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Background. The shortage of healthcare human resources is currently one of the most discussed topics in both Russian and global discourse. Along with the study of such important problems in the healthcare system, as its unevenness, a lack of access to health services among the most vulnerable groups, a low quality of the care provided, etc., much attention is currently paid to the professional competence, adaptation, and retention of mid-level specialists in medical organizations. One possible solution to the above problems is seen in the institute of mentorship.Objectives. To analyze the main approaches to defining the concept of “nursing mentorship” in the foreign and Russian research literature.Methods. A comparative analysis of literature sources by foreign and Russian authors addressing the definition, content, and implementation of nursing mentorship was conducted using the PubMed and eLibrary.ru databases.Results. Three main approaches — “dyadic”, “triadic,” and “integrated” (mixed) — to defining the concept of nurse mentorship were identified. The dyadic approach focuses on the analysis of interpersonal interactions between mentor and mentee. Such interactions arise during a specifically planned and goal-oriented activity aimed at a dynamic psychosocial intervention in the mentee’s professional life to bridge gaps in his/her knowledge and skills and to increase self-confidence. Dyadic mentoring can be of individual, group, distance, peer, cascade, and reverse types. The triadic approach implies interaction not only between mentor and mentee, but also involvement of the medical organization as a party. The administrators are interested in personnel stability, improved professional skills of the staff, increased loyalty and commitment to the organization. The main focus here is on the functionality, formalization, and comprehensiveness of mentoring programs, allowing the goals of the medical organization to be achieved. Within the integrated (mixed) approach, the negative experience of mentoring and the possibilities of forming a culture of mentorship are analyzed. The mentorship culture, while reflecting the interests of the medical organization, bolsters “authentic friendship” within the nursing team. Mentorship is considered as a set of activities that influence mentors, mentees, and the medical organization as a whole, passing through various development phases and stages in the interests of the three interacting parties. The contribution of Russian authors to the development of mentorship consists in the elucidation of issues related to the professional development and sociocultural adaptation of young specialists in the healthcare system, as well as in modeling mentorship relations. Mentorship is considered not only in terms of the specifics of interpersonal professional relations that arise in the mentor and mentee interaction, but also as an instrument in labor management. Mentorship programs can increase the personnel’s commitment to their profession and the results achieved.Conclusion. In the current scientific literature, different approaches to defining the concept of mid-level medical personnel mentorship are presented. The existing experience in organizing mentorship programs may significantly improve their qualitative level, thereby contributing to professional self-realization of both mentors and young nursing specialists.

Introduction. One of the main factors affecting postoperative outcomes in patients with advanced ovarian cancer is the cardiopulmonary status. Several studies have reported that preoperative multifactorial rehabilitation and physical fitness can lead to reduced postoperative morbidity, mortality, shorter length of stay, and improved quality of life in cancer patients. The issue of adaptability to physical activity of overweight and obese patients who undergoing debulking surgery is insufficiently studied. The study of compensatory changes that occur in physically inactive obese patients remains relevant, especially against the background of neoadjuvant chemotherapy, in the conditions of preoperative preparation with ERAS-recommended physical activity. The aim of the study is to determine the differences between women with advanced ovarian cancer and obesity compared to women with normal weight in terms of heart rate variability during exercise. To assess the adaptive capabilities to physical activity of patients with advanced ovarian cancer and obesity at the stage of preoperative preparation, who undergoing debulking surgery. Result. Achieved METs, peak HR, CI, and HR recovery were higher in nonobese women, whereas training had no significant effect in obese women. Women who had already received neoadjuvant CT achieved a lower level of MET (6.8 ± 3.2 vs. 8.9 ± 4.1; P < 0.001). Also, peak HR and CI were lower in women after neoadjuvant CT (126±27 vs. 138±20; P = 0.001 and 0.65±0.22 vs. 0.71±0.22; P = 0.001, respectively). BMI was a significant predictor of exercise capacity only in the obese subgroup, whereas age, peak HR, and prior adjuvant HT were always significantly associated with METs achieved. Conclusions. No significant difference was found between trained and untrained women with comorbid obesity in HR behavior or physical capacity. Different heart rate behavior in patients of this group is thus explained by obesity as such, regardless of the degree of physical training.

