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The article studies the issues related to the problem of sharing by two beneficiaries of a resource with a set of indivisible components. Several types of sharing that consider “envy” and realize it, including through compensatory payments to the beneficiary who does not get the corresponding indivisible component of the resource, have been noted. The difference between the values of possible bonuses at different types of sharing, which are received in addition to the values declared by the beneficiaries, and indivisible components when they are evaluated, has been determined. It has been found in which case it is more favorable for the beneficiary if “envy” is not considered, and vice versa. The method of setting the degree of preference of considering “envy” in the course of distribution of resource components has been proposed, assuming a preliminary agreement of beneficiaries on the use of this method. The result of using it has been analyzed, based on which recommendations to the beneficiaries are formulated, implying additional awareness not covered in the present study. In order to circumvent the issue of uninformedness, indications of one option of its solution have been presented, which can be considered also as possible future directions of research of stochastic nature.

The study aimed to investigate the bactericidal eŠcacy of high-intensity pulsed broadband irradiation in the treatment of infected wounds. An experimental study was conducted on 90 mature male Wistar rats. An infected wound model was created by contaminating with Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida albicans. Animals in Group 1 received high-intensity pulsed broadband irradiation. Animals in Group 2 received traditional UV irradiation. Animals in Group 3 had their wounds cleaned with 0.1% chlorhexidine solution. By the 3rd day of treatment, animals that received pulsed high-intensity broadband irradiation showed a signifiant reduction in contamination by Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa compared to Group 3. By the 7th day of treatment, half or the majority of animals in Groups 1 and 2 showed complete decontamination of wounds concerning Staphylococcus aureus and Klebsiella pneumoniae. Most animals in Group 1 showed complete wound clearance of Pseudomonas aeruginosa. By the 10th day, nearly all animals in Group 1 demonstrated complete decontamination of wounds. Statistical analysis revealed a signifiant difference in the reduction of wound contamination with Staphylococcus aureus and Klebsiella pneumoniae by the 10th day in Groups 1 and 2 compared to Group 3. Thus, the use of high-intensity pulsed broadband irradiation of wounds reduces the degree of pathogenic microorganism contamination in a shorter time frame.

Державна реєстрація актів цивільного стану є одним із форм публічних послуг у сфері адміністративного права. Публічно-сервісна спрямованість органів виконавчої влади та органів місцевого самоврядування є пріоритетною у процесах децентралізації, які відбуваються сьогодні в Україні. У центрі уваги реформи місцевого самоврядування – людина і, як один з важливих факторів комфорту її життя, є надання якісних адміністративних послуг. Кожного дня в Україні народжуються діти, хтось одружується, хтось розлучається, а хтось помирає. Попри всі труднощі, які є на сьогоднішній день, послуга у сфері державної реєстрації актів цивільного стану є найпоширеніша серед громадян України. Збройна агресія Російської Федерації проти України внесла багато коректив як в наше буденне життя так і життя країни загалом. Законодавець попри всі виклики, намагається полегшити бюрократичні процедури, зокрема і у сфері реєстрації актів цивільного стану. Активно впроваджуються новітні технології, вносяться зміни та доповнення до законодавства у сфері державної реєстрації актів цивільного стану. Незважаючи на значний прогрес законодавства у сфері реєстрації актів цивільного стану, на практиці виникають деякі труднощі, особливо у ситуаціях державної реєстрації шлюбу або розлучення, коли одним з подружжя є військовослужбовець, або якщо один з подружжя перебуває за кордоном, або в зоні активних бойових дій, або на тимчасово окупованих територіях України. Щодо тимчасово окупованих територій то на жаль протягом 10 років збройного конфлікту Україна так і не змогла спростити процедуру легалізації актів цивільного стану виданих на тимчасово окупованих територіях України. У звʼязку з цим, громадян України повинні звертатись до суду аби визнати факти, які мають юридичне значення. Тому необхідно аби законодавець урегулював проблемні питання, які з питанням державної реєстрації актів цивільного стану.

Background. Pancreaticoduodenal resection (PDR) is the surgical procedure for cancer of the head of the pancreas, distal common bile duct, duodenum and ampulla of Vater. This surgery is associated with a high risk of complications, the development of which can be influenced by various factors. since pancreatic fistula is a key complication of PDR, the choice of the method for pancreatic anastomosis becomes especially important. Material and methods. The search for publications was carried out using the PubMed and Elibrary systems from January 1980 to January 2024. of the 2,300 sources found, 69 were used to write the review. We included data from both retrospective and prospective clinical trials that were devoted to pancreatoduodenectomy for malignant neoplasms, the difficulties encountered in performing this surgery and ways to solve them. Results. Currently, there are more than 60 types of pancreatico-digestive anastomosis, which indirectly indicates the absence of a universal one that ensures the prevention of pancreatic fistula. The treatment outcomes may be influenced by the nature of neoadjuvant treatment, concomitant diseases, anatomical features, presence of obstructive jaundice and methods of its relief. The main mechanisms of influence of negative factors on the development of complications are considered. an individual approach to the patient, taking into account all factors, can significantly reduce the risk of complications.

BACKGROUND: Among different subtypes of pancreatogenic diabetes mellitus the biggest difficulties of glycemic control arise in patients after total duodenopancreatectomy (TDPE), first of all due to the presence of absolute insulin insufficiency.AIM: Estimating safety and cost-effectiveness Guardian Connect CGM system in early postoperative period in hospitalized patients after TDPE on continuous intravenous insulin therapy (CIVIT).MATERIALS AND METHODS: Glucose measurement results of 26 patients in early postoperative period after TDPE were analyzed. In 12 of them, we used Guardian Connect CGM system. In this group 43 cycles (1 cycle — 6 days, 258 days total) of CGM and 971 glucometer measurements used for CGM calibration were analyzed; in other 14 patients in whom only glucometer was used we analyzed 2496 glycemic values.Cost-effectiveness was calculated over 6 days for CGM and only glucometer use (including cost of CGM, glucometers, disposable materials, clinic wage-costs to medical staff for time required for glucose control).RESULTS: Glucose levels of group #1 were in the target range 5.6 to 10.0 mmol/L (66.7 vs 61.2%, p=0.003) and the range 4.3–11.6 mmol/L (85.2% vs 82.2%, p=0.038) more than in comparison with group #2.The frequency of hypoglycemic episodes (

The article touches upon issues related to the tasks of the national project «Smart City». The paper analyzes the problem of supplying a conditional consumer with heterogeneous products in accordance with his demand for deliveries from several suppliers in a situation with fixed surcharges, in addition to the cost of purchasing each unit of production. For the situation under study, a model of a reduced transport type with a discontinuous piecewise linear objective function of minimized total costs and with a system of linear constraints is constructed. A method for finding the optimal solution one of the many such solutions, based on the ideas of the Hungarian algorithm is proposed, the justification of which is given on the basis of the corresponding lemma. A refinement of the method is presented in the presence of some restrictions related to suppliers. The polynomial complexity of the method, i.e. the problem is quickly solvable, and the significant limitation of the applicability of the method within the framework of the model are noted. Further possible research directions of a stochastic or fuzzy nature are indicated.

Актами цивільного стану є дії та події, які виникають та започатковують, змінюють, доповнюють або припиняють нерозривно повʼязані з фізичною особою та можливістю бути субʼєктом цивільних прав та обовʼязків. До державного реєстру актів цивільного стану громадян в обовʼязкому порядку вносяться відомості: про народження; про усиновлення; про позбавлення та поновлення батьківських прав; про реєстрацію шлюбу; про розірвання шлюбу; про зміну імені; про смерть фізичної особи. Уповноважені органи, які наділені повноваженнями здійснювати державну реєстрації актів цивільного стану є органи державної реєстрації актів цивільного стану (центральний орган виконавчої влади у сфері державної реєстрації актів цивільного стану, відділи державної реєстрації актів цивільного стану Головного управління юстиції Міністерства юстиції України в Автономній Республіці Крим, головних управлінь юстиції в областях, містах Києві та Севастополі, районних, районних у містах, міських (міст обласного значення), міськрайонних управлінь юстиції (надалі – ДРАЦС); виконавчі органи сільських, селищних рад та міських, які не відносяться до міст обласного значення), та дипломатичні представництва і консульські установи України. Актовий запис цивільного стану – це державний документ уповноваженого органу здійснювати державну реєстрацію актів цивільного стану, в якому міститься персональні відомості про особу та підтверджує факт здійснення такої дії або події. Протягом останніх двох років держава значно спростила державну реєстрацію актів цивільного стану. Так зокрема передбачена можливість подачі заяви про реєстрацію шлюбу через Єдиний державний веб порталу електронних послуг (Портал «Дія»), також якщо одним з подружжя є військовослужбовець державна реєстрація шлюбу може проводитися відділами державної реєстрації актів цивільного стану без особистої участі такого нареченого (нареченої), та можливість державної реєстрації актів цивільного стану у дипломатичних установах. Повномасштабне вторгнення РФ в Україну спровокував безпрецедентний потік українців, які були вимушені внаслідок бойових дій тікати з України за кордон. За інформацію Омбудсмена України станом на 2022 рік за кордон виїхало 14,5 мільйона українців. Точні дані зʼясовуються. Однак, багато громадян, які перебувають за кордоном зіштовхуються з проблемами, щодо державної реєстрації актів цивільного стану у дипломатичних установах, що унеможливлює їх повноцінно реалізувати своє право.

