Background. The ongoing COVID-19 pandemic, the human casualties caused by it, and the possibility of new epidemical threats make the search for effective countermeasures actual. One of the most effective tools, as the experience of the COVID-19 pandemic has shown, is restrictive measures of various types, which are especially significant with medical countermeasures being unavailable or insufficient. At the same time, the topic of restrictive measures and their mathematical modeling, especially given its importance, is not sufficiently disclosed in the scientific literature.

The aim. To determine the possibility of assessing the effectiveness of restrictive epidemic control measures using original models of cellular automaton with intercellular boundaries.

Methods. To determine the impact of restrictive measures on the dynamics of the daily increase in infected people, an original cellular automaton with intercellular boundaries was developed, which makes it possible to simulate epidemic control measures of varying stringency. In the simulations carried out using the Monte Carlo method with subsequent statistical processing, we studied the impact of restrictive measures of varying stringency on the number of infected people, the duration of the epidemic, and the quality of forecasting. The final series of experiments simulated the spread of the COVID-19 virus in Germany in the first half of 2020.

The results show that even a simple cellular automaton model with boundaries successfully describes the course of the epidemic and allows us to assess the effectiveness of restrictive measures. The dependence of the daily increase in infected people on the stringency of measures is presented; it is shown what characteristics of the population can influence this dependence. It was found that the measures of medium stringency (40–50 % according to the Stringency Index) have the least predictable effect; they can cause both rapid localization of the focus and the spread of the epidemic to a large part of the population. Weak and strong measures give a more predictable effect.

Conclusion. Cellular automaton models with intercellular boundaries have great potential for modeling the impact of restrictive measures on the course of an epidemic, making it possible to predict the dynamics of infected people based on the population data and the restrictive measures being introduced.

Background. MicroRNAs are short (20–22 nucleotides) non-coding RNAs that can posttranscriptionally regulate gene expression and are considered a regulator of the innate immunity system. Previously, many papers were published on the prediction of the interaction of the single-stranded (+)RNA virus SARS-CoV-2 with human microRNAs, as well as on the profile of circulating microRNAs in patients with COVID-19 of varying severity. However, no works are analyzing the possible contribution of miRNAs circulating in blood plasma to the severity of COVID-19.

The aim. To study the features of the blood plasma microRNA profile of patients with different severity of the new coronavirus infection COVID-19 and to evaluate the possibility of microRNA interaction with the SARS-CoV-2 genome.

Materials and methods. The results of NGS sequencing of plasma miRNAs of 3 recovered and 8 deceased patients with a highly severe form of COVID-19 were studied. Differentially presented microRNAs were determined using bioinformatics methods, and their binding sites with the SARS-CoV-2 genome were predicted.

Results. This study demonstrates that in patients who have recovered from a highly severe form of COVID-19, the level of hsa-miR-19b-3p in the blood plasma is significantly increased. This microRNA makes up about 1.5 % of all circulating microRNAs and can bind to SARS-CoV-2 regions encoding proteins that suppress intracellular immunity mechanisms (NSP3, NSP9). In addition, this miRNA can stimulate the functional activity and proliferation of cytotoxic T-lymphocytes, one of the critical components of acquired cellular immunity against SARS-CoV-2.

Conclusion. The results of the study can be used in the development of antiviral drugs based on RNA interference, as well as in the development of predictive test systems to optimize the tactics of treating patients with COVID-19.

The aim. To assess the thyroid status and its relationship with tumor necrosis factor alpha (TNF-alpha) in post-reproductive women in the acute phase of the COVID-19 of moderate course and 12 months after the disease.

Materials and methods. 85 women aged 45 to 69 years were divided into groups: women without COVID-19, not vaccinated, with no antibodies to COVID-19 (IgG) – control group (n = 15); women in the acute phase of COVID-19 of a moderate course, accompanied by pneumonia – main group (n = 57); patients from the main group who agreed to be examined 12 months after having COVID-19 (n = 14); women with IgG in blood who deny any symptoms of COVID-19 in the last 12 months – asymptomatic COVID-19 (n = 13). Using hormone replacement therapy and the presence of thyroid disease in history were the exclusion criteria from the study.

Results. 75.4 % of patients with COVID-19 had euthyroidism, 12.3 % had subclinical hyperthyroidism. An increase of free thyroxine (free T4) level in women with COVID-19 as compared to the control group (p = 0.004) and the group with asymptomatic COVID-19 (p = 0.054) was found. There was no statistically significant difference in the level of thyroid stimulating hormone between the groups. The level of C-reactive protein in women with COVID-19 was naturally higher as compared to the control group (p = 0.009) and the group of asymptomatic patients (p = 0.001). A lower TNF-alpha level was found in the group of patients without clinical signs of COVID-19 as compared to the control group (p = 0.007) and the group with COVID-19 (p = 0.00007). The analysis of correlation relationships revealed a positive correlation between of free T4 and TNF-alpha levels in women with COVID-19 (r = 0.38, p = 0.004).

