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Radiation proctitis is a complication of radiation therapy used in the treatment of pelvic malignant tumors. The leading clinical symptom of this kind of late radiation complications is recurrent rectal bleeding, leading to the development of anemia. Despite the availability of modern drugs, conservative treatment methods remain ineffective, and minimally invasive endoscopic technologies are not applicable in all cases and can lead to the development of complications in the form of ulcers and fi stulas. About 20 years ago, the world scientifi c community recommended hyperbaric oxygenation (HBO) as a method of treating late radiation damage to the rectum. However, this technique has not been widely used. We have presented the experience of treating the successful use of HBO in the treatment of a 50-year-old patient with chronic radiation proctitis complicated by recurrent rectal bleeding. Conservative and endoscopic methods of treatment in this patient were ineffective. This clinical observation demonstrates that HBO is an effective method of treating rectal bleeding associated with radiation proctitis.

Objective: comparative assessment of long-term oncological results of laparoscopic extralevator and traditional abdominal-perineal resection (APR).Materials and methods. The analysis of immediate and long-term oncological results of treatment of 92 patients who underwent traditional laparoscopic and extralevator APR for low rectal cancer. Inclusion criteria were tumors of the lower ampullar rectum, excluding the performance of sphincter-sparing surgical interventions, and patients’ age up to 75 years. Exclusion criteria: distant metastases, histologically confirmed squamous cell carcinoma. Analysis of immediate and long-term results was carried out.Results. The main group included patients who underwent extralevator APR (n = 62), patients in the control group (n = 30) underwent traditional APR. There were no significant differences in the type of neoadjuvant and adjuvant treatment in the comparison groups (p >0.05). In the group of patients operated on in the volume of extralevator APR, 42 received neoadjuvant chemoradiotherapy versus 19 patients in the group of traditional APR, there was no statistically significant difference (p = 0.21). In the extralevator APR group, perineal plastic surgery was performed significantly more often than in the traditional APR group (p = 0.001). When evaluating the immediate results, there was a statistically significant difference in the total number of complications between the study groups, such complications as bladder dysfunction following after surgery, inflammatory pelvic disease in the perineal wound, perineal hernia occurred significantly more often in the traditional APR group than in the extralevator APR group (p >0.05). In terms of overall and disease-free survival, the groups differed statistically significantly: 5-year overall survival in the main group was 90 % versus 62.5 % in the control group (p = 0.03), 5-year disease-free survival in the main group was 98.5 % versus 65 % in the control group, respectively (p = 0.01).Conclusions. Extralevator APR of the rectum is the most radical surgical intervention than with the traditional APR technique due to the lower risk of a positive circumferention resection margin, therefore, reducing the incidence of local recurrence, and as a result, improving overall and disease-free survival rates compared to the traditional technique.

Transrectal ultrasound (TRUS) is inexpensive and simple method for examining the rectum and surrounding tissues. In particular it is used to preoperatively assess stage, in patients with rectal cancer. By using TRUS is possible to analyze the neoplasm extent, depth of tumor invasion into the layers of the colon wall, the mesorectal lymph node involvement and the circumferential resection margin. This method is comparable to an expensive magnetic resonance imaging scan, and if done correctly could even exceed it. The correct diagnosis, especially in the early stages of the disease, plays an important role in choosing surgical treatment in future. However, to interpret the results, you must be familiar with the anatomy of the rectum and anal canal, as well as follow the simple rules for the preparation and implementation of TRUS. If you follow all the rules, you can answer the question about the possibility of performing organ-preserving surgery and compliance with cancer radicalism.

Primary rectal melanoma is a rare malignant tumor with an aggressive course and poor prognosis. The article describes a clinical observation demonstrating the successful comprehensive treatment of primary rectal melanoma. A patient with a complicated course of rectal melanoma, stage IV of the first stage was performed by surgical treatment with removal of the external intestine according to the Hartmann type with removal of the uterine appendages from both sides of the en-block, and resection of the left pelvic plexus. In the postoperative period, the patient underwent chemoembolization of the liver with combined immunotherapy. The patient is alive two years after the operation; there is no evidence for local recurrence and progression of the disease.

