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Introduction. Esthesioneuroblastoma is a rare neuroectodermal malignant tumor. The incidence of this tumor in children under 15 years of age is 0.1 per 100,000 pediatric population. The information on incidence, disease course, and treatment of esthesioneuroblastoma in children vary significantly and depend on the follow-up period and statistical methods.Objective – to assess risk factors for esthesioneuroblastoma and evaluate treatment strategies used in children and their prospects.Materials and methods. This study included 29 patients aged 2 to 17 years diagnosed with esthesioneuroblastoma and treated at the Research Institute of Oncology and Hematology, N.N. Blokhin Russian Cancer Research Center, Ministry of Health of Russia between 1969 and 2019. The median age upon diagnosis was 10 years. Six patients (20 %) developed the disease early in their life (being under 3 years of age). Esthesioneuroblastoma was equally common in boys and girls. More than half of the patients (n = 15; 51 %) had stage IV disease. The primary tumor invaded the maxillary sinus (n = 25; 86 %), orbit (n = 10; 34 %), ethmoid sinus (n = 18; 62 %), and cranial cavity (n = 12; 41 %). The majority of children (n = 28; 96 %) received pharmacotherapy and radiotherapy (n = 27; 93 %); the total focal dose was 50 Gy in case of primary tumor. The affected cervical lymph nodes were irradiated in 10 (35 %) patients (total focal dose 40 Gy). Ten (35 %) patients have undergone surgery.Results. The follow-up period varied between 3 months and 50 years. Nine (34 %) patients are still alive. Fourteen patients (48 %) died due to tumor progression; 1 (3 %) patient died due to complications from special treatment. Five (17 %) patients were lost to follow-up at different stages.Conclusion. The following risk factors were associated with poor prognosis in children with esthesioneuroblastoma: disease onset in early childhood, no adequate diagnosis of distant metastases prior to specific treatment initiation, disseminated disease, and high Ki-67 index. In patients with advanced cancer, surgeries were effective only in combination with chemoradiotherapy. Long-term treatment outcomes in children with esthesioneuroblastoma are poor due to high risk of recurrence and tumor dissemination.

The objectives of physical rehabilitation are restoration of the activity of the cardiovascular system, prevention of recurrent myocardial infarction and other complications, adaptation of the patient’s body, with a previous myocardial infarction, to the usual daily stress. In our study, we carried out medical rehabilitation (MR) to patients with myocardial infarction using the methods of therapeutic physical activity through terrenkur, scandinavian walking, mechanotherapy.

Maternal diabetes mellitus (DM) is a chronic disease that carries significant risks for the fetus and newborn. Hyperglycemia during pregnancy contributes to the development of structural heart defects, myocardial hypertrophy, and impaired cardiac function in newborns. The objective of the study was to evaluate the echocardiographic parameters of the cardiac function in children born to mothers with type 1 diabetes mellitus (DM1).A prospective study of 163 newborns was conducted on the basis of the Republican Scientific and Practical Center “Mother and Child”. The children were divided into 2 groups. The main group consisted of 107 children born to mothers with DM1 (Gr1), the control group – 56 healthy infants born to women with normoglycemia during pregnancy (Gr2).It was found that a newborn in Gr1 has a larger thickness of the interventricular septum (IVS) (p < 0.001), the posterior wall of the left ventricle (p < 0.001), and the size of the right ventricle (p < 0.001). It was revealed that in Gr1 the frequency of myocardial hypertrophy with an interventricular septum thickness of 5 mm or more is 30.8 %, which is statistically significantly higher in comparison with Gr2 (1.8 %, F = 0.115, p < 0.001). When assessing the blood flow using a pulse-wave Doppler study, the manifestations of the diastolic dysfunction in Gr1 were revealed. The E/A ratio for the flow through the mitral valve in Gr1 was 0.9 (0.8–1.1), in Gr2 – 1.2 (1.0–1.4), p = 0.043. The study confirmed a lower frequency of registration of myocardial hypertrophy with good glycemic control during pregnancy (p < 0.05). Direct correlations between the average level of glycated hemoglobin in mothers and the IVS thickness (r = 0.374, p < 0.05) and the posterior wall of the left ventricle (r = 0.293, p < 0.05) of their newborns were observed in infants in Gr1.The use of pump insulin therapy in pregnant women with type 1 diabetes allowed a statistically significant reduction in the frequency of hypertrophy of the left ventricle in infants in the neonatal period.Diabetes mellitus type 1 in the mother determines not only the risk of congenital heart defects, but also hypertrophic changes in the myocardium, contributes to the diastolic dysfunction in this group of children. The achievement of target levels of glycated hemoglobin during pregnancy, using pump insulin therapy, provides a lower frequency of registration of ventricular septal hypertrophy. The revealed statistically significant differences in the IVS thickness and the posterior wall of the left ventricle in infants born to mothers with type 1 diabetes should be taken into account by doctors in the system of organizing medical care in inpatient settings and at the stage of dispensary observation.

Dysferlinopathies belong to a phenotypically heterogeneous group of neuromuscular diseases caused by mutations in the DYSF gene, which disrupt the expression of dysferlin protein in human skeletal muscle cells. These pathologies are of an autosomal recessive inheritance pattern, their prevalence is 1: 200000. Dysferlinopathies include diseases such as Miyoshi myopathy with primary lesion of the distal fragments of the lower extremities and limb-gridle muscular dystrophy type 2B with primary lesion of the proximal fragments of both the lower and upper limbs, also distal myopathy with anterior tibial onset (DMAT). Nowdays, there are various pathogenetic and symptomatic treatments for hereditary muscular dystrophies but there are very few registered drugs for the etiological treatment of these diseases. This review discusses the main modern methods of gene therapy that can be used to treat dysferlinopathies, such as stop-codon passing, exon skipping, overexpression of other genes, gene transfer, splicosome-mediated trans-splicing, and also describes the latest experimental studies using these methods. In conclusion, exon-skipping and trans-splicing have been identified as the most optimal approaches in the treatment of muscular dystrophies, in particular dysferlinopathies.

Aim. To study the prevalence of comorbidity affecting the choice of antihypertensive treatment, as well as the efficacy and safety of the application of a single pill combination of lysinopril, amlodipine and rosuvastatin (SPC LAR) in hypertensive patients.Material and methods. Observational epidemiological study with the participation of 626 doctors and 13037 hypertensive patients with high cardiovascular risk and dyslipidemia treated with SPC LAR were held in 24 cities of Russia from November 2020 to March 2021. Prevalence and types of comorbidity, changes of blood pressure (BP), of total cholesterol (TC) and blood glucose levels and adverse events were studied during observation. Patients had 3 visits – initially, after 4 and 12 weeks. The obtained data was recorded by doctors through a web portal.Results. Concominant cardiovascular diseases found in all patients (in 38.7% of cases – from 2 to 5 diseases). The most commonly diseases were coronary artery disease (43.1%), metabolic syndrome (36.6%), diabetes (25.2%), chronic heart failure (24.9%), cerebrovascular diseases (12.3%) and chronic obstructive pulmonary disease (0.5%). SPC LAR with minimal doses of components (in 41.1% of patients) or with reinforced antihypertensive or hypocholesterolemic effects, based on the experience of treatment, the patient was prescribed as starting treatment with doctors. Reducing the level of systolic and diastolic BP, as well as the level Tc, respectively, by 20.9%, 16.9% and 29.7% found during the study. Target levels of systolic BP were achieved in 97.6% of patients, diastolic BP – in 99.6%, and target levels TC ≤5 mmol/l, ≤4 mmol/l and ≤3 mmol/l were achieved, respectively, in 94.5%, 68.6% and 23.5% patients. No significant dynamics of the level of glycemia were not found. The treatment was well tolerated by patients. Side effects found in 0.53% of patients (more often there was a dry cough, feet edema and headache). Commitment to treatment was 92.7%.Conclusion. The modern hypertension phenotype has cardiovascular atherosclerosis-associated diseases, which justifies the need to combine antihypertensive and hypolipidemic therapy. Triple SPC LAR, which effectively controlled the blood pressure and improved the violation of lipid metabolism was prescribed to patients in this observational study. The low frequency of side effects and good tolerance of treatment was accompanied by a high adherence of patients to treatment.

