71.5%, 78% and 38%, respectively ( p <0.05 compared to the 1 st and 2 nd groups)., Conclusion: Preventive surgical interventions prevent ischemia and amputation, as well as improves the results of redo surgery.

Introduction: According to the recommendations of the European Association of Urology the presence of a suspicious lesion on MRI is an indication for both primary and secondary MR-targeted biopsies. At the same time, the Russian Society of Urologists recommends to perform mpMR/US fusion biopsy only in patients with a prior negative biopsy. In clinical practice, mpMR/US fusion and cognitive biopsies are the most frequently performed. However, when comparing them, contradictory data on detection of clinically significant prostate cancer is obtained., Objective: to compare the detection rate of clinically significant prostate cancer performing cognitive and mpMR/US fusion biopsies., Materials and Methods: Inclusion criteria: PSA >2 ng/mL and/or a positive DRE, and/or a suspicious lesion on TRUS, and PI-RADSv2.1 lesion more or equal 3. At first, "unblinded" urologist performed a transperineal mpMR/ultrasound fusion and saturation biopsy. Then "blinded" urologist obtained transrectal cognitive biopsy Clinically significant cancer was defined as ISUP more or equal 2., Results: We enrolled 96 patients. Median age was 63 years, prostate volume - 47 cm3 and PSA - 6.82 ng/mL. MpMR/US fusion and cognitive biopsies were comparable in regard to the detection rate of clinically significant (32.3% vs 25.0%; p=0.264), clinically insignificant cancer (25.0% and 26.0%; p=0.869) and overall detection rate (57.3% and 51%;p=0.385). Both biopsies missed clinically significant cancer with equal frequency (5.2%; p=0.839). Histological efficacy also was comparable. The number of positive cores between mpMR/US fusion and cognitive biopsy was equal (34.1% and 31.1% respectively; p= 0.415). At the same time, no statistically significant difference was found with respect to maximum cancer core length (53.1% vs 47.7%, respectively; p=0.293)., Conclusion: The results suggest that both cognitive and mpMR/US fusion biopsies are equally accurate diagnostic methods for clinically significant prostate cancer detection, thus their wider introduction into clinical practice is necessary.

The purpose of this publication is to identify the prevalence of arrhythmia as one of the manifestations of gastrocardial syndrome in patients with hernias of the esophageal orifice of the diaphragm and reflux esophagitis. To evaluate the results of antireflux surgery in the dynamics of arrhythmia regression. Materials and methods: the study included 101 patients with hiatal hernias who were undergoing inpatient examination and treatment. Arrhythmia was detected in 35 (34.6%) of 101 patients with hernias of the esophageal orifice of the diaphragm. Arrhythmias are characteristic of cardiofundal (40%), subtotal (66.6%) and total (100.0%) hernias of the esophageal orifice of the diaphragm, were recorded at a younger age, were dependent on the duration of the underlying disease. Clinical manifestations of arrhythmia depended on the degree of shortening of the esophagus, most often arrhythmias occurred with shortening of the esophagus of the II degree in cardiofundal hernias (68.7%), subtotal (60.0%) and total (100.0%). As a result of antireflux surgery, clinical manifestations of arrhythmia regressed in 19 (54.3%), in 26 (74.2%) patients, electrocardiogram and Holter monitoring indicators decreased or were absent altogether. In conclusion, it should be emphasized that arrhythmias on the background of hernia of the esophageal orifice of the diaphragm, associated with anatomotopographic and physiological features, are a frequent clinical situation characterized by the mutually aggravating effect of both diseases on each other. An instrumental study of the state of the cardiovascular system in the pathology of the upper gastrointestinal tract showed that there is an improvement in the indicators of cardiac arrhythmias associated with the underlying disease, the correction of which is possible only with surgical treatment of the underlying disease.

The aim of the study was to explore different treatment approaches for degenerative-dystrophic damage of the spine and define the most effective treatment methods, their stages regarding the pathogenetic basis of pain syndromes. Diverse treatments for degenerative-dystrophic damage of the spine do not facilitate but even complicate general practitioner's work due to the fact that information on clinical benefits of various drugs and techniques as well as various types of surgery is too contradictory; there is no single method of consistent combined therapy for vertebrogenic pain. There is no universal therapy or surgery that would provide sustainable relief of symptoms of nonspecific back pain and/or radicular syndrome. The pathogenesis of specific clinical manifestations of the disease and the ratio of clinical manifestations and pathomorphological changes are crucial in choosing the treatment. The general principles of treatment are unchanged: rest, analgesics and movement should be combined in appropriate sanogenic proportions in each case. Reduction of oedema and swelling of the intervertebral disc and the spinal nerve root, nerve endings are crucial in relief of pain syndrome. There is no doubt that nonsteroidal anti-inflammatory drugs (NSAIDs) are the most effective in relieving lumbar and radicular pain at the beginning of treatment. In the absence of significant improvement after the use of NSAIDs and the essential sanogenic movement loads, a more dynamic treatment should be used. First of all, different methods of local administration of pharmacological drugs should be used: starting with the simple subcutaneous injection of painful areas and finishing with ultrasound and MRI-controlled injections directly into the area around the damaged nerve root, the epidural space, or the facet joint. In most cases, epidural injections can reach areas of disc-radicular conflict - injection of the drug into the epidural space facilitates diffusion of glucocorticoids (or other pharmacological agents) into surrounding tissues as well as the nerve root regardless of its compression or irritation. Only after the ineffectiveness of NSAIDs and puncture treatments as well as epidural injection and in cases of persistent mechanical compression of the nerve roots taking into account the clinical manifestations, appropriate surgical treatments, both minimally invasive and open, are necessary.