Aim of clinical case presentation. Choice of optimal surgical approach for treatment of intestinal intussusception. Key points. Intestinal intussusception is a rare condition, especially in adults, which can develop due to both benign and malignant neoplasms. Commonly intestinal intussusception is an accidental diagnostic finding, however cases of clinically severe intussusception resulting in impaired passage of intestinal content are described in the literature. Ultrasound investigation and endoscopy contribute significantly to diagnosis of this pathology; however in certain cases computer and magnetic-resonance tomography are required. Surgical approach in intestinal intussusception varies widely from conservative reposition of intussuscepted loop to expanded resection of intestinal segment. Clinical case of ileocecal intussusception caused by melanoma metastasis to the ileum is presented.

The aim of publication. To estimate efficacy of multidisciplinary approach in treatment of patients with rectal cancer together with portal hypertension and liver cirrhosis using the example of clinical case.Original positions. 71 year-old male patient with diagnosed low rectal cancer and concomitant: decompensated liver cirrhosis, portal hypertension with varicose esophageal and stomach veins and hepatocellular failure of class C by Child-Pugh. Patient was treated by simultaneous abdomino-perineal rectal excision with para-aortic lymphadenectomy and retroperitoneal end colostomy, splenectomy, devascularization of the stomach, gastrotomy with stitching of varicose veins at the lower third of the esophagus and the stomach. On the basis of foreign experience, risks of such surgical interventions were analyzed and, based on current clinical case, optimal surgical concept for patients of this category is proposed.Conclusion. Multidisciplinary approach in diversified clinic allows to provide adequate treatment of patients with cancer of the rectum combined with portal hypertension and liver cirrhosis.

A comparative assessment of the processes of the initial stages of decomposition of plant residues (pine needles, spruce needles, leaves of boreal shrubs, moss thalli) in lichen-shrub pine forests and shrub-green-moss spruce forests formed under natural conditions at the northern limit of distribution was carried out. The characteristics of the litterfall initial composition, the rate of decomposition, and changes in the chemical composition of plant residues in the process of destruction caused by the forest type were studied. The higher initial content of Corg in the plant tissues of pine forests is associated with favourable lighting conditions under the forest canopy, while the high content of Mn in the tissues of ground cover plants in spruce forests is due to the direct influence of spruce needle litterfall rich in this nutrient. The results of the study clearly demonstrated that the forest type has a significant impact both on the initial quality of the litterfall of the same plant species and on the rate of decomposition: in the spruce forest, spruce needles and lingonberry leaves with a higher content of nutrients (Mg, Mn, P) and narrow ratios of elements (C:N, C:P) were characterised by more active decomposition processes. However, green moss litter, despite its high quality in spruce forests, decomposed more actively in pine forests, which may be due to a large amount of precipitation in pine forests. Thus, differences in the rate of decomposition of plant residues are influenced by a combination of the plant material quality, temperature conditions, and precipitation amount associated with the forest type.

A comparative assessment of the processes of initial stages of decomposition of plant residues (pine needles, spruce needles, leaves of boreal shrubs, moss thalli) in lichen-shrub pine forests and shrub-green-moss spruce forests formed under natural conditions at the northern limit of distribution was carried out. The characteristics of the litter initial composition, the rate of decomposition and changes in the chemical composition of plant residues in the process of destruction caused by the forest type were studied. The higher initial content of Corg in the plant tissues of pine forest is associated with favorable lighting conditions under the forest canopy, while the high content of Mn in the tissues of ground cover plants in spruce forests is due to the direct influence of spruce needle litter rich in this nutrient. The results of the study clearly demonstrated that the forest type has a significant impact both on the initial quality of the litterfall of the same plant species and on the rate of decomposition: in the spruce forest spruce needles and lingonberry leaves with a higher content of nutrients (Mg, Mn, P) and narrow ratios of elements (C:N, C:P) were characterized by more active decomposition processes. However, green moss litter, despite its high quality in spruce forests, decomposed more actively in pine forests, which may be due to a large amount of precipitation in pine forests. Thus, differences in the rate of decomposition of plant residues are influenced by a combination of the plant material quality, temperature conditions and precipitation amount associated with the forest type.

