Background. Prescribing antibacterial drugs for the treatment of a new coronavirus infection at the outpatient stage is often unreasonable and can also lead to an aggravation of the patient’s condition due to the effect of this group of drugs on the intestinal microflora and lead to other undesirable effects.

The aim: to assess the level of lipopolysaccharide-binding protein and indicators of systemic inflammation in patients with moderate viral SARS-CoV-2 lung disease on the background of antibiotic therapy.

Materials and methods. 60 patients hospitalized in the infectious diseases department with a positive PCR result for SARS-CoV-2 in the age group 44–70 years old were examined. The patients were divided into 2 groups: group 1 (n = 26) – patients who did not receive antibacterial drugs at the outpatient stage, group 2 (n = 34) – patients who received antibiotic therapy. The control group was also selected (n = 20). Patients underwent a study of the level of lipopolysaccharide-binding protein (LBP), ferritin and C-reactive protein in the peripheral blood.

Results. In the group of patients with new coronavirus infection who were admitted to the inpatient stage of treatment and received antibacterial therapy at the outpatient stage, a significantly higher levels of LBP – 37.3 [13.8; 50.4] µg/ml (p˂0.05) and ferritin – 276.00 [184.00; 463.00] µg/ml (p˂0.05) were revealed, compared with group 1 and the control group.

Conclusions. In the group of patients who received antibiotic therapy at the outpatient stage, a significantly higher level of LBP was revealed compared to the group in which this group of drugs was not used. These results indicate the possible impact of uncontrolled and early intake of antibacterial drugs on the gut microbiome and intestinal permeability, and also prove the need for a more responsible approach to the choice of starting therapy for new coronavirus infection. 

Background. The tick-borne encephalitis virus (TBEV) is one of the most dangerous and epidemiologically significant vector-borne pathogens. There is a need for effective antiviral agents for the treatment and prevention of this infection. Previously we found that the mycelium of Inonotus rheades grown on birch wood contains water-soluble substances with strong virulicidal properties against TBEV. It is necessary to check whether the mycelium of I. rheades can synthesize virulicidal substances from wood of other species.

The aim: to study the antiviral properties of extracts of I. rheades mycelium grown on coniferous wood, both in the presence and in the absence of blue light during cultivation.

Materials and methods. The mycelium of I.  rheades was grown on birch, pine, and fir wood. The direct virulicidal effect of the extract was evaluated by the decrease in the titer of the infectious virus incubated in the presence of the extract. The ability of the extract to inhibit the reproduction of the virus in infected cells was studied by  the  calculation of 50  % effective concentration (EC50). The toxicity of extracts for cells was evaluated based on the calculation of 50 % cytotoxic concentration.

Results. Mycelium extracts grown on conifers under blue light do not cause a statistically significant decrease in the concentration of infectious TBEV (p = 0.2563). However, the BP10 extract (pine, blue light) inhibits TBEV reproduction in infected cells (EC50 = 0.28 ± 0.06 mg/mL). Toxicity for SPEV cell culture is low. In the extracts of conifers grown in the dark, no antiviral effect was found at all.

Conclusions. The component composition and mechanism of the antiviral action of I. rheades extracts are determined by the species of the wood substrate. The most promising sources of new drugs in relation to TBEV appear to be extracts of I. rheades mycelium grown on birch and pine. 

The aim of the study to evaluate the anti-ischemic effect of Serratula centauroides and Rhaponticum uniflorum dry extracts for bilateral carotid artery occlusion.

Materials and methods. The studies were carried out on 77 Wistar rats. Rh. uniflorum and S. centauroides dry extracts at doses 50, 100, 200 mg/kg were administered intragastrically for 14 days prior to bilateral occlusion of the carotid arteries. To assess the anti-ischemic effect of the investigated agents, the total mortality, the dynamics of survival, the survival time, the animals’ neurological status were determined using a modified McGraw scale and the brain hydration degree.

Results. S. centauroides at a dose 200 mg/kg reduced the percentage of animals’ death by 2.8 times (p ≤ 0.05) compared with the control. Life expectancy in animals treated with S. centauroides at doses 100 and 200 mg/kg and Rh. uniflorum at dose 100  mg/kg increased by 46, 52 and 64  %, respectively, compared to the control. The neurological deficit lowest severity was observed in animals treated with S. centauroides at dose 200 mg/kg. The most pronounced statistically significant decrease in the brain hydration level was observed in animals treated with Rh.  uniflorum at doses 100 and 200 mg/kg and S. centauroides at dose 100 mg/kg.

Conclusion. S. centauroides and Rh. uniflorum dry extracts have an anti-ischemic effect in cerebral ischemia.

