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Introduction. One of the main causes of treatment failure after allogeneic hematopoietic stem cells transplantation (alloHSCT) for acute leukemia (AL) is disease relapse. In recent years, multiparameter fl ow cytometry (MPC) has been widely used to detect minimal residual disease (MRD) because of its capacity to identify patients with a high risk of relapse due to availability and the ability to obtain results in a timely manner.Aim — to evaluate the prognostic value of MRD status before allo-HSCT and the effect of donor type and conditioning intensity on long-term results of allo-HSCT of MOB-positive patients.Patients and methods. The analysis included 107 patients with acute myeloid leukemia (AML) and 63 patients with acute lymphoblastic leukemia (ALL) who underwent allo-HSCT between September 2015 and June 2020. All patients were in complete morphological remission before allo-HSCT. At the time of allo-HSCT 91 patients with AML and 37 patients with ALL were in the first complete remission (CR), in their second and more than two CRs were 16 and 26 patients, respectively. The median follow-up was 18 (1.5–48) months for AML and 14 (1.8–60.1) months for ALL. Immunophenotypic study was performed before allo-HSCT. MRD was detected using a combination of the “different from normal” method and the search for cells with a leukemia-associated immunophenotype.Results. The disease status at the time of transplantation and the presence of MRD before allo-HSCT were independent factors infl uencing the probability of relapse (disease status: HR = 2.911, 95% CI: 1.328–6.379; MRD before allo-HSCT: HR = 7.667, 95% CI: 3.606–16.304) and post-transplant mortality (disease status: HR = 2.911, 95% CI: 1.328–6.379; MRD before allo-HSCT: HR = 7.667, 95% CI: 3.606–16.304). In univariate analysis, the relapse-free survival of MRD+ patients with AL in the first CR was significantly worse than in MRD– (AML: 23 % versus 57 %, p < 0.0001, ALL: 34 % versus 61.7 %, p = 0.0484), and the probability of relapse in MRD+ patients was significantly higher (AML: 75 % versus 12 %, p < 0.0001, ALL: 57 % versus 7 %, p = 0.0072). Pre-transplant MRD status was not prognostically significant for AL-patients in the second and third remission. The development of chronic GVHD reduces post-transplant mortality if it does not require systemic therapy with glucocorticosteroids (HR = 0.006, 95% CI: 0.008–0.446).Conclusion. Testing for MRD of patients with AL in the first CR before allo-HSCT is necessary for risk stratification and identification of patients who will need preventive post-transplant therapy in order to prevent disease relapse.

Aim. The clinical observation highlights plausible compound origins of diarrhoea, fever and neutrophilic leucocytosis in COVID-19 and the rationale to exclude Clostridium difficile infection in such patients.Key points. A 57-yo female patient was admitted in May 2020 with the complaints of 39 °C fever, general weakness, polymyalgia, diarrhoea to 3–4 times a day (mushy stool, no morbid inclusions). Initial diarrhoea was non-severe and likely triggered by the coronavirus infection. A background antibiotic and putative-immunosuppressive therapy proceeded with watery diarrhoea to 7–8 times a day and C. difficile toxins A and B detected in stool. The C. difficile infection relapsed on day 10 of vancomycin withdrawal and associated with elevated body temperature, diarrhoea and neutrophil leucocytosis; signs of colitis determined in ultrasound and CT. Exacerbation was successfully treated in a repeated metronidazole-combined vancomycin course.Conclusion. Patients with COVID-19 are at risk of clostridial colitis due to massive antibiotic, systemic glucocorticoid and biologics-based therapy they receive. The opportunistic bacterial infection of C. difficile often proceeds undetected due to its potential mirroring of COVID-19 presentation. A screening algorithm in COVID-19 patients with diarrhoea should imply steps for C. difficile detection.

To this date there have been no studies of subclinical atherosclerosis in the patients with calcium pyrophosphate crystal deposition disease (CPPD); in osteoarthritis (OA) such works are rare.Objective: to assess the prevalence of subclinical atherosclerosis of carotid arteries (CA) in patients with CPPD and OA.Patients and methods. The case-control study included 26 patients with CPPD and OA. The diagnosis of CPPD was based on the criteria of D.J. McCarty, diagnosis of OA was based on national clinical practice guidelines. We recorded data on smoking, blood pressure level. Assessed blood lipid spectrum, serum levels of glucose, creatinine, uric acid, CRP. Obesity was diagnosed in accordance with the WHO recommendations. All patients underwent CA Doppler ultrasonography (DUS). An increase in intima-media thickness (IMT) >0.9 mm was considered a manifestation of subclinical atherosclerosis. The SCORE index was calculated for all patients.Results and discussion. The median serum CRP level was comparable in CPPD and OA. The CRP level >5 mg/L was detected in 8 patients with CPPD and in 3 patients with OA (p=0.09). Initial signs of atherosclerosis were present in 11 (42%) patients with CPPD and in 8 (31%) patients with OA (p=0.39). In CPPD, an increase in IMT was associated with a CRP level of ≥5 mg/L in 19% of cases, and in OA – in 12.5% (p=0.08). An increase in IMT >1.3 mm was not found in patients of both groups.Conclusion. In patients with CPPD and OA, subclinical atherosclerosis is often present according to the CA ultrasound. Early detection of uncomplicated subclinical atherosclerosis in CPPD and OA is necessary for timely initiation of treatment aimed to prevent the progression of atherosclerosis and the development of cardiovascular diseases.

The aim. To develop a treatment algorithm with the aim of improving the treatment results of diffuse pigmented villonodular synovitis of the knee. To study and analyze the results of surgical treatment of diffuse pigmented villonodular synovitis of the knee. Materials and methods. The study was based on the results of treatment of 48 patients with pathohistologically verified diagnosis of diffuse pigmented villonodular synovitis (tenosynovial giant cell tumor) of the knee undergoing treatment at the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” from 2010 to 2019. Results. The best functional results can be achieved in patients with diffuse pigmented villonodular synovitis of the knee in stage I of the disease. Using the method of mathematical statistics to evaluate the results obtained, we see that scores obtained through the Lysholm Scoring Scale were statistically significantly different in stages before a surgery (P = 0.000782), 3 months (P = 0.00005) and 6 months after the surgery (P = 0.04); but over time, these differences diminished and became actually insignificant 12 months after the surgery (P = 0.89). Conclusions. Applying our therapeutic algorithm for the treatment of patients with diffuse pigmented villonodular synovitis of the knee, the outcome of the Lysholm score was excellent in 22 % of patients, good – in 45 %, satisfactory – in 21 % and poor – in 12 % of patients.

Annotation. The aim of research is to study correlations of biochemical parameters with glomerular filtration rate according to Cockcroft-Gault, CKD EPI and cystatin C in patients with type 1 diabetes (T1D). 78 men and 62 women aged 22-26 years with T1D were examined. The control group consisted of 8 almost healthy men and 13 almost healthy women of the same age. The level of microalbuminuria and cystatin C was determined in all patients by enzyme-linked immunosorbent assay. Biochemical evaluation of fasting blood glucose, glucose 2 h after exercise, mean value of glucose, creatinine, GFR according to Cockcroft-Gault, CKD EPI and GFR according to cystatin C. Correlation analysis between the series of indicators was calculated using Spearman statistics in the license package “Statistica 5.5”. In patients with T1D, there is no significant correlation in normoalbuminuria between urinary albumin levels and GFR by Cockcroft-Gault (in women), CKD EPI and cystatin C (in all study groups). No significant correlations were found between urinary albumin levels and GFR by Cockcroft-Gault, CKD EPI and cystatin C in the proteinuria group. The correlation analysis revealed in the general group and in women with proteinuria an association between the average value of blood glucose and low GFR levels by Cockcroft-Gault, CKD EPI (negative medium strength correlation r = from -0.31 to -0.46) and elevated creatinine (positive strong correlation r=0.62 and r=0.91), indicating an unfavorable role of hyperglycemia in the development of nephropathy in patients with T1D. Higher correlations of cystatin C with GFR by cystatin C (r= -1.0) than by creatinine with GFR by Cockcroft-Gault (r = from - 0.63 to 0.99) and by CKD EPI (r = from -0.73 to -0.99) were demonstrated. The strength of the correlations increases from GFR by Cockcroft-Gault to GFR by cystatin C. Correlations between creatinine and GFR by Cockcroft-Gault and CKD EPI were characterized by sex differences (greater in women) and an increase in their strength synchronously with an increase in urinary microalbumin. At the same time, there is a consistently high identical value (r= -1.0) of correlations of the level of cystatin C with GFR on cystatin C in all comparison groups. Neither the sex factor nor the degree of albuminuria affected the change in their strength. Only men with microalbuminuria had moderate feedback between creatinine and cystatin C (r= -0.46). In all groups of women, in the general group and in men with normoalbuminuria and proteinuria, the correlations are close to zero, which may indicate the absence of a linear relationship between these indicators. When dividing the sample according to the level of cystatin C between the level of creatinine and the level of cystatin C, the following were found: medium feedback (r= -0.37) in the general group with normoalbuminuria and cystatin C>0.9; moderate feedback (r= -0.37) in the general group and in men with proteinuria and cystatin C

Allergic rhinitis (AR) and chronic rhinosinusitis (CR) can be diagnosed as an independent or combined pathology, as well as a possible complication of each other. Allergic rhinitis is a disease characterized by IgE-mediated inflammation of the nasal mucosa and the presence of daily manifestations of more than one hour and at least two of the following symptoms: nasal obstruction, rhinorrhea, sneezing, nasal itching. The frequency of psychosomatic disorders is quite high and ranges in the population. Studying the mechanisms of disease development provides the basis for rational therapy, not just symptom relief. We have considered the use of elimination therapy for CR associated with AR. This type of treatment is available to all categories of patients, including children and pregnant women at any gestational age. On the basis of the Department of Otorhinolaryngology of A. I. Evdokimov Moscow State Medical University in 2019–2020, a clinical study was conducted, which showed that such a combination of isotonic saline solution and antiseptic leads to improvement of patients and accelerates the recovery. In the process of monitoring 36 patients: in 35 of them achieved clinical cure, 1 patient required the appointment of antibiotic therapy due to the development of symptoms of purulent sinusitis. The results indicate a pronounced advantage of treatment in combination with elimination drugs, which was expressed in a reduction of symptoms during the first week of treatment, their complete regression was noted on the 30th day of use of the drug. Thus, chronic rhinosinusitis and allergic rhinitis are an important medical and social problem, and treatment of such patients requires only an integrated approach with obligatory consideration of the pathogenesis of the disease.Allergic rhinitis (AR) and chronic rhinosinusitis (CR) can be diagnosed as an independent or combined pathology, as well as a possible complication of each other. Allergic rhinitis is a disease characterized by IgE-mediated inflammation of the nasal mucosa and the presence of daily manifestations of more than one hour and at least two of the following symptoms: nasal obstruction, rhinorrhea, sneezing, nasal itching. The frequency of psychosomatic disorders is quite high and ranges in the population. Studying the mechanisms of disease development provides the basis for rational therapy, not just symptom relief. We have considered the use of elimination therapy for CR associated with AR. This type of treatment is available to all categories of patients, including children and pregnant women at any gestational age. On the basis of the Department of Otorhinolaryngology of A. I. Evdokimov Moscow State Medical University in 2019–2020, a clinical study was conducted, which showed that such a combination of isotonic saline solution and antiseptic leads to improvement of patients and accelerates the recovery. In the process of monitoring 36 patients: in 35 of them achieved clinical cure, 1 patient required the appointment of antibiotic therapy due to the development of symptoms of purulent sinusitis. The results indicate a pronounced advantage of treatment in combination with elimination drugs, which was expressed in a reduction of symptoms during the first week of treatment, their complete regression was noted on the 30th day of use of the drug. Thus, chronic rhinosinusitis and allergic rhinitis are an important medical and social problem, and treatment of such patients requires only an integrated approach with obligatory consideration of the pathogenesis of the disease.

