Background. The reproductive health of women is an important aspect of health that affects the reproduction of the population and its quality and is of great importance in maintaining the stable development of society, normal fertility and demographic growth of the population. The unfavorable situation concerning reproductive health of rural women requires more attention and detailed socio-hygienic and medico-demographic study.

Aim of the research. To study the structure and dynamics of gynecological morbidity in rural women on the example of women living in Ekhirit-Bulagatsky district of the Irkutsk region over a period of 2015–2019, and of extragenital pathology in pregnant women.

Materials and methods. The analysis of the structure and dynamics of gynecological morbidity in women (n = 1044), and of extragenital pathology in pregnant women (n = 1314) was carried out in the Regional Hospital N 2 of the UstOrdynsky settlement in 2015–2019. Statistical data processing was carried out using standard  techniques.

Results. Gynecological morbidity in the female population in this rural area over a period from 2015 to 2019 tended to increase. The relationship between this growth and the coverage of the population with preventive medical examination was studied. The correlation between these factors is direct, strong and statistically  significant (r xy = 0.963; p > 99 %). In the structure of extragenital pathology of pregnant women, anemias  and diseases of the endocrine system occupy a special place.

Conclusion. The greater the percentage of female population covered by preventive medical examination, the higher the rate of gynecological morbidity. In the structure of gynecological morbidity in rural women, erosion is in the first place, endometriosis is in second, and uterine myoma is in third. In the structure of extragenital pathology among pregnant women, anemia, thyroid diseases, and diabetes mellitus prevail. The results  indicate the need for a differentiated treatment and diagnostic approach to the management of pregnancy, as well as the development and implementation of comprehensive programs aimed at the formation of reproductive health.

In studies of many medical and biological problems, there is a clear underestimation of the fundamental role of mitochondria in the evolution of eukaryotic organisms on the planet, including fungi, plants and fauna. It is  important to take into consideration numerous fundamental functions of mitochondria when studying the  human physiology and pathology, aging mechanisms. In this lecture, we briefly discuss the origin of mitochondria and their importance in the emergence of plants, which appeared on the planet 1–1.5 billion years later than eukaryotes with mitochondria, and served as the food basis for the rapid evolution of all species of the animal world. In the course of transformation of protobacteria into mitochondria, approximately 1000–1500 genes were transferred to the nucleus of eukaryotes, and the remaining 37 mitochondrial genes (mtDNA) exist in all types of animals. The presence of mitochondria in eukaryotes led to increased production  of reactive oxygen species and accelerated mutations in mtDNA. The spread of sexual reproduction may have been the way of protection against the accumulation of harmful mutations in mtDNA. At the same time, in all animal species mtDNA is inherited only maternally. In humans, the maternal inheritance of mtDNA led to uneven distribution, in small or inbred populations in particular, of a number of diseases with large prevalence in men, as well as male infertility, and in general accelerated aging and shorter lifespan in men, as compared with women. These negative consequences of the maternal inheritance of mtDNA were termed as “mother’s curse”. Recent studies have shown that mtDNA mutations are not the cause of human aging. The crisis of the mitochondrial free radical theory of aging is largely associated with the neglect of the protonated form of the superoxide radical, the perhydroxyl radical, which activates the peroxidation of polyunsaturated fatty acids in mitochondrial phospholipids. This results in production of various biologically active molecules and toxins. Therefore, initially aging may lack the manifestation of specific symptoms because of gradual accumulation of a wide variety of disorders and damages to the structure and functions of mitochondria and cells that finally lead to the development of diseases. The pathologies appear primarily in those organs that have a wide range of functional activity and a high dependence on oxygen consumption, namely the heart, brain, skeletal muscles and vascular epithelium.

Background. Currently, during the COVID-19 pandemic, one of the most pressing healthcare problems is to ensure the safety of the population of the Russian Federation. There is insufficient information on the duration and intensity of post-infectious immunity in relation to SARS-CoV-2, especially in case of inapparent (without clinical signs), mild or latent forms of infection.

Materials and methods. The study involved 99 volunteers with a laboratory confirmed PCR diagnosis of COVID-19 who were residents of the Irkutsk Region and of other regions of the Russian Federation and arrived to work in Bodaybo on a rotational basis. Also the study included 50 conditionally healthy people living in Irkutsk who had negative PCR results for SARS-CoV-2 RNA presence.
Specific IgG and IgM antibodies to SARS-CoV-2 were detected in blood serum by enzyme-linked immunosorbent assay (ELISA) using test systems “ELISA anti-SARS-CoV-2 IgG” (FBUN SSC PMB, Obolensk, Russian Federation), “SARS-CoV-2-IgG-IFA-BEST” and “SARS-CoV-2-IgM-IFA-BEST” (Vector-Best, Novosibirsk, Russian Federation).