Purpose: to evaluate the prospects of customized Finalfit based ablation for optical rehabilitation of a patient with corneal surface errors caused by intrasurgical microtome-induced damage of a corneal flap during a LASIK excimer laser correction of vision.Material and methods. In Helmholtz Center, a patient with such damage was given a phototherapeutic keratectomy (PTK) combined with topographyguided photorefractive keratectomy.Results. In two months after the surgery, the patient’s uncorrected visual acuity rose from 0.15 to 1.0; the spherical component of refraction changed from -3.5 to +1.0 D, the cylindrical component of refraction fell from 1.75 to 0.25 D. Aberrometry demonstrated a decrease of RMS from 2.19 to 0.61 D, Total HOAs from 2.281 to 0.829; Tilt from 0.406 to 0.313; HOA from 1.152 to 0.247, Coma from 0.298 to 0.124, Trefoil from 1.088 to 0.094, SA from 0,127 to 0,021.Conclusion. The clinical case demonstrates the expediency and efficiency of corneal remodeling for the rehabilitation of induced errors of the corneal surface by excimer laser correction of vision based on PTK (Flex scan) + FinalFit after corneal refractive surgery.

Summary. The purpose of the study is - To improve the results of treatment of patients with purulent long-term non-healing wounds of the lower extremities using the method of local negative pressure.in purulent long-term non-healing wounds (PLTNHW). Objectives of the research — according to the clinic’s data, to study the features of the course of the wound process and the microbiological characteristics of purulent long-term non-healing wounds of the lower extremities when exposed to the wound surface of local negative pressure. Conclusions. The use of the local negative pressure method in the complex treatment of patients with purulent long-term non-healing wounds of the lower extremities helps to reduce the duration of the phases of the course of the wound process, early tissue decontamination and a rapid reduction in the size of wound defects.

The Kasabach–Merritt phenomenon is a rare thrombocytopenic consumption of coagulopathy that occurs against the background of such vascular anomalies as kaposiform hemangioendothelioma and giant angioma. Timely diagnosis and treatment of Kasabach–Merritt syndrome which includes therapy for vascular tumors and life‑threatening conditions are critical in resolving this rare vascular anomaly. The aim of the study is to analyze radiation therapy as salvage therapy for kaposiform hemangioendothelioma and giant angioma associated with the Kasabach–Merritt phenomenon.

Objective. Determination of clinical efficacy of the mesenchymal stem cells transplantation in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus. Materials and methods. There were examined 11 patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus Type II with purulent-necrotic processes of the foot, in whom conditions for the direct revascularization of extremity were absent. Microbiological monitoring for the wound discharge, determination of the ankle brachial index and transcutaneous oximetry was performed. The technology elaborated have consisted of two stages. On the first of them a purulent focus sanation (in all the patients the distal amputations of the foot, preserving arterial arch) was done. On the second stage the therapy of the wounds was conducted, using negative pressure, injections of cellular suspension (mesenchymal stem cells) while applying long fine cannula under aponeurosis into the muscles along obliterated vessels in the (10 ± 5) ml quantity with subsequent closure of the wound surface, using fibroblastic matrix. Results. In a year after the treatment critical ischemia in 1 patient was noted, the ischemia Grade III - in 3, and in 7 a IIB Grade have persisted. Conclusion. Performance of indirect revascularization, using autologous mesenchymal stem cells, constitutes an effective and secure procedure.

The article discusses problems of early diagnosis and, accordingly, treatment of hepatorenal syndrome (HRS) in case of obstructive jaundice of blastomatous origin. The results of a comprehensive examination of 37 patients with blastomatous obstructive jaundice (OJ) with clinical and laboratory signs of HRS were analyzed. Patients were evaluated for clinical and biochemical parameters of blood and urine, blood electrolytes, indicators of the blood coagulation system according to unified methods. The main work is devoted to the determination of the biomarker of renal tubular damage, neutrophil-gelatinase-associated lipocaine (s-NGAL) as a marker and indicator of HRS severity, careful and detailed analysis, monitoring of levels (s-NGAL) and other bioactive substances as an indicator of treatment efficacy. Introduction of active ultrasound as a replacement for contrast computer tomography to reduce the load on precompromised kidneys. It has been proven that the level of renal tubular damage, neutrophil-gelatinase-associated lipocaine s-NGAL is an early marker of renal damage whose function is to reduce the severity of damage to the proximal tubules of the kidneys, normalize damaged tissue by participating in apoptosis, increase survival of damaged restoration of damaged epithelium, stimulation of differentiation and structural reorganization of renal epithelial cells. The fact that s-NGAL was not significantly reduced in the stage of recovery of diuresis, confirms the presence of patients with blastomatous MF severe and persistent toxic tubulointerstitial disorders. Based on this determination of the biomarker (s-NGAL) in the serum of patients with blastomatous mechanical jaundice and performing in them at primary ultrasound color Doppler mapping and pulsed wave Doppler imaging of the kidneys with the calculation of the resistance index may serve as early signs of damage.

During pregnancy, the cardiovascular system functions with an increased load. These changes are of a pronounced adaptive nature and provide optimal conditions for the transport of oxygen in the placenta and vital organs of the mother. According to domestic and foreign researchers, 20% of women during pregnancy are first diagnosed with a violation of blood pressure, which negatively affects both the health of the pregnant woman and the fetus. In this regard, for effective pre-gravidar preparation and minimizing the risks of cardiovascular complications, there is a need to develop criteria for pre-nosological diagnosis of various blood pressure disorders in women of reproductive age. The study made it possible to study the indicators of the cardiovascular system at rest and after stress testing in women with different levels of habitual motor activity. As a result, women with low and high habitual motor activity were assigned to the risk group for the development of arterial hypo - and hypertension. The results obtained are the basis for identifying criteria for prenosological diagnosis of early blood pressure disorders.

Summary. Purpose. The improvement of the treatment effect of patients with a decompensated form of the chronic venous insufficiency. Reduction of the reatment period in a hospital by application of the complex treatment. Materials and methods. The work was based on the studies of 24 patients who had trophic ulcers on the lower leg. All patients have undergone combined treatment, including scleroobliteration of perforating veins, phototherapy, platelet-derived growth factor, the use of wound closure with a heterograft. Results and discussion. The combined use of phototherapy and platelet-derived growth factor has significantly reduced the duration of all phases of the wound process. The ultrasound-controlled scleroobliteration has helped to remove a pathological reflux in the insolvent tibial perforators. The studies have shown that the use of phototherapy in the treatment of trophic ulcers with the application of the heterograft has contributed to the rapid cleansing of wounds, accelerating the appearance of granulations and epithelialization, has reduced the need for antibacterial therapy and is an alternative to autodermoplasty. Conclusions. The use of the offered technique allows to reach optimum restoration conditions of the affected fabrics trophism, leads to the decrease in the number of complications and reduces the hospitalization period.

Our research goal was to reveal peculiarities related to changes in endothelin-1 contents in blood serum in young and middle-aged people exposed to occupational noise and industrial welding and silicon-containing aerosols with fibrogenic effects. Another goal was to establish a correlation between endothelin-1 contents and blood pressure, body mass, and dyslipidemia. We examined workers employed at a metallurgic plant in Nizhniy Novgorod region. Endothelin-1 concentration in blood serum was determined with «Endothelin (1-21)», a reagent kit for ELISA produced by «Biomedica Medizinprodukte GmbH & Co KG» (Austria). We detected certain group differences in endothelin-1 contents in blood serum and frequency of its elevated concentrations between workers who had to work under different working conditions. We established a direct correlation between endothelin-1 and blood pressure, total cholesterol, and body mass index. Elevated endothelin-1 contents in people suffering from arterial hypertension can indicate a higher risk of complications this disease might have. People who have elevated endothelin-1 contents but normal blood pressure, total cholesterol within physiological standard and normal body mass index can be recommended to have regular medical check-ups focusing on functional state of their cardiovascular system; endothelin-1 in this case should be considered a risk factor that might cause cardiovascular pathology occurrence. An individual approach is required when assessing elevated endothelin-1 contents and probable use of this parameter as a risk factor that might cause cardiovascular pathology in young and middle-aged people employed under hazardous working conditions.

