Background. One of the most important components of COVID-19 therapy is the suppression of the hyperergic immune response. There is an urgent need of creating the optimal tactics of efficient and safe anti-inflammatory therapy. A new method of treatment of COVID-19 with inhalation of ultra-low (non-cytotoxic) doses of the alkylating drug melphalan is proposed, based on previous experimental, preclinical, and clinical data on its use in severe bronchial asthma.

The aim. To evaluate the efficacy and safety of inhalation of ultra-low doses of melphalan in hospitalized patients with COVID-19-associated lung damage.

Materials and methods. A prospective, open, controlled, blind for the central expert study was conducted. Sixty adult patients were included, 30 patients were consecutively admitted to the hospital and received nebulized inhalations of 0.1 mg of melphalan for 7 days. Thirty patients of the control group were selected by an independent expert retrospectively using the computer algorithm for selecting «close» patients based on the «case-control» principle. The primary endpoints were the dynamics on the WHO Clinical Improvement Scale and the dynamics of dyspnea according to the modified Borg scale, secondary – assessment of adverse events, dynamics of indicators of clinical, biochemical blood tests, lungs computed tomography data from the beginning of inhalations in the melphalan group and from the corresponding day in the control group.

Results. Inhalations of melphalan led to a significant improvement in the clinical condition of patients according to the WHO scale, decrease in the intensity of dyspnea on day 7 of treatment and by the time of discharge, a significant anti-inflammatory effect. Adverse events and dynamics of laboratory parameters did not differ from the control group.

Conclusion. The method of treatment of COVID-19 by inhalation of ultra-low doses of the alkylating drug melphalan is safe and leads to a significant clinical improvement of hospitalized patients with COVID-19-associated lung damage.

Background. External genital endometriosis (EGE) is often the cause of infertility, while coagulation of its foci leads to the restoration of fertility. Often, non-invasive

preoperative diagnosis of EGE is difficult. Today, the issue of laparoscopy in infertility and whether there is a need for additional indications for its implementation remains controversial. Identification of the relationship between certain extragenital diseases with EGE is promising in terms of both understanding the pathogenesis of EGE and predicting its development.

The aim. Identification of the relationship of extragenital diseases with the presence of EGE in infertile women of reproductive age.

Materials and methods. In preparation for assisted reproductive technology programs at the Vitromed Clinic, 1 132 women of reproductive age were examined from 2019 to 2021. Collection and processing of clinical and anamnestic data were carried out. The diagnosis of EGE was verified by laparoscopy with histological examination. The results were analyzed using exact test and binary logistic regression to build a model of the relationship between EGE and somatic pathology.

Results. EGE was detected in 222 patients. A number of somatic diseases were found that are most common in EGE: bowel diseases; minor cardiac maldevelopments; chronic anemia; pathology of the pancreas; chronic tonsillitis; allergy. A logistic regression model was constructed to predict the presence of EGE in patients with the indicated somatic pathology with a sensitivity of 81.53 % and a specificity of 97.25 %.

Conclusion. Identification of comorbid extragenital diseases associated with EGE in women with infertility can serve as a basis for expanding the scope of therapeutic and diagnostic measures, in particular for laparoscopy.

The incidence of recurrence of cervical cancer ranges from 10 to 40 %. The 5-year survival rate for patients with recurrent cervical cancer is about 5–15 % against the background of current drug therapy. Clinical and morphological characteristics of the tumor process are known, which are used as markers of an unfavorable prognosis for the development of cervical cancer recurrence. The search for molecular prognostic markers of the course of cervical cancer continues.

The aim. To determine the level of immune cycle proteins in patients with cervical cancer 0–IV stages, depending on the occurrence of a relapse of the disease.

Materials and research methods. A retrospective analysis of previously obtained results of a study on the local level of immune cycle proteins in patients with cervical cancer was performed. Three years after follow-up, 2 groups were formed: group 1 – patients treated for cervical cancer without signs of disease progression (n = 83); group 2 – patients with cervical cancer with local or systemic recurrence (n = 18). Used statistical methods: non-parametric methods of statistics using the Kruskal – Wallis test; ROC-analysis for significant values in order to calculate threshold values; determination of the quality of the identified predictive markers by calculating the sensitivity, specificity, accuracy.

Results. Local initial threshold values have a predictive value for predicting the occurrence of cervical cancer recurrence: B7.2 < 10.7 pg/ml (Se = 0.87; Sp = 0.73; Ac = 0.76; AUC = 0.78), PD-L1 ≤ 5.1 pg/ml (Se = 0.87; Sp = 0.68; Ac = 0.71; AUC = 0.76), sCD27 ≥ 32.0 pg/ml (Se = 0.75; Sp = 0.78; Ac = 0.78; AUC = 0.75).

Conclusion. Determination of local levels of B7.2, PD-L1, sCD27 in patients with cervical cancer before treatment can be used to predict the development of disease recurrence during 3 years of follow-up.

Background. Achieving a high level of quality of life is one of the priorities in the treatment of chronic diseases. Focusing on the quality of life, it is possible to optimally adjust the treatment plan for patients, influencing the link that suffers most in this pathology. Hypothyroidism is mainly formed as a result of surgery on the thyroid gland, or autoimmune thyroiditis, and at the same time is one of the most common endocrine diseases, is of great social importance due to the potentially adverse effect on most organs and systems, resulting in a decrease in quality of life.

