Background. Preterm premature rupture of membranes (PPROM) is one of the main causes of perinatal morbidity and mortality. Associated oligohydramnios may further exacerbate the condition leading to intra-amniotic inflammation and adverse obstetric and perinatal outcomes in preterm labor.

Aim of the research. To determine an impact of oligohydramnios on patients with preterm premature rupture of membranes.

Materials and methods. We performed a retrospective analysis of two groups of patients with PPROM: 56 patients with oligohydramnios were included in the main group, 111 patients without oligohydramnios were included in the control group. The gestational age varied from 24+0 weeks to 33+6 weeks. Amniotic fluid index, endocervical culture, leukogram and neutrophil-to-lymphocyte ratio (NLR), serum procalcitonin and C-reactive protein levels were assessed in all participants.

Results. We witnessed a plethora of consequences in the group of women with PPROM and oligohydramnios: shorter latent phase, higher incidence of clinical chorioamnionitis, antenatal fetal distress, higher levels of C-reactive protein, leukocytes, neutrophils and NLR, lower level of lymphocytes, and increased growth of potentially pathogenic cervical flora. Moreover, the patients with oligohydramnios demonstrated a significantly higher rate of cesarean delivery. The combination of PPROM and oligohydramnios also take a toll on the condition of the newborns: they have lower 5-minute Apgar score and higher prevalence of respiratory distress syndrome, congenital pneumonia, and necrotizing enterocolitis. Furthermore, newborns from the main group are more likely to be admitted to the neonatal intensive care unit, compared with newborns from the control group.

Conclusion. Oligohydramnios in PPROM is associated with a dramatic rise of numerous complications affecting both the women and the newborns. 

The high prevalence of obstructive sleep apnea syndrome (OSA) causes a steady interest in this pathology. In recent years, one of the urgent problems in modern somnology is the assessment of the main mechanisms of neuronal dysfunction during the day and at night in OSA, the ideas about which, to a large extent, remain contradictory and not fully understood. One of the modern methods for assessing neuronal dysfunction during sleep is the study of the sleep microstructure, and for its assessment, the method of analysis of cyclic alternating pattern (CAP), an EEG marker of unstable sleep, is used. The cyclic alternating pattern is found both in the sleep of adults and children with various sleep disorders and, in particular, with OSAS, therefore, it is a sensitive tool for studying sleep disorders throughout life. With the elimination of night hypoxia against the background of CPAP therapy, the sleep microstructure is restored, the spectral characteristics of the EEG change, and a decrease in the number of EEG arousals after treatment leads to the restoration of daytime functioning. Understanding the role of short-term EEG activations of the brain during sleep can provide significant data on sleep functions in health and disease. Despite the improving diagnosis of sleep disorders using machine algorithms, assessing the relationship of structures and functions of the brain during sleep, neurophysiological data are not entirely clear, which requires further research. In this review, we tried to analyze the results of the main studies of the neurophysiological sleep pattern in OSA against the background of respiratory support during sleep. 

Metabolic syndrome includes the following symptoms: obesity, hyperlipidemia, hypertension, insulin resistance, and cardiovascular disease. The purpose of this review is to elucidate the role of adipokines in the regulation of the L-arginine-NO-synthas-NO signaling pathway in the pathogenesis of metabolic syndrome. The main questions raised in the review are: how adipokine secretion changes, how the level of their receptors is regulated, and which signaling pathways are involved in the transmission of adipokine signals when coupled to the L-arginine-NO-synthase-NO signaling cascade. Adipokines are peptide hormones that transmit a signal from adipose tissue to targets in the brain, blood vessels, liver, pancreas, muscles, and other tissues. Some adipokines have anti-inflammatory and insulin-sensitive effects: adiponectin, omentin, adipolin, chemerin, progranulin. Others have the negative inflammatory effect in the development ofmetabolic syndrome: visfatin, vaspin, apelin. Adipokines primarily regulate the expression and activity of endothelial NO-synthase. They either activate an enzyme involving 5-AMP protein kinase or Akt kinase, increasing its activity and synthesis of NO in the tissues of healthy patients: adiponectin, adipolin, omentin, or inhibit the activity of eNOS, which leads to a decrease in NO-synthase and suppression of mRNA bioavailability: vaspin, visfatin, apelin in metabolic syndrome, and a decrease in its activity leads to dissociation and endothelial dysfunction. It should be noted that the bioavailability of NO formed by NO-synthase is affected at many levels, including: the expression ofNO-synthase mRNA and its protein; the concentration of L-arginine; the level of cofactors of the reaction; and to detect the maximum activity of endothelial NO-synthase, dimerization of the enzyme is required, posttranslational modifications are important, in particular, phosphorylation of endothelial NO-synthase by serine 1177 with the participation of 5-AMP protein kinase, Akt kinase and other kinases. It should be noted that the participation of adiponectin, omentin, and kemerin in the regulation of the L-arginine-NO-synthase-NO cascade in metabolic syndrom opens up certain opportunities for the development of new approaches for the correction of disorders observed in this disease. The review analyzes the results of research searching in PubMed databases, starting from 2001 and up to 2020 using keywords and adipokine names, more than half of the references of the last 5 years. 

Background. Improving the methodology of immunological monitoring in natural foci of plague in the Russian Federation and adjacent territories to increase the effectiveness of epidemiological surveillance of plague is an urgent line of research. The lack of correlation between the production of specific antibodies to the capsular antigen (F1) ofthe plague microbe with other indicators of the state of cellular defense reactivity indicates the need to search for new informative and accessible markers for assessing anti-plague immunity.

