Decapeptide gonadoliberin (GnRH) is the most important regulator of the hypothalamic-pituitary-gonadal (HPG) axis that controls the synthesis and secretion of the luteinizing and follicle-stimulating hormones by gonadotrophs in the adenohypophysis. GnRH is produced by the specialized hypothalamic neurons using the site-specific proteolysis of the precursor protein and is secreted into the portal pituitary system, where it binds to the specific receptors. These receptors belong to the family of G protein-coupled receptors, and they are located on the surface of gonadotrophs and mediate the regulatory effects of GnRH on the gonadotropins production. The result of GnRH binding to them is the activation of phospholipase C and the calcium-dependent pathways, the stimulation of different forms of mitogen-activated protein kinases, as well as the activation of the enzyme adenylyl cyclase and the triggering of cAMP-dependent signaling pathways in the gonadotrophs. The gonadotropins, kisspeptin, sex steroid hormones, insulin, melatonin and a number of transcription factors have an important role in the regulation of GnRH1 gene expression, which encodes the GnRH precursor, as well as the synthesis and secretion of GnRH. The functional activity of GnRH-producing neurons depends on their migration to the hypothalamic region at the early stages of ontogenesis, which is controlled by anosmin, ephrins, and lactosamine-rich surface glycoconjugate. Dysregulation of the migration of GnRH-producing neurons and the impaired production and secretion of GnRH, lead to hypogonadotropic hypogonadism and other dysfunctions of the reproductive system. This review is devoted to the current state of the problem of regulating the synthesis and secretion of GnRH, the mechanisms of migration of hypothalamic GnRH-producing neurons at the early stages of brain development, the functional activity of the GnRH-producing neurons in the adult hypothalamus and the molecular mechanisms of GnRH action on the pituitary gonadotrophs. New experimental data are analyzed, which significantly change the current understanding of the functioning of GnRH-producing neurons and the secretion of GnRH, which is very important for the development of effective approaches for correcting the functions of the HPG axis.

Background. Reactivation of cytomegalovirus infection (CMV) during pregnancy is associated with manifestation of oxidative stress, both in the maternal peripheral blood and in the placental tissues. One of the effects of oxidative stress is a disturbance of the metabolism of fatty acids, which leads to the initiation of the apoptotic cascade, the death of trophoblast cells and, as a result, tissue or organ dysfunction, promoting to the development of a pathological condition. However, an analysis of the current literature indicates insufficient information on this problem in the villous chorion of the placenta in CMV infection.

Aims. To study the relationship between the oxidative stress development and fatty acid imbalance in apoptosis of trophoblast cells during reactivation of CMV in the first trimester.

Material and methods. We examined peripheral blood, urine, a homogenate of the villous chorions from 35 pregnant women with CMV reactivation within 9–11 weeks of pregnancy and from 30 pregnant women without CMV of the same gestation period. We studied levels of IgM and IgG for cytomegalovirus, low-avid IgG antibodies to cytomegalovirus (avidity index), phospholipase A2 content, fatty acid content, number of apoptotic trophoblast cells, fatty acid peroxide content and catalase activity. Sampling and analysis of material from pregnant women was conducted in 2016–2018.

Results. The reactivation of CMV in the first trimester of pregnancy led to an increase content in the phospholipase A2 in villous chorion by 2.5 times, by 1.5 times of fatty acid peroxides, 1.5 times arachidonic acid, palmitic acid by 1.3 times, number of trophoblast cells in a state of apoptosis by 4.7 times and decrease catalase activity by 1.44 times.

Conclusion. As a result of the study, cytomegalovirus-dependent induction of oxidative stress and imbalance of fatty acids triggering apoptosis of trophoblast cells was identified. Increased apoptosis initiates inflammation and destructive processes in the early placenta.

Liver cirrhosis is accompanied by complex hemostatic disorders with an increase in the risk of both hemorrhagic and thrombotic complications. Reduced coagulation protein synthesis, such as factors II, VII, IX, X and thrombocytopenia are associated with an increased risk of bleeding. Reducing the synthesis of such anticoagulants as protein C, protein S, antithrombin III is accompanied by increased generation of thrombin, which leads to procoagulant status, increased risk of venous thrombosis, pulmonary embolism, and portal vein thrombosis. Activation of the coagulation cascade increases the risk of thrombosis, and also plays an important role in liver damage, contributing to the progression of fibrosis. Cirrhosis increases the risk of thromboembolic complications of atrial fibrillation.

