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The aim of the study was to study the effectiveness of the use of immunomodulators and antioxidants in the correction of immune status parameters in patients with adenomyosis. 70 patients were examined, including 57 women (the main group), who were diagnosed with adenomyosis according to the results of a comprehensive clinical, ultrasound and hysteroscopic examination. The control group consisted of 23 gynecologically healthy women. After verification of the diagnosis, all patients with hypertension received standard treatment (SL) (clinical recommendations of the Ministry of Health of the Russian Federation from 2016). Among the female patients, 19 women received only SL (1st subgroup). 38 exhaust gases examined, in addition to SL, received various combinations of antioxidant, immunomodulator, and membrane protector and were divided into two subgroups. The second subgroup included 20 patients in addition to the SL receiving sodium ribonucleate; Hypoxene and phospholipids. The third subgroup included 18 patients who additionally received Inosine + Nicotinamide + Riboflavin + Succinic acid; Meglumine acridone acetate, and glycyrrhizic acid + phospholipids. The analysis of the cytokine status and the compliment system was performed at the time of admission and by the 15th day of observation. Detected changes of the cytokine status, complement system activation, increased oxygen-dependent activity of neutrophils in the peripheral blood (increased production of active oxygen forms as a result of respiratory burst) confirm the presence of immune inflammation on the systemic level. Insufficient clinical-laboratory efficacy of ST in the correction of immune changes has justified the use of drugs with immunomodulating, antioxidant, and membrane protective properties in the pharmacological therapy of adenomyosis, which have been successfully used in the treatment of other diseases with similar disorders.Optimal combinations of immunomodulators and antioxidants in the correction of the immune status of patients with adenomyosis were revealed. The study performed demonstrates the efficacy of correcting immune status parameters in patients with adenomyosis when the standard treatment is combined with antioxidant and immunomodulating agents.

Purpose. Determine the nature of tumor regression and possible complications associated with the retinotoxic effect of melphalan and carboplatin with local chemotherapy.Methods. A histological analysis of 19 enucleated eyes from 19 patients with retinoblastoma was performed after combined organ-preserving treatment, including systemic chemotherapy and local chemotherapy in various doses. The enucleated eyes were fixed in 10 % formalin and processed routinely for histological examination.Results. Significant changes in the tumor tissue such as tumor regression associated with the destruction of the tumor tissue and its replacement with fibrous tissue, glia proliferation, and the formation of petrificates were revealed. Complete regression of the tumor was detected in 3 out of 19 eyes, partial in 13 eyes. There were no signs of regression in 3 eyes. Tumor invasion into the choroid was found in 5 cases, into the anterior sector — in 3 cases, into the optic nerve — in 3 cases. The retrobulbar tumor was presented in 1 case. Retinotoxic complications revealed. Hemorrhagic changes associated with focal necrosis of the central retinal vessels (n = 4), destructive changes in retinal pigment epithelium (RPE; n = 10) associated with the accumulation of melphalan in RPE leading to atrophic processes in the retina. Complications in the form of secondary glaucoma, severe fibrosis and retinal detachment, despite the complete resorption of the tumor, led not only to loss of vision, but also hindered visualization of the fundus and substantiated the need for enucleation in 3 cases. In other cases, enucleation was performed due to continued tumor growth (n = 16) or progression during treatment (n = 3).Conclusions. Retinoblastoma can be controlled with local chemotherapy. However, clinical and morphological examinations of enucleated eyes revealed and confirmed, along with tumor resorption, intraocular complications as a result of the toxic effect of the drugs and the presence of active tumor tissue to varying degrees of therapeutic pathomorphism, which can be explained by the resistance of RB to these drugs. Thus, a further search is needed for drugs that destroy the tumor and minimize the retinotoxic effect.

The article deals with the global problem of plastic pollution of the environment.As a way to solve this problem, it is proposed to reduce the production of disposable plastictableware with a subsequent transition to the use of products that will be safe for theenvironment and human health. This transition involves the development of innovativeprojects to create biodegradable tableware, and materials, equipment and technologies forits manufacture. The implementation of such projects involves not only the creation ofproduct and technological innovations, but also the implementation of changes in the businessprocesses of enterprises. For the effective implementation of these processes, it is proposed touse the developed system of change management strategies, which is distinguished by adetailed elaboration of a set of organizational measures, including measures to motivatepersonnel in order to reduce resistance to the changes. The choice of a specific changemanagement strategy is determined by such criteria as the degree of their radicality, theperiod of execution and the allocated resources.

Purpose. To reveal predictors of small choroidal melanoma transpupillary thermotherapy efficiency using optical coherence tomography-angiography.Patients and methods. 34 patients with small choroidal melanoma at an average age of 55.0 ± 2.9 years were examined. Optical coherence tomography-angiography was performed on an OCT-Angiography Software for RS-3000 Advance Optical Coherent Tomograph, Nidek, Japan, before and 4 months after 1 session of transpupillary thermotherapy. Transpupillary thermotherapy (TTT) was performed with a Nidec DC 3300 diode laser.Results. Prior to TTT — a loop-shaped, cranked-convoluted with an uneven lumen heterogeneous nature of the vasculature of the tumor with numerous bends and interlacing, located under the vessels of the retina in the central zone; the area of neovascular vasculature is 32.82 mm2, the density is 12.42 %. The limiting avascular zone is on the periphery. Around melanoma is a homogeneous hyperreflective rim of dilated choriocapillaries. 4 months after 1 session of TTT in 24 (70.6 %) of 34 cases — occlusion of the choriocapillaries in the central and peripheral zone of the tumor (avascular regions), expansion of the large and medium vessels of the choroid around the focus — predictors of complete tumor devitalization (chorioretinal scar). In 6 (17.6 %) of 34 patients, occlusion of the choriocapillaries in the central zone, expansion of large and medium vessels of the choroid around the tumor, along its periphery and in the paracentral region, retinochoroidal anastamoses along the periphery and in the paracentral zone, heterogeneous neovascularization of the choriocapillaries around; decrease in the area of vasculature — 12.44 mm2, density — 6.15 %, (p < 0.05) — predictors of partial devitalization of small choroidal melanoma (residual tumor). In 4 (11.8 %) of 34 cases, tumor vessels in the tumor area, large and medium vessels of the choroid around, along its periphery and in the central zone, occlusion of the choriocapillaries in the central zone, retinochoroidal anastamoses in the periphery and in the central zone, heterogeneous neovascularization choriocapillaries around; vascular network area — 29.13 mm2, density — 10.17 %, (p > 0.05), lack of devitalization (continued growth).Conclusion. The introduction of optical coherence tomography-angiography revealed the predictors of the effectiveness of transpupillary thermotherapy of the initial melanoma of the choroid, which are various types of tumor vascularization, indicating its about complete, partial or absence devitalization after treatment.

