Background. It is known that menopausal women suffer from sleep disorders. As additional diagnostic methods, it is possible to use the equations of linear classification functions.

Aim: to determine the most informative parameters among the lipid profile, the “lipid peroxidation – antioxidant protection” system parameters and the melatonin secretion chronobiological rhythms in menopausal women with sleep disorders.

Materials and methods. 56 perimenopausal women and 70 postmenopausal ones in accordance with the inclusion criteria participated in this study. Diagnoses of insomnia and obstructive sleep apnea syndrome were made according to the results of specialized somnological questionnaires and polysomnographic monitoring. Spectrophotometric methods for studying of lipid metabolism and the “lipid peroxidation – antioxidant protection” system parameters, an enzyme immunoassay method for determining melatonin were also used. A multidimensional discriminant analysis to reveal the most informative parameters among the parameters studied was used.

Results. The most informative indicators of the metabolic system for sleep disorders in perimenopausal women with insomnia are melatonin 06.00–07.00 h, melatonin 18.00–19.00 h, melatonin 23.00–00.00 h, ketodienes and conjugated trienes, oxidized glutathione; with insomnia and OSAS – melatonin 06.00–07.00 h, melatonin 12.00–13.00 h, melatonin 23.00–00.00 h, substrates with conjugated double bonds, total cholesterol; in postmenopausal women with insomnia – diene conjugates, α-tocopherol, total antioxidant capacity, active products of thiobarbituric acid, reduced glutathione; with insomnia and OSAS – total antioxidant capacity, α-tocopherol, substrates with conjugated double bonds.

Conclusions. The results obtained indicate a great strain in the antioxidant protection system in menopausal women with sleep disorders in response to changes in free radical homeostasis.

Stress reaction of the organism is a process occurring at the cellular, tissue and systemic levels. The organism responds to any adverse effect with a multi-level reaction, which causes the development of stress and, as a result, adaptation. The damaging effect is due to the excessive strengthening of another adaptive effect – lipotropic, that increases the activity of phospholipases and the intensity of free radical oxidation of lipids through the catecholamines and protein kinases. The changes in the immune system during the adaptation stage are to maintain antigenic homeostasis of the internal environment of the organism due to lymphoid cells, lymphocytes and cytokines. Almost all cells with antigen representation function are capable to produce interleukins under certain conditions. The vascular system is a kind of an indicator of any pathological process, determining the state of regulatory and adaptive mechanisms, the features of the connective tissue matrix. Stress causes a restructuring of metabolism and physiological functions, which increases the organism’s resistance to acute death. Thus, the physiological meaning of the stress reaction is the emergency mobilization of energy and structural resources of the organism and the creation of positive background for the implementation of reactions, aimed at maintaining homeostasis in extreme situations.

Background. Processes of antioxidant protection in different ethnicities, living in the same geographical conditions, are of undoubted scientific interest. The ratio of activity of oxidative processes and antioxidant components not only reflects, but also largely determines the metabolism and adaptive capabilities of the organism. The key issue in understanding the regulatory and adaptive role of lipid peroxidation reactions in the body is the idea of the existence of a certain balance with the antioxidant defense system.

Aims: to study the features of the system of lipid peroxidation and antioxidant protection in adolescents of different ethnicities, living in Eastern Siberia.

Materials and methods. Parameters of lipid peroxidation and antioxidant protection were determined in the blood serum by spectrophotometric methods.

Results. We found that adolescent Buryat boys had statistically significant decrease in primary and secondary products of lipid peroxidation: ketodienes and conjugated trienes, malondialdehyde, and components of antioxidant protection: retinol, α-tocopherol, the level of total antioxidant activity of blood and reduced glutathione, in comparison with Caucasian adolescents. In Caucasian adolescents with endocrine disorders, there was a statistically significant increase in the level of ketodienes and conjugated trienes, as well as the activity of superoxide dismutase against the background of a decrease of reduced glutathione, tocopherol, and retinol. We revealed a significant increase in the concentration of ketodienes and conjugated trienes and a decrease of the oxidized glutathione in adolescents with endocrine disorders in comparison with healthy adolescents of Buryat ethnicity.

