Background. Menopause is an independent predictor of the development of metabolic syndrome, in the pathogenesis of which insulin resistance plays a leading role. Early menopause occurs in 5 % of women and, according to several studies, is associated with an increased risk of cardiovascular disease (CVD), which is one of the leading causes of death. The features of the course of metabolic syndrome in women with early menopause have not been sufficiently studied.

The aim: to establish the prevalence of early menopause and its metabolic complications in the female population of Eastern Siberia.

Materials and methods. The study population included 2695  women aged 18 to 80 years, who underwent the annual medical examination. The period of the study was March 2016 – December 2019. Among the surveyed women of 41–45  years old, a group of patients with early menopause (n = 18) and controls (n = 25) were identified. The diagnosis was made according to the STRAW criteria. The study used clinical, instrumental and laboratory research methods, including the assessment of hormonal and biochemical parameters, as well as the assessment of questionnaire data and statistical analysis.

Results. The examined women with early menopause have an increase in BMI, waist volume, arterial hypertension, and an increase in the level of triglycerides and gonadotropic hormones. These changes potentially underlie the relationship between menopause and cardio-metabolic disease.

Conclusion. These findings indicate the need to monitor the hormonal and metabolic parameters in this category of women to ensure timely prevention and correction of long-term complications associated with early menopause. 

Background. In view of the worsening forecast for global temperature rise worldwide, it seems relevant to study the effects of abnormal heat waves on systemic regulatory processes in people with chronic diseases, in particular coronary artery disease (CAD).

Aims. This study aimed to investigate the effect of hyperthermia on oxidative stress parameters in patients with various severity of CAD and in healthy subjects.

Materials and methods. We studied the level of malonic dialdehyde (MDA) and the activity of Cu,Zn-containing superoxide dismutase (Cu,Zn-SOD) in healthy subjects under conditions of 30-day long simulated hyperthermia and in patients with different severity of CAD after the summer heat waves

Results. We revealed signs of oxidative stress in healthy volunteers during model hyperthermia that manifested as an increase in content of MDA in blood plasma. At the  same time we observed increasing activity of Cu,Zn-SOD in erythrocytes that  utilizes reactive oxygen species. The increase of Cu,Zn-SOD activity started with a certain latency what also can be explained by de novo enzyme biosynthesis induction. We also studied oxidative stress parameters in patients at high and moderate cardiovascular risk according to the SCORE risk chart with uncomplicated CAD course and in patients with complicated CAD with severe coronary damage according to angiography during the summer heat waves. We observed accumulation of MDA in blood plasma and increasing activity of erythrocyte Cu,Zn-SOD in patients with uncomplicated CAD. At the same time we noted that accumulation of MDA in blood plasma was not followed by any increase in activity of red blood cell Cu,Zn-SOD in patients with severe complicated CAD. This fact indicates dysregulation of free radical processes in patients with severe course of CAD during the heat waves.

Conclusions. The dysregulation of free-radical processes in patients with a severe clinical course of CAD has been revealed. 

Nowadays multiple heterogeneous chemicals affect the human body. They include drugs, household chemicals, dyes, food supplements and others. The human organism can modify, inactivate, and eliminate the chemicals by biotransformation enzymes. But it is well known that biotransformation can lead to toxification phenomenon. Individuals differ from each other by the rate of chemical modification that promotes accumulation of toxins and carcinogens in some patients. An N-acetyltransferase 2 enzyme participates in the aromatic amines second phase metabolism. This work reviews the acetyltransferase gene polymorphism possible role in diseases development including drug-induced organs damage.

Gene of acetyltransferase has polymorphisms associated with two haplotypes of  fast and slow substrate acetylation. Gene alleles combine in three genotypes: fast, intermediate, and slow acetylators. Acetylation rate plays a significant role in side effects development during tuberculosis treatment and cancer pathogenesis. Recently, new data described the role of enzyme in development of non-infectious diseases in the human. Scientists consider that slow acetylation genotype in combination with high xenobiotic load result in accumulation of toxic substances able to damage cells.

Therefore, acetyltransferase genotyping helps to reveal risk groups of cancer and non-infectious disease development and to prescribe more effective and safe doses of drugs. 

Relevance. In Russia, the live plague vaccine (LPV) is used for specific prophylaxis of plague. Immunological monitoring of humans vaccinated by LPV in order to search for informative diagnostic markers, as well as to improve the tactics of epidemiological surveillance of plague enzootic territories is an urgent area of research.

The aim is to assess the parameters of cellular and humoral immunity in humans revaccinated by LPV who permanently reside on territory of the Tuvinian natural plague focus.

Materials and methods. The study involved 76 volunteers from the Republic of Tuva, revaccinated by LPV. Blood sampling was performed before vaccination and 1, 3, and 6 months after revaccination. The study included the determination of cytokine production (IFN-γ, IL-4, TNF-α), specific antibodies, immunoglobulins (IgM, IgG, IgA and IgE) and lymphocyte subpopulation composition (CD3, CD4, CD8, CD16, CD19, immunoregulatory index).