Purpose. To evaluate the overall, disease-specific, event-free, relapse-free survival of retinoblastoma (RB) patients and cumulative probability of eye survival in such patients.Material and methods. The study included 223 children with RB (126 male, 97 female). Monolateral disease was diagnosed in 69.1 % of cases (n = 154), bilateral disease in 30.9 % (n = 69). The median follow-up was 40 months (interquartile range from 27 to 53 months). According to ABC classification, group A was diagnosed in 16 of 292 eyes (5.5 %), group B — in 53 (18.2 %), group C — in 41 (14.0 %), group D — 58 (19.9 %), and group E — in 124 (42.5 %). Group E was detected twice as often in patients with unilateral RB as in bilateral RB (56.5 % versus 26.8 %; p < 0.01). Stage T1 according to TNM classification was diagnosed in 69 cases (23.6 %), stage T2-T3 — in 213 cases (72.9 %). The extraocular form (stage T4) was detected in 3.4 % of cases (n = 10).Results. The overall five-year survival of patients treated for RB (n = 223) was 96.4 ± 1.4 %. The 5-year disease- specific survival (n = 222) was 96.8 ± 1.3 % in the general cohort, 96.5 ± 1.5 % in the group of children with monocular RB, 97.3 ± 2.7 % for binocular RB. Five-year event-free survival rate of children who received treatment (n = 223) was 66.7 ± 3.6 %, with monolateral lesion (n = 154) — 74.1 ± 4.2 %, with bilateral lesion — 50.6 ± 6.2 % (n = 69). Five-year relapse-free survival took place in 83.3 ± 3.1 %, with monolateral RB — 87.8 ± 3.3 %, with bilateral RB — 73.3 ± 6.4 %. Primary enucleation was performed in 121 of the 223 children treated for RB and included in the study. The frequency of primary enucleation with monocular RB was more than twice as high (55.2 %; 85 of 154 eyes) as with binocular RB (26.1 %; 36 of 138 eyes; p < 0.01). Organ-preserving treatment was carried out in 138 cases (171 eyes). It was effective in 123 (89.2 %) children (152 eyes; 88.9 %). 5-year ocular survival was 85.7 ± 3.7 %, with monolateral RB — 78.2 ± 6.6 %, with bilateral RB — 92.2 ± 2.8 %. Ocular survival counted separately for groups A, B, C, D, equaled 100 %, 100%, 76.6 ± 6.9 %, and 71.1 ± 11.9 %, respectively. The five-year disease-specific survival rate of children with monocular lesion given eye-preserving treatment was 100%, significantly higher than after primary enucleation — 93.4 ± 2.9 %.Conclusions. Modern combined retinoblastoma treatment is able to save the sick children’s lifes and and even their eyes and visual functions, which improves social adaptation and quality of life. It has been shown that, with a binocular form, it is possible to save more eyes than with a monocular form. Eye-preserving treatment administered to patients with intraocular RB under strictly observed criteria does not heighten the risk of metastasis. Yet timely enucleation in cases of absolute indications remains the method of choice in saving the life of a child.

The increased risk of thyroid cancer among individuals exposed during childhood and adolescence to Iodine-131 (131I) is the main statistically significant long-term effect of the Chornobyl accident. Several radiation epidemiological studies have been carried out or are currently in progress in Ukraine, to assess the risk of radiation-related health effects in exposed populations. About 150,000 measurements of 131I thyroid activity, so-called 'direct thyroid measurements', performed in May-June 1986 in the Ukrainian population served as the main sources of data used to estimate thyroid doses to the individuals of these studies. However, limitations in the direct thyroid measurements have been recently recognized including improper measurement geometry and unknown true values of calibration coefficients for unchecked thyroid detectors. In the present study, a comparative analysis of 131I thyroid activity measured by calibrated and unchecked devices in residents of the same neighboring settlements was conducted to evaluate the correct measurement geometry and calibration coefficients for measuring devices. As a result, revised values of 131I thyroid activity were obtained. On average, in Vinnytsia, Kyiv, Lviv and Chernihiv Oblasts and in the city of Kyiv, the revised values of the 131I thyroid activities were found to be 10-25% higher than previously reported, while in Zhytomyr Oblast, the values of the revised activities were found to be lower by about 50%. New sources of shared and unshared errors associated with estimates of 131I thyroid activity were identified. The revised estimates of thyroid activity are recommended to be used to develop an updated Thyroid Dosimetry system (TD20) for the entire population of Ukraine as well as to revise the thyroid doses for the individuals included in post-Chornobyl radiation epidemiological studies: the Ukrainian-American cohort of individuals exposed during childhood and adolescence, the Ukrainian in utero cohort and the Chornobyl Tissue Bank.

Objective: to evaluate the efficacy and safety of glycosaminoglycan-peptide complex (GPC, Rumalon) used in patients with knee osteoarthritis (OA) and comorbidities (hypertension and/or type 2 diabetes mellitus (T2DM).Patients and methods: A 10-month multicenter (13 centers from 10 subjects of the Russian Federation) prospective study included 179 patients with Stages II–III primary tibiofemoral knee OA and comorbidity, a walking pain intensity of ≥40 mm on a visual analogue scale (VAS), and a need for nonsteroidal anti-inflammatory drugs (for at least 30 days in the previous 3 months). The efficiency of treatment was evaluated from the changes in VAS scores for knee pain intensity during walking, the overall WOMAC score and scores of its individual indicators, laboratory parameters, and ultrasound data. All the patients received 2 cycles of GPC treatment with 25 injections, by following the manufacturer's instructions.Results and discussion. Even at 2 months after starting the treatment, there was a statistically significant reduction in pain during walking from 60 (50–69) to 40 (27–53.5) mm on the VAS (p< 0.05), which persisted during the follow-up period. A similar pattern was found when assessing the WOMAC index and its components. The drug demonstrated an anti-inflammatory effect: a decrease in the number of patients with synovitis from 55.7 to 39.2% (p=0.02), the level of high-sensitivity C-reactive protein (hsCRP) from 3.2 (1.3–6.2) to 2.6 (1.2–5.7) mg/l (p< 0.05). GPC was ascertained to have a safety profile.Conclusion. The data of this study confirm the good therapeutic effect and safety of GPC Rumalon in knee OA patients with hypertension and/or T2DM. The drug is shown to have a rapid analgesic and anti-inflammatory effect, as well as a positive influence on all clinical manifestations of OA.

The article discusses the main trends in developing the domestic market of disposable tableware, and substantiates the need for various changes. A model of integrated change management, reflecting the relationship between strategic, technological and cultural changes, is proposed. The author has developed a system of indicators for conducting HR-benchmarking. Based on their analysis, a set of measures will be developed to implement organizational changes.

Introduction.Over the last 20 years the widespread introduction of ultrasound imaging into clinical practice and the emergence of new endovascular technologies in the treatment of varicose veins have brought about a paradigm shift in the surgical treatment and the introduction of innovative minimally invasive technologies (thermoobliteration, chemical obliteration, microphlebectomy), which can be performed on outpatient basis under local anesthesia. Therefore, the widespread introduction of these technologies into the outpatient practice is the foremost task.Objective of the study.Analyse the results of the experience gained in the St Petersburg polyclinics concerning the introduction of hospital-replacing surgical treatment of varicose vein diseases and appropriate training. Materials and methods. We have performed 854 surgeries including endo-venous laser coagulation (EVLС), sclerobliteration (SO) and Varadi miniflebectomy (MF) under local infiltration anesthesia: EVLC + MF in 71%, MF in 12%, EVLC + SO in 9%, EVLC + MF + SО in 3%, EVLC in 3% and SО in 2% of cases. The patients operated on ranged in age from 19 to 78 years (53 ± 21 g), among them there were 611 women and 202 men. The clinical distribution of patients was in accordance with CEAP classification: C2 – 62%, C3 – 22%, C4a/b – 12%, C5 – 2.5%, C6 – 1.5%.Results and discussion.The evaluation of treatment results based on a retrospective analysis of patients’ examination findings after 1, 39, 180 and 365 postoperative days has demonstrated that there is no evidence of intra- and postoperative complications requiring hospitalization, disease recurrence. However, ecchymosis in 35% of cases, limited superficial infiltrates - in 18%, limited superficial thrombophlebitis - in 0.8% have been reported after MF. They have been treated using topical agents. According to the questionnaire, after a year of treatment 96% of patients appear to be satisfied with the results obtained. After a year payback financial costs have been achieved. An effective practical training program has been developed and implemented for innovative technologies for surgery of varicose veins of lower extremities. 42 physicians of outpatient clinics underwent the program.Conclusions.It can therefore be concluded that the further introduction of innovative technologies into the polyclinics is reasonably practicable as it is safe, effective, expands the population’s access to modern technologies, is economically feasible and is perceived positively by patients, reduces the burden on surgical hospitals, improves professional qualifications and expands the professional competencies of surgeons in outpatient settings.

Neonatal sepsis continues to be one of the main problems in the treatment of premature infants due to the variability of the clinical signs, the lack of uniform diagnostic criteria, optimal markers that would not be affected by the course of pregnancy, gestational age, delivery, and the early neonatal period. The objective : to analyze current data on serum markers of neonatal sepsis in newborns including children with extremely low and very low birth weight. The article reviews traditional markers that are currently widely used in resuscitation neonatal practice – C-r eactive protein, procalcitonin, and among the new ones – preadrenomedullin, and presepsin. It lists their positive and negative aspects, compares their characteristics, notes publications that describe the possibilities and limitations of their use for early diagnosis of neonatal sepsis. It has been concluded that among all markers, presepsin is of the greatest interest due to its highest sensitivity and specificity compared to the others.