Conclusions. The moderate course of COVID-19 in the post-reproductive women is associated with an increase of free T4 level, which positively correlates with TNF-alpha level. Twelve months after COVID-19, thyroid status in women remains at the level of the acute phase of the disease.

At present, the problem of increasing the effectiveness of programs of assisted reproductive technologies and successful infertility treatment is still relevant. Assisted hatching used in the devitrificated embryo transfer facilitates the exit of the embryo from the pellucide zone. Yet the clinical efficacy of assisted hatching is relevant and debatable. There are no clear indications for the use of this technology, and no groups of patients have been identified.

The aim of the study. To assess the effectiveness of laser hatching in the frozenthawed embryo transfer programs in patients with tuboperitoneal infertility.

Materials and methods. We examined 300 women with tuboperitoneal infertility who had their embryos frozen for transfer. Inclusion criteria: age from 18 to 35 years; tuboperitoneal infertility; embryos cryopreserved for transfer. Exclusion criteria: age more than 36 years; other infertility factors. Women were divided into 2 groups: group 1 – women who had a frozen-thawed embryo transfer with preliminary laser hatching (n = 137); group 2 – control group (n = 163).

Results. There were no differences between the groups in the mean age, body mass index and the age at menarche. According to the results of the embryological stage, there were also no differences in the number and quality of frozen embryos. The pregnancy rate in the group with preliminary laser hatching was 44.5 %, which is significantly higher than in the control group (42.3 %; р ≤ 0.001). We also found statistically significant differences in pregnancy outcomes: in the frequency of spontaneous miscarriages – 13.1 % and 20.2 % respectively (p ≤ 0.001), in the frequency of term deliveries – 30.7 % and 22.1 % respectively (p ≤ 0.001).

Conclusion. In our study, the using laser hatching in women with tuboperitoneal infertility positively affected the embryos implantation in the cryopreservation protocols. Pregnancy and live birth rates are higher after using hatching technology, and the frequency of miscarriages up to 12 weeks is lower. This provide an opportunity to further study the effect of hatching on long-term outcomes, such as gestation course and childbirth.

Background. Small airway involvement is important in determining the phenotypes of bronchial asthma. Establishing the mechanisms of dysfunction of small airways will make it possible to predict the course and control bronchial asthma.

The aim. To study the relationship between the modification of the composition of fatty acids, lipid inflammatory mediators (eicosanoids, plasmalogens) and the functional state of small airways and to identify lipid biomarkers for the development of small airway dysfunction in bronchial asthma associated with obesity.

Materials and methods. The study included 85 patients with mild, partially controlled asthma. Of these, 39 patients with normal body weight (Group 1) and 46 patients with grade 1–2 obesity (Group 2). The control group consisted of 30 healthy volunteers. The function of the small airways was assessed according to spirometry and body plethysmography. The composition of fatty acids and plasmalogens in blood plasma was assessed by gas chromatography-mass spectrometry. In the blood serum, the content of thromboxane B₂ and leukotriene B₄ was determined. Statistical processing was performed using the Statistica 6.1 program (StatSoft Inc., USA). Relationships between pairs of traits were examined using the Spearman correlation test (r). Differences were considered statistically significant at p < 0.05.

Results. In the combined course of asthma and obesity, dysfunction of the small airways develops against the background of generalized bronchial obstruction. A violation of lipid metabolism was revealed, manifested by an increase in the levels of saturated, monoenoic, n-6 polyunsaturated fatty acids against the background of a deficiency of n-3 polyunsaturated fatty acids and phospholipids with an alkenyl bond – plasmalogens. It has been shown that bronchial asthma, aggravated by obesity, occurs against the background of increased synthesis of inflammatory lipid mediators – eicosanoids (thromboxane B₂ and leukotriene B₄). Evaluation of the correlation relationships between the studied lipids and the function of small airways revealed a high degree of relationship between their participants.

Conclusion. An important pathogenetic link in the formation of small airway dysfunction in bronchial asthma aggravated by obesity is a violation of fatty acid metabolism and plasmalogen synthesis, an increase in the formation of inflammatory lipid mediators.

A systematic review and meta-analysis of data on the problem of enhanced recovery in urology was performed. Inclusion criteria – clinical trials of the enhanced recovery program in urology.

The aim of the study was to assess the significance of the enhanced recovery program (ERP) in the provision of surgical care in the “urology” profile.

Materials and methods. The systematic review was performed according to the guidelines for the presentation of systematic reviews and meta-analyses by PRISMA. The registration number in the international system Prospero was received (CRD42022358982). The review included 364 studies. Studies in urologic oncology were excluded from the meta-analysis. The meta-analysis included 15 studies involving 2293 subjects. A comparison was made between the application of ERP and the standard treatment protocol.