Objective: to evaluate possibility of using the complex preparation (F1 and cell membranes) evaluate the possibilities of using an artificial antigenic complex based on F1 and cell membranes (CM) of the plague microbe in antigen-specific tests in vitro in people vaccinated against plague.

resu. The study involved 153 volunteers living in the territory enzootic for plague (the village of Khandagayty ofthe Ovyur kozhuun of the Tyva Republic and the village of Kosh-Agach of the Kosh-Agach district of the Altai Republic). The study included the determination of spontaneous and mitogen-induced production of cytokines (IFN-γ, IL-4, TNF-α) by blood cells, titers of specific IgG antibodies to the capsular antigen F1 of the plague microbe and concentrations ofthe main classes of immunoglobulins (IgM, IgG, IgA and IgE) in blood serum, as well as immunophenotyping of blood lymphocytes (CD3, CD4, CD8, CD16, CD19).

Results. Comparative assessment of the level of cytokines (TNF-α, IFN-γ and IL-4) in spontaneous/induced F1+CM Y. pestis tests revealed a statistically significant increase in the production of cytokines TNF-α and IFN-γ in the antigeninduced tests compared with spontaneous (p < 0.01).

Conclusion. Thus, the effectiveness of the use of artificial antigenic complex based on F1 and cell membranes ofthe plague microbe has been shown to assess the production of cytokines in antigen-specific cell tests in vitro, which justifies the need for further research. 

Last year the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has started. The new coronavirus is highly contagious and causes severe complications. The mechanisms of humoral immunity and kinetics of SARS-CoV-2 specific antibodies in a population are not well understood. Therefore, we aimed to summarize and analyze numerous global and Russian serological studies for understanding dynamics of the SARSCoV-2 humoral immune response and getting an accurate picture of the seroprevalence to SARS-CoV-2 in the world population. The PubMed and e-library databases were searched from February 2020 to March 2021 using terms “SARSCoV-2”, “antibodies”, “humoral immunity”. At the beginning of the pandemic first studies were cross-sectional by design and were responsible for determination of the seropositivity and for understanding the fundamental humoral immunity parameters of SARS-CoV-2. Since then, longitudinal seroepidemiological studies have been studying antibody kinetics. Seroconversion time for IgM, IgG antibodies varies, but most researchers report the seroconversion of IgM from the 1st to 14th days after the onset of clinical manifestations, and the seroconversion for IgG is around the 14th day with a concentration peak by the 21st day. Regarding seroprevalence we may say about low herd immunity at the COVID-19 pandemic. Thus, global seroprevalence is about 10 %, and more than 20 % for regions with high incidence and among healthcare workers. Seroprevalence studies have to be continued for more accurate monitoring of long-term humoral immunity to SARS-CoV-2, because the majority of the world’s population is still susceptible to SARS-CoV-2 infection. 

Background. The mechanism of the immune response in patients with COVID-19 is still poorly understood and differs from other respiratory infections. Immunodeficiencies and age-related characteristics of immunity can be regarded as factors influencing reinfection and a predisposition to prolonged persistence of SARS-CoV-2. Most of the studies report about post-infection immunity to SARS-CoV-2 for adults and less for children. However, understanding the dynamics of antibody production to SARS-CoV-2 among children as well as other unique features of immune response is extremely important, because this provides to avoid possible complications and long-term outcomes of COVID-19, and predict the epidemic spread of the new coronavirus in the organized groups of children such as kindergartens, schools, study groups and clubs.

Aim: to evaluate the humoral and cellular immunity after SARS-CoV-2 infection in children.

Materials and methods. We reported data of the first phase prospective cohort study of immunity among 60 children living in Irkutsk, Russia within a month after SARS-CoV-2 infection, which took place in October and November 2020.

Results. Immunity of children one month after SARS-Cov-2 infection was characterized by suppressed cell-mediated and humoral immunity, and phagocytosis dysfunction. Reduced phagocytosis by neutrophils was noted for 61.6 % of individuals.

Conclusions. Children after COVID-19 had impaired immunity to SARS-CoV-2, which may be a predictor of chronic infection and other long-term outcomes of COVID-19. 

Introduction. The research aimed at studying the efficacy and safety of anticoagulant therapy in patients with atrial fibrillation (AF), especially in older age groups, is now increasingly relevant.

The aim of the study is to analyze the situation with prescribing anticoagulant therapy in elderly and senile persons with atrial fibrillation in real clinical practice and to demonstrate the possibility of improving the quality of observation and management of a group of patients as part of the work of a specialized team.

Materials and methods. A total of 2,770 medical records of outpatient patients with atrial fibrillation were studied for the period from 2017 to 2019. Of this number, 320 patients with AF of nonvalvular etiology were selected, the average age of which was 70.3 ± 8.15 years. There were 270 women and 50 men. An observational prospective study in 45 elderly and senile patients with AF of non-valvular etiology was carried out by a team of specialized doctors for 12 months.

Results. Of the 301 patients, anticoagulant therapy was prescribed to 166 (55.1 %), of which only 17 (10.2 %) people received proper anticoagulant therapy. The excessive activity was observed in 114 (37.9 %) patients, who underwent antiplatelet therapy with aspirin, and 21 (7.0 %) patients remained without any treatment with anticoagulants nor antiplatelet agents. Although, in the case of both, prescribing aspirin and not prescribing, anticoagulants have been indicated. In the prospective part of the study (for 12 months), all 45 patients continued to take anticoagulants and were systematically monitored. The INR in the target range over 60 % of the time was achieved in 37 % of patients receiving warfarin therapy.