Conclusions. Studying of the processes of lipid peroxidation and antioxidant system of the organism can be used as an additional criterion for complex examination of practically healthy adolescents, which significantly enhance the representation about the adaptation possibilities of the organism to external conditions and can become a basis for effective examination of reproductive health in the future.

The upper respiratory tract is one of the most important biotopes in the human body. Therefore, in order to understand the cause-effect relationships between the microbial world and the pathological state of a person, it is crucial to clarify the relationship of the microbes-associates.

The study involved 74 women with reproductive disorders. The main group – women with chronic endometritis (n = 47). The diagnosis of chronic endometritis was revealed on the basis of morphological signs of histological examination of aspirates from the uterine cavity. The comparison group consisted of 27 women, in whom the chronic endometritis was not confirmed. When applying, women complained more often of infertility and (or) miscarriage. Of the accompanying extragenital diseases, chronic tonsillitis in women of the studied groups was most often diagnosed. Therefore, it was important to give a microbiological description of the nasopharyngeal biotope of these women, as one of the factors that influences the reserves of confrontation of the reproductive function of the body to infections. Nasopharyngeal microbiocenosis of women with chronic endometritis was characterized by deficiency of the indigenous microbiota and a permanent presence in the microbiocenosis of the absolute pathogen (S. aureus) and transient species (enterococci, CNS). Between the representatives of normoflora antagonistic relations were established. The obtained results indicate violations in the nasopharyngeal biotope of these women, which can cause immunodeficiency and, as a consequence, the development and flow of chronic endometritis.

Non-structural protein 5 (NS5) of tick-borne encephalitis virus is an enzyme which is responsible for a copying of viral RNA, and it has a strong structural similarity to RNA polymerases of another RNA virus families. The strains of the virus are separated into three subtypes, which differ by specific mutations in virus proteins, including NS5 protein. The methods of structural bioinformatics allow to construct a model of NS5 protein for several strains of the virus.

The paper presents the comparative analysis of sequences and structures of NS5 protein, for three subtypes of the tick-borne encephalitis virus. The segments of protein were identified where the highest difference between subtypes and within subtypes is observed. These segments, where most of the mutations are accumulated, are located in methyltransferase domain, in the inter-domain interface, and in the three subdomains of polymerase domain. The association between the locations of mutations in NS5 protein and the flexibility of a protein backbone was observed using normal mode analysis. Namely, the most important mutations are located in the parts of protein where the amplitude of synchronous oscillations estimated using normal mode analysis is the highest: in the second zinc binding pocket within polymerase domain, in the N-terminal extension within inter-domain interface, and around an active site of methyltransferase domain.

In recent decades, the methods based on the cell technologies have become more relevant for medical and pharmaceutical research. In this paper, weconsidered the BioStation CT using for continuous in vivo observation of Ehrlich ascitic carcinoma cell culture under the influence of two active substances in different concentrations (from 1.25 to 20 mg/l). As a result of the carcinoma cells condition monitoring for 4.5 days it was shown that substance No 2 does not affect the cell viability while substance No 1 causes the carcinoma cell death, and this active substance effect is dose-dependent. Photodocumentation at two-hour intervals allowed us to research differences in the rate of cell destruction (intensive disintegration in the first day with further stabilization of the living cells number or gradual cell death throughout the experiment), as well as differences in the time of 50 % mortality reaching. Thus in the study it was demonstrated that due to the fact that the BioStation CT combines the properties of a CO₂ -incubator and a microscope this device is promising for toxicological studies and significantly expands the detection possibilities of processes occurring with living cells for a sufficiently long time period making possible further analysis of the cell behavior characteristics throughout the experiment, and that is fundamentally different from the systems allowing only the final result fixation of long-term active substance exposure.

