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Aim. The practical guidelines are intended for primary care physicians, general practitioners, paediatricians, gastroenterologists and general internists to advance the treatment and prevention of gastroenterological diseases in adults and children in therapies with probiotics, prebiotics, synbiotics and their enriched functional foods.Key points. Probiotics are live microorganisms that sustain health of the host when supplied in adequate amounts. Prebiotics include human-indigestible but accessible to gut microbiota substances expediting specific changes in the composition and/or activity of gastrointestinal microbiota that favour the host health. The mechanism of probiotic action comprises the quorum resistance maintenance, nutrient substrate metabolism and end metabolite recycling, macroorganism-sustaining substrate production, as well as the mediation of local and adaptive immune responses.The Russian Federation regulates market differently for biologically active food additives (BAFA), medicinal products (drugs) and functional food products (FFP). We overview the probiotic strains regulated in Russia as BAFAs, drugs and FFPs and provide recommendations on the use of these strains in treatment and prevention of gastroenterological diseases in children and adults.Conclusion. The clinical efficacy of probiotics, prebiotics, synbiotics and fortified functional foods depends on the prebiotic and strain properties and is verified in appropriate comparative clinical trials. Not all probiotics registered in Russia as BAFAs, drugs and FFPs have a strain identity, which provides no warranty of the clinical effect expected. The FFP legislation demands improved regulation mechanisms and control for therapeutic efficacy.

Introduction. One of the most significant issues that require close attention in the treatment and rehabilitation of patients with coronovirus infection is the analysis of the nutritional status of patients and the development of approaches to nutritional support for patients.Aim of study. Analysis of nutritional status of patients infected with COVID-19 and studying the effectiveness of specialized products dietary therapeutic and preventive nutrition during illness and recovery period.Materials and methods. A survey of 283 patients with mild and moderate severity was conducted. The survey showed a significant change in eating behavior in patients during the disease. To assess the effectiveness of nutritional support during the disease and during the recovery period, 36 individuals took a specialized product of dietary therapeutic and preventive nutrition “Detoxifying Kissel” LEOVIT DETOX daily after the diagnosis of COVID-19, both throughout the entire period of the disease, and within 2 weeks after the disease and going to work.Results and discussion. The survey showed the presence of a significant range of eating disorders in patients with coronavirus disease. It was found that in 90% of the respondents during the day, the main meal was 3 or more times. During the disease, the number of main meals decreased in 40% of individuals, and only in 4% of patients this figure increased. When using nutritional support with dietary therapeutic and prophylactic foods during the disease, patients noted a significant decrease in weakness and fatigue, temperature fluctuations, fears, anxiety, suspiciousness and other symptoms began to disappear. The continuation of the intake in the post-ovoid period of the use of nutritional support with the dietary therapeutic and preventive food product “Detoxifying Kissel” LEOVIT DETOX, contributes to a faster recovery of patients.Conclusion. The use of the dietary therapeutic and preventive food product “Detoxifying Kissel” LEOVIT DETOX is an effective method of nutritional support both during the disease and in the post-ovoid period. Long-term use of detoxification products (at least 3–6 months) after the disease is recommended.

Background . Cancer care involves a multidisciplinary approach to diagnosis and treatment of patients. A complex interaction of actors in the deployment of oncology services dictates usage of modern management technologies for improving the quality and efficiency of patient care through processes optimisation. Objectives. Provision of recommendations for patient routing based on research into the oncology service inter-level information exchange, integration of the process approach and electronic services. The lack of a unified information space with a regional oncology service has been explained. Measures are proposed for the patient routing optimisation as part of establishing a unified digital oncology service circuit. Methods . The oncology service was effectively remodelled through functional and information engineering of electronic services and the process management integration to establish a horizontal decision flow between facilities and employees on a process level bypassing the supervisor coordination. Statistical approaches were used to analyse the oncological patient population. Results . The following electronic services have been implemented: specialised patient referral routing, telemedicine and teleradiology. A comprehensive information framework has been created comprising medical, laboratory and radiological information subsystems integrated through regional electronic services of the unified state healthcare information platform. The goals, objectives, general principles, architecture and expected social economic impact on healthcare of Krasnodar Krai have been defined. Conclusion . Use of electronic services ensures an improved quality of specialised care and effective routing of patients. We perceive prospects of the integrated information platform in the extension and improvement of its subsystems’ functionality and content, sourcing more data providers and the circuit expansion to the federal and regional levels.

The purpose of this study was to analyze results of simultaneous septoplasty and functional endoscopic sinus surgery in children. The study included 341 children who underwent endoscopic functional sinus surgery. The average age of patients was 11.2 ± 0.4 years. The follow – up period was 33.06 ± 6.9 months. Endoscopic septoplasty was performed simultaneously with FESS (functional endoscopic sinus surgery) in 72 children (21.1%). A comparative analysis of the results of FESS and endoscopic septoplasty showed a statistically significant association for 15 indicators on the SNOT 20 scale (p < 0.05). Significant differences were found both in general symptoms: sleep disturbance, cough, irritability, dizziness, decreased concentration, fatigue, emotional depression, sadness, grief, and local: nasal obstruction, post-nasal drip, hyposmia, mucosal edema, secretory otitis media, rhinorrhea, dry throat. Correlation analysis of the results of FESS and endoscopic septoplasty in relation to the child’s age did not reveal statistically significant differences: chi2 = 3.42 p = 0.33. The results of the study showed the efficacy of single-stage septoplasty when performing endoscopic rhinosinus surgery in childhood in improving local and general symptoms and a low degree of complications in the postoperative period.