The aim. To analyze the impact of primary hypothyroidism (postoperative hypothyroidism and autoimmune thyroiditis) on the quality of life of patients.

Materials and methods. During the study, a clinical, laboratory and psychological study of 78 women with uncompensated primary hypothyroidism was carried out: 40 women aged 32–76 years with postoperative hypothyroidism (main group) and 38 women aged 36–60 years with autoimmune thyroiditis (comparison group). The quality of life was judged by the indicators of the MOS SF-36 questionnaire.

Conclusion. In the examined patients with primary hypothyroidism, an association between an increase in TSH levels and a decrease in all indicators of the quality of life was revealed. First, indicators of physical functioning, general health, role and emotional functioning worsened. The dependence of indicators on the MOS SF-36 scales with the age of patients, the duration of hypothyroidism, and the level of TSH was revealed. The quality of life in patients with postoperative hypothyroidism was significantly reduced compared to patients who had hypothyroidism due to autoimmune thyroiditis.

The aim of this article is to analyze the genetic and immunological mechanisms of the development of fracture consolidation disorders at the present scientific stage.

Materials and methods. The search for literary sources was carried out in the open electronic databases of scientific literature PubMed and eLIBRARY. Search depth – 10 years.

Results. The review analyzes the literature data on the current state of the study of the molecular genetic mechanisms of reparative regeneration including the development of fracture consolidation disorders. The mechanisms of the most important links of pathogenesis which most often lead to various violations of the processes of bone tissue repair are considered.

Conclusion. The process of bone tissue repair is multifaceted, and many factors are involved in its implementation, however, we would like to note that the leading role in the course of reparative regeneration is played by a personalized genetically programmed response to this pathological condition. Nevertheless, despite the undeniable progress of modern medicine in studying the processes of bone recovery after a fracture, there are still many “white” spots in this issue, which dictates the need for further comprehensive study in order to effectively treat patients with impaired consolidation.

The article is devoted to one of the topical problems of modern science – the problem of correlating a person with his environment. This problem is considered by the scientific community from different angles, depending on the components of the environment. It is generally accepted that the ecological aspects of the study of this interaction lie in the field of biology, chemistry and physiology, and the social sciences remain outside the subject. Man, as a bio-psycho-social being, cannot but interact with the components of the social environment. The article substantiates the methodology for studying the state of the social environment, aimed at optimizing the socio-ecological interaction in the system “man – social environment”. This approach makes it possible to assess the factors of the social environment in terms of the human dimension. The study of the influence of factors of the social environment on the demographic behavior of a person is important for optimizing the socio-ecological interaction in the “man – social environment” system. The article discusses the conditions for the action of an organized personality in a favorable and unfavorable social environment, the direct and indirect influence of environmental factors on a person’s demographic attitudes. Social and intrapersonal interaction in a human-sized and non-human-sized social environment takes various forms and methods, since it depends on the conditions of the individual’s action, including norms and values in the immediate environment of society as a whole. Factors of the social environment that have both direct and indirect effects on the demographic behavior of a person can be used as criteria for assessing the human dimension of the social environment. In conclusion, it is said about the significance of the results obtained for the development of ways of greening the social environment and its harmonization in relation to a person.

The article considers the system-wide impact of socio-demographic factors in the social development of countries and regions in the context of post-global reality. It is emphasized that modern demographic changes are the result of global transformation processes. The permanent relationship of demographic processes with climate change on the planet, the emergence and spread of new infectious diseases, the development of digital technologies, etc. is shown. The meaning of the concept of “post-global reality” is clarified in terms of the uniqueness of modern conditions of social development, in which the desire of a person and society for “openness” is traced in the conditions of growing “social closeness” and “social tension”, which indicates the limited possibilities of society in regulating sociodemographic processes. It is concluded that the spread of new infectious diseasesin the 21st century, especially the new coronavirus infection COVID-19, has contributed to the emergence of new groups of problems associated with a deterioration in health status, an increase in mortality, a decrease in the reproductive and labor potential of the population. The authors substantiate the formation of the concept of “global determinism” in terms of the role of socio-demographic factors in the social development of countries and regions in the context of post-global reality. Among the most influential concepts that contribute to its development are “geographical determinism”, “economic determinism” and actually “demographic determinism”. Based on the materials of a sociological study, it is shown that new external and internal challenges and new crises of a systemic order in the 21st century contribute to social upheaval and profound transformations. It was revealed that the sustainability of social development in the focus of public opinion is directly related to effective public administration and regulation, the effectiveness of national security strategies and strategies for the socio-economic and socio-demographic development of countries and regions.

Background. Tuberculosis associated with HIV infection is becoming almost a new disease, where not only new approaches to treatment are being formed, but there is also a need to improve the quality and search for new means of early diagnosis of tuberculosis infection.

The aim. To evaluate the diagnostic performance of the T-SPOT.TB test for the detection of latent tuberculosis infection and clinical forms of tuberculosis in patients with HIV infection.

Materials and methods. 396 patients registered at the AIDS Center for more than a year were examined. Everyone underwent standard examinations for pulmonary tuberculosis using sputum bacterioscopy techniques with Ziehl – Neelsen staining; a molecular genetic method based on hybridization technology – HAIN-GenoType MTBDRplus; crops on liquid media in the automated BACTEC MGIT 960 system and on Löwenstein–Jensen dense medium. T-SPOT.TB was conducted as a screening for everyone. With positive T-SPOT.TB results, negative results of the MBT search, absence of specific changes on the X-ray a conclusion was made about latent tuberculosis infection. Statistical data processing was carried out using the software package Statistica 10 (StatSoft Inc., USA).