Objective. The aim of the study is to investigate the peculiarities of changes in the immune status of individuals with active and latent forms of herpesvirus infections. Herpesvirus infections are an urgent problem of modern health care. Materials and methods. The prospective longitudinal cohort study included 92 permanent blood donors who were examined twice at 6-month intervals for the presence of specific IgM and IgG antibodies and antigens of herpes simplex viruses 1, 2, Epstein-Barr, cytomegalovirus, human herpesvirus type 6, as well as humoral immunity indicators. Results. In the period from October to April, 68.5 % of blood and its components donors were found to have markers of active herpesvirus infection caused by HSV 1, 2, EBV, CMV, and HHV6. The combination of the detected markers in the absence of clinical manifestations and changes in General and biochemical blood tests indicated asymptomatic reactivation of latent infection. The frequency of reactivations in the autumn and spring months is the same. The absence of IgG production after asymptomatic reactivation of HSV-2 and HHV-6 infections and an increase in IgG concentrations to HSV-1, EBV, and CMV were revealed. EBV infection is the most common among the studied nosologies (98.91 %) and is characterized by statistically significantly higher levels of specific IgG. The effect of asymptomatic reactivation of herpesvirus infections on the levels of total IDA, IgM, IgG, IDE, and CEC was not established. Conclusions. Asymptomatic reactivation of herpesvirus infections does not significantly affect the changes in immune status indicators, and the absence of clinical manifestations, and significant changes in General and biochemical blood tests cause epidemiological risks associated with difficulties in identifying the sources of infection.

The purpose of this review is to characterize the current epidemiological and epizootiological situation in natural foci of hantavirus diseases in different regions of the world, and to analyze the literature data available. Currently, hantavirus diseases are a very urgent threat to the sanitary and epidemiological well-being of the population around the world, which can cause serious complications of the epidemiological situation. About 200 thousand cases of the disease are registered every year around the world, while the intensity and dynamics of the incidence varies significantly in different regions of the world. While in China – the country with the largest annual number of cases worldwide – the overall dynamics of the incidence has a downward trend, which is apparently due to the widespread use of specific disease prevention tools; the number of cases in European countries, on the contrary, shows a clear increase. In the Russian Federation, hemorrhagic fever with renal syndrome (HFRS) is currently the most common natural-focal disease of viral etiology. Data on the prevalence of hantavirus infection in the regions of South-East Asia and the African continent require further investigation, but it is quite obvious that hantavirus infection is a very underestimated public health issue in these regions, and its scale, due to the wide spread of carriers, may be much more considerable than is currently known.

The study and analysis of the treatment outcomes were carried out in 69 patients aged from 40 to 85 years (mean age 53.0±1.0) who had tumours of the body or cardiac part of the stomach T3-4 (according to the UICC classification (ninth edition, 2014)). The distribution of patients according to the localization of tumour lesions in the stomach was as follows: 43 (62.3%) cases found in the body region and 22 (31.9%) found in the proximal section (of which 14 (20 3%) were in the cardia (Type III according to Siewert J.R.), 8 (11.6%) patients had the transition to the abdominal oesophagus (type II according to Siewert JR), 4 (5.8%) patients had the tumour located in the stump of the resected organ. Histologically, the vast majority of neoplasms were represented by adenocarcinoma (94.8%). All other types of tumours made up for 5.2%. The patients received photodynamic therapy with the Photolon photosensitizer and subsequent irradiation with a laser with a wavelength λ = 0.67 μm crossed irradiation fields, which was introduced through the biopsy channel of the endoscope. The light dose and the number of irradiation sessions were determined depending on the degree of damage to the oesophagus and stomach (from 4 to 7 sessions). The light dose of the session was up to 200 J. The power density of the laser radiation is 25 mW/cm2. Endoscopic photodynamic therapy can be used at the stage of combined treatment in combination with chemotherapy and surgery and is an effective means of preventing the failure of the oesophageal-small intestinal anastomosis in the early postoperative period. Due to photodynamic therapy in the preoperative period, the number of complications in the early postoperative period has significantly decreased. The leakage of the oesophageal-intestinal anastomosis developed in 4 cases, which make up 5.8%.

Malignant tumors of parameningeal localization are various morphological neoplasms located in the nasal cavity, nasopharynx, paranasal sinuses and middle ear. As a result of tumor growth, conditions are created for the development of chronic inflammation. Studies of the microbiome of the upper respiratory tract in children with malignant tumors were practically not conducted. Objective of the research: to identify changes in the microbiome of the nasal cavity in children with malignant tumors of parameningeal localization during chemoradiotherapy. Materials and methods: the study included 29 patients with parameningeal tumors, 2–17 years old. Among the included in the study there were 18 boys (62%) and 11 girls (37%). Morphologically, the following were verified: embryonic rhabdomyosarcoma (ERMS) – 17 (58%), alveolar rhabdomyosarcoma (arms) – 3 (10%), other sarcomas – 4 (13%), nasopharyngeal cancer – 5 (17%). All patients received induction chemotherapy. Simultaneous radiotherapy (LT) and chemotherapy (CT) – in 24 (82%) cases. After completing the chemoradiotherapy stage, consolidation therapy continued in 20 (70%) patients. Results: before the start of LT (after the induction stage of chemotherapy), a variety of microflora was observed in the nasal secretions, gram-positive and gram-negative bacteria were isolated in an equal ratio. The absence of growth of microorganisms was determined in 4 (13%) cases before the start of LT. Methicillin-resistant Staphylococcus epidermidis and Staphylococcus haemolyticus were more frequently detected after LT. Colonization of the nasal cavity of Candida albicans occurred before the start of LT in 4 (13%) and persisted after irradiation in 5 (17%) patients. In the delayed period, there was an increase in the percentage of patients who ridiculed gram-negative microorganisms – Pseudomonas aeruginosa in 4 (13%) cases. After 12 months, 3 (10%) patients showed a return of nosocomial flora (S. epidermidis MRSE and S. haemolyticus MRS), a decrease in colonization of P. aeruginosa and the preservation of C. albicans. Conclusion: at different stages of chemoradiotherapy, the nasal mucosa is colonized by various microorganisms that differ in their properties and pathogenicity. The continuation of this study will clarify the clinical significance of certain types of opportunistic microorganisms in the pathogenesis of inflammatory diseases of the upper respiratory tract in children with malignant tumors.

We analyzed treatment outcomes in patients with pelvic organ prolapse (POP), some of whom had signs of undifferentiated connective tissue dysplasia (uCTD). Women from subgroup 1 used a pessary, while women from subgroup 2 underwent electromyostimulation in an outpatient department and performed Kegel exercises. After two treatment courses and pharmacotherapy, all patients demonstrated positive dynamics. Electrostimulation in combination with Kegel exercises was more effective than pessary; the effect was more pronounced in women without uCTD than in patients with uCTD. The results of our study were used for the development of a scale to assess POP severity, which enables a tailored approach to the diagnosis and management of such patients depending on the presence of uCTD.

The article describes the current understanding of the takotsubo syndrome concerning the issues of pathogenesis, differential diagnosis with acute coronary syndrome and strategy of management. There is presented our own clinical observation of a patient with an atypical form of cardiac dysfunction and myocardial geometry.