One of the most severe complications of metastatic lesion of the skeleton is the development of a pathological fracture, which not only affects the quality of life, makes it difficult to carry out adequate systemic treatment, but also has a negative effect on survival. In case of a pathological fracture, the main method of treatment is a surgical method. The main goal of the correction is to achieve stability and reduce metastatic pain in the area of damage or fracture. Today, the most popular organ-preserving operations for metastatic lesions of the femur in combination with pathological fractures are endoprosthesis and intramedullary osteosynthesis. In this paper, a comparative analysis of the results of their use is carried out, the advantages and disadvantages of each of the methods are described.

The aim of this study was to determine the general patterns of pathogenetic changes in the blood coagulation system and in non-specific proteinases and their inhibitors during the development of experimental ischemiareperfusion injury.Materials and methods. The study was conducted on 48 male Wistar rats (180–200 g). We used a model of ischemia-reperfusion injury achieved by applying rubber tourniquets to both hind limbs at the inguinal fold level for 6 hours. Revascularization was performed for 6, 12, or 24 hours following the application of tourniquets, after which we examined the state of the internal and external blood coagulation pathways and the activity of nonspecific proteinases and their inhibitors.Results. Indicators of blood coagulation system change show the development of blood hypocoagulation changes as the reperfusion time increases. By the 6th hour of reperfusion, the prothrombin time (PT) was lengthened by 112.0% (p = 0.0142) and the activated partial thromboplastin time (APTT) by 170.0% (p = 0.0147) compared with values in the control group. By the 12th reperfusion hour, the PT was lengthened by 174.2% (p = 0.0389), and the APTT increased 4.9-fold (p = 0.0002). When the reperfusion period was increased to 24 hours, it was characterized by lengthened PT and APTT, accompanied by an increase in antithrombin III by 11.5% (p = 0.0371) and a decrease in protein C by 71.4% (p = 0.0071). Changes in the non-specific proteinases and their inhibitors were characterized by a 2.8-fold increase in the trypsin-like proteinase activity (p < 0.001) relative to the control, as well as a 2.2-fold decrease in antitrypsin activity and acid-stable inhibitors (p < 0.001), which reached a maximum after 24 hours of reperfusion. A direct correlation was found between indicators characterizing the deficiency of coagulation system factors and a decrease in antiproteinase potential.Conclusion. Hemostatic system disorders are characterized by the development of hypocoagulation during ischemia-reperfusion injury as the result of an increase in the trypsin-like proteinase activity and a decrease in the levels of inhibitors. The established changes may be associated with the deficiency of coagulation factors and proteinase inhibitors and share common pathogenic mechanisms.

COVID-19 pandemic is recognized as a present day major public health burden. Risk factors for developing a more severe course of COVID-19 include increased levels of C-reactive protein and D-dimer. Pulmonary embolism (PE) is challenging in patients with COVID-19. The purpose: to analyze clinical and paraclinical manifestations of PE in patients with COVID-19 in order to develop a system for its early diagnosis, prediction of complications, prevention and treatment. 52 patients aged 28 - 81 y.o. with a diagnosis "Acute respiratory disease COVID-19" have been examined during 2020-2021. (98.08±1.9)% of PE patients had a history of one or more comorbidities, including obesity (80.77%), coronary heart disease (96.15%), hypertension (98.08%), peripheral arteries (92.3%), type 2 diabetes mellitus (48.08%). Evaluation of laboratory parameters revealed increasing lymphocytopenia, leukocytosis, neutrophilia, thrombocytopenia (p