Background. Endometrial cancer (EC) is one of the most significant oncogynecological problems. The main mortality cause in this disease, as in the case of other malignant neoplasms, is the tumor progression. The presence of mutations associated with mismatch repair-deficient is of great prognostic importance. Immunotargeting therapy (ITT), lenvatinib in combination with pembrolizumab, seems to be the most effective solution in the second line treatment of advanced EC without microsatellite instability. At the same time, the group of such patients is heterogeneous in terms of progression-free survival (PFS) on ITT. So that it determines the continuing need to search for reliable parameters steadily associated with the PFS duration in this type of treatment.Aim. To analyze the clinical and morphological features in patients with advanced EC depending on the PFS duration on ITT. Materials and methods. The study included data on patients (n = 36) with advanced EC who received ITT in oncological dispensaries in Siberia and the Russian Far East. The overall patients’ group was analyzed using the Kaplan-Meier method. PFS was defined as the time from the ITT initiation until progression or death against the background of treatment. The influence of the selected factors (clinical and morphological parameters, treatment features, and adverse events) on PFS was assessed using a log-rank criterion. The study participants were then divided into 2 subgroups (15 women and 9 women) according to median PFS. Mann–Whitney tests for independent samples (quantitative measures), and Fisher’s tests (qualitative measures) were used to identify significant differences in comparison subgroups for the selected factors. Differences were considered statistically significant when the significance level was reached (p

Aim. To study the efficacy and safety of combined immunochemotherapy according to the DHAp protocol + nivolumab in patients with refractory/relapsed classical Hodgkin's lymphoma before autologous hematopoietic stem cell transplantation.Materials and methods. The study consisted of 2 phases: 1st - immunotherapy with nivolumab (2 injections as monotherapy at a dose of 240 mg/day with 14 days interval); 2nd - combined immunochemotherapy according to the DHAp protocol + nivolumab (14 days after the 2nd administration of nivolumab): nivolumab 480 mg/day on day 1 in combination with chemotherapy according to the DHAp protocol, 4 cycles in total. The effectiveness of therapy was evaluated after 2 injections of nivolumab, after 2 and 4 cycles of combination therapy. from March 2020 to November 2021, 32 patients were included in the study. The median age was 34 (18-55) years.Results. As of November 2021, the result was evaluated in 32 patients after the 1st stage of treatment (nivolumab monotherapy). A complete response was obtained in 4 (12.5 %) patients, a partial response in 20 (62.5 %) patients, disease stabilization was noted in 5 (16 %) patients, an indeterminate response in 3 (9 %) patients. At the 2nd phase, the efficacy after the 2nd cycle of DHAp + nivolumab was evaluated in 31 patients (complete response was obtained in 19 (61 %), partial response in 11 (36 %)); the final efficacy evaluation (after the 4th cycle of DHAp + nivolumab) was performed in 30 patients, and all patients achieved response to therapy (complete response in 25 (83 %), partial response in 5 (17 %)). 2 patients were excluded from the study.Conclusion. preliminary results of combined immuno- and chemotherapy according to the DHAp protocol showed high efficacy and relatively low toxicity in patients with refractory/relapsed classical Hodgkin's lymphoma before autologous hematopoietic stem cell transplantation.

The paper considers peculiar features pertaining to formation and influence of transport and logistical costs and other losses in the movement process of material, information and financial flows across the boundary infrastructure of the transport and logistical system.