The article contains a literature review devoted to research on the influence of odours on physiological, emotional, and cognitive aspects of human health. The following databases were used at literature search execution: Pubmed, Scopus, Web of Science, MedLine, Global Health, Russian Research Citation Index. A total amount of 60 sources was analyzed for 1983-2019. The experimental research results aimed at studying the influence of odours on such physiological indices a: heart rate, heart rate variability, arterial blood pressure, respiratory rate, skin conductibility reaction, sleep, are described, and emotional and cognitive characteristics of the test subjects. The response to odours exposure was shown to depend on their intensity, hedonistic tone, the chemical structure of the odorant, as well as individual peculiarities of the test subjects, including their past experiences with smelling. In most cases, exposure to unpleasant odours activates the sympathetic nervous system, therefore heart rate, respiratory rate, skin blood circulation and its conductivity increase. Attention concentration increases at the deterioration of cognitive functions. Anger and repulsion reactions are noted at the emotional level; a feeling of discomfort with a motivation to escape appears. The exposure of pleasant odours leads to parasympathetic nervous system activation, heart rate, respiratory rate, skin conductibility, and blood circulation decrease. Cognitive functions improve, the quality of problem-solving increases, attention concentration decreases. A person’s mood gets better; the sensation of happiness appears. At that literature analysis has revealed most of the studies on the human to have significant restrictions: standard exposure methods absence, the difficulty of execution blind experiments that were deemed to be ignorant by test subjects as well as the influence of individual preferences and previous personal experience on the effects generated by the odour. The authors proposed recommendations on the current restrictions prevention and optimization of conducting the experimental research on the influence of odours on humans.

Objectiveis to reduce the risk of infection of people with plague in the territory of a natural focus on the basis of the targeted public health educational work with risk groups.Materials and methods. In 2017, 30 visits were made by epidemiological groups to livestock farms in the epizootic zone to inform the population about the existing risks of plague infection and to conduct interviews to assess the level of alertness regarding the risk of the disease. Work was carried out with risk contingents with coverage of 1652 people (81% of the total number of people living in livestock camps).Results. It was found that 64% of the respondents knew about the danger of plague infection in the region. 91% are aware of the role of marmots in infecting people with plague. 96.3% of respondents are aware of the ban on hunting groundhogs, while 39% continue to prey upon the grey (Altai) groundhog. The identified gaps in the population’s alertness regarding the risk of plague infection were eliminated through active sanitary and educational work with the population.Conclusion. Direct work with the population, anti-epidemic groups, significantly affected the provision of epidemiological welfare as regards plague, which is confirmed by the absence of human plague cases in the natural focus in 2017-2019.

Introduction. In recent years, more and more attention has been paid to the issues of genital prolapse. This is largely due to the increase in women life expectancy and the need to provide them with a decent quality of life, as prolapse is quite often accompanied by dysfunction of the pelvic organs. In recent years, there has been an increasing amount of literature on undifferentiated connective tissue dysplasia (UCTD). However, most of these studies consider therapeutic or vertebro-neurological problems, while the high prevalence rates of this pathology call for additional research on the pathogenetic mechanisms of the effect of UCTD on pelvic organ prolapse, which will allow us to decide on the choice of subsequent treatment.The purpose and objectives. Asess the effect of undifferentiated connective tissue dysplasia (UCTD) on the formation of disorders of the somatic, gynecological and reproductive health status in women with genital prolapse.Materials and methods. To achieve this goal, we examined 204 women with genital prolapse in the POP-Q classification of stage 2–3, of which 97 were diagnosed with UCTD (the main group), and the remaining 107 patients made up the comparison group.Results. To evaluate the influence of UCTD on the formation of somatic, gynecological and reproductive health disorders in women with genital prolapse. We analyzed anamnestic indications for somatic, gynecological and reproductive pathology of women, as well as assessed the current state of health of patients with genital prolapse. It was found that it is UCTD that determines the development of a particular form of gynecological pathology and affects the formation of genital prolapse.Conclusion. UCTD manifests as various forms of somatic and gynecological health disorders throughout the life of women with genital prolapse.

The article presents the issues of assessing the level of safety of pharmacotherapy of chronic diseases of the mental group in a single subject of the Russian Federation. It was found that in the Pskov region, when subsidized drug provision for mental illness is financed from the Federal and regional budgets, epilepsies and schizophrenia are the most expensive. The frequency analysis of the occurrence of side effects when taking psychotropic drugs and their systematization by type A — predictable and type B — unpredictable reactions were performed. It is established that adverse reactions are most often encountered when using anticonvulsants.

The purpose of the study: analysis of medical and social problems and factors affecting the availability and compliance of a gluten-free diet, based on a survey of parents of children with celiac disease living in southern Russia. Purpose of the Study: Analysis of the medical and social problems and factors affecting the availability and adherence to the gluten-free diet based on the results of the questioning survey of the parents of children with celiac disease that are residents of the south of Russia. Children Characteristics and Study Methods. The study include 200 families that bring up the children with the celiac disease at the ages from 10 months to 18 years. The patients included 116 (58%) girls and 84 (42%) boys. The medical and social issues were studied using the developed questionnaire consisting of the open questions and intended as self-administered by the patient parents. Results. 87% of the families noted the significant difficulties in adhering to the diet, 75% were forced to refuse to travel with children, 56% of the surveyed were unable to visit the public spaces, restaurants, and 90% indicated the impossibility and difficulties in purchase of the gluten-free products. The strict adherence to the diet at school age is much worse. The main reasons for the deliberate non- adherence to the gluten-free diet are the high cost of food, lack of funds to purchase it. The patient families spend RUB 8,000– 9,000 per month in average to purchase the gluten-free products. There is a great demand of patients for the imported products with the relevant quality marks. The psychological symptoms were noted in the patients with celiac disease in response to the introduction of the gluten-free diet, manifested by the depression, aggression, irritability, high level of the anxiety. Conclusion. The main difficulties faced by the families that bring up the children and adolescents with the celiac disease include the social and psychological maladjustment of the patients, reduced finances, search and purchase of the high-quality gluten-free products and the necessity to adapt the child and family members to the dietary habits.

The aim of the study was to improve the results of treatment in patients with chronic venous insufficiency with trophic ulcers due to the use of artificial wound dressings and platelet-rich growth factors. The study included 34 patients who had trophic ulcers on the skin of the lower leg (n/3 and c/3). Group I (comparisons) included 11 (32.4%) patients who received conventional treatment; in the second group - 23 (67.6%) patients who underwentcomprehensive treatment according to the method developed by us. The criteria for the study was the presence of trophic ulcers of the leg, which were unhealed for a long time; the presence of posttroflebitic disease; preserved pulsation on the arteries of the limbs. Patients were treated with trophic ulcers by phototherapy, by scleroobliteration of insolvent perforant,and by closing the wound defect with a synthetic wound cover. In all patients of the main group, the treatment time did not exceed 39 days. In the comparison group, this indicator ranged from 28 to 53 days (depending on the area of wounds and the characteristics of thecourse of the wound process).

The paper considers the results of therapy of clinical manifestations of genital prolapse using electromyosymmulation and Kegel exercises. The obtained data allow us to consider this type of conservative treatment quite effective. This therapy can be recommended for women with contraindications to surgical correction of prolapse.

Diabetic macular edema (DME) continues to be an important problem of modern ophthalmology and endocrinology. Therisk of edema is higher in patients with type 2 diabetes. Thus, this is the main cause of irreversible vision loss in these patients. DME is one of the prognostically unfavorable and difficult to treat manifestations of diabetic retinopathy. As themain cause of vision loss in diabetic patients, diabetic macular edema is often not diagnosed immediately, which causes difficulties in the treatment of pathology. Thus, early diagnosis and timely treatment of this disease is the key to successfully counteract the uncontrolled decline in the patients visual functions. In this article, the team of authors highlighted the possibilities of informative instrumental research methods available in the Arsenal of modern ophthalmological services. Based on the analysis of modern literature, the main principles of these diagnostic methods were indicated, their key capabilities and limitations compared to each other were highlighted. Knowledge of these characteristics is, in our opinion, an integral and most important tool in the Arsenal of a practicing ophthalmologist who supervises patients with this pathology.