The work involved a molecular biological technique (ISSR-PCR) using ISSR-primer S-2, with structure (AGC) 6G. Changes in the gastric mucosa in chronic duodenal ulcer disease against the background of severe chronic atrophic gastritis have been analyzed. Noteworthy is the fact that there is a strong correlation between the degree of dysplasia of the epithelium of the gastric mucosa and the mitotic index, the Pearson's correlation coefficient rxy was 0.853, respectively. A strong and very strong correlation relationship between the indicators of the degree of dysplasia of the epithelium of the gastric mucosa by phenotypic characteristics and indicators of DNA typing of samples of the gastric mucosa, the Pearson's correlation coefficient rxy was 0.863, respectively. DNA profiles of the gastric mucosa of patients with duodenal ulcer according to the results of typing by the ISSR-PCR method ranging from 520 to 620 bp. had the character of microsatellite expansions and differed from the profile of the norm, which is evidence of precancerous changes.

Objectives to develop the main strategies of emergency medical care improvement for patients with acute coronary syndrome, in order to reduce the morbidity and mortality in the population of a large industrial region. Material and methods.The study was conducted on the basis of the Moscow regional ambulance station. We used the content analysis, logical, system analysis, the method of mathematical statistics. Results.In the period 20172018, in the region's population, there is a tendency for decrease in the number of calls for ambulance teams caused by acute coronary syndrome. During the analyzed period, we noticed the reduction of the number of cases of pre-hospital thrombolytic therapy (by 17.5%). The response time to the patient's call not more than 20minutes was observed in 92.9% of cases, the number of lethal outcomes in presence of the ambulance team decreased by 4.6%. The results can be explained by the dynamic development of the infrastructure of cities and districts of the Moscow Region, by the improvement of road networks, by the complete renewal of the service's motor vehicle fleet, and by the opening of a number of new specialized medical institutions. A set of medical and organizational measures has been developed and put into practice in the ambulance service of the region, aimed at further improvement of the system of ambulance care for patients with acute coronary syndrome at the prehospital stage. Conclusion.The mortality reduction, preservation and improvement of public health can be achieved only through the comprehensive sustainable development of the regions infrastructure, improvement of the organizational structure of the emergency medical service, mandatory use of algorithms and standards for the provision of medical care to patients at all stages.

Aim. To evaluate impact of different clinical features on prognosis in Diffuse Large B-cell lymphoma (DLBCL) patients and to determine potential correlation between IHC markers (double-expression of c-myc, bcl-2 and p53) on unfavorable clinical characteristics in DLBCL patients.Methods. We analyzed 215 patients with DLBCL who received treatment from 2008 to 2016. We assess impact of different clinical features, such as B-symptoms, extranodal involvement, advanced stages and refractory course on PFS. In this study we also access potentially unfavorable impact of double expression of c-myc and bcl-2 and p 53 by immunohistochemical analysis.Results. In both uni- and multivariant analysis B-symptoms, advanced stages and primary-refractory course were identified as negative prognostic factors for PFS rates. We found tendency to correlation between double expression of c-myc and bcl-2 and high International prognostic index as well as expression of p53 and advanced stages (87,5% vs 56,4% respectively, р = 0,095). Сonclusion. Patients with DLBCL aggressive course of the disease (B-symptoms, advanced stages and primary-refractory disease) have lower rates of PFS. Double-expression of c-myc and bcl-2 and p53 can be potentially associated with aggressive course of the disease.

Background. Dental health in patients with diabetes mellitus type 2 and methods of its correction is an important part in the complex of medical and preventive care of the pathology. Objective. The objective of the research is to study the efficiency of medications with probiotic potency in the process of prosthodontic treatment with whole piece permanent structures of dental prostheses of patients with diabetes mellitus type 2. Material and мethods. Qualitative and quantitative characteristics of oral fluid microbiocenosis of patients with diabetes mellitus type 2 have been studied in the process of the combination treatment including denture treatment with whole piece permanent structures with the use of «Bifidumbacterinum». Bacterial inoculation for oral fluid was done using Gould serial delution method. Results. Progressive reduction in the quantification which marks the content of pathogenic and liable to be pathogenic organisms in patients with diabetes mellitus type 2 stoma was noted after the combination treatment had been done. Herewith, the significance of stabilizing flora agents increased. Conclusions. The results of the microbiological research presented prove applicability of bacterial medication along with a package of measures during oral rehabilitation of patients with diabetes mallitus type 2 .

