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Nutritional support is an important and integral part of the treatment process for critically ill patients. Patients after neurosurgical interventions and patients with damage to the central nervous system, for example, due to acute ischemic stroke, may be due to the severity of the condition in the intensive care unit. This is a separate category of patients and nutritional support for this category of patients has its own characteristics. Enteral nutrition, as the most physiological type of nutrition, should be an integral part of the treatment process in the intensive care unit. In patients in the acute period of a severe condition with brain damage, in addition to the metabolic response to damage, there are also factors that limit the implementation of enteral nutrition: the brain damage itself, being in intensive care, and methods of intensive therapy. The choice of an enteral formula in this category of patients is complex and fundamental to provide adequate nutritional support to cover energy and protein requirements. The purpose of this scientific review is to highlight the issues of choosing a mixture for enteral nutrition of patients in the neurocritical care unit who are in the acute period of a critical ill.

Ischemic stroke remains the predominant cause of disability in the population (3.2 per 1000 population). Only 8% of ischemic stroke survivors can return to their previous work. Nutritional support is an integral part of the multidisciplinary approach to the treatment of ischemic stroke in the intensive care unit during the acute and rehabilitation phases. Brain damage always has metabolic consequences on the patients body, and premorbid malnutrition and stroke-stroke malnutrition significantly affect disease outcomes. The incidence of malnutrition in patients with ischemic stroke varies widely, ranging from 6.1% to 62%, depending on the method for determining protein-energy malnutrition. Despite the relevance of the problem of nutritional support in patients with ischemic stroke, only a few specific recommendations are available in the literature for this category of patients. This review focuses on nutritional support for patients who require mechanical ventilation or admission in the intensive care unit for 48 h.

Caesarean section (cS) is one of the most common obstetric operations in the world. About 32 % of all births end by caesarean section. Postpartum infection at the surgical site, wound infection and endometritis are the main causes of long stays in maternity hospitals and are a source of additional costs for the healthcare system. In 2–16 % of cases postpartum endometritis develops. Many risk factors for the development of postpartum infections have been described. These include maternal factors (such as tobacco use, inadequate prenatal care, obesity, corticosteroid use; prematurity, multiple gestation, and uterine scar), intrapartum and operative factors (such as chorioamnionitis; premature rupture of membranes; prolonged anhydrous period; prolonged labor , especially a long second period; large incision of the anterior abdominal wall; subcutaneous tissue thickness more than 3 cm; subcutaneous hematoma; lack of antibiotic prophylaxis; rapid labor; massive blood loss during childbirth). Effective measures to reduce the incidence of obstetric infectious complications include prophylactic use of antibiotics (preoperative preparation with first-generation cephalosporins and intravenous azithromycin), preoperative showering with chlorhexidine instead of iodine, shaving immediately before surgery, vaginal sanitation, removal of the placenta by traction of the umbilical cord, suturing of the subcutane-ous tissue, if the depth of the wound is larger than 2 cm and suturing the skin with sutures instead of using staples. Establishing an evidence-based optimal care algorithm for patients after caesarean section can reduce the incidence of serious infectious complications.

In the intensive care unit, along with other methods of intensive care, such as maintaining blood pressure, antibiotic therapy, mechanical ventilation, and vasopressors, clinical nutrition should always be present. Clinical nutrition is an integral part of the treatment process in the intensive care unit. A large number of publications concerning the prevention and treatment of intensive care outcome syndrome exist. One of the most important and low-cost strategies to prevent this condition is nutritional support for critically ill patients at all stages of curation, from the moment of admission to the intensive care unit to the end of the rehabilitation course. With the correct appointment of nutritional support, taking into account the indications and contraindications for various nosological forms, the advantages are obvious in the form of improved treatment outcomes. Proper organization of nutritional support in the hospital is the main key to success in early rehabilitation. From the understanding of nutritional support, its effectiveness will depend on its organization and mutual understanding between all links. Based on the experience of creating a laboratory for clinical nutrition and metabolism, it can be concluded that the creation of such a laboratory and the organization of clinical nutrition in a hospital can improve the results of treatment of even the most severe category of patients.

