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INTRODUCTION: In recent decades procedural sedation and/or analgesia (PS/PSA) have been widely used for diagnostic examinations and minimally invasive surgical interventions outside of the operating room. The recommendations for (PS/PSA) presented in the literature contain contradictory data related to indications, contraindications, baseline monitoring level, priority level and sedation protocols. OBJECTIVE: To perform an analysis of current practice guidelines, randomized clinical trials (RCTs), literature review and to systematize data on the potential use of sedatives and narcotic analgesics in procedural sedation. MATERIALS AND METHODS: PubMed, Medline, Embase, and eLibrary were searched for PS/PSA guidelines, RCTs, and articles. RESULTS: The literature review describes the levels of sedation in increase in difficulty and potential risk of complications. A comparative characteristic of first- and second-line drugs for sedation and anesthesia is presented. Minimum requirements for perioperative monitoring of vital signs, sedation and pain levels are formulated. CONCLUSIONS: The PS/PSA in a planned or emergency procedure provides safe, comfortable and successful performance of diagnostic examinations and mini-invasive surgical interventions. The principles of interaction and administration of sedatives with narcotic analgesics are the basis for the use of sedation regimens. The use of scales has important practical value for monitoring the dynamics of sedation levels and for more fine management of sedation doses. There are no absolute contraindications for PS/PSA. PS/PSA is a popular area of practice for the anesthesiologist and resuscitator today. The Russian Federation's lack of regulatory documents on PS/PSA makes it necessary to develop guidelines.

Aim. To evaluate the efficacy and safety of a combination drug containing ambroxol, guaifenesin, and levosalbutamol, oral solution, versus Ascoril Expectorant, syrup (combination of bromhexine, guaifenesin, and salbutamol) in the treatment of productive cough in adult patients with acute bronchitis. Materials and methods. This open-label, randomized, phase III study included patients with acute bronchitis who had a productive cough with difficulty in sputum expectoration. 244 patients were randomized in a 1:1 ratio and received 10 mL of the study drug or reference drug 3 times daily for 2 weeks. After 7 and 14 days of treatment, the physician evaluated patients subjective complaints and the efficacy of therapy. The primary endpoint was the proportion of patients with high and very high efficacy. Results. The primary endpoint was reached by 70 (0.5738) patients in the study drug group and 54 (0.4426) in the reference drug group (p=0.04). The intergroup difference was 0.1311 [95% confidence interval: 0.0057; 0.2566]. The lower limit of the 95% confidence interval was above zero, which confirms the superiority of therapy with the study drug over therapy with Ascoril Expectorant. The proportion of patients with a 1-point total score reduction and with complete resolution of all symptoms according to the Modified Cough Relief and Sputum Expectoration Questionnaire after 7 and 14 days was numerically higher in the study drug group versus the reference drug group. There were no statistically significant differences between the groups in the incidence of adverse events. Conclusion. The efficacy of a new combination drug containing ambroxol, guaifenesin, and levosalbutamol in the treatment of productive cough in adult patients with acute bronchitis is superior to the efficacy of Ascoril Expectorant. The safety profiles of the study drug and the reference drug were comparable.