To date, scientists have found that stress plays an important role in the formation of congenital malformations. It can be caused by the influence of negative environmental factors on the pregnant woman or by her own diseases. One of the consequences of stress is hypoxia. It can be acute and chronic, and can have a negative impact both during pregnancy and during childbirth. They also distinguish local and general hypoxia. The consequences of the negative impact of oxygen deficiency on the embryo and fetus can manifest itself both in utero and after birth, leading to  various kinds of congenital malformations, diseases, and sometimes fetal death, or increase the risk of sudden infant death syndrome. Hyperplasia of blood vessels, the so-called children’s hemangiomas, develops both in utero, especially with chronic fetal hypoxia, and during childbirth. It develops due to insufficient blood supply and oxygen deficiency in various parts of the body, most often in the head and neck. In an embryo under conditions of hypoxia, tachycardia develops – with an increase in heart rate and, if it is ineffective, local vasodilation occurs. Only then, under the condition of continuing hypoxia, does an increase in the number of blood vessels develop. This often leads to the formation of hyperplasia of the blood vessels, the so-called children’s hemangiomas.

This pathology is quite common, especially among fair-skinned children, which makes its study, in particular the factors that cause this pathology, relevant today. 

The aim of this study was to research the clinical and radiological efficacy of  corpectomy and anterior stabilization with titanium mesh cages in patients with myelopathic syndrome associated with cervical spine degenerative diseases.

Material and methods. A retrospective observational cohort study was performed. The study included medical records of patients with cervical myelopathy associated with degenerative diseases of the cervical spine who underwent corpectomy and  anterior stabilization with titanium mesh cages. Clinical and instrumental parameters were assessed.

Results. The study included 28  medical records of respondents who underwent corpectomy and anterior stabilization with titanium mesh implants. The average age of patients was 61.9 ± 11.3 years, males prevailed (60.7 %). By the 3rd month of  postoperative follow-up, the severity of myelopathy significantly decreased (p˂0.001). After 12  months, the severity of cervical myelopathic syndrome also significantly decreased (p = 0.009). The neurological status of 18 (64.2 %) respondents improved in the first 3  months after corpectomy and anterior stabilization with titanium mesh implants and 6 months after the surgery, the status improved in the remaining 8 (30.7 %) patients (p˂0.001). Preoperative values of the Cobb sagittal angle allowed us to conclude the following. In 13 (46.4 %) patients, the normolordotic axis of the cervical spine was noted, in 12  (42.8  %) – the  hypolordotic axis, and in 3 (10.8 %) respondents, the Cobb angle values corresponded to the kyphotic axis of the cervical spine.

Conclusion. The technique of corpectomy and anterior fixation with mesh titanium implants in patients with myelopathic syndrome against the background of  degenerative diseases of the cervical spine makes it possible to improve the clinical status of the latter already 3 months after the operation was performed while maintaining normal biomechanical parameters of the cervical spine and complete decompression of the neural structures and supply their vessels. 

Background. Type 2 diabetes mellitus is one of the most common metabolic disorders in humans. Diabetes mellitus can lead to abnormalities in many tissues of the eye structure, exposing patients to the risk of developing a wide range of ocular pathologies associated with changes in its anterior and posterior segments. The most common complication is diabetic retinopathy.

The aim: to assess the potential clinical significance of lacrimal lysozyme as a minimally invasive biomarker of diabetic ophthalmic disorders.

Material and methods. Three groups were formed during the study. Group  1 (Control, n  =  10) included conditionally healthy people with no type  2 diabetes mellitus. Group 2 (Main 1, n = 15) included patients with type 2 diabetes mellitus, but  no  diabetic manifestations in the fundus. Group  3 (Main  2, n  =  15) included patients with type 2 diabetes mellitus and manifestations of diabetic retinopathy of varying degrees. In patients of all groups, the level of tear lysozyme was assessed.

Results. It was found that the concentration of lacrimal fluid lysozyme in patients with type 2 diabetes mellitus was significantly lower than in healthy patients. In patients with diabetic retinopathy of varying degrees of manifestation (non-proliferative and proliferative forms) against the background of type  2 diabetes mellitus, significantly lower values of lysozyme were observed compared to patients with type 2 diabetes mellitus, but without diabetic ophthalmic manifestations.

Conclusion. It is possible that local detection of lysozyme in the lacrimal fluid may be potential biomarkers of the progression of diabetic retinopathy. 

The aim: to conduct a clinical and diagnostic evaluation of the effectiveness of the administration of a complex of drugs in the region of hemolymphocirculation in optical neuropathy in patients with edematous form of endocrine ophthalmopathy.