Anticoagulants are necessary for the prevention of thrombosis and thromboembolic complications. However, there are no large prospective studies. There is insufficient data on the safety of anticoagulant therapy in cirrhosis. There are difficulties in monitoring anticoagulation in the application of vitamin K antagonists and low molecular weight heparins.

The review presents the available data on the use of warfarin, unfractionated heparin, low molecular weight heparins and direct oral anticoagulants in patients with liver cirrhosis, indicating the need for prevention of venous thrombosis in patients with risk factors, the possibility of preventing decompensation of cirrhosis, reducing the frequency of cardioembolic strokes in patients with atrial fibrillation.

The article describes the criteria for the examination of temporary disability and the establishment of a disability group for idiopathic interstitial pneumonia on the example of a clinical case of nonspecific interstitial pneumonia with a view to a uniform interpretation by clinical physicians and expert doctors of the criteria for persistent functional impairments in the case of respiratory organs and the timeliness of referring to medical and social examination of people suffering from it patients. Temporary disability is caused by the appearance of shortness of breath in patients, which is steadily progressing and leads to a decrease in exercise tolerance. The presence of an unfavorable prognosis in some forms of interstitial pneumonia predetermines the maximum period of temporary disability for 4 months with the subsequent registration of patients for medical and social examination. Restrictive dysfunction of external respiration is not singled out in quantitative criteria of functional persistent disorders of the body to establish the group of disability in the Order of the Ministry of Labor of Russia dated December 17, 2015 No. 1024н, which causes difficulties during the examination. A key sign of persistent respiratory function disorders is respiratory failure, the severity of which is put in its quantitative gradation for recognizing a citizen as disabled. Pulse oximetry is currently available as a verification method for the diagnosis of respiratory failure, which is used for medical and social expertise. The morphological variant of interstitial pneumonia, if histological diagnosis was performed, or the presumptive nosological form diagnosed on the basis of a complex of clinical and radiological data, do not have a direct impact on the result of the examination; just as the volume of drug therapy and the response to it are not taken into account in order to establish the fact of disability.

The constantly growing contribution of depressive disorders to the global disease statistics calls for a growth of treatment effectiveness and optimization. Antidepressants are the most frequently prescribed medicines for depressive disorders. However, development of a standardized pharmacotherapeutic approach is burdened by the genomic heterogeneity, lack of reliable predictive biomarkers and variability of the medicines metabolism aggravated by multiple side effects of antidepressants. According to modern assessments up to 20 % of the genes expressed in our brain are involved in the pathogenesis of depression. Large-scale genetic and genomic research has found a number of potentially prognostic genes. It has also been proven that the effectiveness and tolerability of antidepressants directly depend on the variable activity of the enzymes that metabolize medicines. Almost all modern antidepressants are metabolized by the cytochrome P450 family enzymes. The most promising direction of research today is the GWAS (Genome-Wide Association Study) method that is aimed to link genomic variations with phenotypical manifestations. In this type of research genomes of depressive patients with different phenotypes are compared to the genomes of the control group containing same age, sex and other parameters healthy people. Notably, regardless of the large cohorts of patients analyzed, none of the GWA studies conducted so far can reliably reproduce the results of other analogous studies. The explicit heterogeneity of the genes associated with the depression pathogenesis and their pleiotropic effects are strongly influenced by environmental factors. This may explain the difficulty of obtaining clear and reproducible results. However, despite any negative circumstances, the active multidirectional research conducted today, raises the hope of clinicians and their patients to get a whole number of schedules how to achieve remission faster and with guaranteed results

For an objective assessment of the quality of life (QOL) in areas with different environmental pressures and the development of recommendations for improving medical care, population studies of children are used. The purpose of this study is to assess the risk of a general incidence of mass noncommunicable diseases (МND) of the child population of industrial cities with various environmental pressures as an indicator of QOL. To assess the anthropogenic load in industrial cities, atmospheric air pollution with harmful substances was analyzed. The assessment of the influence of local factors of cities was determined by relative and attributable risks of morbidity using synchronous annual and corresponding to the studied time interval values of background and estimated morbidity, and the influence of common background factors by the value of initial background morbidity at the beginning of the long-term observation period. To assess and rank changes in QOL in areas with different environmental loads, we used the results of the analysis of the long-term risk dynamics of the minority disease of children’s population with long-term exposure to a complex of general and local environmental factors of industrial cities of the Irkutsk region. To do this, we used the criteria developed by the authors for assessing the degree of tension of the medico-ecological situation and the strength of the impact of environmental factors on them by the relative risk levels of the minimum level and the corresponding QOL levels for the specified component.