Introduction. The rising incidence of obesity among children and adolescents has become a major public health problem. Problems of female reproductive function associated with obesity include menstrual irregularities, complications of pregnancy and childbirth, and infertility.Aim. To conduct a prospective analysis of carbohydrate, lipid metabolism, neuroendocrine regulation in women with primary infertility and hypothalamic syndrome of puberty.Materials and methods. Prospective, longitudinal study of adolescent girls (n=170) with hypothalamic dysfunction for 14.2±1.6 years, mean age was 14.41±0.26 years. The second stage of the study included an assessment of the hormonal status and metabolic changes in 86 women, of which 46 were fertile, 26 had primary infertility and 14 had secondary infertility, mean age was 21.89±1.15 years. Clinical and laboratory methods were used to study the indicators of lipid and carbohydrate metabolism, pituitary-ovarian and adrenal hormonal regulation systems, instrumental and functional research methods, as well as statistical analysis methods were carried out.Results. Among adolescent girls with hypothalamic dysfunction a high proportion of secondary amenorrhea − 31% (p=0.042) and metabolic syndrome − 86% was revealed, as well as a significant increase in follicle-stimulating hormone, testosterone, cortisol and a decrease in the concentration of progesterone, inhibin B, an increase in cholesterol, low density lipoproteins, triglycerides, the HOMA index, insulin and a decrease in high density lipoprotein cholesterol. We found a high proportion of polycystic ovary syndrome − 19.8%, polymenorrhea − 18.6%, oligomenorrhea − 19.8%, primary infertility − 30.2%, (p=0.001) in women with a history of hypothalamic obesity in the pubertal period. We determined a set of primary infertility predictors: the presence of triglyceridemia and hyperlipidemia in the puberty period (OR 9.5; 95%CI [1.7–51.9]) and hormone-dependent diseases in the reproductive period (OR 5.6; 95%CI [2.5–18.2]).Conclusion. In our opinion, timely prevention and correction of lipid metabolism disorders in adolescents, as well as early detection of hormone-dependent diseases in the reproductive period are promising for the prevention of reproductive disorders.

Background. The analysis of modern scientific literature indicates that if the list of indications for elective surgery in geriatric patients with benign prostatic hyperplasia (BPH) meets the requirements of urological practice, then the contraindications for this operation clearly do not correspond to them.Aim. Based on the current list of contraindications to elective surgery in geriatric patients with BPH, to develop rational surgical tactics aimed at reducing the frequency and severity of postoperative complications and deaths.Materials and methods. Examination and treatment of 295 geriatric patients with stage 2 BPH (main group A) who underwent planned transurethral resection of the prostate or transpusical adenomectomy in the period from 2007 to 2015 at the Samara Regional Clinical Hospital of War Veterans (the clinical base of the First Research Institute of Clinical Gerontology and Rehabilitation of War Veterans of the Medical University “Reaviz”). During this period, 116 geriatric patients with stage 2 BPH (main group B) using the author’s list of contraindications, elective surgery was contraindicated. They underwent conservative treatment. The control group consisted of 344 geriatric patients with stage 2 BPH who underwent elective transurethral resection of the prostate or transpusical adenomectomy in the same Hospital from 2000 to 2006, taking into account the contraindications to these operations that existed at that time. The age of patients in all groups was from 60 to 89 years.Results. The use of this list made it possible to establish among 116 patients (main group B) excretory absolute contraindications to surgery were performed in 48.3 % of patients, relative present contraindications of the second – in 33.6 %, temporary contraindications of rendering – in 13.8 %, a special contraindication to transurethral resection of the prostate – in 1.7 %, special contraindications to transvesical adenomectomy – in 2.6 %, which contributed to the prevention of possible postoperative complications and deaths among them.Conclusion. The clinical expediency of using the author’s approach to the choice of surgical tactics, taking into account contraindications to elective surgery in geriatric patients of the main group A, compared with patients of the control group, consisted in reducing of postoperative complications and deaths and increasing of good immediate treatment results among them.