Background: A steadily growing number of primary lower extremity arterial reconstructions is inevitably followed by the need to perform repeat interventions. Shunt reocclusion may become a cause of return of ischaemia to the initial level, may significantly increase the degree of limb-threatening chronic ischaemia, as well as lead to the development of an acute condition requiring urgent corrective measures to be taken. A reoperation currently continues to remain the standard of treatment. Despite advances in modern resuscitation, the postoperative mortality rate in such patients reaches 20%., Aim: This study was aimed at assessing feasibility of hybrid technologies in acute thrombosis after reconstructive operations on lower-limb arteries., Patients and Methods: We retrospectively analysed the results of treatment of 66 consecutive patients urgently admitted to the City Clinical Hospital named after S.S. Yudin from 2015 to 2020 with acute lower limb ischaemia caused by acute occlusion of the zone of primary vascular reconstructions previously performed at other medical facilities. Depending on the method of surgical treatment, the patients were divided into two groups. The Study group included 20 patients subjected to open surgical interventions followed by angiographic control and using one or other type of X-ray-endovascular treatment. Endovascular interventions were performed for more than 70% stenoses in the major arteries and zone of the previously performed operation. The Comparison group comprised 46 patients treated without endovascular technologies. They were subjected to thrombectomy from the vascular construction with/without reconstructive-restorative operations., Results: Seventeen (85%) of the 20 Study group patients were operated on in a stagewise manner, with the first stage consisting of an open intervention - thrombectomy and reconstruction followed by angiographic control and roentgenendovascular treatment. The remaining three (15%) patients underwent simultaneous interventions. In the postoperative period, limb amputations were performed in ten (22%) Comparison group patients and in one (5%) Study group patient (p=0.049). There were three (7%) lethal outcomes in the Comparison group, with none in the Study group., Conclusion: A combination of open and endovascular interventions in patients with shunt occlusion after vascular reconstructions makes it possible to reveal the cause of shunt occlusion, as well as to remove multilevel lesions, minimizing surgical wound and contributing to reducing the amputation rate.

The narrative review discusses the data on efficacy and safety of reperfusion therapy (RT) and neuroprotective therapy in ischemic stroke. The influence of therapy on mortality, residual neurologic deficit and disability is analyzed. It was shown that RT (thrombolysis or mechanical thromboextraction) leads to significant decrease of residual neurologic deficit or disability. The influence of RT on mortality is controversial. There is some evidence that RT can increase early mortality due to hemorrhagic complications. Neuroprotective therapy is much less studied in stroke but is recognized as safe. Neuroprotective therapy (i.e. cerebrolysin) can diminish residual neurologic deficit and disability, while it has no influence on mortality.

For the purpose of research and comparative analysis of the features of cerebral blood flow, determined by the ultrasonic duplex scanning (USDS) method, in persons with clinical signs of chronic cerebral venous dysfunction syndrome and different levels of arterial pressure (AP), ultrasound of the head and neck was performed in 104 patients. 78 people - the main group (MG), where patients were selected for clinical signs of the presence of chronic cerebral venous dysfunction syndrome (CCVDS) and different blood pressure levels, were divided into 3 clinical groups: 33 people - people with high blood pressure (157.2±12,2/98.3±4.2) - hypertensive patients; 24 people with labile blood pressure with predominantly normal average blood pressure (125.23±12.2/82.22±4.14) - conditional normotonics; 21 people with low blood pressure (100.32±7.23/65.45±6.4) were hypotonic. Also, 26 patients of the comparison group were recruited - people without clinical signs of CCVDS and different levels of blood pressure, distributed according to the same principle: hypertensive patients - 8 people, normotonic patients - 13 people, hypotensive patients - 5 people. The total age of the patients ranged from 35 to 65 years (mean age 53.60±10.27 years). Among the patients there were 82 women and 22 men. Statistical comparison was performed using Fisher's exact test. The mean velocity indices of cerebral blood flow with varying degrees of reliability, depending on the level of arterial pressure, differed in patients with chronic cerebral venous dysfunction syndrome versus the indices of the comparison groups. The presence of clinical signs of CCVDS in people with different blood pressure levels was accompanied by a significant slowdown in blood flow in most cerebral arteries and a significant acceleration in the Rosenthal vein compared with patients without clinical manifestations of venous dysfunction and with the same arterial pressure. Attention was drawn to the fact that in persons with increased blood pressure, in contrast to the rest of the patients, a statistically significant acceleration of the linear blood flow velocity in vertebral artery at the level of the second cervical vertebra (VA2) was observed (p<0.05). In the subgroups of hypertensive patients with CCVDS, the mean linear blood flow velocity with a significant difference was twice less than the comparison group: a significant decrease in velocity parameters was only in the middle cerebral arteriasis (MCA) basins on both sides (p<0.01, p<0.05 on the right and left, respectively) and on the left in the pools posterior cerebral artery (PCA), VA2, a significant increase in blood flow (p<0.01, p<0.05) - in the veins of Rosenthal (VR). This discrepancy can be explained by the fact that hypertensive patients from the comparison group, that is, without clinical symptoms of CCVDS, already have subclinical manifestations of CCVDS, as evidenced by changes in the USDS indicators.

Pulmonary embolism ranks third among causes of death from cardiovascular diseases after acute coronary syndrome and impairment cerebral circulation. A factor provoking pulmonary embolism in the majority of cases is thrombosis of deep veins of lower limbs. Presented in the article is a clinical case report concerning treatment of a 35-year-old female patient with acute bilateral phlebothrombosis of internal iliac veins with floatation of thrombotic heads in the inferior vena cava and common iliac vein on the left. By means of a hybrid technique, we successfully performed operative intervention: thrombectomy from the inferior vena cava and common iliac veins on both sides with the use of proximal protection TREX (thromboextractor). Control X-ray contrast tomography and ultrasound examination of lower limb veins showed no evidence of rethrombosis. After surgical treatment, the woman received anticoagulant therapy. On POD 5, she was discharged home in a satisfactory condition.

