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In the conditions of warfare in Ukraine, the question of providing medical services to injured civilian and military is especially relevant and severe. In plastic surgeons` professional activities, the task is to restore extensive and deep wound defects in a short term and with a high degree of damaged organ`s restoration, especially supporting function. In this article the authors describe their experience with local keystone perforator island flaps, which are used to reconstruct skin and soft tissue defects of the lower limbs caused by combat injuries. Patients and methods. The authors conducted a retrospective review of 49 keystone perforator flaps for 28 patients (26 men and 2 women) who received treatment in the clinic for bullet, shrapnel, and mine‑explosive injuries between 2014 and 2022. Results. In all cases, extensive wound defects were completely closed during a single‑stage surgical procedure, and the patients were discharged after recovery. Non‑critical complications required secondary sutures in two cases (4%), extending the duration of treatment by 6 days. The time spent in the operating room on the transposition of one flap ranged from 40 to 95 min (mean: 67 min). Conclusions. The findings of the study show that local keystone perforator island flaps are highly effective in the successful reconstruction of lower limb defects caused by combat wounds. The keystone perforator island flap technique requires basic preoperative preparation of the patient, is easy‑to‑use, and exhibits a fairly high level of reliability at the same time. In most cases, keystone perforator island flaps provide primary and single‑stage closure of a large defect in the thigh, in the area of the knee joint, and in the lower leg in the absence of secondary defects that are common at donor sites when alternative techniques are chosen.

Plate-fin heat sinks are widely used for cooling radio electronic, power electronic, and telecommunication components. The current trends in the development of radio and microelectronic systems dictate the need to dissipate large heat fluxes. The present article uses the methods of numerical simulation, verified by experimental data, to study convective heat transfer of different-type heat sinks with partially cut plate fins. The heat sink with partially cut plate fins served as the basis of study. Three types of heat sinks with extended surfaces were also considered. First, we analyzed the fin cut section turned at an angle of 30° and then - the fin cut section with diverging or converging shape. Comparing the thermal and hydraulic performance of such heat sinks showed that the thermal and hydraulic performance of heat sinks with a fin cut section with diverging shape at a turning angle of 30° is by 10% higher than that of heat sinks with partially cut plate fins. As the velocity distribution in the wake shows, the use of heat sinks with partially cut plate fins and turning of their cut sections for cooling real microelectronic devices needs to correctly design an installation, in which the device is located.

Introduction. The COVID-19 impact on hemostasis of stroke survivors with community-acquired pneumonia is an urgent problem. The aim of the study is to analyze the features of clinical and laboratory parameters in cerebral stroke combined with community-acquired pneumonia caused by the SARS-Co-V-2 virus. Materials and methods. The instrumental and laboratory examination results of 88 patients aged 73.0 (12.3) years in the acute period of stroke with community-acquired viral pneumonia symptoms were analyzed. The present study included 39.8 % (n=53) male and 60.2 % female (n=35) with duration of diagnosed infectious disease less than 7 days. The symptoms of cerebral stroke were compared with the results of laboratory testing of the hemostasis system, lipid metabolism, and the activity of the systemic inflammatory response. The severity of lung tissue damage and the outcomes of the diagnosed changes were assessed. Results. All patients had mild or moderate COVID-19. In 87.5 % (n=77) cases unspecified (40.2 %, n=31), cardioembolic (36.4 %, n=28), lacunar (3.9 %, n=3) and atherothrombotic (19.5 %, n=15) ischemic stroke subtype was diagnosed. Focal ischemia lesion in the left middle cerebral artery (LMCA) territory was detected in 45.6 % (n=35), in the right middle cerebral artery (RMCA) territory in 41.6 % (n=32). Manifestations of hemorrhagic stroke were noted in 12.5 % (n=11) with signs of parenchymal hemorrhage in 54.5 % (n=6), ventricular hemorrhage in 27.3 % (n=3), subarachnoid hemorrhages were noted in 18.2 % (n=2). The indicators of the coagulation system in terms of the number of platelets corresponded to 251.3 (90.7); the APTT value was in the range of 29.2 (26.7 33.0) (s); the INR parameter was 1.16 (1.05 1.25); the value of prothrombin ( %) corresponded to the value of 85.9(23.4). Conclusion. We do not observe the great disorders of haemostasis in the most acute period of the stroke. When combined with COVID-19 the most common stroke is ischemic stroke. The stroke survivors with the community-acquired pneumonia caused by SARS-CoV-2 laboratory tests show that increase of inflammatory markers are above the reference range.