Results. A decrease in IgG and IgM and an increase in IgA were found after vaccination with LPV and their increase after revaccination. Correlation relationships were revealed between immunoglobulins, B cells and IL-4. Revaccination leads to an increase seroconversion. The activation of humoral immunity in humans vaccinated against plague is also evidenced by dynamics of changes in the subpopulation composition: an increase in B-lymphocytes and natural killer cells, a decrease in T-helpers and immunoregulatory index, and cellular immunity stimulation is an increase in spontaneous and induced production of pro- and anti-inflammatory cytokines.

Conclusion. It has been shown that LPV is capable of causing the body’s immune restructuring and activating the cellular and humoral mechanisms of immunological protection. For a complete understanding of the development and preservation of  antiplague immunity, it is necessary to continue the annual immunological monitoring of the population living on the territory of the Tuvinian natural plague focus, using additional modern research methods. 

Background. In presence the epizootiological situation on leptospirosis in the territories adjacent to Lake Baikal is not studied well. The showing up of natural focus, discovering of host animal’s species composition and etiological structure of leptospirosis causative agents are essential to plan any epidemiological response and to organize the specific prophylaxis.

Aim: to analyze contemporary characteristics of leptospirosis natural foci at the territories adjacent to Lake Baikal.

Materials and methods. From 2011 till 2020 the territory of nine Irkutsk Region's administrative districts was investigated. Trapping has been done at four kind of sites (wetland, meadow, forest-shrub, steppificated meadow) and boroughs. 1152 small mammals which belonged to 35 species were collected. Collected samples were studied by complex of methods. Serogroup belonging was detected by micro agglutination and decomposition test, and genomic species – by Microflex LT mass analyzer.

Results. A leptospirosis natural foci in the Irkutsk city boundary was newly founded and there were isolated (from small mammals) four pathogenic cultures of leptospiras belonging to Javanica serogroup. Main hosts of causative agents at the territories adjacent to Lake Baikal were defined (insect-eating mammals: tundra shrew, largetoothed Siberian shrew, even-toothed shrew, shrew-mouse, and rodents: root vole, ground vole, narrow-skulled vole, sewer rat). By micro agglutination were defined pathogenic leptospirosis serogroups (Icterohaemorrhagiae, Grippotyphosa, Javanica, Pomona, Sejroe, Autumnalis, Australis), all over 2.4 ± 0.45 % seropositive. Antibody dilution at survey animals ranged from 1 : 20 to 1 : 640. On the grounds of PCR results the mean value of infected animals in studied sample was 16.4 ± 1.14 %. Positive PCR findings were at 19 from 35 animal species.

Conclusion. At the territories adjacent to Lake Baikal In the Baikal region, the proportion of animals that have had contact with pathogenic leptospira is quite high. Natural focus of this infection are highly pervasive in this region, they are evolved mainly in dewy sites. 

The paper analyzes the literature data on the peculiarities of nutrition of students studying in higher educational institutions of various regions of Russia, and the risks of developing food-related diseases. They are largely associated with the adaptation of students to study at a university, the lack of self-organization skills and a lack of  knowledge in matters of rational nutrition. The actual nutrition of  students, on the one hand, is characterized by a lack of macronutrients and micronutrients intake, on the other hand, by excessive consumption of substances that contribute to the development of obesity. The results of numerous studies show a general pattern of unbalanced nutrition of students in terms of the ratio of saturated and polyunsaturated fatty acids, insufficient consumption of dietary fiber, full-fledged proteins, and  excessive intake of simple carbohydrates. Dietary fiber deficiency can  lead to changes in the composition of the microbiocenosis of the digestive tract, a deficiency of omega-3 fatty acids, and consequently, the imbalance of fatty acid composition of the blood cell membrane. 20–40 % of Russian students show signs of severe hypovitaminosis, especially calciferol, which is caused not only by its deficiency in the diet, but also by physical, geographical, climatic and seasonal factors. The analysis of the content of the main minerals in students shows a sufficient content of calcium in the body, an excess of sodium and a lack of magnesium, potassium and  iron, which is due to both the composition of the food consumed and the peculiarities of the accumulation and excretion of these ions. An analysis of the actual nutrition of students shows the need for counseling young people, especially in the first years of study. The introduction of an educational program on optimal nutrition is possible through the practice of curatorial work during the adaptation of the first-year students to student’s life. 

Background. The growth of antibiotic resistance of Helicobacter pylori, a microorganism significant in the development of gastrointestinal diseases and inflammatory periodontal diseases, makes us think about the search for new approaches to the eradication of the microorganism. One solution to this problem may be to develop immunobiological preparations based on microorganisms inactivated with colloidal silver nanoparticles (CSNPs).

The aim. To evaluate the inactivating ability of colloidal silver nanoparticles in vitro and in vivo with respect to H. pylori to determine the possibility of their use in the development of a specific immunobiological preparation.

Materials and methods. The study design consisted in sequential execution of  the  steps of synthesis of colloidal silver nanoparticles with an assessment of the conditionality of the prepared preparations; isolating and identifying pure H. pylori culture; inactivation of H. pylori by synthesized silver nanoparticles; evaluation of the result of H. pylori inactivation in vitro and in vivo.