Chronic pain syndromes in the neck and shoulder girdle are one of the important clinical problems due to their high prevalence. In addition, it's of great interest to study the mutual influence of the musculoskeletal system pathology, balance organs and dentoalveolar system due to the possible negative impact of these structures on each other which surely affects the treatment timing and its results., Objective: To develop a diagnostic algorithm and a comprehensive program for the treatment and rehabilitation of patients with cervicobrachialgia combined with pathological dental occlusion., Material and Methods: The study involved 90 persons of both genders aged 18 to 55 years consisted of 3 clinical study groups (25 patients) and one control group (15 healthy persons). The clinical groups included 75 patients with chronic myofascial pain syndrome in the neck and shoulder girdle resistant to drug therapy, with temporomandibular joint (TMJ) dysfunction and/or pathological dental occlusion (PDO). The groups were formed depending on the chosen treatment methods: manual therapy was used in the 1st group; in the 2nd group - dental treatment aimed at correcting PDO; in the 3rd group the manual therapy was used together with the correction of the jaws' occlusal relationship., Results: In the study course the most effective algorithm for the diagnosis and rehabilitation of patients with cervicobrachialgia caused by pathological dental occlusion was determined. Positive clinical results were noted in patients of all three groups; however, in the 3- group where manual therapy and complex dental treatment were carried out the results are not differing significantly from the controls. The study showed that in patients with myofascial pain syndrome at the cervical and shoulder levels caused by TMJ dysfunction and pathological dental occlusion it's advisable to include manual and osteopathic diagnostics in the algorithm. Manual muscle testing, posture tests in combination with 3D X-ray imaging and computerized functional studying the maxillofacial region should be used to identify etiology-pathogenesis links between these conditions. These methods are also applicable for quality control of treatment., Conclusion: Thus, as a study result the diagnostic algorithm was developed; it allows to determine the relationship of pharmacoresistant pain syndrome of the cervicobrachial region with dental pathology at high degree of accuracy; and a comprehensive interdisciplinary approach to the therapy and rehabilitation of this combined pathology was proposed.

According to the results of modern researchers, the main techniques used in congenital pathology of the aortic valve in children include balloon catheter dilatation of the aortic valve, surgical valvuloplasty, the Ross procedure and replacement of the aortic valve with a mechanical prosthesis. Many surgeons point out that these techniques in congenital pathology of the aortic valve yield suboptimal results. This is often due to the lack of a clear-cut definition between surgeons as to what operation should be performed in a particular age group. According to the reports of the majority of researchers, biological prostheses undergo early degeneration and structural changes in paediatric cardiac surgery and yield the worst results. Comparing the main techniques, optimal haemodynamics is observed after the Ross procedure. A disadvantage of this operation is the necessity of repeat intervention on the right ventricular outflow tract, which is required in 20 to 40%. Concomitant surgery of the mitral valve and/or aortic arch during the Ross procedure significantly increases the lethality and the risk of postoperative complications. Compared with an adult cohort of patients, children after prosthetic repair of the aortic valve using a mechanical prosthesis are more often found to have postoperative complications and a higher mortality rate. Yet another problem encountered in paediatric valve surgery is the unavailability of commercial prostheses sized ?19 mm. The duration of the intraoperative parameters for reconstructions of the aortic valve, the Ross procedure, and replacement of the aortic valve by the results of many studies averagely amounts to 74±34 min, 100±56 min, and 129±71 min, respectively. Yet another method which can be used for neocuspidization of the aortic valve in reconstructive surgery of the aortic root in paediatric patients is the use of glutaraldehyde-treated autologous pericardium. In our opinion, given the simplicity of the procedure, duration of the intraoperative parameters, and acceptable initial results reported by some researchers, the Ozaki procedure may be performed in children.

The topic of renal cystic lesions is described in the article. The localization and structure of solitary, parapelvic and multiple sinus cysts are discussed. The Bosniak classification (1986) is presented, as well as the updated Bosniak classification, in which a number of modifications in 2019 were made. The contemporary diagnostic methods are mentioned, as well as factors that allow to select patient for active surveillance. Current surgical procedures are presented.

The article is devoted to the interaction of a gynecologist and a urologist in a gynecological hospital, based on the experience of the gynecological department at the Clinic of obstetrics and gynecology of the Clinical Center of Sechenov University. The most common clinical scenarios were identified when the participation of a urologist in evaluation and treatment is urgently needed, including large pelvis mass, endometriosis with an involvement of pelvic organs, genital prolapse, small pelvis adhesions as a result of previous surgical procedures and postoperative urinary disorders. A close interaction between two specialties, which are dedicated to pelvic organs disorders, namely gynecology and urology, is extremely popular in modern clinical practice and allows to significantly reduce the number of intra- and postoperative complications, carry out a comprehensive examination and determine individual treatment tactics in a gynecological hospital, which increases quality of medical care.

Aim -to calculate and estimate the number of years of potential life lost (YPLL) due to premature mortality from cerebrovascular diseases in Ukraine, and its share in the array of losses from all diseases of the circulatory system. The information base of the study was official data of the State Statistics Service of Ukraine on the distribution of the deceased by gender, age groups and causes of death in 2018. A comparative analysis of mortality from cerebrovascular diseases in selected countries was carried out using the European database of mortality (MDB) and the database of the Global Study of Disease Burden, Injuries and Risk Factors. The method of potential demography was used to estimate demographic losses due to premature mortality from cerebrovascular diseases. The number of lost years of potential life due to premature mortality from cerebrovascular diseases in 2018 reached 116,563 thousand man-years (104,355 thousand in 2013), which accounted for more than 18% of similar losses as a result of death from all cardiovascular diseases in Ukraine. Revealed a significant disproportion of losses depending on gender - more than two thirds (69.1%) of the absolute number of lost years accounted for men. Ukraine is losing more significant amounts of potential years of life due to high premature mortality from cerebrovascular diseases compared to the developed countries of the world. Assessing real and potential losses due to premature death from cerebrovascular disease is a useful tool to support management decision making. We can recommend a methodology for arguing the development of strategies and programs aimed at combating cerebrovascular diseases, assessing the dynamics of changes in the process of their implementation, and as an indicator of effectiveness.