BACKGROUND: Duchenne muscular dystrophy is the most severe and common form among childhood muscular dystrophies, characterized by a progressive course. One of the main measures to slow down the rate of progression of the disease is physiotherapy, but now there are no recommendations to identify the optimal motor regimen, which is effective and safe for patients with Duchenne muscular dystrophy. AIM: The aim of the study was to evaluate the effectiveness of regular dynamic aerobic exercise in patients with Duchenne muscular dystrophy who are capable of independent movement. MATERIALS AND METHODS: We examined 15 patients with genetically confirmed Duchenne muscular dystrophy aged 4,9 to 9,0 years (mean age 6,9 years) who did not participate in rehabilitation programs with exercise therapy for 6 months prior to inclusion in the study. All patients underwent a course of physical therapy, the duration of the course was 4 months, the course was divided into 2 stages: preparatory stage (individual cardiac functional reserve 5160% with the number of repetitions of each exercise 68 times) and training stage (individual cardiac functional reserve 6170% with the number of repetitions each exercise 1012 times) The duration of the training was 60 minutes. At the baseline and during dynamic observation after 2 and 4 months, the following were evaluated: 6-minute walk test, timed function test (time to stand from supine, running 10 m, time to climb and descent 4 stairs). RESULTS: Statistically significant positive dynamics was revealed: the average values of the distance of the 6-minute walk at the baseline were 478,2 10,1 m, then 489,5 11,4 m (p 0.05) after 2 months and 502,6 10,7 m (p 0.005) after 4 months. The average values of the time to stand from supine at the baseline was 3,7 0,2 sec., after 2 months 3,5 0,2 sec. (p 0.08), after 4 months 3,5 0,2 sec. (p 0.05). Mean values of time to run 10 m at baseline 4,3 0,1 sec., after 2 months 4,1 0,2 sec. (p 0,05), and after 4 months 4,1 0,1 sec. (p 0.005). CONCLUSIONS: Thus, the regular performance of aerobic physical therapy exercises without weights in combination with training on an exercise bike can increase endurance and speed in ambulant patients with Duchenne muscular dystrophy.

Introduction. Purine dysmetabolism is occured by increased production of uric acid, which leads to hyperuricemia and hyperuricuria. The most common forms of purine metabolism disorders are the uratenephropathy, gout, and asymptomatic hyperuricemia. Purpose. To evaluate the data published from 1992 to 2021 on the prevalence, forms of purine metabolism disorders, diagnostics and methods of their treatment. Two hundred and seventy original publications were identified, of which 37 were selected and analyzed. Materials and methods. The search results in the scientific database PubMed, Web of Sciеnce, Sciеnce Direct were analyzed for the queries «urates», «gout», «uric acid», «purine metabolism», «hyperuricosuria», «treatment of urate nephrolithiasis», «luteolin; quercetin», «Smilax riparia». Results. Urates are formed as a result of the metabolism of purine bases, two-thirds of which are excreted with urine. The most common form of purine dysmetabolism is urate nephrolithiasis, which accounts for up to 10% of all forms of kidney stone disease. The main risk factors include low urinary pH, decreased urine output and hyperuricosuria. Treatment options for such stones depend on the size, chemical composition, location, and concomitant diseases. The main methods of treatment are conservative therapy and surgical interventions. Conclusions. Since the available conservative therapy may not be suitable for all patients, and surgical intervention carries certain risks, a unique herbal complex «Uralix®» was created to treat patients with urate stones in the kidneys and urinary tract. Its components luteolin, quercetin and sarsaparilla extract reduce uric acid levels and improve renal function in urate nephropathy.

The study of the features of the clinical course of pregnancy, childbirth in women who have had COVID-19 at different periods of gestation is relevant, especially in the context of a modern pandemic. Purpose of work. To determine the features of the clinical course of pregnancy, childbirth in women with COVID-19 at different periods of gestation. Materials and methods. 57 women who were ill with Covid-19 at different stages of pregnancy were examined. Results and discussion. The peculiarities of the clinical course of pregnancy, childbirth in women who have undergone Covid-19 diseases in the 1st trimesterinclude the syndrome of threatened abortion (73.6 %), placental dysfunction (100%), fetal growth retardation syndrome (42.9 %); in the second trimester - syndrome of threatened premature birth (55.6 %), placental dysfunction (100 %), amniotic fluid pathology (63.2 %); in the third trimester - anemia - in 100 %, antenatal fetal distress - in 42.1 %, pareclampsia - in 47.4 %, pathological blood loss - in 26.3 %. Conclusions. The course of pregnancy and childbirth in women who have undergone COVID-19 diseases in different trimesters of gestation have certain clinical features. Gestational complications in women who were ill in the early stages of the first trimester include the syndrome of threatened abortion, spontaneous abortion, missed abortion, premature birth in the second trimester, fetal growth retardation syndrome in the second and third trimesters. The gestational complications in women who were ill in the second trimester include the syndrome of threatened abortion, premature birth, pathology of amniotic fluid (amniotic fluid of «black» color), the phenomenon of angiitis in the abdominal cavity, placental dysfunction, fetal growth retardation syndrome, distress fetus, antenatal fetal death. The gestational complications in women who were ill in the third trimester include the syndrome of threatened premature birth, placental dysfunction, and fetal distress.