The tissue reaction of pig skin to implantation of decellularized and recellularized dermal matrices on a formed wound defect was evaluated by histological methods on days 2, 5, 8, 16, and 20 after surgery. Differences in tissue response to different matrices were identified. In experimental wounds coated with decellularized dermal matrices, we observed the formation of a scar tissue, which required autodermoplasty on day 12 of the experiment. In wounds coated with recellularized dermal matrices, all layers of the skin completely recovered by day 20 after surgery with the formation of full dermal and epidermal layers. Our findings suggest that reparative morphological changes in the wound depend on the presence of fibroblasts in the implanted dermal matrix.

Sore throat is a common complaint among children and adults. In addition to infection, causes of sore throat include non-infectious pathological conditions. Among possible causes are viruses, bacteria, fungal flora. Identification of etiology significantly affects the disease management. The prescription of systemic antimicrobial agents is justified, if bacterial etiology is confirmed or a child develops complications; the presence of β -hemolytic streptococcus is an absolute indication for antibiotic therapy. Increasingly greater attention is now paid to topical agents in the treatment of bacterial tonsillopharyngitis, in particular, to the drugs that combine the antiseptic and antibiotic properties. The article provides data on the use of a combination drug containing antibacterial substance gramicidin S and antiseptic component cetylpyridinium chloride that proved its efficacy, safety, and low risk of side effects in pediatric and adult patient population. The authors present their own clinical observations of the successful use of this combination drug in paediatric practice. Clinical case 1 . A 15-year-old child K. with a polyvalent drug allergy to antibacterial drugs. Moderately grave condition, subfebrile temperature 37.8 oC; submandibular lymph nodes increased up to 2.0 cm with expressed tenderness; preliminary diagnosis is acute tonsillopharyngitis; Infectious mononucleosis?». Pharyngoscopy showed bright hyperemia of edematous mucous membrane, hyperemia of enlarged palatine tonsils, visualized white plaque; single vesicular rashes on the anterior palatine arches and uvula. The patient received active etiotropic, pathogenetic and symptomatic therapy. Instead of systemic antibacterial therapy, a combination drug based on gramicidin S and antiseptic component cetylpyridinium chloride was chosen. The patient was discharged from the hospital on Day 10 of hospitalization, the child had no complaints, the general condition returned to normal. Clinical case 2 . A 6-year-old child was diagnosed with acute pharyngitis, degree II palatine tonsils hypertrophy, degree II nasopharyngeal tonsil hypertrophy, submandibular and cervical lymphadenitis. The laboratory test results showed absence of β -hemolytic streptococcus. The combination drug based on gramicidin S and antiseptic component cetylpyridinium chloride was prescribed, the pharyngotonsillitis symptoms disappeared on Day 7 of observation. Clinical observations demonstrate the possibility of using the combination drug for the complex treatment of acute tonsillopharyngitis of any etiology, including those that develop in childhood.

Relevance. To study the incidence of different types of resorption of multirooted primary teeth, to specify indications for deciduous molar extraction to prevent eruption abnormalities of permanent posterior teeth in mixed dentition.Materials and methods. Root resorption of 375 multirooted primary teeth (166 first primary molars and 209 second primary molars) was studied on panoramic X-rays of 60 children (30 girls and 30 boys) aged between 7 and 15. Illustrated classification by T.F. Vinogradova (1967) improved by authors was used to determine type and degree of root resorption of multi-rooted primary teeth. Received data were described with absolute values of number of cases and percentage. Chi-square was used to detect differences in sign incidence rate between groups, pResults. There were no statistically significant gender differences (p>0,05) in type and degree of root resorption of multirooted primary teeth. Type A resorption prevailed and constituted 53.3% of all primary molars. Disturbances in root resorption of multirooted primary teeth in mixed dentition were related to health condition of primary teeth. Transition of even resorption to unven was considered a risk factor of delayed eruption and aberrant position of permanent teeth, and indication for extraction of a primary molar in question. Conclusions. 1) Even root resorption (type A) was detected in 53.3% of primary molars in mixed dentition by orthopantomography. 2) Transition from even resorption of primary molar roots to uneven resorption was associated with eruption deviations and delayed premolar eruption. 3) Timely extraction of primary molars with uneven root resorption facilitated correct eruption of premolars and increased effectiveness of secondary prevention of malocclusion in children.