Objective. To study the involvement of the rs1800629 G/A polymorphisms of the TNF-α gene, rs1205C/T of the CRP gene, and rs12218T/C of the SAA1 gene in the predisposition to ankylosing spondylitis (AS) and their role in the formation of clinical phenotypes of AS.Materials and methods. 122 patients with AS were included in the study. All patients had a diagnosis of AS based on the modified New York criteria. The presence of the HLA-B27 antigen was detected in 109 (89.3%) patients, the presence of peripheral arthritis – in 71 (58.2%), enthesitis – in 92 (75.4%), coxitis – in 82 (67.2%) patients. All patients had a high degree of activity with an average BASDAI index of 5.6±1.2. The control group consisted of 142 healthy blood donors. Polymorphisms were studied using allele-specific real-time polymerase chain reaction (RT-PCR).Results. Significant differences were found in the frequencies of genotypes and alleles of the -308G/A polymorphism of the TNF gene and the frequencies of alleles of the rs12218 T/C polymorphism of the SAA1 gene between patients and the control group (p=0.01, p=0.01 and p=0.03 respectively). Logistic regression analysis showed that the presence of at least one -308A allele in the patient’s genotype reduced the risk of developing AS by 4.4 times compared with the GG genotype (p=0.006). In carriers of the GA genotype, the probability of a predisposition to the development of enthesitis was 2.2 times lower than in carriers of the GG genotype (p=0.01). The relationship between the rs1205 polymorphism of the CRP gene and the predisposition to peripheral arthritis has been established. Carriage of the rs1205T allele doubled the susceptibility to arthritis compared with the rs1205C allele (p=0.013). Carriage of at least one rs12218C allele of the SAA1 gene doubled the susceptibility to AS (p=0.018).Conclusion. The data obtained confirm the involvement of polymorphisms rs1800629 of the TNF gene, rs1205 of the CRP gene, and rs12218 of the SAA1 gene in the predisposition to AS. TNF gene polymorphism is associated with the formation of the clinical phenotype of enthesitis, and CRP gene polymorphism is associated with a predisposition to peripheral arthritis.

To date, modern outpatient minimally invasive interventions for varicose veins, such as endovenous laser or radiofrequency ablation, microphlebectomy, sclerotherapy, non-thermal non-tumescent methods (NTNT), are widely introduced into clinical practice in the Russia. In the approved by the Ministry of Health of the Russian Federation in 2021 clinical guidelines "Varicose veins of the lower extremities" they are recommended as preferred over open surgery. At the same time, there are no federal regulations of preoperative examination of patients before these minimally invasive procedures for varicose veins. That is why the medical community is often forced to prescribe unnecessary diagnostic tests on the "just-in-case" principle, in order to protect itself for cases of complications and subsequent checks. This undoubtedly harms both the patients and the medical service, which has an additional useless and inappropriate burden. The purpose of the round table held on September 28, 2021 under the auspices of the Self-Regulatory Organization “The National College of Phlebology” together with the legal partner “The Faculty of Medical Law LLC” (Moscow), was to review the existing legislation on this issue and then to prepare a resolution regarding the justified preoperative examination of patients before minimally invasive interventions for varicose veins of the lower extremities. The prepared document consists of two parts. The first part presents the legal regulation of the diagnostic tests before interventions in phlebology. The second part contains the opinion of the professional community regarding the appropriateness or inexpediency of different pre-procedural examinations. In addition, based on the conclusions of legal analytics, a form of order of the chief physician has been developed, which regulates the diagnostic tests before the considered phlebological interventions in the clinic.

This review includes an analysis of clinical studies evaluating the effect of adenomyosis on reproductive function, as well as a review of studies on the relationship between surgical treat-ment options for adenomyosis and reproductive outcomes. Different studies of women populations after in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) and after surgical treatment of deep adenomyosis have shown that adenomyosis in both cases has a negative effect on the reproductive outcome, although there are significant differences in these populations. In the literature, there are relatively few data on the degree of influence of the depth of the lesion on the realization of the reproductive function, however, a significant correlation was revealed between them. The positive effect of treatment with gonadotropin-releasing hormone agonists, followed by surgical treatment of adenomyosis, has also been described in several literary sources, but there have been no controlled studies on this topic. Many studies do not meet the validity criteria due to the lack of clear criteria for inclusion and exclusion from the study. The choice of the optimal treatment options for adenomyosis based on the actual data is difficult due to the lack of reliable evidence of the relationship between fertility and the degree of adenomyosis. However, it is known that adenomyosis can reduce the likelihood of successful implantation so ramatically that surgical or other treatment options are reasonably recom-mended. At the same time, it is necessary to assess the possible positive effect of the treatment options available in the doctor’s arsenal. Thus, timely referral to specialized treatment of ade-nomyosis may be crucial for the successful implementation of reproductive function in patients with suspicion or with an established diagnosis of adenomyosis in combination with recurrent miscarriage, who refuse to use assisted reproductive technologies, medical institutions. This review will analyze the relationship between infertility and adenomyosis, as well as review studies of reproductive outcomes in different options for surgical treatment of adenomyosis in infertile patients.