The article proposes determining the current state of historical castles and fortifications by establishing a qualitative indicator that reveals their historical and architectural value and integrity, respectively, through the degree of historical and architectural value and the degree of destruction. The definition of the concept of destruction is given. Three degrees of destruction of historical castles and fortifications have been identified. The I degree of destruction – is insignificant, point destruction; the II degree of destruction – is significant destruction; the III degree of destruction – is ruin. The systematization of the existing historical castles and fortifications of Ukrainian Volyn and Podillia according to the degree of destruction has been carried out. Depending on the degree of destruction during the complex process of restorative-reconstructive transformations (RRT), it was proposed to use various methods (preserving and restoring) to preserve, recover, and activate them. Historical castles and fortifications of the I degree of destruction are recommended: museumification and modification of the original function, as the preserving PRT methods, and fragmentary restoration, integral restoration, revalorization with functional development or functional addition, as restoring RRT methods. For the II degree of destruction - museumification with modification of the original function and adjustment, as preserving RRT methods, integral restoration, revalorization, regeneration with adaptation to new functions, as restoring RRT methods. For the III degree of destruction - conservation and museumification, respectively, with a functional interpretation and modification of the original function, as preserving RRT methods, as well as fragmentary restoration and adaptation to completely new functions, as restoring RRT methods. Recommendations are given on topical new functions for these castles and fortifications in their functional adaptation.

Recently, the role of stress-regulatory pathways in the development and progression of type 2 diabetes mellitus (T2DM) and associated cardiovascular diseases has been widely investigated. The aim of the study was to assess the relationship of polymorphic variants P72R (C>G) of the TP53 gene with the functional and metabolic characteristics of type 2 diabetic patients in the East Ukrainian population. Materials and methods. 50 T2DM patients (female/male: 21/29) aged 53.34±1.43 yrs., with diabetes duration of 6.25±0.89 yrs., HbA1c level of 7.12±0.21%, body mass index of 31.19±0.93 kg/m2, with waist-to-hip ratio of 0.96±0.01, with the presence of coronary heart disease in 38 cases, hypertension in 46 cases, and their combination in 37 cases. Characteristics of carbohydrate/lipid metabolism, parameters of insulin resistance, chronic inflammation, and a number of adipokines were determined in the subjects. Genotyping for single nucleotide polymorphism P72R (C>G) TP53 was performed by the method of polymerase chain reaction with appropriate primers and BstUI endonuclease. Testing of null hypotheses was carried out using the t, F and c2 criteria at the significance level of P≤0.05. Results. There was a noticeable tendency (P=0.05) to increase in frequency of the recessive allele G, mainly in men, which requires further extended studies. In addition, carriers of the minor genotype are characterized by a significantly younger age of T2DM manifestation. Under the statistically similar parameters that characterize the degree of obesity and glucose metabolism compensation, the connection of the G-allele with insulin resistance, both hepatic (HOMA-IR) and associated with adipose tissue (HOMA-IR/adiponectin, adiponectin/leptin) was observed. Carriers of the recessive allele are also characterized by an increased atherogenic coefficient relative to the dominant CC genotype, a significant decrease in the levels of adiponectin (total and high molecular weight) and omentin, and an increase in the levels of leptin and vaspin in the circulation. According to the recessive model, the presence of the G-allele is accompanied by a weak but probable increase in the levels of highly sensitive C-reactive protein (CC vs. CG+GG: 1.92±0.42 mg/l vs. 4.62±0.94 mg/l, P