Aim. To provide practical recommendations on the use of probiotics for the treatment and prevention of gastroenterological diseases in adults.General provisions. Probiotics are living microorganisms that benefit the health of the host when administered in adequate amounts. The main functions of probiotics include the support for colonisation resistance, the metabolism of food substrates and utilisation of end metabolites, the production of substrates necessary for the macro-organism, as well as the regulation of local and adaptive immune responses. Probiotics can be registered in the Russian Federation as biologically active food additives (BAFA) or as pharmaceutical products (drugs) in accordance with the microbiological standards and legislative requirements of the Russian Federation. The probiotics registered in the Russian Federation as BAFA for adults include bacteria of the Lactobacillus, Bifidobacterium, Enterococcus, Pediococcus, Lactococcus, Streptococcus, Bacillus, and Escherichia genera, and fungi of the Saccharomyces genus; probiotics registered as drugs — bacteria of Lactobid, Lactobacid, Escherichia and Enterococcus genera and fungi of the Saccharomyces genus. Some probiotics registered in the Russian Federation include probiotic strains that have proved to be effective for the prevention and treatment of antibiotic-associated diarrhea, the prevention of C. difficile-associated disease, the eradication of H. pylori infection, as well as for the treatment of irritable bowel syndrome and functional constipation.Conclusions. The clinical efficacy of probiotics depends on the probiotic strains included in their composition and is confirmed by a comparative analysis of the results of appropriate clinical studies. Not all probiotics registered in the Russian Federation as BAFA or drugs contain bacterial or fungal strains; as a result, the expected clinical effect may not be achieved.

Aim. To evaluate the level of staffing by general practitioners (GP) in medical organizations in Krasnodar Krai.Materials and methods. Indicators characterizing the level of staffing by GPs in Krasnodar Krai hospitals were analysed using data from the state statistical observation form No. 30 “Information about a medical organization” for the 2009–2019 period. According to the data derived from the Krasnodar Krai Patient Register as of 01.01.2020, all GPs were divided into groups in terms of the ratio of the number of served population and the recommended values. Using the data of the Regional Register of Medical Workers as of 01.01.2020, the age composition of GPs was analysed.Results. As of 01.01.2020, Krasnodar Krai featured 228 medical organizations subordinate to the Krasnodar Krai Ministry of Healthcare. Of these, 58 have full-time GP positions. The overall number of GP positions comprises 294, which are currently taken by 198 specialists (1.1% of the total number of doctors and 1.9% of doctors providing medical care on an outpatient basis). Over the studied period, stable indicators of the provision of the Krasnodar Krai population by GPs were noted; however, the level of staffing by GPs in hospitals was decreasing. This indicates a growing trend in the lack of GPs. An analysis of the actual load of 198 GPs showed that, on average, 1 GP serves 1219 people. For 26.8% of GPs, the number of served population increased the recommended values by 1.5 times or more. As a result, over 100,000 adults in the region are served under the conditions of excessive workload on GPs. The average age of GP is 50.1 ± 0.9 years. Currently, more than 25% of GPs are working retirees by age. In the medium term, this value may exceed 50%. Considering specialists who are about to retire, the estimated need for GPs is 146 doctors.Conclusion. In order to provide affordable and high-quality primary health care to the population in Krasnodar Krai, the number of GPs should be increased. In addition, measures should be taken to raise the attractiveness of work in Krasnodar Krai hospitals.

Tonsillopharyngitis is a common disease among pediatric patients. Visits associated with sore throat account for 6 to 8% of all visits to pediatricians and general practitioners. Tonsillopharyngitis can have both infectious and non-infectious etiologies. In pediatric practice, most cases of upper respiratory tract infections are of viral origin, especially in children of early and preschool age. In most cases, uncomplicated course and non-infectious etiology of the disease do not require the administration of antibacterial drugs. The bacterial nature of the disease can be distinguished from the viral one using the data of culture analysis and rapid test for group A β-hemolytic streptococcus (GABHS) or Streptococcus pyogenes . The etiotropic therapy of streptococcal tonsillopharyngitis is antibiotic therapy. In GABHS, antibiotic therapy shortens the duration and reduces the severity of symptoms, reduces the Likelihood of purulent complications, post-streptococcal diseases and prevents the generalization of streptococcal infection. The use of modern antiseptic herbal medicines may be an additional and alternative line of therapy. The authors presented a literature review of the clinical trials results of a modern herbal medicine and provided the results of their own case of the combined treatment of a 10-year-old child with a diagnosis: acute moderate tonsillopharyngitis, bilateral cervical lymphadenitis; acute rhinitis; chronic adenoiditis, exacerbation; degree 2 adenoids. Antibacterial therapy included amoxicillin: oral: 100 mg/kg/day in 2 divided doses for 10 days, combined with an anti-inflammatory and antiseptic herbal medicine due to the complicated course of the disease in the form of concomitant regional lymphadenitis. The course of therapy resulted in clear positive changes: overall well-being improved as early as on the second day of treatment, sore throat and submandibular region ceased to cause pain by 5th day of treatment, the temperature became normal by 5th day of the disease. This clinical observation shows the possibility to introduce an anti-inflammatory herbal medicine to the complex treatment of acute tonsillopharyngitis in children, including cases of complicated course of the disease.