Materials and methods. The results of diagnosis and treatment of 31 patients (61 eyes) with optical neuropathy on the background of edematous exophthalmos in endocrine ophthalmopathy were analyzed. To identify hidden forms of optical neuropathy, such studies were prescribed as computer microperimetry on a confocal infrared ophthalmoscope, a complex of electroretinographic studies: registration of maximum ERG, oscillatory potentials. Latent forms of optical neuropathy were detected in 22 cases. In 9 cases, there were obvious forms of optical neuropathy. All patients underwent a 10-day course of intensive complex treatment, consisting of injections into the region of hemolymphocirculation (projection of the pterygoid fossa) No. 6–8 (No. 3–4 on each side) with an interval of 24 hours of a drug mixture, the formulation of which included Lidocaine 20 mg, Dexazone 4 mg, Hemase 3000 UNITS, Dalargin 1 mg.

Results. In all patients, there was a pronounced positive dynamics in the form of a significant (from 0.6 to 1.0) increase in visual acuity, a decrease in exophthalmos from (2.0 to 3.0 mm), an increase in color and contrast sensitivity.

Conclusions. Due to the violation of venous and lymphatic outflow due to thickening of extraocular muscles and retrobulbar fiber, injections into the hemolymphocirculation region (projection of the pterygoid fossa) of drugs with a wide range of decongestant and metabolic effects are justified, effective and safe. 

Background. Vitelliform dystrophies, first detected in adulthood, may create complications in diagnosis, especially with partial or almost complete destruction of vitelliform material, disguising as various types of macular pathology, such as central serous chorioretinopathy, age-related macular degeneration.

The aim: to study the clinical and instrumental characteristics of the most common forms of vitelliform dystrophies occurring in adulthood.

Materials and methods. Sixty eyes of adult patients with vitelliform dystrophies were included in the study. All patients underwent ophthalmologic examination including family history, best corrected visual acuity, biomicroscopy, and multimodal imaging including fundus photo, SD-OCT, OCT-A, BAF, FA, ICGA. After examination, the patients were divided according to various types of vitelliform dystrophies. The instrumental and diagnostic characteristics of the identified forms of vitelliform dystrophies were studied, taking into account the stage of the process, based on the analysis of clinical data, as well as the results of the most accessible non-invasive research methods, such as SD-OCT, OCT-A, BAF.

Results. The average age of patients was 52.40 ± 20.62 years, there were 13 (43.3 %) women and 17 (56.7 %) men. In 96.67 % of cases, the disease was bilateral. Genetically determined forms of vitelliform dystrophies were more common in sporadic forms. In the studied cohort, 43.3  % were patients with Best vitelliform macular dystrophy, 13.3 % – with autosomal recessive bestrophinopathy, 43.3 % – with pattern dystrophies. In all patients, according to structural OCT data, neuroepithelium detachment, residual vitelliform material in the form of massive deposits, deposits in the form of “stalactites”, “fringes” were determined. In all cases of vitelliform dystrophies, atrophic changes were detected, which intensified with an increase in the duration of the disease. Hyperautofluorescence of the residual vitelliform material in the form of “beads” was often accompanied in the later stages of the disease.

Conclusion. Cases of vitelliform dystrophies identified in adults with partially resorbed vitelliform material require a thorough analysis of structural optical coherence tomography and fundus autofluorescence. 

Background. Pterygium is ubiquitous and multifactorial; today, information on  the  prevalence of pterygium, risk factors, the relationship of its development with concomitant pathology and the type of life activity of patients in various regions of Russia is limited. All of the above led to the conduct of this epidemiological study in the Republic of Bashkortostan.

The aim of the study: to study the prevalence of pterygium, as well as to identify the relationship of risk factors for its development with the type of life activity and concomitant diseases in the urban and rural population of the Republic of Bashkortostan.

Methods. On the basis of the Ufa Research Institute of Eye Diseases, within the framework of the Ural Eye and Medical Study (UEMS) research project, a population study of people living in urban and rural regions of the Republic of Bashkortostan was carried out. The study involved 5899  people, including men – 43.7  % (2585  people), women – 56.3 % (3314 people), urban residents made 42.3 % (2491 people), rural – 57.7 % (3408 people).

Results. As a result of our study, pterygium was diagnosed in 138 people (204 eyes – 2.3 %) (95% CI: 2.0–2.7 %). One-way analysis showed a higher prevalence of pterygium associated (p˂0.10) with a number of systemic and ophthalmic parameters. However, according to the results of multivariate analysis, it was revealed that the prevalence of pterygium was significantly associated with older age (p = 0.006), rural area of residence (p = 0.001) and low educational level (p = 0.03).