The formation and development of osteopathy as a scientific discipline is considered. Despite its one and a half century history, osteopathy is a relatively young medical specialty. At the same time, throughout the history of the existence of osteopathy, its supporters carried out an active search for scientific evidence of its effectiveness. Currently, osteopathy is going through the stage of scientification, its formation as a scientific discipline. However, even now even the term osteopathy itself is often interpreted quite loosely and, in some cases, tendentiously. In this regard, the purpose of this work is to trace the development of osteopathy — from the earliest works of its founders to the latest stage of development, when osteopathy has become more and more consistent with the basic requirements of evidence-based medicine. To achieve this goal, much attention is paid to all stages of the formation and development of osteopathy, both abroad and in Russia. There are considered such problems as the formation of the basic terminology, the development and change of the basic concepts of osteopathy, including the concept of osteopathic lesion and the concept of somatic dysfunctions, the development of modern methods of evidence-based medicine, the dynamics of publication activity of osteopathic researchers. It concludes that new ways of obtaining the data about the health effects of osteopathy will continue to emerge, and the level of evidence and the number of quality clinical trials are likely to change.

The emergence of direct-acting antivirals (DAAs) has become the basis for a new potential treatment for chronic hepatitis C (CHC) in patients with decompensated cirrhosis, who previously had no other alternative than liver transplantation (LT). However, optimal timing of antiviral therapy (AVT) remains an issue. Objective: to present a spectrum of clinical outcomes in LT waitlisted patients with HCV-related cirrhosis, who received and did not receive DAA therapy. Materials and methods. Enrolled for the study were 49 waitlisted patients with HCV-related end-stage liver diseases. The patients were divided into 2 groups: Group 1 included 40 patients who received DAA therapy before LT, while Group 2 consisted of 9 patients who did not receive antiviral treatment while on the LT waiting list. Results. The sample was represented in most cases by patients who had MELD/Na score 20, but Conclusion: DAA therapy carries significant advantages for waitlisted patients with MELD/Na score

The aim. To characterize the main types of neurological manifestations in inflammatory bowel diseases – Crohn’s disease and ulcerative colitis.Main concepts. Neurological disorders represent an important aspect of extraintestinal inflammatory bowel diseases (IBD) manifestations. According to publications, the incidence of psycho-neurological syndromes varies from 0.25% to 47.50% that apparently depends on the patient’s selection in studies. Neurological signs are not always associated with IBD activity and may precede the manifestation of intestinal inflammation. The most typical include cerebral thromboembolism, peripheral and cranial neuropathies, demyelinating disorders, and cerebral vasculitis. The incidence of ischemic stroke in IBD can reach 6.4%, with approx. 20% of affected persons under 17 y.o. Hemiparesis is the predominant consequence. The risk of intracranial venous thrombosis is increased depending on the activity of intestinal inflammation; this complication can precede manifestation of IBD. Fifty per cent increased risk of multiple sclerosis in IBD patients was shown. The types of peripheral nerves involvement include mononeuropathy, plexopathy, multiple mononeuropathy, compression neuropathy, polyneuropathy and cranial neuropathy. Peripheral neuropathy may be found in 32–37% of IBD patients with a special examination. Demyelinating type, sensory axonal polyneuropathy with thin and thick fibers damage, and motor axonal polyneuropathy with thick fibers damage are observed approximately in equal proportions. It is important to differentiate ‘primary’ neuropathy with vitamin B12 and folic acid deficient, alcoholic, diabetic and drug-induced neuropathy. Clinical improvement is usually seen in the course of immunosuppressive therapy. Cranial neuropathy (mostly of II, VI, VII, VIII of cranial nerves) is described in IBD. Neurological disorders associated with administration of metronidazole, sulfasalazine, cyclosporin A, antibodies to TNF-α and integrins α4 and α4ß7 continue to be highly actual.Conclusion. There is a variety of neurologic syndromes in IBD which represents an important part of extraintestinal manifestations. Mild psychoneurological disorders may be not recognized in time. The majority of symptoms and signs may regress in the course of treatment of IBD and nutrients deficiency correction. The special attention should be paid to neurological status control while the biologic and immunosuppressor agents and metronidazole are administered.

Annotation. The aim of the study was to examine the differences in lipid, carbohydrate metabolism and renal function in patients with type 1 diabetes (T1D) with different levels of albumin in the urine depending on the level of cystatin C. The sample was 78 men and 62 women aged 22-26 years, T1D patients. The control group consisted of 8 almost healthy men and 13 almost healthy women of the same age. The level of microalbuminuria and cystatin C was determined in all patients by enzyme-linked immunosorbent assay. Biochemical evaluation of fasting glucose, fasting blood glucose, glucose 2 h after exercise, mean value of glucose, glycated hemoglobin, total cholesterol, triglycerides, GFR according to Cockcroft-Gault, CKD EPI and GFR according to cystatin C. Statistical processing of the obtained results was performed in the license package “Statistica 5.5”, using non-parametric evaluation methods. In T1D patients compared to the control group found significantly higher values – fasting blood glucose, glucose 2 hours after exercise, the average value of glucose, glycated hemoglobin, total cholesterol and triglycerides, cystatin C and lower values – international normal ratio, GFR according to Cockcroft-Gault, GFR by CKD EPI and GFR by cystatin C. With increasing levels of albumin in urine in patients with cystatin C0.9 there were changes in the level of the following indicators: higher values – fasting blood glucose and triglycerides in women with proteinuria compared with women with normoalbuminuria, and glycated hemoglobin and total cholesterol compared with and microalbuminuria; international normal ratio in men with microalbuminuria, compared with men with normoalbuminuria; and smaller values – GFR level by Cockcroft-Gault in men with microalbuminuria compared to men with normoalbuminuria; GCF levels by Cockcroft-Gault in women with proteinuria compared to women with microalbuminuria and GFR levels by CKD EPI in women with proteinuria compared to women with normoalbuminuria and microalbuminuria. With increasing levels of cystatin C, a decrease in glycated hemoglobin in men and women with microalbuminuria and triglycerides in women with microalbuminuria, as well as greater values of the international normal ratio in men with normoalbuminuria and GFR on cystatin C in men and women with normoalbuminuria and micro. Thus, the study obtained results that indicate the existence of differences in the studied indicators between healthy and sick subjects, between men and women and between groups of T1D patients’ men or women with different levels of albumin and cystatin C.

Objective: to study the long-term functional results of creating an orthotopic urinary reservoir from the ileocecal angle in comparison with the Studer technique of creating a urinary reservoir after radical cystectomy in women. Materials and methods. From 2004 to 2018 radical cystectomy for bladder cancer was performed in 120 women. In 71 (59.2 %) patients, an orthotopic urinary reservoir was formed: 48 (67.6 %) from the ileum, 23 (32.4 %) from segments of the colon. This study included 11 patients who had a reservoir formed from the ileocecal angle, including by their own modification, and 13 patients who had a reservoir forme by Studer. The average age of the patients was 62.6 ± 2.6 (29—82) years. The average follow-up time was 77.1 ± 10.5 (19—184) months. The presence and degree of urinary incontinence was assessed using a questionnaire and a Pad test. 12 months or more after the operation, a complex urodynamic study was performed. Results. The overall 5-year survival rate was 92.3 %: in the Studergroup it was 90.9 %, in the ileocecal angle group it was 100 % (p = 0.317). In the general population of patients, 37.5 % were completely continent. Women after plastic surgery by Studer retained urine better than after plastic surgery by ileocecal angle (46.2 % vs 27.3 %), the difference was only for mild urinary incontinence, which was more common in the ileocecal angle group. The frequency of severe urinary incontinence in both groups was the same. Nocturnal urinary incontinence was more common in patients in the Studer group (46.2 %). In the group of patients with ileocecal angle plastic surgery, there was no chronic urinary retention requiring intermittent catheterization, and in the group of Studer plastic surgery — in 1 (7.7 %) case. Analysis of urodynamic parameters revealed the presence of a greater physiological capacity of the urinary reservoir in the group of patients after plastic surgery according to Studer (p = 0.043). In the group of patients with ileocecal angle plastic surgery, higher values of the maximum pressure of the reservoir wall, “leakage pressure” and maximum expulsion pressure are observed, possibly associated with a more pronounced muscle layer of the intestinal segment used. Conclusion . The functional results of the orthotopic reservoir formedfrom the ileocecal angle are comparable to the results of urine derivation using the classical Studer method. Complex urodynamic study showed a direct influence of various characteristics of the reservoir on the nature and degree of urination disorders in patients.