Background & Aims Due to the poor eradication rates of standard triple therapy, the addition of bismuth salts has been proposed for first-line eradication of Helicobacter pylori. We assessed the effectiveness and safety of the combination of bismuth and the standard, clarithromycin-containing triple therapy in eradication of H pylori infection, using data from a large multi-center registry. Methods We performed an interim analysis of data from the European Registry on H pylori Management, a prospective trial registering clinical data and outcomes from infected patients from 27 countries in Europe since 2013. We extracted data on 1141 treatment-naive patients who received first-line treatment with bismuth salts (240 mg) and a proton pump inhibitor (57% received esomeprazole, 18% received omeprazole, 11% received pantoprazole, and 14% received rabeprazole), amoxicillin (1 g), and clarithromycin (500 mg), all taken twice daily. Results Intention to treat and per-protocol rates of eradication were 88% and 94%, respectively. Intention to treat eradication increased to 93% in patients who received 14-day treatments. Adverse events occurred in 36% of patients; 76% of these events were mild, with a mean duration of 6 days. In multivariate analysis, eradication was associated with treatment compliance (odds ratio [OR], 13.0), a double dose (equivalent to 40 mg omeprazole) of proton pump inhibitor (OR, 4.7), and 14-day duration of treatment (OR, 2.0). Conclusions In an analysis of data from a large multi-center registry, we found the addition of bismuth to 14-day standard triple therapy with clarithromycin and amoxicillin to eradicate H pylori infection in more than 90% of patients, based on intention to treat analysis, with an acceptable safety profile and level of adherence. ClinicalTrials.gov no: NCT02328131 .

In spite of scientific achievements in diagnostics and treatment of the diseases of nose and paranasal sinuses in children, this problem remains important. Acute bacterial rhinosinusitis occupies one of the leading positions among ENT diseases in terms of seeking medical care, and often results in the development of orbital and intracranial complications. Rhinogenic orbital complications in children occur more frequently than in adults, where 10–22% are purulent-septic orbital processes with a possible outcome of blindness. The article presents a clinical case of acute purulent rhinosinusitis complicated with a right orbit phlegmon in a four months old infant. Timely diagnosis, early surgical treatment made it possible to stop the inflammatory process, to avoid the development of more severe complications. The specific features of diagnostics and treatment of acute rhinosinusitis in infants, occurring with orbital complications, predetermines the need for an interdisciplinary approach of doctors of different specialties.

INTRODUCTION: The safety of Helicobacter pylori eradication treatments and to what extent adverse events (AEs) influence therapeutic compliance in clinical practice are hardly known. Our aim was to assess the frequency, type, intensity, and duration of AEs, and their impact on compliance, for the most frequently used treatments in the European Registry on Helicobacter pylori management. METHODS: Systematic prospective non interventional registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H. pylori infection in routine clinical practice. All prescribed eradication treatments and their corresponding safety profile were recorded. AEs were classified depending on the intensity of symptoms as mild/moderate/severe and as serious AEs. All data were subject to quality control. RESULTS: The different treatments prescribed to 22, 492 patients caused at least 1 AE in 23% of the cases ; the classic bismuth-based quadruple therapy was the worst tolerated (37% of AEs). Taste disturbance (7 %) , diarrhea (7 %) , nausea (6%), and abdominal pain (3%) were the most frequent AEs. The majority of AEs were mild (57%), 6% were severe, and only 0.08% were serious, with an average duration of 7 days. The treatment compliance rate was 97%. Only 1.3% of the patients discontinued treatment due to AEs. Longer treatment durations were significantly associated with a higher incidence of AEs in standard triple, concomitant, bismuth quadruple, and levofloxacin triple or quadruple therapies. DISCUSSION: Helicobacter pylori eradication treatment frequently induces AEs, although they are usually mild and of limited duration. Their appearance does not interfere significantly with treatment compliance.

Introduction Facial burns are not only a severe burn injury, but result in psychological disturbance. The improvement of the methods of treating facial burns remains topical. The aim of the study was to evaluate the effectiveness of approach based on full-thickness skin autografting for facial burn injuries. Methods During 2000–2019, ninety seven patients with the facial burn were treated in Burn Center. All patient were divided into two groups. The comparative analysis between groups was done. Results Group A was treated with full-thickness skin grafts (42 patients – 43.3%). Since 2010, total full-thickness skin graft was used in 11 patients from Group A. In group B, 55 patients (56.7%) were treated with split-thickness skin grafts, including 9 patients (16.4%) with total split-thickness skin graft transplantation. Total full-thickness skin graft was performed in case of a deep and extensive facial burn and cicatricial deformities. During the long-term period, a positive cosmetic result and the absence of indications for reconstructive operations were noted. Conclusion The approach of facial burn treatment based on total full-thickness skin graft allows conditions for engraftment and adaptation of autograft, reduces the risk of scar developing and achieves maximum cosmetic results of treatment.

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: "Hp-EuReg") allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations.A comparative analysis of the data entered in the register by the Russian research centers "Hp-EuReg", in the period from 2013 to 2018, was conducted.Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period.In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.от имени научного комитета и исследователей Hp-EuReg Наблюдательное многоцентровое проспективное исследование, инициированное Европейской группой по изучению Helicobacter pylori и микробиоты (EHMSG), проводится в 27 странах Европы. Данные российской части Европейского регистра ведения инфекции Helicobacter pylori (European Registry on the management of Helicobacter pylori infection, протокол: «Hp-EuReg») позволяют проанализировать реальную клиническую практику диагностики и лечения H. pylori и сопоставить ее с международными рекомендациями. Материалы и методы. Проведен сравнительный анализ данных, внесенных в регистр российскими центрами исследования «Hp-EuReg» в период с 2013 г. по февраль 2018 г. Результаты и обсуждение. Для первичной диагностики H. pylori доминируют инвазивные методы: гистологическое исследование (20,3% в 2013 г. и 43,9% в 2018 г.) и быстрый уреазный тест (31,7 и 47,8% соответственно). Наиболее часто назначаемым режимом эрадикации является 10-дневная тройная терапия (62,8-76,2%), эффективность которой per protocol не превышает 79%. Ведущим методом контроля эффективности остаются инвазивные тесты (гистологическое исследование), однако намечается тенденция к росту применения неинвазивных методов: моноклонального теста на антиген H. pylori в кале (с 17% в 2013 г. до 29,3% в 2018 г.) и уреазного дыхательного теста (с 6,9 до 18,3% соответственно). Серологический тест с целью контроля эрадикации продолжают использовать от 8,2% в 2013 г. до 6,1% в 2018 г. Не проводился контроль у 28% больных. Выводы. В России сохраняются значимые отклонения клинической практики от отечественных и международных рекомендаций, как при проведении эрадикационной терапии, так и на этапе контроля ее эффективности.