At the current stage of reconstructive surgery development, perforator flaps have confidently taken a priority place when choosing a method for wound defects cover. However, wounds with significant volume defects of both soft tissues and the bone skeleton remain especially difficult challenges for the surgeon. The desired result of such defects repair could be a technique that allows surgeons to carry out an effective reconstruction in one step.The paper describes in detail the surgical and vascular anatomy, design, preoperative preparation and surgical technique for the mobilization of the free vascularized fibula perforator flap containing a fragment of the bone di-aphysis. Clinical examples of orthoplastic reconstruction in different locations are presented.The authors conclude that free fibula flap allows effective one-stage reconstruction of extensive wounds after trauma or oncological resections, including extensive defects of the skeleton, without significant loss of support function in the donor area. A chimera-style composite flap, which contains soft tissues and a fragment of the fibula, can already be called as a “workhorse" for orthoplastic reconstruction on the lower extremities and in the field of maxillofacial surgery.

Using the method of quantum-chemical modeling of a system of gold nanoparticles on a graphite substrate with various defects, a decrease in the density of states of gold atoms during the adsorption of hydrogen near the interface is shown. Substrate defects, such as vacancies and cutoffs of the graphene plane, contribute to a decrease in the density of states during the adsorption of hydrogen atoms.

The aim: To analyze the problem of university management in the cultural and philosophical aspects. Materials and methods: The research was conducted in the form of a written questionnaire. Students were supposed to give a single answer to each question. The survey was conducted in September 2017-2018 and 2018-2019 academic year at Ternopil National Medical University. It encompassed 274 second-year Ukrainian students of medical, dental and pharmaceutical faculties and Institute of Nursing and 228 first, second and third year foreign students, who have come from the USA and study at the faculty of foreign students and International School of Medicine. Although the number of foreign students who participated in the survey was small, we believe that the number of respondents was sufficient enough to draw conclusions about the general trends in the issue under study. Results: Analysis of responses given by Ukrainian and American students allowed us to single out certain trends and specific differences in their outlook and professionally relevant persuasions and attitudes. A positive peculiarity is that the main motive that prompted Ukrainian students to choose a medical profession was that they believe it to be humane and noble (36%). Despite this, many students consider other important criteria when choosing a profession; particularly that it is prestigious and well-paid (21 % and 13 % respectively). The negative sign is that relatively big amount of students in the comparison with Western countries (the USA in particular), indicate that the occupational choice was influenced by their parents’ desire (14 %). Conclusions: The role of pedoetology as one of the priorities of pedagogical science and practice, which should generalize managerial aspects, has been proved. The experience of university education of the USA in the questions of educational management has been analyzed. An overview of the basic concepts relevant to the management of American higher education has been conducted. The features of university management in the USA in modern conditions have been characterized. The differences in the field of professionally significant value orientations between Ukrainian and American students have been investigated. The emphasis is given to the role of teachers’ philosophical culture in successful teaching and learning.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a peripheral neuropathy, predominantly motor neuropathy, with a progressive or relapse-remitting course. Fatigue is a condition characterized by a physical or mental feeling of lack of energy or lack of motivation for action, which is often present in patients with CIDP.Objective: to assess the severity of asthenia in CIDP patients.Patients and methods. Examinations were made in 34 inpatients treated for documented CIDP that met the international European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria. A study group included patients with CIDP, whereas a comparison group consisted of volunteers without psychiatric illness, who were compensated for somatic diseases.Results and discussion. In the patients with CIDP, the level of fatigue was found to be much higher than normal. Approximately half of the CIDP patients had obvious asthenia. However, the level of fatigue did not correlate with the severity of the course of CIDP.Conclusion. The findings suggest that fatigue is important in patients with CIDP that should be taken into account in the treatment of these patients.