Background. Colorectal cancer is among the most lethal and prevalent malignances in the world. The management of localized colorectal cancer is highly debated. Surgical resection of the rectum, such as total mesenteric excision (TME) is usually associated with significant morbidity and mortality. The integration of various chemotherapy options into the standard treatment of localized rectal cancer could potentially enhance the tumor control with a subsequent reduction in the frequency of recurrence, thus improving overall and disease-free survival. Moreover, there are categories of patients for whom surgical treatment is contraindicated and chemotherapy will be more useful for them. Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for elderly patients with comorbidities; therefore this issue remains a matter of debate.Aim. We aimed to consider alternative approaches to the treatment of localized rectal cancer and the management of selected patients with this diagnosis.Material and Methods. We searched for publications in the Pubmed, eLibrary databases and up-to-date information on the basis of world cancer associations.Conclusions. Comparison of surgery with concurrent chemoradiotherapy for localized rectal cancer showed that in some cases neoadjuvant therapy can be useful and successful, acting as an ideal alternative. However, this approach may be suitable for selected patients who meet certain criteria. In addition, a follow-up care after treatment should include a specific range of diagnostic imaging tests.

The problem of laryngeal papillomatosis remains unsolved for a long time in spite of a number of proposed treatment techniques. Frequent relapses, persistent hoarseness, repeated surgical intervention, all these call for new solutions. The article describes the findings of the study involving 50 patients of advanced age with laryngeal papillomatosis who were treated with a new method at I.M. Sechenov First Moscow State Medical University and leading clinics of the Moscow region.

A new way of developing a mathematical model of the dynamics of the factors forming the considered social, political, economic, ecological or other space of life activity of society, depending on local changes in parameters affecting these factors, is presented. A feature of the proposed approach is the use of a matrix of marginal values included in the study that make up the Jacobi matrix of noted factors. The dependence of the factors describing the socio-economic system on the parameters of the model is obtained in explicit form. Under certain conditions, the described relations have the form of mappings close to extension. A generalized assessment of these transformations is proposed. Accounting for this assessment is important for preventing crisis phenomena. The model is intended to be used for informational, forecasting, management and governance purposes in the presence of a sufficient digitalization’s degree of public structures, without which it is problematic to receive and transmit data for building the model, and perform related calculations.

Aim. Search and selection of microorganisms with active enzymatic properties for possible biodestruction of pyrethroids.Materials and Methods. For effective screening and selection of the most active isolates, for the subsequent development of biotechnological methods for the destruction of pesticides and reduction of their toxicity, samples of the phylosphere and rhizosphere of agricultural crops, food products, etc. were taken. The isolates were evaluated by intracellular metabolism and the production of exoenzymes. The isolated microorganisms were identified on the basis of the "Bergi Bacteria Determinant". Screening of microorganisms for the development of biotechnological methods to reduce the toxicity of ecotoxicants included the following stages: selection of sources, sampling, seeding on a dense medium for isolation of pure culture, replanting of pure culture and investigation of biological properties of isolated strains.Results. In order to search for microorganisms capable of utilising pyrethroids, isolates of microscopic fungi and bacteria were obtained. Of the 23 selected strains, 12 had the widest spectrum of activity, while 5 strains showed the most pronounced and stable antagonistic activity against pathogenic microorganisms at various temperature parameters from 30°C to 42°C (Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus). For the selected strains, the environment was optimised to activate cellular metabolic processes. The activity of amylases, proteases, xylanases and cellulases of the fungus Trichoderma, and proteases of L. plantarum, L. lactis, B. subtilis and Propionibacterium was evaluated. Studies of the effect on the synthesis of hydrolytic enzymes of various concentrations in the culture medium in the presence of xylan polysaccharides, cellulose, starch and casein protein were carried out.Conclusion. Toxicological studies of the selected isolates and of a composition consisting of these isolates in the form of a culture suspension on the simplest stylonychia were carried out. Biotesting on isolated aquatic microorganisms (Trichoderma, L. plantarum, L. lactis, B. subtilis and Propionibacterium) showed that the percentage of dead infusoria (S. mytilus) in both the experiment and the control showed no significant differences. A microbiological composition has been created that can be used to protect the environment when exposed to toxicants of agrotechnogenic origin. The selected strains were tested for the possibility of biodegradation of pyrethroids using the example of cypermethrin.

Background. An increase in the incidence of optic neuritis (ON) among the workingage population, the complexity of etiological diagnosis and the choice of adequate etiotropic therapy, as well as a disappointing prognosis for vision due to the development of optic nerve atrophy determines the high social significance of this problem.The aim. Comprehensive clinical, functional, morphometric and laboratory-immunological evaluation of results of using the drug Imunofan® in combined treatment of ON associated with herpesvirus infection (HVI).Materials and methods. The study involved 39 people (39 eyes) with acute ON associated with HVI. The standard treatment regimen for the patients included the appointment of solutions: dexamethasone in a decreasing scheme, a 1 % Emoxypine® preparation 0.5 ml and 12.5 % Dicynone® preparation 0.5 ml through an irrigation system implanted into the retrobulbar space, with subsequent appointment of medicinal means of neuroprotection (Picamilon® and Semax®). All patients were divided into two groups. The main group – 22 patients, whose standard inpatient treatment was supplemented with intramuscular administration of the drug Imunofan®, 50 μg daily for 10 days. The control group consisted of 17 patients, who were treated only according to the standard method.Results. Analysis of obtained data showed that more significant positive dynamics was noted in patients of the main group.Conclusion. The clinical efficacy of the drug Imunofan® in the complex therapy of ON associated with HVI was characterized by relief of signs of inflammation in the optic nerve in the main group immediately after the end of the course of treatment, while in the control group – only after 3 months; an increase in the best corrected visual acuity by 1.3 times, a decrease in the incidence of postneuritic optic nerve atrophy at a follow-up period of 12 months.

Chronic rhinosinusitis with nasal polyps (CRSP) is a heterogenous disease. We have earlier detected differences in severity of clinical manifestations, cellular infiltration degree shown in nasal polyps, of eosinophil-to-neutrophil ratio, efficacy of intranasal glucocorticosteroid baseline therapy, and various inflammatory patterns for several cytokines on the mRNA expression level in different phenotypes with isolated CRSP cases, CRSP associated with respiratory allergy (RA), or non-allergic bronchial asthma.The purpose of this work was to study the cytokines of TGF-â family in the tissues of nasal polyps in patients with different CRSP phenotypes. The research involved 292 patients suffering from CRSP divided into 3 phenotypic groups. Group I consisted of patients with isolated CRSP free of associated BA and/or sensitization to atopic allergens. Group II included patients with CRSP combined with respiratory allergy and was further divided into two subgroups. I.e., Group 2a comprised patients with CRSP, allergic BA (aBA), and allergic rhinitis (AR), while the patients with CRSP, AR, and non-allergic BA were placed to the group 2b. The patients suffering from CRSP complicated with non-allergic BA were allocated to the group III. The patients with hypertrophic rhinitis served as control. The levels of TGF-â1, TGF-â2, and TGF-â3 proteins (pg/mg) were measured by means of multiplex immunoassay approach in supernates of tissue homogenates from nasal polyps removed by surgery, and in posterior parts of inferior nasal conchae. The total protein level was determined in tissue supernatant, with cytokine contents recalculated for the mg/ml protein concentration for standardization of measurements.In the control group, trace concentrations of all three growth factors were detected. Significant difference in protein contents was found for the studied cytokines, depending on CRSP phenotype. The levels of TGF-â1 and TGF-â2 were statistically lower in isolated CRSP than in other groups of comorbid CRSP patients. TGF-â1 and TGF-â2 concentrations were significantly lower in CRSP + allergic BA group IIa than in CRSP + nonallergic BA and CRSP + RA groups. The amount of TGF-â3 cytokine was maximal in CRSP + non-allergic BA group III compared to the patients with isolated CRSP of group I and CRSP + non-allergic BA group 2a.Conclusions.The high level of all three TGF-â isoforms in patients with CRSP compared to the control group suggested a high potential of mucous membranes of paranasal sinuses for active tissue remodeling followed by nasal polype formation.Different mechanisms were presumed for development of local pathological process in different clinical phenotypes of CRSP, depending on the comorbid pathology, especially, BA or respiratory disorders.Minimal TGF-â1 and TGF-â2 levels were detected in isolated CRSP.The highest concentrations of TGF-â1, TGF-â2, and TGF-â3 were discovered in the patients with CRSP accompanied by non-allergic BA as compared to the groups with isolated CRSP and CRSP+allergic BA.5. Determination of TGF-â1, TGF-â2, and TGF-â3 levels can serve as an additional criterion for differentiating between the mechanisms of mucous membrane damage in local pathological process in tissues of comorbid patients with different CRSP phenotypes.