Results. The conditionality of the synthesized colloidal silver nanoparticles of size 30  ±  3  nm, obtained using a step-by-step technique, was estimated by electron microscopy. Testing the inactivating activity of CSNPs on H. pylori showed that their effect on the culture for 3 hours at a ratio of volumes of CSNPs and 1:1 culture leads to a gradual decrease in the concentration of the microorganism until its complete death and lack of growth on the fifth passage. During the evaluation of the effect of CSNPs on H. pylori, it was shown that the inactivated culture retains its cultural and tinctorial properties; alters morphological properties and biochemical activity; becomes more sensitive to antibiotics and L. acidophilus; ceases to establish in the body of mice with an immunosuppression condition.

Conclusions. Proposed method of synthesis of silver nanoparticles with proven inactivating activity against H. pylori can become a stage of biotechnological process of development of vaccine preparation both on the basis of given microorganism and in complex with CSNPs possessing multilevel antimicrobial effect, antioxidant and immunomodulating activity. 

Introduction. Due to their high biocompatibility, substances based on nanosized selenium particles, encapsulated in natural or synthetic polymer matrices, are promising materials for the creation of biomedical preparations of diagnostic and therapeutic value. Selenium nanoparticles are successfully used in the diagnosis of various types of cancer. In addition to the diagnostic value, selenium nanoparticles have their own prophylactic and oncological effect. This paper presents the results of a study of the toxicity of the Se nanocomposite encapsulated in the polymer matrix of arabinogalactan (SeAG). The emergence and development of the pathological process in the tissue of the brain, liver and kidneys during subacute administration of this nanocomposite was studied.

Materials and methods. Twenty white outbred male rats weighing 200–220 g were used in the work. Animals were orally administered a solution of the selenium nanocomposite at a dose of 500 μg per kilogram of animal body weight for 10 days. Then, using the methods of histological analysis, the severity of the biological response of the organism to the introduction of this nanocomposite was assessed. An analysis of the state of the tissue of the liver, kidneys and the sensorimotor cortex of the brain was carried out.

Results. With the intragastric administration of this drug, there is stasis of blood in the portal tracts, a pronounced macrophage reaction and diapedesis of leukocytes in the liver tissue. There is a decrease in the number of normal neurons per unit area, a decrease in the number of astroglia cells and an increase in the number of  degeneratively altered neurons in the tissue of the sensorimotor cortex. There is also an increase in connective tissue in the cortex of the kidney, with the formation of fibrosis and a decrease in the area of the Shumlyansky – Bowman capsule.

Conclusion. The effect of the investigated nanocomposite is characterized by the development of a pronounced pathological process in the central nervous and hepatorenal systems of the body. 

This article provides a literature review of the past 60 years, conducted using keywords through the PubMed Internet resource, dedicated to the methods of surgical treatment of hemorrhagic stroke. The existing published results of clinical studies do not allow us to draw unambiguous conclusions about the superiority of conservative or neurosurgical treatment in relation to the functional recovery of patients. There is a statistical significance of the advantages of surgery based on the prevention of dislocation syndrome, control of intracranial hypertension, and prevention or at least reduction of the effect of blood and its degradation products on the surrounding healthy tissue. However, large randomized controlled trials have failed to demonstrate this benefit in terms of mortality or functional outcome.

There are two main areas of hemorrhagic stroke surgery – open surgery and minimally invasive methods. The practice of open surgery is associated with high trauma rates, as well as with certain risks and complications. However, craniotomy is a lifesaving measure in critical situations with signs of persistent increased intracranial pressure leading to neurological impairment. The ability to control intracranial pressure provides a chance for the choice of more optimal tactics of surgical treatment.

Today, the gold standard for intracranial pressure monitoring is the installation of invasive intraventricular or intraparenchymal transducers. The method is appreciated for its accuracy, however, there are a number of disadvantages in the form of the possibility of hemorrhagic and infectious complications, as well as the high cost of the sensor itself, which limits its routine use. The inability to measure intracranial pressure before surgery causes an unreasonable expansion of indications for choosing an open method of surgery, which reduces the possibility of a better functional outcome.

All of these points make it urgent to search for a non-invasive method for measuring intracranial pressure, which would contribute to the timely choice of a surgical method without the danger of worsening the clinical outcome. 

Inherited metabolic diseases are a large group of inherited monogenic diseases. Metabolic disorders can cause child disability and mortality. Tandem mass spectrometry is a powerful technology that allows to diagnosis a large number of hereditary metabolic diseases. Clinical manifestations are variable, but more often the damages of nervous system, heart, liver, kidneys, hyperammonemia, hypo/hyperglycemia take place. The disease can make its debut at any age, but the severe forms of the disease manifest at infancy. Early diagnosis and treatment can significantly improve the  prognosis; many countries expand the list of diseases included in screening programs. At the beginning of 2021 in most regions of the Russian Federation mass newborn screening is carried out for five hereditary metabolic diseases. The age and the range of clinical manifestation are variable; therefore, knowledge of this pathology is very important both for pediatricians and therapists, and for specialized doctors. The article presents a brief description of next groups of metabolic diseases: aminoacidopathies, organic acidurias and fatty acid oxidation defects. 