Conclusion. In the actual clinical practice of Kyrgyzstan family medicine centers, older patients with atrial fibrillation receive inadequate antithrombotic therapy. The main drug of choice for specialists remains warfarin, a therapy that can be recognized as adequate only in a small number (16 %) of patients. The ability to improve the quality of surveillance and management of a group of patients with AF and high adherence to treatment was demonstrated by the work of a specialized team of doctors. 

The review describes a number of competing views on the main causes of cholesterol accumulation in atherosclerotic vessels. On the one hand, unregulated cholesterol influx into arterial intima is primarily related to the increasing proportion of atherogenic lipoproteins in the lipoprotein spectrum of blood. On the other hand, the leading role in this process is assigned to the increased permeability of endothelium for atherogenic lipoproteins. The increased ability of arterial intima connective tissue to bind atherogenic blood lipoproteins is also considered to be the leading cause of cholesterol accumulation in the vascular wall. The key role in cholesterol accumulation is also assigned to unregulated (by a negative feedback mechanism) absorption of atherogenic lipoproteins by foam cells. It is suggested that the main cause of abundant cholesterol accumulation in atherosclerotic vessels is significant inflow of this lipid into the vascular wall during vasa vasorum hemorrhages.

The article also provides arguments, according to which disorder of fatty acid metabolism in arterial wall cells can initiate accumulation of neutral lipids in them, contribute to the inflammation and negatively affect the mechanical conditions around the vasa vasorum in the arterial walls. As a result, the impact of pulse waves on the luminal surface of the arteries will lead to frequent hemorrhages of these microvessels. At the same time, adaptive-muscular intima hyperplasia, which develops in arterial channel areas subjected to high hemodynamic loads, causes local hypoxia in a vascular wall. As a result, arterial wall cells undergo even more severe lipid transformation. Hypoxia also stimulates vascularization of the arterial wall, which contributes to hemorrhages in it. With hemorrhages, free erythrocyte cholesterol penetrates into the forming atherosclerotic plaque, a part of this cholesterol forms cholesterol esters inside the arterial cells. The saturation of erythrocyte membranes with this lipid in conditions of hypercholesterolemia and atherogenic dyslipoproteinemia contributes to the process of cholesterol accumulation in arteries. 

The development of cardiosurgical care for paediatric and neonatal patients is undergoing the rapid growth. Complex, multi-stage reconstructive operations and the use of invasive monitoring are associated with high risk of venous and arterial thrombosis.

The cardiac surgery patient is inherently unique, since it requires controlled anticoagulation during cardiopulmonary bypass. Moreover, the most cardiovascular pediatric patients require antithrombotic measures over the perioperative period. In addition to medication support with the use of various groups of antithrombotic agents, vascular access management is justified in order to minimize the risk of thromboembolic complications, which can affect both the functional status, and common and inter-stage mortality.

The purpose of this review was to systematize the available data on risk factors contributing to the development of thrombotic complications in patients with congenital heart disease.

An information search was carried out using Internet resources (PubMed, Web of Science, eLibrary.ru); literature sources for period 2015–2020 were analysed. As a result of the analysis of the literature data age-dependent features of the haemostatic system, and associated with the defect pathophysiology, and undergone reconstructive interventions were described. The issues of pathophysiology of univentricular heart defects and risk factors associated with thrombosis were also covered.

Moreover, aspects of intraoperative anti-thrombotic support are discussed, as well as measures to prevent thromboembolic complications in this population.

Coordinated actions of haematologists, cardiologists, anaesthesiologists, intensivists, and cardiac surgeons will allow achieving a fine balance between risks of bleeding and thrombosis in the population of paediatric patients undergoing cardiovascular surgery. 

Background. Endothelial cells are the site of productive replication, hematogenous spread and persistence for a variety of viruses, including cytomegalovirus, which play a critical role in the development of vascular complications associated with cytomegalovirus infection due to developing endothelial dysfunction.

Aim: to reveal the role of inflammatory mediators (tumor necrosis factor alpha, interleukin-1β, interleukin-8) in the formation of umbilical cord vascular endothelial dysfunction in reactivation of latent cytomegalovirus infection in the third trimester of pregnancy.

Material and methods. The standard method of solid-phase (“sandwich” variant) enzyme immunoassay was carried out to study pro-inflammatory cytokines (tumor necrosis factor alpha, interleukin-1β, -8), endothelin-1, nitrite anion in the blood of the umbilical cord of newborns from mothers who come through reactivation of latent cytomegalovirus infection in the third trimester of pregnancy. The work includes examination data of 78 newborns born at 38–40 weeks of gestation. Among them: 45 newborns were born by CMV-seropositive women with reactivation of latent cytomegalovirus infection in the third trimester of pregnancy (main group) and 33 – by CMV-seronegative women (control group). Umbilical vein blood serum was chosen as the material for the study.

Results. In the blood of the umbilical vein of newborns from mothers with reactivation of latent cytomegalovirus infection in the third trimester of pregnancy, a high level of pro-inflammatory cytokines was detected: tumor necrosis factor alpha, interleukin-1β, interleukin-8 (p < 0.001) with a simultaneous increase in the content of endothelin-1 and nitrite anion (p < 0.001), compared with similar indicators for healthy newborns.