Aim. To evaluate the effectiveness of the developed special sports complex in the prevention of hypodynamia and obesity among firefighters-rescuers.Materials and methods. A survey of 490 men with no history of chronic infectious and non-infectious diseases aged 20-59 was conducted. 328 people were the main group, 162 people were the control group. The baseline data included anthropometric development indicators, bioimpedance test results, the extraction of biochemical blood test results; the body mass index (BMI) and the ratio of waist and hip circumference were determined. A questionnaire was conducted to identify hypodynamia (according to the IPAQ questionnaire) and the nutrition structure (according to the questionnaire on the food label literacy questionnaire, past). Both questionnaires were adapted to the Russian Federation. Statistica for Windows 8.0 was used for statistical processing. We used a comparison of the means of the Student method. To compare the values expressed in percent, the method of inverse trigonometric Fisher transformations was used.Results. We have developed and proposed for firefighters-rescuers, included in the main group, special sports complexes, which were used for 6 months. These complexes represent additional physical training by the developed method. There are two of them: one with an emphasis on the prevention and rehabilitation of people with osteochondrosis of the lumbar spine, and the other for cervical and thoracic localization, including with a syndrome of shoulder-scapular periarthritis.Classes were held 3 times a week, the duration of 1 session was 45-50 minutes. The choice of the complex was carried out at the request of firefighters-rescuers. The first complex was selected by 52 people. Based on the results of the study, against the background of the use of sports complexes, there was a 2-fold decrease in the incidence of obesity. Such a high efficiency is due to the fact that obesity of the I degree prevailed among the firefighters-rescuers. In addition, the frequency of occurrence of dyslipidemia, hyperglycemia, and hypodynamia decreased.Conclusion. The use of this sports complex can reduce the risk factors for development of disability among rescue firefighters by preventing hypodynamia and reducing the incidence of hyperglycemia and dyslipidemia, as factors in the development of obesity.

On behalf of the scientific Committee and researchers Hp-EuReg European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. Materials and methods. The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy. Results. The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effectiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clarithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Еradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. Conclusion. Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children's Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.Российский консенсус по диагностике и лечению хронического панкреатита подготовлен по инициативе Российского 'Панкреатологического клуба' с целью выяснения и консолидации мнений отечественных специалистов (гастроэнтерологов, хирургов и педиатров) по наиболее важным проблемам диагностики и лечения хронического панкреатита. Настоящая статья продолжает серию публикаций, разъясняющих наиболее важные положения междисциплинарного консенсуса и посвящена вопросам заместительной ферментной терапии.

Given the high rates of dental disease de children with neuropsychiatric disorders, there is a need to develop an algorithm to provide the necessary dental care. Embedded regulations "Multistep" represents "rehabilitation area" dental individualized care for children with neuropsychiatric disorders, in which the central place is occupied by the interaction of the child and the adult (the doctor and parents) in terms of medical and correctional environment, creating favorable conditions for the compensation of polymorphic disorders, dental adaptation full rehabilitation.

The purpose of the first multidisciplinary Consensus: to comprehensively analyze the pathophysiological, clinical, and pharmacotherapeutic aspects of the syndrome of increased epithelial permeability (SPEP) as one of the basic mechanisms of the development of human pathology. The Consensus presents the structure of the three main levels of cytoprotection: preepithelial, epithelial and subepithelial, and the structure of intercellular tight contacts in epithelial tissues and endothelium is considered in detail. The clinical sections of the Consensus are devoted to the role of SPEP in diseases of the digestive system, cardio-cardio-vascular and other visceral systems. A separate section summarizes the materials illustrating the significant role of SPEP in mental disorders and diseases of the nervous system. A separate chapter of the Consensus is devoted to cytoprotective therapy in SPEP. Cytoprotective effects of such proton pump inhibitor as rabeprazole, bismuth preparations and probiotics have been shown. Special attention is paid to the clinical and pharmacological specialties of the cytoprotector of rebamipide. Clinical the effectiveness of re-bamipide shown as in functional, so in organic lesions of the digestive system. Its anti-cancer preventive effects are of practical importance.