QOL in terms of the minimum number of children’s diseases in the period under review decreases as a whole due to the increasing influence of general background (regional) factors throughout the region, and in the studied cities in addition from the influence of local adverse factors, including anthropogenic pollution of atmospheric air.

A significant decrease in the local anthropogenic load is accompanied by a decrease in the associated additional МND and the severity of the additional to the background decrease in QOL in the industrial cities of the region, especially in Angarsk.

Background. The feasibility of creating a screening Index for the comorbidity of mental disorders and cardiovascular diseases in the practice of the cardiologist dictates the need to validate existing algorithms.

Aim. To validate the previously proposed Index of psychocardiac comorbidity in prediction of outpatient recommendation of psycho-pharmacotherapy for cardiology patients.

Materials and methods. Medical records of 302 consecutive patients of cardiac in-patient department were retrospectively analyzed with ROC-curve to estimate the predictive value of previously proposed Index of psychocardiac comorbidity for out-patient recommendation of psycho-pharmacotherapy.

Results. The prevalence of outpatient psycho-pharmacotherapy in the examined patients was 15.2 %; this group of patients was more polymorbid and was characterized by a higher proportion of women and a higher prevalence of a labile course of arterial hypertension. The sedative antipsychotics, non-benzodiazepine tranquilizers and mood stabilizers were predominant pharmacological groups. An analysis of reproducibility of Index of psychocardiac comorbidity was provided on a cohort of cardiology in-patient department (n = 302). Index calculated by using the formula I = C + 3(6)×Q + 3×W + 8×A (C – number of Comorbid diagnoses, Q – Quake in the chest, palpitations or arrhythmia, onset before 55 (3 points) or 50 (6 points) years; W – Women; A – labile Arterial hypertension). Area under ROC-curve in validation cohort was 0.828 ± 0.035 (p < 0.001). Positive predictive value of Index was maximal for the score of ≥ 13.

Conclusion. The proposed Index of psychocardiac comorbidity is a valid tool to predict the prescription of psychopharmacotherapy in cardiology patients.

The 21st century is characterized by the exacerbation of the problem formation and spreading of drug-resistant strains throughout the world. Genetic mutations of Mycobacterium tuberculosis lead to the formation of drug-resistant forms because of long-term use of anti-tuberculosis drugs. The Russian Federation is among the top three countries with a high burden of tuberculosis with multidrug resistance (MDR). The estimated number of cases of tuberculosis with MDR in the Russian Federation was 60,000, which corresponds to half the burden of the European Region in 2015. In the Irkutsk region from 2014 till 2018 the proportion of TB cases with MDR cases increased from 15.2 % to 18.3 %. According to the reference laboratory of the Irkutsk Regional Clinical Tuberculosis Hospital, a significantly higher level of MDR among primary diagnosed was registered in the cities (27.7 %) and the lowest in rural areas of the region (16.5 %). Among the cohorts of patients with tuberculosis, the highest proportion of MDR was in the northern territories of the region (43.1 %), in Irkutsk district (41.2 %) and in large cities, including Irkutsk (38.5 %). Positive correlations were established between cohort of primary diagnosed TB with MDR and among populations in areas with high morbidity along the railway (r = 0.91; p = 0.00001), in the Irkutsk region (r = 0.89; p = 0,00008), and also in the Irkutsk city (r = 0.91; p = 0.00002). This is probably due to the influence of reservoir of tuberculosis infection formed in these localities. The regulatory documents of the Ministry of Health of the Irkutsk Region was developed on the basis of the data obtained, and they include recommendations for improving the diagnosis of tuberculosis in the region using fast and accelerated microbiological diagnostic methods.

The problem of the back pain in pregnant women is one of the most important in modern medicine. 65–90 % of pregnant women complain of the back pain. The women may have the back pain from the early stages of pregnancy, or it may occur with the growth of the fetus.

The causes of the pain during pregnancy are late reproductive age, high body mass index, physical strain, pain during previous pregnancies. Vertebrogenic and pelvic pain in pregnant women can first appear at the beginning of the gestational period. According to various authors, the frequency of such pain is 30–35 %. As a rule, painful neurologic manifestations begin in the third trimester, on average at the 18 th –22 nd week of pregnancy. About a half of women with early manifestation of lumbosacral pain during the pregnancy keep suffering from pain for a year after giving birth. In 20 % of cases, symptomatic pain is felt for 3 years after the delivery. The primary factors causing the pain syndrome is the shift in the centre of gravity due to enlargement of the pregnant uterus of the postural balance. The localization of the pain depending on the peculiarities of the posture can be different. In most of cases the lower back, thoracolumbar passage, sacrum, with the occasional radiation to buttock or pelvic joint, are affected. One of the most common pain syndromes in gynecology is the myofascial syndrome characterized by hyper tonus of the muscles and fasciae and ligaments of the pelvic minor.