Introduction. The problem of corruption has acquired a particular importance in light of ubiquitous corruption scandals, entangling both developing and developed countries. Currently, a number of often contradicting hypotheses has been posed on the ways corrupt practices impact protest potential of a society and stability of a political system, as well as on the role of anti-corruption policy in the alleviation of such impact. This article aims to survey and compare different researches analyzing the impact of corruption and anti-corruption policies on different aspects of modern Russian society; in particular, their impact on protest potential and political stability. The author’s hypothesis lies within the assumption that The System anti-corruption policy, which is a prioritized instrument for political and administrative activities of state and municipal authorities in the prevention of corrupt practices, significantly reduces the extent of protest potential and facilitates political stability in a society.Methodology and sources. Methodological basis of this article is a multiparadigm approach to studying the phenomenon of corruption. As part of this research, a raft of empirical research conducted by domestic and foreign authors has been analyzed (E. M. Uslaner, P. Heywood, J. Rose et al.). Authors also use the results of an internet survey conducted with 580 participants (predominantly students of Russian universities) in 2020. The respondents were self-selected, convenience sampling. Manifold research and sociological surveys demonstrate the difficulty of generalizing the results.Results and discussion. Substantial amount of empirical data reflects an adverse effect of corrupt practices on the livelihood of a modern society. These practices entail the decrease in GDP growth rates, avert domestic and foreign investments, amplify social and economic inequality, decrease tax revenue and lead to social welfare underfunding. It ultimately results in the lack of public trust towards state institutions as well as the decrease of generalized trust. Even though there is a positive correlation between endemic corruption and political volatility, the results of other research cast doubt on the extent to which corruption may influence economic development and political stability.Conclusion. In general, the conducted research has allowed for the inference that the prevalence of corrupt practices may either amplify social instability and increase the protest potential or it may have no influence at all on political activity of a society and stability of political regime. At the same time, the implementation of anti-corruption policies by the authorities significantly reduces the level of protest potential and fosters political stability.

Purpose. To assess increasing the functional effectiveness of the results of endovitreal surgery in patients with rhegmatogenous retinal detachment (RRD) by using modern pharmacotherapy drug in the postoperative rehabilitation.Material and methods. 108 people (108 eyes) with RRD. All patients underwent standard three-port vitrectomy, after which tamponade of the vitreous cavity with silicone oil with its removal 3 months after operation was performed. Patients were divided into 2 groups: the first – 60 people who received Cytoflavin on the background of standard therapy, and the second – 48 people with postoperative treatment only with standard therapy. Depending on the visual prognosis calculated before the operation, both groups were represented patients with satisfactory (A subgroup) and low (B subgroup) visual prognosis. Laser Doppler fluometry (LDF) was used to study chorioretinal microcirculation: microcirculation index and microcirculation efficiency index were recorded. Using OCT angiography (OCT-A), signs of macular ischemia were investigated: choroidal thickness, area nonperfusion of foveal avascular zone, density in the superficial capillary plexuses and density in the deep capillary plexuses in the macular area.Results. The inclusion of Cytoflavin in the postoperative rehabilitation of patients with RRD increases the possibility of a favorable functional outcome of the operation, affects the positive dynamics in the state of the capillary plexus in the macula. In the aggregate of patients of the 1st group, the increase in visual acuity was 2 times higher than in patients of the 2nd group 6 months after surgery. Also, in patients of the 1st group there was a more significant activation of chorioretinal blood flow according to LDF and OCT-A.Conclusion. The prescription of Cytoflavin in the postoperative treatment of patients underwent endovitreal surgery of RRD, regardless of the visual prognosis, increases the functional outcome of the operation. Improvement in visual functions in patients receiving Cytoflavin therapy is directly related to improved intraocular blood flow and macular perfusion.

The article proposes methods of searching passenger travel routes in conditions where one or more optimization criteria must be taken into account in the presence of a pedestrian system and multi-type transport systems with their topologies, sets of parameters and tariff plans. The author carried out the research by means of mathematical modeling of the transport system in the form of its deterministic graph model. The author chose Dijk-stra's algorithm as the basic algorithm, on the basis of which the modifications of the previous ones were carried out and the construction of a new search technique was carried out. As a result, the study obtained algorithms for solving single-criteria and multi-criteria problems on graphs. For multicriterial problems, the author used the convolution method and the method of ordering criteria by the degree of decreasing their significance. The field of application of the developed algorithms is information systems focused on the end user and on the structures that design and manage transport networks.

Purpose. To study clinical, statistical, anatomical, optical and functional properties of primary keratoectasia (PKE) in patients living in Far Eastern Federal District of Russia.Material and methods. A retrospective analysis of medical outpatient cards of 481 patients with PKE who observed in the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution. We studied the detectability of PKE over the years, their quantitative structure and staging, visual acuity, refraction, maximum keratometry-readings and minimum corneal thickness.Results. Keratoconus (KC) occurred in 445 (92.5%) patients, pellucid marginal degeneration (PMD) occurred in 36 (7.5%). Among patients with KC, it was observed in 309 (69.4%) men and 136 (30.6%) in women. PMD was diagnosed in 19 (53%) men and 17 (47%) women. In 386 (86.7%) people with KC, the lesion was bilateral. Among the remaining 59 patients with KC, 6 people (1.3%) had a one-sided process, and 53 (12%) patients had signs of subclinical KC in the second eye. Bilateral PMD was detected in 35 (97%) people, in one (3%) patient the disease was detected in one eye. At comparable average values of refraction and corneal thickness in eyes with PMD and KC 1st stage, astigmatism-at PMD were 2–2.5 times greater.Conclusion. Among patients with KC, 34.9% eyes have the 2nd stage of the disease, in which visual acuity are already sufficiently reduced, and 28.5% eyes have KC the 3rd and the 4th stage and can be classified as visually impaired. The revealed differences in ratio of functional and refractive indexes of eyes with KC and PMD necessitate wider study of their diagnostic features and results of treatment latter.