Objective. To investigate in experiment a functional state of mitochondria from the brain cells after its acute ischemic injury and processes, which take place in the brain in conditions of experimental ischemia/reperfusion; to analyze a correlation of the states investigated with the ischemic-reperfusion changes in the brain of patients, having the aortal arch aneurism, operated in environment of hypothermia and artificial cerebral perfusion. Materials and metods. First stage of the investigation consisted of estimation of the cerebral cells mitochondria state in conditions of ischemia/reperfusion of the neurons primary culture, obtained from embryos of rats of the 17 - 18 gestation days, using mechanical and the enzyme dissociation in the brain cortex. The second stage of the investigation was conducted on 14 white male rats (Rattus norvegicus). In 7 animals ischemia/reperfusion of the brain was simulated, using temporary mechanical blockade of blood flow along vessels of aortal arch with its subsequent restoration, as following: thoracotomy was performed along lower edge of the third rib, making surgical access to aortal arch and main vessels with their mechanical occlusion during 30 min. Additionally in 7 experimental animals thoracotomy only without impact on cerebral blood flow was performed. After extraction of animals from the experiment the blood was collected from the heart cavities, the brain was extirpated from the skull in accordance to standard method. After finishing of the experiment MTT-test was accomplished for estimation of vital capacity of the brain neurons. The principal parameters of the mitochondria functioning and velocity of their respiration in States II and III were estimated in accordance to Chance and in a respiratory control - a ratio of respiration velocity in a State III towards respiration velocity in a State IV in accordance to Chance. Transmembranous mitochondrial potential in cellular suspension, consisting of cells of the brain. Activity of lactate dehydrogenase in the culture environment was determined. Immunohistochemical investigation of the neurons culture was conducted. Membranous mitochondrial potential was estimated in the neurons cultivated. Respiration of isolated mitochondria was measured. Energetic state of mitochondria was determined. The development degree of apoptotic processes was determined in accordance to the DNA fragmentation degree. Results. There was established, that index of respiratory control of mitochondria from the ischemized brain, measured in pH 7.4, was lowered more than by 40%, comparing with corresponding index of mitochondria, obtained from a control culture. Velocity of a completely stimulated respiration of mitochondria (State III), which were extracted from the brain in 24 h after ischemia/reperfusion, was significantly lower, than velocity of respiration in mitochondria of control cultures, witnessing presence of damage in respiratory chain and transition of electrons of cerebral cellular mitochondria in ischemia/reperfusion, as well as incapacity of such mitochondria to transit electrons effectively from oxidation substrate towards oxygen due to damage of some complexes of the electron-transporting chain. Thus, in conditions of ischemia several processes, impacting mitochondrial functioning and cellular bioenergetics, occur simultaneously. Due to simultaneous action of these processes the mitochondrial functioning fails so significantly, that becomes one of the key moments in cerebral cellular dysfunction and death. Statistically meaningful difference, taking into account the results, between two groups of investigated animals was not revealed. Conclusion. In environment of ischemia/reperfusion of the brain in its cells a significant disorders of mitochondrial function occur, which are demonstrated by raising of generation of the oxygen active forms, and by lowering of transmembranous mitochondrial potential and velocity of mitochondrial respiration by 40%, what is accompanied by development of lactate-acidosis. It is expedient to apply a mitochondria-directed antioxidants in complex of the treatment measures in the brain ischemia/reperfusion, as well as desintegrators of respiration and oxidated phosphorilation.

Objectiveof the study was to identify epidemiological peculiarities of HFRS outbreak in the territory of the Saratov Region in 2019 and to determine the key factors contributing to the intensity of epidemic process.Materials and methods.Analyzed are the data on 2702 cases of HFRS registered in the territory of the Saratov Region in 2019, obtained from the Rospotrebnadzor Administration in the Saratov Region and Center of Hygiene and Epidemiology in the Saratov Region. The basic method of investigation was epidemiological one with application of advanced information technologies.Results and discussion.Retrospective analysis of epidemic HFRS manifestations in the Saratov Region showed that HFRS outbreak of 2019 was the largest over the period of disease reporting, both by the number of cases (2702) and by the duration. Early onset of increase in the incidence (may) and allocation of the majority of cases to the territory of the natural park “Kumysnaya Polyana”(75 %) should be considered as characteristic features of the outbreak. We have conducted epidemiological zoning of the Saratov Region allowing for dividing the Region into four types of territories which differ by the level of risk of HFRS exposure (very high, high, medium, and low), as well as distinguishing the most hazardous in terms of HFRS infection territories of Saratov. The key factors affecting the surge in HFRS cases were high numbers of infected rodents during spring months of 2019 due to mild and extremely snowy winter of 2018–2019; reduction in forest engineering works aimed at turning the focal territory into aesthetic forestry. The change in the character of exploitation of 9 % of the natural park “Kumysnaya Polyana” resulted in the increase of population contacts with natural-focal complexes. Mass visits to natural focus during early spring period against the background of low alertness to risks of HFRS infection led to explosive growth of HFRS incidence.

Whipple's disease is caused by Tropheryma whipplei and is known to have protean clinical presentation which could be influenced by patient's immunologic and genetic features. In contemporary literature abundant amount of data could be found on extensive prevalence of infectious endocarditis caused by Tropheryma whipplei . This article presents history of a patient who was observed because of ischemic heart disease, angina pectoris, myocardial infarction, possible ischemic cardiomyopathy and in whom infectious endocarditis complicated by severe aortic regurgitation needing aortic valve replacement surgery was eventually diagnosed. Our patient did not meet Duke criteria, which is a sign of infectious endocarditis caused by Tropheryma whipplei , but a thorough analysis of the disease course, clinical features, heart ultrasound and clinical improvement on specific therapy against Tropheryma whipple i aroused our suspicion, and morphological and bacteriological analysis of the involved (excised) valve, confirmed the diagnosis of Whipple disease. The article presents differential diagnostic criteria of aortic insufficiency and possible causes of coronary insufficiency in the absence of marked coronary atherosclerosis.

—Exosomes are extracellular vesicles that represent an important mode of intercellular communication. It is thought that exosomes can carry biologically active molecules associated with the progressive spreading of amyotrophic lateral sclerosis (ALS). ALS is a fatal neurodegenerative disease characterized by the progressive death of motor neurons. Angiogenin is likely to be important in the pathogenesis of ALS. This paper analyzes the content of angiogenin in blood plasma, CSF, and exosome fractions obtained from blood plasma and CSF in ALS. The study included 30 patients with ALS and 26 age and gender matched healthy controls. The relative amount of angiogenin in plasma and CSF was significantly higher than in exosome fractions (p < 0.05). A comparison of angiogenin content in plasma and exosome fraction revealed lower angiogenin levels in patients with ALS compared to healthy volunteers (p < 0.05), which may indicate a protective role of angiogenin. Higher concentrations of angiogenin in plasma and its exosome fractions tended to correlate with better functional states in patients. Therefore, a reduction of angiogenin levels in plasma and the exosome fraction from plasma may be a marker of disease progression, but these data need to be confirmed in a larger cohort.

In children under 14 years of age, the main route of HIV transmission remains perinatal. We studied a group of HIV-infected women (105 patients), whose newborns underwent perinatal contact (55 children) and those who didnt (50), as well as a control group of noninfected pregnant women (80). The patterns of pregnancy and delivery in HIV-infected women with different stages of the disease receiving antiretroviral therapy (ART) were considered. The main complications of pregnancy and childbirth in these patients were determined. The possible effect of ART on newborns was studied, it is shown that children often have a violation of the functional state of the kidneys.

Objective. To analyze the surgical treatment results in patients, suffering carotid arteries stenosis, using endarterectomy in combination with conservative therapy. Materials and methods. Results of treatment were analyzed in 58 patients, suffering hemodynamically significant stenosis of carotid arteries and/or presence of embologenic pluck, in whom from 2017 to 2019 yrs in V. T. Zaytsev Institute of General and Urgent Surgery NAMS of Ukraine, Kharkov intraoperative supportive conservative therapy, taking into account the risk for development of the cerebral ischemia and the reperfusion syndrome, was conducted. There were 52 (89.7%) men and 6 (10.3%) women. Middle age of the patients operated on have constituted (65 ± 15) yrs. Results. Basing on the literature data analyzed as well as on investigation of the thrombocytes aggregation in patients in perioperative period the algorithm of supportive conservative therapy was elaborated: injection of 5000 IU heparin 5 min before the internal carotid artery clamping under the ICT control; injection of Citicoline 1000 mg 5 min before the internal carotid artery clamping to the patients with neurological deficiency in accordance to the neurological test data and with application of a temporary by-pass. In all the patients in postoperative period the complications were absent. Control of the carotid arteries passability and the ischemia zone state on the 14th day was conducted, the carotid arteries stenosis was not revealed. Nonsignificant complications, such as the stressed hematoma, demanding postoperative wound revision and hemostasis performance, were observed in 4 patients. In 2 patients postoperative period was complicated by the hypoglossal nerve paresis because of its squeezing by hematoma. Conclusion. Citicoline injection before the carotid artery clamping in the carotid endarterectomy with a temporary by-pass permits to lower the risk for development of neurological complications, and while development of postoperative reperfusion syndrome –to reduce its signs.