To evaluate the effectiveness of the developed method of acupuncture in the complex of conservative treatment of pain in patients with osteochondrosis of the cervical spine in the neurosurgical Department of Irkutsk Scientific Centre of Surgery and Traumatology, 58 patients were under observation, 38 of whom were treated with acupuncture. The results of treatment were evaluated by the applying VAS testing and conducting stimulation electroneuromyography. The patients had 9–10 sessions of corporal and auricular acupuncture. Acupuncture was carried out according to 1st or 2nd variants of inhibitory action. When selecting points, the locally segmental principle was used, and the effect was carried out on symmetric points of general action (P7, GI4, GI 11 , E36 , RP6, VB34), on local pain ah shi points, in “near” and “far” points from the pain zone; on standard points of meridians of calming action: sympathetic, sedative and analgesic (points-cracks). Specific pain points were used: in pain in the area of the shoulder girdle – R5, E37, R4: in the rear surface of the chest and region of the scapula – T26, V43, V11; in neuralgia – V60, TR5, VB41. Corporal reflexology “enhance” auricular, we used impact on АТ55, АТ13, АТ22, АТ51, АТ34. In cases of severe pain and musculotonic syndromes, treatment was initiated with effects on auricular points: АР37 point of the cervical spine and АР55 point Shen Men. When comparing the results of VAS testing before and after the treatment, in all patients we noted a decrease in the intensity of pain, and 16 of patients went into the category of “mild cases”. The positive dynamics is confirmed by the data of electroneuromyographic studies: an increase in the amplitude of the M-response and a decrease in latency, a change in the characteristics of the F-wave. The obtained data indicate the high efficiency of acupuncture in the treatment of pain and muscle-tonic syndromes in patients with spinal osteochondrosis.

The article presents the review of domestic and foreign literature on the use of neurophysiological diagnostic methods – electroneuromyography (ENMG) and electromyography (EMG) in degenerative-dystrophic diseases of the spine. The ENMG method is of great importance for theoretical neurology, obtaining new data on the structural and functional organization of the central and peripheral nervous system in the process of individual development. Electromyography as a diagnostic method studies the electrical activity of the peripheral apparatus of the nervous system. With these methods we directly evaluate both voluntary bioelectric activity of muscles at rest and during their activation (EMG), and caused by stimulation (ENMG). Most authors believe that modifications of stimulation electromyography are objective diagnostic methods that allow to assess the functional state of the peripheral nervous system. Interesting is the fact that changes in EMG and ENMG parameters for osteochondrosis of the spine are recorded even in the absence of external manifestations of the disease. At the same time, for patients with myofascial syndrome in lumbar osteochondrosis, a bilateral decrease in the direct and reflex excitability of motoneurons is characteristic, a slowing down of the pulse along the arc of the H-reflex on the side of the pain and a two-sided local acceleration of the pulse on the distal part of the efferent part of the H-reflex arc from the popliteal pits to soleus muscle. Noteworthy is the fact that the pathological process in the nervous tissue according to ENMG in patients with osteochondrosis of the spine with unilateral radicular syndromes is bilateral. The work of our clinic has shown that diagnostic electroneuromyography can be considered as a medical procedure – electropuncture, according to its results, tactics of both surgical and conservative treatment can be determined. Data of EMG and EMG, carried out after the end of any of the listed types of treatment, serve as an objective control of their effectiveness.

The paper presents the results of surgical treatment of 12 patients with stenosing processes of the vertebral canal at the craniovertebral transition due to chronic, unstable type 2 injuries of the C odontoid process (classification of fractures of odontoid process proposed in 1974 by Anderson and D’Alonzo). Patient examination included clinical-neurologic examination, review spondylograms of the cervical spine in 2 projections, MSCT, MRI. All patients were admitted to the clinic with external fixators (cervical support collar or Philadelphia collar). In the preoperative period, all patients were divided into 2 groups according to indications and contraindications for the application of the HALO-device. The first group consisted of 7 people, with cervical spine still fixed with the cervical support collar or Philadelphia collar, and the second group consisted of 5 patients with C_II fracture fixed and corrected in the preoperative period by the HALO-device. All patients underwent surgical intervention – posterior approach decompression of the spinal canal and dural sack in the craniovertebral passage by C_I laminectomy, partial resection of the posterior margin of the occipital aperture followed by the implementation of atlanto-axial occipitospondylodesis (a clamp with shape-memory effect for posterior occipitospondylodesis, OOO “MITS SPF”, Novokuznetsk, Russia). A comparative analysis of the results of surgical treatment of posttraumatic stenoses of the vertebral canal with and without the use of the HALO-traction device was performed. The results was better in the second group, which makes it possible to consider the second variant of surgical treatment more pathogenetically justified. Thus, HALO-traction restors anatomo-topographic relationships in the craniovertebral zone creating hard external fixation, helping to avoid intraoperative complications.