Background. At present, intraocular drops of silicone oil, which is a lubricant for disposable syringes used for intravitreal injections, are being actively studied. Among the undesirable effects of their presence are patient’s complaints of visual discomfort associated with floating opacities, as well as a potential connection with episodes of intraocular inflammation and increased intraocular pressure.

The aim: to assess the prevalence of silicone oil droplets in the vitreous in patients treated with multiple intravitreal injections.

Materials and methods. A single-center retrospective cohort study was carried out. Inclusion criterion: treatment with multiple (at least 5) intravitreal injections of drug solutions performed according to registered indications. The study group consisted of 86 eyes of 85 patients (56 women, 29 men; age – from 36 to 89 y.o., average – 71.7 y.o.), who received an average of 13.2 injections of solutions of various drugs.

Results. Drops of silicone oil were detected by biomicroscopy in 57 eyes (66.28 %) and by ultrasonography in 76 (88.37 %). The coincidence of the results of applying the methods was recorded in 73.26 % of observations. Seven (8.1 %) patients had characteristic complaints. Four patients (4.7  %) had a history of aseptic vitreitis. The  hypothesis was  confirmed that the possibility of silicone oil droplets getting into the vitreous increases with the number of intravitreal injections. A similar relationship was established in relation to the possibility of the appearance of characteristic complaints in patients due to the presence of drops and episodes of aseptic vitreitis.

Conclusion. The release of drops of silicone oil from syringes during intravitreal injections is an urgent problem that requires further study. In the Russian Federation, the situation is aggravated by the lack of prefilled syringes with drugs approved for administration into the eye cavity, as well as the lack of syringe models designed for use in ophthalmology. 

Introduction. Noise-induced hearing loss is a rather prevalent condition and can be distressing for a substantial proportion of patients, although researches describing psychological characteristics in noise-induced occupational hearing loss patients are not numerous.

The study aims to find the effects of occupational noise on the psychological status among noise-induced hearing loss (NIHL) patients.

Methods. Two groups, cross-sectional design. Study sample: 44 occupational noiseinduced male forming NIHL patients group (n = 21) and a control group (n = 23). Both groups were tested using the Russian versions of psychological questionnaires.

Results. Almost one third of NIHL patients are the highly anxiety individuals as compared with the healthy participants (p < 0.01). Mixed type of response to the surrounding reality combined a high need for self-actualization with high self-control, tendency to inhibit and restrain behavioral reactions, in this case it is possible to “overlap” both neurotic and behavioral responses, which can affect the general overstrain and manifest by the somatization of the internal conflict. In general, NIHL patients use constructive cognitive, emotional and behavioral coping strategies. Patients use both constructive and tense defense mechanisms. Conclusion. It has been established that in patients with NIHL, in comparison with practically healthy persons, tension accumulates, and a tendency to psychotraumatization appears. However, it is currently difficult to determine whether NIHL is a predisposing factor for these psychological characteristics, so further research is needed to determine how significant this relationship is. Key words: noise-induced hearing loss, occupational noise, psychological profile>˂ 0.01). Mixed type of response to the surrounding reality combined a high need for self-actualization with high self-control, tendency to inhibit and restrain behavioral reactions, in this case it is possible to “overlap” both neurotic and behavioral responses, which can affect the general overstrain and manifest by the somatization of the internal conflict. In general, NIHL patients use constructive cognitive, emotional and behavioral coping strategies. Patients use both constructive and tense defense mechanisms.

Conclusion. It has been established that in patients with NIHL, in comparison with practically healthy persons, tension accumulates, and a tendency to psychotraumatization appears. However, it is currently difficult to determine whether NIHL is a predisposing factor for these psychological characteristics, so further research is needed to determine how significant this relationship is. 

This review provides a general foreign overview of the current understanding and  prevalence of professional burnout among medical workers and summarizes the emerging trends in the management of the organization of work of nurses, preventing burnout, and an analysis of practices aimed at preventing burnout. Burnout negatively affects both mental and physical health, as well as increases economic losses and employee turnover.

Burnout depends on factors such as job satisfaction, professional rank, hospital level, gender, professional values, negative emotions, and core competencies.

Burnout syndrome is closely related to compassion fatigue syndrome, compassionate gratification and is part of the broader concept of professional quality of life. Compassion refers to recognition, understanding, emotional resonance, empathic concern and tolerance for the suffering of others, and motivation and action in relationships to help others.

The analysis of foreign literature has shown the relevance of this problem and, first of all, for nurses. The peculiarities of the work of nurses lead to the fact that their burnout is higher than among other medical workers. Various approaches to the management of professional burnout have been proposed. Burnout management can focus on the organization, the individual, or a combination of interventions.

When people have a positive belief system, work involvement, and access to many personal resources, they are less likely to experience stress and burnout.

Nursing burnout has worsened during the COVID-19 period and has exposed new pressing health issues. The COVID-19 pandemic has shown a shortage of nurses and has become a major problem in many countries.

The attitude of the community, the importance and the need for specialized and professional care, especially in situations of great difficulty and suffering, is important for medical personnel. Public sincere gratitude for the work of healthcare professionals will help build compassion for professionals who risk their lives to help people. 