Conclusion. Reactivation of latent cytomegalovirus infection in the third trimester of pregnancy is associated with the formation of a systemic fetal inflammatory response determined by a high concentration of inflammatory mediators (tumor necrosis factor alpha, interleukin-1β, interleukin-8) and an increase in vasoactive compounds (endothelin-1 and nitrite-anion) leading to the formation of dysfunction of the vascular endothelium of the umbilical cord. 

Background. The incidence of colon cancer over the past decade has been growing markedly in the Russian Federation, with about 50 % cases detected at stagesIII–IV of the disease, when a clear clinical picture of the disease appears. In this regard, the search for new methods for early diagnosis of RTK is undoubtedly relevant.

Objective. To determine the standard composition of the aerobic parietal colon microbiota and the level of cytokines (chemokines and growth factors) in patients with cancer of the left half of the colon and to assess the possibility of using these data in the diagnosis of the tumor process.

Materials and methods. Blood tests were performed on the day of the study using two test systems (BioLegend): multiplex kit for determining growth factors, chemokine multiplex kit. The composition of the intestinal microbiota was determined in colon biopsy specimens by the bacteriological method using the standard test systems StaphyTest, StreptoTest, and EnteroTest.

Results. There is an increase in the number of Clostridiumspp. and a decrease in Bifidobacteriumspp., E. coli in the colon during the transformation of a healthy person’s mucosa into a malignant tumor (p < 0.05); a clear tendency was revealed for both an increase (EGF, HGF, M-CSF, PDGF-AA, PDGF-BB, IP-10) and a decrease (MCP-1, RANTES) of the level of chemokines and growth factors under colon cancer conditions. In addition to general quantitative changes in the intestinal microbiota, the level of the investigated substances, a statistically significant dependence was established on the sex, age of the patient, as well as the degree of differentiation and form of tumor growth.

Conclusion. It was established that changes in the quantitative composition of the intestinal microbiota, the level of some biologically active substances that occur precisely in the conditions of colon cancer, can be interconnected and interdependent, and also serve as an additional diagnostic marker in the detection of a malignant tumor. 

Aim: to identify clinical and laboratory biomarkers that determine the nature of the course of myopic choroidal neovascularization (mCNV) and the response to anti-VEGF therapy in women.

Material and methods. A prospective non-randomized study was conducted in 52 patients (52 eyes) with active mCNV, treated with ranibizumab intravitreally, 0.5mg. After 12months, the suppression of CNV activity, the number of injections and the fellow eye inclusion in the pathological process were taken into account. There were 2 groups: with a favorable clinical course (n = 31, age – 33,0 ± 5,1 years, anterior-posterior axis (APA) 28,5 ± 0,3 mm) and an unfavorable clinical course (n = 21, age – 34,0 ± 4,1 years, APA – 29,01 ± 0,1 mm). Structural retinal changes, choroid thickness, retinal blood flow, and heart rate were evaluated using OCT and OCTA protocols (Optovue XR Avanti, USA). Studies were conducted before the start of therapy and then one time per month. The concentration of sex and pituitary hormones (ELISA analyzer “Immunohem-2100”), lipoprotein A, Apo B/Apo A (Accent 200 Cormay, Poland), coagulogram data (Helena C-2, UK), and the concentration of highly sensitive C-reactive protein in blood serum before the start of antiangiogenic therapy were studied once.

Results. In the first group, 1.4 ± 0.7 ranibizumab injections were administered to suppress the CNV activity. In the opposite group – 3.5 ± 2.1 injections, in 73.7 % of cases, relapses were diagnosed, in 3 cases – primary CNV in the fellow eye. Clinical and laboratory biomarkers of the unfavorable clinical course of mCNV were identified: extreme choroidal thinning, highly organized membranes of a large area, dome-shaped deformation of the posterior pole, excess of the reference values of lipoprotein A, fibrinogen and highly sensitive C-reactive protein by two or more times, an imbalance of sex and pituitary hormones (excess of the reference values of prolactin, follicle stimulating hormone, cortisol, progesterone concentration decrease), a predominant change in the menstrual-ovarian cycle according to the type of amenorrhea and opsomenorrhea.

Conclusion. Myopic CNV biomarkers in women allow predicting the response to anti-VEGF therapy, the formation of relapses and the inclusion of the fellow eye in the pathological process. 

Cataracts in diabetes mellitus lead to decreased visual function and blindness. Cataract surgery for diabetes mellitus has limitations and complications. The search for effective means of conservative cataract therapy continues. The review presents the analysis of data from scientific sources, mainly for 2015–2020 using Internet resources (PubMed, Web of Science, Medline, eLibrary.Ru, Cyberleninka). In the work, diabetic cataractogenesis is presented as a sum of interrelated pathobiochemical processes. The main ones are the polyol pathway of glucose conversion, non-enzymatic glycation and oxidative modification of lens proteins, which are enhanced in diabetes mellitus. The lens has a high protein content. The formation of high molecular weight protein aggregates is of particular importance for the appearance of light scattering zones and a decrease in lens transparency. This review presents data on anti-cataract compounds that affect post-translational crystallin modification, prevent osmotic and oxidative stress in the lens, and exhibit antiglycation properties. This information shows that the search for means of pharmacological correction of cataractogenesis should be carried out among compounds with antioxidant and antiglycation activity. 