The purpose of the research was to study physical health of patients with gastric cancer, the identification of markerspredictors of gastric cancer.

Material and methods. This article presents the results of a survey with 150 patients diagnosed with stomach cancer. The research was conducted on the basis of the department of oncoabdominal surgery of Krasnoyarsk Regional Clinical Oncological Hospital named after A.I. Kryzhanovskiy in the period from 2016 to 2017. Patients with established gastric cancer, awaiting for surgical treatment, were examined using anthropometric methods of research. We evaluated the physical status of patients of different age diagnosed with stomach cancer. We also calculated body mass index and Tanner’s index of sexual dimorphism (1968), according to the last we determined the type of gender dimorphism. Distribution of healthy men and women in the population of the Krasnoyarsk Territory was taken for comparison.

Results. We have obtained the following markers: overweight and obesity, sex inversion in men of the II period of adulthood and the elderly to gynecomorphy, and in women of the II period of adulthood – to mesomorphy.

Conclusions. These markers are used for assessment of the physical status of patients with stomach cancer. They, together with the already known risk factors of gastric cancer development, will help to identify groups with an increased risk for gastric cancer development at the stage of medical examination of the population.

Vibration disease is one of the leading in the structure of occupational diseases. A more detailed study of the pathogenesis, expanding the possibilities of diagnosis of vibration disease, is necessary. The aim of the study is to determine the diagnostic value of stabilometry, quantitative sensory testing and neuroenergocarting in vibration disease associated with the combined effects of local and general vibration. Materials and methods. Two groups of patients were examined: with the diagnosis of vibration disease associated with the combined effect of local and general vibration – 50 people (age 48.7 ± 3.1 years), not in contact with vibration – 30 people (age 49.1 ± 2.8 years). The study of the equilibrium function, the determination of the level of the constant potential of the brain by 12 standard leads and the determination of temperature and pain sensitivity. Statistical processing of the results was carried out using the software package “Statistica 6.0” (StatSoft Inc., USA). Differences were considered statistically significant at p < 0.05. Results. In vibration disease, the vertical stance of patients is more unstable than in patients with no contact with vibration. In patients with vibration disease, there is a decrease in the threshold of cold sensitivity and an increase in the threshold of thermal sensitivity and thermal pain compared to the control group. According to our data, the increased level of permanent potential in patients with vibration disease is observed in the central (22.7 (12.6; 30.7) mV) and right central (20.4 (11.5; 27.1) mV), also the average level of permanent capacity in this group is increased – 17.1 (8.4; 25.8) mV.

Conclusion. The results obtained indicate the involvement of the neurosensory complex united by single thalamic and cortical centers in the pathological process and confirm the diagnostic value of the methods used.

Background. Magnetic resonance imaging not only has powerful capabilities for visualization, but is also of interest in terms of obtaining ideas about microstructural and biochemical changes in the tissues of the joints in osteoarthritis.

Aims. To assess the possibility of T2-images of magnetic resonance imaging in the diagnosis of microstructural changes in the subchondral bone in osteoarthritis.

Materials and methods. 62 patients with osteoarthritis and 8 volunteers without osteoarthritis were examined. All patients underwent magnetic resonance imaging of knee. To assess the variability of transverse relaxation time, the T2-images segmentation of the subchondral segmentation in the frontal projection was performed by hand. The proton density was estimated from a 3D histogram on a scale of 0 to 255.

