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The article considers proposals developed according results of the study and targeted on improving social regulation of medical activities on basis of complex institutional approach. The complexity of approach lies in the fact that in regulation of public relations in health care opposition between norms of law and norms of morality is not allowed because in medicine they inter-condition and inter-complement each other. The institutional aspect of approach is reflected in tight interaction of moral and legal foundations, as well as in mechanisms of implementation of social standardization of specific sphere of medical activity. The formalized model of integrated institutional approach is presented. The importance of bioethics, in which principle of inter-complementarity of morality and law is realized to its maximum extent is emphasized. The significance of structural principles of bioethics that characterize totality of stable relationships of subjects of medical intervention is highlighted. The emphasis is made on interrelation between principles of bioethics and medical ethics, on norms of medical ethics, that largely determine content of professional duty of physician. The norms of medical ethics are grouped into three systems: “doctor-patient”, “doctor-colleague” and “doctor-society” that are contained in international ethical documents and “The Code of Professional Ethics for Physicians” of the Russian Federation. The importance of internal and external mechanisms of implementation of complex social regulation of medical activity is marked.

Progressive pulmonary fibrosis is a major problem in respiratory medicine. Currently, there are no reliable biomarkers for early diagnosis of progressive pulmonary fibrosis, which leads to delayed diagnosis. Aim. To determine the role of serum biomarkers CA-19-9 and CA-125 and the possibilities of capillaroscopy of the nail fold in the diagnosis of progressive pulmonary fibrosis. Materials and methods. The study included 43 patients with interstitial changes in the lungs. Based on the presence/absence of signs of progression over the previous 12 months, patients were divided into 2 groups. All patients underwent forced spirometry, body plethysmography, diffusion test, CT, lung ultrasound, capillaroscopy of the nail fold, study of serum concentrations of CA-19-9 and CA-125. Results. In the group of patients with a progressive fibrotic phenotype of Interstitial lung diseases, a greater severity of capillaroscopic changes and a higher level of CA-19-9 were revealed. Correlation of these parameters with changes according to CT scan data (Warrick test) and lung ultrasound was shown. Conclusion. The data obtained demonstrate the possibilities of non-invasive diagnosis of progressive fibrosing interstitial lung diseases and require further research and prospective follow-up to assess the diagnostic and prognostic role of the studied biomarkers, as well as to determine their place in clinical practice.

Lateral wear of the locomotive wheel flange is one of the main types of wear that occurs during rolling stock operation. An important characteristic of a rail wheel rim is its wear resistance, which directly depends on the carbon content in steel. The carbon content in wheel steel of group 2 in the amount of 0,55–0,65 is due to the fact that at its lower concentration, the proportion of grain boundary ferrite increases, which leads to a decrease in the contact strength of wheels, and a higher one leads to a tendency to brittle fracture.The increased carbon content makes it possible to harden the surface of steel. Plasma and laser hardening technologies can be used to reduce tyre flange wear and increase the service life of locomotive wheelsets.The objective of this work is to determine advantages and disadvantages of technologies for laser and plasma hardening of working surfaces of tyres of wheelsets of railway rolling stock.The comparative analysis related to microstructure and microhardness of wheelsets tyres of the 2TE25KM diesel locomotive which are made of wheel steel of group 2 according to GOST 398-2010 state standard and hardened respectively by plasma and laser hardening.The tasks set were solved using theoretical and experimental research methods. The preparation and study of hardened samples was carried out using the equipment of the testing laboratory of LLC Scientific and Technical Association «IRE-Polus».A study referred to hardened zones in various areas and sections of the tyre. Tribological tests concerned wear resistance of specimens hardened with a high-power fiber laser. The main advantages and disadvantages of laser and plasma hardening processes are revealed.The conducted studies allow making a conclusion that the use of laser hardening technology for hardening wheelsets tyres, as an alternative to the plasma hardening process, is highly promising.

Novel D–π–A–π–A′ chromophores with different substituents in the donor moiety were synthesized and NLO coefficients for composite polymer materials doped with them were measured.

Sarcoidosis is a multi-organ granulomatosis of unknown origin. Modern diagnostic methods allow detecting this disease at an early stage. The absence of specific markers requires a comprehensive approach to diagnosis based on comparison of radiation, clinical, morphological and functional data. The course of sarcoidosis without damage to the respiratory system presents significant difficulties. It is extremely important to understand the time and means of starting Sarcoidosis’s treatment to avoid the early initiation of hormones and cytostatics and, on the other hand, to timely respond to progression and threatening conditions. Methods. Clinical recommendations are based on the analysis of Russian and English publications of the latest sarcoidosis research. The target audience of these clinical guidelines are therapists, general practitioners, pulmonologists, TB doctors, rheumatologists, dermatologists, radiation diagnosticians, immunologists, and clinical pharmacologists. Each thesis-recommendation for diagnosis and treatment is evaluated on an 1 to 5 scale of levels of evidence and an A, B, C scale of the grades of recommendations. The clinical guidelines also contain comments and explanations for the theses-recommendations, diagnostic algorithms, treatment strategies, reference materials on the use of recommended drugs. Conclusion. Current information on epidemiology, clinical manifestations, diagnosis and management strategies for patients with sarcoidosis are covered in the presented clinical guidelines. Approved by the decision of the Scientific and Practical Council of the Ministry of Health of the Russian Federation (2022).