Background: Osteoarthritis (OA) is a significant social problem as it is the most common disease of the joints. OA is a multifactorial disease in which great attention is paid to hereditary factors. Recently, a number of studies have demonstrated the contribution of a number of genes to the subjective assessment of pain in OA, which is the main symptom of this disease. The association of P2X7, TRPV1 and TACR1 genes and some others with pain sensitivity has been shown. One of the risk factors of pain among many others, is the increased weight. Abdominal adipose tissue is a source of release of pro-inflammatory adipokines that cause systemic inflammation associated with damage to many tissues, including subchondral bone, synovial membrane. Leptin is an endogenous hormone from the adipokine family encoded by the obesity gene leptin (LEP) and which is synthesized primarily in adipocytes.Aims: To investigate the possible association of rs2167270 (A19G) polymorphism of the LEP gene with pain intensity in ­patients with knee OA.Materials and methods: The study was conducted among women diagnosed with OA. Using the VAS scale (Visual analog scale), patients with mild knee pain — group 1 (VAS ≤ 40 mm) and patients with moderate or severe pain — group 2 (VAS>40 mm) were selected for pain assessment. Genetic variants of A19G leptin gene polymorphism were studied by polymerase chain reaction followed by restriction fragment length analysis (PCR-RFLP) method.Results: In the group of patients with moderate or severe pain intensity (group 2, n=61), a statistically significant association was shown with a higher body mass index (p=0.006) and an increased frequency of carriers of the 19GG genotype (p=0,051) compared to group 1 (n=36). Carriers of the 19GG genotype statistically significantly had a higher rate of knee pain and an early age of OA debut compared to carriers of the 19AA genotype (p=0,035 and p=0,015, respectively).Conclusions: The findings open up new possibilities for predicting pain symptoms in patients with knee OA by genetic testing of A19G polymorphic variants of the leptin gene.

Clinical response to methotrexate (MT) therapy in rheumatoid arthritis (RA) can be predicted on the basis of some single nucleotide polymorphisms (SNPs) of genes, involved in folate metabolism. One of these SNPs is the rs1801394 (A66G) polymorphism of the methionine synthase reductase gene (MTRR). We investigated the association of this polymorphism with the clinical characteristics of RA patients after 6 months of MT therapy. Studies of the relationship between the response to MT therapy and the rs1801394 polymorphism have not been carried out in Russia previously.Objective: to study the possible association of the rs1801394 polymorphism with the clinical characteristics of patients with RA after 6 months of MT therapy.Patients and methods. The study included 60 patients with RA who met the ACR / EULAR criteria (2010) and received≥20 mg MT per week continuously. Based on the EULAR criteria, patients were divided into two groups: group 1 (n=30) with a good (DAS28>1.2) and group 2 (n=30) with an unsatisfactory (DAS28 Results and discussion. The frequency distribution of the A66G polymorphism genotypes in both groups was similar, however, in the 2nd group with an unsatisfactory response, there was a tendency towards a higher frequency of the mutant GG genotype (p=0.067). An association of the A66G polymorphism with gender and disease duration was found. In group 1, the AG genotype was more often detected in men than in women (p=0.017). In group 2, the AG genotype was also more common in men (p=0.075). In addition, in this group, carriers of the G allele (genotypes AG and GG) had a longer duration of the disease than carriers of the AA genotype (p=0.003 and p=0.005, respectively).Conclusion. In the present study, the relationship of the studied polymorphism rs1801394 of the MTRR gene with gender and duration of RA disease was established.