Results. According to the results of a comprehensive examination, tuberculosis was diagnosed in 174 patients, verified using various methods of searching for Mycobacterium tuberculosis in 116 patients (66.6 %). Infiltrative (63.8 %) and disseminated (24.7 %) tuberculosis were more often diagnosed. Latent tuberculosis infection was diagnosed in 52 patients, 170 HIV-infected patients have no data for tuberculosis at this stage.

Conclusions. T-SPOT.TB can be used in the diagnostic complex of monitoring patients with HIV infections – as a screening method to detect latent tuberculosis, for preventive chemotherapy.

Background. Infective endocarditis (IE) is defined as an infection of a native or prosthetic heart valve, endocardial surface, or permanent cardiac apparatus. Currently, the determination of microorganisms that induce a disease or are involved in the process of pathogenesis by PCR is one of the most modern and rapid tests.

The aim. To determine and to compare the spectrum of infectious pathogens in homogenate samples of native heart valves and blood of patients with IE.

Materials and methods. Twenty patients with confirmed IE diagnose were examined, admitted for hospitalization at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo, Russia) in 2019. The range of tests used in the study was aimed at detecting such microorganisms as Streptococcus pyogenes, Streptococcus agalactiae, Enterobacter spp., Klebsiella spp., Staphylococcus spp., Streptococcus spp., Bacteroides fragilis, Bacteroides vulgatus, Bacteroides thetaiotaomicron, and Bacteroides ovatus.

Results. The study found that 19 samples of heart valves were characterized by the presence of microorganisms from the genus Streptococcus spp., wherein Streptococcus agalactiae was found in two patients. Staphylococcus spp. Were found in 16 samples of valve homogenate. Detection of other pathogens revealed only two cases of Enterobacter spp., Klebsiella spp. When analyzing blood samples from patients with IE, not a single infectious agent was identified. The study revealed a statistically significant difference (p < 0.001) between the incidence of Staphylococcus spp. in samples of valve homogenate and peripheral blood of patients with IE. There was also a statistically significant difference (p < 0.001) for Streptococcus spp. both in samples of valve homogenate and peripheral blood from patients with IE.

Conclusion. Molecular genetic research using PCR technologies has low efficiency in detecting the pathogen in the circulating bloodstream, as well as in blood culture. However, the study of homogenized biopsy specimens of the heart valve structures removed during surgery may allow correcting antimicrobial tactics in the early postoperative period of prosthetics.

Background. In patients with atopic dermatitis, the persistence of microorganisms on the skin surface is high, which can enhance the expression of MIG/CXCL9, exacerbating inflammation and activating keratinocyte apoptosis, however, the dynamics of this chemokine in atopic dermatitis has not been studied.

The aim. To study the concentration of chemokine MIG/CXCL9 in the dynamics of atopic dermatitis and determine its role in the pathogenesis of dermatosis.

Materials and methods. The study included 80 patients aged 13 to 44 years with limited and widespread atopic dermatitis and 30 practically healthy volunteers. The therapy of patients, the collection of biological material were carried out in the Regional Dermatovenerologic Dispensary in Chita, laboratory tests were performed at the Chita State Medical Academy in the period from 2018 to 2020. The MIG/CXCL9 level was studied during exacerbation and remission of the disease in blood serum and skin exudate by flow cytofluorimetry using LEGENDplex Human Proinflammatory Chemokine Panel (BioLegend, USA). In healthy volunteers, skin exudate sampling was carried out by the “skin window” method. For statistical processing, the Microsoft Excel (Microsoft Corp., USA) application software package and SPSS Statistics 25.0 (IBM Corp., USA) were used.

Results. The concentration of chemokine MIG/CXCL9 in the skin exudate is greater than in the blood serum. With a limited form of the disease in adolescents, the level of MIG/CXCL9 in the skin exudate is 8.1 times higher than the control values, with a common form – 9.3 times. In adults with advanced atopic dermatitis, the concentration of chemokine IL/CXCL9 in the skin exudate is 20.8 times higher than the values of the control group.

Conclusion. In atopic dermatitis, the level of chemokine MIG/CXCL9 is higher in the cutaneous pathological process. In the pathogenesis of the disease, MIG/ CXCL9 inhibits collagen synthesis and promotes apoptosis of keratinocytes, followed by the formation of hyperreactivity of the skin, its dryness and peeling.

Anthropometry is known as the basic method for the body physical status assessment.

The aim. The study examined anthropometric and somatometric indices in the working age men and investigated physical development variables specific for the region in terms of being used for early diagnosing obesity-related risks for non-infectious diseases.

Materials and methods. One hundred and twenty-three male subjects aged 32–40 participated in the survey (mean age was 35.2 ± 0.2 years). Subjective main physical

development parameters were analyzed.

Results. Participants’ average body length variables were seen to be significantly higher than those in other Russia’s regions and some other countries. The similar tendency was observed for subjective body mass, chest circumference, and body mass index variables with disharmonic somatotype and hypersthenic type of body constitution revealed in examined working age men in comparison with younger male subjects. Musculoskeletal mass loss and fat accumulation indicate the development tendency of sarcopenia in men of working age. Excessive body weight prevalence in 32–40-year-old men was 47 %, and 17 % of the examinees were diagnosed with 1st degree obesity.