Conclusion. The prevalence of pterygium in Republic of Bashkortostan according to the UEMS study was 2.3 %, or 23 people per 1000 population among people over 40 years old. The nature of the settlement influences the prevalence of pterygium in  the Republic of Bashkortostan. Pterygium was more common among older people among all respondents who took part in the study. In the study, pterygium was not a biomarker of general somatic diseases. 

Background. Approximately 50 % of children with cerebral palsy have vision problems, manifested in strabismus, impaired eye mobility, refractive errors, nystagmus development and partial atrophy of the optic nerve.

The aim: to present a clinical case of combined correction of myopia and divergent strabismus in a patient with cerebral palsy (CP).

Materials and methods. A clinical case of combined correction of myopia and divergent strabismus in a patient with cerebral palsy is presented. General anesthesia was used to perform a two-stage treatment under one anesthesia: the first stage – laser myopia correction by femtosecond extraction of the lenticule through a small access (SMILE) to both eyes, the second stage was the strabismus correction by performing tenoscleroplasty of the external rectus muscle and resection of the internal rectus muscle of both eyes. The sequence of stages is due to the relative traumatism of strabismus surgery, in some cases, accompanied by a reaction from the bulbar conjunctiva and the cornea in the form of edema, which, during subsequent femtosecond vision correction, can affect the refractive result and worsen visual acuity in the postoperative period.

Results. The performed treatment let significantly increase uncorrected visual acuity, achieve a correct and stable eye position, which became the basis for changing the vision nature from monocular to binocular.

Conclusion. Thus, modern laser and surgical technologies in combination with an adequate anesthesia allow rehabilitating patients as much as possible in a short time, even with severe forms of cerebral palsy, and significantly improving the quality of life. 

The article presents an overview of modern publications on epidemiology, risk factors, and the main links of the etiology and pathogenesis of age-related macular degeneration (AMD). The nonexudative or “dry” form of age-related macular degeneration is a multifactorial progressive pathological process caused by hereditary predisposition, general and local disorders of lipid metabolism, negative changes in  the blood supply to the eye, age-related destruction of the Bruch’s membrane and retinal pigment epithelium, the appearance of signs of local and systemic inflammation, the development of oxidative stress with the impact of toxic lipoperoxidation products on the structures of the posterior segment of the eye. Recent studies have discovered new ways of retinal pigment epithelial cell death in response to oxidative stress in AMD, in particular necroptosis, which, in addition to classical apoptosis, is considered the main mechanism of this process. It is noted that the development of AMD may be associated with an age-related decrease in the level of estrogen in women. The analysis of the data on the etiopathogenesis of age-related macular degeneration presented in the modern literature indicates the need for further research and generalization of local and general pathological processes developing in the dynamics of retinal visual function disorders by specialists of various scientific disciplines. 

Background. The problem of the development of emotional intelligence and  the  search for its relationship with various factors remains relevant, since in modern research there are contradictory data on the nature of the relationship of emotional intelligence with academic performance.

Aims: to clarify the magnitude and sign of the relationship between the level of development of emotional intelligence of university students and their academic performance.

Materials and methods. Eighty-three 83 students from 18 to 47 years old participated in the study. They all were students of 1–4th years of bachelor’s degree in Moscow universities in the areas of “Psychological and pedagogical education”, “Pedagogical education with two training profiles”, “Pediatrics”, “Nursing”. The research method applied was a written survey (methods of D.V. Lyusin, N. Hall, questionnaire). The Spearman correlation method was used to study the relationship between variables.

Results. The sample was dominated by female undergraduate students (n = 75). The average level of emotional intelligence development prevails among students, the level of interpersonal emotional intelligence development is higher than the level of intrapersonal emotional intelligence development. The trend in increasing academic performance of master’s degree students in comparison with undergraduate students has been revealed. A correlation was found between students’ academic performance and general emotional intelligence (r = 0.331; p˂0.01). The closeness of the correlation between the components of emotional intelligence and academic performance is more pronounced in relation to interpersonal emotional intelligence (r = 0.3407) than to intrapersonal (r = 0.3251; p˂0.01).

Conclusion. We have found that the higher the level of academic performance of students, the higher the level of emotional intelligence; interpersonal emotional intelligence of students is more closely related to academic performance. 

Background. Insufficient knowledge of the professional deformation of bailiffs with the accumulated research material that reveals the essence of this phenomenon, as well as the need to take into account the specifics of the activity and individual and personal characteristics of this category of employees, determine the relevance of this study.