Results. At the first stage of osteoarthritis, the intensity of the magnetic resonance signal decreases over the entire surface of the tibial plateau, with minimal values in the region of the medial part of the knee joint. At stage 2 osteoarthritis, there was an even greater decrease in the number of protons that made the phase transition with the lowest value in the medial region. The subchondral bone texture in stage 3 was characterized by a significant decrease in signal intensity in the region of the medial plateau of the tibia. In the terminal stage of osteoarthritis.

Conclusion. The revealed regularity of the change in the relaxation time spectrum of T2-images reflects the degenerative process in subchondral bone with osteoarthritis.

Transosseous osteosynthesis continues to occupy a leading position among the methods of treatment of damage to the tubular bones of the extremities. This article presents a survey of 47 patients: 22 men and 25 women aged 25 to 60 years with fractures in the middle third of the radial shaft with displacement of bone fragments. The peculiarity of the external fixation device we used is that all transosseous elements are represented by 1.5 mm pins, inserted through both cortical layers of each bone, at levels from I and VIII. The pins are inserted simultaneously through both bones, thus excluding the rotational function of the forearm.

The essence of the study is a comparative analysis of the blood system parameters in patients with diaphyseal injuries of the radial bone, operated by the transosseous osteosynthesis method using the external fixation device of pin configuration. Any damage to the body, (a fracture or related surgery), is accompanied with various changes in the system of hemodynamics and metabolism.

The laboratory blood tests performed in the group of patients with damage to the radial shaft treated with transosseous osteosynthesis by external fixation device of pin configuration, revealed certain regularities in changing of blood parameters: increased number of platelets, increased level of fibrinogen and level of soluble fibrin complexes, which promotes the activation of the internal mechanism of blood clotting.

Background. Multi-layer spiral computed tomography shows that the main cause of shoulder instability is glenoid cavity bone defect. The aim of our research was to assess the effectiveness and safety of biodegradable implants in the treatment of patients with chronic posttraumatic anterior shoulder instability under conditions of bone defect of glenoid cavity margin by the restoration of anatomic shape and structure of scapula articular surface.

Materials and methods. We performed a pilot study based on the results of surgical treatment of 7 patients using 4.5 mm biodegradable compressing screws. In preoperative period, all patients had standard two-dimensional X-rays and MSCT with 3D-reconstruction. In postoperative period, all patients had check-up X-ray right after the surgery and MRI in 3 months after the surgery.

Results. The results of the treatment were assessed by common clinical criteria, functional criteria, X-ray evidence and intraand postoperative complications. We registered strong functioning of an arm and an increase in the range of motions. Data from Rowe/Zarins and DASH questionnaires showed that the patients totally recovered. X-ray evidence showed consolidation of non-free autograft to the zone of scapula bone defect without osteolysis or widening of a drilled hole. We did not observe either a failure of union, or any formation of false joint, or any screw fractures in bone tissue. Beyond that, we did not observe any complication in postoperative period and early postoperative complications in particular.

Conclusion. Pilot study with use of modern biodegradable implants in osteoplastic stabilization of shoulder joint at recurring instability showed their effectiveness and safety in patients of young and active working age. However, considering small number of patients in pilot study we cannot extrapolate our results to all similar and analogue cases of using biodegradable implants. In this regard, it is necessary to perform major multicenter clinical randomized study for further long-term observation and detection of possible unwanted side effects.

Adhesive disease of the abdominal cavity is a common medical problem that impairs the patients’ life quality. Adhesive intestinal obstruction ranks first in the structure of acute bowel obstruction. The levels of complications and postoperative mortality are not likely to decrease. Consequently, the studies on preventing adhesive disease are still in progress, which requires an animal model to induce abdominal adhesive process. Numerous factors of peritoneum injury result in adhesion formation. Experimental surgery offers various techniques of inducing the adhesive process in the abdominal cavity based on mechanical, chemical, biological, implantation injury factors. Recent trends in intra-abdominal adhesion stimulation are designed to approximate at maximum an animal model and present surgical and gynecologic procedures. In the review article, we survey and systematize different ways of inducing intra-abdominal adhesive process with various injury factors. The choice of study animal, the ways of peritoneum injury, followed by septic or aseptic inflammation are analyzed. The rating scales for the severity of adhesive process are also organized and compared. The number of existing models is large which is evident of the outstanding problem and promising outlook of scientific research.