Results. The use of ERP leads to an expected two-fold reduction in the duration of postoperative length of hospitalization (OR = –1.96; 95% CI: –2.56÷–1.36; p < 0.00001). The reduction in the duration of hospitalization with the use of ERP in urology does not lead to the increased risk of readmission or re-operation (p = 0.35). The risks of developing postoperative complications ≥ Class 2 by Clavien – Dindo classification were comparable in both groups (p = 0.13). The use of ERP increases the expected success of the treatment by 1.74 times (OR = 1.74; 95% CI: 1.08–2.79; p = 0.02). With the use of ERP in reconstructive urology, a significantly lower risk of complications was established (p = 0.02).

Conclusion. The ERP program allows you to reduce the time and cost of treatment, reduce the likelihood of re-hospitalization and achieve better treatment results. The use of ERP is not accompanied by increased risk of complications > Class 2.

The aim of the review is to analyze the prevalence of sarcopenia in the elderly age group, the causes of its occurrence, and to present modern methods of prevention and physical rehabilitation. The study focuses on the relationship between exercise, training effects and physiological mechanisms, as well as the safety of various types of strength, anaerobic and multimodal training, which have a positive impact during the prevention and rehabilitation treatment of sarcopenia. Literature reviews, meta-analyses, and original studies are included that focus on older people in all settings, using validated assessment tools and methods. A literature search was conducted in four electronic databases – PubMed, Cochrane Library, Scopus, Springer, for the period from 2012 to June 30, 2022. There were no restrictions on the language bias of the publication. Search strategy. The keywords used to define the terms of participation in the review are “older/advanced age”, “sarcopenia” and “sarcopenic obesity”. Articles were included if they met the following criteria – cohorts with mean or median age ≥ 60 years and any of the following definitions of sarcopenia: European Working Group on Sarcopenia in the Elderly (EWGSOP), Asian Working Group on Sarcopenia (AWGS), International Working Group on Sarcopenia (IWGS). To ensure comparability of interventions, the review included studies that were conducted for at least 8 weeks, and the distribution of patients by study design was randomized. Also, articles involving hospitalized patients are excluded.

Background. The study of the association of risk factors and atherosclerotic burden assessed by coronary angiography is promising in terms of both understanding the pathogenesis of the disease and predicting its development. The aim of the study was to investigate the relationship between traditional risk factors and the severity of coronary atherosclerosis in patients with stable CHD.

Materials and methods. Risk factors were studied in 100 patients who underwent angiography. Based on the Gensini (GS) score, participants were divided into groups: patients with moderate lesion of coronary arteries (GS = 8–39), with severe lesion (GS ≥ 40), and control group (GS = 0). To verify the association between the variables, Pearson’s chi-square test was used. The results were presented as relative risk (RR) and the confidence interval (95% CI).

Results. It was found that in patients with GS score less than 40 points, statistically significant factors were hypertension (RR = 2.6; 95% CI: 1.023–10.09; р = 0.018), family history (RR = 2.94; 95% CI: 1.501–5.762; р < 0.001), depression (RR = 1.81; 95% CI: 1.202–2.738; р = 0.028), In patients with GS ≥ 40, the most important factors were diabetes (RR = 1.72; 95% CI: 1.187–2.511; р = 0,017), family history (RR = 2.02; 95% CI: 1.233–3.315; р = 0.002), inactivity (RR = 1.85; 95% CI: 1.219–2.824; р = 0.005). The GS scores were significantly higher in smokers compared non-smokers (44.0 vs. 32.0; p = 0.043).

Conclusion. The most significant influence on the development of coronary atherosclerosis is exerted by a family history and physical inactivity. Arterial hypertension and depression are associated with moderate coronary artery disease. Severe athero sclerosis is associated with diabetes mellitus, long smoking history, low levels of high-density lipoprotein cholesterol.

Perioperative ischemic stroke is a potentially fatal complication that greatly increases the risk of poor outcome in surgical patients. Despite the relatively low prevalence among patients undergoing non-cardiosurgical and non-neurosurgical interventions (about 0.1–1.0 %), the total number of annually developing perioperative ischemic strokes in patients of this profile is high due to the large number of operations performed in the world. Since the publication in 2014 of the last fundamental work on the prevention of perioperative stroke, approaches to primary and secondary prevention, diagnosis, conservative and reperfusion treatment of ischemic stroke have been seriously modified. The numerous changes that have taken place have created the prerequisites for revising existing approaches to providing care for perioperative ischemic stroke. In 2021, updated documents of foreign researchers/ associations on the problem of perioperative ischemic stroke in non-cardiac and nonneurosurgical patients were published. This review, which consists of two parts, presents current data that summarizes the most relevant information on this topic. The first part of the review outlines the general provisions on perioperative ischemic stroke (definition, risk factors, pathogenesis, predictive models), strategies for pre- and intraoperative prevention.

Background. Some stress responses contribute to the formation of bacterial antibiotic resistance, including the soxRS oxidative defense regulon. Elevation of reactive oxygen species production and oxidative stress was detected in bacterial cells exposed to various environmental stresses. It can be supposed that a stress-mediated increase in the level of reactive oxygen species will activate the expression of the soxRS regulon genes, which may provide pre-adaptation to antibiotics.