Additional covering of the lower pole with allomaterial or its synthetic analogues during immediate breast reconstruction is being performed at the N. N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia, for last 7 years. Initially, epidermal flap was the only option for lower pole coverage; later acellular dermal matrix was used as part of clinical approbation. Average complication rate ranges from 20–35 % due to blood circulatory (supply) disorders.Since 2018, a titanised mesh been used as an additional coverage of the lower pole in the department of breast tumors. Through coating characteristics and its structure the frequency of fatal complications significally decreased.

The aim of study is a comparative evaluation of the efficacy and safrty of ultra-low-dose spinal analgesia, epidural and paravertebral analgesia to labor pain relief. Material and methods. Four groups of 40 women tookpart in the study: one group is 40 patients, the labor pain was relieved by epidural analgesia. The second group consisted of 40 women in labor, anesthesia was carried out with ultra-low-dose spinal analgesia, 3rd group is 40 women who were anesthetized with paravertebral analgesia. The control group is 40 patients without anesthesia. The parameters of central hemodynamics were monitored: heart rate, blood pressure, mean arterial pressure. The motor block was estimated on the Bromag escale. The dynamics of the opening of the cervix, the duration of the first and second stages of labor was estimated. Implications and negative inluence of the anesthesia, the effect of analgesia on the fetus were also registered. Results. Epidural analgesia showed high efficiency and safety, but the frequency of hypotension in this group was significantly higher than in other groups, an inrease in the positivity of the exacerbation period was found. Ultra-low-dose spinal analgesia also had a sufficient analgesic effect in the first stage of labor. However, short-termeffect did not always provide effective analgesia of the second period of labor in comparison with other methods. In general the advantages of paravertebral analgesia in the form of a significant acceleration of cervical dilatation and a decrease in the time of delivery are revealrd. There were no cfses with score of 2 of Bromage scale of a motor block with paravertebral analgesia, while in the epidural group and the ultra-low-dose spinal analgesia isolated cases with a score of 1 and 2 were encountered. Paravertebral analgesia does not result to hypotensionas against other neuro-axial methods of analgesia. Conclusion. Neuroaxialmethods provide a sufficient level of analgesia can reduse anomalies of labor and do not affect negatively the fetus. All presented methods of analgesia have their place in obstetric anesthesiology. There is the possibility of choosing the most appropriate method of anesthesiain every obstetrical situation.

The objective of the study is to assess the effect of rs6707530 polymorphism of the FN1 gene and rs1150754 polymorphism of the TNXB gene on the healing of lung tissue destruction in patients with newly detected pulmonary tuberculosis.Subjects and methods. 82 patients older 18 years with newly diagnosed pulmonary tuberculosis with destruction were enrolled in the study. X-ray data were assessed on the 2nd, 4th and 6th months of the study. Patients were divided into 2 groups depending on the efficacy of chemotherapy intensive phase.Results. In the group of patients with an effective course of chemotherapy, the frequency of carriers of G allele (p < 0.001) and T/G genotype (p = 0.01) in rs6707530 locus of the FN1 gene was higher. While T/T genotype (p = 0.002) and T allele (p < 0.001) prevailed among the patients with persisting destruction of lung tissue after the intensive phase of chemotherapy.

The aim of the study is a comparative evaluation of the efficacy and safety of ultra-low-dose spinal analgesia, epidural and paravertebral analgesia to labor pain relief. Material and methods . Four groups of 40 women took part in the study: one group is 40 patients, the labor pain was relieved by epidural analgesia, The second group consisted of 40 women in labor, anesthesia was carried out with ultra-low-dose spinal analgesia, 3rd group is 40 women who were anesthetized with paravertebral analgesia.The control group is 40 patients without anesthesia. The parameters of central hemodynamics were monitored: heart rate, blood pressure, mean arterial pressure. The motor block was estimated on the Bromag escale. The dynamics of the opening of the cervix, the duration of the first and second stages of labor was estimated. Implications and negative influence of the anesthesia, the effect of analgesia on the fetus were also registered. Findings . Epidural analgesia showed high efficiency and safety, but the frequency of hypotension in this group was significantly higher than in other groups, an increase in the positivity of the exacerbation period was found. Ultra-low-dose spinal analgesia also had a sufficient analgesic effect in the first stage of labor. However, short-termeffect did not always provide effective analgesia of the second period of labor in comparison with other methods. In general the advantages of paravertebral analgesia in the form of a significant acceleration of cervical dilatation and a decrease in the time of delivery are revealed. There were no cases with score of ‘2’ of Bromagescale of a motor block with paravertebral analgesia, while in the epidural group and the ultra-low-dose spinal analgesia isolated cases with a score of ‘1’ and ‘2’ were encountered. Paravertebral analgesia does not result to hypotensionas against other neuro-axial methods of analgesia. Conclusion . Neuroaxialmethods provide a sufficient level of analgesia can reduce anomalies of labor and do not affect negatively the fetus. All presented methods of anesthesia have their place in obstetric anesthesiology. There is the possibility of choosing the most appropriate method of anesthesiain every obstetrical situation.

The achievements of fundamental science have recently become the most widespread in the field of reproductive medicine. The biology of human development has mostly become understandable and manageable, thanks to new technologies. Some stages of the early human embryogenesis are predictably reproduced in the laboratories of assisted reproductive technologies (ART). Nevertheless, despite all the achievements, the success (birth of a healthy child) does not exceed 30% of the started cycles. That is why there is a continual search for new methods and their combinations to achieve better results and develop standard protocols for managing patients with infertility. The purpose of this work is to analyze the feasibility of genetic screening of embryos (NGS) and to compare the effectiveness of using donor and own oocytes when transferring a single embryo in cryocycles. We have analyzed the 536 cryocycles. There were four groups of patients with single embryo transfer (SET): group 1 - cycles with NGS, embryos with genetically euploid status taken for selection for transfer with used own oocytes (NSd, n=20); group 2 - cycles with single embryo transfer without NGS and using own oocytes (nSd, n=446); group 3 - cycles without NGS, using donor oocytes (nSD, n=8). All groups 1, 2, and 3 were near the same with an average age (34,1 - 34,3 - 34,6 years, respectively). Due to the small size of group 3, another (4th) observation group was taken (cycles without NGS, using donor oocytes, nSD, n=62), but without age restrictions, where the average age of patients was 42.3 years. Analyze of the survival rate shows significant decreasing in the group used donor cells (3 groups) than in groups (1 and 2) used own cells (84.62% vs 100%, p=0.060 and 91.96%, p

Biopsy of signal (sentinel) lymph nodes (LN) has been performed at the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia, for almost 20 years. In the first few years, contrast-visual method (1 % blue isosulfan and triphenyl methane control) was used in 640 patients with early (T1–2N0M0) breast cancer. In 150 patients from this cohort, standard axillary dissection was performed irrespectively of the results of signal (sentinel) biopsy. The rate of false positive responses varied between 4.6 and 6.6 %. Since 2012, radioisotope method of visualization of signal LN with intratumor administration of99mТс-technephyte colloid particles has been used (in 708 patients with T1–3N0M0 breast cancer). This type of signal LN biopsy had the following diagnostic characteristics: sensitivity was 58.9 %, specificity was 96.2 %, diagnostic accuracy was 87.1 %.In parallel with this study, in 2016 a study of diagnostic accuracy and safety of biopsy of axillary LN after neoadjuvant systemic therapy was started. The study included 263 patients with T1N1–3M0, T2–3N0–3M0, T4N0–1M0 breast cancer. To evaluate clinical status of axillary LN, ultrasound, single-photon emission computed tomography, mammography at baseline and after completion of neoadjuvant chemotherapy ± targeted therapy (trastuzumab) were performed. In some patients, in the recent years a double method of signal LN labeling (radioisotope and fluorescent methods) was used.In patients with baseline cN+-status, the rate of false positive signal LN biopsy conclusions was 13.6 %, in patients with baseline cN0-status it was 7.7 %.The study of double contrast of axillary LN and targeted label of metastatic LN prior to neoadjuvant systemic therapy continues. In total, various modifications of biopsy of signal LN were performed in 2,000 patients with breast cancer.The study protocol was approved by the biomedical ethics committee of N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia.All patients gave written informed consent to participate in the study.