The level of natriuretic peptide is regarded as a prognostic predictor of postoperative heart failure in modern cardiac surgery, and moreover, this hormone is included in the standards of its early diagnosis around the world. This study was conducted at the Irkutsk Cardiac Surgery Center. The results of treatment of 78 patients were analyzed in order to determine the relationship between the dynamics of brain natriuretic peptides and the course of the early postoperative period in operations with artificial cardiopulmonary bypass. Patients were divided into three groups according to the level of natriuretic peptide elevation in the postoperative period. The study proved the dependence of the postoperative period on the multiplicity of the increase in the level of natriuretic peptide B-type.

It was found that the higher the rate of increase in the hormone, the lower the numbers of the cardiac index in the postoperative period, longer duration of inotropic support (p > 0.05) and higher doses of adrenomimetics (p > 0.05). The duration of mechanical ventilation was also longer in the groups where a high level of natriuretic peptide was recorded (p > 0.05). Thus, the multiplicity of natriuretic peptide elevation can be a prognostic criterion for the postoperative period in cardiac patients. It is important to note that a single determination of the level of natriuretic peptide should not be used as a marker of postoperative heart failure and this study confirmed the necessity to monitor the dynamics of brain natriuretic peptide’s level in the perioperative period in patients operated with extracorporeal cardiopulmonary bypass.

Background. Nasal anthropometry is an important aspect of maxillofacial and plastic surgery especially in the preoperative stage of rhinoplasty. Multislice computed tomography (MSCT) permits to assess quantitative the variant nasal anatomy using measuring.

Aims: to determine the possibilities of MSCT-anthropometry in nasal configuration grade.

Materials and methods. We performed a proand retrospective analysis of MSCT data of maxillofacial region of 50 patients (aged 35 ± 10.7 years old) with changes of nasal height and width and 35 women (32.9 ± 8.4 years old) with normal nasal configuration. The variant anatomy consists in long nose (n = 16), short nose (n = 17), wide nose (n = 17). The nasal height was measured from the nasal root (nasion) to the nasal base (subnasion), the nasal width is the distance between the most lateral aspects of the alae nasi. Besides, the nasal index was calculated. The descriptive statistics of obtained data were presented by mean and standard deviation (SD), also the multiple regression analysis was used. Values of p = 0.005 were considered statistically significant.

Results. The results showed that the average nasal height in patients with normal configuration is 51.9 ± 2.63 mm, with short nose – 45.2 ± 1.36 mm, with long nose – 60.3 ± 1.28 mm. The mean nasal widths are 34.9 ± 1.88 mm in normal configuration, 38.8±3.57 in wide nose. The nasal indexes were calculated, their features were detected. These obtained results correlate with anthropometric data of different studies.

Conclusions. MSCT-anthropometry is an objective imaging method of variant nasal anatomy that could provide improving quality of diagnostics of patients seeking rhinoplasty and choose a surgical approach.

The main place in the diagnosis of obstructive jaundice belongs to radiation research methods. Their choice is determined by the nature of the disease, efficacy, safety and cost of the study. The article describes the computer-tomographic symptoms of malignant and benign diseases of the hepatopancreatoduodenal region.

To study the possibilities of multispiral computed tomography in the diagnosis of diseases, the results of examination of 62 patients with manifestations of mechanical jaundice syndrome were analyzed on the basis of the surgical Department of the Irkutsk city clinical hospital N 1. The mean age of the examined patients was 56 ± 4.5 years. In the ratio of 2:1.4 women dominated. Biliary obstruction of benign genesis prevailed, which was found in 44 (61.1 %) patients, among which the most common cause was: choledocholithiasis (34 (54.8 %) patients), choledoch strictures (9 (12.5 %) patients) periampular diverticula (2 (1.9 %) patients). The reason for the obstruction of malignant genesis (18 (38.9 %) patients) were: adenocarcinomas of the head of the pancreas (11 (29.0 %) patients), bile duct tumor (5 (8.0 %) patients), volume formations of the duodenum (2 (3.2 %) patients).