Elderly and aged patients appear to have a significantly increased risk from a cardiosurgical intervention combining three-valve reconstruction and prosthetic repair of the ascending portion of the aorta. Triple-valve pathology in pronounced mitral insufficiency is often accompanied by concomitant dilatation of the left atrium, i. e., atriomegaly. With the aim to eliminate the syndrome of compression of surrounding tissues and normalize intracardiac haemodynamics, reduction of the left atrium should become an inherent procedure for atriomegaly in patients with multiple-valve pathology.

Migraine is the most common chronic neurological disease. Migraine is in the top 5 causes that reduce the quality of life. In recent years, neuromodulation techniques are successfully used with primary headaches. Several variants of non-invasive neuromodulation have been shown to be effective in various forms of migraine. This review analyzes clinical trials and case reports of the effectiveness and safety of non-invasive stimulation of the first branch of the trigeminal nerve in migraine.

Ageing is considered to be the major and non-modifiable risk factor for the development of hypertension and cardiovascular diseases. During ageing, the vascular system undergoes structural and functional alterations, including endothelial dysfunction, thickening of the vascular wall, reduced distensibility and increased arterial stiffness. Vascular rigidity results from fibrosis and remodelling of the extracellular matrix, processes that are associated with ageing and are amplified in hypertension. These events may be induced by vasoactive agents, such as angiotensin II, endothelin-1, and aldosterone, which are increased in the vasculature during aging and hypertension. Complex interaction between the process of ageing and prohypertensive factors results in accelerated vascular remodelling and fibrosis, as well as increased arterial stiffness. Hypertension accelerates and augments age-related vascular remodelling and dysfunction, and ageing may impact on the severity of vascular damage in hypertension, thus strongly suggesting close interactions between biological ageing and blood pressure elevation. Molecular and cellular mechanisms underlying vascular alterations in ageing and hypertension are common and include aberrant signal transduction, oxidative stress and activation of pro-inflammatory and pro-fibrotic transcription factors. Strategies to suppress age-associated vascular changes can ameliorate vascular damage associated with hypertension. This article looks into vascular alterations occurring during ageing and hypertension, focussing particularly on arterial stiffness and vascular remodelling, also emphasizing the importance of diagnostic methods.

A balanced diet has always been part of a set of preventive measures with cardiovascular diseases (CVD). The aim of the research is to present relevant international data on the role of nutrients in reducing the risk of CVD. Results . This article discusses current data on the effect of consumption of saturated and unsaturated fatty acids, trans fats, cholesterol, dietary fiber, protein, edible salt potassium, magnesium and vitamins on the state of the cardiovascular system and the prevention of CVD. Recommendations on optimal nutrition are given to reduce cardiovascular risks, including those according to the new 3rd edition of the Guide to Cardiovascular Medicine (The ESC Textbook of Cardiovascular Medicine, 3 edn). Conclusion . When managing patients with cardiovascular diseases, it is necessary not only to take into account international nutritional recommendations, but also to focus the patient's attention on how to comply with them., Competing Interests: The authors declare no overt and potential conflict of interest related to the publication of this article., (Copyright© GEOTAR-Media Publishing Group.)

Currently, prostate cancer (PCa) is one of the most important problem of modern medicine, including economical issue. The detection of PCa compared to any other cancers progressively increases with age. Currently, PCa is the most commonly diagnosed solid tumor. Radical prostatectomy and radiation therapy are considered standard of treatment for PCa. However, while excellent long-term oncologic results can be achieved, these methods are often associated with significant complication rate, which negatively affects the quality of life of patients. Technological advancement and their implementation in medicine have increased treatment opportunities in oncourology. The purpose of this literature review is to study alternative treatment methods of localized PCa and compare their efficiency with conventional therapy.

The aim of the study was to study the effect of the gel on the basis of recombinant human angiogenin on the rate of regeneration of donor palatal wounds. The study involved 20 patients (8 men and 12 women) aged 32 to 55 years. Patients were divided into two groups: the 1 st group is a study group (n=10), whose patients in the postoperative period used a gel based on recombinant human angiogenin, the 2 nd group is a control group (n=10) in which a gel based on recombinant human angiogenin was not used. Patients in both study groups underwent vestibuloplasty with simultaneous plasty of the attached keratinized gingiva with a free gingival graft from the area of the hard palate. The operations were carried out at the stage of disclosing dental implants, simultaneously with the installation of healing abatements or 4 weeks before dental implantation. For histological examination, tissue samples were obtained from the region of the edge of the donor's wounds of the palate at the 7 th and 14 th days after surgery. As a result of the study, significant differences were found in the comparison groups when assessing the processes of inflammation, angiogenesis and epithelization. The local application of the gel containing recombinant human angiogenin resulted in a rapid decrease in the intensity of inflammation in lamina propria mucosae and a significant decrease in the bulk density of cell infiltrates, accelerating regeneration. This is primarily due to the stimulation of the development of epidermal growth factor (EGF), vascular endothelial growth factor (VEGF) and increased blood supply to the affected area, as well as an increase in the proportion of fibroblasts. The most important observation was the increase in the rate of epithelialization of donor wounds of the hard palate.