The objective: To conduct a comparative assessment of efficacy of Cytoflavin and Cellex for management of cognitive disorders after videolaparoscopic cholecystectomy performed under general inhalation anesthesia with sevoflurane.Results. In three representative groups (n = 30) of patients, markers of inflammation (CRP and IL-6), levels of brain-specific proteins (S-100 and NSE) were studied. Neuropsychological testing were performed by using the MoCA test, frontal dysfunction test battery (FAB) by two stages (stage I ‒ on the eve of the operation, stage II ‒ on the 7th day of the postoperative period). In patients of Group I (n = 30), disorders of higher mental functions of the early postoperative period persisted, which served as the basis for finding ways to eliminate and manage the identified disorders. For this purpose, Cytoflavin was used in Group II (n = 30), and Cellex was used in Group III (n = 30).Comparative characteristics of the level of brain-specific proteins revealed a statistically significant decrease at stage I in Groups II and III versus Group I. The lowest level of both NSE (by 1.45 μg/l, p = 0.041) and S-100 (by 10.1 ng/l, p = 0.044) was observed in Group III versus Group II. In addition, at the second stage of the study, the greatest severity of the inflammatory response was noted in Groups II and III of patients compared to Group I and this degree of severity could be potentiated by the ongoing drug therapy. If in Group I, disorders of higher mental functions persisted on the 7th day of the postoperative period, then as a result of the ongoing drug therapy in Groups II and III, it was possible to achieve significantly better results of neuropsychological testing.Conclusion. Administration of drug therapy contributed to the improvement of higher mental function eliminating cognitive deficit in the early postoperative period.

The paper considers the applicability of small perturbation theory to assessing the variations of the prompt neutron lifetime caused by variations in the isotope composition of a lead-cooled fast reactor. The generalized small perturbation theory formulas have been developed to calculate derivatives of the prompt neutron lifetime regarded as a bilinear neutron flux and neutron worth ratio. A numerical algorithm has been proposed for the step-by-step application of the small perturbation theory formulas to assess the prompt neutron lifetime variations caused by a major perturbation in the reactor isotope composition, e.g. by the complete change of the material used earlier as the neutron reflector. The advantage of the proposed approach has been shown which consists in that it is basically possible to determine the role of different neutron reactions, isotopes and energy groups in and their contributions to the total prompt neutron lifetime variation caused by major changes in the reactor isotope composition.

Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic fibrotic interstitial pneumonia with a progressive course and poor prognosis. The prevalence of IPF in the Russian Federation is about 8 – 12 cases per 100,000 population. The basic treatment of IPF is antifibrotic agents.Methodology. The target audience of these clinical recommendations are therapists, general practitioners, pulmonologists, pathologists, radiologists, and medical rehabilitation doctors. Each thesis-recommendation about diagnostic and therapeutic procedures has been scored according to the scale of classes of recommendations from 1 to 5 and A, B, C scale of the levels of evidence. Clinical recommendations also contain comments and explanations to the theses, algorithms for the diagnosis and treatment of idiopathic pulmonary fibrosis, and reference materials.Conclusion. The presented clinical guidelines cover current information about the etiology and pathogenesis, clinical manifestations, diagnosis, treatment, and prevention of idiopathic pulmonary fibrosis. These guidelines were approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2021.

This monograph is devoted to the system of administrative justice bodies in India, their functions, structure, jurisdictional process, as well as the reform of this legal institution launched in 2021. Over a hundred normative acts and dozens of judicial acts were studied for writing this work. Legislation in the area under study is decentralized, and even the principles underlying the process are understood by each body in its own way. The paper contains an analysis of the studies of Indian jurists on this topic. Scholars are generally of the opinion that the 42nd amendment of the Constitution of India has a positive impact, however, the further development of specifying norms in judicial precedents, due to the hypertrophied function of the Supreme Court, had a negative impact on the uniformity of law enforcement practice. Streamlining and efficiency in resolving administrative disputes, originally the goal of regulatory reforms, have corroded both over-regulation and legal emptiness. The system has ceased to be harmonious and trustworthy to serve the interests of Indian society. Administrative tribunals as islands in the field of legal uncertainty. There are no restrictions on the creation of a single format, a policy aimed at changing the social system (globalization and digitalization). Some of the acts regulating the activities of quasi-judicial bodies date back to the time of the British colony and are outdated in essence of regulated relations. The norms of the process either duplicate the powers of the court in civil proceedings, or abound in subtleties that do not always correspond to legal realities. There is no staging and no clear order. The author believes that the current system of administrative justice in India needs reform.