The development of respiratory complications in patients after surgical treatment of lung cancer remains a serious problem, far from being resolved today. Pain remains the main factor that leads to a decrease in respiratory function in the postoperative period.

The aim of this study is to evaluate the effect of intrapleural lymphotropic blockades on the incidence of respiratory complications in the postoperative period in patients undergoing surgical treatment of lung cancer.

Materials and methods. 103 patients with operable forms of lung cancer, who underwent anatomical lung resection or pneumonectomy, were treated in the Oncology Department of the Tomsk Regional Oncology Center. The patients were divided in two groups. The first group included 52 patients, who were supplemented with intrapleural lymphotropic blockades. The second group consisted of 51 patients who received a standard multimodal scheme of analgesia in the postoperative period. In the postoperative period, we assessed severity of pain in patients, and the frequency and types of respiratory disorders.

Results. The analysis of the results revealed a significant decrease in the intensity of pain syndrome the first 12 hours after surgery in the group of patients, who underwent lymphotropic blockade. The analysis of the frequency of respiratory disorders in the study groups also revealed significant reduction in the number of complications in patients in the group with lymphotropic blockade. Acute postoperative pain, that prevents full natural ventilation, plays one of the key roles in the pathogenesis of respiratory complications in patients after surgical treatment of lung cancer.

Conclusion. The use of multimodal analgesia of intrapleural lymphotropic blockade in the complex allows to reduce the pain syndrome and provide psycho-emotional comfort of the patient in the early postoperative period, thereby reducing the risk of respiratory disorders.

Significant interest in the problem of genetic oncological diseases is due to an increase in the frequency of their detection, existing difficulties of early recognition, disagreements in the clinical and morphological criteria for diagnosis and evaluation of prognostic factors, the absence of generally accepted standards of treatment and objective assessment of their results.

The introduction of new diagnostic technologies into clinical practice (molecular genetic studies, the ability to determine a wide range of hormones and peptides, immunohistochemical determination of general and specific markers, modern methods of topical diagnostics, etc.) allowed us to identify a specific genetic substrate of various types of endocrine organ tumors, previously unknown nosological forms, improve the ability to predict the disease on the preclinical level, to assess their place and importance in the structure of general oncopathology.

The issues of terminology, classification, criteria for the degree of malignancy and prognostic factors of hereditary endocrine diseases are particularly relevant. The article presents and analyzes the modern classification and terminological definitions of this group of diseases. The problem of hereditary endocrine tumor diseases and syndromes associated with neuroendocrine tumors (NETs) and multiple endocrine neoplasia syndromes (MEN-syndromes) has been described. In conclusion, the situation with the study of this problem in the Russian Federation is analyzed.

We present the results of 7-year follow-up of a patient with primary immunodeficiency, such as severe combined immune deficiency, X-linked variant. The child has been ill from 11 month of age. He was taken to the Regional Infectious Disease Hospital in Irkutsk by sanitary aviation in extremely serious condition, which threatened his life. At 1 year 2 months he was transferred to Irkutsk State Regional Children’s Clinical Hospital due to deterioration of the general condition, prolonged fever, expressed by hypoxemia. At 1 year 3 months he was diagnosed with primary immunodeficiency, X-linked severe combined immune deficiency, persistent CMV infection in the department of clinical immunology of the Republican Children’s Clinical Hospital in Moscow. The diagnosis was confirmed by molecular genetic method (mutation с.664С˃Т was detected in exon 5 of the IL2RG gene in the hemizygotic state). At 1 year 9 months, haploidentical transplantation of hematopoietic stem cells from the father was performed. According to the chimerism, immune transplant rejection was observed after 1.5 months. At 2 years 11 months, the boy successfully underwent allogeneic bone marrow transplantation from an unrelated donor in the Children’s Oncology and Hematology Hospital of the University Hospital Freiburg (Germany). The child is being regularly observed in Irkutsk State Regional Children’s Clinical Hospital. He suffers from respiratory infections 4–5 times a year in a mild form. He corresponds to peers in physical and psychomotor development.