Aim: To evaluate the efficacy and safety of cytoflavin as an additional agent in the treatment of painful diabetic polyneuropathy and to analyze changes in the life quality of the patients studied., Material and Methods: An analysis of treatment data was carried out in 61 patients with verified painful diabetic polyneuropathy, who were divided into 2 groups depending on the therapy regimen. Patients of the main group (n=36) at the start of the therapy with gabapentin additionally received cytoflavin: intravenously, slowly, 10 ml diluted in 0.9% NaCl 200 ml for 10 days, followed by switching to per os 2 tablets 2 times a day for 25 days. Patients of the comparison group used gabapentin in comparable doses as an analgesic symptomatic therapy. Clinical neurological and anamnestic methods were used to monitor and assess the condition of patients., Results and Conclusion: Cytoflavin inclusion in the standard symptomatic treatment of patients with painful diabetic polyneuropathy contributed to a more pronounced decrease in the subjective assessment of pain (VAS scale) by the 10th day (42.8±2.4 mm versus 58.2±2.1 mm in the comparison group) and its maximum level of decline to 21-25 days. The achieved result was maintained by the 35th day (21.4±1.1 mm against 22.4±1.7 mm in the comparison group). At the same time, the quality of life of patients as assessed by SF-36 was significantly increased after treatment. The results obtained, along with the safety of the drug, allow us to recommend its inclusion in the treatment regimens for patients with this pathology.

Background: Comorbidity constitutes a serious challenge for rehabilitative medicine. The comorbidity of the dorsopathy of the lumbar spine and irritable bowel syndrome mutually complicates the clinical course of both conditions, significantly reduces the patients' quality of life. and increases the costs of diagnostic procedures and restoration of the working capacity. The approaches to the non-pharmacological management of the patients presenting with these diseases remain to be developed., Aims: The objective of the present study was to evaluate the effectiveness of the proposed combined non-medicinal rehabilitation modality which included a course of therapy with the application of modulated sinusoidal currents, total wrappings with the use of a Rapan saline solution, and sedative inhalations additionally introduced into the basic medicinal therapy of the patients presenting with dorsopathy of the lumbar spine combined with irritable bowel syndrome in the stationary phase., Materials and Methods: A total of 59 patients at the age from 20 to 65 years suffering from dorsopathy of the lumbar spine and concomitant irritable bowel syndrome were examined and treated. All the patients were randomized into two groups, the main (n=21) and control (n=38) one, matched for the sex and age. The patients in the control group received the conventional medical treatment in accordance with the adopted medical and economic standards during 2 weeks. The patients of the main group received, in addition to the basal medicinal therapy, the proposed combined rehabilitative physiotherapeutic treatment that included a course of therapy with modulated sinusoidal currents, total wrapping with the use of a Rapan saline solution, and sedative inhalations of the of peony root extract. The effectiveness of these rehabilitation modalities was monitored before and after the course of therapy based on the estimation of bowel function dynamics, the severity of pain syndrome, and the patient's quality of life in terms of the health status with the use of the SF-36 questionnaire., Results: The therapeutic and rehabilitative procedures resulted in a well apparent improvement of the genera condition in the patients of the main group associated with a greater degree of reduction of the incidence of specific clinical symptoms, more rapid relief of the pain syndrome, and a more pronounced improvement of the quality of life indices in comparison with the same variables in the patients comprising the control group. After the course of the treatment and rehabilitation, the incidence of spinal pain in the patients of the main group was significantly reduced by 87% (p=0.001) compared with those of the control group (32%; p=0.005). The frequency of abdominal pain decreased in the main group by 47% (p=0.021) versus the control group (by 27%; p=0.007). The quality of life indices increased 1.2 times in the main group but remained unaltered in the control group., Discussion: The patients of the main group exhibited a more pronounced than in the control group positive dynamics of health conditions characterized by a well apparent reduction in the incidence of the major clinical symptoms of the disease, faster alleviation of the pain syndrome, and the marked improvement of the quality of life indices., Conclusions: The results of the study with the inclusion of therapy with modulated sinusoidal currents together with total wrapping using the Rapan saline solution and sedative inhalations into the program of the combined treatment of the patients presenting with dorsopathy of the lumbar spine and concomitant irritable bowel syndrome provide a basis for recommending this physiotherapeutic modality for personalized rehabilitation of this group of patients under conditions of a therapeutic clinic.

Here we present the study of enzymes involved in the regulation of extracellular matrix metabolism. It was the first study of this kind in the European part of the Arctic zone of the Russian Federation (AZRF). The contents of matrix metalloproteinases (MMP-1, -2, -3, -9) and tissue inhibitors of matrix metalloproteinases (TIMP-1, -2, -4) were measured in blood plasma of 91 men in AZRF (67o N) and 14 men in Western Siberia. The contents of MMP-1, MMP-9, TIMP-1 and TIMP-4 in plasma of northerners were higher compared to those of the residents of Western Siberia (55o N). Age-related dynamics of MMP and TIMP contents had a mixed trend in northerners. The maximum contents of MMP-1 and MMP-9 and of MMP-3 were observed in 30-39 and 40-49 years old groups, respectively. The contents of these enzymes tended to decease with age. The maximum contents of TIMP-1 and TIMP-2 and of TIMP-4 were in 50-59 and 60-69 years old groups, respectively, while the minimum contents of these enzymes were in the group of young men up to 29 years old. Hyaluronidase activity was minimal in 30-39 years old group and increased with age up to maximum values at 50-59 years old. Age-related imbalance of MMP/TIMP system (MSE content reduction with age vs TIMP content increase in older age groups) can be considered one of the reasons of the identified age-related increase of interstitial fibrosis and premature aging of the northerners.