The work presents the analysis of ultrasound diagnostic of traumatic hematomas of the spleen in 12 patients after blunt abdominal trauma. Traumatic injuries of large (4 patients) and giant (5 patients) sizes prevailed. Only 3 patients had medium sized traumatic lesion. Ultrasound examination was performed for all patients as a primary procedure and for dynamic observation. We tracked evolution of traumatic spleen injuries and identified four stages of pathological process in case of aseptic development: the stage of “fresh hemorrhage”, the stage of “formed clot”, the stage of “aseptic lysis of the clot”, the stage of “connective tissue organization”. We determined the evidence of pyogenesis of spleen hematomas, identified the stage “bacterial lysis of the clot” and stage of “forming capsules”. We determined the indications and contraindications for the minimally invasive treatment of spleen hematoma. Percutaneous evacuation of the spleen hematoma was performed in all patients. In four cases of minimally invasive treatment was puncture. In one patient the treatment was completed with a single puncture, in 3 patients – with a double one. Drainage of spleen hematomas was performed in 8 patients. We analyzed the results of minimally invasive treatment of traumatic injuries of the spleen under ultrasound control. Minimally invasive treatment was successful in 11 patients. Only 1 patient was operated for post-traumatic aneurysm of the splenic artery due to the continuing bleeding into hematoma.

Background. A significant number of medical students refuse to work on a specialty obtained in medical universities after its completion or during the first years of professional activity.

Purpose of the study: to conduct a sociological study of the adherence of students of a medical university to employment in a specialty received at a university, as well as factors of its motivation.

Methods. A sociological survey of graduate students of ISMU was conducted using specially designed questionnaires.

Results. It was revealed that more than 5 % of students do not plan to work on the received specialty after graduating from a medical university. Only every fourth respondent after graduation is going to return to his place of permanent residence, one of four intends not to return, and half have not yet decided on the choice of a further place of work and residence. Work with undergraduates about bringing them to the territory of the initial residence is organized by the administration of municipal entities and medical organizations poorly. Meanwhile, the requirements of graduates presented to a potential employer in terms of the level of wages and the creation of conditions for residence and professional activity are not overstated.

Conclusion. Working with graduates and taking specific steps to implement their requirements is the most logical option for joint activities of medical universities, health authorities, administrations of medical organizations and local self-government bodies to create favorable conditions for securing young professionals in their chosen field of activity.

The work is devoted toanew suture in the formation of tracheo-tracheal anastomosis. Despite the improvement of surgical technique in tracheal interventions, the number of postoperative complications (insufficiency and stenosis of anastomosis) remains high, with postoperative lethality reaching 18.2 %. The main problem is the lack of a unified point of view on the choice of the method of anastomosis, in particular, inclusion in the mucosal suture. Several variants of tracheo-tracheal anastomosis are suggested, but a large number of complications testify to the shortcomings of the methods used.

The aim of this work is to optimize the imposition of a continuous single-row suture for the formation of tracheo-tracheal anastomosis with a shortening of the trachea.

Materials and methods. The study was carried out on the basis of the scientific department of experimental surgery with the vivarium of Irkutsk Scientific Centre of Surgery and Traumatology using Wistar rats, and approved by the ethical committee.

Results. A technique for the formation of tracheo-tracheal anastomosis with the use of an original continuous singlerow suture with a shortening of the trachea was developed. Step by step a sequence of operations from access to the cervical trachea to the formation of an anastomosis.

Conclusion. The discussed version of the seam in the formation of tracheo-tracheal anastomosis makes it possible to accurately compare and reliably stabilize the sewn ends of the trachea.

The aim was to assess the effect of silver nanoparticles on the expression of proand anti-apoptotic proteins caspase-3 and bcl-2 by discriminant analysis.

Materials and methods. 120 sexually mature outbred male rats were divided into 8 groups (pure arabinogalactan (AG), pure poly-1-vinyl-1,2,4-triazol (PVT), nanobiocomposites on the AG and PVT matrix at a dose of 100 and 500 μg/kg. The administration was done orally for 9 days. The experimental study was carried out in two stages. The first stage included the examination of animals immediately after the end of the exposure of the studied substances (early period), the second stage – a survey 6 months after the end of the exposure (the long-term period).