Results. The results of a study of the humoral immunity of patients with asymptomatic and clinical forms of COVID-19 are presented. The data indicate the production of specific IgG in the blood serum of people in 2–3 weeks after SARSCov-2 infection and reaching its maximum level on the 20–21st day. The seroconversion rate  was 94.9 %. It was shown that the geometric mean titer of antibodies in asymptomatic and mild forms of coronavirus infection did not differ statistically and amounted to 1:512 and 1:632, respectively. Higher titers of antibodies (1:1600) were detected in the moderate form.

Conclusion. The research results can serve as a basis for studying the dynamics of changes in the indicators  of the humoral immune response in patients with COVID-19 and for clarifying the duration of their post- infectious immunity in order to predict the development of the epidemic situation and to ensure the planning of specific prevention.

Background. Arterial hypertension during pregnancy is accompanied by pronounced changes in microcirculation and hemostasis in the system, the state of which is largely determined by the structural and functional properties of red blood cells and platelets. The study of quantitative and morphometric characteristics of blood cells will expand the existing understanding of their role in the pathogenesis of hypertensive disorders.

Aim of the research. To study the quantitative and morphometric indicators of red blood cells and platelets in pregnant women with various forms of hypertensive disorders, on the basis of which to develop an additional method for the diagnosis of preeclampsia.

Materials and methods. 237 women in the third trimester of pregnancy were examined. The main group (167 women) included patients with various forms of hypertensive disorders. The comparison group included 70 pregnant women without signs of hypertensive disorders. The characteristic of clinical and anamnestic data of the studied groups is given. A comparative analysis of the number and morphometric parameters of red blood cells and platelets was performed.

Results. With moderate and severe preeclampsia, a decrease in the level of red blood cells, hemoglobin and hematocrit was not accompanied by changes in red blood cell indices. In women with preeclampsia, regardless of the presence of chronic arterial hypertension, an increase in the average dry weight, average volume and degree of platelet anisocytosis was detected. In severe preeclampsia and preeclampsia with underlying of  chronic arterial hypertension, an increase in the number of large forms of platelets and their granulocytosis was revealed, and in addition, in severe cases of preeclampsia, a decrease in platelet level was noted.

Conclusions. Modern hematological analyzers make it possible to establish the nature of not only quantitative, but also morphometric changes in red blood cells and platelets, thereby complementing the existing understanding of the pathogenetic mechanisms underlying hypertensive disorders in pregnancy. Using average dry platelet mass and average blood pressure may be useful in diagnosing preeclampsia.

Background. It is known that in ulcerative colitis there is a violation of the barrier function of the colon mucosa, which can lead to pathological changes inside cells, including in the membranes of red blood cells. The stability of the erythrocyte membrane and its ability to deform largely depends on the composition and interaction of protein structures inside it. A significant decrease in the content of the main protein components of the erythrocyte membrane in ulcerative colitis was found in comparison with healthy people.

Aim of the research. Taking into account the available data, we conducted an additional study to analyze the effects of the relationship between the protein components of the cytoplasmic membrane of erythrocytes in patients with ulcerative colitis and clinically healthy people.

Materials and methods. The study involved men and women with ulcerative colitis in the period of exacerbation (n = 51) and clinically healthy individuals matched by sex and age (n = 30). The analysis of the interaction effects of ten main protein components of the erythrocyte membrane was carried out. For each protein under study, its average value was determined, and within the studied groups all proteins were divided into two categories – above and below their average level. Analysis of variance was used to quantify the contribution of each identified factor.

Results. It was found that the effect of the relationship is not inherent in all categories of protein components. In ulcerative colitis, the effects of interaction with such important structural proteins as spectrins and ankyrin disappear. In the effect of band 4.1 protein, in contrast to clinically healthy individuals, a new independent factor appears – glyceraldehyde-3-phosphate dehydrogenase, and in the effect on actin – an anion-transport protein.

Conclusion. In ulcerative colitis, significant changes occur in the membrane of red blood cells, leading to a violation of the relationships between proteins, a decrease in the total content of the studied proteins and the loss of some of the effects of independent factors on the level of certain protein structures. Based on the findings, adjustments can be made to the treatment of ulcerative colitis in order to strengthen the erythrocyte membrane.