Conclusion. The survey identified the modern population of male northerners as having negative tendencies in their somatometric picture, which involves disharmonic somatotype, sarcopenia, excessive body weight, and 1st degree obesity and results in significant risks for non-infectious inflammation and cardiovascular diseases at the studied age.

The prevalence of sudden death from chronic heart failure and cardiac arrhythmias caused by myocardial infarction is a complex problem in cardiology. Post-infarction cardiac remodeling occurs after myocardial infarction. This compensatory-adaptive reaction, regulated by mechanical, neurohumoral and genetic factors, includes the structural and functional changes of cardiomyocytes, stromal elements and extracellular matrix, geometry and architectonics of the left ventricular cavity. Adverse left ventricular remodeling is associated with heart failure and increased mortality. The concept of post-infarction cardiac remodeling is an urgent problem, since the mechanisms of development and progression of adverse post-infarction changes in the myocardium are completely unexplored. In recent years, the scientist attention has been focused on neurotrophic factors involved in the sympathetic nervous system and the vascular system remodeling after myocardial infarction. Nerve growth factor (NGF) is a protein from the neurotrophin family that is essential for the survival and development of sympathetic and sensory neurons, which also plays an important role in vasculogenesis. Acute myocardial infarction and heart failure are characterized by changes in the expression and activity of neurotrophic factors and their receptors, affecting the innervation of the heart muscle, as well as having a direct effect on cardiomyocytes, endothelial and smooth muscle vascular cells. The identification of the molecular mechanisms involved in the interactions between cardiomyocytes and neurons, as well as the study of the effects of NGF in the cardiovascular system, will improve understanding of the cardiac remodeling mechanism. This review summarizes the available scientific information (2019–2021) about mechanisms of the link between post-infarction cardiac remodeling and NGF functions.

Walking and balance disorders in elderly patients are the most common manifestations of various diseases of the nervous system. Balance imbalance is the leading cause of injuries in the elderly, leading to a limitation of both the patient’s ability to work and communication in the social environment, which in particular cases leads to a loss of independence, reducing the quality of life. Walking disorders are an important, difficult to resolve medical and social problem. The aim of the study was to identify the physiological and clinical aspects of age-related gait disorders with an emphasis on neurological pathogenetic causes. A detailed study of modern foreign medical literature and current international clinical guidelines was carried out with further systematization of the data obtained. Falls in the elderly are a common and major factor that threatens the independence of older people. The frequency of falls increases with age. Treatment for fall injuries does not always include identifying the cause of the fall. In the elderly, loss of balance is most commonly due to multiple causes, including impending threat to the homeostatic mechanisms that maintain postural stability combined with age-related impairments in balance, gait stability, and cardiovascular function. Gait disorders are a major cause of functional impairment and morbidity in the elderly. Most gait disorders in the elderly are multifactorial and have neurological components. In developed countries, there is a trend towards aging of the population: the percentage component of the elderly part of the population is growing. It is violations of balance, stability and walking, to a large extent, that lead to the inability of the patient to provide his quality of life at a satisfactory level on his own, to disability and failure in the workplace. Early diagnosis of gait disorders can prevent premature disability and limit the independence of elderly patients. It is important to note that a history of falls is a predictor of the risk of new falls.

Background. A crucial role in the development of cancer is played by the tumor microenvironment (TM) – a microenvironment that is formed as a result of the interaction between the tumor tissue and macroorganism cells. The concentration of TM cytokines in the blood varies depending on the activity of the tumor and the presence of a metastatic process. It is advisable to study the existing mediator imbalance of TM, its characteristic features in the process of tumor development for the diagnosis and prognosis of the tumor process.

The aim. To identify markers of tumor progression in the study of tissue and serum cytokines in women diagnosed with breast cancer.

Materials and methods. The object of the study is blood serum cytokines and tumor supernatants (MCP-1, VEGF, TNF-α, IFN-γ, TGF-β1, G-CSF, GM-CSF). The study involved 80 patients with breast cancer aged 50–69 years and 26 practically healthy women aged 41 to 62 years. A standard examination of women was conducted; a cytokine profile study was conducted before the appointment of therapy. To study the cytokine profile at the tissue level, tumor biopsies (n = 30) and biopsies of unchanged breast tissue (n = 6) were incubated to determine the production of MCP-1, VEGF, TNF-α, IFN-γ, TGF-β1, G-CSF, GM-CSF.

Results. There was a moderate positive correlation between the stage of the disease and the level of TGF-β1, MCP-1 blood serum, a weak one – with G-CSF. In the incubated tumor tissue, a high positive correlation of cytokines on the stage of the disease is observed in growth factors: VEGF (R = 0.79; p > 0.05) and TGF-β1 (R = 0.61; p > 0.05).

Conclusion. The study revealed the characteristic features of the cytokine profile of blood serum and tumor tissue in breast cancer at local and widespread stages. The revealed differences in the level of cytokines should be used as additional diagnostic indicators of the degree of activity and prevalence of the tumor process.

Optical coherence tomography (OCT) in everyday routine practice is the method of choice for the instrumental diagnosis of glaucoma in adults. As a non-invasive and safe method of visualizing structural changes in the retina and the optic nerve, the method is of particular value in pediatric practice. At the same time, OCT diagnostics in children is associated with certain difficulties, both during the study and when interpreting the scan results.