The aim – to use multislice computed tomography (MSCT)-coronary angiography data to determine the presence of atherosclerotic process progression in coronary vessels in the dynamics of the three-year follow-up period in patients after STEMI and coronary artery stenting.Materials and methods. 66 MSCT-coronary angiography studies were performed in 19 men after primary myocardial infarction with ST-segment elevation (STEMI) and coronary artery stenting. All patients were male, ranging in age from 38 to 66 years, with a mean (Me 55.6; (Q1–Q3 (49–64)) years, and 18 of 19 (94.0 %) patients developed Q-MI. 1 patient (6 %) had non-Q-MI. A month after acute MI, patients underwent MSCT of the heart with coronary vascular contrast. Re-examination was performed one, two and three years after the development of STEMI. According to the results of MSCT coronary angiography determined the functional status of stents, as well as the presence or exclusion of signs of restenosis (about 50 % or more) or thrombosis 100 % – occlusion) in the stent coronary artery and in non-infarction-causing arteries. With the progression of atherosclerotic plaque, an increase in atherosclerotic plaque of more than 20 % was taken into account compared to the previous study.Results and discussion. By the end of the first year after MI in 11 of 19 (57.9 %) patients according to MSCT-coronary angiography, no progression of atherosclerotic lesions of the coronary arteries was observed. 1 patient (5.6 %) had stent restenosis, which was confirmed by CAG data. Progression of atherosclerotic lesions was observed in 7 patients (36.8 %), 3 of them (16.6 %) in the stent artery, and in 4 patients in the non-infarction-causing artery. In the second year after myocardial infarction, compared with the annual examination, in 6 of 14 (42.9 %) no progression of atherosclerosis was observed, and in 7 of 14 (50 %) progression of atherosclerotic lesions not in the stent artery, and only in 1 of 14 – progression of atherosclerosis in the stent artery. In the third year after the development of MI, 10 of 14 (71.4 %) had no progression of atherosclerosis, and 4 patients showed progression in both IOA and other arteries.Conclusions. MSCT coronary angiography is an informative method in assessing the functional status of stents and determining the progression of coronary atherosclerosis in the infarct-causing artery and other coronary arteries in patients after MI and coronary artery stenting in the dynamics of three-year follow-up. The lack of progression of atherosclerosis was accompanied by slightly lower levels of low-density lipoprotein cholesterol, compared with patients with progression of atherosclerosis.

The aim of the study was to evaluate the effect of type 2 diabetes mellitus (T2DM) and obesity influence on the left ventricular (LV) remodeling peculiarities in hypertensive patients. Materials and methods. In total, 327 patients, aged 38–74 years, were comprehensively examined. The enrolled patients were divided into 4 groups in dependence of the presence of associated disease: the 1st group – n = 87 hypertensive patients with T2DM combined with obesity, the 2nd group – n = 71 hypertensive patient with T2DM and the 3rd group – n = 65 hypertensive patients with obesity; the comparison group consisted of 74 patients with essential hypertension (EH) but without obesity or diabetes. Echocardiography was performed according to the standard method of H. Feigenbaum to estimate the LV parameters. HbA1c was determined by turbidimetric method. Serum glucose levels were determined by ELISA. Results. When comparing the three patient groups with those who had only EH, the most significant influence was found in combined influence of T2DM and obesity on the development of unfavorable type of LV remodeling with values of χ2 = 29.371 and Pearson's contingency coefficient (C) ‒ 0.393 (P < 0.05). The presence of concomitant T2DM without obesity had a significant moderate relationship with the development of unfavorable LV geometry, χ2 = 11.029 and C ‒ 0.266 (P < 0.05), which indicates a much smaller impact on the process compared to the polymorbid effect of T2DM with obesity. Comparison of patients with a combination of EH and obesity with those who had only EH did not show a significant effect of concomitant obesity on the development of unfavorable types of LV geometry with values of χ2 and C: 0.529 and 0.062, respectively (P > 0.05). Conclusions. Essential hypertension with type 2 diabetes mellitus and obesity polymorbidity, but not in combination with type 2 diabetes mellitus or obesity alone, has the most significant association with hypertrophic types of LV remodeling. The co-existence of type 2 diabetes mellitus and obesity in hypertensive patients leads to the development of predominantly LV concentric hypertrophy.

Endothelial dysfunction is considered one of the main mechanisms for the further development of arterial hypertension (AH) and its complications, and endothelin-1 (ЕТ-1) plays one of the key roles in this process. Endothelium is drawn into the pathological process at the earliest stages of AH development. ЕТ-1 is currently considered as a marker and predictor of the stage and consequences of AH, chronic heart failure (CHF), coronary heart disease (CHD), in particularly, acute myocardial infarction (MI), heart rhythm disorders, pulmonary hypertension, atherosclerotic vascular injury, target vascular disorders. One factor that may influence the level of ЕТ-1 is the endothelin-1 gene Lys198Asn polymorphism, which is considered by many researchers as a possible genetic marker of AH. However, the effect of this polymorphism on the level of plasma ЕТ-1 level in patients with AH of varying severity in Ukraine is understudied. The basis of this work were the materials of a complete examination of 160 patients with a verified diagnosis of AH I, stage II of 1, 2, 3 degrees (main group) and 110 apparently healthy persons (control group). Patients of the main group were divided into three subgroups: 1st group ­– 75 patients with normal body weight; 2nd group – 48 overweight patients; 3rd group – 37 patients with alimentary obesity. In obese patients, the waist circumference in women was around 103 (96–115) cm, and in men – 108 (105–116) cm, which indicates an abdominal type of obesity in these patients. As a result of the study, it was found that the level of ЕТ-1 is higher in patients with AH who suffer with overweight and obesity as compared with patients with AH and normal body weight. Also, the peptide level depends on the genotype of patients and is higher in AH patients with the genotype Asn198Asn and Lys198Asn as compared to carriers of the genotype Lys198Lys.

Introduction . Psychosomatic disorders (PSR) develop as a result of somatization of psychogenic factors. In osteopathy, PSRs are reflected in the so-called psychoviscerosomatic disorder which is a variant of a global neurodynamic functional disorder characterized by poly-regional disorders of tissue mobility that are associated with psychoemotional overloads. In most cases of PSR, neurotization of patients is obligate due to the involvement of a number of nervous structures in the pathological process and the subsequent general decrease in the body's adaptive reserves. According to the polyvagal theory of S. Porges (1995), the vagus nerve is divided into two functionally different branches: nucl. dorsalis n. vagi and n. ambigius. Third core nucl. tractussolitarii is the endpoint of many afferent pathways through n. vagus from peripheral organs, which forms the central regulator of the vagal system. In the process of phylogenesis, the vagus nerve system became more complex due to the inclusion of the pathways of the trigeminal, facial, accessory and glossopharyngeal nerves. S. Porges distinguishes the autonomic vagus nerve associated with passive regulation of visceral functions and the social or intellectual vagus, which is responsible for the processes of attention, movement and communication. The auditory sensory system provides encoding and evaluation of acoustic stimuli that determine the ability to adapt. We suggested that by affecting the auditory system, it is possible to affect the autonomic nervous system and reduce the severity of individual symptoms of PSR. The goal of research — is to study the effect of white noise (WN) stimulation of the auditory sensory system on the manifestations of the disease in patients with cervicalgia (CA). Materials and methods . In the period from 03.2020 to 07.2020 on the basis of the «Professor Novikov'sFamily Osteopathy Clinics», an analytical one-stage (cross-sectional) study was conducted, which involved 109 patients with an established clinical diagnosis of CA, who were divided into two groups: an experimental group (76 people) exposed to WN, and a control group (33 people), in which there was no such exposure. To irritate the auditory sensory system, a WN with a frequency of 1-22,05 kHz was used. Patients of the experimental group were divided into 3 groups depending on the level of neuroticism: low (13 people), medium (49 people), high (14 people). The examination included an assessment of the level of neuroticism, biomechanical indicators that characterize the volume of movements in the cervical region, and the level of pain. The L. I. Wasserman questionnaire was used to assess the level of personal neuroticism. The volume of movements in the cervical spine in degrees was determined using an original device for determining the mobility of the cervical spine. Subjective assessment of pain was performed using the VAS scale. To obtain a quantitative assessment of the achieved result, a «B-A-analysis» method is proposed, based on the evaluation of the modules of 6-timer (by the number of analyzed indicators) vectors A (after the study) and B (before the study) and pairwise analysis of the corresponding components of these vectors. Results . Patients of the main group in subgroups with high, medium and low levels of neuroticism irritation auditory system has led to increased range of motion in the cervical spine that best identified patients with low levels of neuroticism, and minimally high. No significant changes were registered in the control group. There was no convincing difference in the dynamics of VAS indicators. Conclusion . The study showed the possibility of influencing biomechanical parameters when the auditory sensory system is irritated by WN in patients with CA, and the result differed depending on the level of neuroticism — high, medium, low. The subjective assessment of the pain syndrome in VAS case is significantly influenced by the emotional component. Thus, if the nervous system is exposed, the biomechanical parameters changes take place, and it indirectly confirms the integrity and interdependence of the neurodynamic and biomechanical components of functional disorders. The results suggest further study of the possibilities of using WN in patients with various somatic dysfunctions accompanying PSR.

Аrterіаl hypertensіon – іs one of the most аcute medіcаl аnd socіаl problems іn the world. Despіte the obvіous successes іn the treаtment of hypertensіon, the totаl number of hypertensіve pаtіents іn the world hаs exceeded 1 bіllіon people аnd іs steаdіly іncreаsіng; by 2022, аccordіng to аpproxіmаte estіmаtes, іt mаy аmount to 1.5 bіllіon cаses. Аt the sаme tіme, hypertensіon іs the leаdіng cаuse of deаth of the populаtіon (12.8%), whіch іs 7.5 mіllіon people per yeаr. Іn turn, а hypertensіve crіsіs іs аn аcute, pronounced іncreаse іn blood pressure, аccompаnіed by clіnіcаl symptoms аnd requіrіng аn іmmedіаte controlled decreаse from the purpose of preventіng or lіmіtіng dаmаge to tаrget orgаns. Bаsed on thіs defіnіtіon, іt іs іmportаnt to emphаsіze once аgаіn thаt іt іs unаcceptаble to clаssіfy epіsodes of аn аcute pronounced іncreаse іn blood pressure thаt аre not аccompаnіed by clіnіcаl symptoms to hypertensіve crіsіs. Іn аddіtіon, іt іs іmportаnt not to refer to hypertensіve crіsіs аs cаses of аcute myocаrdіаl іnfаrctіon, аcute cerebrovаsculаr аccіdent, аccompаnіed by а secondаry pronounced іncreаse іn blood pressure (due to pаіn syndrome, аcute cerebrаl іschemіа, etc.). Thus, the hypertensіve crіsіs should іnclude those cаses when аn аcute pronounced іncreаse іn blood pressure precedes аnd іs the cаuse of аcute dаmаge to tаrget orgаns. The іssue of treаtment of аrterіаl hypertensіon аnd hypertensіve crіses does not lose іts relevаnce now. The possіbіlіtіes of rаpіd аnd effectіve relіef of crіses аt the prehospіtаl stаge hаve іncreаsed severаl tіmes wіth the аdvent of the drug ebrаntіl. The mаіn goаls of the treаtment of hypertensіve crіsіs аre relіef of the crіsіs, post-crіsіs stаbіlіzаtіon, аnd preventіon of repeаted hypertensіve crіses.