Objective:A comprehensive study of the prevalence and structure of risk factors (RF) of cardiovascular diseases (CVD), the daily dynamics of central aortic pressure and arterial stiffness in healthy women of different age groups.Materials and methods:the study involved 161 women aged 18 to 65 years with one or more CVD RF. All volunteers underwent a survey, 24-hour blood pressure monitoring with determination of arterial stiffness and daily dynamics of central aortic pressure, determination of carotid-femoral pulse wave velocity (cfPWV) and vascular stiffness by volume sphygmography.Results:the examined were divided into 3 groups: 1 group of 52 women of young age from 18 to 30 years (23.8 Ѓ} 5.3 years); 2 group of 54 women from 31 years before the onset of menopause (41 Ѓ} 5.9 years); group 3 — 54 women in the postmenopausal period (55.4 Ѓ} 5.8 years). High prevalence of modifiable CVD RF among women of various ages was revealed: smoking, non-compliance with dietary recommendations, lack of physical activity. Obstetric and gynecological pathologies prevail in younger age groups. In group 1 the studied parameters correspond to normal in most parameters. Significant differences in central and peripheral pressure, arterial stiffness indicators, with the exception of cfPWV, were identified in group 2 in comparison with young women. A comparative analysis of groups 2 and 3 showed a significant difference and worsening of indicators characterizing the degree of development of arterial stiffness, the contribution of the reflected wave and the associated dysfunction of the left ventricle.Conclusion:a comprehensive study of arterial stiffness allows you to identify subclinical changes in the vascular wall and evaluate their progression in women of different age groups.

Introduction: the article analyzes one of the aspects of Russian and international experience in immunological diagnostics and immunological prophylaxis of certain diseases, namely application of procedures that may restrict the rights of citizens while ensuring public safety. This topic is becoming more and more controversial due to collision of public and private interests, so its study appears to be highly relevant. Purpose: to evaluate the legality and validity of restricting the rights of citizens as part of application of immunodiagnostics and immunoprophylaxis procedures, to formulate proposals on improving legal regulation covering the procedures themselves and the harm compensation procedures in case of postvaccinal complications – all based on the analysis of scientific information sources, legal acts, materials of law enforcement statistics, opinion polls, foreign experience. Methods: dialectical, formal-logical, functional, sociological and other general scientific methods of research; specific legal methods: comparative-legal and formal-legal. Results: the approaches to understanding immunodiagnostics and immunoprophylaxis procedures and their significance have been analyzed, the problematic aspects of legal regulation and law enforcement in this sphere, and also violations of legislation have been identified; the experience of compensating for harm caused by vaccination has been studied. Conclusions: in order to effectively achieve the goals of public health maintenance and boosting public confidence in the procedures of immunodiagnostics and immunoprophylaxis, and to ensure the rights of citizens, a set of measures is needed as follows: constant cooperation with civil society institutions that should go in parallel to the application of medical and pharmacological advances accompanied by the improvement of legal norms; control over the safety of drugs; budget financing of alternative diagnostic methods and additional examinations aimed at reducing the risk of harm to health and at identifying all the contraindications; maximum public awareness of all procedures and medications when obtaining voluntary informed consent; imposition of restrictions on persons who refused to undergo the procedures in strict accordance with the law and in proportion to the real danger to the public interest; additional training of medical staff; improvement and simplification of procedures for compensation for harm in the event of postvaccinal complications with the priority of non-judicial procedures; increase of the compensation size.

Aim. To study lipid-lowering therapy in patients with high and very high risk of cardiovascular events (CVEs) at the outpatient and inpatient care stages in Irkutsk.Material and methods. We analyzed 260 discharge summaries of patients with hypertension of high and very high risk of CVEs for the second half of 2019: 145 — from a hospital; 115 — from outpatient records. Patient adherence to statin therapy, achievement of target lowdensity lipoprotein cholesterol (LDL-C) levels in each patient subgroup was assessed.Results. The proportion of patients who reached the recommended LDL-C levels in accordance with the 2017 guidelines tends to increase in comparison with prior data. High adherence to lipid-lowering therapy was accompanied by an increase in the proportion of patients reaching the recommended LDL-C levels. In most cases, regardless of cardiovascular risk, low-dose statin therapy were used. A detailed analysis of adherence to statin therapy using questionnaires revealed that more than half of patients in high-risk categories (64%) did not comply with lipid-lowering therapy.Conclusion. Favorable trends were revealed in relation to an increase in the proportion of high-risk patients reaching target LDL-C levels. Adherence to statin therapy remains low. Previously established problems in managing such patients remains: stereotyped lipid-lowering therapy prescriptions without taking into account cardiovascular risk, the use of low-dose therapy, and the frequent prescription of statins with a lower lipid-lowering effect. Inpatients use higher statin doses than outpatients.

Background Heart failure (HF) is characterised by systematic inflammation and chronic metabolic dysregulation. HF enhances the release of pro-inflammatory cytokines, induces activation of the complement system, production of autoantibodies, and over-expression of the major histocompatibility (MHC) complex class II molecules. It is known that skeletal muscles are exposed to the immunologic injury in disease; and muscle tissue appeared to be affected by HF leading to the muscle weakness and exercise intolerance development. However, molecular abnormalities occurring in HF patients' muscles and the mechanisms underlying its development are not clarified. Purpose To understand the molecular mechanisms underlying skeletal muscle immune and non-immune impairments in HF. Methods 8 health donors and 5 HF patients with reduced ejection fraction (NYHA Class II and III) were enrolled in this study in accordance with the principles under the Declaration of Helsinki (1989). mRNA of skeletal muscle biopsies of gastrocnemius lateralis were sequenced on Illumina HiSeq. RNA-seq analysis was performed using STAR with reference genome GRCh38 and featureCounts program; differentially expressed genes (DEGs) were assessed using R package DESeq2 with FDR=0.01 and log2 fold change (l2fc) >1.5 filter; pathway analysis was performed using clusterProfiler in R (FDR=0.01). Results 1404 differentially expressed genes distinguish muscles of HF patients and controls. Among upregulated genes there are different classical MHC molecules and specific one HLA-G (l2fc=2) that has been previously shown appeared in muscles under autoimmune myopathies, and potentially protect them. Unregulated DEGs were responsible for the activation of many molecular immunological pathways: type I interferon signaling pathway (16 DEGs out of total 89), regulation of T cell proliferation (14/153), neutrophil degranulation (31/485), granulocyte differentiation (7/32), negative regulation of viral process (11/53), that indicates about specific inflammatory response in HF muscles. Response to hypoxia (22/314) and gluconeogenesis pathways (12/87) were also activated. Downregulated genes include SLC5A1 (l2fc=−4) sodium glucose cotransporter; NRP3 (l2fc=−4) that plays a role in modulating intravascular volume and vascular tone; MMP1 (l2fc=−13) involved in the breakdown of extracellular matrix; the expression of many genes responsible for DNA-repair (44/534) and cilium assembly (34/366) was also suppressed. Conclusion Transcriptome analysis shows immunological and non-immunological alterations in HF skeletal muscles and provides the information about molecular mechanisms of its development. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation grant