The aim: to identify and describe the individual and personal qualities of bailiffs with various professional deformation types.

Material and methods. In this work, the following research methods were used: the author’s questionnaire for assessing seven types of professional personal deformation; psychological testing of individual and personal qualities using methods regulated by departmental documents; statistical methods (descriptive statistics, two-stage cluster and correlation analyzes). The study involved 277 employees of the Federal Bailiff Service of the Arkhangelsk region.

Results. Bailiffs showed such professional deformations as overcontrol, authoritarianism and conservatism. The interrelation of all professional deformation types severity with the individual and personal qualities of the bailiffs, which are among the professionally important qualities, has been established. At the same time, the insufficient expression of these qualities contributes to the professional deformation development. The only exceptions are the level of active communication and normativity, which, with excessive development, also contribute to the appearance of personality deformations and contribute to a decrease in the effectiveness of activities. Most types of character accentuations and their various combinations contribute to the professional deformation development of bailiffs, i. e., are her personality markers. Moderate severity of the dysthymic type of character accentuation reduces the likelihood of developing occupational deformity.

Conclusion. Within the framework of the practical use of the results of this study, it is necessary, when conducting professional selection of personnel and periodic assessment of personnel, to pay attention to the level of expression of professionally important qualities that have a relationship with key types of professional deformation. This will allow timely implementation of measures to prevent the development of professional deformations of employees. 

The aim of the study. To determine the informational value of psychometric indicators used for the integral assessment of cognitive status in cardiac patients, and to find those that would help differentiate the individual sensibility to postoperative cognitive dysfunction (POCD).

Materials and methods. The clustering methods were analyzed the extended psychometric testing data in 256 cardiac surgery patients. The psychometric testing carried out 3–5 days before and on days 7–10 after surgery using the psychophysiological complex program “Status PF”.

Results. The cluster analysis revealed that the most informative tests for a screening risk assessment of POCD are the testing the speed of response to visual stimuli with feedback of changes in the stimuli exposition according to the individual reaction time and the testing short-term memory (memorized words). While the analysis of postoperative psychometric indicators, the patients in a modified clustering group were characterized by a deterioration of verbal memory and a decrease of the time reaction to visual stimuli whereas that its observed acceleration in the general “stable” group.

Conclusion. The clustering methods enabled the identification of cardiac surgery patients in the preoperative stage who had less cognitive reserve for recovery after surgery. The changes in the relationship of complex visual and motor response, attention, and memory indicators, which depended on the belonging to the identified clusters, suggest that the preoperative period is characterized by the dedifferentiation of cognitive functions indicating a cognitive deficit. 

Today, there are significant requirements for the professional competencies of a teacher, among which a special place is occupied by competencies that determine the effectiveness of work with different categories of students. The article presents the results of a theoretical comparison of conceptual approaches to the identification and development of professional competencies of future teachers. The metacognitive competencies underlying self-learning are analyzed. The role of special work within the framework of individual educational courses, trainings and practices in higher education, aimed at developing metacognitive strategies and competencies of future teachers, is substantiated. The article proposes a support structure for the components of metacognitive competence (metacognitive knowledge, declarative knowledge, metacognitive strategies). After analyzing the concept map and comparing various models of identification and development of metacognitive competence, the authors single out research, managerial and communicative competences in its structure.

An analysis of domestic research highlights the role of managing competencies for  working with a gifted child and shows that a future teacher must constantly develop regulatory and personal qualities in himself and in a gifted student. When working with a gifted student, a teacher needs metacognitive competence, which is formed in the process of asking questions to oneself, in attempts to try other strategies for solving pedagogical situations. The teacher is required not only to be able to teach, but also to constantly learn himself in order to be able to solve non-trivial situations together with students.

It is shown how the relationship between a teacher and students affects psychological health, well-being, psychological burnout, the quality of professional activity, the ability to work with a gifted person. The conclusion is made about how approaches to the professional training of specialists in the educational sphere should change in order to provide the opportunity to work with the category of gifted children. 

Background. The article examines the factors of the development of mathematical giftedness in the context of distance learning, depending on the choice of computer mathematical packages and digital platforms. Mathematical giftedness is considered as one of the types of special intellectual giftedness associated with mathematical thinking.

The aim. To identify the links between the cognitive structures and types of the mathematical thinking that affect the development of mathematical giftedness, with the specifics of the use of digital resources in distance learning.

Materials and methods. The analysis of the features of distance learning and its influence on the development of mathematical giftedness is performed; a comparative study of the relationship between the child’s productive informational activity and the implemented distance learning tools was carried out; methods of selection of digital resources, different in the presented forms and levels of activity of distance work, which contribute to the development of mathematical giftedness of students, have been investigated.