Purpose. In prospective research to assess clinical efficacy of different surgical treatments for patients with chronic ocular ischemic syndrome (COIS) associated with hemodynamically significant internal carotid artery stenosis (ICAS).Material and methods. The research included 20 patients with 3rd degree severity COIS. Patients were divided into 3 groups due to type of their treatment. 1st group – 7 patients; only carotid endarterectomy (CE) of ICAS was performed; 2nd group – 6 patients; panretinal photocoagulation (PRP) of retina was performed; 3rd group – 7 patients; combined treatment: PRP of retinal capillary non-perfusion areas was performed by the 1st stage, then after 2 weeks by the 2nd stage CE was performed. All patients underwent standard and specialized ophthalmologic examination methods. Assessment of blood flow in brachiocephalic vessels, vessels of eye was performed by ultrasound scan, spiral computed tomography, fundus fluorescein angiography.Results. Monitoring of groups of patients for 1 year depending on type of treatment of COIS, allowed us to determine tactics of patients management and features of the postoperative period. CE at hemodynamically significant ICAS caused positive dynamic in intraocular blood flow, which contributed to improvement and preservation of best corrected visual acuity in 71% of patients; preventive PRP of retina, before performing reconstructive surgery of ICAS, optimized and reduced the time of visual recovery. PRP of retina as independent method of treatment of COIS, complicated by neovascular glaucoma, caused full or partial regression of neovascularization in iris, which increased possibilities of its effective treatment.Conclusion. Combined staged treatment of COIS associated with hemodynamically significant stenosis, which including PRP of retina and CE of ICAS, allows to stop the progression of ischemia in retina and to avoid complications, leading to loss of vision, and can be recommended for use in clinical practice for the treatment of COIS. PRP of retina can be use to stabilize process at impossible to perfomed CE. Surgical reconstruction of the ICAS, despite restoration of blood flow in ophthalmic artery, can aggravate processes of ischemic damage to the neurosensory layer of the retina with decreased vision.

Purpose: to study the effect of differentiated treatment approach in patients with varying degrees of severity chronic ocular ischemic syndrome (OIS) on clinical course of disease and hemodynamics of eyes in prospective research.Patients and methods. The research included 20 patients with chronic OIS. Patients were divided into 4 groups due to severity of chronic OIS and type of treatment. 1st group — 7 patients with moderate severity chronic OIS and hemodynamically significant of internal carotid artery stenosis (ICAS); only carotid endarterectomy (CE) of ICAS was performed. 2nd group — 6 patients with severe degree chronic OIS and hemodynamically significant stenosis of ICAS; 2 weeks before CE, panretinal photocoagulation (PRP) of retinal capillary non-perfusion areas was performed. 3rd group — 4 patients with severe degree chronic OIS, complicated by rubeosis iris and increased IOP on hypotensive regimen, on the background of hemodynamically insignificant ICAS; PRP of retina was performed. 4th group — 3 patients with moderate severity chronic OIS with hemodynamically insignificant ICAS; course of neuroprotective therapy was performed. All patients underwent standard and specialized ophthalmologic examination methods. Assessment of blood flow in brachiocephalic vessels, eye vessels was performed by ultrasound scan, spiral computed tomography, OCT-angiography with the AngioVue.Results. Monitoring of patients’ groups for 1 year after chronic OIS treatment allowed us to determine tactics of patient management depending on degree of ICAS and severity of chronic OIS. Reconstructive surgery at hemodynamically significant ICAS caused positive dynamic in intraocular blood flow, which contributed to improvement and preservation of BCVA in 71 % of patients. Preventive PRP of retina, before performing reconstructive surgery of ICAS, optimized and reduced the time of visual recovery. PRP of retina as independent method of treatment of chronic OIS, complicated by neovascular glaucoma, caused full or partial regression of neovascularization in iris, which increased possibilities of its effective treatment. Neuroprotective pharmacotherapy in early stages of chronic OIS, in absence of indications for reconstructive surgery and PRP of retina, improved the prognosis for patients’ vision.Conclusion. Differentiated treatment approach in patients with chronic OIS, due to changes of hemodynamics of internal carotid artery, has improved indexes of hemodynamic and visual acuity.

Background: Management of the isolated form of cystic dystrophy of the duodenal wall (CDDW), or pure form of groove pancreatitis, is controversial. Pancreatoduodenectomy is considered to be the most suitable procedure for CDDW. Pancreas-preserving procedures (PPDR) have been described as surgical options for the cases where only the duodenum has been involved. There are no studies comparing pancreas-preserving vs. pancreas-resecting procedures for this disease.Aim: To analyze the results and outcomes of PPDR and other treatment approaches to CDDW and to review the literature.Materials and methods: We performed a retrospective analysis of 82 patients with CDDW who received treatment from February 2004 to April 2019. We compared short-term and long-term results of treatment of 15 patients with isolated CDDW after PPDR and 42 patients with CDDW after pancreatoduodenectomy.Results: The preoperative diagnosis was correct in 81 of the cases (98.8%). The patients experienced abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Twelve patients with CDDW took conservative treatment due to rejection of the operation. The other patients underwent cystoenterostomies (8), duodenum-preserving pancreatic head (DPPH) resections (6), pancreatoduodenectomy (42) and PPDR (15) with zero mortality. Full pain control was achieved after PPDR in 93%, after pancreatoduodenectomy in 83%, and after draining procedures in 18% of the cases. Newly onset diabetes mellitus (7) and severe exocrine insufficiency (5) were common after pancreatoduodenectomy and never occurred after DPPH resections and PPDR. Weight gain was significantly higher after pancreatoduodenectomy and PPDR, compared to other treatment modalities.Conclusion: PPDR is the optimal surgical procedure for the isolated form of CDDW. Early detection of CDDW allows for preservation of the pancreas. The pure form of groove pancreatitis is a disease of the duodenum, and the Whipple procedure should be considered excessive for this disease.

Purpose. Estimate of clinical efficacy of combined use of aflibercept and meldonium at tachyphylaxis of neovascular age-related macular degeneration (nAMD) to ranibizumab. Patients and methods. Comparative analysis of treatment results of nAMD in 25 eyes (25 patients) aged from 52 to 79 years was carried out. Main criterion for the patients inclusion was presence of nAMD resistant to intravitreal injections (IVI) of VEGF inhibitor ranibizumab with visual acuity values of not less than 0.1. Patients with different ophthalmologic pathology, accompanied by development of macular edema, with glaucoma and after any eye operations, performed during study period, were excluded from study. Before using aflibercept, all patients were treated with ranibizumab for 1.5–2 years (from 5 to 7 injections). The lack of persistent positive result was cause for change of course treatment of this patients on aflibercept (3 monthly injections) for enhance anti-vasoproliferative effect. The patients were divided into two groups — main and comparison, comparable by sex, age, visual acuity and type of choroidal neovascularization. In the main group, 3 aflibercept IVI were supplemented parabulbar injections of 0.5 ml of meldonium (with concentration of 500 mg / 5 ml) daily for 10 days. Patients of the comparison group did not receive meldonium. Results. The supplement of meldonium in the main group, relative to the comparison group, led to increase in 1.5 times of best corrected visual acuity, in 1.2 times of b-wave amplitude of the electroretinogram, preservation of the neuro- and pigment epithelium of retina, complete regression of neovascularization. Conclusion. Findings results evidence about clinically advisable to use meldonium in course treatment in patients with nAMD, resistant to ranibizumab, with aflibercept IVI for increase visual functions and stabilize the degenerative changes in neurosensory retina, pigment epithelium and choriocapillary layer.

Purpose. The analysis of clinical efficacy of combined treatment of pellucid marginal degeneration (PMD), which included the implantation of intrastromal corneal ring segments (ICRS) and corneal collagen crosslinking (CXL).Material and methods. The analysis of results in the treatment was carried out in 12 eyes of 7 patients with PMD. A quantity and characteristic parameters of the implantable ICRS were determined using the own method of calculation based on keratotopography data. After 3 months, the procedure of local CXL was performed. The follow-up period was 1 year. In the process of observation the parameters of uncorrected (UCVA) and best corrected (BCVA) visualacuity, spherical equivalent and cylindrical component of subjective refraction were examined on the 1st day, 3 and 12 months after the start of treatment. At the same time the keratotopography data were analyzed – the cylindrical component and maximum keratometry and their dynamics. Keratopachymetry and endothelial cell density were examined before treatment, and 3 and 12 months after the treatment.Results. On the 1st day after the ICRS implantation, the refractive effect of operation varied from 7.0 to 10.5D (mean 7.6±2.1). A slightly decrease of refractive effect, which did not affect the functional results, was noted 3 months after operation before CXL. After CXL at the end of the follow-up period, the refraction of the cornea remained stable. An UCVA increase compared with the baseline by an average of 0.28±0.09, and for BCVA – by 0.09±0.05 was observed already on the 1st day after the ICRS implantation. One year after beginning of treatment, the UCVA increased by 0.32±0.18, BCVA – by 0.32±0.11 and amounted respectively 63.5±17.3% and 83.8±12.5% of retinal visual acuity before the treatment. At the same time, the parameters of keratopachymetry and endothelial cell density practically did not change after the performed treatment.Conclusion. The performed analysis showed a high efficiency and a safety of the combined treatment of PMD in the correction of refractive disorders, characteristic for this disease that allowed an increase in visual acuity of operated eyes and to ensure their stability for 1 year of follow-up period. Long-term results of proposed method require a further study.