The trophic chain, which manifests the correlation at nutritional level between various macro- and microorganisms, is an important factor of the ecosystem; it can show the migration of various substances within the chain “soil — water — plant — animals”. The trophic chain in Borgoy depression area was studied due to the profound correlation between the compositional characteristics of the soil and pronounced organoleptic features of meat of the sheep that feed on grass in this area. For the experiments, control and experimental samples of soil, water, plants and mutton meat were examined. The samples taken near the saline lake within the Borgoy depression on the west of Beloozersk village served as an experimental sample. The samples taken 30 km from the salt lake near Petropavlovsk village in the Republic of Buryatia served as control sample. Experiments have shown that the soil of the Borgoy depression is a saline soil, with a depth of the salt horizon of 0–30 cm, and the salt belongs to chloride-sulfate-soda type of salinity. It is noted that the saline soil is characterized by a much higher content of carbonates, chlorides and cations of sodium, potassium and magnesium. Correlation was found between the isotopic composition in soil, vegetation and the raw meat materials. More profound certain organoleptic features of Borgoy mutton were noted. It’s highly probable that this fact is associated with the peculiarities of the mineral, chemical, and amino acid compositions of meat of the livestock that lives in the pastures of the Borgoy depression, characterized by saline soils. Despite the increased content of heavy metals such as lead and copper in the soil, data on sheep muscle tissue showed that all values of toxic elements content are within the permissible concentration range. The transfer of heavy metals from the soil to the aboveground part of plants is hindered by the underground root part, which serves as barrier.

Objective. A comparative assessment of the efficacy and safety of the preemptive use of ibuprofen and ketoprofen in patients undergoing elective surgery under general anesthesia.Material and methods. A multicenter randomized prospective study included 58 patients grouped into 2 arms. Ibuprofen 800 mg in Group 1 (N=32), and ketoprofen 100 mg in Group 2 (N=26) were administered intravenously 30 minutes prior to surgical procedure, and afterwards every 12 hours during patient’s stay in the intensive care unit. Efficacy and safety were assessed using a visual analog scale (VAS), patient’s need in opioid analgesics, laboratory parameters (serum levels of cortisol, cystatin C, CBC, coagulogram, TEG) and instrumental methods (algesimetry — qNOX).Results. VAS values were 32.4% lower in Group 1 vs Group 2 in the immediate postoperative period, P=0.003. By the end of Day 1 this difference was no longer visible following the use of promedol. There was a correlation between qNOX values at the end of surgery and VAS values at patient’s waking up from anesthesia (P=0.0007). Cortisol plasma concentrations in groups 1 and 2 did not differ significantly, P=0.105. The average daily promedol consumption in Groups 1 and 2 was 42±17.5 mg/day and 50±19.7 mg/day, respectively, P=0.022. Cystatin C concentrations in the first morning after surgery was 0.95±0.29 mg/l in the ibuprofen group, and 1.19±0.43 mg/l — in the ketoprofen group, P=0.027. Signs of renal dysfunction were documented in 4 out of 32 patients (12, 5%) from Group 1, and in 10 of 26 (38.5%) patients from Group 2 since the end of surgery and up to the first postop morning, the Chi-squared value was 0.031. Hemostasis was not affected by NSAIDs use in both groups.Conclusion. Ibuprofen provided more powerful analgesia, than ketoprofen in the postoperative period, while during surgical procedure both drugs showed similar anlgesic efficacy. Patients on ibuprofen required significantly fewer additional boluses of opioid analgesics. Both drugs showed no clinically significant effect on hemostasis and hematopoiesis. More rare occurrence of renal dysfunction in Group 1 patients is indicative of lower nephrotoxicity of ibuprofen.

AbstractA new type of metal-free oxygen electrode has been proposed. Its distinguishing feature is applying as an active layer nanodispersed graphitic carbon nitride with electrocatalytic properties controlled by synthesis conditions. Optimal conditions of thermochemical synthesis of g-C3N4 by a heat treatment of a solid mixture of melamine precursor and nitrogen-rich urea additive have been defined. The obtained layered g-C3N4 has been characterized by XRD, selected area electron diffraction, TEM and FTIR. An investigation of the electrocatalytic characteristics of oxygen electrodes has been carried out in a fuel half-cell with alkaline electrolyte. The electrochemical characteristics of the obtained g-C3N4 material with melamine-to-urea ratio 1:2 have been shown to be close to those of platinum electrodes. Electrochemical studies have shown that the obtained carbon nitride is a promising material as metal-free catalyst for oxygen electrodes of fuel cells The long-term testing of produced materials confirmed that they were stable over six months.