Cystic fibrosis is genetic multisystem disorder with a predominant lesion of the respiratory tract. The duration and quality of life of these patients depends on the state of respiratory function. Progressive lung dysfunction is still the leading cause of mortality patients with cystic fibrosis. End-stage lung diseases in patients with cystic fibrosis, lung transplantation is a viable method of treatment. It has the ability to prolong life of these patients. Survival in cystic fibrosis has steadily increased medical treatment and post-transplant. Chronic rhinosinusitis (with nasal polys and without) impacts almost all cystic fibrosis patients, leading to significant reductions in quality of life. Chronic rhinosinusitis with nasal polyps is prevalent in the cystic fibrosis patients, and it is often a recalcitrant infection with multidrug resistant organisms. Medical therapies such as nasal irrigations, nasal steroids, and antibiotics are critical for managing symptoms, but functional endoscopic sinus surgery is necessary for refractory cases. The unified airway hypothesis suggests that sanitation bacterial infection in the upper airway can also decrease bacterial burden in the lungs. The article presents a clinical case of successful endoscopic sinus surgery in a 15-year-old patient with chronic rhinosinusitis with nasal polyps and cystic fibrosis after lung transplantation. The intervention was performed under General anesthesia and controlled hypotension. Bilateral antrostomy, ethmoidectomy and Draf IIb frontal sinusotomy were performed by endoscopic endonasal approach. There were no intra - and post-operative rhinosurgical or lung complications. The follow-up period was 18 months. At present, there is no relapse of chronic polypous rhinosinusitis, and there are no indications for revision intervention.Муковисцидоз (МВ) — это наследственное мультисистемное заболевание с преимущественным поражением респираторного тракта. Именно от состояния дыхательной функции зависят продолжительность и качество жизни таких пациентов. Прогрессирующие изменения легочной ткани служат ведущей причиной летальности при МВ. Пересадка легких является способом продления жизни пациентов с МВ в терминальной стадии патологии легких. Разработка консервативных схем лечения, а также возможность трансплантации легких значительно увеличивают показатель выживаемости больных с МВ. Хронический риносинусит как с полипозом, так и без встречается в большинстве случаев заболевания. При этом превалируют формы с полипозом и полирезистентной флорой. В качестве терапии эффективны консервативные подходы, такие как ирригация полости носа, топические интраназальные стероиды, антибактериальные препараты, однако в случае устойчивого течения риносинусита показано проведение функциональной эндоскопической хирургии пазух носа (functional endoscopic sinus surgery, FESS). Согласно гипотезе о единой дыхательной системе, санация очагов инфекции в верхних отделах респираторного тракта приводит к снижению бактериальной нагрузки его нижних этажей. В статье представлен случай успешного проведения эндоскопической полисинусотомии у пациентки 15 лет с полипозным риносинуситом и МВ, состоянием после трансплантации легких. Вмешательство выполнялось в условиях общей анестезии и контролируемой гипотонии. С применением эндоскопического эндоназального подхода выполнены двусторонняя срединная антростомия, полипоэтмоидотомия и фронтотомия по Draf IIb. Интра- и послеоперационных осложнений, как ринохирургических, так и со стороны легких, не было. Катамнез составил 18 мес. В настоящее время состояние ребенка по основному заболеванию расценивается как стабильное средней тяжести, рецидив хронического полипозного риносинусита не отмечен.

Background: The frequent coexistence of gastroesophageal reflux disease (GERD) with functional dyspepsia (FD) and an irritable bowel syndrome (IBS) has been described in the literature. Aim: To study the specific features of GERD clinical course and diagnosis in patients with GERD in combination with FD and constipation predominant IBS (IBS-C) in comparison to patients with isolated GERD; to assess the efficacy of lactulose and itopride hydrochloride. Materials and methods: A total of 60 patients with GERD, FD (Rome criteria III), and IBS-C (Rome criteria III) and 29 patients with isolated GERD were examined. GERD diagnosis was based on clinical, endoscopic, and pH-metric criteria. For 4 weeks 10 patients with combination of non-erosive reflux disease (NERD), FD and IBS-C received lactulose monotherapy and other 10 patients received combination of lactulose with itopride hydrochloride. Clinical symptoms and pH-metric parameters were assessed before and 4 weeks after treatment. Results: Combination of GERD, FD and IBS-C was noted more frequently in women under 40 with normal body mass index (р

Background: There are inconsistent data on the changes of functional performance in subcortical structures of visual system caused by early binocular vision impairment. Aim: To study neuronal functional activity of the dorsal lateral geniculate nucleus (LGNd) in monocularly deprived cats and strabismic cats. Materials and methods: 4 cats with monocular convergent strabismus, 7 cats with monocular divergent strabismus, 3 monocularly deprived cats and 4 intact cats were studied. Histochemical method was used to detect cytochrome oxidase – the mitochondrial enzyme of respiratory chain correlating with neuronal functional activity. Optical density in ocular-specific layers A and A1 was measured on the images of stained LGNd sections, and the contrast was calculated. Results: Relative reduction of functional activity in the layers innervated from deprived and squinted eyes was demonstrated in LGNd bilaterally. In strabismic animals, the changes were observed only in the projection of the central part of the visual field, whereas in monocularly deprived animals the changes were in the projection of the whole visual field. Conclusion: These findings indicate differences between the mechanisms determining the development of strabismic and deprivation amblyopia. Thus, in amblyopia, preservation of peripheral stereoscopic vision is possible.