Rheumatoid arthritis is known as a highly prevalent disease worldwide, often resulting in stable loss of capacity for work or complete disability over short period from the onset. Detected changes in the joint morphology may depend on the basic treatment received as well as depend on the level of control over the disease progression. The aim of this work is to study the diagnostic potential of Doppler ultrasound technique and Dopplerography in assessing the severity of changes in the knee joints depending on the received basic treatment and the level of control over disease in patients with rheumatoid arthritis. Correlation analysis carried out to compare the severity of bone erosions' indicators and the level of C-reactive protein has revealed no significant correlations. At the same time, there has been found a strong correlation between the level of C-reactive protein values and the blood circulation rate in the arteries of the pannus in all studied groups at the beginning of treatment and in 6 months of the therapy (r≥0.65, p≤0.03). The obtained results clearly demonstrate the effectiveness of the ultrasound diagnostics, especially Doppler indicators, in assessing the effectiveness of the basic treatment for patients with rheumatoid arthritis.

Rheumatoid arthritis is a widespread disease in general population, which can progress to the permanent disability as in a short-time as in long-time periods. It was considered that estimated changes of the joints' morphology in patients suffering on rheumatoid arthritis may depend on the basic treatment received and, eventually, on the control over rheumatoid arthritis progression achieved. The aim of our work is to study the accuracy of using elastometry method in evaluating the severity of knee joints' synovitis in patients with rheumatoid arthritis and its dependence on received basic treatment and achieved control over rheumatoid arthritis progression. By using a correlation analysis, we found a close relationship between the stiffness of the synovial membrane of the knee joints and the level of C-reactive protein (r = 0.63, p = 0.022), as well as with the level of erythrocyte sedimentation rate (r = 0.66, p = 0.019) in all groups of patients at the time of inclusion to the study. This relationship was present even after 6 months of therapy (r = 0.61, p = 0.043) and (r = 0.59, p = 0.023), respectively. Performed correlation analysis also showed the dependence of the morning joints' stiffness severity with the synovial membrane stiffness indicators (r = 0.57, p = 0.018), with the severity of pain in the knee joints (calculated by using The Visual Analogue Scale) and with the severity of knee joint synovial membrane stiffness (r = 0.56, p = 0,024) at the time of inclusion. So, it was considered a presence of relationship between synovial stiffness and clinical manifestations of rheumatoid arthritis. This relationship was present even after 6 months of therapy (r = 0.57, p = 0.038) and (r = 0.63, p = 0.024), respectively. The obtained results clearly demonstrate the accuracy of evaluating the knee joints' synovial stiffness by using elastometric indicators in assessing the effectiveness of received basic treatment in patients with rheumatoid arthritis.

Introduction. Spinal muscular atrophy is a severe neuromuscular disease characterized by rapid progression of muscle weakness and early death. Pathogenetic therapy with nusinersen can significantly change the course of the disease and enable the patient to acquire new skills. The study of the efficacy and safety of nusinersen therapy in patients with type 1 spinal muscular atrophy should be continued. The aim of the study was to assess the safety and efficacy of nusinersen therapy in patients with type 1 spinal muscular atrophy for 6 months as part of an expanded access program at federal and regional healthcare facilities. Materials and methods. Patients with type 1 spinal muscular atrophy received nusinersen therapy under the expanded access program (NCT02865109). Patients were evaluated before starting treatment and 6 months after starting treatment. Overall motor development and motor function was assessed using the Hammersmith Infant Neurological Status Scale Part 2 and the Philadelphia Pediatric Hospital Neonatal Motor Scale. Results. 41 children aged 6 to 38 months received nusinersen therapy between July 2019 and March 2020. At the time of analysis, all patients were alive and continued treatment. The average improvement on the Hammersmith Hospital Neurological Status Scale was 3.7 points after 6 months of therapy compared to baseline (n = 39, p Scale for the Diagnosis of Motor Function in Newborns was 9.8 after 6 months of therapy from baseline (n = 30, p Conclusion. The efficacy and safety of nusinersen have been demonstrated in real clinical practice in Russia in the treatment of early-onset spinal muscular atrophy.

The reactivity of EEG power in the individually defined μ frequency ranges was studied in the central, frontal, and parietal EEG leads in children imagining an action, watching the real action, and performing the action him- or herself. The study involved 39 children aged 17–41 months. Analysis of the variance of EEG power in the μ range demonstrated significant desynchronization in the central, frontal, and parietal EEG leads on observation and performance of actions. The Observing a real action situation was accompanied by greater power desynchronization in the μ range in the medial frontal (Fz) and medial parietal (Pz) loci as compared with the Observing a fake action situation. With the aim of identifying the role of the mirror neuron system in speech assimilation processes, we analyzed the characteristics of EEG μ rhythm reactivity in children with different levels of receptive speech development, as defined using the Bayley test. Children with high levels on the receptive speech scale were found to display greater EEG power desynchronization in the μ range when observing a real action in the frontal (F3) and parietal (P3) loci of the left hemisphere as compared with children with intermediate levels on this scale. The results obtained here show that children demonstrating higher levels of activation of the mirror neuron system have higher levels of speech comprehension.

Non-compliance to treatment recommendations of patients with chronic diseases is a global medical problem that significantly affects the effectiveness of treatment, leading to serious medical and economic consequences. Sufficient research on the problem of non-compliance with medical recommendations has led to the creation of a holistic concept of medical compliance. The purpose of the work was to estimate the main factors influencing the compliance to antihypertensive therapy of middle age patients with Arterial hypertension. Material and methods. We investigated 40 patients 50-60 years old (mean age 56.6±4.5 years) with Essential Arterial hypertension. Socio-demographic, clinical, pathopsychological, psycho-diagnostic methods (Morisky Medication Adherence Scale, self-assessment anxiety scale Charles D. Spielberger – Y. L Hanin, the Scale of Internality in relation to health and illness, the study of the self-esteem of mental states by H. J. Eysenck, the study of the level of depression by the Beck Depression Inventory), mathematical and statistical methods were used. Results and discussion. With the Morisky Medication Adherence Scale survey, we distinguished three groups of patients: with high (22.5%), middle (27.5%) and low (50.0%) levels of adherence to the combined therapy of hypertension. Socio-demographic factors in patients with low adherence to treatment were determined by lower level of education and absence of continuous marital relations. Clinical characteristics of patients with low compliance level included the presence of 3rd degree of severity, I stage of the Arterial hypertension, often comorbidities (Diabetes Mellitus 2nd type, Chronic Obstructive Pulmonary Disease, Ischemic Heart disease), long tobacco smoking. According to the psychopathological and psycho-diagnostic examination, patients with an internal type of personality control, low anxiety and depression mostly showed the low level of compliance and also more frequent aggressiveness in the self-esteem of mental states (p

The use of modern pharmacological agents in the treatment of complications of diabetes mellitus does not solve all problems of this severe and diverse pathology, so the search for using of methods of physical therapy and rehabilitation for patients with diabetic peripheral polyneuropathy remains relevant. In addition, an effective combination of medications and physical therapy can accelerate the achievement of diabetes compensation, prevent or cause regression of neurovascular complications. The purpose of the work was to evaluate the efficacy of physical therapy application for patients with diabetic peripheral polyneuropathy in outpatient treatment. Material and methods. We examined 30 patients aged 55-70 years with diabetes mellitus of the 2nd type, complicated by diabetic peripheral polyneuropathy. The patients were divided into two groups depending on the conducting of the proposed physical therapy. A course of physical therapy lasted 3 months and consisted of 36 sessions and relaxation exercises with dosed walking. Dynamic assessment of the severity of manifestations diabetic peripheral polyneuropathy was performed using visual analogue scale and the Questionnaire DN4 (Bouhassira D. et al., 2005). Moderate and severe diabetic peripheral polyneuropathy with the existing pain syndrome, sensory and motor disorders were diagnosed. Results and discussion. The results of the course of physical therapy demonstrated substantial (up to 40%) decrease of severity of diabetic peripheral polyneuropathy symptoms only in patients of the main group. The average subjective pain assessment after a course of physical therapy by the visual analogue scale in patients from the main group was 3.2±1.3 cm, with a variation from 2 to 5 cm. Reduction of pain syndrome as a result of course of physical therapy can be considered objective and significant, because the values of visual analogue scale were different from the previous ones in average of 15.3±1.3 mm. According to the DN4 questionnaire, after the course of physical therapy patients from the main group demonstrated the average values 5.1±0.7 points, with the differences of the score from 4 to 6, which confirmed the presence of a positive influence on the neurovascular complications of diabetes mellitus in patients with diabetic peripheral polyneuropathy. Conclusion. Therefore, an additional prescription of complex physical therapy by its effectiveness demonstrates significant benefits in reducing of the clinical manifestations and progression of diabetic peripheral polyneuropathy in patients with diabetes 2-type in comparison with medical therapy along. The conducted study allowed us to prove the efficiency and to propose the inclusion of complex physical therapy treatment programs for patients with diabetic peripheral polyneuropathy during outpatient treatment

The use of multi-label biochemical panels is justified by the fact that different markers reflect the severity of various pathological processes (disorders of carbohydrate and fat metabolism), which in their interaction are indicators of decompensation of a single pathology – diabetes in particular. The aim of the work was to study the differences in biochemical parameters in healthy and patients with type 1 diabetes mellitus (T1D) depending on the level of albumin in the urine. 78 men and 62 women aged 22-26 years, patients with diabetes mellitus type 1, who were hospitalized in the therapeutic department в № 1 and № 2 of Vinnytsia Regional Highly Specialized Endocrinology Center and 8 practically healthy men and 13 practically healthy women of the same age were examined. The level of microalbuminuria was determined in all patients by enzyme-linked immunosorbent assay. Fasting blood glucose and 2 hours after a meal were determined by enzymatic, amperometric analysis on a biochemical analyzer Biosen C_Line, manufactured by EKF Diagnostic (Germany). The average value of blood glucose was calculated mathematically. To determine glycated hemoglobin (HbA1c), we used the method of high performance liquid chromatography on a D 10 analyzer, manufactured by Bio-Rad (USA). The International Normal Ratio (INR) was determined using a set of reagents to determine the prothrombin time, prothrombin ratio and international sensitivity index, which is specified in the passport to the set (manufacturer of PC-K-TEST "Granum"). Total cholesterol and triglycerides were determined by colorimetric photometric method (using enzymes) on a biochemical analyzer using standard kits from Olympus AU480 (USA). Statistical processing of the results was performed in the license package "Statistica 5.5", using non-parametric evaluation methods. When comparing the level of biochemical parameters between patients with T1D and normo-, microalbuminuria and proteinuria with healthy men or women, patients found higher values: fasting glucose (in men – by 29.1 %, 30.9 % and 42.0 %; in women – by 29.7 %, 33.2 % and 46.0 %); glucose 2 hours after exercise (for men – by 27.4 %, 30.8 % and 36.1 %; for women – by 30.4 %, 32.4 % and 40.2 %); the average value of glucose (for men – by 26.2 %, 30.8 % and 39.3 %; for women – by 28.7 %, 34.0 % and 43.1 %); glycated hemoglobin (47.8 %, 48.8 % and 45.8 % for men; 27.2 %, 50.2 % and 54.4 % for women). Also, in patients with T1D men and proteinuria and women with normoalbuminuria and proteinuria compared with healthy men or women found higher cholesterol values (17.8 % in men and 7.6 % and 26.0 % in women); and in patients with T1D men with proteinuria compared to healthy men – 31.3 % higher triglyceride levels. When comparing the level of biochemical parameters between patients with T1D in men or women with proteinuria, higher values were found: fasting glucose compared with men with normoalbuminuria by 22.2 % and with women with normoalbuminuria by 30.3 % and microalbuminuria by 23.7 %; the average value of glucose compared with men with normoalbuminuria by 20.8 % and microalbuminuria by 14.0 %; glycated hemoglobin compared to women with normoalbuminuria by 15.9 %; compared with men with normoalbuminuria and microalbuminuria – by 24.8 % and 20.3 %, or with women with normoalbuminuria and microalbuminuria – by 24.9 % and 28.0 %; triglycerides compared with men with normoalbuminuria by 23.0 %. When comparing the sex differences in the level of biochemical parameters between healthy or between patients with T1D and normo-, microalbuminuria and proteinuria in men and women, only higher values of glycated hemoglobin by 14.1 % in women with proteinuria and total cholesterol by 8.3 % in women with normoalbuminuria were found. Thus, between healthy and patients with T1D and different levels of albuminuria there are differences in biochemical parameters, and they are greater the higher the level of albumin in the urine.