В умовах щораз більшої кількості іноземних студентів у ЗВО України перед фахівцями з української мови як іноземної постає проблема розробки нових підходів до її навчання. У руслі комунікативного підходу метою таких занять є вільне спілкування в чужомовному мовному середовищі. Лінгводидактичні чинники зумовлюють вибір викладачем методів та засобів навчання. У статті запропоновано апробоване заняття з дисципліни «Українська мова як іноземна» на тему «У місті. Урок 1». Визначальними для лексико-семантичної системи заняття є урбаністичні поняття, поняття місця (локусу) та розташування. Лексичне наповнення заняття розкривається через укладений текст «У місті» та комплекс граматичних вправ, які підпорядковані головній темі. Текст випереджає розуміння студентів та містить ті граматичні категорії, які є предметом розгляду на занятті. За допомогою таблиць розкрито такі граматичні категорії, як місцевий відмінок іменника та узгодження іменника з прикметником. Вміння використовувати у мовленні місцевий відмінок є дуже важливим при зануренні в іншомовне середовище. Ця граматична категорія розглядається у зіставленні з називним відмінком, що полегшує його вивчення і розуміння. Також розглянуто творення якісно-означальних прислівників від прикметників. Використання таблиць дозволяє візуалізувати граматичний матеріал, структурувати його, також сприяє кращому запам’ятовуванню. Запропоновано тренувальні вправи з метою розрізнення цих частин мови та вживання прикметників і прислівників у реченні з огляду на їх сполучуваність з різними частинами мови. Завдання скомпоновано так, щоб і вивчити новий матеріал, і повторити попередньо вивчений, як-от: узгодження прикметника з іменником. Практичним результатом повинне стати вільне застосування вивченого лексико-граматичного матеріалу у повсякденному спілкуванні.

The article describes a clinical case of kidney stone disease (KSD) in a child of 4 y.o. with calcium urolithiasis. Analysis of chemical content of the kidney stones revealed their calcium-oxalate composition. According to the results of clinical exome sequencing the patient found to be a heterozygous carrier of a pathogenic variant c.695A>G (p.Tyr232Cys) in the gene SLC7A9, attributable for an autosomal recessive form of cystinuria type B. Because of the uroliths calcium composition the patient was also genotyped for SNPs in 15 genes involved in calcium metabolism. Polymorphisms associated with increased risk of calcium urolithiasis were found in 8 of 15 tested genes. The findings could explain clinical features of the patient.

The aimof the study was self-regulation of behavior and other psychological aspects of adaptive-compensatory mechanisms in patients with schizophrenia and myasthenia, in comparison with a group of healthy subjects.Materials and methods.The study involved 91 people: patients with schizophrenia (N=30); patients with moderate and severe myasthenia gravis (N=31); comparison group — conditionally healthy people (N=30). The participants were examined by experimental psychological methods: «The style of self-regulation of behavior», «Test of life-meaning orientations», «Semantic time differential».Results.Differences in the general level of self-regulation of behavior and its particular aspects in patients with schizophrenia and healthy were revealed, patients with myasthenia gravis don’t show differences from patients with schizophrenia and the control group. In terms of the general meaningfulness of life, patients with schizophrenia differ from healthy ones, while they don’t differ from those suffering from myasthenia gravis, which don’t have differences with the comparison group. In external internality, chronically ill patients don’t reveal differences, but differ from healthy ones. In the psychological perception of the present, patients with schizophrenia and myasthenia differ from healthy ones in assessing its activity and size. Patients with schizophrenia reveal differences with healthy ones in its emotional coloration and structure, not differing from those suffering from myasthenia gravis, which don’t show differences with the control group. Patients with schizophrenia differ from healthy patients in the sensibility of the future, but don’t differ from patients with myasthenia gravis who don’t reveal differences with healthy individuals.Conclusions.The targets of psychocorrectional effects are indicated. For patients with schizophrenia — the development of skills for differentiation and impulse control, behavioral flexibility and correlation of results with the original goals. For patients with myasthenia gravis — reliance on available classes in the cognitive and spiritual spheres that compensate for the appearance of physical limitations. Common to both nosologies are measures that increase the meaningfulness of life, highlighting the spheres of influence on the disease, rational acceptance of responsibility for what is happening. The skills to enjoy everyday activities are important.