To date, the factors affecting the course of the reparative process after non-penetrating deep sclerectomy (NPDS) have not been fully determined. There is no systematic information about the regulatory role of the cytokines TGF-β, IL-6, IL-8 and MMP-9, VEGF A 121 and 165 in the formation mechanisms of the newly created pathways consistency of intraocular aqueous humor outflow.

Purpose. To determine possible ways of impact of biologically active aqueous humor molecules of the anterior chamber and lacrimal fluid on the hypotensive effect of non-penetrating deep sclerectomy.

Methods. A prospective study of 65 patients with open-angle glaucoma before and 12 months after NPDS and 22 patients without eye hydrodynamic disorders with the determination of the initial concentrations of biologically active molecules in the lacrimal fluid and aqueous humor of the anterior chamber. Twelve months after NPDS all patients were divided into three groups, depending on the hypotensive effect of the operation, according to the criteria.

Results. Multivariate discriminant analysis showed the greatest inter-group differences, calculated by the square of the Mahalanobis distance, between group 3 with no hypotensive effect of NPDS and the control group (R2 = 8.48, p = 0.001). The most informative features that determine the differences between the 4 groups in the total population, calculated according to the Fischer F-test, were MMP-9 (F = 14.7, p = 0.001) and TGF-β (F = 7.08, p = 0.001) in the aqueous humor of the anterior chamber. In pairwise comparison of groups 1 and 2, the maximum level of significance according to the F-criterion was characteristic of the level of tear IL-6 (F = 21.25, p = 0.001), with approximately equal degree – IL-8 (F = 7.85, p = 0.001) and VEGF (F = 7.12, p = 0.001), to a lesser extent TGF of aqueous humor (F = 4.43, p = 0.001) and MMR-9 (F = 2.23, p = 0.001). Between groups 1–3, the maximum differences according to the Fisher criterion were observed in the IL-8 (F = 20.99, p = 0.001), TGF (F = 8.75, p = 0.001) and to a lesser extent – TGF (F = 5.83, p = 0.001).

Conclusion. The analysis of the obtained data showed the decisive role of the imbalance of proinflammatory cytokines, signaling proteins with prolymphoangiogenic activity, and MMP-9 in the aqueous humor of the anterior chamber, as well as in the initial state of the lacrimal fluid in the postoperative healing processes after NPDS. 

The problem of early diagnosis of the central nervous system damage in newborn before the onset of clinical symptoms remains relevant at the present time.

The aim of the study was to optimize the hypoxic brain damage diagnosis in full-term newborns by analyzing the concentration of cytokines in the umbilical cord blood.

Materials and methods. During the first stage of the study, a prospective analysis of concentrations of interleukins (IL-1β, IL-4, IL-6, IL-8, IL-10), TNF-α and neuron-specific enolase (NSE) in the umbilical cord blood serum of full-term newborns was performed. The second stage of the study included the retrospective analysis of clinical data and instrumental research methods. The main method for diagnosing in the development of hypoxic brain damage in newborns was neurosonography.

Results. The development of hypoxic brain damage is evidenced by the concentration of IL-1β over 30.3 pg/ml, IL-4 – over 1.7 pg/ml, IL-6 – over 79.4 pg/ml, IL-8 – over 107.7 pg/ml, NSE – more than 10.3 ng/ml and TNF-α – more than 1.6 pg/ml in umbilical cord blood.

Conclusion. The results of the study confirmed that the comprehensive assessment of the cytokines concentration in the umbilical cord blood improves the hypoxic brain damage diagnosis in newborns. Analysis of the level of these markers immediately after the birth will optimize the management tactics of newborns who have undergone hypoxic exposure in antenatal and intranatal period. 

Aim of the study: to analyze the data of studies aimed at studying and substantiating the urgent need to create in Russia comprehensive habilitation programs for people with fetal alcohol syndrome, fetal alcohol spectrum disorders and other mental disorders.

Methods. The results of Russian and foreign studies have been analyzed concerning the following problems: observation and diagnosis of people with fetal alcohol syndrome and fetal alcohol spectrum disorders; studying the experience of foreign countries in addressing issues of prevention and overcoming of fetal alcohol syndrome and fetal alcohol spectrum disorders; studying the experience of Russian specialists (obstetricians-gynecologists, neurologists, psychiatrists, psychologists, correctional teachers, etc.) working with the diagnosis of “Alcohol syndrome in the fetus”; assessing the socio-economic impact of organizing programs for the prevention of fetal alcohol syndrome and fetal alcohol spectrum disorders by comparison with similar indicators in other countries.

Results. The presented analysis of the data indicates that there is an urgent need for timely diagnosis of the disease, the search/creation of new drugs, for the treatment of the consequences of alcohol syndrome and the organization of training of specialists in this area. The article shows the importance of providing lifelong medical and social assistance to people with fetal alcohol spectrum disorders, as well as to their families. The effectiveness of the creation of a system of measures for the prevention of fetal alcohol syndrome and fetal alcohol spectrum disorders throughout the country has been confirmed.

Conclusion. The development at the state level and implementation of prevention programs will significantly reduce the birth rate of children diagnosed with “Alcohol syndrome in the fetus” and, thus, reduce the costs of the state and society on overcoming the consequences of FAS/FASD. At the same time, timely and well-organized habilitation of people with FAS/FASD will significantly improve the social situation in society as a whole, as well as reduce the psychological burden on every family faced with this problem. 