Background. Stroke is the most important medical and social problem due to its high proportion of morbidity, disability and mortality among patients of working age.

Aims. The aim of the study is to predict the course of the acute period of hemorrhagic parenchymal stroke (supratentorial hemispheric hematomas) based on neuroimaging data (localization, lateralization, hematoma volume) and neurophysiological data.

Materials and methods. 86 patients suffering from hemorrhagic stroke of supratentorial localization were examined. The level of consciousness, cognitive functions, and neuroimaging data were evaluated (EEG, heart rate variability,  event-related auditory potential). The condition of patients on admission and over time was assessed on the basis of the Glasgow Coma Scale (GCS), the expanded Glasgow Coma Scale and the NIHSS.

Results. Based on the results of cluster analysis and expert assessments, two groups of patients were identified: with a relatively favorable and unfavorable course of the acute period of hemorrhagic stroke. Differences in neurophysiological parameters in the groups were established: an increase in the power of theta  oscillations and a decrease in the frequency of theta oscillations of the electroencephalogram, a decrease in the amplitude of the N2P2-component of the cognitive evoked P300 potential, an increase in heart rate in an unfavorable course. An artificial neural network has been created to predict the course of the acute period of hemorrhagic stroke upon admission.

Conclusion. Machine learning methods allow creating algorithms for predicting the level of consciousness of patients, the acute period of development of intracerebral hematomas of supratentorial localization, the possible development of disease outcomes in patients with non-traumatic intracerebral hematomas based on neurophysiological parameters, as well as the volume of hematoma. A correlate of the unfavorable dynamics turned out to be a reduced bioelectrogenesis in the associative zones of the cortex during stimulus recognition  and decision-making, as well as the unfavorable dynamics of the level of consciousness corresponded to a decrease in the amplitude and greater latency of P2N2-peaks, reflecting insufficient activation of the cortical structures during stimulus recognition.

Every year, the number of operations on the lumbar spine with the use of various spinal fusion techniques increases, which leads to an increase in the number of cases in the long-term period of surgical treatment, the formation of pathology of the adjacent segment (ASP), which is part of the structure of the failed back surgery  syndrome (FBSS). It is known that the pathology of the adjacent segment is a general term and covers two concepts: the degeneration of the adjacent segment (ASDeg) and the disease of the adjacent segment (ASDis). ASDeg is represented by radiographic changes occurring in the adjacent spinal motion segments during spinal surgery with spinal fusion, and ASDis refers to the clinical symptoms that develop during radiographic changes in these segments. With the pathology of an adjacent segment, clinically significant degenerative changes in it are not always formed. If these X-ray changes are formed and correlate with clinical and neurological manifestations, then surgical treatment is indicated. This pathology can be treated with repeated surgical intervention, which this article demonstrate with the clinical example of surgical treatment of the adjacent segment of the spine during fusion.

Traumatic brain injury is one of the main causes of both acute and long-term morbidity that concern that affects individuals in all demographics. The processes that occur during traumatic brain injury and neuroinflammation cannot be fully explained in most clinical and preclinical researches.
Neuroinflammation is a very complex interaction between the cells of the innate and adaptive immune systems. The development of reactions of the innate immune system occurs under the influence of various signals that are released from damaged cells and tissues. This leads to the activation of neutrophils, microglia  and astrocytes, the release of complement, as well as the release of histamine by mast cells.
Subsequently, activation of an adaptive immune response leads to the development of later effects of neuroinflammation. The topic of biomarkers in traumatic brain injury is extensive and rapidly developing. We presented an overview of the most common and well-studied biomarkers in the literature regarding head injury in humans and their role in predicting the outcome in traumatic brain injury. 
Among the presented biomarkers, the most specific for traumatic brain injury are interleukins-6, -8, -10 and matrix metalloproteinases. We can use interleukin-6 to predict the outcome and risk of complications of traumatic brain injury. The concentration of interleukin-8 shows the relationship of the biomarker with mortality. We can use interleukin-10 to confirm the results of computed tomography in traumatic brain injury. Matrix metalloproteinases present the degree of violation of the blood-brain barrier and brain dysfunction. Other indicators need a more complete study to clarify their role in this pathology. Of course, for a more reliable conclusion about the patient›s condition, it is preferable to use the data of several biomarkers at the same time.

One of the main causes of pain in the cervical spine, which causes the development of neurological deficit, is the stenosing process of the spinal canal with compression of the neurovascular structures. To determine the tactics of treatment, to predict the consequences of the disease, timely diagnosis of the functional state of  neural structures is of great importance.