The aim. To study changes in the expression of soxRS regulon genes in Escherichia coli cells exposed to NaCl, acetic acid, and heating.

Materials and methods. Gene expression was measured in cells bearing reporter gene fusions (soxS::lacZ, nfo::lacZ). An overnight broth culture was diluted in fresh LB broth to OD600 = 0.1 and cultivated at 37 °C without stirring until OD600 = 0.3, then the stressors were applied.

Results. Exposure to NaCl and acetic acid activated the expression of soxRS regulon genes, while heating caused a decrease in gene expression. An increase in the expression level was observed in cells subjected to stresses of low intensity (which did not cause a decrease in the number of colony-forming units (CFU) by the 4^th hour of exposure compared to the beginning of the stress exposure) and medium intensity (which caused a 10-fold decrease in the number of CFU), whereas high-intensity stresses (which caused a decrease in the number of CFU by more than 10 times), regardless of their nature, were accompanied by a decrease in the expression of the soxRS regulon genes.

Conclusion. Under the conditions studied, only the osmotic stress caused by the addition of NaCl was accompanied by a significant activation of the soxRS regulon genes. Sublethal exposure to NaCl, causing an increase in the expression of soxRS regulon genes by 2–2.5 times, may provide pre-adaptation of bacteria to the factors that this regulon is aimed at counteracting, including antibacterial drugs.

The article presents a review of the main circadian mechanisms regulating carbohydrate metabolism and their role in maintenance of energy homeostasis; the molecular genetic structure of the circadian system is also discussed. The role of adipose tissue and other organs and systems in the maintenance of circadian rhythm of carbohydrate metabolism, both in health and in obesity and diabetes, is highlighted. Particular attention is paid to diurnal rhythms of endocrine factors responsible for metabolic patterns of hormones such as cortisol, growth hormone and melatonin. Gender differences in the circadian regulation of energy and carbohydrate metabolism are also discussed, as well as their changes in different age periods. Article provides detailed review of the mechanisms of glucose utilization, reactivity of the pancreatic islets and peripheral insulin sensitivity shifts at different time periods of the day in people with normal body weight, android and gynoid types of obesity, both in women and men. Protective factors of energy metabolism circadian regulation structure preventing the development of diabetes mellitus and cardiovascular disease in individuals with so-called “metabolically healthy” obesity type are discussed. Article provides a review of various pathways of circadian rhythm disturbances, mechanisms of their development, as well as exogenous and endogenous factors leading to carbohydrate metabolic circadian rhythm misalignment, such as shift work, untiming of natural and artificial lighting, jet lags, sleep disorders. Represented data contribute to a new look at the pathogenesis of obesity and carbohydrate metabolism disorders in various types of obesity in men and women, that provides basis for searching for new effective methods of prevention and treatment of these conditions, elaboration of evidence-based diets and physical activity recommendations, as well as approaches to their medical treatment.

According to various researchers, the prevalence of unruptured cerebral aneurysms (CAs) in the general population varies from 2 to 5 %. In the vast majority of cases, CAs do not have clinical and neurological manifestations and are discovered incidentally during routine neuroimaging studies. CAs can cause intracranial hemorrhage. As a rule, hemorrhages of this type occur in patients aged 40–60 years. It has been established that about 10–15 % of patients die from an aneurysmal hemorrhage before they receive specialized medical care. Recurrent aneurysmal intracranial hemorrhage is the main cause of high mortality and disability in this group of patients. The search for literature sources in the scientific databases PubMed/Medline, EMBASE, Cochrane Library and eLibrary demonstrated the existence of numerous studies devoted to the study of molecular biology and biophysical mechanisms of formation, growth and rupture of CAs. Combining the results of these studies was the motivation for writing this literature review. The paper reflects in detail the role of inflammation and molecular genetic factors in the growth and rupture of the CAs, and presents the biophysical factors of the rupture of the CAs. The authors pay special attention to the shape, size and coefficient of the CAs as the most important geometric risk factors for the formation and rupture of the CAs. This review presents current data on mathematical modeling of various types of CAs with an assessment of the risk of rupture of the latter, which has found its application in wide clinical practice. The authors also attempted to describe the hemodynamic features in various types of CAs. In turn, the type of blood flow in the CAs cavity largely depends on the size and shape of the latter and the geometry of the carrier artery, which is the basis for preoperative planning and the choice of tactics for surgical treatment of patients with unruptured CAs.

The aim. To analyze the results of surgical treatment of sacral schwannomas with their extension into lower pelvis.

Materials and methods. We analyzed the clinical results of surgical treatment of 25 patients with sacral schwannomas, including those with ventral extension and growth into pelvic cavity. All patients were operated at the Clinic of Neurosurgery of the Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan for a 10-year period. The analysis of literature describing prevalence, classification, diagnosis and surgical treatment of sacral tumors and schwannomas in particular was carried out. The features of the course, diagnosis and surgical treatment of sacral schwannomas and accepted surgical methods for their treatment are described.