The review analyses the information on the epidemiological situation on COVID-19 around the world. Presented is the assessment of the major epidemiological parameters (basic reproductive rate, lethality, incubation period, and serial interval). Demonstrated is the share of severe cases among different age groups and the general structure of incidence by the severity of clinical course. The paper provides the classification of response models internationally depending upon the complex of measures undertaken at different stages of epidemic process. Reviewed are the key response actions to control the COVID-19 transmission in different countries of the world and the Russian Federation and given is the assessment of their effectiveness.

Aim. To study the changes of echocardiographic parameters and their relationship with the procollagen I C-terminal propeptide (PICP) during hospitalization of patients with ST-segment elevation myocardial infarction (STEMI) and preserved left ventricular (LV) systolic function.Material and methods. A total of 120 (100%) patients hospitalized with STEMI were examined. Upon admission, all patients underwent standard examinations to verify myocardial infarction (MI), including coronary angiography and, if necessary, coronary stent implantation. The mean values of LV ejection fraction (LVEF) were 40-49% in 3 patients (2,5%), Results. By the 12th day, a significant decrease in the following parameters of the transmitral flow was revealed: DT (p=0,049), dE (0,012), Em (0,029), Em/ Am (p=0,000), Em/PICP (p=0,001). This indicates diastolic function deterioration. At the same time, by the end of hospitalization, systolic function deterioration was recorded in 15,1% of cases. Initially, a higher PICP on the 1st day relative to the control group tended to decrease the concentration by the 12th day, but the differences did not reach statistical significance (p=0,466). Correlation analysis showed a relationship between PICP and echocardiography (Tei index, p=0,026, and mitral annulus velocity, p=0,049).Conclusion. At the hospital stage of treatment of patients with STEMI and preserved LVEF, a negative changes of echocardiography parameters characterizing diastolic dysfunction was revealed. Positive correlation was established between the concentration of PICP with mitral annulus velocity and the Tei index, indicating an association between the myocardial fibrosis and diastolic dysfunction.

The aim of the research is to study the dynamics of fibrosing markers of C-terminal procollagen, type I propeptide (PICP) and N-terminal propeptide type III procollagen (PIIINP) in patients with ST-segment elevation myocardial infarction (STEMI); to identify possible correlation between concentration of PICP and PIIINP with the degree of cardiac fibrosis and diastolic dysfunction (DD) in a year after MI. Material and methods. The analyzed sample included STEMI patients with preserved contractility of the left ventricular myocardium (LV). During MI 1-st day the ejection fraction due to Simpson method was ≥50%. On the 1-st and 12-th days of the disease, as well as in a year, the concentration of PICP, PIIINP in venous blood serum was determined in all the studied participants. Standard echocardiographic study was performed with an assessment of LV diastolic function and determination of the following parameters: e’ (septal part displacement), Em (lateral part displacement), and IOLP (indexed left atrium volume). In a year after STEMI, all patients underwent magnetic resonance imaging (MRI) with a contrast agent to determine the severity of fibrotic myocardial damage. Results. PICP concentration significantly decreased by annual stage relative to hospital period (p

The aim of the study was to create individualized surgical treatment tactics in patients who underwent anastomosing intestinal surgery using the express method for determining cryoglobulins. The study was based on a study of the results of treatment in 96 patients who underwent resection of segments of the small intestine with the formation of inter-intestinal anastomoses, in the SI «ZIGUS NAMSU» during the period from 2015 to 2018 years. Using a high-quality rapid method for the determination of cryoglobulinemia (CGE) during surgery can significantly affect surgical tactics: with a low level of cryobilk in blood serum, it can perform a resection of a segment of the small intestine with the formation of primary small intestinal anastomoses; when the level of cryobilk in blood serum is more than 80 mg / l, which corresponds to a positive rapid test for cryobilk, one should refrain from the formation of primary anastomoses, and use the tactics of the formation of “delayed” anastomoses, in severe general condition of patients (and a high level of CGE – more 600 mg/l) – also the formation of the final small intestinal stoma.

Summary. Due to analysis of the factors that lead to incompetence of bowels` anastomosis and sutures the levels of risk of the development of this complication were created. The surgical tactics depending on the level of risk of the development of bowels` sutures and anastomosis incompetence was created. The method of forming of late bowels` anstomosis in patients with high and moderate levels of risk of the development of bowels` sutures and anastomosis incompetence were created. This method excludes performing of multistaged intraabdominal operations. The using of developed algorithm allows to decrease postoperative morbidity and mortality.

Purpose: to evaluate the efficiency of simultaneous topography-guided photorefractive keratectomy (PRK) with accelerated collagen cross-linking in the treatment of stage I keratoconus.Material and methods. 38 patients (49 eyes) aged 18 to 44 with stage I keratoconus were treated with simultaneous topography-guided PRK combined with accelerated corneal collagen crosslinking. Along with standard ophthalmological testing, patients underwent aberrometry, confocal microscopy, optical coherence tomography of the cornea, imaging of the anterior eye section on a Scheimpflug analyzer, and examination of the biomechanical properties of the cornea. The follow-up period was 2 years.Results. Two years after surgery, uncorrected visual acuity which originally was 0.23 ± 0.03 showed a statistically significant increase and reached 0.72 ± 0.02; best corrected visual acuity improved from 0.44 ± 0.03 to 0.89 ± 0.02; the refractive power of the cornea fell from 45.03 ± 0.28 to 42.55 ± 0.31 D; the spherical component of refraction reduced from -2.00 ± 0.19 to -0.73 ± 0.09 D; the cylinder component reduced from 2.46 ± 0.14 to 0.79 ± 0.07 mm, the thinnest point of the cornea reduced from 486.30 ± 4.78 to 406.80 ± 6.51 μm. The highest order aberrations showed the following results: Coma index reduced from 0.27 ± 0.12 to 0.08 ± 0.07, Tilt reduced from 0.53 ± 0.11 to 0.10 ± 0,09, and Trefoil reduced from 0.13 ± 0.04 to 0.05 ± 0.02.Conclusion. The analysis of clinical and functional results, biomechanical properties and structures of the cornea confirmed the efficacy and safety of the combined treatment of patients with stage I keratoconus.

Introduction . The randomized MPACT study showed that nab-paclitaxel plus gemcitabine results in statistically significantly longer life expectancy. The objective of this retrospective study is to obtain relevant data on the efficacy of this combination in real clinical practice in Russia. Materials and methods . The study included patients with morphologically proven locally advanced or metastatic pancreatic cancer, with a general condition assessed on the ECOG scale between 0-2, which received gemcitabine and nab-paclitaxel. Immediate and long-term treatment outcomes were evaluated. Results . 142 patients, who received treatment from 2009 to 2019 in 17 centers from 11 regions of Russia, were included in the study. Assessment of the objective effect was made in 134 patients. Objective effects were detected in 34 (25.4%) cases. The median time-to-progression was 6.1 months (95% confidence interval (CI) 4.8-7.4), the median length of life was 14.2 months (95% CI 10.6-17.9). An elevated CA19-9 level is the only independent adverse prognostic factor for progression-free survival (RR = 8.0, 95% CI 1.4 -43.8, p = 0.02) according to Cox multivariate regression analysis. The number of previously conducted chemotherapy lines (p = 0.34), ECOG status (p = 0.70), age over 70 years (p = 0.45), serious comorbidity (p = 0.97) did not have a statistically significant effect on progression-free survival. Findings . The gemcitabine and nab-paclitaxel combination has a relatively higher efficacy in advanced pancreatic cancer. The immediate and long-term results of its use in real clinical practice in Russia are consistent with data obtained in the Western countries.