A review is given for the state of the art and future development of the geothermal power engineering. Different diagrams of GeoPP are shown for different levels of geofluid temperature. A special focus is made on challenges for petrothermal power production. The huge amount of heat from petrothermal resources can be harnessed through creating geothermal circulation systems within the dry rocks. Estimates for system lifetime and heat production capacity of circulation systems are given for different flow rates of coolant.

Aim. To study the association of blood pressure (BP) and hypertension (HTN) with salt intake estimated by the survey and the urinary Na+ concentration among men and women 25-64 years old, examined within the ESSE-RF and ESSE-RF-2 studies.Material and methods. Representative samples of the Russian population aged 25-64 years were examined. At the first phase in 2012-2014, 21,888 people (men — 38,2%) were included, and at the second phase in 2017 — 6,714 people (men — 44,7%). The response rate was 80%. We used standard questionnaire. Adding more salt and the consumption of salted foods (sausages, deli meats, and pickled foods) in the criteria “daily or almost daily” was considered excess salt intake (ESI). BP measurement was carried out in a sitting position on the right hand. BP was measured twice with an interval of about 2-3 minutes. HTN was diagnosed at a systolic BP (SBP) ≥140 mm Hg and/or diastolic BP ≥90 mm Hg, or in case of antihypertensive therapy. In ESSE-RF-2, an analysis of the morning urine was additionally performed. Na+ was determined using the EX-Ds ion-selective electrolyte analyzer. All participants were stratified by the quintiles of urine sodium level. Data analysis was performed using the software package R 3.6.1. The models of linear and logistic regression were used. The differences were considered at pResults. The average level of SBP significantly increases with an increase in Na+ in urine: 1,04 (0,60-1,48) mm Hg for the quintile of sodium distribution (p+ levels. The consumption of sausages and deli meats has the greatest effect, causing an increase in the average Na+ level by 11,59 (7,06-16,12) mmol/l (p+ in the urine (p=0,15 for the difference hypothesis). One point on the scale increases the Na+ level by an average of 7,51 (5,01-10,02) mmol/l, SBP by an average of 0,74 (0,41-1,07) mm Hg and the odds of HTN by 1,1 (1,06-1,15) times (pConclusion. In the pattern of ESI components, processed meat and sausage products take first place in terms of association strength with urine sodium. The questionnaire used to assess the proportion of people with ESI can be recommended for assessing this risk factor during screening. ESI detected by the questionnaire is associated with elevated BP and urinary Na+ values.

Chronic renal failure (CRF) is one of the most challenging problems of contemporary medicine. Patients with chronic renal failure usually need renal replacement therapy as either hemodialysis, peritoneal dialysis or a kidney transplant. The latter is the most promising option for end-stage kidney disease. However, the shortage of donor organs, the complexity of their delivery, the difficulty in finding an immunologically compatible donor and the need for lifelong immunosuppression triggered advances in modern tissue engineering. In this field, the primary priority is focused on developing bioengineered scaffolds with subsequent recellularization with autologous cells. Using such constructs would allow for solving both ethical and immunological problems of transplantation. The aim of this pilot study was to develop a new method of renal decellularization using small laboratory animals. Materials and methods The study investigated the morphological structure of the obtained decellularized matrix and quantitatively tested DNA residues in the resulting scaffold. We proposed a new biophysical method for assessing the matrix quality using the EPR spectroscopy and conducted experiments on the matrix recellularization with mesenchymal multipotent stem cells to estimate cytotoxicity, cell viability and metabolic activity. Results The obtained decellularized renal matrix retained the native tissue architecture after a complete removal of the cell material, had no cytotoxic properties and supported cell adhesion and proliferation. Conclusion All the above suggests that the proposed decellularization protocol is a promising method to produce tissue-engineered kidney constructs with possible clinical application in the foreseeable future.

Introduction . Polyhexamethyleneguanidine hydrochloride (PHMG) is an antimicrobial biocide of the guanidine family. In the period from August 2006 to May 2007, more than 12 500 patients were admitted to hospital with a history of drinking illegal cheap “ vodka ” in 44 different regions in Russia, of whom 9.4% died. In reality, the “ vodka ” was an antiseptic liquid composed of ethanol ( ≈ 93%), diethyl phthalate, and 0.1 – 0.14% PHMG (brand name “ Extrasept-1 ” ). Material and methods . We performed an analysis of the clinical features and outcome in four poisoning treatment centers in the cities of Perm, Ekaterinburg, Irkutsk, and Khabarovsk. A total of 579 patients (215 females and 364 males) with similar symptoms were included. Results . The main symptoms on admission included jaundice (99.7%), skin itch (78.4%), weakness (96%), anorexia (65.8%), dizziness (65.3%), nausea (54.8%), vomiting (22.6%), stomach ache (52.7%), diarrhea (32%), and fever (50%). Mild symptoms were found in 2.5% of cases, moderate in 63%, and severe in 34.5%. Laboratory results were (mean SD): total bilirubin 249 158 μ mol/L, direct bilirubin 166 97 μ mol/L, cholesterol 14 8 mmol/L, alanine aminotransferase 207 174 IU/L, aspartate aminotransferase 174 230 IU/L, alkaline phosphatase 742 751 IU/L, and gamma-glutamyltranspeptidase 1199 1095 IU/L. Patients generally recovered over a period of 1 – 5 months, although high levels of alkaline phosphatase and gammaglutamyltranspeptidase were still found in all patients examined after 6 months. Sixty-one patients (10.5%) died between 23 and 150 days after poisoning. Local cholestasis, infl ammatory infi ltration, and fi brosis developing into cirrhosis were found by liver biopsy. Conclusion. Acute liver injury caused by PHMG-hydrochloride or PHMG in combination with either ethanol or diethyl phthalate can be characterized as cholestatic hepatitis with a severe infl ammatory component causing high mortality.