Introduction. Constipation is a derangement of the motor, secretory and/or evacuation function of the colon. The same symptoms are recorded in at least 20% of the population in the developed countries – as those occurring sporadically or for a long period.Basic content. The secretory function of the colon significantly affects stool consistency and its free movement. The secretion increases by 8–10 times in the presence of local mechanical irritation. Intestinal mucus is produced by colonic goblet cells. The frequency, time of defecation and stool consistency is in large part determined by the motor function of the colon. The relation of various types of contraction varies depending on the main function – propulsion or mixing. Rhythmic phasic contractions in the colon generate a pendular movement with slow propulsion of the contents and absorption of water. The tonic contractions enhance the mixing effect of weak rhythmic contractions. The propulsive contractions are specifically attributed to the lower gastrointestinal tract and occur spontaneously. They occur quite regularly, from 2 to 10 times a day, and ensure the propulsion of intestinal contents over great distances in the colon. When reaching the sphincter area, such wave causes its relaxation by mechanisms of descending inhibition. The dietary regime and adequate intake of carbohydrates with various chain lengths, including dietary fiber, as well as flavonoids and other components that modify peristaltic activity and secretion, play an important role in the regulation of intestinal secretion and peristalsis. The drugs enhancing intestinal secretion and peristalsis, such as bisacodyl and sodium picosulfate, are also used to treat constipation. These substances hydrolyse into bis-(p-hydroxyphenyl)-pyridyl-2-methane in the intestine, which, upon contact with the receptors in colonic mucosa, stimulates propulsive activity and increases intestinal secretion. The selective action of sodium picosulfate is confined to the colon.Conclusion. Pharmacological and non-pharmacological treatments for constipation are aimed at maintaining and enhancing the natural propulsive contractions of the colon and intestinal secretion.

Cystatin C improves the risk stratification among people with diabetic nephropathy, the risk of mortality, cardiovascular disease, disorders of the visual organ and nervous system in the preclinical and early stages. The aim of the study was to study the frequency of angio-, retino- and neuropathy, as well as differences in general clinical and anthropometric parameters in patients with type 1 diabetes (T1D) with different levels of albumin in the urine depending on cystatin C. The sample was 78 men and 62 women aged 22-26 years, patients with T1D, who were hospitalized in the therapeutic department №1 and №2 of the Vinnytsia Regional Highly Specialized Endocrinology Center. The control group consisted of 8 healthy men and 13 healthy women of the same age. The level of microalbuminuria and cystatin C was determined for all patients by enzyme-linked immunosorbent assay. The frequency of angio-, retino- and neuropathy, general clinical (systolic, diastolic, pulse) and anthropometric (height, weight, body surface area, waist circumference, body mass index) was assessed indicators. Statistical processing of the obtained results was performed in the license package “Statistica 5.5”, using non-parametric evaluation methods. It was found that in the group of men with cystatin C0.9 with increasing albuminuria, the percentage of patients with more severe microvascular complications of T1D. In patients with diabetes mellitus 1 compared with the control group systolic blood pressure is significantly higher and increases with increasing albumin levels in the urine (with cystatin C0.9 – in men with normo-, microalbuminuria by 4.9% and 7.2%, in women with proteinuria by 19.5%). Similar changes were found for diastolic blood pressure (with cystatin C0.9 – in men with microalbuminuria by 9.0%; in women with normo- and proteinuria by 9.5% and 21.5%) and heart rate (with cystatin C0.9 – in men with microalbuminuria by 12.0%, in women with normo-, microalbuminuria and proteinuria by 10.1%, 16.3% and 25.3%). In patients with T1D compared to the control group, the length of the body is significantly smaller and decreases with increasing levels of albumin in the urine (with cystatin C0.9 – in men with normo-, microalbuminuria by 5.2% and 7.3%, in women with normoalbuminuria and proteinuria by 2.6% and 4.3%). Similar changes were found in men for body weight (with cystatin C0.9 – with normo- and microalbuminuria by 10.2% and 25.4%) and body surface area (with cystatin C0.9 – with normo- and microalbuminuria by 8.2% and 16.2%). The size of the waist circumference in patients with T1D with normoalbuminuria is significantly higher, and in patients of other groups significantly less than in healthy subjects (with cystatin C0.9 – with microalbuminuria by 5.1%). Compared to healthy women, the waist circumference was significantly higher in sick women (with cystatin C0.9 – with normo- and proteinuria by 9.7% and 6.0%). In patients with T1D men with proteinuria compared with the control group, the value of the body mass index was significantly lower by 9.7% (cystatin C0.9) compared with healthy women. Thus, between healthy and patients with T1D with varying degrees of albuminuria, differences in general clinical and anthropometric parameters were found, and they are greater the higher the level of cystatin C.

Atrial fibrillation (AF) is the most common cardiac arrhythmia after extrasystole, which reduces the duration and impairs the quality of life. The purpose of our literature review was to get Ukrainian physicians acquainted with two studies conducted by groups of Japanese scientists. They were purposed on the investigation of AF prevalence, included a significant number of patients to determine gender- and age-associated peculiarities, explored the presence of additional risk factors and the relationship of this disease with other types of cardiac disorders and comorbidities. In particular, the group of investigates, headed by Yasuko Iguchi, MD, performed in-depth investigation of 41 466 unemployed habitants of Kurashiki city, aged over 40 years, to establish AF presence and prevalence of concomitant risk factors. It has been established that in men AF prevalence was twice as high than in women: 2.4 vs 1.2 %, respectively (p, Фибрилляция предсердий (ФП) — самое распространенное после экстрасистолии нарушение сердечного ритма, которое уменьшает продолжительность и ухудшает качество жизни. Целью нашего обзора литературы является ознакомление отечественных врачей с двумя исследованиями, проведенными группами японских ученых. Они изучали распространенность ФП, включали значительное количество пациентов с определением их половозрастных особенностей, исследовали наличие дополнительных факторов риска, а также связь этого заболевания с другими формами сердечной и сопутствующей патологии. В частности, группа исследователей под руководством доктора медицины Ясуюки Игучи осуществила углубленное обследование 41 466 неработающих жителей г. Курашик старше 40 лет на предмет наличия в них ФП и сопутствующих факторов риска. Установлено, что распространенность ФП среди мужчин была вдвое выше, чем среди женщин — 2,4 и 1,2 % соответственно (p, Фібриляція передсердь (ФП) — найпоширеніше після екстрасистолії порушення серцевого ритму, яке зменшує тривалість і погіршує якість життя. Метою нашого огляду літератури є ознайомлення вітчизняних лікарів з двома дослідженнями, проведеними групами японських науковців. Вони вивчали поширеність ФП, включали значну кількість пацієнтів із визначенням їх статево-вікових особливостей, досліджували наявність додаткових чинників ризику та зв'язок цього захворювання з іншими формами серцевої та супутньої патології. Зокрема, група дослідників під керівництвом доктора медицини Ясуюкі Ігучі здійснила поглиблене обстеження 41 466 непрацюючих мешканців м. Курашики віком понад 40 років на предмет наявності у них ФП та супутніх чинників ризику. Встановлено, що поширення ФП серед чоловіків було вдвічі вищим, ніж серед жінок — 2,4 та 1,2 % відповідно (p

This article overviews and systemizes published data on the ways of implementing differ e nt methods of biofeedback, robotic devices, and brain-computer interfaces (BCI) for rehabilitation of children with cerebral palsy (CP). Aim. To survey implementation practices and clinical outcomes of rehabilitation technologies and possible neurophysiological mechanisms underlying their efficacy in patients with CP. We searched PubMed, Web of Science and eLIBRARY.ru databases for relevant publications using specified keywords. Results . The analysis of relevant literature has shown that robotic technologies and BCIs with biofeedback based on electroencephalography and electromyography parameters are rapidly developing and implemented for the rehabilitation of children with CP. The first evidence of effectiveness for such methods and approaches has been found. However, there is a lack of fully developed conventional standards for the use of such rehabilitation methods and protocols in children. Control groups comprising of children with CP are often absent in such studies. In many cases, the variations of neurophysiological and neurochemical parameters before and after a course of rehabilitation are not evaluated. Having such data would help clarify physiological mechanisms underlying effective rehabilitation of motor functions and then design more adequate rehabilitation procedures and medication protocols.