Objective: To improve the diagnosis and treatment of acute cerebrovascular accident in patients with community-acquired pneumonia caused by the novel coronavirus infection (COVID-19). Materials and methods: For the first time, clinical manifestations of strokes in patients with diagnosed new coronavirus infection (COVID-19) were analyzed in 130 patients. The study was conducted in two groups. The main group consisted of 69,2 % (n = 90) with a clinical and instrumental diagnosis: novel coronavirus infection in combination with stroke. The control group (30,8 %; n = 40) included the cases of ischemic and hemorrhagic stroke without signs of SARS-CoV-2. In both groups, the severity of the disease and pathogenetic subtypes were compared, and the features of the laboratory biochemical data were studied. Statistical analysis of the outcomes was carried out taking into account the severity of brain and lung tissue damage. Results: In patients with cerebral stroke against the background of the new coronavirus infection (COVID-19), the prevalence of ischemic stroke cases (86,4 %) was noted for undetermined (41,4 %) and cardioembolic (35,7 %) pathogenetic subtypes (according to TOAST) with localization in the carotid basin (89,7 %). In hemorrhagic stroke, parenchymal hemorrhage was observed with a greater frequency (54,5 %). The severity of the diagnosed strokes according to the NIHSS scale was up to 13,16 (8,80) points with less severe brain damage — Glasgow coma scale (14,0 (12,0 15,0). In the group of the patients, a widespread lesion of the lung tissue was diagnosed in 82,2 % of cases. No significant increase in the incidence of clinically significant manifestations of systemic and organ hypercoagulation was established. Conclusions: In stroke patients with COVID-19, ischemic manifestations with undetermined and cardioembolic subtypes without age and gender features prevail, with no differences in the severity of the course and a large number of favorable outcomes. A high activity of inflammatory and infectious changes was established by clinical laboratory.

In Russia, the methodics of phenological observation processing have been developing during many years. This aimed to unify the names of phenological phases and phenomena, uniform the signs of the onset of a particular phenological event. However, it was not possible to achieve this aim and develop a widely accepted system of the names and signs until now. For example, some synonyms are still used to name the same phenomenon. A lack of an adequate comparison with the phenological observation programmes of other countries, differences in methodological approaches to organise the phenological observations make it difficult to compare Russian data with foreign ones. However, unlike many other countries, Russia has accumulated a huge long-term experience of conducting phenological observations collecting both in the system of research organisations and by voluntary observers (volunteers). This paper was aimed to develop proposals to standardise the phenological programmes and unify the methodological aspects of the phenological observation organisation in Russia. By now, all the necessary conditions have been created for this purpose. In Russia, phenological observations are being conducted under the programme «Chronicle of Nature» in more than 100 Protected Areas. In some of them, these observations have been collected up to 100 years. Since the XIX century, phenological data are being accumulated thanks to the voluntary network of the Russian Geographical Society. Observational data from Protected Areas are stored in the form of manuscripts both in the Ministry of Natural Resources of Russia and in each particular Protected Area. The data collected by the voluntary observers are stored in the Phenological Centre of the Botanical Institute of RAS. The data are also being published partially in the regional offices of the Russian Geographical Society in the form of nature calendars. To optimise the composition and number of observations, we have proposed the main (basic) and additional phases and phenomena, whose names are given in accordance with the European System Biologische Bundesanstalt, Bundessortenamt and Chemical Industry (Russian-language synonyms of the names are also provided), as well as unambiguously interpreted signs of the onset of phenomena, and species recommended for use in phenological observations. According to the programme of hydrometeorological observations, we have proposed 51 phenomena (including 36 basic ones) and methods to identify the dates of these phenomena. For plants, we have proposed to record six development phases and 32 phenomena (including 11 basic ones), as well as three phenomena for fungi, 15 basic phenomena for birds, and seven phenomena for invertebrates. The proposed basic programmes and methodological approaches can serve as the basis for recommendations to conduct the phenological observations. They are intended to be used by the staff of Protected Areas (primarily, nature reserves and national parks), Russian Geographical Society, Phenological Centre of the Botanical Institute of RAS, and other interested organisations, services, and nature lovers.

We studied the patients had the acute cerebrovascular events after the community acquired pneumonia evoked by new COVID-19 infection. The aim of our paper is improving the diagnosis and treatment of that condition. Materials and methods . We analyzed the stroke clinical features of 121 patient suffering from community acquired pneumonia induced by COVID-19 for the first time. Two groups were formed depending on the proved pulmonary damage. The main group included 69.4 % of patients (n=84) with diagnosis of new coronavirus disease plus stroke. Patients with ischemic and hemorrhage stroke in absence of SARS-CoV-2 signs were formed control group (30.6 %; n=37). We compared severity of the diseases and explored the biochemical characteristics in the both groups. Outcomes of severe cerebral and pulmonary injury were analyzed statistically. Results . Post-stroke patients with coronavirus disease showed predominantly the ischemic stroke (86.4 %) for unspecified (41.4 %) and cardioembolic (35.7%) pathogenetic subtypes (according to TOAST) with localization in the carotid basin (89.7 %). The hemorrhagic stroke more often was accompanied by parenchymal hemorrhage (54.5 %). The severity of the developed stroke according to the NIHSS scale is up to 13.16 (8.80) points with less severe brain damage Glasgow coma scale (14.0 (12.0 15.0). In the group of patients, widespread lung tissue damage was diagnosed in 82,2% of cases. The reliable increase of clinically relevant hypercoagulation signs was absent. Conclusions . Post-stroke patients with COVID-19 mainly have ischemic signs with unspecified and cardioembolic subtypes in absence of any sex and age features. The differences in disease severity are absent. The outcomes of diseases are mainly favorable. The high activity of inflammatory changes is clinically revealed.