Four-wire distribution electrical networks of 0.4 kV equipped with automated systems of electrical energy accounting are considered. The problem of identifying the resistances of the wires of the distribution network is solved on the basis of the effective values of voltages and currents, as well as of their phase shift angles obtained by the accounting system in the power supply node of the network and from its subscribers for the selected observation intervals. A brief analysis of the known methods and technologies used in this area of research is carried out. The importance of the formulated problem for applied problems, such as control and diagnostics of electrical energy losses, as well as the technical condition of the network, is noted. A method (algorithm) is proposed that allows determining unknown, unequal complex resistances of inter-subscriber sections of the distribution network. In these resistances, the reactive components are considered equal within the inter-subscriber section; the active components differ due to the influence of unequal flowing currents and/or weather factors. At the same time, data from two different network operating modes are required, which are selected based on the analysis of the dynamics of changes of supply currents and/or voltages by the accounting system device connected to the power supply node. Considering that the active resistances of the wires must remain unchanged, the mode that is used for calculations is the one that is before the change in power consumption in the network and the next one immediately (about 0.1 s) after it. An example of a calculation that demonstrates the reliability of the proposed equations of the method that has been developed on a simulated distribution network is given. The research results are focused on the improvement of automated accounting systems and the implementation of their new functions that elevate the reliability of distribution networks, as well as allowing for the rapid identification of non-technical losses of electrical energy.

Materials and methods. This study analyzed the results of treatment of 62 patients with severe COVID-19 in the intensive care unit using selective hemoadsorption of cytokines. All patients with severe COVID-19 were admitted to the intensive care unit within 14 days from the disease onset were subdivided into two groups. Group 1 patients (n=32) received on a top of standard treatment the hemoperfusion (HP) procedure for 4 hours, for 2–3 days in a row, using a cytokine sorption column composed of mesoporous styrene-divinilbenzen copolymer matrix. Group 2 patients were not subjected to extracorporeal blood purification. All patients received IL-6 inhibitors at a baseline in accordance to the temporary guidelines. We evaluated factors of unfavorable outcomes by analyzing changes in biochemical markers of systemic inflammatory response and mortality rates in patients of both groups.Results. Initiation of HP later than 10 days from NCI onset (P < 0.001), length of stay in the ICU, extent of lung damage (P = 0.036) and the SOFA (Sequential Organ Failure Assessment) score (P = 0.009) were the most powerful predictors of unfavorable outcome. Levels of systemic inflammatory response markers (interleukin- 6, CRP, D-dimer) in both groups did not significantly affect the survival rates and length of hospital stay (P > 0.05). HP group demonstrated better survival (P < 0.05). Mean hospital stay was 31 and 27 days, ICU stay — 11 and 8 days for Groups 1 and 2, respectively (P < 0.05).Conclusion. Treatment of severe COVID-19 patients with HP using novel domestic hemosorbent composed of styrene-divinilbenzen copolymer matrix resulted in decrease in CRP levels on the first day after application and, with early onset, contributed to a significant increase in survival and decreased hospital and ICU stay. Additional studies are warranted to clarify the optimal timing of the initiation of HP in severe COVID-19 patients.

THE PURPOSE. The process of o n-line calculation of electricity losses in three phase distribution electric networks (DEN) with a voltage of a 0,4 kV, where monitoring of electricity losses (commercial accounting) is carried out by an automated information measuring system of electrici ty monitoring and accounting (AIMS EMA) is considered. The problem of operative detecting of unauthorized power take -offs in the DEN under condition of unknown values of parameters of the network equivalent circuit, i.e. resistances of its interpersonal sections, which can change significantly over time because of external climatic factors (temperature, humidity, etc.) is being solved. METHODS. The procedure of the proposed calculation can be implemented by the available means of AIMS EMA. It is based on simultaneous measurements for the same observation interval of effective values of current and voltage, active and reactive powers at the beginning of the DEN and at each subscriber. In the course of periodic measurements of these mode parameters, the initial data used in the proposed calculation are formed. RESULTS. The analysis of the known methods of solving this problem is carried out, their disadvantages are shown and the new methodology, which is based on a preliminary operative calculation of reliable values of the resistances of interpersonal sections, provided that unauthorized power take -offs are possible in DEN is presented. While solving, the conditions of equality of resistances of the phase and neutral wires within the interpersonal section of th e DEN are used. The proposed method makes available the implementation of the operative calculation of technical losses in DEN and the identification of the commercial losses (unauthorized power take -offs) in it, as well as a detailed analysis of subscribe r data in order to detect the location (coordinate) and the amount of unaccounted electricity. CONCLUSIONS. The proposed methodology can be used in existing AIMS EMA without the introduction of additional measuring means (functions).