Background. Preserving the health of the population, including those involved in sports, is one of the priority directions of the state policy of the Russian Federation. In accordance with the existing legislative and regulatory framework, a system for monitoring the quality and safety of medical care is being implemented in health care institutions, which also applies to medical and physical training services. One of the levels of functioning of such a system is the activity of the medical commission. Intensive training and competitive loads make increased demands on the body and are considered a risk factor for the health of athletes, which serves as the basis for their in-depth medical examination and dispensary observation. Therefore, the primary task of the medical commission during the prophylactic medical examination of athletes is to issue an expert opinion in difficult cases regarding the training and competitive activity of persons with deviations in the state of health.

The objective of the research was to study of the activities of the medical commission during the prophylactic medical examination of athletes in the conditions of a medical and physical service on the basis of a scientific analysis of the results of its work for two years.

Materials and methods. We studied the medical documentation of athletes who passed the medical commission for two years (2018–2019; n = 82 and n = 81, respectively). The nature of the decisions made and the structure of their reasons were analyzed using the Pearson chi-square test with amendments.

Results. The share of positive and negative decisions of the commission, as well as temporary suspension from sports by years, their statistical dependences and the strength of the connection between the results are shown. The stability of the negative conclusions of the commission, as well as the structure of their reasons, was revealed (р ˃ 0.05). At the same time, in the second year of observation, they were more often temporarily suspended from sports due to musculoskeletal system diseases and less often as a result of injuries (p < 0.05).

Conclusion. The main regularities of the distribution and formation of expert decisions of the medical commission for the years under study were revealed. The necessity of its activity for the medical and physical training service during the medical examination of athletes is noted, as well as the factors that prevent this are indicated. 

Background. The problem of the effect of adolescent idiopathic scoliosis on the functional condition of the lower limb muscles is still highlighted insufficiently.

Aim. Analysis of the degree of involvement of the lower limb muscles in the pathological process in adolescents with idiopathic scoliosis.

Methods. A comparative analysis has been made on the results of examination of 209 adolescents: 25 adolescents with idiopathic scoliosis; 170 normal adolescents; 14 adolescents with congenital scoliosis. The moments of force ofthe lower limb muscles were evaluated using dynamometric stands. Electrophysiological characteristics of the lower limb muscles were registered by the method of global and stimulation electroneuromyography.

Results. The decrease in the amplitude of voluntary EMG of the femoral muscles in adolescents with idiopathic and congenital scoliosis is accompanied by dropping the moments of force relative to the values of the control group. The leg muscles are characterized by the preservation of the values of force at the level of normal test subjects under the conditions of the reduced voluntary EMG of high frequency. The amplitude of the M-responses of the indicator muscles and the values of the excitation propagation velocity along the motor fibers were also preserved. There are no statistically significant correlations between the amount of the spine deformity, on the one hand, and the values of asymmetry of the characteristics of the muscles in adolescents with idiopathic scoliosis.

Conclusion. In adolescents with idiopathic scoliosis the function of femoral muscles is decreased, and there is no relationship between the amount of the spine deformity and the values of asymmetry of the characteristics of the lower limb muscles. The similar character of muscle function changes in adolescents with idiopathic and congenital scoliosis can testify that the cause of the observed changes is not the disease etiology, but the insufficient level of motor activity. 

Injuries and degenerative changes of tendons are common damages of the musculoskeletal system. Due to its hypovascular character the tendon has a limited natural ability to recover. For typical surgical treatment, the tendon integrity is restored, but in most cases, there occurs formation of the connective tissue scar resulting in structural and mechanical functionality disruption. The insufficient effectiveness of traditional therapy methods requires the search for alternative ways to restore damaged tendon tissues. This article discusses new effective methods for improving the treatment that base on the use of cellular technologies among which one of the main directions is mesenchymal stem cell application. Due to mesenchymal stem cells, there is a shift from pro-fibrotic and pro-inflammatory reactions of cells to pro-regenerative ones. Stem cells being multipotent and having among other things tenogenic potential are considered a promising material for repairing damaged tendons. The article also describes the sources of progenitor tendon cells including the tendon bundles and pericytes the main markers of which are Scx and Mkx that are proteins of the transcription factor superfamily, and Tnmd that is transmembrane glycoprotein.

The growth factors that not only enhance the proliferative activity of mesenchymal stem cells but also promote in vitro tenogenic genes expression as well as the collagen Itype production what is necessary for tendon formation are considered. Along with growth factors, the morphogenetic protein BMP14 is presented, this protein increases themesenchymal stem cell proliferation and contributes directed tenogenic differentiation of these cells, suppressing their adipogenic and chondrogenic potentials.

In recent years, mesenchymal stem cells have been used both separately and in combination with various growth factors and different three-dimensional structures providing the interaction with all of the cell types.

The issues of the latest 3D-bioprinting technology allowing to make tissue-like structures for replacement damaged tissues and organs are discussed. 3D-bioprinting technology is known to allow acting exact spatio-temporal control of the distribution of cells, growth factors, small molecules, drugs and biologically active substances. 

Introduction. Chronic recurrent instability of the shoulder joint is a frequent outcome of conservative treatment oftraumatic dislocation of the shoulder (2.8–30 % of cases). Preoperative examination largely determines the outcome of surgical treatment of this pathology.