Aim: To evaluate the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (IS)., Material and Methods: A randomized double blind multicenter placebo-controlled, in parallel groups trial included 151 patients (62 men and 89 women) with hemispheric IS. Using a method of simple randomization, 150 patients (62 men and 88 women), aged 40-79 years, were randomized into two groups. Patients of Group I were treated with mexidol: 500 mg/day IV infusion for 10 days, followed by 125 mg tid (375 mg/day) PO for 8 weeks. Patients of Group II received the placebo according to the same scheme. The total duration of patients' participation in trial ranged from 67 to 71 days., Results: By the end of treatment, the mean score on the modified Rankin scale (mRS) was lower in Group I compared to Group II (p=0.04). In Group I, the decrease in mRS mean score (Visit 1-5) was more prominent (p=0.023), percentage of patients with 0-2 scores by mRS scale (Visit 5) was higher (p=0.039), mean NIHSS score lower (p=0.035) in Visit 5 compared to group II. By the end of treatment, the decrease in mean NIHSS score in patients with diabetes mellitus was more prominent in Group I in comparison with Group II (p=0.038). In Group I, the dynamic of improvement of quality of life was more prominent and started from Visit 2 in general population and subpopulation of patients with diabetes mellitus. The share of patients with no problems with movement in space was higher in Group I (p=0.022). There were no statistically significant differences in frequency of side effects in patients of both groups., Conclusion: It is recommended to include mexidol in therapy of patients with IS in the acute and early rehabilitation stages.

The main extracellular matrix components in Arctic residents were studied. Northerners had increased levels of total glycosaminoglycans, hyaluronan, and collagen IV in plasma and both general and peptide-bound hydroxyproline in urine, which indicates an accelerated metabolism of the main extracellular matrix components compared with comparison group (residents of Siberia). Age-related remodeling of extracellular matrix in northerners manifested in changing ratio and quantity of its main components. Levels of total glycosaminoglycans, hyaluronan, fibronectin, hydroxyproline and its fractions increased with age while the level of collagen IV changed insignificantly. Average positive correlation between extracellular matrix components and biological aging indicators is suggestive of relationship between these two processes: aging - which is accelerated in the Arctic and pathological remodeling of extracellular matrix as it is associated with accelerated aging. Changes in local regulation system including those related to matrix metalloproteinases and their tissue inhibitors may be one of the reasons for pathological remodeling of extracellular matrix.

The proinsulin is one of indices reflecting functional activity of pancreas. Under insulin-independent diabetes ration proinsulin/insulin increases. The study was carried out to evaluate content of proinsulin and other biochemical indices of blood serum depending on stage of compensation of diabetes mellitus type II. The content of proinsulin in blood serum was detected using "sandwich"-technique enzyme-linked immunosorbent assay (BioVender, Czechia). The concentration of proinsulin in blood serum of control group comprised 2,56 ± 0,23 nmol/l. No gender and age differences were established concerning content of proinsulin in blood serum of patients. The concentration of proinsulin was twice higher than control level in group of patients. Two main groups were singled out: one with high content (concentration thrice exceeded average value in control group) and another with low content of proinsulin (within standard value). The patients with stages of compensated and sub-compensated diabetes (n=35) retained low concentration of proinsulin. At the stage of decompensation of diabetes (n=40) concentration of proinsulin was thrice higher than standard value. This group was characterized by increasing of concentration of glucose, fructosamine and decreasing of concentration of C-peptide. At the stage of decompensation concentrations of triglycerides, total cholesterol and atherogenicity index increased reliably. The concentration of proinsulin at the stage of decompensation positively correlated with level of glucose and concentration of triglycerides. Therefore, measurement of concentration of proinsulin can be used as an important diagnostic criterion permitting to judge about degree of decompensation of diabetes and development of its complications., Competing Interests: The authors declare no conflict of interest.

Nowadays, an arsenal of diagnostic methods is used in diagnosis of pulmonary embolism, which includes x-ray, angiography, perfusion-ventilation scintigraphy, CT and magnetic resonance imaging, Doppler and laboratory studies. Purpose of our study was to evaluate the diagnostic significance of determination of some parameters of hemostasis (D-dimer, Soluble fibrinmonomer complexes, fibrinogen), homocysteine, hs-CRP and multidetector computed tomography in suspected pulmonary embolism. We have examined 54 patients -31 men and 23 women, aged 18 to 76 years, with characteristics of pulmonary embolism. According to our data, Multidetector computed tomography angiopulmonography , measuring D-dimer, fibrinogen and related hyperhomocysteinemia with increased level of hs-CRP may serve as binding, diagnostically significant laboratory markers in the diagnosis and treatment efficacy of pulmonary thromboembolism.

Objectives: Evaluation of effectiveness of Mexidol in optimization of hypolipidemic therapy in ischemic stroke and diabetes mellitus patients., Material and Methods: Authors analyzed the indicators of lipid status: total cholesterol, low-density lipoproteins, high density lipoproteins, triglycerides and concentration of platelet factor-4, β-tromboglobulin, von Willebrand factor in 68 patients with acute ischemic stroke and diabetes mellitus. Authors investigate the dynamics of these parameters (1(st), 21(st), 3-d and 6(th) month after onset stroke) depending on timing and dose of Mexidol., Results: Long time therapy of Mexidol may optimize of hypolipidemic therapy in ischemic stroke and diabetes mellitus patients.