Results. The average follow-up period of the patients in our study was 61.6 ± 2 months. Compared with the initial indicators of patients in the postoperative period (1 year after the surgery), a good clinical result with the regression of symptoms was registered in 17 (68 %) out of 25 patients, and 10 (40 %) of them had a significant regression of neurological disorders. 3 (12 %) operated patients had a deterioration of neurological disorders in the form of aggravation of sensitive disorders; one patient had an aggravation of pelvic organ dysfunction. Radical removal of the tumor was achieved in 24 (96 %) out of 25 cases; subtotal resection was performed in 1 (4 %) patient. The number of relapses and continued growth of tumors in our series was 12 % (3 out of 25 patients). The mortality rate was 0 %. The complications were registered in 3 (12 %) cases and manifested as wound liquorrhea in cases of using posterior approach.

Conclusion. The degree of radicality of tumor resection and clinical outcomes is directly related to the selected surgical approach.

Surgical treatment is often accompanied by such complication as bleeding, and ophthalmic surgery is not an exception. The bleeding risk depends on many factors, the most significant are age, arterial hypertension, hepatic and renal impairment, prior stroke or treatment with oral anticoagulants.

The aim. To evaluate the structure of patients taking novel oral anticoagulants (NOACs) with an assessment of activated partial thromboplastin time before ophthalmosurgical treatment.

Materials and methods. 54 patients taking oral anticoagulants were included in the study. A retrospective analysis of medical histories of patients who had surgery for ocular pathology was carried out. The patients were divided into two groups: group 1 – 28 patients whose activated partial thromboplastin time (APTT) did not exceed 45 seconds; group 2 – 26 patients with APTT more than 45 seconds. The criterion for the numerical expression of APTT is the safety of performing regional anesthesia against the background of taking anticoagulant drugs. Statistical processing was performed using the Mann – Whitney test (p < 0.05).

Results. A comparative analysis of the results showed that the patients of the group 2 had higher rates of APTT. At the same time, they were less likely to have acute cerebrovascular accident (11.5 % compared to 21 % of patients in the group 2) and prior acute myocardial infarction (19 % and 28 %, respectively). Among all the patients, women and slightly older patients prevailed.

Conclusion. Patients with atrial fibrillation make up the majority of patients undergoing ophthalmosurgical treatment and taking NOACs. Surgical treatment method was phacoemulsification with intraocular lens implantation. Studying APTT before the surgery allowed us to identify a category of patients with high APTT, to prescribe the withdrawal of the drug before the surgery in order to create optimal conditions for surgical treatment.

The aim. To assess the dynamics of cytokine content in tear fluid of primary openangle glaucoma (POAG) patients at various terms after non-penetrating deep sclerectomy (NPDS) in relation to the functional state of the outflow tracts.

Material and methods. We carried out prospective examination of 65 patients with advanced stage of primary open-angle glaucoma after NPDS. Depending on the course of the postoperative period and the conditions for achieving the hypotensive effect of NPDS, all patients were divided into three groups: group 1 – with the optimal hypotensive effect; group 2 – with the conditional hypotensive effect; group 3 – with no hypotensive effect after NPDS. The intraocular pressure and the concentration of TGF-β, MMP-9, IL-6, IL-8, VEGF-A (121 and 165) in the tear fluid were studied using ELISA method in pre- and postoperative period. We studied the outflow tracts using optical coherence tomography and carried out ultrastructural analysis of filtering blebs tissue.

Results. In group 1, the minimum initial concentrations of IL-6, IL-8 and TGF-β in the tear fluid and their moderate increase in the postoperative period; high concentrations of MMP-9 at all stages and an increase in VEGF-A by 2 months after NPDS were registered. In group 2, there was a high level of VEGF-A in the tear fluid before and 2 months after NPDS, an increase in TGF-β, IL-6 and IL-8 in the tear fluid in the early period with their suppression in the late period, as well as an increase in MMP-9 in the early postoperative period. Group 3 had maximum concentrations of TGF-β and IL-8 in the tear fluid initially and in the early postoperative period, suppression of MMP-9 in the tear fluid 2 weeks after and of VEGF-A 2 months after NPDS.

Conclusion. Initially high concentrations of IL-6, IL-8, and TGF-β in the tear fluid and the suppression of MMP-9 and VEGF-A in the postoperative period contribute to the surgical failure of the NPDS.