The presence of additional fully formed accessory breast (polymastia), accessory nipples (polythelia) or other options ectopically positioned breast tissue is fairly rare developmental anomalies. Its occurrence frequency is approximately 1% of the general population. This article describes a rare case of localization of additional mammary glands and their surgical correction.

There are many measures for the effective functioning of the system of health protection of women and children in the Samara region: organizational, improving the system of legal norms, aimed at the optimization of medical aid to mother and child, strengthening the material-technical base of medical institutions, mastering modern methods of diagnosis and treatment, training of medical personnel at a high level. Plan of measures of structural transformation health care delivery system on women and children included the adoption of the regional target program “Health of the Samara region children” for 2013-2015. Within the framework of its implementing are used new prevention technologies affecting on indicators morbidity and mortality of the child population.

Phylloid (leaf-shaped) breast tumors are a rare disease and constitute 0.3–0.5% of all breast tumors. Due to the rare frequency of occurrence, as well as the small number of randomized studies that have been conducted on this pathology, there is currently no standardized approach to the diagnosis and treatment of phylloid tumors. The reports about these rare cases appearing in the literature are, as a rule, descriptive, which only emphasizes the difficulty of differential diagnosis, the development of the correct tactics for treating such patients. In connection with the rarity, it is very difficult to diagnose correctly this pathology, which requires a highly qualified doctor as a diagnostician in the initial contact with such a patient, and a pathologist doctor who establishes the final morphological diagnosis. Often, leaf-shaped tumors are mistaken for mammary fibroadenomas. Such difficulties in correct diagnosis in the preoperative period can lead to errors in the planning of treatment. Also, the recommendations for the treatment of patients with this diagnosis are not fully understood, since up to now there are no accepted treatment standards in both Russian and foreign recommendations. Due to the fact that this pathology of mammary glands is rare, the principles of treatment are based on small retrospective studies and clinical observations. In this review, we will discuss the results of major retrospective studies, including data on epidemiology, etiology, diagnostic approach, strategies and results of treatment of this complex group of breast pathologies.

The study included 108 patients with B-cell lymphoma which had complication with invasive aspergillosis, 57 patients with Hodgkin lymphoma (HL) and 51 patients with non-Hodgkin lymphoma (NHL). All patients in both groups received chemotherapy before the development of invasive aspergillosis, 73% of patients with HL and 67% patients with NHL received chemotherapy for induction and consolidation of remission. The main predictive factors for IA in patients with HL and NHL were: prolonged lymphocytopenia (70% vs 48%), agranulocytosis (64% vs 71%), use of glucocorticosteroids as part of treatment protocol (61% vs 85%), presence of B – symptoms (63% vs 48%), respectively. In most cases nosocomial invasive aspergillosis was diagnosed in both groups: 65% vs 83% respectively. We identified etiological agents in Hodgkin and non-Hodgkin lymphoma patients: A. fumigatus (50% vs 39%), A. niger (43% vs 33%) and A. flavus (7% vs 8%). The lungs were involved in 100% cases, in group with NHL patients 6% had combined lesions in lungs and other organs and different types of tissues. Clinical manifestation of IA was nonspecific in both groups: fever – 83% vs 76%, cough – 75% vs 59%, respiratory insufficiency – 50% vs 40%, respectively. CT-signs of IA were also nonspecific in both groups: infiltrative (75% vs 66%), focal changes (61% vs 63%), and «ground-glass opacity» (28% vs 31%), respectively. In most cases patients were treated with voriconazole in both patients (88% vs 98%). Overall 12-weeks survival in patients with Hodgkin lymphoma and invasive aspergillosis was 84%, in patients with non-Hodgkin lymphoma and invasive aspergillosis – 81%.