This review summarizes the data from the literature and our own research in the diagnosis and monitoring of congenital and juvenile glaucoma from the standpoint of our own long-term clinical experience in using optical coherence tomography. We consider the physiological changes of the retina and optic nerve, attention is focused on the need to create a pediatric regulatory database of retinal thickness, the factors that determine the normal range of the data obtained and allow distinguishing physiological processes from pathological ones are identified. Clinical cases confirming the value of OCT in combined pathology are presented as examples.

Background. Myopia is the most common clinical refractive error of the eye. Only in Russia, there are about 15 million myopic people. Currently, in addition to traditional correction (glasses, soft contact lenses), keratorefractive surgery actively develops; however, due to the initial parameters of the cornea or the magnitude of the refractive error, it may be contraindicated to the patient. Nowadays an alternative to these correction methods for young patients with refractive errors of high and ultra-high degrees is the implantation of a phakic intraocular lens.

The aim. To evaluate the efficiency of refractive errors correction using phakic IOL implantation.

Materials and methods. We carried out a retrospective analysis of outpatient records of 56 patients who received surgical treatment for myopia and complex myopic astigmatism at the Orenburg branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the period from 2019 to 2020 (110 eyes), all patients underwent implantation of a phakic intraocular lens IPCL V2.0, IPCL V2.0 TORIC. Patients were examined before surgery and on the first day after surgery. In addition to standard, special clinical and functional examination methods were used: optical biometry on the IOL-Master 700, determination of the density of endothelial cells using an endothelial microscope, examination of the fundus under cycloplegia; if necessary, peripheral laser coagulation of the retina was performed before calculating phakic IOLs.

Results. All operations and the early postoperative period went without complications. The target BCVA (0.75–1.0) was achieved in 90 (81.8 %) eyes. All patients were satisfied with the treatment results.

Conclusion. Implantation of IPCL V2.0 and IPCL V2.0 TORIC phakic IOLs is an effective method for correcting refractive errors, regardless of the degree of myopia and the presence of astigmatism.

Background. An increase in the incidence of optic neuritis (ON) among the workingage population, the complexity of etiological diagnosis and the choice of adequate etiotropic therapy, as well as a disappointing prognosis for vision due to the development of optic nerve atrophy determines the high social significance of this problem.

The aim. Comprehensive clinical, functional, morphometric and laboratory-immunological evaluation of results of using the drug Imunofan^® in combined treatment of ON associated with herpesvirus infection (HVI).

Materials and methods. The study involved 39 people (39 eyes) with acute ON associated with HVI. The standard treatment regimen for the patients included the appointment of solutions: dexamethasone in a decreasing scheme, a 1 % Emoxypine^® preparation 0.5 ml and 12.5 % Dicynone^® preparation 0.5 ml through an irrigation system implanted into the retrobulbar space, with subsequent appointment of medicinal means of neuroprotection (Picamilon^® and Semax^®). All patients were divided into two groups. The main group – 22 patients, whose standard inpatient treatment was supplemented with intramuscular administration of the drug Imunofan^®, 50 μg daily for 10 days. The control group consisted of 17 patients, who were treated only according to the standard method.

Results. Analysis of obtained data showed that more significant positive dynamics was noted in patients of the main group.

Conclusion. The clinical efficacy of the drug Imunofan^® in the complex therapy of ON associated with HVI was characterized by relief of signs of inflammation in the optic nerve in the main group immediately after the end of the course of treatment, while in the control group – only after 3 months; an increase in the best corrected visual acuity by 1.3 times, a decrease in the incidence of postneuritic optic nerve atrophy at a follow-up period of 12 months.

Introduction. Vascular macular edema (ME) is the most common in diabetic retinopathy and retinal vein occlusion. To assess the efficacy and safety of ongoing treatment the dynamics of the best-corrected visual acuity is always taken into account, however, taking into consideration the subjectivity of this indicator, objective methods of assessing the morphofunctional state of the retina should be performed. These include optical coherence tomography and microperimetry.

The aim of the study is to evaluate the role of focal retinal photosensitivity (FRP) in assessing the efficacy of micropulse treatment of macular edema of vascular genesis.

Material and methods. The study group consisted of 110 patients (110 eyes) including 74 patients (74 eyes) with diabetic macular edema (DME) up to 500 μm and 36 patients (36  eyes) with ME up to 500  μm caused by branch retinal vein occlusion. The patients were divided into two groups randomly: in the first group micropulse was performed using a green laser (λ = 532 nm), in the second group – a yellow laser (λ = 577 nm).

Results. In both groups ME decreased significantly to 342 ± 11 µm (M ± σ), maximum corrected visual acuity and FRP increased to 0.59 ± 0.07 and 23.9 ± 1.7 dB (M ± σ), accordingly. Statistically significant difference in treatment efficacy depending on laser length wasn’t detected.

Conclusion. FRP in the area of edema of neuroepithelium (NE) has a direct correlation with NE thickness and is an important indicator of the retinal functional state and can be used to develop a personalized approach to patient treatment and assess the effectiveness of ME treatment. Application of micropulse for treatment of vascular genesis focal ME with height up to 500 μm is effective and safe, as it allows to decrease reliably the thickness of NE in the edema zone and improve clinical and functional indices, reliably increase FRP.