Background. Despite the ease of implementation, harmlessness, painlessness and speed of the study, the method of autofluorescence does not belong to the routine and often used because of the dependence on the skill of the dentist in interpretation of the resulting visualization. Foreign and domestic researchers speak about the need for thematic training of dentists for the widespread introduction of the autofluorescence method into practice. There is no data proving the influence of training on the skill of interpretation autofluorescence images and showing the dependence of the skill on the duration of training and its frequency.

The aim of the study was to conduct a comparative analysis of the results of interpreting autofluorescence images of the oral mucosa by dentists before and after thematic training.

Methods. 308 dentists interpreted 20 images of autofluorescence of the oral mucosa before and after the thematic training, 10 of them were of potentially malignant diseases of the oral mucosa, 10 – of benign lesions and paraphysiological anomalies. Correctly identified mucosal changes presented in the autofluorescence image were considered positive results of decoding. The results were evaluated relative to the duration of training and its frequency, taking into account the duration of breaks, according to the average number of positive results.

Results. Before the thematic training, dentists on average decoded 8.41 ± 4.89 images, after training – 12.11 ± 3.12 images. The difference before and after the thematic training between the number of positive results of interpretation autofluorescence images is statistically significant (t = –14.1, p˂ 0.001). There was no significant difference in the results of interpretation potentially malignant oral diseases (F = 1.67; p = 0.190) and benign lesions and conditions (F = 0.647; p = 0.524) between the three groups that studied for 6, 12 and 18 hours. There is a correlation to the duration of the interruption of training with positive results of decoding (r = –0.3376; p˂ 0.001). The positive results of interpretation of autofluorescence with regular monthly 6-hour training had significant increasing trends (12.11 ± 3.12 and 13.22 ± 1.76, t = –3.41, p = 0.001; 13.22 ± 1.76 and 14.40 ± 1.81, t = –4.74, p˂ 0.001).

Conclusion. Thematic training improves the skill of interpretation autofluorescence images in dentists. The regularity of short-term training is more important for maintaining the interpretation skill than the duration of training.

Background. Patients’ dissatisfaction with the results of surgical correction of lesser toes deformities, the shortcomings of methods aimed at eliminating the lateral deviation of the toe in the metatarsophalangeal joint necessitated the development of a new surgical method.

The aim. To evaluate short-term results of the new surgical method for the treatment of patients with lesser toes deformity, accompanied with deviation of the toe.

Materials and methods. A method of surgical treatment of deviated deformity of the small toes is proposed. The method includes precise marking of the metatarsal osteotomy line according to the previously calculated parameters of optimal shortening and displacement of the metatarsal bone, performing oblique diaphyseal osteotomy of the metatarsal bone, displacing its distal part along the osteotomy plane. According to the proposed method, nine patients were operated on who had a syndrome of nonrigid hammer-like deformity of the second toe with lateral deviation of the toe in the metatarsophalangeal joint. In all patients, the deformity of the second toe was associated with hallux valgus.

Results. As a result of the application of the proposed method, it was possible to achieve deformity correction, eliminate the lateral deviation of the second toe in the metatarsophalangeal joint, restore congruence in the joint, achieve consolidation of bone fragments without loss of correction, and improve the appearance and function of the foot. Three months after the operation, a statistically significant improvement was determined, according to the AOFAS LMIS scale, having reached 94.5 ± 4.64 points, which made it possible to speak about the achievement of a good functional result of treatment. Patients noted the opportunity to wear standard footwear, to carry out their labor activity, to engage in physical culture, were satisfied with the result.

Conclusion. The use of the proposed new surgical method for deflected deformity of the lesser toes makes it possible to correct the deformity, eliminate lateral deviation of the toe, relieve pain syndrome, achieve a good cosmetic and functional result, restoring the patients’ ability to wear standard shoes. 

The frequency of rotator cuff injuries in people over 45 years of age is 25.6–50 %, and  40  % of these injuries are massive. Shoulder rotator cuff injury causes disorders in biomechanics of the shoulder joint such as anterior-superior dislocation of the humeral head. Injury of the deltoid muscle combined with a massive rupture of the rotator cuff causes proximal dislocation of the humeral head during any active movement. In  the  treatment of these cases, surgical methods of treatment are used, such as transposition of the latissimus dorsi muscle, proximal capsule plasty, and reverse shoulder arthroplasty. We present a successful clinical case of treatment of a patient with chronic massive injury of the right shoulder joint rotator cuff tendons in combination with the injury of shoulder joint proximal capsule, dislocation of the right humerus head, and hypotrophy of the anterior portion of the deltoid muscle. We performed transposition of the latissimus dorsi tendon in combination with shoulder joint proximal capsule plasty with an autograft of the peroneal longus tendon. The check-up X-rays show that the dislocation of the right shoulder joint was eliminated. In the early postoperative period, the patient started physiotherapy exercises of the operated limb using abduction pillow. By the 7^th day after surgery, the abduction of the operated limb reached 70°. The described surgical technique allows to restore congruence in the shoulder joint and the function of the injured limb in severe multiple injuries of the shoulder joint structures. 