The aim of the study was to provide a clinical assessment of the developed algorithm for the surgical treatment of patients with recurrent anterior shoulder joint instability. Materials and methods. The results of treatment of 98 patients with recurrent anterior shoulder joint instability were studied. Preoperative examination included clinical tests, MRI or CT with calculation of bone loss. Fifty-six patients (57.1 %) underwent Bankart operation, 14 patients (14.3 %) – Latarjet operation. Twenty-three patients (23.5 %) underwent Bankart + Remplissage surgery, and 5 (5.1 %) – Latarjet + remplissage. The result was assessed on the ROWE scale.

Results. Bone defects significant in the formation of instability (“glenoid off track”) were found in 19.4 % of patients, and “glenoid on track” – in 80.6 %. According to the proposed algorithm for treating patients with anterior recurrent instability of the shoulder joint, the “glenoid off track” state was an indication for Latarjet surgery. When “glenoid on track” was used, indications for Bankart operation were displayed. The remplissage procedure was indicated in case of the presence of a Hill-Sachs grade 3 defect or the presence of hyperelasticity of the tissues of the shoulder joint. The mean ROWE score for the entire group of patients before surgery was 41.5 ± 12.8 points, and 15 months after sur gery – 94.9 ± 3.4 points. Two recurrent dislocations were revealed, one of which was associated with repeated trauma, and the other – with an incorrect choice of stabilization technique. One complication (axillary nerve neuropathy) was observed, which was arrested conservatively.

Conclusions. The proposed algorithm allowed us to obtain positive results in 97.9 % of cases. 

Background. The introduction of the combined and sequential application of transosseous and intramedullary blocked osteosynthesis in limb lengthening requires an experimental study of the features of distraction regenerate. For small animals (in particular rabbits), special models are required.

Aims. To develop experimental models of sequential and combined use of transosseous and intramedullary osteosynthesis in limb lengthening and substantiate their effectiveness.

Materials and methods. A comparative study was carried out on 30 rabbits of the Soviet Chinchilla breed. Experimental models of sequential (EM-1) and combined (EM-2) application of transosseous and intramedullary osteosynthesis with preservation of the apparatus during the fixation period to simulate blockage were studied in the main groups. For comparison, sequential (comparison model 1 – CM-1) and combined (comparison model 2 – CM-2) use of transosseous and intramedullary osteosynthesis with dismantling of the apparatus at the end of distraction were modeled. The control was a regenerate formed according to the classical Ilizarov method. Radiographs were performed in dynamics, CT and morphological studies – at the end of the fixation period.

Results. It was noted that regenerates of the same type in structure were formed in the EM-1 and CM-1 groups, as in the EM-2 and CM-2 groups. With successive methods, the spindle-shaped form of the regenerate prevailed, the formation of a pronounced periosteal component was noted. Powerful cortical plates, according to morphological studies, are formed from the periosteal and intermediate zones. With combined techniques, the cortical plates are formed thinner and predominantly from the periosteal component, the shape of the regenerate is closer to fusiform. In the comparison groups, the total time of surgical interventions was 25–50 % longer, in 50 % of cases there was a loss of length or deformation of the regenerate.

Conclusions. The developed models of sequential and combined use of transosseous and intramedullary osteosynthesis for limb lengthening with preservation of fixation with an apparatus to simulate blocking have proven to be reliable in terms of fixation and easy to use on small laboratory animals.. 

Background. There are significant differences in the diagnosis of interstitial cystitis/painful bladder syndrome (IC/ BPS), in particular, controversy regarding the diagnostic role of cystoscopy or hydrodistension cystoscopy.

The aim of the study was to evaluate the results of cystoscopy with hydrodistension in women with IC/BPS.

Materials and methods. The study involved 126 women with IC/BPS, mean age – 46.7 ± 14.0 years. The duration of the disease was 6.0 ± 2.8 years. Questionnaires PUF, VAS, USS, and potassium test were used. Cystoscopy and urinary bladder hydrodistension were performed.

Results. The sum of points on the PUF scale was 8.14 ± 1.76, on the VAS scale – 5.45 ± 0.93, on the USS scale – 2.63 ± 0.91. A positive potassium test was detected in 91.3 % of cases, the sensitivity of the test was 86.5 %, the specificity – 84.6 %. The anatomical bladder capacity was 308.0 ± 77.5 ml. The average indicator of maximum bladder filling in women with mild pain was higher than in moderate and severe pain by 30.9 % (p < 0.05) and 53.0 % (p < 0.01), respectively. In 11.9 % of cases, polyps were detected at the external opening of the urethra. During cystoscopy, diffuse mucosal bleeding was detected in 39.8 % of cases, diffuse submucosal bleeding – in 21.4 %, rare glomerulations – in 14.3 %, Gunner’s lesions in 12.7 % of cases. After hydrodistension, the changes were more often diffuse (n = 57). There was a significant relationship (r = –0.57, p < 0.01) between the maximum filling of the bladder and the degree of severity of mucosal abnormalities. The severity of changes in the mucous membrane of the bladder positively correlated with the sum of points on the PUF questionnaire (r = +0.61, p = 0.003), on the VAS questionnaire (r = +0.59, p = 0.008) and according to the USS questionnaire (r = +0.66, p = 0.005).

Conclusion. Cystoscopy can be used to examine IC/BPS in accordance with the recommendations of international societies. The obtained data can help to improve the effectiveness of IC/PBS diagnostics. 

With the development of molecular genetics, the field of personalized medicine based on genetic data has been growing at a phenomenal pace. Genetic tests can identify health risks, ancestry, and genealogy, as well as the prediction of drug responses. However, very limited research exists about the marketing practices of companies, which promote and sell DNA ancestry and health-related genetic tests directly to the public.