Materials and methods. An informative method for diagnosing stenosing processes of the cervical spine, along with radiography and MRI, is electroneuromyography (ENMG). The analysis was based on 35 patients with a stenosing process of the spinal canal at the cervical level (17 men, 18 women), the average age of patients was 47.7 ± 9.9 years.

Results. In the study of changes in the functional state of the axillary, radial, ulnar and median nerves, with stenosing processes, a unidirectional deviation of the entire ENMG complex of indicators of the limb with pain syndrome and contralateral limb was noted. A decrease in the amplitude of the maximum M-responses is recorded due to damage to the peripheral motor neuron and axon degeneration. Selective damage to the slow-conducting anterior motoneurons does not cause a decrease in the speed of impulse conduction due to demyelination. Bilateral changes in late electroneuromyographic phenomena (F-wave) are possibly caused by a  general reaction of the peripheral and central nervous systems.

Conclusion. In patients with a stenosing process of the cervical spine with severe clinical manifestations, ENMG values can be used both to determine indications for surgical treatment and to assess the dynamics of changes in the postoperative period.  

Ultraviolet crosslinking is a pathogenetically oriented method of treating primary and secondary corneal ectasias that cause irregular astigmatism and visual impairment. Advanced stage of the disease, when the initial thickness of the cornea is below 400 mc, is a contraindication to the use of the standard «Dresden» protocol of the procedure. In such cases, it is possible to use modified UV crosslinking protocols. This article presents the modern crosslinking methods used for progressive keratoconus in advanced stages with a thin cornea. The presented methods are combined taking into account principled approaches – using additional tools and without them. Both approaches are based on a temporary artificial increase in the thickness of the cornea during the procedure in order to reduce the likelihood of damage to the deep layers of the cornea. The evolution of crosslinking protocols for thin corneas began with the use of hypoosmolar solutions that increase the thickness of the cornea to safe values. However, such an approach was not stable and the change in pachymetry parameters during the procedure created difficulties in its standardization. The use of different staff to increase the thickness of the cornea by providing an additional layer like a contact or biological lens seemed more encouraging. At the same time, the low permeability of these additional layers to oxygen, much needed for the UV crosslinking process of macromolecules, limited the overall effectiveness of the procedure. As a result of the progressive development of technologies and  the improvement of devices, the logical continuation of the trend of modifying the crosslinking protocol was the  introduction of an individual approach to customization of the protocol. The described modified protocols, taking into account the different principles of the surgical approach in ultraviolet radiation, set forth the results, evaluate their effectiveness and safety when applied to patients with a thin cornea.

Background. The state of health of modern schoolchildren occupies one of the most important positions in the modern world. Improper nutrition with an intensive educational load and low physical activity contribute to the development of “school” diseases.

Aim. To assess the actual nutrition of school-age children using the example of third-grade students and to determine its impact on physical development and school morbidity.

Materials and methods. The survey was conducted from November 2019 to March 2020. 33 children aged 8–9 years were studied. The nutrition of children was studied using a questionnaire for parents, which included questions about the frequency of eating various foods during the week. Physical development was assessed by height, body weight, and chest circumference. Incidence data were copied from medical records (form 026-y). The statistical analysis included the calculation of the error of relative values.

Results. The children›s diet was found to lack protein products (meat, eggs, poultry). On average, 3–4 times a week, 42 ± 1.50 % consume meat, 52 ± 1.51 % poultry, and 45 ± 1.51 % eggs. There was an increased consumption of foods containing a large amount of fat and carbohydrates, so 1–2 times a week 45 ± 1.51 % eat chips, and 55 ± 1.51 % drink sweet carbonated drinks and juices. The assessment of physical development showed an increase in the number of children with disharmonious development (49 ± 1.51 % for the entire sample). Analysis of morbidity revealed the prevalence of diseases of musculoskeletal system: postural disorder – 24 ± 1.29 % of children, flat foot – 15 ± 1.08 %. Body weight indicators were higher or lower than normal in 24 ± 1.29 % of schoolchildren, including a decrease in body weight in 18 ± 1.16 % and an increase  – in 6 ± 0.72 % of children. 

Conclusions. The study noted a lack of protein consumption, which is necessary for the implementation of growth and development, while an excess of carbohydrates inhibits these processes. Thus, nutrition plays a leading role in the health and physical development of schoolchild.

Aim of the research. To prove the effectiveness of using isotonic honey drink “Gold F25 IsoDrink Light” (IsoDrink-L) based on the study of the hydration process and endothelial function in young athletes.