Lithium is the first and the lightest in the series of alkali metals, to which, in addition to lithium, two very biologically important elements – sodium and potassium, as well as trace elements rubidium and cesium, belong. Despite its formal affiliation to the group of alkali metals, lithium, like many other chemical elements of the «atypical» second period of the periodic table (for example, boron), is more similar in its chemical properties not to its counterparts in the group, but to its «diagonal brother» – magnesium. As we will show in this article, the diagonal chemical similarity between lithium and magnesium is of great importance for understanding the mechanisms of its intracellular biochemical action. At the same time, the intragroup chemical similarity of lithium with sodium and potassium is more important for understanding the mechanisms of its absorption, its distribution in the body and its excretion. Despite the 70 years that have passed since John Cade’s discovery of the antimanic effect of lithium, the mechanisms of its therapeutic action are still not completely understood. In the end, it turns out that the mechanism of the therapeutic action of lithium is extremely complex, multicomponent, unique and not imitable. Certain aspects of the mechanism of its action may be compatible with the mechanisms of action of other mood stabilizers, or with the mechanisms of action of so-called «lithium-mimetics», such as ebselen. However, no other drug to date failed to fully reproduce the biochemical effect of lithium on the body.

Background. The use of atypical antipsychotics in schizophrenia contributes to the reduction of psychotic, affective, negative and cognitive disorders.

Aims. To evaluate the effectiveness of ziprasidone therapy in patients with schizoaffective disorder and paranoid schizophrenia with episodic course.

Materials and methods. In accordance with ICD-10 there were 14 (63.6 %) people with schizoaffective disorder (F25), 8 (36.4 %) people with paranoid schizophrenia, episodic course (F20.x1). Treatment with ziprasidone lasted 42 days. The dose of ziprasidone in 6 patients (27.3 %) was 80 mg, in 10 patients (45.5 %) – 120 mg, in 6 patients (27.3 %) – 160 mg. Evaluation of the effectiveness of ziprasidone therapy was carried out using psychometric scales (PANSS, General clinical impression scale to assess the effectiveness of therapy – CGI-S, CGI-I), adverse events were registered with the UKU scale.

Results. The number of respondents was 19 (86.3 %) (reduction of the total score on the PANSS scale > 20 % of the pre-treatment level). Ziprasidone was effective in patients with schizoaffective disorder with a significant decrease in total score on PANSS subscales to the 14 th day of therapy (p < 0.05), with paranoid schizophrenia with episodic course – by the 21st day (p < 0.01). According to the CGI-S scale at the end of therapy, “borderline condition” was observed in 10 patients (52.6 %), mild severity – in 3 (15.8 %), normal condition – in 6 (31.6 %). CGI-I scale showed a significant improvement in 10 patients (52.6 %), marked improvement – in 9 patients (47.4 %). Among the mild adverse events that do not require discontinuation of the drug, we noted: weakness – in 3 patients (15.8 %), drowsiness – in 3 (15.8 %), impaired concentration – in 2 (10.5 %), orthostatic dizziness – in 2 (10.5 %), galactorrhea – in 1 (5.3 %).

Conclusions. Ziprasidone is an effective antipsychotic drug that has a safe tolerability profile. It can be used in patients with schizoaffective disorders and paranoid schizophrenia with episodic course.

The protection of neurons from damage and death is an important challenge in the development of treatment of brain ischemia and neurodegenerative diseases. This study aims to investigate protective effect of the extract prepared from Chelidonium majus, which contains total alkaloids. In the present study, we examined antioxidant activity of total alkaloids from Chelidonium majus in vitro. Hydroxyl radical and lipid radicals were detected using spin trapping agents with ESR spectrometer. Chelidonium majus extract exhibited dose-dependent scavenging effects on lipid radicals. Halfmaximal inhibitory concentration (IC₅₀) of the extract was 2.96 mg/ml, whereas for hydroxyl radicals it was 55.13 mg/ ml. These results showed that extract of Chelidonium majus is partly inhibited free radicals. Antioxidant effects of this extract were further demonstrated by protecting enzyme activity of the mitochondrial respiratory electron transport chain (complex I) in isolated brain mitochondrial dysfunction induced by MDA. However, it did not change the decreased level of complex II, and malate dehydrogenase (MDH) in a concentration of 12 and 25 mg/ml. Here, we examined the neuroprotective effect of the extract from Chelidonium majus against oxidative stress in cultured cortical neurons, using MTT. We found that pretreatment with the extract of Chelidonium majus (0.05 and 0.5 mg/ml) significantly inhibited H₂O₂-induced cell death in cortical neurons.