Background. Annual disability index among patients with rheumatogenic retinal detachment (RRD) is 2–9 %. One of the factors, causing the development of morphofunctional disorders of macula, is the change in intraocular hemodynamics. Aim: substantiation of rational timing of neuroprotection with cytoflavin depending on the prediction of visual functions after endovitreal surgery of RRD.Materials and methods. There were 21 patients (21 eyes) with RRD. A three-port vitrectomy with silicone tamponade and its subsequent removal was performed. Two groups of patients: the 1st group – 10 patients with tolerable prediction of restoration of visual functions (increasing of visual acuity to 0.4–0.2 relative units), the 2nd group – 11 people with low level of visual prognosis (increasing of visual acuity to 0.15 and lower). All patients received cytoflavin at both stages of surgery. We used laser doppler flowmetry (microcirculation index (MI) and microcirculation efficiency index (MEI)). The criteria of “sufficiency” of cytoflavin receiving was periods of recovery of MI and MEI to indexes that were not significantly different from the norm.Results. Dynamics of response of chorioretinal microcirculation at both stages of endovitreal surgery of RRD was unidirectional. At the same time, the indexes of MI and MEI under influence of cytoflavin in patients with tolerable level of visual prognosis reached maximum index at the 15th day of observation as at the stage of silicone oil tamponade and after its removal; and in patients with low level of visual prognosis only at the 25th day of observation.Conclusions. Therapy with cytoflavin neuroprotection in patients after endovitreal surgery of RRD leads to significant increase of indexes of chorioretinal blood flow. The period of cytoflavin treatment justified until achievement of the required positive dynamics of chorioretinal microcirculation depending on the level of visual prognosis: tolerable – 15 days, low – 25 days.

The work discusses modern issues of etiopathogenesis, treatment of chronic pharyngitis. The results of the application of a modern method for the diagnosis of mass spectrometry of microbial markers (MSMM), which allows to detect the microorganisms in a biofilm, in a “sleeping state” under the protection of mucin are presented. With the help of this express method, it is possible to conduct a determination of the content in a smear from the pharynx 57 biomarkers of microorganisms at the same time 2 hours after delivery to the laboratory. It was found that 100% of the examined patients with a recurring course of HF (n = 62) increased the total content of microorganisms, which indicates the need for antibacterial therapy; 87% of patients have elevated levels of endotoxin, which is a sign of general intoxication; 71% of patients have reduced plasmalogene content and these patients may be at increased risk for lipid metabolic disturbances; in 100% of the examined patients with frequent exacerbations of CP in the pharynx the nasopharyngeal microflora (coccal) is determined, as well as new etiopathogenetically significant microorganisms (not detected by PCR and cultures), among which there are 7 transient microorganisms (normally in the orifice their level = 0), 11 resident (6- found in the throat in the norm in the minimum level and 5 in the high content). Also, with the help of MSMM, a significant or moderate increase in the content of herpes, cytomegalovirus was detected in the majority (75%) of patients, which indicates the important role of the viruses of the herpes group in the etiopathogenesis in the recurrent course of CP; level of Candida spp. elevated in half of patients; the content of normal microflora is increased in 71% of patients, which indicates the preservation of local resistance in patients with chronic HF, examined by the authors. Thus, the use of MSMM for chronic fever allows to identify new etiopathogenetic microorganisms, on this basis to prescribe a more effective therapy. Thus? it is possible to carry out personified, more effective treatment.

The Russian consensus on exo - and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo - and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

Aim of investigation. To study early outcomes of surgical treatment of intestinal obstruction of neoplastic origin. Material and methods. Overall 730 patients operated for acute bowel obstruction of neoplastic origin for the interims of 1993-2005 and 2010-2016 were studied. All operations were carried out urgently for decompensated intestinal obstruction within 1 day after admission to medical institution. Urgent operations were performed according to oncologic treatment principles in the same way as elective surgery. Results. In 603 of 730 patients (82.6%) the tumor was localized distally to the transverse colon. Early postoperative motility for the period of 1993-2002 was 22.8%, for the period of 2011-2016 - 10.2%. The rate of primary radical interventions in the general framework of operations was 88.3%. Conclusions. Original approach to colorectal cancer surgical treatment complicated by acute large-intestinal obstruction resulted in significant decrease in early post-operative motility. Successful performance of radical operations at the first treatment stage considerably facilitates further treatment, social and medical rehabilitation.

It is appropriate and necessary to examine the functional state of the autonomic nervous system and the quality of life in patients with cholelithiasis using the mathematical analysis of the heart rhythm at the present-day level. Materials and methods: 136 patients (115 women and 21 men) were examined, of which 70 patients after cholecystectomy with cholelithiasis and 66 patients with cholelithiasis. Fractional chromatic minute-type duodenal intubation with an analysis of the biochemical and microscopic composition of the bile was used to assess the biliary system condition. The examination of the autonomic nervous system was carried out by determining the heart rhythm using the cardiointervalography method with further mathematical analysis of the structure and variational pulsometry. Changes in the autonomic status in patients with cholelithiasis before and after cholecystectomy differ in general patterns: adaptive possibilities decrease and sympathetic activity of the autonomic regulation increases. An increase in the lithogenicity of bile, which positively correlates with the level of sympathicotonia, is characteristic for patients with cholelithiasis before and after cholecystectomy. The autonomic regulation in patients with cholelithiasis after cholecystectomy improves, however, the high bile lithogenicity persists.

Purpose. Analysis of visual functions in children in remote postoperative period after laser coagulation (LC) of threshold stages of retinopathy of prematurity (ROP).Patients and methods. In 2017, we selected and investigated 18 children, who previously had an LC of threshold stages of ROP in 2008–2009 in the Khabarovsk branch of the S.N. Fyodorov State Institution Eye Microsurgery Complex (continuous sampling method). There were 5 boys and 13 girls aged from 8 to 9 years at the time of LC. Anterior and posterior eye segments of the eyes (biomicroscopy, ophthalmoscopy), visual acuity, clinical refraction, concomitant pathology were evaluated.Results. We have revealed that regressive ROP after LC is characterized by the presence of serious anatomical and functional changes in the eyes. First, these are refractive disorders, which revealed in 90.5% of cases. Most often revealed: myopic refraction — 61% of all cases, of which more than half (53%) is its high degree; or its combination with compound myopic astigmatism (77% eyes); anisometropia was detected in 39% children. These refractive disorders led to the development of strabismus (61% children) and mixed amblyopia (60%). Despite the combined ophthalmologic pathology, 17% children developed visual functions with achievement of binocular vision, in most children visual functions still continue to develop, although they are not high due to amblyopia. High visual acuity (from 0.8 and above) in both eyes was formed in 22% children; visual acuity in the range of 0.5–0.7 in both eyes was formed in 17% children. Unfortunately, 44.5% children at the time of examination had low visual functions (in the range of 0.05–0.4) in both eyes. Extremely low visual acuity (from 0.01 to 0.04) in both eyes was identified in 11% children; absolute blindness in one of the eyes was in 11% children.Conclusions. LC is reliable way to prevent vision loss from retinal detachment in children with threshold stages of ROP.

Purpose: to study the frequency and structure of undifferentiated connective tissue dysplasia (UCTD) in school-age children with myopia, their relationship to choroidal thickness and course of myopia.Patients and methods. The object of study was 120 children (240 eyes) aged 11–13 years with school axial myopia (axial length (AL) from 24.5 to 26.0 mm). Special ophthalmological examination included optical coherent tomography of macular zone (“RTVue 100” Optovue, USA) and “Cross Line” scan for measuring choroidal thickness in foveal area and 1000 μm from it in nasal and temporal regions.Results. According to studies, the phenotypic signs of UCTD were diagnosed in 56 children (46.7%) with school myopia, the largest group included phenotypic signs of locomotor syndrome; 14 children (25%) had a weak degree of UCTD, 34 children (60.7%) — moderate degree and 8 children (14.3%) — pronounced degree. Comparative characteristic of changes in choroidal thickness detected a high degree of interrelation between the severity of clinical manifestations of UCTD and the level of decrease in blood-flow in the choroid. In children of the main group with signs of UCTD, the annual growth of AL exceeded the same parameters in children of the control group by more than 2.5 times (p < 0.05); due of accumulation of phenotypic signs of UCTD, a more noticeable tendency to decrease of choroidal thickness and the increase of AL was observed (p < 0.05). The statistical analysis confirmed the presence of significant negative correlation between the decrease in average thickness index in segment of the macular map and the degree of increase of AL (p < 0.05).Conclusions. According to results of diagnostic screening, in 46.7% children with school myopia, we detected phenotypic signs of UCTD. The method of optical coherence tomography showed that with increasing severity of UCTD, indexes of choroidal thickness in the macular zone are significant decreased. In the catamnesis (duration 1 year), it was found that in children with myopia with moderate and pronounced degrees of UCTD, increase of AL is associated with degree of thinning choroidal thickness, which indicates violations of biomechanical status of sclera.