Currently there are many experimental markers of diabetic nephropathy, but clinical practice focuses mainly on the presence of albuminuria, which usually manifests itself in both adults and children on average 5-7 years after the onset of diabetes. The aim of the study was to study the general clinical and anthropometric parameters in patients with type 1 diabetes mellitus (T1D) depending on the level of albumin in the urine. The study included 78 men and 62 women aged 22 to 26 years with T1D. The control group consisted of 8 healthy men and 13 healthy women of the same age. The level of microalbuminuria was determined in all patients by enzyme-linked immunosorbent assay. The assessment of general clinical (pulse, systolic, diastolic pressure) and anthropometric (height, weight, body surface area, waist circumference, body mass index) indicators was performed. Statistical processing of the obtained results was performed in the license package “Statistica 5.5”, using non-parametric evaluation methods. It was found that angio-, retino- and neuropathy occurred in all patients with T1D. Simultaneously with the increase in albuminuria, the percentage of patients with deeper degrees of these complications increased. It was found that with increasing levels of albumin in the urine in most cases increases the percentage of patients with a correspondingly severe degree of these complications. Thus, in patients with T1D men found: angiopathy of the III degree with normoalbuminuria – 12.5 %, with microalbuminuria – 40.0 %, with proteinuria – 53.8 %; retinopathy of the II-III degree with normoalbuminuria – 0 % and 7.5 %, with microalbuminuria – 4.0 % and 40.0 %, with proteinuria – 100 % and 0 %; II-III degree neuropathy with normoalbuminuria – 65.0 % and 0 %, with microalbuminuria – 92.0 % and 0 %, with proteinuria – 0 % and 92.3 %. In patients with T1D women were found: angiopathy of the III degree with normoalbuminuria – 29.0 %, with microalbuminuria – 13.0 %, with proteinuria – 62.5 %; retinopathy of the II-III degree with normoalbuminuria – 3.2 % and 9.7 %, with microalbuminuria – 4.3 % and 26.1 %, with proteinuria – 87.5 % and 0 %; II-III degree neuropathy with normoalbuminuria – 71.0 % and 0 %, with microalbuminuria – 91.3 % and 0 %, with proteinuria – 12.5 % and 75.0 %. In patients with T1D with normo-, microalbuminuria and proteinuria, the value of systolic, diastolic blood pressure and pulse, in most cases, significantly higher than in healthy subjects (respectively in men by 6.1-18.3 % – 3.6-20.3 % and 4.2-14.7 %; in women – by 5.0-20.0 % – 9.1-22.8 % and 8.0-31.6 %). The value of these indicators increased with the increase in the level of albumin in the urine (respectively in men by 11.4 % – 16.1 % and 10.1 %; in women –- by 13.3 % – 10.0 % and 21.8 %). Patients with T1D had lower values of growth (respectively in men by 4.6-9.2 %; in women – 2.2-4.1 %), weight (only in men by 9.0-26.4 %) and body surface area (respectively in men by 7.2-17.7 %, in women – 4.8 % only in the group of proteinuria). Body mass index in sick men, compared with healthy, was significantly lower only in the group of proteinuria (by 5.5 %); and in women it was higher in the groups of normo- and microalbuminuria (by 10.6 % and 11.2 %). Patients with T1D women compared to healthy women had a larger waist circumference (by 5.5-11.8 %), and in patients with T1D men – on the contrary, this figure was lower in the group of microalbuminuria (by 4.0 %). Thus, the differences in general clinical and anthropometric parameters between patients with T1D with different levels of albumin in the urine and the degree of complications from the vascular and nervous system allow to assess the severity and compensation of the disease, and comparison of these indicators with the control group possibilities of disease development and peculiarities of the pathological process.

Gallstone disease is revealed in 10–20% of the population with a clear tendency to affect the younger population. In a clinically manifested course, cholecystectomy remains the treatment of choice. Symptoms and signs persist or even become more severe after gallbladder surgery in 10-15% of cases (“postcholecystectomy syndrome”). Postcholecystectomy syndrome includes heterogeneous disorders of liver, pancreas, duodenum, sphincter of Oddi, etc. that can be associated with errors or negative consequences of surgical intervention. Often, symptoms may persist because of previously unrecognized chronic diseases of neighboring organs. The spectrum of effective conservative measures is rather limited. The Advisory Board was held on May 4, 2019, in Almaty (Kazakhstan) to re-estimate the definitions and categories related to the issue of the postcholecystectomy syndrome and to develop the diagnostic and treatment algorithm for patients with the postcholecystectomy dysfunction of the sphincter of Oddi. The statements discussed by the interdisciplinary team of gastroenterologists and surgeons were addressed to general practitioners, therapists, gastroenterologists, and surgeons. The Advisory Board emphasized that organic and functional biliary diseases manifest mainly by biliary pain, main characteristics of which were defined in the Rome IV consensus based on the statistical analysis of a large pool of clinical data. For a more accurate bile duct system assessment and the exclusion of cholelithiasis, the examination algorithm was proposed, which included abdominal ultrasound investigation, endoscopic ultrasound investigation of the pancreatobiliary area, and magnetic resonance cholangiopancreatography. Diagnostic algorithm for differentiation of functional biliary disorders from organic gastrointestinal pathology was developed. Sphincter of Oddi dysfunction may be considered as a postcholecystectomy syndrome manifestation in 1.5-3% of cases. Apart from rational nutrition, conservative management of functional gastrointestinal diseases implies pharmacological therapy. The efficacy of non-steroidal anti-inflammatory drugs, prokinetics, nitrates, antispasmodics, calcium channel antagonists, botulinum toxin, and hymecromone was demonstrated in previous studies. Papillosphincterotomy is not effective in relieving biliary pain in cases of the sphincter of Oddi dysfunction. The proposed algorithm for the management of patients with the postcholecystectomy syndrome was presented.

The objective: to study clinical manifestations of tuberculosis relapses and their treatment outcomes in patients with HIV infection.Subjects and Methods. 132 medical records of patients with tuberculosis relapses were analyzed; 69 of them were HIV-positive and 63 were HIV-negative. All of them were admitted to Irkutsk Regional Clinical Tuberculosis Hospital from 2016 to 2019, and then continued treatment of tuberculosis on the out-patient basis. Treatment efficacy was assessed in February 2020.Results. More severe clinical forms of tuberculosis relapses were typical of HIV patients including generalized forms affecting the central nervous system. Therefore, among these patients, the mortality rate is significantly higher (24.6%) than in tuberculosis relapses with no concurrent HIV infection (6.3%), p ≤ 0.05.

The dry eye syndrome (DES) belongs to the group of tear film disorders, which are caused by either lowering of tear secretion or by the tear film instability. DES lowers the working capacity, worsens the quality of life and, if its symptoms are ignored for a long time, may lead to serious vision disorders, including blindness. The influence of environmental factors may be one of the reasons for intensification of the DES caused symptoms. In addition, there is a concept of iatrogenic DES, caused by a systemic and local use of medicinal drugs, by contact lenses, and by ophthalmological surgical and non-surgical manipulations. The purpose of the research was to study the clinical-pharmacological characteristics of medicinal drugs in terms of peculiarities of their application in patients with DES who have adjoining disorders as well as to determine medicines that may contribute to DES occurrence and exacerbation causing secondary lowering of tear production and sensor glandular secretion, inflammation of Meibomian glands or direct irritation. Materials of the research included the data of the medicinal drugs’ register, the search database of medicinal drugs Compendium, prescribing information and labelling of the drugs. Methods of research: biblio-semantic, content-analysis, segmenting, graphic, system analysis. It has been determined that 194 medicinal drugs, which in accordance to the 1st level of ATC-classification system belong to 10 pharmaco-therapeutic groups, have certain treatment peculiarities in patients with dry eye syndrome. DES is mentioned in different sections of prescribing information and labelling of the drugs: «side effects» – 172 drugs, «peculiarities of use» – 21 drug, «drug-to-drug interaction» – 1 drug. Segmentation of the market by the type of medicinal form demonstrated a significant prevalence of eye drops and pills (34.02% and 33.50% respectively). Taking into consideration the prevailing share of eye drops among other medicinal forms, which cause iatrogenic DES, further research is required to study their composition and define the correlation between the content of excipients and the risk of development of side effects in the form of dry keratoconjunctivitis of local ophthalmological medicinal drugs. The results of the conducted complex research determine the groups of medicinal drugs that should be prescribed with special caution for pharmacotherapy of various organs and systems in patients with the risk of DES acquisition or exacerbation. The most numerous among them are such groups as S01E – Antiglaucoma drugs and myotics, L01X – Antineoplastic drugs and N02B – Analgesics and antipyretics, which account for 21.13%, 12.37% and 9.79%, respectively. Presence of information about the risk of DES development as a result of drug-to-drug interaction in only 1 of 194 prescribing information and labelling of the drugs signifies an extremely low level of attention to the issue of medicinal drugs’ synergy in terms of their side effects.

Introduction. The feasibility of reconstructing an orthotopic urinary reservoir after radical cystectomy (RCE) in women is still debatable. This is due to the peculiarities of the physiology and anatomy of the female lower urinary tract and an increased risk of developing urinary incontinence or urinary retention after surgery.Purpose of the study. Studying long-term functional results of creating an orthotopic urinary reservoir by VIP in comparison with the technique of creating a urinary reservoir by Studer after RCE in women.Materials and methods. The study included 32 women who underwent RCE with the formation of an orthotopic urinary reservoir by to Studer — 13 patients and a «spherical» reservoir in the VIP — 19 modification. At the time of surgery, the age of patients was 61.1±1.9 years (29 ‒ 82). The average follow-up time was 77.5±7.8 months (17 ‒ 157, median 82). The patients who underwent a more complex type of plastic were younger than the patients operated on by the Studer method (p = 0.014). The groups did not differ statistically in other parameters.Results. The overall five-year survival rate in the Studer group was 90.9%, and in the VIP group — 94.7% (p = 0.596). 59.4% of patients were completely continent. Women after plastic surgery by VIP held urine better (68.4% vs 46.2%). The incidence of mild urinary incontinence was higher after Studer surgery. The incidence of severe urinary incontinence was the same in both groups. Nighttime urinary incontinence was the same in both groups. Intermittent catheterization was used more often by patients after VIP plastic surgery than after Studer surgery (21% vs 7.7%). In urodynamic studies, it was shown that the lower physiological capacity of the reservoir according to Studer due to more intense peristalsis of the reservoir wall, which causes involuntary leaking of urine, hyperperistalsis of the reservoir and a higher frequency of urinary incontinence causes more complete emptying in patients less residual urine, less need for self-catheterization. In the group of patients with plastic surgery according to VIP, a high physiological capacity of the reservoir with a lower pressure of the walls of the reservoir during the filling phase was recorded. This is manifested by a lower incidence of urinary incontinence, and, at the same time, a more significant amount of residual urine and a higher need for patients for self-catheterization.Conclusion. The formation of an orthotopic urinary reservoir with favourable long-term results is possible in women after RCE. The most beneficial in terms of the quality of daily held urine is the VIP modification, which is characterized by sufficiently high capacity and low intraluminal pressure. However, with this method of surgery, the risk of hypercontinence increases, which requires periodic catheterization. A complex urodynamic study made it possible to show the direct effect of various characteristics of the reservoir on the nature and degree of impaired urination of patients.