Furthermore, the use of a luciferase reporter (ARE-luc) assay showed that extract from Chelidonium majus activates protective signaling pathway in primary cortical neurons through ARE/Nrf2 pathway.

Together, this suggests that total alkaloids from Chelidonium majus may be neuroprotective by increasing anti-oxidant gene expression.

The aim of the research: study the features of surgical treatment of epidermoids.

Materials and methods. We present a literature review and the clinical case of surgical treatment of a patient with epidermoid. We have searched medical databases: Medline, Russian Science Citation Index, EMedicine, United Medical Knowledge Base. We considered the features of the clinic, diagnosis, and surgical intervention. The article presents a clinical example of successful surgical treatment of a patient with an epidermoid cyst of the posterior cranial fossa. The result of the literature review was the writing of a clinical lecture; the current state of the issue of etiopathogenesis, diagnosis and management of patients with epidermoids was studied.

Results. The authors found that total microsurgical removal is the method of choice, and the operative technique should be aimed at preventing postoperative aseptic meningitis. Although it was not possible to establish the cause of the development of aseptic meningitis, the authors assume that the mechanism of its formation lies in the self-breaking of the capsule of the epidermoid cyst, probability of which was confirmed by a number of studies. Further study of this pathology is a promising direction in neurosurgery.

Conclusion. Difficulties in the diagnosis and choice of surgical tactics point at the need for detailed preoperative planning of surgical intervention, performing a precise total removal of a lesion with compliance with preventive measures for aseptic meningitis to improve clinical results and reduce the incidence of perioperative complications.

Background. The problem of chronic pancreatitis in recent years is acute, primarily due to the occurrence of complications and pain that forces you to turn to a surgeon. The main cause of deaths is the failure of the pancreatic anastomosis and the occurrence of bleeding into the cavity of the pancreatic intestinal anastomosis (40 %).

Aims: to improve the results of duodenum-preserving resections by introducing the technology of sealing the pancreaticintestinal anastomosis.

Materials and methods. The clinic operated 225 patients with chronic pancreatitis. All patients before the operation and in the postoperative period were carried out clinical and biochemical studies, the Frey operation was performed. Patients were divided into two groups. The first group, the group of comparison, included 184 (81.8 %) patients with pancreatoenteroanastomosis formed without additional sealing methods. The second group – the main one – consisted of 41 (18.2 %)patients in which the suture of the pancreatic anastomosis was strengthened with an adhesive composite or with the loop of the small intestine.

Results. After the surgery, complications in the control group were recorded in 19 (8.4 %) patients: failure – in 6 (3 %), bleeding into the lumen of pancreatoenteroanastomosis – in 9 (4 %), mortality was 1.8 % (4 persons). There were no complications in the main group. The analysis of the amylase content in the drainage fluid revealed high values in the control group on the 3rd day – 916 ± 15 U/l, in comparison with the main group – 437 ± 16 U/l (p < 0.05). The data obtained indicate that the cause of insolvency of the pancreatic-intestinal anastomosis is the penetration of enzymes through the pancreatic-cervical anastomosis zone into the abdominal cavity. When analyzing the results, it turned out that the failure of the pancreatic-intestinal anastomosis was not detected in any case in patients with sealing.

Conclusion. The escape of enzymes destroys the tightness of the superimposed fistula and is characterized by an increase in the level of amylase in the drainage fluid. The proposed sealing technologies decrease the number of postoperative complications and improve the results of treatment.

Introduction.On the territory of the Ekhirit-Bulagatsky district of the Irkutsk region zones of sympatry of four Ixodes ticks species are found, where the species and genetic diversity of infectious agents transmitted through tick bites may be more pronounced than in foci with a mono-dominant type of ticks’ population. In this connection, the study of the species and genetic diversity of representatives of the Anaplasmataceae family in the sympatry zone of the Ixodes ticks of closely related species was of scientific interest.

Objective: To study the species and genetic diversity of members of the Anaplasmataceae family in the zones of sympatry of Ixodes ticks Ixodes persulcatus, Dermacentor silvarum, D. nuttalli and Haemaphysalis concinna, to identify the main carriers and potential reservoir hosts of ehrlichia and anaplasma.