This paper formulates and solves a multivariate problem related to modeling the logistics of war reserve stockpiling for successful combat operations in the armed conflict area. The relevance of the study is related to a comprehensive solution to the problem of war reserve stockpiling to fulfill the objectives of a military operation, considering the capabilities of materiel suppliers, complex logistics of war materiel transportation to armed conflict areas, and military threats arising from the martial law in the country. The study creates a set of models that allow: prioritizing war materiel types for reserve stockpiling; formulating requirements for the size of reserves; selection of a rational structure of logistics supply chain, considering the risks of military threats; ensuring the success of combat operations in the armed conflict area. The article analyzes the existing problems of war reserve stockpiling under martial law, which arose due to: the variety of war materiel; small supply batches; different materiel manufacturers and suppliers located at a great distance from the armed conflict area; heterogeneous transport environment of supply; risks associated with military threats during war materiel reserve stockpiling. A method of presenting the importance of certain war materiel types for supply to the armed conflict area is proposed, considering the combat capability of individual weapons and assessments of military experts. The requirements for the amount of war materiel reserve in the interval representation, from the minimum to the maximum value of the inventory, have been formed. The minimum war materiel reserve to be used in the armed conflict area provides the necessary parity of military forces. Simultaneously, the nature of hostilities does not change, but the risks associated with the enemy's actions to destroy the war materiel reserve (war of reserves) may manifest themselves. The maximum war materiel reserve provides confidence in achieving the objectives of a military operation in the armed conflict area, but is difficult to implement due to the limited capabilities of weapons and materiel suppliers and existing military threats. An optimization model for the war reserve stockpiling was created, considering the limited capabilities of suppliers, permissible time for reserve stockpiling, and the risks that may arise from military threats and their impact on the logistics of war materiel supply (war of logistics). An optimization model for the war reserve stockpiling was developed, considering the combat capability of certain types of weapons, which makes it possible to create asymmetry in the military parity of forces due to the increased combat characteristics of modern weapons (quality over quantity). Due to the multitude of materiel manufacturers (possible suppliers) and various variants for the formation of supply chain, the task of enumeration of possible variants for the composition and structures of the logistics supply chain for war reserve stockpiling was formed and solved. The number of warehouse variants and logistics supply chain structures is estimated using the methods of enumeration theory, and a set of variants is formed for subsequent comparison and selection of a rational option. An optimization model for the formation of logistics links in the supply chain was created to form the necessary war reserve stocks in the armed conflict area. The example of HIMARS MLRS stockpiling illustrates the effectiveness of the proposed approach for successful combat operations in the armed conflict area, using both quantitative and qualitative assessments when comparing possible stockpiling variants. The scientific novelty of the study is related to the development of a set of original optimization models, models of the variant enumeration for the structures of the logistics supply chain, which allows scientifically sound formulation of requirements for the size of the war reserve stock for successful fulfillment of the objectives of a military operation in the armed conflict area, considering the capabilities of materiel suppliers, long supply chains in a heterogeneous transport environment, short delivery time, and the risks of military threats. It is advisable to use the results of the study for planning war reserve stock, for their effective use in the combat zone, justifying the composition of materiel manufacturers and suppliers, forming a logistics supply chain, which will ensure the success of combat operations in the armed conflict area.

This paper focuses on metacognition facilitation through digital narratives. The objectives of the study were to explore how the creation of digital narratives strengthens the formation of metacognitive skills, and which teaching practices promote awareness of learning. The process of digital narrative creation connects literacy, language, technologies, and metacognitive planning, debugging, monitoring, and assessment strategies. A metacognitive awareness inventory questionnaire was used to assess the level of metacognitive skill formation, and content analysis and descriptive statistics were employed to analyze interviews and discussions. The study involved engineering and pedagogy students from three universities. Findings demonstrated improved metacognition subject to the implementation of appropriate teaching practices and the existence of an educational partnership between students and teachers. The most relevant practices were identified, and it was concluded that digital narratives may be an efficient strategy for the development of metacognitive skills including knowledge about cognition and regulation of cognition.

The paper is aimed at defining a multi-comfortable urban architectural environment and strategies for achieving it during the restoration-reconstructive transformations of historical city centers. The definition of the “multi-comfortable urban architectural environment” is given. Its ten criteria are highlighted and recommendations are given for its achieverment. A model of a multi-comfortable historical urban environment has been developed, where its image (beauty) – function (interest) – infrastructure (convenience) – “urban performance” (activity), criteria for multi-comfort and key strategies suitable for improving each of the four components are interconnected. The developed model, the highlighted criteria for determining the multi-comfortable urban environment, and the proposed recommendations will be useful in the development of complex projects of restoration-reconstructive transformations of historical cities, as well as in the new design in them. It has been determined that a multi-comfortable urban architectural environment, where a person is in the main, should be the result of any restoration-reconstructive transformations of historical city centers.