The article presents a case of a fatal outcome of a 15-year-old teenager with cerebral vascular thrombosis, which developed in the post COVID-19 period. The young man came in with complaints of headache, vomiting, photophobia, hyperacusis. It was known that at an early age he had been operated on for the Arnold – Chiari anomaly, had a subdural-peritoneal shunt. Two weeks before hospitalization, he suffered a new coronavirus infection of mild severity, which was confirmed by a positive analysis of a smear from the oropharynx by polymerase chain reaction. Cephalgia was acute, stopped for a short time after the use of analgesics. During the examination, the patient laid with his eyes closed, asked for silence and blackout in the ward. Any movement of the head was accompanied by dizziness, headache, vomiting. During an objective examination, no pathological changes were found on the part of the internal organs. The neurological status was determined by photophobia, double vision, asymmetric face, asymmetry of the eye slits S > D, drooping of the left corner of the mouth, nystagmus, hyperacusis. There was no rigidity of the occipital muscles. Meningeal signs were negative. There were no pelvic disorders. According to the laboratory examination, lymphocytopenia, thrombocytosis, acceleration of ESR, moderate increase in ferritin, D-dimers were detected. Conducted neuroimaging methods (MSCT of the brain with intravenous contrast, brain MRI, ultrasound diagnostics of cerebral vessels) did not find any blood clots in intracranial and extracranial vessels. Low-positive values of IgM antibodies to cardiolipin were revealed. According to the results of polymerase chain reaction, polymorphism G20210A was detected in the prothrombin gene. The patient received high-dose glucocorticoids and heparin for treatment. Despite the therapy, a month and a half after hospitalization, the teenager died from thrombosis of the central venous sinuses (cavernous sinus on the left, transverse sinuses, jugular veins), which were confirmed on autopsy. This clinical case of venous sinus thrombosis in a teenager in the post COVID-19 period presented diagnostic difficulties, since accurate imaging methods did not detect the presence of a blood clot in the cerebral vessels.

Body composition reflects the dynamic processes in a child’s development. The recommended restrictive diets for patients with advanced chronic kidney disease (CKD) contribute to a high risk of sarcopenic muscle wasting as diagnosed by bioimpedancemetry.

The aim of the study. To assess BMI and body composition in children with CKD, to identify features of body composition in patients with different BMI Z-score values.

Materials and methods. The physical development of 110 children with CKD of different stages was assessed. Patients were divided into two clusters: Group 1 (92 children) with BMI from 10.95 to 21.5 kg/m², BMI Z-score did not exceed +2.0 (without obesity); Group 2 (18 children) – BMI from 24.11 to 37.2 kg/m², Z-score BMI – more than +2.0 (obese). All underwent bioimpedancemetry, the proportion of fat and active cell mass was assessed. The comparison was carried out by nonparametric statistics methods.

Results. Changes in body composition were revealed: children without obesity had severe protein-energy deficiency in 7 cases (7.6 %). The difference in the proportion of fat mass in children of different groups, Me [Q1; Q3]: Group 1 – 18.00 % [14.00; 22.00], Group 2 – 35.00 % [21.98; 41.00], (Mann – Whitney U-test: U = 279.5, p = 0.00001). In Group 1, the active cell mass was 53.50 % [51.00; 56.00], in Group 2 – 41.50 % [39.00; 47.00] (U = 174.5, p = 0.000001), there were no significant differences in other parameters of bioimpedancemetry.

Conclusions. The proportion of active cell mass is lower in overweight children, with a significant predominance of the proportion of fat mass, which indicates the depletion of protein reserves due to their redistribution and possible insufficient alimentary intake in advanced stages of CKD.

Background. The model of sleep reactivity to stress considers sleep reactivity to stress as a link in the pathogenesis of insomnia disorder – the degree to which stress disturbs sleep, which manifests as difficulty in initiating and maintaining sleep.

The aim. To study clinical and psychological features as well as subjective and objective sleep indexes of subjects with high level of sleep reactivity to stress.

Materials and methods. The psychological status, subjective indexes of sleep and sleep reactivity to stress according to Ford Insomnia Response to Stress Test were studied among 18–75 year-old subjects without significant sleep disturbances and patients with chronic insomnia. Polysomnography was performed for objective evaluation of sleep parameters.

Results. It was found that individuals with high levels of sleep reactivity to stress were characterized by high levels of anxiety, restlessness, and neuroticism. According to results of Pittsburg questionnaire, a lower quality of sleep was revealed. These findings were correlated with objective indexes of sleep according to polysomnographic studies: less deep sleep and its lower efficiency due to sleep disturbances.

Conclusions. Individuals with high sleep reactivity to stress are characterized by greater anxiety combined with subjective and objective sleep disturbance like insomnia type.

The problem of reverse shoulder arthroplasty with various deformities of the glenoid is relevant for modern traumatology and orthopedics. In addition to various defects, the methods of solving which can be eccentric reaming of the glenoid by milling cutters, bone autoplasty, augmentation, the use of individual implants, orthopedic traumatologists have to deal with a decrease in the mineral density of the bone tissue of the scapula.

The aim of this study is to demonstrate the possibility of using hydroxyapatite paste together with bone autoplasty in revision shoulder arthroplasty in conditions of a massive defect and reduced glenoid bone density.

Discussion. The article presents a case of surgical treatment of a patient with the consequences of a fracture of the proximal metaepiphysis of the humerus and local osteoporosis of the glenoid by the method of reverse shoulder arthroplasty in combination with the use of hydroxyapatite paste. A detailed description of the operation technique is given.