Aim: to evaluate the efficiency of decimeter wave therapy and halotherapy, which were additionally added to basic therapy, in patients with chronic obstructive pulmonary disease (COPD) concurrent with hypertension at the inpatient stage., Subjects and Methods: 36 patients aged 20 to 75 years with Stages I-II COPD concurrent with Stages I-II, first-second grade hypertension were examined and treated. The clinical examination included collection of complaints and medical history data, clinical laboratory and instrumental (electrocardiography, spirography) studies, and health-related quality of life (using the SF-36 questionnaire). The patients were randomized into two groups: a study group and a comparison group. The study group patients received decimeter wave therapy and halotherapy in addition to basic drug treatment; the comparison patients had basic drug therapy., Results: Pre- and postoperative comparative analysis of the major clinical manifestations of comorbidities revealed more pronounced positive changes with the lower rate of clinical manifestations in the study group. It was also observed to have a more marked reduction in blood pressure (BP) with its goal levels achieved. The mean pulse BP decreased by 28% in the study group (p=0.000005) and did not statistically reduced in the comparison group. In the study group patients, the integral quality-of-life indicator after a package of medical rehabilitation measures became statistically significantly higher by 35%. This indicator in the comparison group was statistically significantly unchanged., Conclusion: The directionality of the proposed rehabilitation complex towards the common pathogenetic components of the development and progression of COPD and hypertension, as well as the high efficiency of the complex justify its appropriate inclusion in the combination treatment and rehabilitation of this category of patients.

Aim: To examine the incidence of polymorbidity (PM) and changes in its rates in 2003 to 2011 in cardiac and gastroenterologic patients living in the Novosibirsk Region and the Republic of Sakha (Yakutia) in accordance with gender, occupation, and residence., Subjects and Methods: The dynamics of PM rates was analyzed in 13 496 patients who had been examined and treated at the Cardiology and Gastroenterology Departments, Therapeutic Clinic, Research Institute of Experimental and Clinical Medicine (Novosibirsk), 2003-2011. The study used an archival research method and a statistical analysis of all nosological entities, groups, and classes in ICD-10, regardless of whether the diagnosis was primary or concurrent., Results: There was an increase in PM rates among the therapeutic clinic's patients of regardless of their gender and occupation. There were gender differences in the incidence of PM: its higher rates were noted in the women than those in the men among both the residents of the Novosibirsk Region and those of the Republic of Sakha (Yakutia). More significantly higher PM rates were registered in the male inhabitants of the Novosibirsk Region. There were also regional differences in the incidence of PM: its rates proved to be higher in the patients in the Republic of Sakha (Yakutia) than in those in the Novosibirsk Region in 2003-2007. At the same time, the growth rates for PM were more marked in the patients in the Novosibirsk region than in those in the Republic of Sakha (Yakutia); these differences levelled off in subsequent years., Conclusion: The findings indicate a pronounced increase in the incidence of PM in cardiac and gastroentorologic patients and determine a need to keep in mind the influence of gender, social, and regional factors on its development in order to create and improve a primary and secondary prevention, diagnosis and treatment system.

The study included 253 men aged 22 to 74 years. Was shown that at the end of the first period of middle age the accumulation of adipose tissue was enhanced that was associated with the change of dominance from the gynoid to the android type of obesity. The most pronounced increase in the frequency of occurrence of individual components and the overall metabolic syndrome was diagnosed in men in the second period of middle age with a following decrease in the frequency such components as hypertriglyceridemia, low HDL cholesterol and hyperglycemia in elderly age. In the all three age groups the value of the index of visceral obesity was significantly higher in men with android type of obesity compared with gynoid. Thus, the men with gynoid compared with android type of obesity have a lower risk of development metabolic syndrome in all age groups.

Assessment of the quality of life for male inhabitants of the Russian European North demonstrated decreased indices of physical health component (the scale of role functioning determined by physical condition) and mental health component (the scales of social functioning and role functioning determined by emotional state and mental health) compared to the inhabitants of Siberia as a comparison group. Men aged up to 29 had the highest values at all scales. The values decreased with age. The most prominent decrease was observed for the scales of general well-being and pain intensity. There was a moderate decrease for the scales of physical functioning, role functioning determined by emotional state, and role functioning determined by physical condition. Quality of life was closely related to self-reported health of northerners, pathological index, molecular marker of aging, and biological age. Negative correlation between these values implies the deterioration of physical and mental health with biological age. The quality of life for northerners also correlated with hormonal status. There was a relationship between testosterone and three scales of physical health components; between cortisol and one scale of physical component; and between both dehydroepiandrosterone sulfate and insulin and the scales of physical and mental components of health. The effect of various hormones on different age groups of northerners was demonstrated.

Diagnostically informative biochemical and coagulative correlators in various atherosclerotic lesions of carotid arteries are developed. It has been established positive correlation of the degree of stenosis and intima-media thickness of carotid arteries with the following biochemical parameters: total cholesterol, LDL cholesterol, Apo-B, Lp(a), triglycerides, hs-C-reactive protein(CRP), interleukines (IL-1ß and IL-6), fibrinogen, D-dimers. Negative correlation was stated with respect to HDL cholesterol, Apo-A-1, protein C. The established correlators of carotid intima-medial layer and the studied laboratory indices favour their inclusion into carotid atherosclerosis monitoring.

The effects of recombinant IL-2 on apoptosis of lymphocytes of healthy donors were studied in in vitro experiments. It was shown that the inductive and inhibitory effects of IL-2 on apoptotic process depend on the dose of the cytokine and cell microenvironmental conditions. Culturing of lymphocytes with recombinant IL-2 increases the percent of cells with reduced transmembrane potential, reduces the content of intracellular proteins Bcl-2, Bcl-X(L) and и Bax, and increases the level of Bad. The proapoptotic effect of this cytokine is realized with participation of nuclear transcription factor NF-κB and transcription factor P53.

We studied the in vitro apoptosis-inducing effect of recombinant TNF-α (rTNF-α) on blood lymphocytes from healthy donors. rTNF-α-induced apoptosis was accompanied by an increase in the number of cells with low mitochondrial transmembrane potential, increased intracellular content of reactive oxygen species, reduced content of Bcl-2, Bcl-xL, and Bax proteins, and elevated Bad content. The molecular mechanisms of these changes are discussed.