Methods. In the course of the study, 1106 specimens of adult ticks and 49 samples of small mammalian livers from the Ekhirit-Bulagatsky area were analyzed. Anaplasma and ehrlichia DNA were detected by two-round PCR in the presence of genus- and species-specific primers from the 16S rRNA gene region. The nucleotide sequences of the 16S rRNA gene and the fragment of the groESL operon were identified in some samples. Sequencing was carried out according to the Sanger method. Comparative analysis was performed using the BLASTN program and ClustalW method. Epidemiological data analysis was performed using parametric methods of statistical processing of the material.

Results. The DNA of Ehrlichia muris and Anaplasma phagocytophilum were detected in all studied species of ticks in their sympatry area. However, the rate of infection of taiga ticks was significantly higher than that of H. concinna and Dermacentor spp. Potential reservoir hosts of the Anaplasmataceae family members can be classified as Microtus oeconomus, M. gregalis, Myodes rutilus and Sorex spp. When analyzing the nucleotide sequences of the 16S rRNA gene, three genetic variants of anaplasma were detected. The nucleotide sequences of the A. phagocytophilum groESL operon belonged to two genetic groups.

Background. The creation and the attempt to introduce into medicine new nanostructured materials dictate the need for careful study of their safety for human health and the environment. At the same time, the existing classical approaches to safety assessment do not always objectively reflect the real state of affairs; therefore, there is a need to introduce new approaches, including methods of intracellular safety assessment of nanoparticles and nanomaterials.

The aim of this study was to evaluate expression level of apoptosis-regular proteins caspase-3 and bcl-2 in neurons of white outbred rats exposed to nanocomposites consisting of nanoparticles of metals (silver, bismuth and gadolinium) on a natural matrix of arabinogalactan isolated from Siberian larch wood.

Materials and methods. Sixty outbred male rats were exposed to nanocomposites for 9 days at a dose of 500 μg of metal per 1 kg of animal body weight. The introduction of substances was carried out orally using atraumatic probe. Study of the activity of proteins of apoptosis modulators caspase-3 and bcl-2 and calculate the percentage of different types of reacted neurons was conducted. Statistics 6.1 was used to process results, p-values less than 0.01 were acknowledged as statistically significant.

Results. It was found that the activation of apoptotic process occurs only when the nanocomposite is affected with the addition of silver nanoparticles, which are realized in a significant increase in the percentage of all types of neurons under study.

Conclusion. Monitoring proteins – regulators of apoptosis can serve as a marker of early damage to nerve cells, since glial cells can form at the site of dead neurons that do not fulfill the main function of transmission of nerve impulses. The results obtained allow us to substantiate the need for a more thorough and prolonged study of silver nanoparticles encapsulated on the arabinogalactan matrix.

The article describes the experience of successful diagnostics and treatment of giant non-organ extraperitoneal tumor combined with a cystoma of uterine appendages.

Patient P., 43 years old, was hospitalized in the oncology department, diagnosed with “Abdominal tumor, right ovary?” The state was satisfactory, after palpation of the abdomen, a lumpy formation of a densely elastic consistency, from the womb to the epigastric region, was found. An ultrasound revealed a homogeneous tumor formation 30×28 cm from the border of the uterus to the liver. When performing median laparotomy, a dumbbell-shaped tumor (36×26×20 cm) was found in the retroperitoneal space with involvement of the mesentery of the small intestine, lower horizontal portion of the duodenum, mesentery of the transverse colon, superior mesenteric vessels, aorta and jejunum. In the right appendages, a cystoma 12–15 cm in diameter was found, with inversion and necrosis. Adnexectomy was performed. An express lymph node biopsy revealed cells suspicious for malignancy. The tumor was mobilized and removed as a single unit with retroperitoneal tissue, lymph nodes in combination with resection of 70 cm of the jejunum and fenestrated resection of the duodenum. The resulting gut defect 9×7 cm was sutured with a precision single-row suture. Inter-intestinal anastomosis “endto-end” was formed. Nasointestinal intubation was performed. The abdominal cavity was sutured, and two tubular drainages were installed. The postoperative period was uneventful. The histological conclusion: fibrous histiocytoma of the mesentery of the intestine with malignancy in the center of the node, in the ovary – total hemorrhagic infiltration of all layers, edema. The tumor conference consultation was recommended. After 1.5 years, the patient was admitted with the same clinical picture. During laparotomy, a tumor recurrence was discovered, the nodes of which were located in the retroperitoneal space, in the abdominal cavity with invasion to organs and large vessels. The case was recognized as inoperable, the laparotomic wound was closed completely. Sixteen days after surgery the patient was discharged.