Conclusion. The described clinical case demonstrates the effectiveness of the technique of using hydroxyapatite preparations for shoulder joint replacement.

Rationale. Alveococcosis is a rare disease, its diagnosis and treatment depend on surgical techniques, equipment and clinical experience. The aim. To develop a diagnostic algorithm and compare the results of surgical treatment of patients with liver alveococcosis in different periods of time.

Materials and methods. At the first stage, we carried out a retrospective analysis (1995–2007) of 33 patients with alveococcosis (a comparison group). At the second stage, a prospective clinical study (2008–2021) was performed on 39 patients (the main group). The number of patients was determined in accordance with the inclusion and exclusion criteria, and the study groups were comparable in age, sex, parasite localization (p > 0.05). For the names of operations, the WHO classification of alveococcosis was used.

Results. In the main group, there is an increase in the applicability of: enzyme immunoassay; ultrasound and computed tomography; biopsy. Complications decreased by 2.7 times from 54.6 % in the comparison group to 20.6 % in the main group (χ² = 8.97; df = 1; p = 0.003). The average duration of operations, as well as the average volume of blood loss in the comparison group and the main group were, respectively: with atypical resection – 220.4 and 180.2 min (p = 0.003), 640.1 and 480.0 ml (p = 0.005); with anatomical resection – 296.2 and 247.2 min (p = 0.002), 1450.2 and 1150.3 ml (p = 0.018); with cytoreductive resection – 230.2 and 200.1 min (p = 0.004), 860.3 and 670.4 ml (p = 0.001). There were 13 (39 %) cytoreductive resections in the comparison group, and 3 (8 %) in the main group (χ² = 4.74; df = 1; p = 0.029).

Conclusion. Timely diagnosis of alveococcosis leads to an increase in the number of radical resections, and modern surgical technologies and equipment can reduce the time of surgery, blood loss and the number of complications.

Background. Enteroatmospheric fistulas (EAF) that occur during the use of the “open abdomen” surgical tactics are a complex surgical pathology with a high mortality rate.

The aim. To assess the effectiveness of treatment of various forms of enteroatmospheric fistulas in patients with postoperative peritonitis using vacuum aspiration technology.

Methods. We assessed the results of the surgical treatment of 46 patients with EAF in the late course of postoperative peritonitis (PP). Three clinical and morphological groups were distinguished: group 1 (n = 24) – EAF in small wounds of the anterior abdominal wall; group 2 (n = 15) – EAF opening into limited cavities; group 3 (n = 7) – EAF opening into laparostoma wounds. In group 1, a fistula was formed using continuous aspiration devices or VAC systems. In group 2, we used continuous aspiration of intestinal contents from the cavity. In group 3, laparostoma was treated using vacuum devices with isolation of the intestinal fistula and simulation of a floating enterostoma.

Results. Group 3 of patients with EAF was characterized by a high flow rate (1224.2 ± 210.3 ml), duration of treatment (87.3 ± 12.5 day), extensive laparostoma (335.4 ± 14.3 сm2), high mortality rate (57.1 %). The best results of treatment were obtained in groups 1 and 2. The flow rate was 675.8 ± 154.3 and 541.3 ± 114.1 ml, the duration of treatment was 2 or 3 times less (37.7 ± 6.1 and 26.4 ± 5.2 days), the mortality rate was 8.3 % and 6.7 % respectively.

Conclusion. EAF that occur when using the “open abdomen” surgical tactics due to the impossibility of their isolation in extensive wounds of the anterior abdominal wall are complicated clinical and morphological forms. For their treatment, it is advisable to use VAC systems, aimed at the treatment of both the anterior abdominal wall wound itself and the intestinal fistula opening into it for its gradual extraterritorialization by modeling a floating enterostoma in a vacuum device.

Treatment of patients with iatrogenic injuries of the biliary tract is the most difficult and important section in hepatobiliary surgery. When analyzing the causes, it was found that in 70–94 % of cases this type of injury is observed during cholecystectomy. We present a rare clinical case of the development of secondary biliary cirrhosis due to iatrogenic trauma of the biliary tract. This injury caused long-term suffering for the patient due to the further development of complications of cirrhosis, specifically of portal hypertension. The latter caused repeated recurrent profuse bleeding from varicose veins of the esophagus. The use of a minimally invasive transjugular intrahepatic portosystemic shunt procedure for the first time in the Udmurt Republic was of particular relevance in solving this problem. This procedure has become a key one in solving the abovementioned problems and will become the preventive measure for the cirrhosis progression in the future. It is also important to focus on prophylactic measures aimed at preventing iatrogenic injuries of the biliary tract, as this problem can cause irreversible complications. Prevention should include adequate examination and visualization of the bile ducts and gallbladder before surgery, their careful mobilization, compliance with the rules of operation with electrosurgical instruments, as well as the use of additional minimally invasive techniques such as choledoscopy, cholangiography and intraoperative ultrasound. Besides that, all manipulations should be carried out under strict control and clear visualization of instruments and anatomical structures of organs. The article provides a detailed description of the technique of transjugular intrahepatic portosystemic shunt surgery, as well as presents X-ray images obtained during this operation.