The expression of leukemia-inhibitory factor mRNA in human fetal tissues and mononuclear cells was studied during ontogeny. The expression of mRNA isoforms for leukemia-inhibitory factor was tissue-specific at the stage of prenatal development. The transition from antenatal and neonatal development to the postnatal period was accompanied by a decrease in the expression of mRNA isoforms for leukemia-inhibitory factor in mononuclear cells.

Apoptosis of blood neutrophils from healthy donors was studied under conditions of cell culturing with different concentrations of H(2)O(2), selective NO synthase inhibitor, and inductor of NO synthesis (L-arginine). In vitro incubation of neutrophilic leukocytes with 5 mM H(2)O(2) led to activation of the apoptotic program in neutrophils, which was seen from increased content of Bax protein in the cells and increased number of apoptotic cells in the culture. Increased content of annexin-positive cells after incubation of neutrophil culture with NO synthase inhibitor suggests involvement of NO in the regulation of neutrophil apoptosis under conditions of oxidative stress, while L-arginine prevented H(2)O(2)-induced programmed cell death.

Chronic viral hepatitis C is associated with decreased production of TNF-alpha by the peripheral blood mononuclear leukocytes irrespective of virus genotype and degree of the morphological activity of the process in the liver. This process positively correlates with the increase in the content of TNF-alpha soluble receptor (molecular weight 55 kDa), which can play a role in the mechanisms of immunopathogenesis of long persistence of hepatitis C virus in the body.

During recent 10 years (1990-1999) essential changes occurred the epidemiology of viral hepatitis A (VHA) in Estonia: simultaneously with a decreased level of morbidity (morbidity rate per 100,000 of the population was 78.4 in 1990 and 7.7 in 1996, or 1,241 and 112 cases, respectively), a shift in the age structure of patients from children of preschool age to older age groups took place. Everyday contacts were the main established route of VHA transmission in recent years, but in more than 80% of cases the risk factors of the virus transmission remained obscure. During the regional outbreak of VHA in North Estonia in 1998 (937 out of 989 cases registered in the country) a rise in morbidity was observed among young people aged 15-29 years, when a wide spread of parenteral viral hepatitides B and C and drug addiction were registered in this region. During this outbreak VHA was transmitted mainly through everyday contacts. Still the considerable prevalence of injection drug users who practiced the group use of syringes and needles and took drugs from common containers, a sufficiently high level of the mixed forms of the disease (more than 18% of all registered cases of VHA), detected for the first time, make it possible to suggest that the parenteral transmission route could appear among persons belonging to the above mentioned group. Vaccination is regarded as the most effective measure for the prophylaxis of VHA.

The functional metabolic activity of peripheral blood neutrophils in acute virus hepatitis B (VHB) and/or virus hepatitis C (VHC) was evaluated. 48 patients were examined; of these, VHB was diagnosed in 28 patients and VHC was diagnosed in 9 patients and the mixed form of virus hepatitis (VHB + VHC), in 11 patients. Determination of adhesive capacity of neutrophils, production of superoxidase anion in the nitro blue tetrazolium (NBT) test, activity of myeloperoxidase (MPO) and acidic phosphatase (AP), the amount of cation proteins (CP) was made. Most pronounced functional dysbalance of neutrophil leukocytes and considerable changes in biochemical characteristics of the activity of the infectious process in patients with the mixed form of virus hepatitis were established. These data demonstrated that in acute virus hepatitis B and C at the peak of the disease such characteristics of the functional activity of neutrophils as results of the NBT test, the activity of MPO and AP, as well as the amount of CP, were highly informative.

The etiological structure of viral hepatitides among the adult population of Tallinn and the occurrence of markers of hepatitis B and hepatitis C virus infections in medical workers, addict introducing drugs intravenously and hemodialysis patients were studied. Changes in the etiological structure of viral hepatitides were established: they took the form of a decrease in the level of hepatitis A morbidity and the considerable growth of the role of hepatitides B and C, as well as the newly detected circulation hepatitis D virus. About one-third in the structure of morbidity in viral hepatitides were hepatitis cases without markers of hepatitis A, B or C viruses (non-A, non-B, non-C). The highest rates of hepatitis B virus infection (78.9%) and hepatitis C virus infection (82.5%) were detected among drug addicts. Their level of HBsAg was 8.8%. In the group of medical workers, 25% of the examinees, i.e. every fourth person, had markers of hepatitis B virus, while antibodies to hepatitis C virus were detected in 5% of cases. Among hemodialysis patients these rates were 21.4% and 10.7% respectively.

Among the first detected patients, there was a reduction in the proportion of subjects with posttuberculous changes in the lung decreases in the presence of the deteriorating epidemiological situation. Risk factors of social diseases are of much importance in the development of tuberculosis at present. Infiltrative processes with lung tissue destruction and bronchogenic dissemination are essential in the clinical pattern of the disease. Exogenous infection and superinfection play an important role in the pathogenesis of tuberculosis. For most patients with tuberculosis without residual changes in the lung, the optimum hospital stay is 6 months and the total duration of a basic treatment regimen is 1-1.5 year. To reduce the time of treatment in patients with tuberculosis developed in the presence of residual changes in the lung is now inadvisable.

Implantation of the chondrogenesis inductor (demineralized osseous powder) into the subcutaneous fat in the area of the rat lower extremity muscles caused clear histological, histochemical and ultrastructural manifestations of ectopic chondrogenesis in certain zones of close contact with the inductor. Fibrogenic mesenchyme cells and fibroblasts proliferating by the glottis between the 6 th postoperative day and forming the bands, invading the glottis between the inductor granules were probably the object of chondrogenic transformation. Stages of these cells chondrogenic differentiation, hyaline cartilage forming and manifestations of its following ossification were followed up. The process of the induced ectopic chondrogenesis after fibrogenic cells transformation into chondroblasts passes the stages similar to that of the cartilage embryogenesis.