BACKGROUND: At the end of the twentieth century, mammary gland contour correction using polyacrylamide gel (PAAG) became widely popular. The surgical approach must be improved because of the negative consequences associated with this technique. AIM: This study aimed to evaluate the possibilities of air-plasma technology in the treatment of long-term septic manifestations of polyacrylamide mammary syndrome as well as the prevention of its recurrence based on the analysis of histological examination findings. MATERIALS AND METHODS: Biopsy samples of eight women aged 38 to 59 years, who had undergone gel augmentation of the mammary glands six to 20 years ago, were studied. The complex treatment included air-plasma flow in cutting coagulation modes and nitric oxide therapy. A morphological study of the focus was performed before and after exposure to the plasma flow. RESULTS: Before treatment, chronic granulomatous inflammation and helioma were revealed in six cases; and acute phlegmonous-necrotic soft tissue inflammation in two cases. On the fifth day after combined necrectomy, single loci of the gel were visualized, the majority of which was vaporized. Chronic inflammation was less pronounced than the original histograms. During the sanitation with nitric oxide, the early appearance of foci of fibroblastic proliferation and marginal epithelialization was registered. CONCLUSIONS: Exposure to the air-plasma flow contributes to effective sanitation of purulent focus and gel total elimination Nitric oxide therapy (NO-therapy) accelerates the development of granulation tissue.

Objective. The aim of the investigation was to study the possible association of the rs7574865 polymorphism of the STAT4 gene with syndesmophytes (SMP) of the spine in patients with ankylosing spondylitis (AS).Subjects and methods. The study included a cohort of 100 patients, 79 men and 21 women with a diagnosis of AS.All patients were positive for the HLA-B27 antigen, had a mean age of 39.6±10.9 years and a mean disease duration of 60,4±28,4 months. The association of the rs7574865 polymorphism of the STAT4 gene with the SMP of the cervical, thoracic and lumbar spine was studied. For genotyping of the rs7574865 polymorphism, the method of allele-specific polymerase chain reaction in real time (RT-PCR) was used.Results. Spearman’s correlation analysis showed a statistically significant positive relationship between SMP in the thoracic spine and rs7574865 polymorphism of the STAT4 gene (r=0.23; p=0.022). The frequency of GT genotype carriers in the group of patients with thoracic spine trSMP(+) was statistically significantly lower than in the alternative group trSMP(–) (28.2% and 50.8%, respectively; p=0.025). Carriage of the GT genotype in patients with AS reduced the risk of trSMP(+) formation in the thoracic spine (OR=0.31) and this genotype was protective. No reliably significant association of the studied polymorphism with SMP of the cervical and lumbar spine was found. Patients with trSMP(+) were statistically significantly older in age, had a longer duration of the disease and a higher functional BASFI index compared with patients without trSMP(–).Conclusion. Genetic testing of the rs7574865 G/T polymorphism of the STAT4 gene in patients with AS opens up the possibility of using this polymorphism as a genetic marker-predictor – X-ray progression of structural changes in the thoracic spine.

Malnutrition is a common geriatric syndrome, which often undiagnosed, leads to impaired physical and mental functioning and patient prognosis. Geriatric patients admitted to hospital with acute and subacute conditions and pain syndrome are in an especial risk zone. The article presents a clinical case of the development and correction of malnutrition in an 84-year-old patient with aseptic necrosis of the femoral head. Risk factors and existing approaches to the management of patients with malnutrition are discussed.

Recently collated scientific data on the management of C1 clinical class of chronic venous disorders; wide prevalence of the disease and high variability amongst medical practitioners in relation to managing this category of patients and absence of any regulatory documents has prompted the development of clinical guidelines for the treatment of patients with reticular varicose veins and telangiectasias of the lower extremities and various parts of the body. These guidelines have been developed by a self-regulated organization Association “The National College of Phlebology”. The purpose of the de novo guidelines is to systematize the existing evidence and offer minimal standards of care for chronic venous disorders in C1 patients.

There is an increase in the number of patients worldwide who require special home feeding after discharge from the hospital Home clinical nutrition (HCN). The yearly prevalence of home clinical nutrition in 2017 was at 463 cases per million in the United States of America whereby in the 90s it was around 163360 per million in the United States of America and Europe. There isnt an established practice of HCN in the Russian Federation and thereby no data on the amount of patients who require HCN and the new risks associated with it because there isnt prior experience in conducting it. To study the routine practice and identify patients who need HCN, we planned a multicenter observational monitoring programme. The goal of the study is patient monitoring who are unable to completely cover their energy needs with the help of conventional nutrition.