The clinic-rentgenological differential diagnosis is difficult especially in case of localized mediastinal disease. Just detailed histological diagnosis allows making a right tactic decision and choosing effective therapy. Furthermore, some indolent B-cell lymphomas and T-cell lymphomas can arise in mediastinum. Mediastinal tumors are frequent in young adults, and most of these neoplasms are lymphoproliferative disorders. The spectrum of mediastinal lymphoma is broad. The most often of them are large B-cell lymphomas: classical Hodgkin lymphoma, primary mediastinal large B-cell lymphoma, diffuse large B-cell lymphoma and mediastinal grey zone lymphoma.

Antibiotic resistance of microorganisms is one of the most acute problems of modern obstetrics. The paper analyzes current antibiotic resistance. It considers the mechanisms of its formation and ways to overcome the resistance.

“The cost of illness” is a detailed index for assessing the socio-economic losses caused by illness and related disability and death in money terms. The indicator is used in a variety of tasks, including the prediction of the positive effect of the medical devices introduction planning of the complex of medical-diagnostic and preventive measures in the healthcare system. The authors discussed in detail the structure of containing cost of illness losses (costs) - direct, indirect and intangible, briefly describes the key techniques for assessing cost of illness. SWOT-analysis carried out in the paper proved that “strongs” and “opportunities” despite possible negative impact of the internal and external factors contribute to the successful use of the “cost of illness” indicator in a wide range of different applications. In an aspect of the problem the key indicators of the road transport situation in Russia are described and the comparison of some key performance indicators of road transport situation in the country and in the world was carried out. Using specific examples in the field of traffic injuries the expedieny of the effect of the cost of illness-consequence on the structure of the cost of illness-cause was shown. Based on the foregoing, the modification of the structure of “cost of illness” proposed, taking into account an additional element, which we called “additive” losses, determining the contribution of a disease or condition in the cost of the other, which is the root cause of it. In view of these results it was concluded that the economic “assessment of the cost” of various diseases in the context of their relationship is of interest both from a theoretical and applied perspectives, and deserves further detailed study.

Summary. Objective: to investigate the effectiveness and factors that can influence on surgical treatment of isolated recurrent ovarian cancer involving the liver. Materials and methods: A retrospective analysis of medical documentation of ovarian cancer patients, who underwent surgical removal of the recurrent tumors localized in the liver, performed in State Establishment «Zaitsev V.T. Institute of General and Emergency Surgery of the Academy of Medical Sciences of Ukraine» from January 2001 to December 2010 (n = 29). Results. Overall survival increased significantly while disease-free interval (DFI) increase (after primary cytoreduction) and optimal secondary cytoreduction is achieved. Median overall survival for DFI 24 months – 61 months (p

The article presents the results of analysis of the relevant publications and research works over the last 20 years, devoted to the value of radiation therapy in the treatment of low-grade gliomas. This literature review reflects the role and place of radiation therapy in the treatment of such patients according to the latest research data and modern standards of treatment developed by the most authoritative scientific institutes and international research groups.

The paper highlights the topical problems of nosocomial infection in the practice of obstetrics and perinatology. It systematizes procedures for controlling the occurrence of nosocomial infection and preventing its spread, such as identification of risk groups and risk factors and prerequisites for complications of epidemiological surveillance, as well as specific diagnosis in pregnant women. Group B streptococcus, one of the major pathogens of nosocomial infection, is described.

The paper considers the role of the immune system, endoplasmic network stress, metabolic dysregulation, and epigenetic mechanisms in the pathogenesis of essential hypertension, as well as the limited possibilities of therapy with existing antihypertensive agents.

The article is devoted to problem of pancreatic intra- and extrasecretory function impairment in patients with pancreatic cancer after a astropancreatoduodenal resection. New technical aspects of pancreatoenteroanastomosis were suggested to prevent its insufficiency.