The article analyzes two rare cases of acquired intestinal obstruction in children. In the first child at the age of 2 years, who suffered a retrosternal total coloesophagoplasty for extended post-burn chemical esophageal stenosis, early postoperative adhesive intestinal obstruction appeared on the 8th day of the postoperative period, which was eliminated laparoscopically. The next day, against the background of drug stimulation of the intestine, a small intestinal invagination developed, diagnosed with ultrasound examination. Relaparotomy and disinvagination were performed.

The second patient, the 15 years old girl, who had suffered from closed abdominal injury and a pancreatic injury, manifested the signs of high partial intestinal obstruction a day after the trauma occurred. Initially, its cause was considered to be hematoma of the omental bursa. Fibrogastroduodenoscopy (FGDS) and X-ray diagnostics did not reveal the cause of intestinal obstruction, but after FGDS procedure the patient’s condition improved within 3–4 days, and then the clinical signs of small bowel obstructive adhesion confirmed by X-ray and laparoscopy. With laparoscopy in the middle section of the small intestine, a hyperinflate “whitish” section about 12 cm long, dense in palpation, was identified, which was the cause of obstruction. Through minilaparotomic umbilical access from the abdominal cavity, a loop of the jejunum with a foreign body inside was exteriorized. With transverse enterotomy trihobezoar 10×4×4 cm was removed from the lumen, which moved from the stomach and led to obstruction of small intestine. The outcome of the treatment was good in both cases.

The article describes a rare case of a foreign body removal from the tracheobronchial tree of a child. In the acute period of aspiration, the girl developed severe hypoxia, a terminal condition caused by the standing of a foreign body in the infraglottic space, a spasm of the vocal cords and obstruction of the lumen of the respiratory tract. In emergency tracheal intubation in a medical institution at the place of residence, the foreign body was moved more distally, which allowed to restore lung ventilation, stabilize the child’s condition and transport her to a specialized medical institution where X-ray and endoscopic examination were performed. It was found that the one-year-old patient had a screw cap tightly wedged into the lumen of the right main bronchus, and the screw’s opposite sharp end punched the left wall of the trachea above its carina. There was a potentially high risk of perforation of the main vessels of the mediastinum with massive bleeding and an unfavorable outcome. Endoscopic removal of a foreign body was technically impossible due to the peculiarity of its transverse arrangement and perforation of the wall, which served as an indication for emergency thoracotomy. A longitudinal sternotomy was performed, providing good access to the distal trachea, the main bronchi and the great vessels. Then we performed transverse bronchotomy in the initial part of the right main bronchus on half of its circumference, removed the foreign body, sutured the wall of the bronchus. The length of the extracted self-drilling screw was 35 millimeters. Postoperative early and late periods went without complications. At follow-up, mucosal surface of the right main bronchus was pink, the vascular pattern was visible, the bronchus was freely passable, not deformed.

Background. In recent years, various methods of combined anesthesia during abdominal surgery have been introduced into clinical practice.

Aim. To demonstrate the possibilities of a combination of high prolonged spinal anesthesia and endotracheal anesthesia during abdominal surgery.

Materials and methods. A clinical case of combined use of high prolonged spinal anesthesia and endotracheal anesthesia in a 48-year-old patient with a tumor in the right half of the ascending part of the right half of the colon is presented.

Results. The patient received a puncture of the spinal space at a standard point and was installed a spinal catheter in the cranial direction for 3 cm. An isobaric solution of marcaine in the initial dose of 20 mg was injected into the catheter. The regulation of the development of the block was regulated by the inclination of the head end of the table by 60°. After that endotracheal anesthesia was performed on the basis of fentanyl and propofol. This combination allowed to expand the scope of surgical intervention, provided adequate pain relief intraoperatively and in the postoperative period, without the use of narcotic analgesics. With the appearance of signs of recovery of pain sensitivity, intraoperatively or in the postoperative period, re-introduction of the anesthetic into the spinal catheter was performed in half of the initial dose with liquor barbotage. In the early postoperative period, the patient was on strict bed rest with a head end of the bed raised at 30–45°. The method provides complete segmental blockade and muscle relaxation in the area of operation, stability of central hemodynamics during surgery and in the postoperative period.

Conclusion. This type of anesthesia is more easily tolerated by patients, accompanied by early awakening and extubation, characterized by stability of central hemodynamics, reduced risk of complications, the possibility of prolonging anesthesia with lower doses of narcotic analgesics in the intraoperative period, providing high-quality anesthesia in the postoperative period without resorting to the use of narcotic analgesics.