This paper describes the revision of the thyroid dosimetry system in Ukraine using new, recently available data on (i) revised 131I thyroid activities derived from direct thyroid measurements done in May and June 1986 in 146,425 individuals; (ii) revised estimates of 131I ground deposition density in each Ukrainian settlement; and (iii) estimates of age- and gender-specific thyroid masses for the Ukrainian population. The revised dosimetry system estimates the thyroid doses for the residents of the settlements divided into three levels depending on the availability of measurements of 131I thyroid activity among their residents. Thyroid doses due to 131I intake were estimated in this study for different age and gender groups of residents of 30,353 settlements in 24 oblasts of Ukraine, Autonomous Republic Krym, and cities of Kyiv and Sevastopol. Among them, dose estimates for 835 settlements were based on 131I thyroid activities measured in more than ten residents (the first level), for 690 settlements based on such measurements done in neighboring settlements (the second level), and for 28,828 settlements based on a purely empirical relationship between the thyroid doses due to 131I intake and the cumulative 131I ground deposition densities in settlements (the third level). The arithmetic mean of the thyroid doses due to 131I intake among 146,425 measured individuals was 0.23 Gy (median of 0.094 Gy); about 99.8% of them received doses less than 5 Gy. The highest oblast-average population-weighted thyroid doses were estimated for residents of Chernihiv (0.15 Gy for arithmetic mean and 0.060 Gy for geometric mean), Kyiv (0.13 and 0.051 Gy) and Zhytomyr (0.12 and 0.049 Gy) Oblasts followed by Rivne (0.10 and 0.039 Gy) and Cherkasy (0.088 and 0.032 Gy) Oblasts, and Kyiv City (0.076 and 0.031 Gy). The geometric mean of thyroid doses estimated in this study for the entire Ukraine essentially did not change in comparison with a previous estimate, 0.020 vs. 0.021 Gy, respectively. The ratio of geometric mean of oblast-specific thyroid doses estimated in the present study to previously calculated doses varied from 0.51 to 3.9. The highest increase in thyroid doses was found in areas remote from the Chornobyl nuclear power plant with a low level of radioactive contamination: by 3.9 times for Zakarpatska Oblast, 3.5 times for Luhansk Oblasts and 2.9 times for Ivano-Frankivsk Oblast. The developed thyroid dosimetry system is being used to revise the thyroid doses due to 131I intake for the individuals of post-Chornobyl radiation epidemiological studies: the Ukrainian-American cohort of individuals exposed during childhood and adolescence, the Ukrainian in utero cohort, and the Chornobyl Tissue Bank.

Introduction. Modern surgery is a complex, multifaceted area of medicine that plays an important role in the struggle for health, working capacity and human life. In recent years, in surgery, much attention has been paid to the improvement and development of new surgical equipment, including that based on ionizing and non-ionizing radiation, its application range being widened, which allows patients being provided with high-tech and less traumatic procedures. However, the use of such equipment resulted in the appearance of new adverse occupational factors of ionizing and non-ionizing nature at the workplaces of surgical team members, which can have a negative effect on the personnel. Material and methods. Data of x-ray and laser radiation level studies at the workplaces of medical personnel in modern operating rooms are reported. Results. Total normalized power of the effective x-ray dose during the use of x-ray surgical unit at the workplaces of surgical teams in most cases was revealed not to exceed allowable dose rate, while in the process of certain procedures, such as vessel embolization, it can exceed allowable levels. The total annual effective radiation exposure dose of x-ray surgery teams depends on the number of performed operations, their type, complexity, and can exceed a basic radiation dose limit for A and B group personnel. The intensity of diffusely reflected laser radiation at workplaces of surgeons can significantly exceed maximum allowable levels, sometimes up to 600 times. Discussion. Considering an ever-gaining use of high-tech equipment generating laser and X-ray radiation and increasing number of exposed medical personnel, hygienic assessment of these radiation levels at workplaces of surgical team members and development of measures to improve working conditions is an important issue for maintaining workers’ health. Conclusion. To assess the occupational risk degree to the health of surgeons it is necessary to conduct in-depth studies of their health status.

Aim.Analysis of the results of surgical treatment in patients with epibulbar malformations.Patients and Methods.The study included 126 patients with a preliminary diagnosis of “epibulbar neoplasm”, who received treatment from January 2013 to December 2017. Male patients were 57.9 % (n = 73), female — 42.1 % (n = 53). The age range was from 6 months to 82 years (13.0 ± 11.4). All patients underwent complex ophthalmological examination and surgical treatment with histological verification of the obtained material. In case of deficiency of own tissues, when the conjunctival defect was closed, plastic was made using an amniotic membrane.Results.67 (53.2 %) patients had a diagnosis of dermoid of the conjunctiva and / or cornea. In 14.3 % of cases, a diagnosis of lipodermoid with spreading into the eyelids fornix was established. In 7 patients there was a combined lesion, of them in 4 cases with Goldenhar syndrome, 1 case with Jadassohn syndrome and in 2 cases without syndromic disorders. In 10 patients, multicentric lesions were noted with the formation of several dermoids. Choristomas of different structures were identified in 41 patients (32.5 %). Complications of surgical treatment included limitation of eye mobility (n = 9), ptosis of the upper eyelid (n = 7), diplopia (n = 4), ocular deformity (n = 3), corneal perforation (n = 1), symblepharon (n = 1) and entropion (n = 1), which required additional surgical interventions with a favorable functional outcome.Conclusions.Diagnosis of epibulbar malformations requires a comprehensive ophthalmological examination to determine the prevalence of the process, the extent of the lesion in order to plan the timing and tactics of surgical treatment. Congenital epibulbar malformations of the eye are subject to surgical treatment with the growth of lesion, chronic inflammation, cosmetic dissatisfaction and spread to the central parts of the cornea. The use of the amniotic membrane improves normal epithelization and reduces the degree of postoperative scar deformation.

Psychological features of mothers who have given birth to premature babies present one of the most complex and insufficiently explored areas of modern perinatal psychology. The progressive increase of the children born before the term as well as the insufficient development of psychological care programs for mothers at the women's consultation and nursing departments of newborns dictate the urgency and necessity of this problem. Using psychological techniques, the authors comprehensively assessed the personality characteristics, motives for the pregnancy preservation, personal and situational anxiety of mothers of premature babies at Perinatal Center №.1. The assessment revealed that the mothers with premature low-birth-weight babies experienced a sharp increase in situational anxiety compared to personal anxiety, while the mothers of full-term babies with a normal weight tended to decrease the level ofsituational anxiety. In addition, the mothers of premature babiessufferfrom expressed and severe depression more often than the mothers of full-term babies(p

The article notes the tasks associated with cognitive models of domain management. The patterns of development of the industrial sector of the economy are highlighted and the cost component is designated as a key composition of the development of production. With the use of the decision system “IGLA”, the connectedness of the system to the concept and the concept to the system on the basis of the constructed cognitive map was determined, which served as the basis for constructing development scenarios on the example of textile production.

In the article there is presented material for the study of neuro-emotional exertion of interventional radiologists as one of the leading harmful factors of the working process. The analysis of the work activity, its structure and timing of the work of interventional radiologists has shown the work of interventional radiologists to be characterized by high neuro-emotional exertion, which is mainly caused by the intellectual and emotional compartments, and in some cases, irrational regime of the work. Their work is referred to the heuristic activity that requires the solution of complex tasks during operations and the sole manual operating process. They perform the work in conditions of lack of information on the health status of the patient and lack of time. The interventional radiologist is personally responsible for the quality of the treatment of the patient, his health and life. While performing operations the interventional radiologists are at risk of contracting infectious diseases, including viral hepatitis and HIV, they are exposed to drugs, x-rays, there is a danger of electrical injuries. High exertion of the work of interventional radiologists may cause neurosis, astheno-vegetative syndrome, hypertension, occupational fatigue, and also lead to conflict situations.The comparative evaluation of the exertion of the work carried out by two methods showed that total exertion of the work of interventional radiologists on the hygienic assessment and special assessment, for the hygienic assessment is assessed as grade 3, grade 3, and by the method of special assessment of working conditions being high as 3 class 1 subclass, because it only evaluates the sensory load and the monotony of work. Special assessment does not allow to evaluate completely the exertion of employees. It significantly underestimates the significance of this harmful factor, if the work is not only sensory, but also intellectual, emotional stress, irrational regime of work. The dependence of the results of measures of social protection of personnel, leads to a decrease in their level of security and increases the likelihood of development of professionally caused diseases.