Prophylaxis, diagnostics and correction of nutritional status disturbances is considered as one of the main treatment methods of patients with COVID-19 infection-directed to resolve systemic inflammatory response and correction of metabolic response to a viral infection. Systemic Inflammatory Reaction (SIR) manisfestation as a result of viral infection leads to pronounced metabolic processes disturbances. The main metabolic manifestations of SIR is reflected as hypermetabolic-hypercatabolic syndrome with complex disturbances of protein, lipids and carbohydrates metabolism, increased consumption of carbohydrate-lipid reserves and breakdown of tissue proteins. Thus, adequate correction of metabolic disorders and a wholesome nutritional support, taking into account the clinical picture, severity of the disease, ongoing respiratory and intensive care therapy is an integral component in treating patients with COVID-19 infection which determines the efficiency of its treatment and reduction in mortality. Given the relevance of the problem, the authors decided that it was important to increase the COVID-19 treatment efficacy by producing guidelines based on the most fundamental provisions of the modern approach to nutritional support in critical patients with community acquired pneumonia, acute respiratory failure, ARDS, sepsis, multiple organ failure.

The objective: to assess changes in energy expenditures (EE) when reducing pressure support (PS) as a predictor of the patient’s readiness for transfer to spontaneous breathing. Subjects and methods. The study included 33 patients who had been on mechanical ventilation for at least 7 days. PS reduced from 20 to 4 cmH2O at the interval of 4 cmH2O. At each level, the patient's EE were measured with indirect calorimetry. At the end of the study, spontaneous breathing trial (SBT) was performed. Results. In 22 (67%) patients, at least one episode of a statistically significant increase in EE was observed upon transition to a lower level of PS (Group 1). In remaining 11 (33%) patients, with decreased level of PS, EE decreased or did not significantly change (Group 2). SBT was successful in 14 out of 22 patients from Group 1 and all 11 patients from Group 2. The absence of episodes of increased EE during decreased PS was a predictor of successful SBT (sensitivity – 44%, specificity – 100%). Conclusion. The absence of episodes of a statistically significant increase in EE during the transition to a lower level of PS is a highly specific predictor of successful SBT.

This summary paper presents a generalized action plan for hospitals and outpatient clinics during the COVID-19 coronavirus pandemic. Now the pandemic is the most relevant global challenge. Taking into account that the medical world does not have much clinical experience with COVID-19 and other coronaviruses, such as SARS-CoV and MERS-CoV, thoroughness and caution in assessing and treating pregnant women is an extremely urgent topic. The authors of this article summarized the world experience in managing patients with coronavirus disease and brought it into a unique algorithm that was considered most rational.

Introduction: “The aim of our study was to analyze the effect of dienogest on the endometrioid glands in myometrium, a morphological assessment of the effect of the drug, taking into account its safety, as well as an assessment of changes in the quality of life of women associated with a decrease in the severity symptoms of adenomyosis.” Materials and methods: The study included women aged 20–50 years, with histologically confirmed adenomyosis, which was manifested in them by the presence of pelvic pain, abnormal uterine bleeding, painful, and/or heavy menstruation, as well as the presence of anemia. Patients were divided into three groups depending on the name of the drug that they used: 24 patients of Group I received the drug “Visanne” at 2 mg/day for 6 months. In the second group, 24 patients received the combined oral contraceptive drug Klaira, which contains gestagen and estrogen. The third group included 24 patients who received the Jeanine preparation continuously (21–21–21) for 6 months and then received it for an additional 6 months according to the scheme (7 + 21), containing ethinyl estradiol and dienogest. Results: After the appointment of drugs for 6–12 months, bloody discharge from the genital tract in Group I completely stopped in all 10 women; in Group II, the discharge decreased in four women and completely stopped in eight women; and in group III, the discharge decreased in three women and completely stopped in seven women, pain in Group I completely stopped in six women out of eight (75%) and decreased in two women out of eight (25%); in the second group, the pain stopped completely in 7 women out of 12 (58.3 %) and decreased in 5 women out of 12 (41.6%); in the third group, pain completely recovered in 6 women out of 10 (60%) and decreased in 4 women out of 10 (40%). According to the morphological assessment (Figures 1 and 2) of the myometrium section with endometrioid glands before treatment, Group I had 12.2 ± 3.8* glands before treatment and from 1.4 ± 0.8* endometrioid glands after treatment. In the second group, the number of glands before treatment was 10.8 ± 1.4* and after treatment from 3.8 ± 0.7 glands, and in the third group before treatment, 6.7 ± 2.1 endometrioid glands were determined and after treatment 2.7 ± 1.4 glands in the field of view (Figure 1). Conclusion: Dienogest is effective in the treatment of endometriosis and reduces both the clinical manifestations of adenomyosis (abnormal uterine bleeding and chronic pelvic pain) and laboratory blood counts, increasing hemoglobin levels, together with a decrease in the activity of the endometrioid glands in myometrium. Dienogest is a highly selective progestogen against progesterone receptors and has anti-proliferative activity in isolated human endometrial cells. Given the indicators of the 36-Item Short Form Survey questionnaire, the quality of life in all the studied groups improved in all parameters, which indicates the effectiveness of the dienogest-containing drugs used.