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children’s Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

1Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children’s Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky Saratov State Medical University, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Ministry of Emergency Situations of Russia, Saint Petersburg; 27Federal Research Center, Krasnoyarsk Research Center, Siberian Branch, Russian Academy of Sciences, Research Institute of Medical Problems of the North, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus (a consensus document) on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian «Pancreatic Club» under the Delphi system. Its aim was to identify and consolidate the opinions of Russian experts on the most topical issues of the diagnosis and treatment of chronic pancreatitis. The interdisciplinary approach involved the participation of leading gastroenterologists, surgeons, and pediatricians.

The study of platelet-rich plasma efficacy in the treatment of patients with knee osteoarthritis (OA) was performed. 188 patients were included and divided into three groups. Group 1 - 82 patients with OA, where hyaluronic acid was used for treatment, Group 2 - 36 patients, and Platelet Rich Plasma (PRP) and hyaluronic acid were used, Group 3 - 70 patients, only PRP was used. It`s been found that the use of PRP for treatment is characterized by a pronounced clinical efficacy compared with use of hyaluronic acid, which manifests in reduced detection rate of edema, hyperthermia and hyperemia. The use of PRP leads to pain reduction in the knee joint and increase the functionality of patients, that confirmed by more pronounced declining of visual analog scale indicators, Leken index and the WOMAC index values increase. The presented results of study are consistent with authors who believe that the lack of side effects and complications when using PRP indicates the safety of its use in clinical practice.

Objective: to study the impact of cerebral hypoxemia on the indicators of neuroinjury, by relying on the diagnosis of post- operative cognitive impairments, and the neuroinjury marker S100b protein and to examine the relationship of postoperative cognitive mpairments. Subjects and methods. Forty-eight non-cardiac surgical and non-neurosurgical patients with verified cerebrovascular disease, who had been operated on under total intravenous anesthesia with propofol and total myoplegia, were examined. Blood S100b protein levels were determined after cerebral hypoxemia detectable by transcranial oximetry. Postoperative delirium was diagnosed by the ICU-CAM test; postoperative cognitive dysfunction was diagnosed according to the Montreal cognitive assessment scale in the periods: 7 days, 1, 3, and 6 months, and 1 year, by using the control group, the Z scores of these indicators were standardized. Results. Cerebral desaturation led to early postoperative disorders, such as delirium and dysfunctions, in 72.7% of the cases. Cerebral saturation parameters correlated moderately, but significantly with neuropsychological indicators at 30 days of the study and 3 months after surgery and just stronger with S100b protein level. The risk of postoperative cognitive impairments in relation to the values of S100b protein was validly predicted in the models of logistic regression and ROC analysis. The rate of early and persistent cognitive dysfunction differed statistically significantly in patients with prior delirium; the logistic regression model validly predicted a relationship between this event and the neuropsychological indicators on 7 days postsurgery. Conclusion. In the patients with cerebrovascular diseases, cerebral hypoxemic episodes are dangerous. When they occur, there is an increased risk of postoperative cognitive impairments, including long-term problems. The above-threshold S100b protein concentration of 0.26 ng/mg is an early predictor of postoperative cognitive disorders.

The system under consideration is the PDU contact network of high-voltage direct current from the longitudinal line at the voltage of the order of units of kHz allowing to reduce drastically the mass of power electromagnetic elements in converters and to expand the opportunities of controlling the power supply system.

In this research the occupation layer of the ancient settlement of Staraya Maina is considered by means of paleoecological methods as an indicator of man impact of the early Middle Ages (V-XIII century) on the investigated territory.