Aim to identify outdated terms and make changes to the terminology of spondyloarthritis.At the first stage of the work, the terms divided into two categories: "outdated" definitions and terms that need to be improved or unified. Subsequently, each member of the Expert Group of Spondyloarthritis at the Association of Rheumatologists of Russia (ExSpA) presented by its own definition of the designated term or agreed with the previous term. At the next stage, the existing definitions were put together. After discussion, experts left a term that scored at least 2/3 of the votes. The special opinion of experts was recorded, whose did not coincide with the majority opinion. An open vote was conducted, when defining an "outdated" term with the unanimous decision of all group members, this term was not recommended for further clinical use.The work carried out allowed us to identify a number of terms that are not recommended for use in clinical practice. Number of terms are defined, which should be used when discussing the problem of spondyloarthritis.The Expert Group of Spondyloarthritis at the Association of Rheumatologists of Russia suggests using or, accordingly, not using a number of terms and their definitions in clinical practice.Цель исследования: выявить устаревшие термины и внести изменения в терминологию, используемую при обсуждении проблемы спондилоартритов. Материалы и методы. На первом этапе работы собраны уже употребляемые термины, их разделили на две категории: «устаревшие» определения и термины, требующие доработки или унификации. В дальнейшем каждый член Экспертной группы по изучению спондилоартритов при Ассоциации ревматологов России (ЭкСпА) представлял свое определение обозначенного термина либо соглашался с прежним термином. На следующем этапе имевшиеся определения сводились воедино, после обсуждения оставляли термин, который набрал не менее 2/3 голосов, отдельно фиксировалось особое мнение экспертов, чье мнение не совпадало с мнением большинства. При определении «устаревшего» термина проводили открытое голосование, при единогласном решении всех членов группы этот термин не рекомендовался для дальнейшего клинического использования. Результаты. Проведенная работа позволила выделить ряд терминов, которые не рекомендованы к употреблению в современных условиях, даны определения и расшифровка целого ряда терминов, которые, напротив, целесообразно использовать при обсуждении проблемы спондилоартритов. Заключение. Экспертный совет по спондилоартритам при Ассоциации ревматологов России предлагает использовать или, соответственно, не использовать ряд терминов и их определения в повседневной клинической практике и при описании клинических и иных исследований.

The purpose of the study was to examine overall survival and the incidence of major adverse cardiovascular events, as well as economic expenditures for treatment of patients with occlusion of the femoropopliteal-tibial segment and critical ischaemia in low competence of the outflow channel, with a poor prognosis for endovascular or open revascularization of lower-limb arteries.We studied the results of treating a total of 68 patients with lower-limb critical ischaemia and low parameters of the outflow channel competence. Primary arterial reconstruction was performed in 48 cases. At various terms after revascularization due to thrombosis of the reconstruction zone and the development of gangrene, amputation of the lower limb was performed: at 3 to 11 (n=25) and at 12 to 24 (n=25) months. Primary amputation of the lower limb was performed in 20 patients. The endpoints of the study included overall survival, the incidence of major adverse cardiovascular events, and economic expenditures for the in-hospital treatment. The average duration of follow-up amounted to 2 years.The obtained findings demonstrated that in patients with lower-limb critical ischaemia and low parameters of the outflow channel competence, redo arterial reconstructions and amputation within 11 months, as well as a high level of surgical risk were associated with a low overall survival rate and the development of major adverse cardiovascular events in the remote period. Secondary surgical interventions on the major vessels significantly increased the cost of treatment.Цель исследования - изучение общей выживаемости и частоты "больших" неблагоприятных кардиоваскулярных событий, а также экономических затрат на лечение больных с окклюзией бедренно-подколенно-берцового сегмента и критической ишемией при низкой состоятельности русла оттока, с плохим прогнозом для эндоваскулярной или открытой реваскуляризации артерий нижних конечностей. Изучены результаты лечения 68 пациентов с критической ишемией нижней конечности при низких показателях состоятельности русла оттока. В 48 случаях произведена первичная артериальная реконструкция. На различных сроках после реваскуляризации в связи с тромбозом зоны реконструкции и развитием гангрены была произведена ампутация нижней конечности: в срок от 3 до 11 (n=25), и от 12 до 24 (n=25) месяцев. Первичная ампутация нижней конечности выполнена 20 пациентам. Конечными точками исследования были общая выживаемость, частота развития 'больших' сердечно-сосудистых осложнений, экономические затраты на стационарное лечение. Средний срок наблюдения - 2 года. Проведенное нами исследование показало, что у больных с критической ишемией нижних конечностей и низкими показателями состоятельности русла оттока повторные артериальные реконструкции и ампутация в течение 11 месяцев, а также высокий уровень хирургического риска ассоциируются с низкой общей выживаемостью и развитием "больших" неблагоприятных кардиоваскулярных событий в отдаленном периоде. Повторные оперативные вмешательства на магистральных сосудах значительно увеличивают стоимость лечения.

Цель исследования оценить безопасность и эффективность методики общей ингаляционной анестезии ксеноном в сравнении с тотальной внутривенной анестезией (ТВА) пропофолом у пациентов пожилого и старческого возраста при спинальных нейрохирургических операциях. Материал и методы. Проспективное рандомизированное исследование включало 60 пациентов (средний возраст 74,611,2 года), оперируемых по поводу различной патологии позвоночника и спинного мозга. Критерии включения: больные с физическим статусом по ASA IIIIV и сопутствующей сердечно-сосудистой патологией. Все пациенты до операции имели плохие функциональные резервы (менее 4 МЕТ) вследствие основного заболевания и значительного ограничения двигательной активности. В 1-й группе больных (n30) была использована методика общей ингаляционной анестезии ксеноном, во 2-ю группу (n30) вошли пациенты, оперированные в условиях ТВА на основе пропофола. В обеих группах в качестве анальгетика применяли фентанил. Были сопоставлены показатели основных параметров гемодинамики, кислотно-основного состояния и газового состава артериальной крови, данные мониторинга глубины анестезии и периода пробуждения, неблагоприятные события и осложнения. Результаты. Проведенное исследование показало, что ксеноновая анестезия отвечает высоким требованиям безопасности у пациентов пожилого возраста. Гемодинамический профиль ингаляционной анестезии ксеноном более предпочтителен по сравнению с ТВА пропофолом. В 1-й группе не отмечено критических эпизодов интраоперационной гипотензии и аритмий в отличие от 2-й группы, где для коррекции гипотензии у 12 человек применяли инотропные препараты и вазопрессоры (допмин/норадреналин). Интраоперационный объем инфузионной терапии достоверно меньше в группе ингаляционной анестезии ксеноном по сравнению с ТВА пропофолом. Во время ингаляционной анестезии ксеноном у пожилых людей значения BIS-мониторинга показывают достаточное соответствие с клиническими признаками глубины анестезии. Значения BIS-индекса были идентичны рекомендуе- мому профилю в обеих исследуемых группах. Все пациенты в 1-й группе были экстубированы в операционной (среднее время экстубации 3,80,4 мин) и переведены в палату пробуждения. Во 2-й группе пациенты были экстубированы в операционной либо в палате пробуждения (среднее время экстубации 6,90,4 мин). Заключение. Ксеноновая анестезия является эффективной и безопасной методикой у пациентов пожилого и старческого возраста при проведении спинальных нейрохирургических оперативных вмешательств. Основные преимущества ингаляционной анестезии ксеноном стабильность гемодинамических показателей и быстрое пробуждение. Ксеноновая анестезия предпочтительнее для больных с сопутствующей кардиальной патологией.