Results. The following factors were assigned to the development of mathematical giftedness by means of digital resources: the formation of a child’s productive informational activity; implementation of innovative approaches to teaching; implementation of the methodology for the selection of digital resources. It was found that  the  implementation of mathematical abstractions by digital means of visualization improves the quality of assimilation of concepts, forms a stable interest in the subject, and contributes to the development of topological thinking. The work identifies specific psychological problems arising in the process of implementing distance learning mediated by computer technologies, the resolution of which affects the possibility of developing mathematical giftedness, in particular: the problems of emotional saturation and the construction of interpersonal relationships. As specific factors, contributing to the solution of these problems, the following are proposed, in particular: increasing motivation, designing group tasks, special systems of tasks, implemented according to the principle of engagement, the solution of which leads to competition and cooperation. The understanding of mathematical abstractions is facilitated by computer applications that implement technologies for rendering graphic components.

Conclusions. Based on the analysis of cognitive structures and types of mathematical thinking, conclusions are drawn about the specifics of the use of digital resources in the process of distance learning, contributing to the effective development of student’s mathematical giftedness. 

Background. Reverse arthroplasty is an effective method of treating severe injuries and diseases of the shoulder joint. In cases of severe osteoporosis, defects and deformities of the glenoid, there are risks of incorrect installation and instability of the components of the endoprosthesis. In the literature data, the problem of osteoporosis in the endoprosthetics of the shoulder joint and methods of its solution are rather poorly reflected, which was the reason for this study.

The aim: to develop algorithms for diagnosing the state of the bone tissue of the articular cavity of the scapula and methods for solving its deviations during reverse shoulder arthroplasty.

Materials and methods. Forty-eight patients who underwent reversible shoulder joint replacement were examined in the Department of Adult Orthopedics of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics. A standard preoperative examination of patients developed in the department was performed, as well as additional calculations of bone density in Hounsfield units and according to X-ray densitometry were performed. The parameters of bone density of the glenoid (in HU) were compared with the data of densitometry.

Results. According to the results of densitometry, the patients were divided into groups. A direct dependence of the bone density of the glenoid and the indicators of densitometry was revealed. Algorithms of treatment and preoperative preparation of patients with bone density deficiency for reverse shoulder arthroplasty have been developed.

Conclusions. In the studied groups, 100 % of patients with indicators below 139 HU were diagnosed with osteoporosis or osteopenia, and patients with more than 257 HU had normal bone mineral density. 

Intra-articular fractures of the elbow joint are severe for the treatment of damage. Methods of treatment of intra-articular fractures of the distal humerus are  immersion osteosynthesis with spokes and screws, bone and transosseous osteosynthesis. However, the percentage of complications and unsatisfactory outcomes of surgical treatment of these injuries remains high. The unsatisfactory results of  treatment include contractures, ossification, post-traumatic arthrosis, as well as purulent-inflammatory complications of surgical treatment. Our accumulated experience of osteosynthesis of intra-articular fractures of the distal humerus with the help of submersible implants, experience of hardware treatment of joint injuries and their consequences (developed in the Department of Adult Orthopedics of the National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov), allowed us to offer surgical techniques for the combined use of these methods. The article presents a case of successful surgical treatment of a patient with a comminuted intra-articular fracture of the distal humerus by osteosynthesis with bioresorbable implants in combination with a hinge-distraction apparatus for  external fixation by  O.V.  Oganesyan. A detailed description of the technique of osteosynthesis, postoperative rehabilitation is given. The described clinical case shows the effectiveness of the combined osteosynthesis technique and the advantages of using bioresorbable fixators over metal implants. 

The article presents a review of literature data in order to study current problems in the diagnosis and surgical treatment of liver echinococcosis. At the present stage of technological progress, it is possible to study the genetic, anatomical and pathophysiological aspects of echinococcosis. The article highlights the advantages and disadvantages of surgical operations performed in patients with echinococcal liver damage. Methods and results of surgical treatment in various clinics are considered. The main surgical directions in the treatment of parasitic liver damage have been determined. These are more radical anatomical and extensive liver resections and minimally invasive, including laparoscopic and robotic techniques. Each of the methods used has its own niche of application and its own limitations. An opinion is expressed about the prospects for the development of minimally invasive methods of surgical treatment. The authors note the actual absence of a unified standardized tactics of surgical treatment at the moment. It is noted that the literature contains only fragmentary data on the possibility of combining minimally invasive and classical methods of surgical treatment. Despite the introduction of new methods of treatment, the percentage of complications and mortality are still high. Thus, the lack of uniform diagnostic standards and principles for determining surgical tactics testifies to the urgency of the problem of treating parasitic liver damage and determines the search for new solutions in order to improve the results of surgical treatment of this pathology. 