Hypertension is a global public health problem. One of the reasons contributing to the development of arterial hypertension is endothelial dysfunction, which is expressed in the imbalance of vasoactive indicators of vascular tone - nitrogen oxide and endothelin-1. Monitoring the indicators of endothelial dysfunction in workers exposed to harmful occupational factors will help to identify a risk group for the development of occupationally caused diseases of the cardiovascular system and, in particular, arterial hypertension, for early implementation of preventive measures. This study aims to identify the relationship between endothelin-1, nitrogen oxide metabolites and blood pressure in young and middle-aged people occupied in harmful working conditions, to evaluate the studied parameters as possible markers for diagnosing the risk of hypertension. Two hundred thirty-six (236) employees of young and middle age were examined of one of the metallurgical plants of the Nizhny Novgorod region. In order to characterize the state of vascular tone, a coefficient was used that represents the ratio of the concentration of nitrogen oxide (μmol/L) to endothelin-1 (pg/ml) (NOx/ET-1). It was revealed that in one-third of people with normal and high normal blood pressure, the NOx/ET-1 value was 2-3 times less than in people with optimal blood pressure, which indicates the occurrence of endothelial dysfunction and the possible development of persistent arterial hypertension. Harmful occupational factors negatively affect vascular tone - the value of NOx/ET-1 in individuals exposed to harmful factors was 3-4 times less than in individuals not subjected to such exposure. The NOx/ET-1 coefficient can be used as an informative indicator when monitoring health conditions with an in-depth examination of working people; it can be a criterion for the risk of developing hypertension.

Aim. To assess the correlation of fibrosis biomarkers with parameters of diastolic function (DF) in assessing global longitudinal strain in patients with ST-segment elevation myocardial infarction (STEMI) and preserved left ventricular ejection fraction (EF).Material and methods. We examined 50 patients (100%) with primary STEMI and preserved LVEF at the end of hospitalization. On the 1st day of MI, standard diagnostic investigations were carried out. On the 12th day, the serum concentration of procollagen type I carboxy-terminal propeptide (PICP), N-terminal propeptide of procollagen type III (PIIINP), and galectin-3 was determined, as well as echocardiography was performed to assess left ventricular DF. After 1 year, all participants underwent reassessment of PICP, PIIINP, and galectin-3 serum levels. Echocardiography was also performed with an assessment of DF and LV global longitudinal strain.Results. According to speckle-tracking echocardiography, LV global longitudinal strain was visualized in 30 patients (60%), who were included in the final analysis. In the rest of the patients (40%), the limitations did not allow the technique to be performed. During the hospitalization, signs of diastolic dysfunction (DD) were detected in 5 (16,6%) patients; after 1 year, their number increased by 7 (23,3%). During the 1-year follow-up, the total number of patients with echocardiographic signs of DD was 20 (67%). At the same time, global strain parameters indicated the presence of DD in 23 (77%) patients. However, comparison of the incidence of DD according to echocardiography and using the speckle-tracking technology did not show significant differences (p=0,283). Throughout the entire follow-up period, the concentration of the studied fibrosis markers significantly exceeded the control group values. We recorded associations of global strain parameters with biochemical markers of fibrosis and LV DF indicators.Conclusion. Fibrosis biomarkers (PICP, PIIINP, galectin-3), assessed in the subacute period of MI in patients with preserved EF, correlated with indicators of global myocardial strain, which indicates the potential value of their determination for predicting and detecting DD in the postinfarction period.

Introduction. In recent years, in occupational pathology, much attention is paid to professionally caused diseases, a special place among which is occupied by cardiovascular pathology. Vascular wall stiff ness is considered as an independent cardiovascular risk factor. This makes it important to study the mechanism of development of arterial stiffness, a key component of which is inflammation.The aim of the study was to identify the relationship between immune parameters and vascular wall stiff ness according to volumetric sphygmography in workers exposed to industrial aerosols.Materials and methods. A survey was conducted of 55 men working in conditions of exposure to industrial aerosols, and 32 men who do not have professional contact with industrial pollutants. Serum concentrations of class A and G immunoglobulins, cytokines, tumor necrosis factor α, and C-reactive protein were determined by solid-phase enzyme immunoassay. Assessment of elastic properties of the vascular wall was carried out by volumetric sphygmography.Results. Increased production of anti-inflammatory interleukin–8, immunoglobulin G and C-reactive protein, as well as increased cardiovascular and ankle vascular index on the right and left in the group working under the influence of industrial aerosols was found. Median concentrations of immunoglobulins, interleukins and C-reactive protein were independent of changes in the value of the cardiovascular ankle vascular index. Increased rigidity of the vascular wall was accompanied by an increase in the production of tumor necrosis factor α. Thus, in the group of persons with increased stiff ness, the level of this cytokine was 3 times higher than in the group of persons with normal values of the cardiovascular-ankle vascular index. The relationship between the cardiovascular ankle vascular index and the concentration of tumor necrosis factor α (r=0.61; p=0.009), C-reactive protein (r=0.54; p=0.02) and feedback with the level of anti-infl ammatory interleukin–10 (r=0.36; p=0.04) was revealed.Conclusions. The established significant correlations between cytokines (tumor necrosis factor α, interleukin–10), C-reactive protein and individual indicators of volumetric sphygmography (cardio-ankle vascular index) indicate the pathogenetic role of cytokines and acute phase proteins in the violation of elastic properties of the vascular bed in workers under the influence of industrial aerosols.

Purpose of the study. To estimate the incidence of newborn's healthcare associated infections (HAI) and intrauterine infections in the Russian Federation, Moscow and three maternity hospitals in Moscow. Materials and methods. The retrospective epidemiological analysis of neonates HAIs and intrauterine infections during 2008–2017 was performed in the Russian Federation and Moscow and during 2009–2017 in three maternity hospitals (MH) in Moscow. In this study the maternity hospitals would be known as MH № X01, № X02 and № X03. Also, in this study, the calculation and analysis of the proportion of cases of newborn's HAIs and intrauterine infections with laboratory confirmation were performed in Moscow's maternity hospitals. The data was selected from Form № 2 for the Russian Federation and Moscow. Also, the data of the maternity hospitals was drawn from the base of the Hygiene and Epidemiology Center in Moscow. The morbidity rate of HAIs and intrauterine infections of newborns was counted on 1,000 newborns. Microsoft Office Excel 2010 software packages were used for this purpose. The calculation of the increase / decrease rate was made by the method of least squares. Results. The incidence of intrauterine infections and HAIs of newborns in the Russian Federation, Moscow, and maternity hospitals is characterized by the next mutual trends – a significant dominance cases of intrauterine infections' over the cases of HAI, extremely irregular registration and distribution of the nosologies' proportion. Concerning to the dynamics of morbidity during 2009–2017 in maternity hospitals in Moscow, the HAIs newborn's incidence has tendency of decline, and intrauterine infections has considerable increase of the incidence. This consistent pattern is observed in all described maternity hospitals. The structure of the incidence in maternity hospitals is similar to each other. The leading diagnoses among intrauterine infections are intrauterine infection without a lesion and intrauterine pneumonia. The interest of other infections is about 1%. The proportion of cases with laboratory confirmation of the newborn's HAIs and intrauterine infections is extremely small. Besides that, there were identified some indirect signs of poor-quality registration of nosocomial infections. Conclusion. Significant difference in the number of cases of newborn's HAIs and intrauterine infections and their multidirectional incidence trends, once again point to the concealment of a part of nosocomial infections, under such diagnoses, as intrauterine infection without a lesion and intrauterine pneumonia. Laboratory confirmation of cases of HAIs and intrauterine infections in the maternity hospitals is carried out only by a small proportion of patients. Thereby, the incidence rates of HAIs of newborns and intrauterine infections in maternity hospitals in Moscow raise doubts about their reliability.