Aim: to consider association of chronic adrenal insufficiency in patients with APS of adults with polymorphism of class II HLA genes, CTLA-4 and PTPN-22. Materials and methods. The case-control study involved 78 patients with APS 2, 3, 4 types and 109 healthy subjects). Alleles of the HLA class II genes, CTLA-4 and PTPN-22 were identified by the multiprimer allele-specific PCR method. The statistical analysis was carried out using the exact two-sided Fisher test. The association of the chronic adrenal insufficiency in patients with APS was determined by the value of the odds ratio (OR - odd's ratio), the value of 95% confidence interval (95% CI - confidence interval). Results and discussion. Haplotypes DR3-DQ2 (OR = 4.06), DR4-DQ8 (OR = 5.78), genotype DR3/DR4 (OR = 19.7), DQA1 * 0301 allele (OR = 4.27), as well as genotype DQA1 * 0301 / DQA1 * 0501 (OR = 13.89) predispose to the development of APS of adults compared to the control group. APS patients were divided into two groups according to the presence of chronic adrenal insufficiency (APS 2 and 4 types - in one group and type 3 APS in the other group). Haplotype DR3-DQ2 (DRB1 * 17-DQA1 * 0501 -DQB1 * 0201) (OR = 2.6), as well as the genotype DR3/DR4 (OR = 4.28) found the strongest association with the development of adrenal insufficiency in patients with APS of adults. Protective haplotypes DRB1 * 01-DQA1 * 0101-DQB1 * 0501 (p

Surface doping of AISI420 steel is carried out in a single vacuum cycle, and consisted of spraying a thin (0.5 μm) film of Zr-Ti-Cu alloy by electric-arc sputtering of a cathode of the composition Zr-6 at.% Ti-6 at.% Cu, and the subsequent irradiation of the system “film (Zr-Ti-Cu alloy) / (AISI420 steel) substrate” with an intense pulsed electron beam. It is shown that the concentration of zirconium in the surface layer of steel decreases with an increase in the energy density of the electron beam (ES). It is established that formation of a surface alloy is accompanied by the following: formation of a cellular crystallization structure (the average cell size increases from 150 nm at ES = 20 J/cm2 to 370 nm at ES = 40 J/cm2); formation of a dendritic crystallization structure in the presence of refractory element particles (titanium or zirconium); decomposition of a solid solution with the release of zirconium carbide particles (particle sizes increase from (10-15) nm at ES = 20 J/cm2 to (30-40) nm at ES = 40 J/cm2). Particles of the carbide phase based on chromium of the composition Cr3C2, Cr7C3 and (Cr, Fe)23С6, along with zirconium carbide particles, are revealed upon the irradiation of the system “film (Zr-Ti-Cu alloy) / (AISI420 steel) substrate” with an intense pulsed electron beam (ES = 40 J/cm2). Chromium carbide particles have a round shape; their sizes vary from 40 nm to 60 nm. The analysis of phase transformation diagrams taking place under equilibrium conditions in systems Fe-Zr-C; Cr-Zr-C; Fe-Cr-Zr is carried out. It is established that ultra-high cooling rates that occur during the irradiation of the system “film (Zr-Ti-Cu alloy) / (AISI420 steel) substrate” with an intense pulsed electron beam impose restrictions on formation of phases of the intermetallic type. It is suggested that formation of predominantly carbide phases in the surface layer of the material is conditioned upon high mobility of carbon atoms in steel.

The author in the article on the basis of the results of a specific sociological study shows the importance of traditions and innovations in the system of managing Russian higher education to ensure the educational security of the state in the conditions of the transition of the world economy to science-intensive technologies, the unification of legislation, and the integration of production. The technology of investigating the problem is presented on the basis of a complex of theoretical and empirical methods. The methodology of studying education as an open system in which traditions are subjected to destruction by the forces and means of a hybrid war is revealed. Possible threats, dangers, objectivity and subjectivity of the conflict of traditions and innovations in the management system of higher education are shown. The author substantiates the necessity to minimize the conflict by the organization of strategic management of the main institutions of the society. The shortcomings of our system of higher education management are revealed, which do not allow implementing the best practices of the Bologna process. The rationale for introducing innovations and preserving domestic traditions is presented. The ways of prevention of conflicts of traditions and innovations in the system of management of higher education in Russia are determined. The results of the study of the conflict of traditions and innovations in the system of management of Russian higher education showed that the introduction of Western educational innovations led to destructive conflicts. The main reasons for the contradictions between traditions and innovations are shown.

The creation in the middle of the 20th century vaccines against poliomyelitis (PM) – inactivated vaccine (IPV) and live oral vaccine from Sabin strains (OPV) with various properties, advantages and disadvantages, but highly effective, made it possible to implement the idea of elimination of PM. Since 1988, the WHO Global Program of PM eradication has achieved remarkable success: the incidence of PM caused by wild poliovirus (PV) has been reduced by 10 thousand times, the number of endemic countries has been reduced to 3, the circulation of wild PV has been discontinued in 4 regions of the world the wild type 2 of PV has been eradicated, and wild type 3 of PV has not been detected for almost 5 years. Under conditions of a decrease in the incidence of PM caused by wild PV, the known negative properties of trivalent OPV made its further use problematic. These negative properties are: 1) the ability to cause post-vaccination complications and 2) the genetic instability of Sabin strains, especially PV of type 2, and their ability under certain conditions (primarily in conditions of low collective immunity to PV) to quickly restore neurovirulence, transforming into circulating vaccinederived PV (VDPV), capable of causing incidents and outbreaks of PM. In order to reduce the risk associated primarily with type 2 PV, WHO proposed a global switch to the use of bivalent OPV from types 1 and 3, completed in 2016. In 2019, WHO plans to complete eradication of type 1 and 3 PVs, and in 2022 completely abandon the OPV. The precondition for the safety of such tactics is the maintenance of high collective immunity to PM. There are several threats to the security of this strategy. PVs can “silently” circulate in the human population for a long time without clinical manifestations of PM, which, with inadequate epidemiological surveillance can lead to the return of PM. The reintroduction of both wild PV and Sabin strains can occur from institutions that preserve / work with PV. The source of VDPV can be people with primary immunodeficiencies, which continuously excrete PV. It is necessary to maintain surveillance over the PM, expand additional types of surveillance for the PV, strict containment of all PVs. The only way to maintain collective immunity is immunization with trivalent IPV. The current global shortage of IPV poses a significant threat to the world’s epidemiological well-being. The solution to the problem is the development of a new generation of safe and effective vaccines, improving the ways of introducing IPV, developing antiviral drugs.

Objective. To assess the efficacy and safety of amtolmetin guacil (AMG) in patients with knee joint osteoarthritis (KJOA) and associated dyspepsia in real clinical practice. Methods . 220 patients with KJOA with severe pain syndrome in KJ ≥ 40 mm in VAS and dyspepsia were included in the observation study. AMG was administered at a dose of 600 mg twice daily for 28 days. Patients had three visits: before starting treatment, on Day 14 ± 3 (visit 2), on Day 28 ± 3 (final visit) to assess the pain dynamics (according to VAS), stiffness and functional activity according to WOMAC index, general health assessment (according to VAS) and a quantitative assessment of dyspepsia (SODA index). Results. Of 219 patients, about 72.5% reported pain reduction from 65 to 27 mm at the end of the study. All indicators of three scales of the WOMAC index decreased statistically significant (р

Dexmedetomidine is a high-selective α2-agonist, which is used as an anesthetic component, and it is expected to induce polyuria. Initially, it was mainly used for sedation in emergency wards, and further this medicine got widespread use in anesthesiology. The major positive effect of dexmedetomidine is related to its central sympatholytic action and suppression of the activity of sympathetic nervous system. This medicine also provides a favorable hemodynamic profile. However, it has a number of certain disadvantages. The present clinical study reports development of acute polyuria syndrome due to the administration of dexmedetomidine during spinal neurosurgery.

Taken the rising mortality and morbidity of the population due to cardiovascular diseases (CVD), rehabilitation of cardiovascular patients remains actual. Regular exercises are the leading components of cardiorehabilitation, that is evidently beneficial. Taken this, the question raises on the adequacy and efficacy of training regimens. Utilization of the parameter representing the velocity of heart rate decline by every minute of recovery phase after the exertion, is quite informative. The borderline set for heart rate, with increasing cardiovascular risk if below. Dynamics of such parameter during the programs of physical rehabilitation might be a marker of the events efficacy. Recently, there is a deficiency of information on the normal parameters of heart rate recovery rate in CVD patients. Hence a question raises, on the unification of approaches in evaluation of recovery period and data collection on the influence of long term exercises on CVD prognosis.