Currently tuberculosis is considered as a group of diseases united by one etiological factor. The pathogenesis of certain localizations of tuberculous inflammation, in particular peritoneum tuberculosis, hasn’t been sufficiently studied. The role of cytokine mechanisms in the development of the disease and the elaboration of non-sterile immunity requires further experimental studies, in particular the creation of a reproducible model on laboratory animals.

The aim: to study the effect of TNF-α on the development of tuberculosis of the serous coat of the abdominal cavity, as well as to evaluate the possibility of modeling tuberculous peritonitis in laboratory animals using infliximab.

Materials and methods. The studies were conducted on 18 male rabbits, which were simulated peritoneal tuberculosis by intra-abdominal administration of a suspension of Mycobacterium tuberculosis. 10 rabbits of the experimental group were intravenously injected with an infliximab solution and an iron (III) hydroxide sucrose complex intraperitoneally a day before infection.

Results. In the control group of animals, tuberculosis either didn’t develop, or in a third of cases it affected only the pulmonary parenchyma, while proliferative processes prevailed. On the contrary, in animals with inactivated TNF-α, in 100 % of observations, tuberculous peritonitis was detected with associated lung damage and the predominance of alterative caseous processes.

Conclusion. The created model of tuberculous peritonitis shows the leading role of TNF-α in the activation of macrophages, as well as in attracting cells to the site of infection. This is the primary signal necessary for the formation and stability of granulomas since the neutralization of this cytokine leads to a loss of control over the infection and the destruction of the granuloma with the development of destructive tuberculosis in the serous coat of the abdominal cavity. 

The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.

The aim: to consider the clinical and diagnostic features of intestinal tuberculosis and Crohn’s disease, to show the role of various methods of their diagnosis (CT of the abdominal cavity, CT-enterography, colonoscopy with biopsy).

A clinical example shows a case illustrating the difficulties of diagnosing intestinal tuberculosis, initially diagnosed as Crohn’s disease. The features of the course, complex diagnosis and treatment of intestinal tuberculosis and its complications during immunosuppression are demonstrated. At the first stage of treatment, the patient’s data related to CT of the chest organs, colonoscopy and histological examination of biopsy samples were incorrectly interpreted. As a result, a wrong diagnosis of Crohn’s disease was made, and immunosuppressive therapy was prescribed that provoked a generalization of the existing tuberculosis process. Subsequently, repeated surgical interventions were performed for complications of intestinal tuberculosis – perforation of tuberculous ulcers, peritonitis. Based on the analysis of the literature data and our own observation, it is shown that granulomatous inflammation in the study of intestinal biopsies doesn’t always allow us to make a clear diagnosis, first of all, there are intestinal tuberculosis and Crohn’s disease in the differential diagnostic series. The use of histobacterioscopy according to Ziehl – Neelsen, the study of fecal matter by luminescent microscopy, as well as molecular genetic methods for detecting DNA MTB allow us to verify the diagnosis. If Crohn’s disease is misdiagnosed as intestinal tuberculosis, then the prescribed anti-tuberculosis therapy can cause harm and lead to a delay in the underlying disease treatment. The reverse misdiagnosis is potentially more dangerous: if tuberculosis is misdiagnosed as Crohn’s disease, then the appointment of immunosuppressive therapy can lead to the generalization of tuberculosis and the development of fatal complications. 

Background. The treatment of purulent-inflammatory processes of soft tissues remains today an area of surgery that is not given enough attention by specialists of both inpatient and outpatient levels, with many unresolved problems. Of particular importance in the pathogenesis of purulent-septic processes are the emerging microcirculation disorders due to the formation of micro-clots. An important point that aggravates the course of the disease is the development of thrombohemorrhagic syndrome. As a result, even with a variety of antibacterial drugs and the ыavailability of  new treatment methods, it is often not possible to achieve positive results in the treatment of this heavy contingent of patients.

Aim: to improve the effectiveness of complex therapy of patients with extensive soft tissue phlegmon by relieving thrombohemorrhagic syndrome.

Materials and methods. Cryoplasma-anti-enzyme therapy in the composition of complex treatment was received by 59 (48.8 %) patients of the main group, 62 (51.2 %) patients of the comparison group received only the generally accepted treatment. In each group, there are three variants of the course of the disease – moderate, severe and septic.

Results. The analysis of the clinical course of the disease showed that in patients of the first group, wounds were cleared of necrotic masses and purulent discharge with filling them with healthy granulation tissue 5.3 days faster than in the second group (p˂0.001). The number of deaths decreased – 11.9 % in the first group against 27.4 % in the second group (p˂ 0.001). The number of deaths decreased – 11.9 % in the first group against 27.4 % in the second group (p˂ 0.001). The proportion of thrombotic and thromboembolic causes of death in the first group (14.3 %) was lower than in the second (17.7 %) (p˂ 0.05).

Conclusion. The use of cryoplasma-anti-enzyme therapy as part of complex treatment contributed to the effective relief of thrombohemorrhagic syndrome, the  elimination of microcirculatory disorders, which allowed performing plastic closure of  a  wound defect 1.6  times faster, prevented the progression of multiple organ failure, and contributed to a reduction in mortality. 