The aim of the study was to explore the clinical, radiological, functional indicators of hypersensitivity pneumonitis (HP) in combination with arterial hypertension, to assess the effect of these diseases on each other.Methods. The study included 50 patients with hypersensitivity pneumonitis (HP) and 49 patients with arterial hypertension (AH). The patients were divided into three groups. The main group included 24 patients with hypersensitivity pneumonitis combined with AH. The comparison group was 26 patients with HP without AH; the control group was 25 patients with arterial hypertension alone. Clinical symptoms, radiological findings, and results of instrumental tests were analyzed.Results. The intensity of clinical symptoms (shortness of breath, cough) was significantly higher in the main group than in the control and comparison groups. Exercise tolerance estimated from the six-minute walk test was significantly lower in the main group. The clinical status correlated with the functional testResults. Volumetric and velocity spirometry values tended to decrease more in the main group compared to the other two groups. The lung diffusion capacity was significantly lower in the group of patients with HP in combination with AH compared to the group of patients with hypertension only. A similar trend was observed when assessing the chest CT: significantly more pronounced changes were found in the main group. EchoCG showed a significant increase in pulmonary hypertension and volumes of the right heart in the main group compared to the group of patients with AH alone.Conclusion. The present study provides evidence of the greater intensity of respiratory symptoms, decreased functional status, ventilation disorders, dilated heart cavities, greater risk of fatal vascular complications in patients with HP associated with hypertension.

The recommended drugs for the treatment of COVID-19 are, on the one hand, experimental in nature, but at the same time, they have many side effects that cause long-term complications in organs and systems, including osteoarticular. Based on the analysis of modern domestic and foreign literature, to determine the effect of not only the new coronavirus infection COVID-19, but also the drugs used to treat it, on the human osteoarticular system. In the course of the study, a scientific search was made for publications in the electronic databases PubMed, MedLine and e-Library for the period from January 2000 to October 2021 for the main keywords. Due to successive “waves” of the COVID-19 pandemic, the number of patients receiving non-specific therapy, including corticosteroids, will increase in the coming years. Preliminary data on COVID-19 and similar trends during the Sars-COV-1 epidemic of 2003 show that the pathogenesis of Sars- Cov-2 and its treatment with high doses of corticosteroids may increase the risk of osteonercosis in patients, which will inevitably lead to an increase in orthopedic diseases in patients not only the middle age group, but also young patients in the near future. Currently, studies are required aimed at risk stratification, studying the pathogenesis of damage to the musculoskeletal system after COVID-19 and the effectiveness of preventive and therapeutic measures in such patients.

With prolonged chemotherapy of tuberculosis patients, side effects often occur. A well-known part of them is associated with metabolic disorders of complex B vitamins.

A combination of factors, including Western European eating habits, physical inactivity and genetic predisposition, lead to a dramatic increase in adipose tissue mass. A special place is occupied by abdominal obesity, in which there is an accumulation of adipose tissue in the mesentery of the small intestine and the omentum. Developing in conditions of visceral obesity, insulin resistance, dyslipidemia and systemic inflammation are one of the key components of the pathogenesis of type 2 diabetes mellitus, cardiovascular diseases, non-alcoholic fatty liver and pancreas disease, polycystic ovary disease, some forms of cancer (breast cancer, endometrial cancer, colonic and direct intestines). At the same time, the pathogenetic role of adipose tissue is not limited to its participation in the formation of the cardiometabolic continuum and oncogenesis. The most important role of metabolically active fat in the pathogenesis of many respiratory diseases is known, including bronchial asthma, obstructive sleep apnea and pulmonary hypertension. This paper presents an overview of current data on immunological, pathophysiological and clinical features of the phenotype of the combination of respiratory diseases with overweight and obesity.Совокупность факторов, среди которых западноевропейские особенности пищевого поведения, гиподинамия и генетическая предрасположенность, приводит к драматическому увеличению массы жировой ткани. Особое место занимает абдоминальное ожирение, при котором происходит аккумуляция жировой ткани в брыжейке тонкой кишки и сальнике. Развивающиеся в условиях висцерального ожирения инсулинорезистентность, дислипидемия и системное воспаление являются одними из ключевых компонентов патогенеза сахарного диабета 2-го типа, кардиоваскулярных заболеваний, неалкогольной жировой болезни печени и поджелудочной железы, поликистоза яичников, некоторых форм онкологических заболеваний (рак молочной железы, эндометрия, толстой и прямой кишки). Вместе с тем патогенетическая роль жировой ткани не ограничивается участием в онкогенезе и формировании кардиометаболического континуума. Установлено участие жировой ткани в патогенезе многих респираторных заболеваний, в числе которых бронхиальная астма, обструктивное апноэ сна и легочная гипертензия. В работе представлен обзор современных данных по иммунологическим, патофизиологическим и клиническим особенностям фенотипа сочетания респираторных заболеваний с избыточной массой тела и ожирением.