Increasing evidence suggests that oxidative stress and induction of mitochondrial permeability transition in cardiomyocytes are linked to tissue damage and the development of diabetic cardiovascular complications. The aim of this study was to assess the effects of quercetin (Q) on oxidative stress and mitochondrial permeability transition in the heart of rats with type 2 diabetes mellitus (DM). Type 2 DM was induced in 12-week-old male Wistar rats by intraperitoneal injections of 25 mg/kg streptozotocin twice per week followed by a high-fat diet during four weeks. The rats were divided into three groups: control intact group (C, n = 8), untreated diabetic group (Diabetes, n = 8) and diabetic rats treated with Q (50 mg/kg/day per os for 8 weeks) after diabetes induction (Diabetes+Q, n = 8). Administration of Q increased insulin sensitivity and normali­zed the functional state of cardiac mitochondria due to increased aconitase and succinate dehydrogenase activities in rats with type 2 DM. Q also ameliorated oxidative stress, decreasing the level of advanced oxidation protein products and increasing the activity of thioredoxin-reductase in heart mitochondria of diabetic rats. In addition, Ca2+-induced opening of the mitochondrial permeability transition pore was significantly inhibited in diabetic rats treated with Q in comparison with the untreated diabetic group. These data demonstrate that Q can protect against oxidative stress, mitochondrial permeability transition induction and mitochondrial dysfunction in cardiomyocytes of diabetic rats. We suggest that the use of Q may contribute to the amelioration of cardiovascular risk in type 2 DM.

Objective: to offer additional criteria for assessing registration quality of congenital infections and neonates’ pyoseptic infections. Material and methods: a retrospective epidemiological analysis of congenital infections incidence, pyoseptic infections of puerperas and neonates during 2007–2017 was conducted in this study. All subjects of the Russian Federation were divided into some groups according to registered incidence rate and ratio among congenital, pyoseptic infections of puerperas and neonates with using the method of ranging. Comparative correlation analysis was conducted between puerperas’ pyoseptic infections and neonates’ congenital infections in accordance with registered rate. The sample of the date was taken from Statistical Reporting Form No 2 «Report on infectious and parasitic diseases» for the Russian Federation during 2007–2017, Unified interdepartmental information and statistical system. Results: in most regions of the Russian Federation the registration of healthcare associated infections puerperas and neonates is at a low. More than a half of subjects have low incidence rates (less than 1,0) for one or more of the considered infections. Until now, there are several subjects that do not register healthcare associated infections at all. The absence of correlation relation between the morbidity of the puerperas’ pyoseptic infections and neonates’ congenital infections on the whole in the country confirms this fact. At the same time, the correlation analysis of separate regions with the registration close to the real figures has shown a strong positive relationship between puerperas’ pyoseptic infections and congenital infections. Conclusion: thus, it can be concluded that the presence of relation between rates of incidence of puerperas’ healthcare associated infections and neonates’ congenital infections can be used as one of the epidemiological criteria for assessing the completeness of the registration of healthcare associated infections.

Objective. Elaboration of method for hermetization of sutures of the small bowel anastomosis in conditions of peritonitis. Materials and methods. The experiment was performed on 20 white male rats of a Wistar line owing a body mass approximately 250 g. The protocol for the laboratory animals care, the content and methods of experimental work were corresponded to principles of European Convention for defense of a vertebrate animals, which are used for research and scientific purposes (Strasbourg, 1986). Results. The experimental investigation conduction have shown the possibilities of application of physical (the light waves of a certain length) and biological (the tissue growth factors) methods in prophylaxis and treatment of an acute inflammatory reactions and for stimulation of reparative processes. Conclusion. The trend for further investigation of prophylactic measures for the small bowel anastomoses insufficiency, using the electro–magnet impact of the low–intense of the light spectrum in combination with application of the tissue growth factors, demonstrate a perspective.

Objective : to assess quality-of-life (QoL) dynamics in patients with rheumatoid arthritis (RA) when initiating therapy with biological agents (BAs) in real clinical practice. Patients and methods . The investigation enrolled patients with RA from the patient cohort participating in the TERMINAL-II multicenter Russian study, who newly initiated BA therapy. In the self-assessment terminal, the patient completed HAQ, EQ-5D, and RAPID-3 questionnaires. DAS28, SDAI, CDAI, and RAPID-3 were used to determine disease activity. The patient's functional status and QoL were assessed using the HAQ index and the EQ-5D questionnaire, respectively. The efficiency of the therapy was analyzed 6 months after the start of the study according to the standard procedures. Results and discussion . The investigation enrolled 156 RA patients: 79.6% females; mean age, 45.8±13.2 years; disease duration, 7.6±5.6 years. The patients had high RA activity (a mean DAS28 of 5.2±1.2, a mean SDAI of 39.5±16.4, a mean CDAI of 27.5±10.4, and a mean RAPID-3 of 15.1±3.6) and previous inefficacy of synthetic disease-modifying antirheumatic drugs (DMARDs) after at least 6 months of therapy. Only 1.2% of patients had a good functional status comparable to the population-based control (HAQ 40.5). 70% of patients needed to take non-steroidal anti-inflammatory drugs (NSAIDs). The first BA was chosen in accordance with the recommendations for administration of BAs and in terms of their availability in a specific region of the Russian Federation. The first prescribed BA was tumor necrosis factor-a (TNF-a) inhibitors in 112 (71.8%)patients, anti-B-cell therapy in 14 (9.0%), an interleukin-6 receptor inhibitor in 16 (10.3%), and a leukocyte costimulatory inhibitor in 14 (9.0%). Comparison of the patients receiving newly initiated therapy with TNF-a inhibitors and drugs with other mechanisms of action showed that the patients who had abatacept received higher doses of methotrexate (MTX), but lower doses of glucocorticoids (GCs) than those who were prescribed rituximab and tocilizumab. A statistically significant decrease in DAS28, SDAI, CDAI, and RAPID-3 scores was achieved after 6 months of therapy. Improvements of functional status and QoL in patients were also noted (p

Objective. Modification of technical methods of performance of pancreatico-duodenal resection (PDR) for improvement of immediate results of surgical treatment, reduction of postoperative morbidity and lethality. Materials and methods. The treatment results analysis in 125 patients in the clinic of the Zaytsev Institute of General and Urgent Surgery in 2012-2018 yrs, in whom PDR was the main procedure of the treatment, have constituted the base of the investigation. There were 96 (76.8%) men, and 29 (23.2%) women. The middle age group of the patients have constituted 62.4%. Malignant tumors of the pancreatic head stages I-III in accordance of classification of American Join Committee on Cancer of the AJCC 8th were revealed in 72% patients. All the patients were examined in accordance to the standard protocol, adopted in the clinic. Gastropancreaticoduodenal resection was conducted in 66.4% patients, the pylorus-preserving PDR - in 33.6% patients. Reconstructive stage on solitary loop in accordance to Whipple method was done in 31.2% patients, on isolated loop in accordance to Roux method - in 58.4%, and in accordance to the method elaborated - in 10.4%. To enhance the pancreaticojejunoanastomosis safety we proposed several technical variants, including formation of pancreatico-jejunoanastomosis in modification “duct-mucosa” in accordance to procedure, elaborated in the clinic and applied in 20% of the patients. Results. The postoperative complications severity was estimated in accordance to classification of Clavien-Dindo (2004), and specific complications, immediately connected with PDR, - in accordance to recommendations of experts of International Study Group of Pancreatic Surgery (ISGPS). Early postoperative complications were revealed in 37.6% patients, of them in 26.5% patients - severe. Among specific complications pancreatic fistula (58.8% patients) and postoperative gastrostasis (33.3%) have prevailed. The early (in the terms up to 30 days) postoperative lethality have constituted 13.6%. Conclusion. The technical methods of the PDR performance, elaborated by the authors, permits to improve the immediate results of this procedure in tumoral and inflammatory diseases of the pancreatic gland head, to lower the specific complications rate and the associated lethality.