Formation of intra-abdominal adhesions is a common consequence of abdominal surgery. Operative trauma is an essential component of any surgical intervention. This problem is particularly relevant in patients with intestinal obstruction resulting from a tumor, when it is necessary to perform reconstructive surgery after urgent obstructive resection of the colon. The review presents the data on current views of epidemiology, etiology, and pathogenesis as well as quantitative and qualitative classifications of intra-abdominal adhesions. The methods of prevention and diagnosis of abdominal adhesions have been discussed. The results of the effectiveness of the use of surgical, pharmacological and barrier methods for adhesion prevention have been presented.

One of the main problems in the area of influenza prophylaxis and pandemic prevention is the development of cross-reactive vaccines, i.e. vaccines directed against all subtypes of human influenza viruses. Such vaccines are being developed in many countries for more than 10 years. A number of vaccines are presently undergoing clinical trials. We created Uniflu candidate vaccine based on recombinant HBc4M2e protein consisting of 4 tandem-connected copies of the highly conserved ectodomain of M2 protein of the influenza A virus. These 4 copies were genetically fused to the carrier protein, namely hepatitis B core antigen. Commercially available Derinat was used as adjuvant in the candidate vaccine. Preclinical studies on laboratory animals (mice, ferrets) demonstrated that immunization with Uniflu leads to significantly higher level of specific immunoglobulins in the blood and bronchoalveolar lavages. Moreover, it produces immunoglobulins belonging to subtype IgG2a that is the most important mediator of antibody-dependent cytotoxicity. The vaccine under review stimulates the proliferation of T-lymphocytes, as well as the formation of CD4+ and CD8+ T-cells synthesizing ɣ-IFN. When infected with the lethal doses (5 LD50) of influenza A viruses of the subtypes H1N1, H2N2, H3N2, and H1N1pdm09, immunized animals typically developed mild form of illness. This kept them alive in 90-100% of cases, which demonstrated almost complete protection from death. Replication of the virus in the lungs of immunized mice was reduced by 1.8-4.8 log10. High immunogenicity of the vaccine, and reduced clinical symptoms following experimental infection, were demonstrated in ferrets as well. The developed recombinant vaccine Uniflu has high specific activity and cross-protection. Uniflu can be proposed as pre-pandemic vaccine, provided that it passes clinical trials.

Urrently, the problem of foreign bodies in the airways of children continues to be relevant. Aim - to assess the effectiveness of diagnostics and treatment of children with foreign bodies in tracheobronchial tree. Materials and methods. In the Department of otorhinolaryngology, the SBHI of MAMRRCI n.a. M.F. Vladimirskiy, we performed an integrated research of 189 children of different age, who had aspirated foreign bodies in the airways. We studied anamnestic, clinical, roentgenological and endoscopic criteria for the diagnosis of this pathology; we also studied the frequency of clinical complications caused by aspiration. Results. Follow-up observation of these children shows a significant frequency of remaining changes in the lungs after removal of foreign bodies. Discussion. In our opinion, for correct diagnosis and provision of qualified care to sick children it is necessary to raise awareness of parents and primary care physicians about the dangers of this pathology. If there is a reason to suspect a foreign body in the airways, consultation in a specialized institution is vitally important. The only correct method of treating children with foreign body in the airways, even at the slightest suspicion, is timely performed tracheobronchoscopy.

Nowadays, colorectal anastomotic leak is a threatening surgical complication, especially in low and ultralow rectal resections. Attempts to resolve this problem fultimately lead to the creation of permanent stoma. Preservation of rectal anastomosis is an important task, because in case of its leakage, more than 50 % of patients will have the need for permanent stoma. In this article the authors review various treatment options for anastomotic leakage. Methods of treating presacral sinuses that resulted from mesorectumectomy and techniques of their drainage, as well as the effectiveness of endoscopic methods with biologic glue were discussed. Methods that do not lead to anastomotic leak are more preferable in terms of improvement of quality of life of patients and further prognosis.

Purpose. To study the clinical effectiveness of the system of complex treatment of optic neuritis (ON) associated with herpesvirus infection(HVI), including methods of immunopharmacotherapy. Patients and methods. The clinical study involved 55 people (55 eyes) with acuteON associated with HVI. The treatment regimen for all patients included 10 days the addition of Dexamethasone solution to optic nerve on decreasing scheme, Emoxypine 1% 0.5 ml, and Dicynone 12.5% 0.5 ml through irrigation system implanted in retrobulbar space, in combination with appoint of neuroprotective drugs (Picamilon and Semax). Depending on features of immunotherapy, all patients were divided into 3 groups. The first group consisted of 20 patients, whose treatment in addition to the above included intravenously infusions 6 mg of Polyoxidonium from the moment they entered the eye hospital. The second group included 17 patients who received in addition to Polyoxidonium, muscle injections of Cycloferon, in mode and doses according to the manufacturer's instructions. The third group of patients (18 peoples) — with using etiotropic immunotherapy that consisted of combination of Polyoxidonium, Cycloferon and endonasal electrophoresis of 0.25% solution of Derinat. The duration of immunotherapy was 10–12 days. Results. The analysis of obtained datas showed that more significant positive dynamics was noted in the clinical course of ON in patients of the 3rd group of observation, who simultaneously received complex of 3 immunotropic drugs in comparison with group 1 and 2, in the treatment of which we used one immunotropic drug Polyoxidonium, or its combination with Cycloferon, without Derinat. Conclusions. The method of etiotropic and pathogenetic immunotherapy developed by us, represented by the combination of Polyoxidonium, Cycloferon and Derinat, at ON, associated with herpesvirus infection, allows to shorten by 2 times or more the period of stopping of signs of inflammation in optic nerve, to exceed the average visual acuity in the period of clinical recovery by 0.5–1.3 times and improve functional results of treatment in the absence of recurrence of the disease within 1 year of observation

Purpose. To study hemodynamic of optic nerve (ON) in process of complex pathogenetic direct treatment in patients with anteriorischemic optic neuropathy (AION). Patients and methods. 43 patients with acute phase AION were exanimated and treated. Besides the functional results (visual acuity, visual field), the diagnosis AION was based on indicators of ophthalmologic and angiographic researches of ON. Patients were divided into two groups. 23 patients were in the main group. They received neurometabolic medicinal preparations (MP) through a silicone retrobulbar catheter. The control group consisted of 20 patients who had the traditional method of medicines injection. Indexes of hemodynamic were estimated according to Doppler ultrasound of local blood flow at the short posterior ciliary arteries (SPCA). At the same time following indexes were estimated: Peak Systolic Velocity (PSV, cm/sec), End Diastolic Velocity (EDV, cm/sec), Average Blood Velocity (ABV, cm/sec), Index of peripheral vascular resistance (R1, M ± m). Results. After the end of hospitalization of patients with AION, more favorable shifts in indexes of hemodynamic in SPCA were reached in patients of main group of research that authentically exceeded the similar data obtained at patients in the control group. Improvement of blood flow of ON was followed by positive changes of thickness of the retinal nerve fiber layer and condition of disk ON. To the final stage of researches (12 months from beginning of treatment) according to degrees of functional disorders severity in the main group of patients prevailed I (14 patients, 60%), less often II degrees (9 patients, 40%) of optic nerve atrophy and absented patients with III degrees of defeat of ON. Among patients of control group II–III degree optic nerve atrophy (12 patients, 60%) met more often, less often I degrees (8 patients, 40%). Conclusion. The conducted research showed that at patients with AION receiving sub-Tenon's infusions of MP more significant favorable functional results were reached thanks to increase of indicators of blood flow in SPCA: PSV — on 24.5%, EDV — on 16.2%, ABV — on 32.2% that significantly exceeds similar data at patients in control group with traditional methods of MP injections.