The goal of this work was developing of highly informative an enzyme-linked immunosorbent assay (ELISA) for the detection of IgG and IgA antibodies against to Chlamydia trachomatis, as well as comparative characterization of developed assay using standardized control materials. The study was conducted using: monoclonal antibodies (McAbs) to human IgA and IgG; recombinant Ch. trachomatis proteins – Pgp3, major outer membrane protein (MOMP); two panels of characterized sera and four reference ELISA kits. The study of immunochemical activity of peroxidase conjugates of McAbs was performed in comparison with conjugates of commercial analogues: anti-IgG McAb 2A11 and anti-IgA McAb AD3. About half of the conjugates from the received McAbs panel were more active compared to the reference antibody conjugates. It was quite justified to use the conjugates of antibodies that interact with different antigenic determinants. When IgG antibodies were detected to MOMP, it was justified 1.14-1.56 times more; when IgA antibodies were detected to MOMP, it was justified 1.16-1.37 times more. ELISA for detecting IgG/IgA antibodies to MOMP and Pgp3 of Ch. trachomatis were evaluated using appropriately described serum panels OCO-42-28-313-00 and OCO-42-28-314-00. Comparative studies of the developed ELISA for the detection of IgG and IgA antibodies to the MOMP and Pgp3 of Ch. trachomatis showed their prominent advantage over the commercial analogues, which more clearly demonstrates the difference in the ratio of average values of optical density of positive and negative samples of the described panel of sera: this indicator for commercial kits was 1.36-3.59 times less.

The paper gives the definition of remission in axial spondyloarthritides (axSpA), which has been developed by the Spondyloarthritis Study Group of Experts. The work used the Delphi technique. At stage 1, based on the analysis of the data available in the literature and on their own clinical experiences, the experts proposed some variants of the definition of remission and ways of its evaluation in patients with axSpA. At Stage 2, the definitions that had received at least 80% of the votes via anonymous voting were selected and adopted without further discussion. Those that had received an equal number of votes were reconsidered and additionally discussed; then there was repeat voting, by choosing the final definition. As a result of their discussion, the experts formulated the definitions of clinical laboratory and magnetic resonance imaging (MRI) remissions. They proposed the following remissions in axSpA: drug and drug-free, clinical laboratory, and MRI remissions, as well as a remission in the presence and absence of structural changes in the locomotor system, as evidenced by imaging techniques. Criteria for clinical laboratory remission and basic tools for its evaluation that can be used in real clinical practice and researches have been elaborated.

Development of methodology for reconstruction of individualized exposure doses for persons residing atradioactively contaminated after Chornobyl accident territories.Materials and methods of research. The methodology is based on the data of radio-ecological (ground, meal) anddosimetric (WBC measurements) monitoring held in Ukraine in 1986-2013, the results of which are saved in databases of Central Ecological and Dosimetric Register of Radiation Protection Laboratory of NRCRM. It is presentedfour levels of individualization of exposure doses. Each subsequent level of the model is based on the previous oneand takes into account additional parameters, and as a result a model of the next level comprises more number ofexposure situations and provides more accurate estimates. Using the methodology it is necessary to select a modelof such level that enables to solve in the best way the assignments posed before a researcher. For the population ofradioactively contaminated territories, two main ways of exposure are considered: (a) external gamma-exposurefrom radionuclides in the ground, and (b) internal exposure from consumption of radioactively contaminated meal.The dose is evaluated from all the main radionuclides of radioactive accident deposition, and in case of internalexposure after 1986 - only from radio-isotopes of cesium (134Cs and 137Cs).Individualized doses are evaluated for different age groups of population residing in 10 raions of the mostcontaminated after Chornobyl accident Oblasts of Ukraine: Zhytomyr, Kyiv, Rivne and Chernihiv Oblasts. Dose esti-mates are presented weighted by the number of residents in settlements of specific raions. Among them are: thedose for 1986, doses accumulated during the first 15 years after the accident (1986-2000), and during the periodof 32 years after the accident (1986-2017).Average raion dose reconstructed for adult residents of the most radioactively contaminatedNarodychy Raion of Zhytomyr Oblast in 1986 was 18 mSv, and accumulated during the whole period after the acci-dent was 51 mSv. The lowest doses among abovementioned 10 raions were obtained by persons residing at the ter-ritory of Kozelets and Ripky Raions of Chernihiv Oblast. Average dose for them in 1986 constituted 1.3 and 1.7 mSv,and the one accumulated during 32 years was 6.1 and 6.2, respectively.Meta doslidzhennia. Rozrobka metodyky rekonstruktsiï indyvidualizovanykh doz oprominennia naselennia, iakemeshkaie na radioaktyvno zabrudnenykh vnaslidok Chornobyl's'koï katastrofy terytoriiakh.Materialy ta metody doslidzhennia. Metodyka bazuiet'sia na danykh radioekologichnogo (ґrunt, produkty kharchu-vannia) ta dozymetrychnogo (LVL-vymiriuvannia) monitoryngiv, shcho provodylys' v Ukraïni u 1986–2013 rr., rezul'-taty iakykh zberigaiut'sia u bazakh danykh Tsentral'nogo ekologo-dozymetrychnogo reiestru laboratoriï radiologichno-go zakhystu NNTsRM. Predstavleno chotyry rivni indyvidualizatsiï doz oprominennia. Kozhen nastupnyĭ riven' ba-zuiet'sia na poperedn'omu i vrakhovuie dodatkovi parametry, zavdiaky chomu model' nastupnogo rivnia okhopliuie bil'-shu kil'kist' sytuatsiĭ oprominennia ta nadaie tochnishi otsinky. Pry vykorystanni metodyky slid vybyraty model'togo rivnia, iakyĭ naĭkrashchym chynom dozvoliaie rozv'iazaty postavleni pered doslidnykom zavdannia. Dlia naselen-nia radioaktyvno zabrudnenykh terytoriĭ rozgliadaiut'sia dva osnovnykh shliakhy oprominennia: (a) zovnishnie gamma-oprominennia vid radionuklidiv u ґrunti ta (b) vnutrishnie oprominennia vid spozhyvannia radioaktyvno zabrudne-nykh produktiv kharchuvannia. Doza obchysliuiet'sia vid usikh osnovnykh radionuklidiv radioaktyvnogo avariĭnogo vy-kydu, a u vypadku vnutrishn'ogo oprominennia pislia 1986 roku - lyshe vid radioizotopiv tseziiu (134Cs ta 137Cs).Rezul'taty. Indyvidualizovani dozy rozrakhovano dlia riznykh vikovykh grup naselennia, iake meshkaie u 10 raĭonakhnaĭbil'sh postrazhdalykh vnaslidok chornobyl's'koï avariï oblasteĭ Ukraïny: Zhytomyrs'koï, Kyïvs'koï, Rivnens'-koï ta Chernigivs'koï. Navodiat'sia otsinky doz, zvazhenykh na chysel'nist' naselennia u naselenykh punktakh (NP) ok-remykh raĭoniv. Sered nykh: doza za 1986 r.; dozy, nakopycheni za pershi 15 pisliaavariĭnykh rokiv (1986–2000 rr.)ta za 32-richnyĭ period (1986–2017 rr.) pislia avariï.Vysnovky. Seredn'oraĭonna doza, rekonstruĭovana dlia doroslykh zhyteliv naĭbil'sh radioaktyvno zabrudneno-go Narodyts'kogo raĭonu Zhytomyrs'koï oblasti u 1986 r. sklala 18 mZv, a nakopychena za ves' pisliaavariĭnyïperiod – 51 mZv. Naĭmenshi dozy sered zaznachenykh 10 raĭoniv otrymaly osoby, shcho meshkaiut' na terytoriï Koze-lets'kogo ta Ripkyns'kogo raĭoniv Chernigivs'koï oblasti. Serednia doza dlia nykh u 1986 r. stanovyla 1,3 ta 1,7 mZv,a nakopychena za 32 roky – 6,1 ta 6,2 mZv vidpovidno.