Materials and methods. A randomized controlled study was performed in young athletes under the age of 18 years. Athletes of the main group (n = 40) consumed IsoDrink-L for a month; athletes of the control group (n = 34) consumed water and isotonic drink “X”. A bioimpedance-based device was used to determine the total amount of water, the absolute and relative proportions of intra- and extracellular water, as well as the ratio of extracellular water to the total amount of water. Hematocrit, specific gravity and color of morning urine, samples with reactive hyperemia and hyperventilation in the brachial artery, including the determination of the endothelial sensitivity index were assessed.

Results. All athletes had dehydration in the form of extracellular dehydration, cellular hyperhydration, “blood  thickening”, hyponatremia, increased specific gravity and urine color, as well as endothelial dysfunction. All  symptoms disappeared after using IsoDrink-L for 1 month. No dynamics was observed in the control group,  where 95 % of the athletes took water and 5 % – isotonic drink “X”. ROC analysis showed that the endothelial sensitivity index with a sensitivity of 95.8 % and a specificity of 99.4 % detects endothelial dysfunction. The canonical correlation coefficient between the set of hydration-dependent and endothelium-dependent signs was R = 0.71 (p < 0.0001). We established the danger of uncontrolled water consumption for rehydration in young athletes, as well as the high efficiency of isotonic honey drink and the evidence for its use for the correction of dehydration and endothelial dysfunction. A low awareness of athletes, doctors and coaches about the importance of using effective methods of rehydration in children’s sports was revealed.

Conclusion. It was found that water imbalance in young athletes directly or indirectly contributes to the development of endothelial dysfunction, thereby increasing cardiovascular risk. Original approaches to the development of honey isotonic drink for young athletes with proven hydrating and endothelium-protective properties are proposed.

Background. The opposition function of the thumb is extremely important and is provided mainly due to the biomechanical features of the trapeziometacarpal and metacarpophalangeal joints. Surgical treatment of complex deformities of these joints is often described in isolated studies, and there are practically no descriptions of the results of their combined treatment. The authors of the article did not find a single report on total arthroplasty of the adjacent joints of the thumb.

Aim of the study. To analyze the clinical observation of two patients in the early period after performing sequential non-simultaneous total arthroplasty of the trapeziometacarpal and metacarpophalangeal joints of the thumb using ceramic endoprostheses. Both endoprostheses were presented in pairs with two unconnected components, installed using the press-fit method. When the head and cup interact, there are no shear forces in them that impede multiaxial movements.

Materials and methods. The study included two patients: a 67-year-old man and a 77-year-old woman. Patients had stage 3 osteoarthritis of the trapeziometacarpal and metacarpophalangeal joints of the thumb and underwent staged surgical treatment (about 2–3 years between the stages). In 1 month and 1 year after the treatment we assessed the results using clinical and instrumental research methods.

Conclusion. No complications were observed during the follow-up. There were no indications for revision surgery. The design features of ceramic endoprostheses, due to their short stems, make it possible to combine components in the adjacent joints of the thumb. In our opinion, joint arthroplasty is an effective and promising method of functional restoration. It remains the patient’s last hope for maintaining painless, stable mobility of the thumb.

Background. The ability to control regeneration processes is a key link in the development of methods for treating patients with post-traumatic disorders of reparative osteogenesis. 

Aim of the study. To evaluate the effectiveness of the fusion of the tibia by local application of the interferon-beta preparation with autogenous bone marrow punctate in post-traumatic disorders of reparative regeneration.

Material and methods. The analysis of the effectiveness of clinical application of autogenous bone marrow with interferon-beta-1b in 64 patients with delayed consolidation and pseudarthrosis of the tibia was carried out. All patients underwent external bone fixation. In order to optimize reparative osteogenesis during the operation, a mixture containing 3–4 ml of bone marrow with 8 million IU/0.5 ml of interferon beta-1b solution was injected locally into the interfragmental space.

Results. With puncture local injection of interferon-beta with punctate of autogenous bone marrow with  delayed consolidation, fusion of the tibial fracture was achieved in 100 % of cases. In patients with a diagnosis  of a pseudarthrosis of the tibia, a positive result was achieved in 90.3 % of cases. Thus, the local application of autogenous bone marrow together with the interferon-beta preparation made it possible to achieve bone fusion in post-traumatic disorders of bone regeneration in 95.2 % of cases.

Conclusion. With delayed consolidation and developing hypertrophic pseudoarthrosis in conditions of stable fixation with anatomical reposition of fragments, puncture autotransplantation of a mixture of bone marrow with a solution of interferon-beta is proposed.