The aim of investigation was to study experimentally the morphological features of tissue integration of two-layer titanium nickelide (TiNi) knitwear when replacing thoracoabdominal defects.

Materials and methods. The experiments were carried out on 40 Wistar rats. The experimental animals were divided into two comparison groups: in Group A (n = 20) the defect was replaced using a two-layer knitted tape made of TiNi, in Group B (n = 20) a polypropylene mesh implant was used. The technique of the operation and the peculiarities of keeping the animals did not differ. Animals were taken out after 14, 30, 60 and 90 days of experiment. The macroscopic structural features at the site of implant fixation to tissues and at the sites of contact with underlying organs were studied, and the inflammatory process was assessed. The histological and electron microscopic study was carried out with an assessment of the features of tissue integration through the mesh structure of knitwear.

Results. Thirty days after the surgery in four cases of Group B the appearance of the chest wall deformation at the site of implant fixation was noted, in one case the deformation site was located along the lateral edge of the abdominal wall. Among the animals of Group A no such changes were recorded. The histological and electron microscopy examination revealed that the porous structure of the TiNi wire, as well as the biomechanical and biochemical properties of the two-layer metal knitwear, ensure optimal integration of the endoprosthesis in the body tissues, forming an elastic frame close to natural. In Group B, on the contrary, the reaction of the body caused by the implanted polypropylene prosthesis was characterized by more pronounced fibrosis, and tissue integration through the mesh structure of the implant was not observed.

Conclusion. Two-layer TiNi knitwear in the replacement of complex structures of the thoracoabdominal zone showed promising results, which opens up prospects for further clinical research.

Background. Mortality from acute myocardial infarction with ST-segment elevation in cardiac hospitals ranges from 4.5 to 7 %, and these data has not decreased in recent years. The most common cause of death in patients is cardiogenic shock, the likelihood of which directly depends on infarct size. It is quite clear that there is an urgent need to create drugs to limit the size of infarction and prevent the occurrence of cardiogenic shock.

The aim. To evaluate the role of reactive oxygen species and redox-sensitive protein kinases in the infarction-limiting effect of opioid peptide deltorphin II in cardiac reperfusion in rats.

Materials and methods. Coronary occlusion (45 min) and reperfusion (120 min) were performed in rats anesthetized with α-chloralose. The selective δ₂-opioid receptor agonist deltorphin II, a hydroxyl radical scavenger 2-mercaptoprpionyl glycine (2-MPG), a superoxide radical scavenger tempol, the protein kinase Cδ (PKCδ) inhibitor rottlerin, the PI3-kinase inhibitor wortmannin, the inhibitor of ERK1/2 kinase PD98059 were injected before of reperfusion of the heart.

Results. Deltorphin II contributed to a two-fold decrease in infarction size. Injection of 2-MPG, tempol, rottlerin, wortmannin, PD98059 alone had no effect on infarction size in rats. 2-MPG and tempol did not affect the infarction-reducing effect of deltorphin II. Rottlerin, wortmannin, and PD98059 eliminated the cardioprotective effect of deltorphin II.

Conclusion. The infarction-reducing effect of deltorphin II does not depend on the production of superoxide radical and hydroxyl radical. Superoxide radical and hydroxyl radical do not play a significant role in reperfusion injury of the heart after coronary occlusion (45 min). PKCδ, PI3-kinase, and ERK1/2 kinase are involved in the infarction-limiting effect of deltorphin II in myocardial reperfusion.

Background. Tuberculosis (TB) infection remains relevant as one of the leading public health problems in Russia.

The aim. To characterize the dynamics and trends of epidemiological manifestations of TB infection in the Omsk region.

Materials and methods. An observational descriptive-evaluative epidemiological study was carried out in the Omsk region from 2009 to 2021. The data available in the Federal statistical observation forms NN 7, 8, and 33, and results of the bacteriological study of patients with respiratory TB were analyzed.

Results. In the Omsk region, an improvement in the epidemiological situation was observed from 2009 to 2021. It was associated with a decrease in TB prevalence by 3.7 times (from 325.6 to 86.7), mortality – by 5.8 times (from 21.1 to 3.6), incidence – by 2.7 times (from 130.7 to 48.4 per 100,000). At the same time, proportion of microscopy/culture-positive patients infected with multidrug-resistant Mycobacterium tuberculosis strains increased from 9.2 to 29.8 % among all patients, and from 15.5 to 30.6 % among newly diagnosed patients. There was a trend towards an increase in the number of cases with primary extensive drug resistance of M. tuberculosis. The incidence of tuberculosis associated with HIV infection has increased 10 times and reached 15.6 per 100,000 population.

Conclusions. In the Omsk region, there is a change in the structure of M. tuberculosis strains with a predominance of multiple and extensive drug resistance along with decrease in TB incidence and mortality. New approaches are needed to organize the system of epidemiological surveillance and control of TB infection.