Purpose. The analysis of clinical effectiveness of a triplex transplant in recovery of extensive through eyelid defects. Patients and methods. 18 patients were under observation (18 eyes) aged from 27 to 68 years with extensive through eyelid defects. The area ofdefects varied from 69 to 105 mm2 (average 87.5 ± 9.0 mm2). The reasons of through eyelid defects were: a mechanical trauma —5 patients, an explosive trauma — 2 patients, result of surgery of tumors a century — 11 patients. All patients were divided into2 groups. The main group consisted of 9 people (9 eyes) who had triplex transplant containing a temporal muscle for replacement ofthrough eyelid defects. The control group consisted of 9 people (9 eyes) who had a double-layer tissular transplant for replacement ofthrough eyelid defects. Besides basic ophthalmologic examination, the research of speed and intensity of recovery of local hemodynamic of transplant was conducted to all patients. The examination was made in 3, 10 days, 1 month after operation, then once in 6 months. Results. In 1 month after operation in main group reparative process came to the end with formation of a gentle thin hem on border of skin transplant. Color of skin transplant was identical to nearby tissues. Secondary cicatricial deformations of skin transplant were absent. Only in 5 patients of control group in 1 month after operation process came to the end with formation of thin hem on border of transplant. 3–6 months later rough deformations of transplant was not observed in any patients of the main group. Cicatricial shortening of the operated eyelid with formation of partial coloboma and eversion of eyelid were in 3 patients of control group that demanded carrying out the second stage of surgical treatment. Conclusion. The offered method of blepharoplasty with use of a temporal muscle makes a practical contribution in development of the perspective direction of a reconstructive plastic surgery of extensive through eyelid defects.

The authors investigated features of diagnostics and surgical treatment of lung cancer which was complicated by purulent destructive process. The possibilities of radical operative intervention were considered after preliminary adequate treatment of purulent complications in 226 patients. It was noted, that the diagnostic thoracotomy should be used in doubtful cases in order to estimate the resectability of lung cancer.

Purpose. Assessment of efficiency in the use of a multi-component tissue complex for an optimization of reconstructive plastic surgery for extensive cicatrical deformations of blepharons.Material and methods. The analysis of plastic reconstruction of extensive cicatrical defects of blepharons was carried out in 30 patients (30 eyes) aged from 27 to 68 years (average: 52.9±14 years). The reasons of cicatrical deformations of blepharons were: mechanical traumas – 9 patients, gunshot injuries and explosive traumas – 4, tumor surgeries – 12, stings of animals – 5. The area of the eyelid defect was from 69 to 105 mm2(average: 87.5±9.0 mm2).All patients were divided into 2 groups. The main group included 15 patients (15 eyes) who underwent the operation with the technique of layerby-layer reconstruction of the eyelid using a three-layer multicomponent tissue complex consisting of a mucoperiosteal flap, a muscle-fascial flap of the temporal muscle, free skin graft. The comparative group was composed of 15 patients (15 eyes) where a two-layer graft was used which consisted of a mucoperiosteal flap and a skin flap on the nourishing base to recover the penetrating extensive eyelid defect.Results and discussion. On the 5th day after the operation, signs of infection and hematoma of the eyelids were absent, and there was a moderate edema of tissues in all patients of the main and comparative groups.On the 10th day after the operation, the skin graft acquired a pink tint on its entire surface in patients of the main group. In the comparative group, the pink shade of the skin graft was noted only from the side of the nourishing pedicle, the rest part kept a pale shade and areas of epidermal necrosis.After 1 month, the reparative process culminated in the formation of a tender fine scar, and the mobility of the eyelids appeared in the patients of the main group. The size of palpebral fissure varied from 9 to 11mm (on average 10.1±0.5mm), the deviation of the palpebral fissure size was about «-»16%. In the comparative group, the reparative process was completed by the formation of a tender fine scar only in 5 patients. In 10 patients a reduction of the graft and a formation of scar tissue retraction were observed, with a deviation in the size of the palpebral fissure by 8-12mm (on average 10.9±1.0) compared with the healthy one. Visible scar deformations of the eyelids were not observed 3 months after the operation in patients of the main group. The deviation of the palpebral fissure size was «-»7-8%. In the comparative group a cicatricial shortening of the operated eyelid with the formation of coloboma and ectropion occurred in 3 patients.During 2 years of follow-up, the correct position and anatomy of the eyelids remained in the patients of the main group, the size of the palpebral fissure averaged to 11.7±0.5mm and did not differ significantly from the healthy eye (11.9±0.4mm), p>0.05.Within the same period in the comparison group 5 patients had an incorrect position of the operated eyelid (retraction, ectropion, entropion), which required repeated plastic reconstructions.Indices of hemodynamics: in the main group, the complete correspondence of parameters of blood flow to the tissues of the healthy eyelid occurred 1 month after the operation (p>0.05). In the comparative group positive changes were detected only 3 months after blepharoplasty. In the comparative group positive changes were detected only 3 months after blepharoplasty.Conclusions. The proposed combined method of blepharoplasty for extensive complicated cicatrical defects allows to reduce its multistage approach, to increase donor resources in order to receive the desired plastic material, to empower ophthalmoplasty without serious postoperative complications, to improve esthetic results of rehabilitation. Key words: blepharoplasty, extensive cicatrical defects of blepharons,

Anti-influenza drugs and vaccines have a limited effect due to the high mutation rate of virus genome. The direct impact on the conservative virus genome regions should significantly improve therapeutic effectiveness. The RNA interference mechanism (RNAi) is one of the modern approaches used to solve this problem. In this work, we have investigated the antiviral activity of small interfering RNA (siRNA) against the influenza A/PR/8/34 (H1N1), targeting conserved regions of NP and PA. Polycations were used for intracellular siRNA delivery: chitosan’s derivatives (methylglycol and quaternized chitosan), polyethyleneimine, lipofectamine, and hybrid organic/non-organic microcapsules. A comparative study of these delivery systems with fluorescent labeled siRNA was conducted. The antiviral activity of three small interfering RNAs targeting the NP (NP-717, NP-1496) and PA (PA-1630) influenza A viruses genes was demonstrated, depending on the chosen carrier. The most effective intracellular delivery and antiviral activity were observed for hybrid microcapsules.

Purpose. Assessment of optimum quality in the work organization of the diagnostic department at the Khabarovsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, a detection of opportunities of its further development.Material and methods. The analysis of organizational structure and activity algorithms of the diagnostic department of the Khabarovsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution was carried out in interrelations with various forms of payment.Results. Intensity of a daily flow of patients was 170-200 people. In their structure 80-90 individuals were invited for a treatment, 30-40 patients for a repeated appointment. Organizational measures allowed to reduce a duration of patients stay on the diagnostic examination line up to 10-15 min. In structure of a daily flow of patients the coordination department planned to invite 80-90 individuals for the surgery and conservative treatment, 30-40 patients – for the re-appointment after their performed treatment (surgery). A number of organizational arrangements allowed to reduce the duration of stay for one patient on the diagnostic line from 30- 60 min. to 10-15 min. (5-7 diagnostic examinations). Duration of passing of the diagnostic line in case of doctor consultations proceeded from 1 to 1.5 hours. The daily loading of diagnostic department already reached the maximum functional handling capacity (up to 200 patients a day) and now works at a peak of throughput opportunities. Frequency of refusal cases to perform the surgery was 13-15%.Conclusions. The Diagnostic Department of the Khabarovsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution has accumulated a considerable experience; the optimum organization of work allows to increase its capacity up to 200 patients a day.

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.

We consider a problem of adaptive parameter selection of short-wave data transmission systems such as information signal type, noise combating code type and parameters, operating frequency in case of step-by-step control of transmission process in dynamically changing conditions of radio wave propagation and interference environment. We have obtained explicit expressions of objective functions for reaching the maximum information rate of data transmission and maximum probability of exact message delivery within the time not exceeding the given time. The distinguishing feature of the objective functions is the fact that they do not depend on threshold values established subjectively. The feasibility of the suggested algorithms is guaranteed due to the fact that all the original data required for adaptive control including information on standby frequencies are formed with the given accuracy during information exchange by means of analyzing working signals and secondary decoding products.