Incidence and prevalence of non-tuberculous mycobacteriosis (NTM) are recorded in many countries, but the rates vary. There are no official statistics on the prevalence and incidence of NTMs in the Russian Federation at the moment. The regulatory and expert clinical database for NTMs has not yet been developed. The aim of thе article is to share the experience of the Federal State Scientific Institution “Central Research Institute of Tuberculosis” (FSSI “CRIT”) in working with patients with NTMB over the past 7 years. Methods. The study included 190 patients with a confirmed diagnosis of NTMB who were treated at the FSSI “CRIT” in 2011 – 2018. Before the diagnosis of NTMB, all patients were followed for a long time by various specialists (pulmonologists, general practitioners) for various chronic respiratory diseases. NTMs were isolated from the diagnostic material by the culture method. The material was inoculated into a liquid medium in an automated BACTEC MGIT 960 system and into Levenshtein – Jensen dense medium until the culture growth was obtained. The HTM species was determined using DNA strips GenoType® Mycobacterium CM by Hain Lifescience (Germany). Results. More than half of the examined patients were registered with a phthisiatrician for various clinical forms of pulmonary tuberculosis (disseminated, fibro-cavernous, focal). In 85.6% of cases, no MBT DNA was found in the sputum and skin tests with recombinant tuberculosis antigen (Diaskintest®) were negative. Nevertheless, the changes in the lungs detected on the chest CT and even a single detection of acid-fast microorganisms (AFB) without typing led to an erroneous diagnosis of tuberculosis. In some patients (6.8%), a combination of pulmonary tuberculosis and NTMB was diagnosed. Bronchiectasis and COPD were the most common chronic nonspecific lung diseases. 66.7% of the patients had centrilobular foci characterized by the involvement of not only the bronchial wall but also the pulmonary vessels. NTMB resistance to a wide range of antibacterial drugs was determined in 118 patients (out of 190). The prolonged use of chemotherapy drugs revealed a wide range of drug intolerance. Side effects were handled in various ways: drug replacement (with consideration to the sensitivity), temporary withdrawal, and drug discontinuation. Conclusion. This work reflects the long-term experience of the FSSI “CRIT” staff with patients with NTMs, which can be used in creating national recommendations on NTMs.

Four new complexes [Ln(pfaa)3(H2O)2]n (Ln = Eu (1), Tb (2)) and [Ln2Cd2(pfaa)10 (phen)2(EtOH)2]·2MeCN (Ln = Eu (3), Tb (4), phen = 1,10-phenanthroline) based on pentaphorphenylacetic acid (Hpfaa) have been prepared and completely investigated. The structures of compounds 1 and 3 were studied by single crystal X-ray diffraction analysis: the isostructural complexes 1 and 2 represent 1D coordination polymer, while the isostructural complexes 3 and 4 are molecular compounds. Complexes 1–4 show strong lanthanide-centred luminescence, since the introduction of phenanthroline leads to a significant increase in the observed lifetime (τobs) and photoluminescent quantum yield.

Clinical signs of systemic connective tissue dysplasia in children with acute and recurrent torticollis were studied. 225 clinical cases were analyzed. The predominance of joint hypermobility and asthenic physique in the group of children with recurrent torticollis was revealed and proved by the medical statistics methods. In this group, such skeletal clinical forms as flat-valgus deformity of the feet, kyphosis, scoliosis were observed.

In cases when there is a need to visualize the posterior part of the tibia and talus, the subtalar joint and the possibility of performing osteosynthesis or arthrodesis, the most optimal is the posterior surgical approach. The article presents a demonstration of successful arthrodesis of the ankle joint using an LCP plate with angular stability of screws from the posterior surgical approach in a patient with renal osteodystrophy receiving renal replacement therapy. The result of treatment according to the AOFAS scale 4 months after the operation was 70 points, the severity of pain according to the VAS was 1/2 point. Clinical and radiological characteristics were assessed as satisfactory, taking into account the severity of the deformity and the severity of osteoporosis against the background of concomitant pathology.