Coronary heart disease (CHD) ranks first among the causes of death from cardiac events. Patients who have previously undergone surgical treatment – coronary artery bypass grafting (CABG) – are not immune from the return of angina due to the progression of atherosclerosis in the native coronary arteries or degenerative changes in the shunts. Therefore, the issue of redo surgery in this group of patients is debatable.

The aim of the research is to show that the use of alternative sternotomy approaches and the rejection of artificial blood circulation (ABC) are considered as possible measures to improve the results of redo CABGs.

Materials and methods. In the Cardiac Surgery Unit No. 1 of the Irkutsk Regional Clinical Hospital from 2003 to 2020, 6773 off-pump CABG surgeries were performed. Of these, 6338  (93.6  %) surgeries were performed using median sternotomy and  435  (6.4  %) surgeries were performed using minitoracotomy or subxyphoid access. Of the 6338 CABG surgeries performed using sternotomy, 58 (0.9 %) were performed repeatedly. All redo surgeries during the period under review were performed by minithoracotomy or subxyphoid access. The indication for redo surgery was the return of angina of III or IV functional class, which did not respond to optimal drug therapy. When performing 54 redo surgeries, the access was leftsided mini-thoracotomy. In 3 patients, CABG was performed by subxyphoid access and in 1 patient – from right-sided mini-thoracotomy.

Results. 58 redo CABG surgeries were performed. There was no damage to the access of the heart or functioning shunts. Complications were noted in 5 (8.6 %) patients. In 1 case, a second operation was required due to bleeding from the intercostal artery. In other cases, there were rhythm disturbances, or the need for inotropic support.

Conclusion. Performing redo off-pump CABG surgeries using mini-accesses reduces the risk of damage to the heart and functioning shunts, eliminates manipulations on the ascending aorta, and avoids difficulties with cardioplegic protection of the myocardium with a functioning mammarocoronary graft. 

Background. The rapid development of laparoscopic surgery can significantly reduce trauma during operations in the retroperitoneal space. These goals are also achieved by retroperitoneoscopy (RPS), which has become widespread in the last twenty years. The main difficulties for surgeons were associated with a small workspace and a lack of clear anatomical landmarks. Different access methods have different features, advantages and disadvantages, the analysis of which helps to optimize surgical treatment and accelerate patient rehabilitation.

Aim: to study the advantages and disadvantages of retroperitoneoscopic and transperitoneal laparoscopic surgical methods of treatment.

Materials and methods: We analyzed 305  case histories of patients operated on for various kidney diseases. The patients were divided into 2 groups: Group 1 – patients who underwent surgery using an extraperitoneal retroperitoneoscopic approach, Group 2 – patients who used the transperitoneal laparoscopic approach. A comparison of two methods of surgical treatment of kidney diseases, retroperitoneoscopic and laparoscopic access, was carried out. The following indicators were compared: duration of surgery, length of hospital stay, need for analgesics, frequency of postoperative complications.

Results. The duration of the operation with retroperitoneoscopic surgery was reduced by more than 15 % compared with the laparoscopic approach. Shorter periods of pain relief were required, and the number of complications also decreased. The duration of inpatient treatment did not differ significantly.

Conclusion. Retroperitoneoscopic approach can be used as the method of choice for operations on the retroperitoneal space. 

The egg has always been and remains an ideal object for conducting various scientific research. An egg is an isolated egg cell outside the mother’s body. Therefore, it is an ideal object for studying embryogenesis and performing various manipulations during embryogenesis and before the birth of a viable organism. The existing methods allow conducting experimental manipulations with the embryo in  situ, inside the egg shells without damaging them. However, the achievement of ideal parameters for closing the defect of the fertilized egg shell in the experiment is the key to  the successful completion of the experiment. Periods of embryogenesis, especially at the last stage, when osteogenesis occurs, require the presence of a sufficient amount of calcium ions in the metabolism of the developing chicken, which are vital for the formation of a full-fledged chicken.

The aim: to develop an optimal method for closing the defect and fixing the egg shell after manipulation or during the experiment.

Materials and methods. The experiment was carried out on fertile eggs of the breed of chickens – meat breed of broilers Ross-308 (ROSS-308), JSC Poultry Farm “NovoBaryshevskaya” (Koltsovo, Novosibirsk Region, Russian Federation). In the experiment, 120 fertilized eggs were used. Eggs weighing 60–70 g were incubated at a temperature of 37.5–38.0 °C and 50–55 % humidity. Comparative anatomical and physiological parameters were evaluated on the 7th, 14th, 20th day of incubation and on the 1st day of the postnatal period. In the experimental group, the shell defect was covered with a fragment of the egg shell of the donor. Incubation was carried out in an incubator – a household incubator “Nesushka” (Novosibirsk, Russian Federation).

Results. The proposed method of fixing and closing the defect of the fertilized egg shell excludes the use of foreign materials that have an adverse effect on the development of the embryo. There were no anatomical and physiological deviations in the chicks of the study group when comparing the indicators with the parameters in the comparison group and the Hamburger – Hamilton classification. 

Background. Currently, obesity has become one of the most important medical and social problems in the world due to its high prevalence. Numerous literature data indicate that high BMI is associated with increased mortality from cardiovascular diseases.