Background. Along with the measures to restore the basic body functions and prevent secondary brain injury, one of the key areas of modern rehabilitation is nutritional and metabolic support. Aims: to improve the results of the treatment of the patients by optimizing the system of nutritional and metabolic rehabilitation using enteral, parenteral, combined parenteral-enteral nutrition methods, who are undergoing rehabilitation after recovering from Coma resulting from injuries and diseases of the central nervous system. Methods. In a prospective cohort study, the results of the study and complex treatment of 113 patients after recovering from Coma as a result of brain injury of various etiologies who were undergoing rehabilitation in the period from 2017 to 2019 in the FNRC RR were analyzed. Results. Indirect calorimetry has proven to be the most accurate method for creating an effective and adequate program of nutritional and metabolic support in patients in chronic critical conditions who recovers from the coma. In patients who recovers from the coma, due to the excessive process of hypercatabolism, increasing protein requirements: the average protein requirements for a patient who recovers from the coma are 1.261.5 g of protein per kg/weight. Conducting optimal nutritional support for patients recovering from Coma involves determining the functional state of the gastrointestinal tract. To build an effective and adequate program of nutritional and metabolic support where accurate determination of energy needs is of great importance. Conclusions. The indirect calorimetry method is a valuable tool for assessing energy needs, although without taking into account the functionality of the gastrointestinal tract and other factors affecting body compositions, it may not be sufficient to prescribe optimal nutritional support in patients after recovering from Comatose.

The aim of the study was investigation of association of the rs7574865 polymorphism of STAT4 gene (Signal Transducer and Activator of Transcription 4, a family of signal transduction and transcription activation molecules 4) with very early rheumatoid arthritis (RA) in Russian patients, and the study of the relationship of "phenotype – genotype", particularly of positivity for antibodies to cyclic citrullinated peptides (ACCP), their concentration, the presence of erosive joint damage at inclusion in patients the study with the STAT4 gene polymorphism. Material and methods. The study was conducted in the framework of the program REMARKA (Russian study of Methotrexate and biological drugs in Early active Arthritis). 85 patients with very early RA with a duration of symptoms no more than 6 months, not receiving disease modifying anti-rheumatic drugs (DMARD) and biologicals were included. Results and discussion. The analysis of the distribution of genotypes and alleles of STAT4 rs7574865 polymorphism showed that the frequencies of g/G, G/T and T/T genotypes differ at the level of the prominent tendency to statistical significance between patients with RA and the control group (p=0.05). The frequency of minor allele T in RA is significantly higher than that in the control group, and this allele is associated with a predisposition to RA [odds ratio (OR) 1.7; 95% confidence interval (CI) 1.1–2.8; p=0.03]. In the study of the "genotype – phenotype" relationship, STAT4 gene polymorphism correlated with erosive joint damage (r2=0.289; p=0.008). In carriers of the homozygous genotype TT, the number of erosions at inclusion in the study was significantly higher compared with carriers of genotypes GG/GT (median 5.50 [0.754; 7.5] and 0.00 [0.00; 2.00], respectively; p=0.003). The risk of erosion is also associated with the polymorphism of the STAT4 gene (OR 8.6; 95% CI 1.0–204.9; p=0.03). A difference of the ACCP level depending on STAT4 gene polymorphism was revealed: carriers of at least one minor allele T (G/T+T/T) had significantly higher concentration of ACCP than that in carriers of homozygous GG genotype: 248.97±151.00 and 179.51±147.01 U/ml, respectively; p=0.048).Conclusion. The study showed that in Russian patients with very early RA, the STAT4 gene rs7574865 polymorphism is associated with both predisposition to the disease and prognostically unfavorable manifestations (phenotypes) of the disease, namely, with the development of erosion in the early stages of the disease and an increase of the ACCP level.