Nowadays, adhesive small bowel obstruction (ASBO) is a disease characterized by the stable increase in the number of patients, a significant level of postoperative complications, and a high risk of disability and death. The objective of the article was the research and analysis of relevant data of video laparoscopic treatment of patients with ASBO and possible postoperative complications. A small percentage of complications in clinical centers with a large flow of patients of this profile and rapid postoperative recovery of patients promote the active introduction of laparoscopic adhesiolysis in practical medicine. The analysis of foreign and domestic literature showed that the faithful adherence of indications for application of the technique for resolving intestinal obstruction and restoring passage through the gastrointestinal tract allows to achieve better results and avoid iatrogenic and infectious complications. Thus, laparoscopic treatment can and should be the operation of choice only in a carefully selected group of patients (the first manifestation of ASBO, the absence of pronounced ischemic changes in the intestinal wall and (or) the predicted presence of a small number of peritoneal adhesions), in all other cases, the use of laparotomy is indicated. Currently, there is a clear trend towards an increasing recognition and use of laparoscopy in surgical practice. It is becoming the preferred choice in clinical centers with extensive experience in the treatment of patients with ASBO due to an insignificant percentage of complications and a rapid postoperative recovery.

According to experts of the World Health Organization the lower back pain (LBP) prevalence in developed countries reaches the pandemic size, and it is a serious medical and socio-economic problem. Acute back pain is transformed into chronic in 10–20 % of working age patients′ cases; this causes serious psychological disorders appearing, forms painful behavior and persists even when the initial pain trigger is eliminated. Data from metaanalyses of randomized controlled trials indicate the effectiveness of the osteopathic approach in the treatment of LBP patients. At the same time the osteopathic correction is effective not only for acute pain, but also for chronic pain. A case from clinical practice is described demonstrating the possibility of osteopathic correction of a LBP patient.

Objective. To reveal the causes of unsatisfactory results and mistakes in treatment of patients with pigmented villo-nodular synovitis of a knee joint with the objective to improve this disease diagnosis, as well as the results of treatment and rehabilitation/ Materials and methods. Through the period 2010 - 2018 yrs we conducted a retrospective analysis of medical documents (the case histories) in 77 patients with pathohistologically verified diagnosis of pigmented villo-nodular synovitis of a knee joint, who were treated in the clinic of Institute of Traumatology and Orthopedics (ITO), Kyiv and operated on a knee joint. Results. The causes of unsatisfacory results of treatment for pigmented villo-nodular synovitis of a knee joint are the disease severity, and its diffuse form, absence of the diagnosis-treatment algorithm for this process and rehabilitation of the patients, what leads to diagnostic and tactical mistakes on the treatment process stages. Conclusion. The awaiting tactics in diagnosis and treatment of pigmented villo-nodular synovitis constitutes a wide-spread tactical mistake. Insufficient knowledge of traumatologists in a knee joint surgery leads to tactical faults as well. Most treatment mistakes occur as a consequence of unreadiness of orthopedist-traumatologist for possible intraoperative accidental revealing of pigmented villo-nodular synovitis of a knee joint, as well as because of absence of intraoperative tactics and material gears for treatment of this disease and its outcomes.

The paper describes a clinical case of a male patient with verified systemic lupus erythematosus (SLE) and manifestations of lupus nephritis with impaired renal nitrogen excretory and filtering functions, central nervous system lesion (focal epilepsy), hematological (hemolytic anemia) and immunological (anti-double-stranded DNA antibodies, hypocomplementemia, positive antinuclear factor) disorders, and antiphospholipid syndrome (APS). The disease originated from APS: thrombosis in the radial and ulnar arteries. Subsequently, organ damages were considered as a consequence of thrombotic microangiopathy, which can occur with both APS and SLE.

—The suprachiasmatic nucleus (SCN) regulates the functioning of the body in accordance with circadian rhythms thanks to the pacemaker neurons present in it and afferents modulating these neurons. One of the afferents is represented by nerve fibers containing only the first enzyme for the synthesis of catecholamines, tyrosine hydroxylase (TH). In ontogeny, the concentration of these fibers (amount per unit volume of tissue) reaches a maximum on the 10th postnatal day (P10), and then gradually decreases. The aim of this work was to verify our assumption that, in TH-containing fibers in SCN of rats, L-DOPA is synthesized from L-tyrosine as the final secretory product, and the efficiency of this synthesis is higher in the early postnatal period than in adults. The synthesis of L-DOPA was evaluated by an increase in the total content of L-DOPA in SCN and in the incubation medium after a two-hour incubation of SCN in a medium with or without L‑tyrosine. We found that the addition of L-tyrosine to the incubation medium led to a multifold increase in the total L-DOPA content in SCN and in the medium, which is evidence of the synthesis of L-DOPA as a final product in TH-containing fibers. A comparative analysis of the synthesis of L-DOPA in SCN at P10 and P60 showed that the synthesis rate (a ratio between the total content of L-DOPA in SCN and in the incubation medium to the incubation time) at P60 exceeds the synthesis rate at P10, while the efficiency of L‑DOPA synthesis (a ratio between the rate of L-DOPA synthesis and the total protein content in SCN) is higher at P10. Thus, we obtained evidence of L-DOPA synthesis in TH-containing SCN nerve fibers, and the efficiency of this synthesis in rats in the early postnatal period is higher than in adult animals.

—The suprachiasmatic nucleus (SCN) regulates functions in accordance with circadian rhythms thanks to the pacemaker neurons present in it and afferents modulating their activity. One type of afferent is nerve fibers containing only tyrosine hydroxylase (TH) and secreting (L-dihydroxyphenylalanine) L-DOPA. The aim of this work was to test the hypothesis that L-DOPA comes from TH-containing fibers into neurons containing only aromatic L-amino acid decarboxylase (AAAD), where dopamine is synthesized. The synthesis of dopamine was evaluated by its content in SCN in intact rats on the 10th postnatal day (P10) and on P60, as well as by the total dopamine content in SCN and in the incubation medium after incubation of this nucleus in the medium with or without L-DOPA. It was shown that in intact rats SCN contains dopamine at the same concentration at P10 and P60. Some of the experiments with incubation of SCN slices were performed with rats injected with neurotoxins of monoaminergic neurons to exclude the synthesis of dopamine from L-DOPA in monoaminergic structures. At P10, during incubation of SCN in L-DOPA-containing medium, an increase in dopamine synthesis was observed equally in animals in control (normal) and after exposure to neurotoxins, which indicates synthesis of dopamine only in monoenzymatic AAAD-containing neurons. In a similar experiment at P60, the addition of L-DOPA into the incubation medium also led to an increase in the synthesis of dopamine, however, in animals exposed to neurotoxins to a lesser extent than in the control. This means that in adult animals, dopamine is synthesized in SCN mainly in monoenzymatic AAAD-containing neurons and to a lesser extent in monoaminergic structures. Thus, it was shown that dopamine in SCN is synthesized in monoenzymatic AAAD-containing neurons from L-DOPA secreted by monoenzymatic TH-containing fibers.

Interest to the studies of life quality by scientists and practitioners is constantly growing, as this unique approach allows to fundamentally change the traditional view of the problem of the disease and the patient. By investigating the quality of life as an integral index of the patient's condition, it is possible to assess the complex impact of the disease on the patient's life, to compare the effectiveness of various interventions, to predict the disease course. However, the problem of assessing the quality of life in patients with tuberculosis under conditions of alcohol consumption remains poorly understood. To establish the level of quality of life in patients, 102 men with newly diagnosed tuberculosis, with preserved sensitivity to anti−tuberculosis drugs were examined. The AUDIT test was used to assess their alcohol consumption, and the MOS SF−36 questionnaire was used to analyze the quality of life parameters. The study also assessed quality of life parameters and alcohol consumption in groups with varying prevalence of tuberculosis and the presence of mycobacteria or no bacterial excretion. According to the findings, the following conclusions can be drawn: pulmonary tuberculosis leads to a decrease in quality of life with the greatest depression in the group of patients who abuse alcohol; quality of life indices are significantly lower in patients with advanced tuberculosis and bacterial excretion, while the level of alcohol consumption in these groups is significantly higher than in patients with localized forms and lack of bacterial excretion. Interestingly, when interviewing patients, none of them rated their health as "excellent", answering the first question of the SF−36 questionnaire, and 100 % of respondents to question 11 answered "definitely not" to the statement "I expect my health to deteriorate". The obtained research data on the parameters of quality of life in patients with tuberculosis can be used to achieve the highest effectiveness of therapy and targeted psychosocial rehabilitation. Key words: tuberculosis, alcohol, quality of life, bacterial excretion.

Bone regeneration of patients with osteoporosis takes significantly longer than the rehabilitation period of individuals without bone pathology. This is due to the predominance of destructive processes in the setting of osteoblastic reaction weakened by osteoporosis, persistent inflammatory reactions, as well as proliferating connective tissue.Aim. Тo study the nature and dynamics of processes involved in the destruction and regeneration of bone tissue under various conditions, taking forensic medical assessment into account.Material and methods. We studied the autopsy and biopsy material of bone tissue using clinical-instrumental and histological research methods.Results. Using atomic force microscopy, it was found that in individuals with osteoporosis the formation of endosteal callus exhibits features associated with the impaired interlacing of collagen fibres due to the expanded space between them, and, as a result, an impaired connection between osseous structures with a low level of mineralisation.Conclusion. In accordance with paragraph 24 of Order 194n On the Approval of Medical Criteria for Determining the Severity of Harm to Human Health verified systemic osteoporosis that was the setting for the fracture, which in fact is a pathological fracture, should not be considered as damage to health.

Functional dyspepsia (FD) is one of the dysregulatory lesions of the upper digestive tract. This syndrome has fairly well-defined clinical manifestations that include borderline psychopathological disorders. Its diagnosis becomes a method for ruling out organic gastrointestinal and mental illnesses. Treatment for FD is complex and includes a behavioral component, prokinetics, myotropic spasmolytics, antisecretory drugs, and tricyclic antidepressants. The efficiency of therapy directly depends on a physician's ability to choose an individualized regimen.