The aim: to study the relationship between overweight and generalized obesity with the development of fatal and non-fatal cardiovascular events among residents of the Chui region of the Kyrgyz Republic, taking into account gender and age.

Material and methods. This study was carried out as part of the international crosssectional epidemiological study “Interepid”. The total follow-up period was 7 years. Life status at the end of the follow-up period was monitored in 1096 respondents out of 1341 initial cohorts (response – 82.1 %). The endpoints were cases of fatal and non-fatal cardiovascular events. The frequency of events was assessed using methods of analysis of survival (Cox proportional hazard regression model, parametric survival models, survival by the Kaplan – Meier method).

Results. A total of 181 cases of fatal and non-fatal cardiovascular events (16.44 %) were recorded during the follow-up. In persons with normal body weight, the incidence of cardiovascular complications was 10 %. In overweight individuals, the value of this indicator increased and reached 17.99 % (p˂ 0.001), and in individuals with obesity – 24.5 % (p˂ 0.0001). The increase in the frequency of events with the increase in body mass index did not depend on the gender of the respondents but was typical only for people under 60 years of age. For elderly patients, there was no relationship between BMI and the development of cardiovascular complications. In contrast, the relative risk had an insignificant tendency to decrease by 2.6 % for every 1 kg/m2 increase in body mass index (RR – 0.974; 95% CI: 0.924–1.025).

Conclusion. The increase of body mass index above 25 kg/m2 is an independent risk factor for the development of fatal and non-fatal cardiovascular events in the analyzed cohort of the Chui region residents, regardless of gender, but only in persons under 60 years of age. 

The aim: to study the structure and dynamics of population immunity to SARSCoV-2 of the population of the Southern Regions of the Far East (SRFE): Khabarovsk, Primorsky Krai and Amur Region during the COVID-19 epidemic in 2020.

Materials and methods. The work was carried out according to the program for assessing population immunity to SARS -CoV-2 of the population of the Russian Federation according to the methodology developed by the Rospotrebnadzor with the  participation of the St.  Petersburg Pasteur Institute. The study was approved by  the  ethical committee of the St.  Petersburg Pasteur Institute. The selection of participants was carried out by a questionnaire method using cloud technologies. The  volunteers were randomized by age by stratification into 7  age groups: 1–17, 18–29, 30–39, 40–49, 50–59, 60–69, 70+ years old. Territorial randomization consisted in limiting the engaging of volunteers – no more than 30 people from one enterprise. After the initial cross-sectional study, a 3-stage seromonitoring was carried out, in which the same volunteers participated. Antibodies to the SARS-CoV-2 nucleocapsid were determined in peripheral blood serum by the enzyme immunoassay using an appropriate set of reagents produced by the State Scientific Center for Medical and Biological Sciences of the Rospotrebnadzor (Obolensk). Statistical analysis was performed using the Excel package. The confidence interval for the proportion was calculated using the A. Wald, J. Wolfowitz method with A. Agresti, B.A. Coull’s correction. The statistical significance of the differences was calculated online using a specialized calculator. The statistical significance of the differences was assessed with a probability of p˂ 0.05, unless otherwise indicated.

Results. In a comparative analysis, the highest morbidity was observed in the Khabarovsk Territory, the lowest – in the Primorsky Territory. The level of seroprevalence among the population of the region was 19.6 % (95 % CI: 18.2–21.1) in  the  Khabarovsk Territory, 19.6  % (95  %  CI: 18.1–21.2) in the Primorsky Territory19,6 % and 45,5 % (95 % CI: 43.7–47.3) in the Amur region. The highest seroprevalence was noted among 1–17 years old children, mainly due to the subgroup of 14–17-years-olds. The smallest proportion of seropositive was found among 40–49-year-olds in the Khabarovsk Territory (14.7 %, 95 % CI: 11.2–18.6), 18–28-yearolds in the Primorsky Territory (13.3 %, 95 % CI: 10.0–17.1) and 30–39-year-olds in the Amur Region (36.3  %, 95%  CI:  31.7–41.6). No statistically significant dependence of  seroprevalence on territorial and occupational factors has been established, with the exception of an increase in the proportion of seropositive medical workers in Primorsky Territory. In the process of 3-stage seromonitoring, a regular increase in the proportion of seropositive people was revealed in all SRFE. The resulting tendency is correctly described by a second-order polynomial. A relationship was revealed between the number of convalescents and persons in contact with them, which made it possible to calculate the base reproductive number (R₀) in the range from 1.4 (Primorsky Territory) to 2.4 (Amur Region). Analysis of seroprevalent volunteers showed that the number of asymptomatic individuals varied from 94.1 % (95 % CI: 92.8–95.3) to 98.3 % (95 % CI: 98.8–99.2). This indicates that most of the volunteers had COVID-19 asymptomatically.

Conclusions. A comparative study showed the prevalence of seroprevalence in the Amur Region compared with the Khabarovsk and Primorsky Territories. The relationship between the number of convalescents and persons in contact with them was noted. The value of the base R₀ is calculated. It has been shown that more than 90 % of seropositive individuals in the COVID-10 SRFE were asymptomatic.