The objective of research was to study the state of prooxidant and antioxidant systems in the tissues of the lungs, kidneys, pancreas and salivary glands at burn disease. The intensity of the free radical processes was evaluated on the basis of the content of malondialdehyde (MDA) and antioxidant system – based on the indexes of its enzymatic chain: superoxide dismutase and catalase in homogenates of the studied organs. It has been found that changes in experimental burn disease depend on the studied organs and the stage of burn disease. The activation of free radical processes observed in all investigated organs (lungs, kidneys, pancreas and salivary glands). Reactive oxygen species induce lipid peroxidation, which is a universal marker of tissue damage. MDA appears in the body during degradation of polyunsaturated fatty acids and it’s a marker of lipid peroxidation and oxidative stress. It was found the increasing of MDA in all organs, especially in the lungs and kidneys at stage of burn shock. Under these conditions it was observed the decrease of superoxide dismutase and catalase in all investigated organs. At burn disease there is development of disbalance between the action of prooxidant and antioxidant systems due to the activation of free radical processes.

In normal cell apoptosis and proliferation are strictly controlled by intra- and extracell mechanisms. These signals interfere with cell pathways through cell receptors, estrogen, progesterone, HER2/neu receptors in the case of breast cancer. Expression of apoptotic and proliferative genes is different in breast cancer depending on hormonal status. Besides correlation analysis shows different role of cell receptors in proliferation control in normal and breast tissue.

Early breast cancer (BC) diagnosis is a basis for overall and relapse-free survival improvement. But methods of X-ray and morphological examination sometimes are failed in BC diagnosis. New molecular markers may give more information about BC progression. One of these markers is mammaglobin. We studied 114 tissue samples: 57 I—IV stages BC samples and 57 samples of morphologically normal breast tissue (MNBT). mRNA mammaglobin expression was assessed by qPCR with reverse transcription. mRAN mammaglobin expression was significantly higher in BC samples as compared to MNBT (p = 0,0019), besides expression level decreased during BC progression: minimal level in T3 (p = 0,0338), grade 3 (p = 0,037) and stage IV (p = 0,035) tumors. hMAM expression correlated with steroid receptors (estrogen receptor, progesterone receptpor) in MNBT (p < 0.05), but not in BC tissue. hMAM mRNA expression decreased during BC progression and correlated with steroid receptors in MNBT. hMAM expression profiling may be used as a marker in BC diagnosis.

This review considers the classification of cardiorenal syndromes (CRS), the pathogenesis of heart failure, and a search for therapeutic targets for its treatment, biomarkers for heart and kidney failure, difficulties in therapy and reversion of the pathogenetic continuum of CRS, and promises for the use of some new technologies to treat this condition.

The review considers the results of studies of the psychosomatic aspects of rheumatoid arthritis (RA), which have been published in the past 5 years. In particular, there is evidence for the impact of chronic pain on the psychological status of patients with RA, for that of the disease on quality of life in the patients, their sociopsychological and interpersonal relationships; trials of the efficiency of additional treatment options for RA are given.

Retroperitoneal tumours arre rare and compose 0,01-0,3% of all tumours types. The basic method of retroperitoneal tumour treatment is surgical resection which is carried out in 43-95% of patients. In this study we present analysis of surgical treatment of 104 patients with retroperitoneal tumours. Complited resection was made in 87 patients (83,7%); partial surgical resection - in 7 patients (6,7%), explorative laparotomyes have been executed in 8 patients (7,7%), symptomatic operations - 2 patients (1,9%). Operability percentage - 88,1%. Resectobility - 90,3%. Level of an intraoperation and postoperation complications was 29,8% and hospital lethality - 4,2%. Analysis of surgical treatment direct resultstestifies to high indicators of operability of patients with retroperitoneal tumours resectobility. Surgical treatment of retroperitoneal tumours isn't accompanied with high frequency of postoperative complications and lethality.