Electroretinography is a non-invasive electrophysiological method standardized by the International Society for Clinical Electrophysiology of Vision (ISCEV). Electroretinography has been used for the clinical application and standardization of electrophysiological protocols for diagnosing the retina since 1989. Electroretinography become fundamental ophthalmological research method that may assesses the state of the retina. To transfer clinical practice to patients the establishment of standardized protocols is an important step. It is important for monitoring successful molecular therapy in retinal degeneration. Retinitis pigmentosa or achromatopsia and, consequently, affected cones or rods photoreceptors is corresponded to complete absent of electrical response. Thus, detection of even modest improvements after therapeutic treatment is required. Standardized protocols allow the implementation of electroretinography under conditions of optimization of sensitivity and specificity during clinical trials. It should be noted that the literature on retinal diseases demonstrates clinical cases in which patients may have several retinal diseases at the same time. In such cases, it is necessary to detect a group of characteristics of electrophysiological signals with high accuracy to improve the application of various diagnostic solutions. The classification of electroretinogram signals depends on the quality of labeled biomedical information or databases, in addition to this, the accuracy of the classification results obtained depends not only on computer technology, but also on the quality of the input data. To date, the analysis of electroretinogram signals is realized manually and largely depends on the experience of clinicians. The development of automated algorithms for analyzing electroretinogram signals may simplify routine processes and improve the quality of diagnosing eye diseases. This article describes the formation of the parameters of pediatric electroretinogram database parameters for the development of doctor’s decision-making algorithm. The signal parameters were obtained by extracting the parameters from the wavelet scalogram of the electroretinogram signal using digital image processing and machine learning methods.

The article presents an overview of domestic research devoted to the development of students’ emotional intelligence by means of art technologies. The relevance of the problem of developing emotional intelligence in modern students is determined by the objectives of higher education. Despite the serious experience gained in Russia in the use of art in teaching and personal education, the active penetration of art technologies into the education system began to occur relatively recently, which explains the time frame of the review study – 2019–2021. The analysis was performed in December 2021 using the national bibliographic database of scientific citation. The research was conducted using such combinations of keywords as “emotional intelligence”, “development of emotional intelligence of students”, “art therapy”, “pedagogical art therapy”, “art technology”, “art therapy at the university” in Russian for the period of 2019–2021. Out of 902 publications devoted to art therapy, the problem of using art technologies in higher education, the development of emotional intelligence through art technologies, the authors selected 49 publications. The analysis of the selected publications showed that the problem of the development of emotional intelligence arouses increased interest among researchers. However, the development of emotional intelligence in students is not a priority. In the system of professional education, the topic of emotional intelligence is not given enough attention, which is unacceptable and does not meet the requirements for the level of training of modern specialists. In recent studies, the possibilities of using art technologies in the development of students’ emotional intelligence have not been sufficiently disclosed. There is a need for further development of a program for the development of students’ emotional intelligence, presentation and description of art therapy techniques and techniques, their place and role in the development of emotional intelligence. Undoubtedly, building up the evidence base and substantiating methods for verifying the effectiveness of various art technologies will be a promising direction.

Background. In the context of increasing robotization and digitalization of most of the routine and algorithmic types of human activity, the problem of the creative development of each child and the individualization of education in a public school, especially in the field of natural science education, arises.

The aim. To study the prerequisites and opportunities for digitalization of the creative development of students as a means of increasing the reflexivity of their mental activity in solving creative problems and individualizing the educational process in a public school based on the subject of chemistry.

Methods. At the first stage of the study, a survey of chemistry teachers was used. At the second stage, diagnostic tasks in chemistry were developed to verify the identified stereotypes; at the third stage, ways were studied to overcome stereotyped ideas in chemistry by schoolchildren; and at the fifth stage, the possibility of digitizing mental actions using the CREO_DATUM computer program was studied.

Results. Of the 70 different variants of erroneous ideas in the school chemistry course, 18 thinking stereotypes turned out to be the most common. The possibility of overcoming stereotypes is not associated with additional classes and explanations of teachers, but with the independent solution of creative tasks by students, since in this process the reflection of schoolchildren develops, which is a condition for overcoming stereotypes. The optimal time in the classroom for students to complete short creative tasks is 10–12 minutes. It is sufficient to measure such creative actions of students as divergence, criticality, uniqueness. To digitize the mental activity of students when solving creative problems in chemistry and to automate the construction of graphs for the creative development of each student, the CREO_DATUM program was developed and tested.

Conclusion. Long-term studies of the possibility of using subject-creative tasks based on the material of a school chemistry course for the development of creativity and reflexivity of students serve as a rationale for designing digital means for individualizing the creative development of students.

The article presents a description of the study of the effectiveness of methodological tools aimed at developing metacognitive competence in future elementary school teachers in the classroom on the methodology of teaching mathematics to younger students.