The paper provides information on the distribution of phonemes /o/ and /ô/ in the South Russian dialect of the village of Rogovatoye (Stary Oskol region, Belgorod district), presenting it in the form of a concise dictionary, which includes data on the reflexes of *o and *ъ in stems, some cases of /o/ and /ô/ that stay for *a, *ě, *e in stems, /o/ and /ô/ in loanwords and a list of inflections with reflexes of *o and *ъ.

In recent years, the effect of critical conditions on intestine and the role of such changes in maintenance and progression of systemic disorders are of particular attention. This issue is relevant in critically ill neurosurgical patients too. Intestine morphology and microbiome changes in these patients represent a wide field for researches in intensive care and prevention of secondary damage to other organs and systems. This review ensures a current approach to the problem of intestine morphology and microbiome changes in critically ill neurosurgical patients. We reviewed the data from clinical studies and experiments reproducing a critical condition in animals. Most publications are indexed in the PubMed, e-library, Google Scholar databases. We also analyzed the data from NEJM, JAMA, Lancet, Critical Care and other issues. The manuscript contains an overview of 44 foreign and 13 domestic references; over 50% of researches were published within the past 5 years. Searching depth was over 50 years.В последние годы все большее внимание уделяется влиянию критического состояния больного на кишечник и роли возникающих в нем изменений в поддержании и нарастании системных нарушений (так называемой энтеропатии критических состояний). Эта проблема актуальна и при критических состояниях у больных нейрохирургического профиля. Вопрос изменения кишечной морфологии и микробиома у таких пациентов представляет собой широкое поле для исследований в области интенсивной терапии и профилактики вторичного поражения других органов и систем. В обзоре представлены результаты систематического поиска публикаций, посвященных изменению морфологии и микробиоценоза кишечника, главным образом у пациентов с нейрохирургической патологией, а также с данными воспроизведения критического состояния в экспериментальных моделях у животных. Большинство публикаций проиндексированы в базах данных PubMed, e-library, Google Scholar, также использованы данные медицинских изданий NEJM, JAMA, Lancet, Critical Care и других. Статья содержит обзор 44 зарубежных и 13 отечественных источников; более половины работ составляют публикации за последние 5 лет. Глубина поиска составила более 50 лет.

Background ― A number of studies confirmed a crucial role of type 1 interferon in pathophysiology of connective tissue diseases. Interferon regulatory factors (IRF) coordinate an expression of type 1 interferon, while interferon regulatory factor 5 (IRF5) gene was recently identified as causing predisposition to systemic lupus erythematosus and Sjögren syndrome. The objective of our study was to identify possible association of IRF5 rs2004640 (G/T) single nucleotide polymorphism with systemic sclerosis (SSc). Material and Methods―The study involved 236 individuals, including 105 patients with SSc diagnosis and 131 control individuals from Moscow region. The latter were healthy, unrelated to each other, their genders and ages were matched to those of SSc patients. Allele-specific real-time polymerase chain reaction (PCR) was used to study IFR5 rs2004640 polymorphism. Results ― We detected significantly higher percentage of IRF5 T-allele carriers in all patients (59.5%), those with diffuse cutaneous SSc (67.3%), patients with interstitial lung lesions (62.3%), and those with positive titers of anti-topoisomerase I antibodies (66.3%), compared with control group (46.2%). The odds ratios (OR) were: 1.71 (р=0.00), 2.40 (р=0.0004), 1.93 (р=0.002), and 2.30 (р=0.0008), correspondingly. Conclusion ― The replacement of nucleotide G by T in the IRF5 rs2004640 gene polymorphism was associated with a predisposition to SSc. Our data implied an existence of a novel SSc pathogenetic pathway associated with important role of type 1 interferon in pathophysiology of connective tissue diseases.

A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.