Aim. To evaluate the awareness and attitude about genetic testing in the population of a large industrial city in Russia (on the example of Irkutsk).

Materials and methods. A total of 305 respondents – 265 of them were students of higher educational institutions of Irkutsk. The study was conducted on condition of anonymity. The questionnaire was available on the Internet on the basis of the Google Forms service. All basic concepts were explained to the participants during the survey.

Results. 94.1 % are interested in conducting genetic testing on a commercial basis. Of the total number of survey participants, 72.8 % expressed a desire to undergo the analysis “Hereditary predisposition to diseases”, 61 % – “Monogenic diseases”, 52.1 % – “Ethno”. In addition, out of the total number of respondents surveyed, 36.7 % want to undergo genetic testing for research: features of metabolism and food intolerance “Diet”, 22 % – susceptibility to injuries and speed of recovery of physical form “Sport”, 18 % – to hereditarily determined susceptibility to drugs “Pharmacy”. It follows from the answers that the greatest interest among the surveyed people is the determination of predisposition to cardiovascular diseases – 72.5 %, to Alzheimer’s disease – 48.3 % and diabetes mellitus – 40.3 %.

Conclusion. The results obtained indicate an interest in the study of predisposition to cardiovascular and neurodegenerative diseases. There is a high need to analyze the assessment of the clinical usefulness of genetic research, to assess the impact of research results on human behavior and the system of regulation of genetic testing in healthcare in general. 

Background. Dirofilariasis is a vector-borne helminthiasis that tends to expand spatial boundaries in areas with temperate and cold climates. In the Voronezh oblast, located in the Central Black Earth Region of the Russian Federation there were previously isolated reports of cases of dirofilariasis in humans and dogs, but this issue was not specifically studied.

Aims. To determine the degree of infection of dogs with Dirofilaria immitis and Dirofilaria repens in the Voronezh oblast in order to determine the level of epidemiological risk.

Materials and methods. For seven years, targeted work was carried out to study the spread of different types of dirofilariae in dogs in the Voronezh region. Blood from 3 498 dogs of different breeds, ages, conditions of keeping and household use was examined. Dirofilaria larvae were counted using the Fuchs-Rosenthal camera. The type of dirofilaria larvae isolated from the blood of dogs was determined by the histochemical method. The antigen of the imaginal form of D. immitis was detected using a chromatographic test system the ImmunoRun Antigen Detection Kit Caninae Heartworm Biogal chromatographic test system (Israel). Statistical processing of the material was carried out in the Microsoft Excel 2010 program. Studies were carried out with the consent of animal owners and in accordance with the European Convention for the Protection of Vertebral Animals used for experimental and other scientific purposes (Strasbourg, 1986).

Results. As a result of the conducted studies, it was found that in the Voronezh oblast, the average infection of domestic dogs (Canis familiaris) with dirofilariasis is 14.14 ± 0.31 %. The indicator depends on the conditions of keeping animals and makes 27.15 % in stray dogs, 25.26 % – in service dogs and 10.54 % – in apartment dogs. In service dogs, the species D. repens occurs in 52.39 % of cases, D. immitis – in 42.95 %, mixtinvasia – in 4.80 % of cases. In stray dogs, the species D. repens prevails (80.10 %). The second type of D. immitis was established in 10.0 % of cases. At the same time, both types were also established in 10.0 % of cases. The maximum number of cases of dirofilariasis occurs in urban dogs (65.87 %), which is due to the high density of their population and close contact with the vector of transmission in urbanized areas. The seasonal dynamics of infestation is determined by the year-round detection of cases with a peak in October (46.77 %). The number of cases of dirofilariasis increases with age, in dogs from one to six years old it reaches maximum of 63.26 %. There is an epidemiological risk of dirofilariasis in the Voronezh oblast. This is due to the existence and active functioning of synanthropic and natural foci of invasion on the territory of the Voronezh oblast. 

The authors describe the life and activity of a famous scientist and qualified Russian surgeon, a great man with distinguished leadership ability in medicine and higher medical education, Professor Vsevolod Ivanovich Astafyev.

As a student, Vsevolod I. Astafyev was keen about emergency surgery, and worked a lot in experimental laboratory. He graduated from the Kursk medical institute with honors, completing by the time his PhD thesis. However, he gave up postgraduate study and began working as a surgeon in a district hospital. After returning to the Kursk medical institute, Vsevolod I. Astafyev worked as an assistant at the hospital surgery department and successfully defended his PhD thesis. At the age of 35, he defended his doctorate thesis and competed for a post of the head of hospital surgery department at the Irkutsk medical institute. He had continued to be actively engaged in science, pedagogy and practical surgery, and organized the Siberian branch of the All-Soviet Union Scientific Center of Surgery of the USSR Academy of Medical Sciences. The branch had a clinical base with 220 beds at the Irkutsk regional hospital. Vsevolod I. Astafyev created a school of polyvalent surgeons, lecturers, and scholars.

In 1987, Vsevolod Astafyev accepted an offer to become the deputy head doctor of the Republican hospital of Yakutia. Shortly after coming to Yakutsk city, he was elected a deputy of the supreme council of the Yakut Republic. On his initiative, supported by the Republic’s governance, a modern equipped medical center was built and put into operation within a short time. The so-called “sanctuary of science” still successfully works as one of the leading clinics of Russia and abroad.