Results. The most distinguished groups were the groups that were administered silver nanoparticles on the AG matrix at a dose of 100 and 500 μg/kg.

Conclusion. Comparison of the results of the discriminant analysis allowed to fully determine the effect of silver nanoparticles on the expression of proand anti-apoptotic proteins caspase-3 and bcl-2 when they were introduced on the AG and PVT matrix. In the AG groups and nanobiocomposites based on it, in the feature space, it was shown that the most remote by differentiating characteristics are the groups nAG100 and nAG500. In nanocomposites on the PVT matrix, a group of animals differing in differentiating features has not been identified.

Priorities and directions of development of the Russian economy are connected with the eastern territories. The purpose of the study is to the identify key problems and substantiate indicators of the hygienic and epidemiological welfare of the population of Siberia. Two blocks of characteristics (“public health” and “environment”) are considered in dynamics for 5 years in the context of the subjects of the Siberian Federal District. Four groups of territories differed in terms of the incidence rate and the average life expectancy (ALE) using cluster analysis. It is shown that ALE depends on economic indicators. The incidence is associated with the amount of gross pollutant emissions in the atmospheric air (r = 0.83–0.96; p < 0.001). The assessment of the influence of the habitat on the health of the population at the level of the macroregion allowed to substantiate the hierarchy of the most significant factors. More than 98 % of the environmentally related component of morbidity is associated with the amount of gross emissions of harmful substances in the air (the contribution was 69 %), the provision of the population with doctors (12.6 %) and inpatient beds (6.7 %), the gross regional product (6.5 %), clean water consumption (3 %) and average per capita income (0.8 %). In conclusion, for the successful implementation of preventive strategies, an important stage is the development of a set of solutions for the effective use of resources available in the region (financial, personnel, medical, rehabilitation).

Infectious mononucleosis (MI) is caused by the Herpes viridae family of viruses. Currently, most researchers assign a leading role to the Epstein-Barr virus. In present time there are no unified clinical classification of infection mononucleosis, but many authors recognize the visceral form which involves cardiovascular system, adrenal glands, lungs, central neural system and others organs. The article describes a clinical case of MI in the 28-year-old patient. She applied for medical help with complaints of fever up to 39 °C, weakness in the legs and arms, weight loss and received symptomatic treatment on an outpatient department. After 2 months on the background of deterioration, she was hospitalized in an infectious diseases hospital with severe symptoms of intoxication, lymphoproliferative syndrome, myocarditis, pericarditis, hepatitis, polyneuropathy with quadriparesis, hypochromic anemia, thrombocytopenia. She was consulted by an oncologist and diagnosed with cervical cancer. Laboratory confirmation was obtained – Epstein-Barr virus was detected in the blood. Against the background of antiviral therapy, a regression of clinical symptoms was achieved in a week. The patient was transferred to a oncological hospital. It is recommended to examine patients with high fever of unknown etiology on myocardial infarction for the timely appointed etiotropic therapy.

An anomalous origin of the left coronary artery from the pulmonary artery, or Blund – White – Garland syndrome, is a rare congenital heart disease in which an anatomically correctly formed left coronary artery extends away from the pulmonary artery. Most patients with this defect die from progressive left ventricular failure during the first year of life, and the rest may suddenly die in adolescence or adulthood from acute coronary insufficiency. Several surgical methods of correction of the defect have been proposed, but a small number of observations do not allow one to express unequivocally in favor of one of the methods of performing the operation. We present our own observation of a surgical correction of a defect in a teenager. We performed off-pump aortocoronary bypass surgery of the anterior interventricular artery, and separation of the left coronary artery from the pulmonary artery by ligation, with the stitching of the left coronary artery. The issue of the expediency of tying hypertrophied collaterals between right coronary artery and left coronary artery systems was discussed with the purpose of reducing competitive blood flow after performing left coronary artery shunting. Experience in performing coronary artery bypass surgery without artificial circulation made it possible to perform an off-pump operation.