The data of research vortexactive stabilizers, vortex generators which can deflect increasing the critical angle of attack in the gusty wind was investigated.

Aim. To improve measures aimed at ensuring the continuity of the dynamic health monitoring of students on the basis of medical institutions of the University. Methods. On the basis of the technology «client-server», which is oriented on the management system of the Firebird databases, developed was an information-analytical system of dynamic observation of the health of students. Results. This system presumes a specific algorithm for the medical examination, first of all the screening methods: psychological testing, measurement of anatomical and physiological parameters, obtaining of the medical history, physical examination, cardiorhythmography and routine clinical and laboratory tests. With the help of original methods the medical information system provides a complex report on the state of health of the student and on the risks of the most common diseases in this age group. Conclusion. Health care providers of medical institutions of a University can use the developed system for dynamic monitoring of the health of the students.

Покращення надійності навігації безпілотного літального апарату у збуреній атмосфері та при поривах вітру, забезпечується за допомогою аеродинамічних характеристик безпілотного літального апарату. Представлено вивчення ефективності генераторів вихорів на передній кромці в дозвукових аеродинамічних трубах. Розглянуто аеродинамічні особливості БПЛА з вихроактивним крилом, котрі необхідно враховувати при розробці системиавтоматичного управління

The type of film flow whereby the fluid flows in the form of many streamlets is typically called a rivulet flow. Whereas an individual streamlet bounded by two contact lines is called a rivulet. Special attention has been paid to rivulet flows because of their practical value for a variety of devices in power engineering and chemical technology, such as absorbers, distillation columns, evaporators, and heat exchangers for the liquefaction of natural gas. In the present paper the waves in vertical rivulet are investigated analytically. The Kapitza-Shkadov model is used to describe the wavy rivulet flow since it was well proven in the study of nonlinear waves in falling liquid films over a wide range of Reynolds numbers. The equations of the wavy rivulet flow are derived on the basis of the weighed residual method. These equations turn out to be the projections of the Shkadov's model equations on system of basis functions, constructed in special way. Linearizing these equations results in the dispersion relations for plane waves. The stability criterion for rivulet flows is deduced, and the analysis of dispersion relations depending on dimensionless parameters is carried out.

We analyzed striate cortex electrocorticograms of 12 cats in the following states: at rest with eyes closed and with eyes open; after light electrical stimulation of the ears; drowsiness; opening of the eyes after drowsiness; narcotic sleep. Spectral and periodometric analyses of the ECOG revealed state-dependent differences in power spectra from cats in two frequency bands (2.8–5.0 and 13.8–20.8 Hz). It is suggested that the ratio of ECOG power spectra in these frequency bands can be used to evaluate brain activation in cats.

In this paper the numerical–experimental methodology of studying bubble flows is considered. The effective numerical CFD algorithms for 3D calculation of two-phase flows with explicitly chosen of interface boundary and calculation of surface tension forces are offered. The new high-precise experimental technique permitting to control and to describe 3D effects of bubble flows as average in time and space, so local instant is described. The main attention of this paper is focused on validation and verification of numerical model (before submitted at NURETH11 conference) as with usage of the tests, accessible from the literature and outcomes of experiments obtained in IT SB RAS (Novosibirsk).Copyright © 2006 by ASME

Spatio-temporal interactions within complex receptive fields in the cat visual cortex were investigated by sequential presentation of two stationary stimuli. When two stimuli were presented in phase (on-on or off-off) in the order corresponding to preferred direction of movement, facilitation or weak inhibition of the response to the second stimulus was observed, whereas if it corresponded to zero direction of movement, the response was strongly inhibited. In the case of stimulation out of phase (on-off or off-on), in the order corresponding to the preferred direction of movement, considerable inhibition of the response to the second stimulus was observed, whereas in the opposite order, facilitation or weak inhibition was observed. The strength of interaction between different parts of the field depended on the distance between them and the duration of the interval between stimuli. Directional selectivity of "complex" neurons is thus ensured by asymmetry of spatio-temporal interactions between receptive field inputs of the same type. Interactions between inputs of different types, arising when a multiedge stimulus (bar, grating) can be used by the visual system to distinguish an object from the background and to assess changes in size of objects and the relative velocity of their movement.

Results of a study of the friction stabilization section and thickness of a liquid film flowing along a vertical wall are presented. Spectral analysis of friction pulsations is used to study the transition from laminar to turbulent flow mode in the film.

Results of measuring the instantaneous velocity profiles in a laminar fluid film in the presence of stationary waves of different shape on its surface are presented.

Results of an experimental study are shown where the shearing stresses at a vertical wall during downward film flow of a liquid were measured by the electrodiffusion method. The film thickness was measured by the shadowgraph method.