During many decades, rabies remained endemic on the territory of Ukraine. In certain historical periods, the epizootic process of rabies developed with the alternate inclusion of different species of animals as a source and a reservoir of the virus which are of great interest to many scientists. Therefore, the purpose of our study was to conduct an analysis of rabies epidemiology on the territory of Ukraine from 1950 to 2019 based on collected reliable archival data. Collected archival data have shown that over the past 70 years sources of rabies infection varied from domestic to wild carnivorous and vice versa with three major epizootic peaks. The first and the highest peak in the entire study period was recorded in 1951 (3 724 cases) and was caused by the spread of the rabies virus solely through dogs. The second peak with lower number of cases was recorded in 1979 (1 594 cases) when the dominant role in the spread of rabies virus turned to foxes. Finally, the third peak in 2007 (2 932 cases) was triggered by the combination of animals (foxes, dogs, and cats) as the source of the pathogen. Considering significant peaks and downturns and the varying degrees of involvement of domestic and wild animals in spreading of the pathogen, we have identified five historically important stages in the development of the epizootic process: the stage of «urban» or «dog» rabies (1950–1959), relative stability (1960–1969), «sylvatic» or «fox» rabies (1970–1990), relative safety (1991–1999), and expansion (2000–2019). At the stage of «urban» rabies dogs played a significant role as a source and a reservoir of the virus. In the epizootic aspect, dogs made up 54.3 % of all rabies cases, while cats and wild animals (wolves, raccoon dogs, foxes, raccoons, martens, and lynxes) – 1.58 % and only 0.05 % respectively. Domestic animals (cattle, pigs, horses, goats, etc.) made up the rest 44.07 %, but they were «victims» and did not contribute to the further spread of the virus. Moreover, in 89 % of cases dogs were a source of rabies for humans. The stage of «relative stability» was marked by decline of epizootics throughout Ukraine and decrease in the number of deaths to 140 per year. «Sylvatic» or «fox» rabies stage was characterized by the involvement in the epizootic process of a new species of animals – the red fox (Vulpes vulpes). During this stage the proportion of wild animals in the total number of cases was 33.9 %, cats – 17.7 %, and dogs – 12 %. In 46.5 % of cases foxes were the main source of rabies for humans, while cats and dogs in 34.2 % and 11.8 % of cases respectively. The stage of «relative safety» was marked by the repeated prolonged decline of epizootics and the increasing role of dogs and cats in the epizootic process. The last stage of the expansion took place against the background of the increasing population size and proportion of rabies cases among domestic carnivores (up to 44.6 %) and foxes (up to 36.5 %), which contributed to the widest distribution of the virus, and remains a significant problem nowadays. While in the period of «urban rabies» vaccination of dogs together with the regulation of their population allowed to reduce the number of rabies cases by 26 times in 15 years, nowadays regulation of fox and domestic carnivores populations in combination with oral vaccination of wild and parenteral vaccination of companion animals, unfortunately, do not give visible result. So, it is extremely important not only to increase the quality of preventive measures against rabies, but also to increase their quantity in order to cover all three major sources of rabies – dogs, cats, and foxes.

At present, one of the main tasks of the state is to develop and improve the system of health protection and quality of life of the younger generation. In this regard, the search for simple non-invasive methods of monitoring the health of children, and especially young athletes at various stages of their competitive activity, is of great importance. It is known that the leading place among the factors influencing sports performance is occupied by a number of authors with the peculiarities of metabolic processes of sportsmen [1, 2], hemodynamics [3, 4], neuromuscular activation [5, 6], activity of the central nervous system [7, 8]. It has been shown that systematic repetition of dosed muscle load increases not only physical endurance in sportsmen but also their body resistance to hypoxia [4]. However, to date, the literature practically lacks data from complex controlled studies on the assessment of the functional state of the body in young athletes. At the same time, it should be noted that changes in the parameters of external respiration are one of the most important markers of medical and biological control of training, both for beginners and highly qualified sportsmen [9, 10]. In our opinion, studying the features of external respiration in athletes of cyclic sports of different orientation can be useful in building schemes, choosing modes and methods of their training process. In this connection, the purpose of the present research was the comparative characteristic of the external breathing system of young sportsmen of cyclic sports of orienteers and track-and-field athletes who are at the stage of a basic training mesocycle. The study was carried out with the participation of 20 young male and female athletes engaged in athletics and sports orientation. The 1st group (10 people) included athletes engaged in track and field athletics, athletes stewards (runners for 800–3000 meters, the average distance during training from 1500 to 4000 meters, pace – about 5 minutes per 1 km.), the 2nd group (10 people) – athletes engaged in orienteering (the average distance of running from 3000 to 6000 meters, pace – about 6–7 minutes per 1 km.). The age of athletes was within 13–15 years. The external breathing apparatus is most developed for orienteering athletes who have elements of staying load in the training process, with predominance of aerobic type of energy exchange, while for athletes-athletes the most characteristic was high power of forced exhalation and values of maximum ventilation of the lungs, which is due to a high degree of adaptation of these athletes to anaerobic load of high intensity. Young orienteering athletes recorded higher values in the «tranquil breathing» test as compared to track and field athletes. Thus, YEL on the average is 11.97 % (p

SummaryThe aim of the study is to analyze the medical care support for victims withcomplicated gunshot wounds of the extremities at levels II–IV in order to improve theresults of the comprehensive treatment.102Materials and methods. Analysis of the comprehensive treatment of 175 patientswith gunshot wounds of the extremities at the levels of medical care was carried out. Inthe main group (86 patients), comprehensive treatment was used, namely repeatedsurgical dressings, vacuum (including washing) aspiration, ultrasonic cavitation ofwounds, stimulation of local reparative processes, local treatment of wounds withcolloidal dressings with nanosilver, antiseptics, antibacterial and symptomatic therapy.In the comparison group, the treatment was carried out according to the generallyaccepted methods. The results of treatment were assessed using the anatomical andfunctional full-scale Matisse-Lyuboshits-Schwarzberg.Results. At the II level of medical care, a direct relationship was establishedbetween the quality (timeliness, radicality, use of medical magnets, C-arch) of thesurgical treatment and the number of infectious complications. The bacteriological datarevealed the effectiveness of primary antibacterial therapy with ceftriaxone andciprofloxacin. The widespread use (58%) of infiltration anesthesia can limit the surgicalactivity in deep wounds and affect the quality of primary surgical care.At level IV, after the treatment in the main group, there was a faster clearance ofwounds, a reduction in the terms of inpatient treatment, a lower number ofcomplications (12.8% in comparison with 23.6% in the control group), includinginfectious 3.5% (control group 9%). The reasons for the impaired healing were the nonoptimal timing of surgical interventions (during the period of immunosuppression), theincorrectly chosen (simplest) method of wound closure (application of delayed sutureswith autodermoplastics), violation of the doctor’s recommendations by the patient.Conclusions. Improvement of the results of treatment of victims with gunshotwounds of the extremities at the II level of medical care requires shortening the terms ofevacuation, active use of modern methods for surgical treatments (medical magnets, Carch), appropriate methods of anesthesia (conduction, spinal, epidural anesthesia),adequate antibacterial therapy (ceftriaxone, ciprofloxacin); planning of restorativesurgical interventions taking into account the period of immunosuppression (4–21 days),anatomical, psychological characteristics of the patient, the choice of the appropriate(and not the simplest) method of wound closure.Analysis of treatment results proved the effectiveness of the developed method ofcomprehensive treatment of gunshot wounds of the extremities, which made it possibleto reduce the duration of treatment by (6.0±2.2) days, reduce the number ofcomplications by 10.8% and can be recommended as a method of choice in thetreatment of this pathology.

One of the features of the developing suprachiasmatic nucleus (SCN), the "biological clock" of the body, is the early expression of dopamine (DA) receptors in the absence of dopaminergic neurons as a source of DA. Only recently we showed that DA in SCN is synthesized together by nerve fibers containing only tyrosine hydroxylase (TH) and neurons containing only aromatic L-amino acid decarboxylase (AADC). This study was aimed to assess specific characteristics of the phenotype of TH-fibers in ontogenesis. For this purpose, PCR and immunohistochemical analysis of the expression of genes and proteins such as TH, AADC, vesicular monoamine transporter (VMAT), and receptors for DA (D1, D2) was performed. We have detected numerous TH-immunoreactive fibers in SCN of young and adult rats. VMAT was observed in some of them, which suggests vesicular storage of L-DOPA. Considering the key role of TH-fibers in cooperative synthesis of DA, we assumed the presence of their dopamine regulation. Using double immunolabeling, we showed that D1 and D2 are present in TH-fibers in adult rats, and only D1 in young rats. According to PCR, D1 and D2 are also expressed in neurons of SCN in adult rats and only D1 in young rats. Thus, it was shown for the first time that VMAT and D1 are coexpressed in TH-fibers synthesizing L-DOPA in SCN in young and adult rats, and also D2 receptors in adult rats, which suggests vesicular storage and dopamine regulation of L-DOPA secretion, respectively.

SummaryAim. To compare the closed and open surgical method of correction of saddledeformity of nose (SDN) according to our own experience, to determine the possibilitiesand effectiveness of rib autografts (RA) to eliminate SDN in functional rhinoseptoplasty(RSP) in servicemen of the Armed Forces of Ukraine.Materials and methods. RA was used in five cases of SDN patients. Threeoperations at SDN were performed according to the closed method (main group), twooperations were performed according to the open method (control group). All patientswere male. The average age of patients in the main group was (35±7.1) years, thecontrol group was (32±6.3) years, and the age difference was not statisticallysignificant. An area of the right 6th costal cartilage was used for reimplantation in allpatients, as first stage of the operation classic endoscopic septoplasty with laser lowerturbinoplasty was performed.Results and discussion. The aesthetic shape of the nose was achieved in all patientsof both groups, the function of nasal breathing was restored. Everyone’s wounds healedwith primary tension. Reactive, soft tissue edema regressed faster with the closedmethod, the rehabilitation period was reduced by (19±2.1) days in the main groupcompared with control patients (p

Inflammatory diseases of the nasal cavity and paranasal sinuses are identified as the leading cause of upper respiratory disorders. Nose breathing is of crucial importance to provide the entry for air to get into the respiratory system. In addition to oxygen saturation, nose breathing provides the exchange of air in the paranasal sinuses. This process is required to maintain normal microflora of the nasal cavity. In contrast, mouth breathing occurring during the inflammatory diseases of the nasal cavity is associated with discomfort and poor health-related quality of life and results in inflammation. Viral inflammatory disorders often exacerbate a patient’s condition and provoke bacterial inflammation. Recent widespread occurrence of antimicrobial resistance forced to change the paradigm in the treatment of inflammatory disorders and to refocus on time-proved topical therapies. Systemic antibiotics are now used only for strict indications. Other treatment options are widely applied. Thus, silver preparations characterized by antiseptic and bactericidal properties allow to avoid complications and to aid the recovery. They are the best choice of topical agents for treating acute rhinosinusitis. KEYWORDS: acute rhinitis, acute rhinosinusitis, acute respiratory viral infections, antibacterial drugs, topical treatment, argentum proteinate. FOR CITATION: Ovchinnikov A.Yu., Miroshnichenko N.A., Nikolaeva Yu.O. Effective and safe treatment for the inflammatory diseases of the nose and nasopharynx. Russian Medical Inquiry. 2020;4(4):238–242. DOI: 10.32364/2587-6821-2020-4-4-238-242.