Im - to evaluate the prevalence of laryngeal papillomatosis in adults and children, to analyze the structure of the disease and to generalize the dynamics of the disease in the Moscow region. Materials and methods. The authors have carried out an epidemiological analysis of laryngeal papillomatosis in the Moscow region in the period from 2008 to 2014. Results. According to the received data, the prevalence of laryngeal papillomatosis in the Moscow region is 2.3 per 100000 children and 1.95 per 100000 adults. Discussion. Based on the epidemiological data, the significance of laryngeal papillomatosis in adults and children has been proved, and increased morbidity has been revealed. Laryngeal papillomatosis is one of the most important social and health problems. Taking into account the significant increase in the incidence of laryngeal papillomatosis in adults and children, it is necessary to focus on the organization of preventive measures aimed not only at preventing relapses, but also against the spread of HPV infection among healthy population in the Moscow region. To conclude, it is necessary to carry out annual analysis of the structure and course of the disease in the Moscow region.

Area Moscow’s regional research clinical institute n.a. M.F. Vladimirskiy Abstract. The article analyzes the experience of application of the immunomodulator Polyoxidonium in patients with respiratory diseases. Polyoxidonium has expressed immunomodulatory activity, providing nonspecific protective effect against a broad spectrum of pathogens, is not based on direct inhibition of microorganisms, and stimulation of the immune system of the macroorganism. In addition, the drug has antitoxic and antioxidant properties. In the acute period of the disease, Polyoxidonium is recommended to assign in combination with etiotropic therapy, and in the period of rehabilitation or prevention of infectious diseases possible use of the drug as monotherapy.

Chronic rhinosinusitis (CRS) is a heterogeneous, multifactorial disease of unknown etiology, with an underlying deficient immune response to infectious and other triggers, leading to their incomplete elimination and persistence of inflammation. Development of CRS is made possible by a deficient response of the innate immunity of nasal and paranasal sinus mucosa. The main factors of non-specific defense system of nasal and paranasal mucosa are the function of cell junctions between epithelial cells, mucociliary clearance, pattern recognition receptors (PRRs), antigen presenting cells, and phagocytosis. The multirowed ciliate epithelium of nasal and paranasal sinus mucosa is covered by a thick layer of mucus containing more than 200 proteins. Changes in the qualitative composition of the nasal mucus in CRS manifests in overexpression of the main mucins MUC5AC and MUC5B and decreased synthesis of lactoferrin and lyzocin. Ciliary dyskinesia or abnormalities in their microstructure lead to decreased efficacy of mucociliary clearance. Diminished expression of proteins of tight junctions (TJ) ZO-1 and occluding results in decreased density of intercellular contacts and increased permeability of epithelial barrier. In addition, CRS is characterized by deficient Tolllike receptors (TLR) 9, 2 and 4, as well as increased counts of M2 macrophages in the mucosa. This results in suppressed phagocytosis and antimicrobial mucosal defense. Lower levels of STAT3 protein causes an imbalanced reaction of innate and adaptive immune response and disordered reparation processes. With abnormal functioning of all the above mentioned mechanisms, no immune elimination of infectious agents can take place, with increased susceptibility to viral and bacterial infections of the upper respiratory tract. This opens the door to development of CRS, including that with polyps. Investigation of the innate immunity factors would allow for predicting of inflammation in a given patient, as well as for development of new approaches to its conservative management.

The authors discuss specifics of the wound process in modern combat injury of the ear, significance and specifics of diagnosis of gunshot ear injury related to individual characteristics of gunshot wounds with consideration of the accepted anatomical classification of the injured zones. Typical complications of ear injuries are described that can result in death. The authors analyze an approach to surgical treatment of traumatic ear injuries based on their own experience, including non-conventional choice of the type of surgery. They proposed an algorithm to assess the auditory and vestibular analyzers in the injured based on their analysis of date obtained from 772 patients, determine types of pure-tone audiograms typical for acoustic and barotrauma, and underline the informative value of optokinetic nystagmus assessment. Various types of conservative management of the sequelae of the mine-blast ear trauma are discussed aimed at potential minimization of the post-traumatic reactions of the auditory and vestibular analyzers. The authors draw attention to the importance of early treatment, the highest effectiveness of combination therapy and plasmapheresis. They propose their experience of care for the above mentioned traumatic injuries to improve treatment efficacy.

Purpose. Morphological and functional evaluation of results of intravitreal injections of ranibizumab in treatment of choroidal neovascularization (CNV) caused by degenerative myopia (DM). patients and methods. The study included 32 patients (32 eyes) aged from 29 to 55 years with the CNV, developed due to the DM. They received 0.5 mg (0.05 ml) ranibizumab according to the standard. Indications for repeat intravitreal injections of ranibizumab were retention of the CNV activity or its recurrence. In addition to the standard ophthalmologic examination all patients were examined with fluorescein angiography (FAG) with photodetection of fundus picture and optical coherence tomography (OCT) of the retina (sizing subretinal neovascular membrane (SNM), evaluation of retinal foveal thickness (FCS). The study was conducted before the introduction of ranibizumab, monthly during the first 6 months after surgery, and then, in the absence of symptoms of CNV activity, every 2-3 months. The total follow-up was 12 months. results. the transition the CNV in inactive form according to FAG was observed in 25 people (78.1%) was observed after 1 month (single injection of ranibizumab). The angiographic signs of CNV activity remained after the first injection in 7 patients (21/9%). They received second intravitreal injection of ranibizumab. After 3 months from the beginning of observation according to FAG and OCT data relapse of activity of myopic CNV occurred in 5 patients (15.6%) after a single injection, and in 2 patients (6.3%) — after a double injection of ranibizumab. After 6 months according to FAG disappearance of pathological leakage of the dye was diagnosed in 87.5% of patients (28 eyes). After 12 months follow-up all 32 patients had remission of the pathological process with no evidence of CNV activity with formation of local subretinal fibrosis with choriocapillaries atrophy. Conclusions. It took from 1 to 3 (average 1.58) injections of ranibizumab to transfer the active phase of the CNV in inactive. Complete inhibition of the growth and activity of myopic CNV was accompanied by positive morphological and functional results, which led to a significant improvement in visual acuity in 2 times at the observation period of 12 months.

Purpose. Analysis of the quality of a medical ophthalmic care (QMOC), provided to patients at the Branch from 2010 to 2014.Material and methods. Evaluation of the QMOC was carried out on continuous selection of inpatients and outpatients for the period 2010-2014. Two basic components of clinical outcomes were assessed: the technology of treatment and functional results. The total quantity of the studied patients was 115394 persons. The assessment of quality in maintaining medical documentation was performed in the analysis of 106347 medical anamnesis and files of the patients who finished treatment at the Branch during 2010-2014. The patients’ satisfaction with QMOC was checked by an anonymous questionnaire using the assessment scale. Results. The maximum clinical outcome (10 or 12 points) was achieved in the treatment process in the vast majority of patients (98.8%). The deviation from a standard of clinical result of treatment took place in 1.2% of cases. The review and analysis of the causes of deviations of the clinical outcome of treatment from the standard allowed significantly to reduce the quantity of complications within the postoperative follow-up period – 1.7 times. A systematic analysis of completeness of diagnostic examination, adequately chosen treatment allowed to reduce the number of complications in the postoperative period in 2 times. Analysis of all types of defects in maintaining primary medical documentation allowed to decrease them during 2010-2014 in 1.5 times. Despite the available defects, in general the QMOC was always highly evaluated by all categories of respondents and was fluctuated from 98.8% to 100%.Conclusion. The system of an assessment of clinical result of treatment of patients applied at the Branch and developed at the S. Fyodorov Eye Microsurgery Federal State Institution allows to reveal effectively defects of diagnostic examination and disturbance of technology in the treatment. Its use, according to the analysis for the period 2010-2014, allowed to reduce the frequency intra- and post-operative complications twice.

Colorectal anastomosis failure is one of the serious complications following abdominoperineal resection of the rectum, accounting for approximately 40 % of cases. Mortality rate in patients with colorectal anastomosis was reported to be 39 % and above 90 % in cases with anastomosis located in the abdomen. The literature analysis showed the importance of the problem of colorectal anastomosis failure, thus dictating the necessity of searching for the new methods of prevention and treatment for this serious complication. The aim of the study was to analyze the literature on the risk factors for colorectal anastomosis. The main factor influencing anastomotic leakage is the height of the anastomosis above the anal verge. The authors’ data were often contradictory.