The aim of the study is to empirically test the effectiveness of a set of methodological techniques used in the classroom on the methodology of teaching mathematics to future elementary school teachers as a means of developing their metacognitive competencies. The hypothesis of the study is the assumption that one of the effective means of developing metacognitive competencies in future elementary school teachers is special classes for compiling original scenarios of verbal mathematical problems for younger students. A professionally developed verbal composition of a mathematical problem sets the vector of mental activity for the younger student. It requires the developer to build a forecast of the child’s mental actions, determine algorithms and levels of difficulty in obtaining the right solution. The study used methods for testing students’ cognitive characteristics (intelligence) and peer review of their “metacognitive knowledge”, “metacognitive skills”, “metacognitive experience” and “metacognitive strategies”. The methodological solutions implemented in the classroom have shown their effectiveness. For the practice of preparing future primary school teachers, it is important that the well-organized development of compositions of textual mathematical problems for younger students is an effective means of developing their metacognitive competencies.

The article presents the results of studying the personality characteristics of elderly scientists who have maintained scientific productivity for a long time. The problem that has to be solved and has got a huge scientific and practical significance is to find the psychological preconditions for the peak achievements of scientists and to define the social and psychological factors that contribute to maintaining the high productivity of elderly scientists for a long time.

The aim of the study is to determine the key personality traits of famous elderly scientists at the stages of their professional development.

Research methods. The presented data were obtained using the research interview “Life Values and Life Path”, developed by V.S.  Mukhina. Empirical material was collected in the course of interviewing famous Russian scientists of older age (from 65 to 94 years old), involved in research activities and making a significant contribution to the development of the humanities and technical sciences. When forming the sample, we followed the logic of V.S. Mukhina, who interviewed older scientists who are the founders and leaders of well-known scientific schools, who have a doctorate in science, the academic title of professor, membership in the academy of the Russian Academy of Sciences, Russian Academy of Medical Sciences or Russian Academy of Education and continue active scientific work. Data on the peak achievements of older scientists were taken from the scientometric databases of the Russian Science Citation Index and the Russian State Library.

Results. The data representing the peak achievements of the elderly scientists were taken from the scientometric databases and interpreted according to the provisions of differential and acmeological analysis for professional activities of scientists. The analysis of interviews, autobiographical descriptions and peak achievements of the elderly scientists allowed to reveal that the peak achievement (acme) is the joint result of psychological preconditions (personal traits of scientists, physical conditions) and social conditions of professional activity (social status of a scientist, belonging to a scientific school, availability of organizational and financial resources). The several productive periods, which are called within the acmeology field as “micro-acme”, can be indicated in the scientific work of elderly scientists throughout the period of their scientific activity. At the same time, the peak achievements of scientists as a rule are spaced in time with an optimal combination of preconditions and conditions for scientific creativity.

Background. The study of the prevalence and structure of various types of online behavior, the characteristics of the content consumed by adolescents of different age, sex and ethnic groups is an important area of scientific research.

The aim. To study the features of online behavior and the structure of content consumed in Abakan adolescents of various age and sex groups and ethnicity (Russians and Khakasses).

Materials and methods. 1400 adolescents of the city of Abakan (Republic of Khakassia) aged 12–18 were examined: 962 (68.7 %) Russians, 438  (31.3  %) Khakasses, 678 (48.4 %) boys and 722 (51.6 %) girls, aged 12–14 years – 39.8 % and 15–18 years – 60.2 %. The type of online behavior was verified using the Chen scale (CIAS). Emotional and behavioral disorders were diagnosed using the SDQ questionnaire. The indicators were compared in groups formed by sex, age and ethnicity. The data were processed using the Statistica 12.0 program (StatSoft Inc., USA).

Results. It has been established that the prevalence and structure of online behavior among adolescents in Abakan depends on gender, age and ethnicity. Pathological Internet use (PIU) is more common among Khakasses, more often in the older age group. Regardless of ethnicity, maladaptive online behavior (pathological and maladaptive Internet use) is recorded more often among girls. In the structure of consumed content, gaming addiction prevails, social network addiction is in second place, and the proportion of mixed and undifferentiated Internet addiction is less. Dependence on online games prevails in boys, while dependence on social networks and undifferentiated internet addiction prevail in girls.

Conclusion. One of the reasons for the greater prevalence of maladaptive online behavior among Khakasses may be the association of maladaptive Internet use with the presence of emotional disorders and behavioral problems that reach the borderline level and are causally significant factors in the development of Internet addiction. Adolescents with maladaptive online behavior, who have not yet reached the level of formed Internet addiction, are the target group requiring medical and psychological assistance.

Currently, gallstone ileus is an unusual complication of cholelithiasis (0.3–3.0 %) and a rare cause of mechanical bowel obstruction (0.1–4.0 %). The rarity of the condition makes it impossible to plan the large prospective randomized clinical trials, so the analysis of case reports is significant for decision making in the management of gallstone ileus. We report a case of gallstone ileus in a middle-aged male who had a history of surgery for duodenal ulcer perforation in past. A combination of peptic ulcer disease and cholelithiasis is based on a reduced gastrointestinal hormones secretion. Clinical specialists need to consider information about the greater frequency and asymptomatic clinical course of gallstone disease against a background of duodenal ulcer. Duodenal ulcer scar and bulbar deformity may promote to the cholecystoduodenal fistula formation. In the presence of an acute bowel obstruction symptoms and the absence of gallbladder instrumental examination results, it is possible to recommend the prior gastroduodenoscopy for the pre-operative pneumobilia detection. The optimal surgical approaches for acute gallstone ileus are still controversial.

Background. The leading symptom of achalasia of cardia (AC) is dysphagia, along with other symptoms significantly affecting the quality of life of patients.