Gastrostomy is used to feed palliative patients with dysphagia. Currently, the preference is given to percutaneous puncture methods of gastrostomy, which do not require general anesthesia. Percutaneous puncture techniques are possible only if the patency of the upper parts of the digestive tract still exists for the «pull method» and can require additional X-ray irradiation in case of the «push method». These operations require expensive disposable kits, which affects the prevalence and availability of the technique. Therefore, the use of an alternative minimally invasive gastrostomy through minilaparotomy is justified. Minimal-invasive pressure gastrostomy is known for a long time, and in combination with small access, it can be successfully used to provide nutrition for palliative patients with dysphagia. Most patients with dysphagia have a thin anterior abdominal wall, which allows using minimal access. It is important to choose the right place of the incision so that access is in the area of the formation of the fistula. To obtain additional diagnostic information one can use a radiography of the abdominal cavity, which shows the gas bubble of the stomach, and other high-tech methods: ultrasound, spiral computed tomography, etc. At the same time such patients do not require general anesthesia, it is possible to perform the operation under a local anesthesia. The article provides a detailed description of the technique of minimal invasive laparotomy gastrostomy and two clinical observations of palliative patients who underwent this operation.

Among patients with floating rib fractures without pneumo- and hemopneumothorax or after their elimination, the most severe disorders of ventilation and circulation occur in patients with multiple bilateral rib fractures and a fracture of the sternum manubrium with the formation of a floating sternocostal segment of the chest. At the same time, the suction aero- and hemodynamic function of the chest is disturbed, there is pressure on the heart and large vessels. As a result, the efficiency of external respiration progressively decreases, the respiratory muscles are exhausted, which requires an urgent transfer to artificial ventilation of the lungs. The article presents a clinical case of successful treatment of such a chest injury using the author’s technique (Patent No. 2621871 of the Russian Federation). The extrathoracic silicone reinforced splint has two horizontal branches that go around the mammary glands. The splint is attached to the floating sternocostal segment with ligatures passed behind the sternum and laterally – to stable sections of the ribs along the posterior axillary line on both sides. The tire reliably holds the sternocostal segment from paradoxical movements. The tire is removed after 3  weeks. By this time, fibrous calluses are formed in places of fractures of bones and cartilage, and the swelling of the chest wall subsides. Superficial bedsores in the places of fixation of the splint are epithelialized under the scab within 7–8 days. The patient was examined a year later, her condition was satisfactory, she had no complaints, there was no chest deformity. The technique is less traumatic, it is indicated for patients with polytrauma and in other cases. 

The modern stage of functioning of domestic health care is characterized by the formation of regulatory and legal requirements for the system of internal control of quality and safety of medical activity.

One of the tasks of internal control of quality and safety of medical activity is to ensure and assess the compliance of medical care provided by medical workers to the criteria for assessing the quality of medical care, as well as to consider the reasons for non-compliance of medical care provided to these criteria. Requirements to quality criteria, procedures for assessing the quality of medical care, compliance with the established procedure of medical records maintenance and development of measures to eliminate and prevent violations are established by various regulatory documents. At the same time, of great importance for a medical organization is not only the fulfillment of requirements in the field of quality control and safety of medical activity, but also the introduction of an effective system of internal control of quality and safety of medical activity, based on regulatory and legal requirements and giving real results.

It determines the necessity of creating in a medical organization the system of collection and analysis of quality data and development of internal documents, establishing the processes of quality control and assessment of medical care, the methodology of selecting medical documentation for control and assessment of the quality of medical care, as well as the requirements to the results of analysis and documenting of decisions made.

The article presents the experience of Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivian on the creation of a system for collecting and analyzing data on the quality of medical care and making management decisions to eliminate and prevent nonconformities, which operates within the framework of the quality management system of medical care of the institute. 

Background. Acute pancreatitis retains its leading position in the structure of urgent abdominal pathology, maintaining a high postoperative mortality, despite the emergence of new methods of surgical treatment.

The aim of the study: to evaluate pathomorphological changes in the pancreas, surrounding organs and tissues, clinical manifestations in dynamics after local cryotherapy on the pancreas in animals with experimental pancreatic necrosis for subsequent use of the method in clinical practice.

Material and methods. An experimental study was performed on Wistar rats, in the main group, pancreatic necrosis was simulated with subsequent cryotherapy, in the control group, pancreatic necrosis was simulated and simple pancreatic mobilization was performed, in the third group, cryotherapy was performed on an unchanged gland. With the help of modern statistical methods, the effectiveness and safety of cryotherapy techniques were evaluated.