The adsorption of hydrogen on bimetallic gold–nickel and gold–copper nanoparticles is simulated quantum chemically. We find that the changes in the adsorption properties of the bimetallic nanosystem are due to the change in distances between atoms and the redistribution of the electron density in the cluster. This leads to an increase in the bond energy of the hydrogen atom near the Ni/Cu atoms; and a decrease, near the Au atoms of the bimetal cluster.

Membrane theory of muscle weakness in hereditary muscular dystrophy was described with accent of predominated Ca 2+ ions in skeletal muscle due to destruction of the sarcolemma and other membranes of the different organelles of the skeletal muscle. Showed the role of CT, MRI and phosphorus NMR-spectroscopy as well as the noninvasive the analysis cell-free fetus DNA in maternal plasma for prenatal diagnostic of muscular dystrophies. The different a trial attempts of treatment of muscular dystrophy was described.

Kidney stone disease (KSD) is an actual problem of modern health care. By now, more than 80 monogenic forms of urolithiasis have been described. To diagnose such forms of KSD different molecular genetic technologies are used. In the current article 5 clinical cases of KSD among the patients aged 1-9 years old are presented. All of them underwent comprehensive instrumental, clinical, laboratory and molecular genetic investigations. DNA analysis was carried out by Next Generation Sequencing method (NGS) (target NGS-panels and Whole Exome Sequencing). In all cases the molecular genetic cause of the disease was found - idiopathic infantile hypercalcemia type 1 (gene CYP24A1 - 3 cases) and cystinuria (gene SLC7A9 - 2 case). Several unknown genetic variants were found in CYP24A1 (c.1379G>T, c.1156A>T, c.1286T>C) and SLC7A9 (c.920T>A). The importance of genetic testing and the role of genetic counseling for patients with KSD were shown.

Chronic inflammatory demyelinating polyneuropathy (CIDP) in patients with diabetes mellitus (DM) occurs approximately 9—11 times more frequently than in the general population. Objective : to assess the characteristics of CIDP in the presence of DM. Patients and methods . A total of 109 patients with CIDP diagnosed according to the international EFNS/PNS criteria were examined. Seventeen patients had type 1 or 2 DM; the remaining 92 patients did not. Results and discussion . The patients with CIDP and DM were found to have significantly more obvious neurological deficit, lower levels of selfservice, and a shorter time to diagnose CIDP than those with CIDP without DM. The concurrence of CIDP and DM is ambiguously assessed. On the one hand, there are indications of a strict correlation between these conditions, and on the other, the absence of this association. Our study showed that more obvious neurological deficit in DM can be related to the additional damaging impact of chronic hyperglycemia as impaired metabolism of nerve fibers and deterioration of their trophism. The autoimmune nerve damage occurring in CIDP is superimposed on the already existing impairments in the microcirculation and dysfunction of peripheral nerves, thereby increasing their damage. Conclusion . The course of CIDP in the presence of DM differs from that of «pure» CIDP, which should be taken into account in managing these patients.