The aim. Based on the results of questioning patients using special and general questionnaires and using special methods for studying the closing function of the cardia, to evaluate the quality of life of patients with stages 2–4 of AC after video-laparoscopic esophagocardiomyotomy according to Heller with anterior hemiasophagofundoplication according to Dor.

Materials and methods. The basis of the work was the analysis of the results of esophagocardiomyotomy according to Heller with anterior hemiesophagofundoplication according to Dor in 106 patients with stages 2–4 of AC. The postoperative follow-up period averaged 2 ± 0.4 years. In the pre- and postoperative periods, the results of fluoroscopy of the esophagus and stomach, manometry of the esophagus and the esophageal-gastric junction were studied, and three questionnaires were used (Eckhardt scale, GIQLI questionnaire and SF-36).

Results. Analysis of the data obtained showed that the clinical manifestations of the disease in the postoperative period decreased in all patients with stages 2–4 of AC, the results in patients with stage 2 were better than in patients with stages 3 and 4 (p < 0.05). The results of fluoroscopy of the esophagus and stomach, manometry of the esophagus and the esophagogastric junction showed improvement in the postoperative period in patients at all stages of the disease, the results of patients with stage 4 were worse compared with stages 2 and 3 (p < 0.05).

Conclusion. Videoendoscopic esophagomyotomy according to Heller with anterior fundoplication according to Dor significantly reduces the severity of clinical manifestations of AC and improves the quality of life in patients with stages 2–4 of AC, as a result of which surgery should be recommended to patients already at stage 2 and organ-preserving surgery at stage 4 of the disease.

Background. Coxarthrosis prevalence rates are necessary to assess the socio-economic significance of this pathology and to calculate the need for endoprosthetics. Information about the provision of medical care to patients with coxarthrosis is presented in the reports of various medical organizations, but in state statistical reports at the regional level this nosological form is not taken into account as a separate line.

The aim. To estimate the prevalence of coxarthrosis based on the combined use of medical records from various sources in a region with a specialized clinic for prosthetics of large joints.

Materials and methods. A retrospective descriptive epidemiological study based on materials from the Irkutsk region for 10 years (2008–2017) was carried out. Three main sources of data on patients with coxarthrosis were used: continuous and randomized samples based on population visits to polyclinics (n = 24 029), information from the bureau of medical and social expertise on disability (n = 19 081) and information from a specialized clinic on total hip arthroplasty (THAP) (n = 6227). The dynamics of indicators by years, the distribution of patients by sex, age and groups of disabilities have been analyzed. Regional indicators of incidence and prevalence of coxarthrosis were calculated based on extrapolation of sample data.

Results. The following average annual regional indicators for patients with coxarthrosis were calculated: primary visits to polyclinics (incidence) – 73.8 (71.9–75.7) with a frequency of visits 1.9 times a year, the frequency of THAP operations – 3,3 (3,0÷3,6), disability – 10.1 (10.0÷10.3). The median age of patients at the initial visit was 61 years (Q1 = 46; Q3 = 76). The proportion of men among different groups of patients ranged from 41 to 44%, the proportion of disabled people among patients of the polyclinic and surgical hospital – from 45.2 to 47.1%. The estimated prevalence of coxarthrosis among the adult population was 413.5 (410,6÷416,4) / 10000.

Conclusions. The epidemiological analysis algorithm described in the article is proposed as the first stage in assessing the social and economic significance of coxarthrosis and the regional need for arthroplasty of large joints.

Background. Incidence and prevalence of socially significant infectious diseases are the most important indicators of the quality of life and sanitary and epidemiological well-being of the population.

The aim is to identify structural, quantitative and dynamic features of incidence and prevalence of socially significant infectious diseases among the population in the post-Soviet period (on the example of the Irkutsk region).

Methods. The materials of the forms of federal statistical observation № 2, № 12, databases posted on the websites of the Federal State Statistics Service, the Unified Interdepartmental Information and Statistical System, the Center for Demographic Research of the Russian School of Economics were used in the study. An epidemiological analysis of morbidity indicators and a comparative assessment with the average Russian data have been carried out. Trend analysis was performed by linear regression analysis using the SPSS software (IBM Corp., USA).

Results. The highest levels of tuberculosis prevalence in the Irkutsk region were noted in the period from 1999 to 2013 (352.1–436.9 ⁰/₀₀₀₀). The incidence rate of syphilis increased by 1997 to the maximum value – 431.4 ⁰/⁰⁰⁰⁰; in subsequent years, the incidence rate decreased, amounting to 28.8 ⁰/₀₀₀₀ in 2019. Very high incidence rates of gonorrhea, trichomoniasis, chlamydia were noted in the region until the end of the 2000s. The dynamics of the prevalence of HIV infection since 1999 was characterized by a rapid increase in the indicator (in 2018 – 1995.0 ⁰/₀₀₀₀), which made the region one of the most unfavorable in the country for this type of pathology. Thus, in the Irkutsk region since the second half of the 1990s until the late 2000s – early 2010s there was a pronounced increase in the incidence of socially significant infectious diseases to very high values, significantly exceeding the national average. In the subsequent period (2012–2019), there was a consistent decrease in the incidence rate.

Conclusion. The quality of life of the population of Siberia in the post-Soviet period suffered to the greatest extent. This led to a rapid increase in the levels of morbidity with socially significant infectious diseases. A transition to the state model of the advanced development of human potential is required to reduce morbidity to an acceptable level.