Results. The optimal duration of cryoapplication is an interval of 3–4  seconds at a temperature of –195.75 °C, it is not accompanied by the formation of a cryonecrosis zone, promotes the regeneration of acinuses, does not damage the accumulation of endocrine cells, interrupting the course of pancreonecrosis, does not lead to a fatal outcome, a pronounced adhesive process, other serious intraabdominal complications.

Conclusion. Cryotherapy on the pancreas in experimental pancreatic necrosis in  the  optimal temperature-time regime is accompanied by significantly lower mortality, is a safe technique and can be tested in clinical practice for the treatment of patients with this pathology. 

Background. In the world, dozens of new local wound healing agents are developed and improved every year, which undergo preliminary tests on laboratory animals due to the presence of common phases of the course of the wound process with humans.

The aim of the study was to evaluate the wound healing effect of matrices obtained on the basis of the recycling of collagen-containing waste.

Materials and methods. Collagen matrices are obtained from substandard leather raw materials subjected to treatment with fermented milk composition (KM1) and lactic acid (KM2). The wound healing effect was studied on the model of thermal burns on Wistar rats in 5 groups: 1st – control (natural wound healing); 2nd – experimental 1 (processing KM1); 3rd – experimental 2 (processing KM2); 4th – experimental 3, comparison group (“Levomekol”) and 5th – intact animals (normal, without burns). Wound healing was assessed by the results of planimetry on days 1, 3, 5, 7, 9, and 13 and by histological analysis of the skin tissue on days 6, 13, and 20. On days 6 and 13, the summary antioxidant activity, the total content of leukocytes, erythrocytes, the activity of the catalase enzyme, and the content of malondialdehyde were determined in the blood of rats.

Results. With thermal damage to the skin, an IIIA degree burn was formed, accompanied by the development of dry coagulation necrosis. The use of collagen matrices restored the total content of leukocytes, reduced the area of the burn wound, normalized the content of malondialdehyde, the total antioxidant activity and the activity of catalase in the blood. Histomorphometric studies have confirmed the dynamics of skin tissue recovery after a burn. The effectiveness of the use of matrices was comparable to the pharmacopoeial drug “Levomekol”. A higher wound healing effect was noted when using the KM1 matrix.

Conclusion. On the model of thermal burn, the wound-healing effect of collagen matrices was established, as evidenced by the results of restoring the number of leukocytes, reducing the area of the burn wound and restoring the histostructure of the skin. One of the molecular and cellular mechanisms of wound healing is the inhibition of lipid peroxidation reactions and the restoration of the antioxidant potential of the body. 

Background.Heat shock effects can initiate apoptosis of oocytes and corpus luteum cells in mammalian ovaries. During folliculogenesis, follicular apoptosis is regulated by Bcl-2 and BAX proteins which are key effectors of granular cell death. Mechanisms of disruption of the ovarian corpus luteum development under heat stress remain largely unclear.

Aim of the research: to identify the expression features of anti-apoptotic Bad and proapoptotic Bcl-2 proteins in the rat ovarian luteocytes in the acute (by day 3) and recovery (by days 7 and 14) periods after a single exposure of experimental hyperthermia (EH) (rectal temperature 43.5 °C).

Materials and methods. The expression of Bad and Bcl-2 was determined immunohistochemically using an indirect two-stage streptavidin-biotin method.

Results. On day 3 after EH, the expression areas of both Bad and Bcl-2 increased 2-fold, but the ratio of Bcl-2/Bad areas did not change, indicating that the intensity of apoptosis along the mitochondrial pathway in luteocytes in the acute period was  maintained within physiological values. On day  7, the Bad and Bcl-2 expression areas remained at the level of day 3, but the Bcl-2/Bad index decreased, indicating the activation of the apoptosis internal pathway in the ovarian corpus luteum cells. By day 14, the protein expression areas decreased (Bad – by 1.7 times, Bcl-2 – by 3.2 times) compared to the acute period, and the Bcl-2/Bad index decreased by 2 times compared to the control and the acute period group.

Conclusion. The observed predominance of proapoptotic Bad protein over antiapoptotic Bcl-2 in luteocytes on day 14 after EH indicates the anti-apoptotic protection violation, which leads to the apoptosis mitochondrial pathway activation of  the latter. A decrease in Bcl-2 expression can be regarded as a manifestation of the defective luteocytes removal mechanism and the body’s desire to normalize the ovarian-uterine cycle disrupted by high temperature exposure.