Introduction. Myasthenia gravis is one of the most common autoimmune neuromuscular diseases, the peak incidence is in the age of 20–40 years. However, studies show that throughout the world in recent decades there has been an increase in the prevalence and incidence of myasthenia gravis among older people.Purpose of the study – to evaluate the clinical manifestations and diagnostic features of myasthenia gravis in patients with an onset of diseases in the elderly.Materials and methods. The retrospective, non-interventional study included 315 patients over 18 years old with a reliable (3 out of 4 criteria) and an undoubted (4 out of 4 criteria) diagnosis of myasthenia gravis, the duration of the disease for up to 5 years, undergoing inpatient treatment from 2001 to 2017 years. The severity of the clinical manifestations of myasthenia gravis was assessed using the Myasthenia Gravis Foundation of America scale. We were taken into account the information about the first symptoms, duration of the period from the onset of the disease to the verification of the diagnosis, results of the examinations, the presence of concomitant diseases and treatment methods.Results. The most common symptom of myasthenia gravis in the group of patients with debut disease aged 60 years and older was ptosis (p 0.005). At the first examination in the group of elderly patients among the incorrectly diagnoses prevailed: stroke or decompensation of chronic cerebral ischemia (p = 0.0002). With a comparable duration and severity of myasthenia gravis in different age groups, the combination of anticholinesterase drugs, glucocorticosteroids and azathioprine (p = 0.01) at a lower daily dose (100 mg) was more often used for the treatment of elderly patients compared with young and middle-aged groups (150 mg) (p = 0.03).Conclusion. Diagnosis of myasthenia gravis in elderly patients presents the greatest difficulties, and symptoms of manifestation during initial treatment are often regarded as a manifestation of vascular pathology. Despite the presence of concomitant diseases characteristic of this age group, myasthenia gravis does not differ in the severity of the course. To achieve remission and compensation of symptoms, elderly patients do not need large doses of symptomatic and pathogenetic drugs.

Written ofmodern classification ofmuscular dystrophies (in modification), clinical-genetic peculiarities and diagnostics of basic types ofmuscular dystrophies (limb-girdle types, distal types, ocylopharyngeal and oculopharyngodistal).

Urolithiasis is a clinically and socially significant disease that requires long-term follow-up in order to prevent stone recurrence. Currently, telemedicine consultations in the "patient-doctor" format are actively used in urology, however, the methodology, technological base and assessment of the efficiency of remote monitoring of the patient's health status are virtually not developed.To provide basics for the methodology of remote monitoring of patients with urolithiasis for detailed comprehensive examination and comprehensive metaphylaxis of recurrent stone formation.A comprehensive clinical examination was carried out on the basis of the Institute of Urology and Human Reproductive Health, the National Medical Research Center on Urology and the Institute of Digital Medicine of FGAOU VO I.M. Sechenov First Moscow State Medical University during the period from 1st February to 1st December 2020. A total of 30 patients with urolithiasis were included in the study. Remote monitoring of health status was carried out using a portable analyzer "ETTA AMP-01" on dipstick. Data transmission was performed through a mobile application, which is part of the "NetHealth" information system (www.nethealth.ru). The values and frequency of urine tests performed by the patient independently, as well as patient satisfaction and adherence to the monitoring technology were evaluated. Analytical, clinical, sociological and statistical research methods were used.By systematizing published data and our own clinical experience, we have developed a model for remote monitoring of the health status of patients with urinary stone disease, which included a system of indications and contraindications, a program and an order of the monitoring, as well as a basic technological solution (medical devices and a hardware-software complex). In this study, median duration of remote monitoring was 168 days. According to the questionnaire, general positive assessment and desire to continue telemonitoring was seen in 100.0% of cases, while 86.7% of patients positively evaluated the technical accessibility and reliability of the system and 93.3% considered the quality and availability of medical care as high.A methodology for remote monitoring of patients with urolithiasis has been developed with the aim of preventing recurrent stone formation. There was a high adherence of patients to remote monitoring with a tendency to decrease in values after 4 and 6 months. During these periods, it is necessary to carry out routine consultations by the physician who appointed remote monitoring in order to continue the follow-up program. There was a high satisfaction of patients with remote monitoring, and they pointed out the quality and availability of urological care owing to telemedicine technologies.

Primary hyperoxaluria is a group of rare inherited diseases characterized by impaired oxalate metabolism with the early manifestation of urolithiasis and the development of the chronic kidney disease. The mutations in the AGXT, GRHPR, HOGA1 genes are attributable for different types of primary hyperoxaluria leading to the dysfunction of specific enzymes involved in the oxalate metabolism. The article summary the current data on the epidemiology, genetic and biochemical aspects of pathogenesis of the primary hyperoxaluria types 1-3. The variety of clinical signs and disease severity depend on the type of hyperoxaluria.

The article proposes a methodology for assessing the innovative activity of a company, one of the areas of values of state corporations: «Innovation, innovative development, the ability to upgrade». To evaluate the effectiveness, the principle of decomposition of a global goal was used with its replacement for individual specific tasks according to the designated functional subsystems and objects (blocks) of assessment, which together give a generalized description of technological, technical innovations, their development and use, implementation of the latest digital information technologies, results intellectual research, the development of new business processes, management methods, organizational forms in business practice, as well as ability to sustainable renovation, improvement and prospects for innovative growth of the company and its sustainable renewal.The scoring methodology using the developed criteria boundaries of efficiency from ambitious to low efficiency and with assignment of significance scales by expert means involves the inclusion in each assessment block of six to fifteen traditional and composite author’s indicators, the complexity of which is determined by the complexity of the subject of the study and the described process. The methodology is universal in nature, can be used for large corporations and small companies according to a reduced set of indicators, it can be used in determining ratings.

Introduction Urinary stone disease is one of the most significant urologic diseases, since its prevalence increases annually, which makes it necessary to study and improve effective preventive measures, diagnostic methods and to implement new treatment interventions. Aim to study changes in blood flow in the renal cortex and medulla in patients with ureteral stones using CT perfusion. Materials and methods From 2017 to 2019, a total of 53 patients with upper ureteric stones were evaluated at the Russian-Japanese Center for Imaging and the Institute of Urology and Reproductive Health of the FGAOU VO I.M. Sechenov First Moscow State Medical University. Preoperatively, all patients underwent CT perfusion. The study was performed on a Toshiba Aquilion One 640 in volume mode with a slice thickness of 0.5 mm. In this study, blood flow changes were evaluated depending on the degree of dilatation of collecting system. Results In patients without dilatation of the collecting system, the average values of cortical and medullary blood flow and blood volume were within normal values. In patients with a dilatation of collecting system, there were significant differences cortical and medullary blood flow between the affected renal unit and contralateral side (27% and 34%, respectively). A decrease in cortical and medullar perfusion by 55% and 58%, respectively, in patients with the dilatation of calyxes was more pronounced in comparison with a decrease in perfusion in patients with the dilatation of only the ureter and pelvis. Conclusion CT perfusion performed on the 640-slice CT scan allows an objective assessment of changes in renal blood flow in patients with ureteric stones.

The aim To assess the diagnostic performance of dual-energy computed tomography (DECT) in the evaluation of the composition of urinary stones "in vivo". Materials and methods A total of 91 patients aged from 20 to 70 years old (mean 42.7) with urinary stone disease were examined at Sechenov University, including 68 men (75%) and 23 women (25%). Prior to surgery, all patients underwent DECT (Canon, Japan) in order to predict the chemical composition of urinary stones in vivo. Extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) was performed in 53 (58.2%), 18 (19.7%) and 20 (22.1%) patients, respectively. Postoperatively, all stones or stone fragments (n=91; 100%) were examined using a comprehensive physical and chemical analysis (X-ray phase analysis, electron microscopy, infrared spectroscopy). Results In 6 patients (6.6%) staghorn stones were diagnosed, while in 15 (16.5%), 17 (18.7%), 22 (24.2%) and 31 (34.1%) stones were located in ureteropelvic junction, pelvis and ureter, respectively, including 24 patients with lower ureteric stones (26.4%). Prediction of the stone composition in vivo was carried out on the basis of the one indicator, the dual energy ratio (DER). The threshold values of DER for different types of stones were taken from the literature. All stones were divided into 4 groups according to the DECT results: vevellite stones (n=40, 43.9%), Ca-containing stones without vevellite (n=34, 37.3%), uric acid stones (n=10, 10.9%) and struvite stones (n=7, 7.9%). Thus, when comparing the results of DECT and physical and chemical analysis, in the first group four stones were incorrectly assigned by DECT to the group of Ca-containing stones without vevellite and three stones were incorrectly assigned to the group of struvite stones; in the second group four stones were incorrectly assigned to the group of vevellite stones; in the third group one stone was incorrectly assigned to the group of struvite stones; in the fourth group one stone was incorrectly assigned to the group of vevellite stones and one stone in the group of uric acid stones. In order to increase the diagnostic efficiency of DECT, we performed a comprehensive analysis of five specific DECT indicators (stone density at 135 kV, Z eff of the stone, DER, DEI, DED) using discriminant analysis. Thus, the sensitivity, specificity and overall accuracy of DECT with the use of just one indicator (DER) were 83.3%, 89.8%, 86.8% for vevellite, 88.2%, 92.9%, 91.2% for Ca-containing stones without vevellite, 90%, 98.8%, 97.8% for uric acid stones and 60%, 95.3%, 93.4% for struvite stones, respectively. When using discriminant analysis with five specific DECT indicators, higher values of sensitivity, specificity and overall accuracy were seen: 95.2%, 89.8%, 92.3% for a vevellite, 85,3%, 96,4%, 92,3% for Ca-containing stones without a vevellite and 100%, 100% and 100% for both uric acid and struvite stones, respectively. Conclusions Dual-energy computed tomography is a highly informative method which allows to perform preoperatively the reliable assessment of the chemical composition. DECT in patients with urinary stone disease allows to optimize the treatment strategy and carry out preventive measures on individual basis, taking into account the stone type.