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Tyrosine kinase inhibitors have radically changed the course of chronic myeloid leukemia, significantly increasing survival and reducing the risk of disease progression. Nearly 50–70 % of patients achieve a consistently low or undetectable level of minimal residual disease – a deep molecular response. The long-term tyrosine kinase inhibitors treatment in about one-third of patients is accompanied by toxicity which impairs the quality of life. Therefore, the safe treatment discontinuation is relevant. The results of clinical trials have shown 40-60% possibility of maintaining treatment-free remission in patients with long-term deep molecular respons; however, all patients with molecular relapse regain molecular remission after the resumption of tyrosine kinase inhibitors therapy. Currently, clinical and biological factors associated with maintaining treatment-free remission are being studied. It is assumed that cessation of tyrosine kinase inhibitors therapy can improve the quality of life, but approximately 30 % of patients are reporting musculoskeletal pain – so called “withdrawal syndrome” – that begins or worsens after stopping tyrosine kinase inhibitors therapy. The mechanisms for the development of this phenomenon are currently unclear. Thus, many aspects concerning treatment-free remission require to be studied, which determines the importance of clinical trials in this area.

The results of studies on elderly patients with COVID-19 indicate presence of serious comorbidities, including cerebrovascular disease, infection of the central nervous system, and cognitive deficits. Impaired cognitive functioning may be due to neurological damage, combined and potentially reversible effects of depression, anxiety and sleep disturbances.The purpose of the study: to identify characteristics of cognitive impairment of elderly patients hospitalized for COVID-19.Material and methods: the study involved 35 patients: 15 men and 20 women (median age 61.0 years, interquartile range (IQR, 25.0-75.0 percentiles) — 50.0-69.0 years, established clinical diagnosis: “New coronavirus infection COVID-19 (PCR+)”. Inclusion criteria were: 1) confirmation of the diagnosis of COVID-19 by clinical and PCR methods, 2) absence of mental disorders, incl. cognitive impairment prior to COVID-19. The exclusion criterion was age under 40 and over 90 years. The severity of COVID-19 was assessed in accordance with the criteria of the Interim Guidelines of the Ministry of Health of the Russian Federation. Clinical and psychopathological method, psychometric testing using the MMSE scale were used. Monitoring of current physical condition was carried out using The National Early Warning Score (NEWS2) for COVID-19. MMSE testing and monitoring of NEWS2 were carried out twice: upon presentation of cognitive complaints in the first days of hospitalization (1st measurement) and at discharge (2nd time point) Statistical processing was carried out using the STATISTICA 12 package. When comparing features, two-tailed Fisher’s test and Wilcoxon’s test were used. Correlation analysis was carried out using Kendall’s test. The level of statistical significance was p

The opinion article is devoted to the analysis of a large-scale 24-week multinational observational prospective cohort study «The effectiveness of vortioxetine in depression in real clinical practice» (BELIEVE). The study demonstrated the achievement of functional recovery of patients with depressive disorder when using vortioxetine, good efficacy and tolerability of the drug for the treatment of depression in a large and heterogeneous patient population representative of everyday psychiatric practice. A significant improvement in depressive and cognitive symptoms, productivity and quality of life of patients was achieved, while the greatest effect was observed when using vortioxetine as the first line of therapy. The results of the study confirmed the data of numerous RCTs devoted to the use of vortioxetine in the treatment of depressive disorder, and they can be used when choosing tactics of antidepressant therapy in conditions of routine psychiatric.

The aim of the study was to investigate the structure of delirium in elderly patients with different outcomes of coronavirus infection.Materials and Methods. The study was carried out on the basis of Hospital for War Veterans, St. Petersburg. The study involved 30 patients: 13 male and 17 female (median age (Med) 70.5, interquartile range (IQR) 62-83) with clinical diagnosis: "New coronavirus infection COVID-19 (PCR+), F05.86 other delirium in association with other viral and bacterial neuroinfections. Peculiarities of delirium manifestations were studied using Delirium Rating Scale-Revised-98 (DRS-R-98). Current physical condition was monitored using The National Early Warning Score (NEWS2) for COVID-19.Results: All patients had moderate to severe disorders of the wake-sleep cycle on the DRS-R-98 scale. In addition, perceptual and long-term memory impairments were common. A significant correlation (p

A review of the literature is devoted to post-COVID neuropsychiatric disorders. The article reveals the concept of post-COVID syndrome, provides the definitions of NICE and WHO, describes the clinical picture of post-COVID as a systemic disease. Data are provided on the increase in psychiatric morbidity at various times after the coronavirus infection, including depression, anxiety, cognitive impairment, and asthenia. An asthenoneurotic symptom complex with severe asthenia and cognitive dysfunction, which is often accompanied by prolonged anxiety-depressive symptoms, is described as the main characteristic of the post-COVID syndrome. Cognitive impairments within the framework of the post-COVID syndrome are mainly represented by memory impairments, a decrease in the ability to concentrate, deterioration in executive functions, regardless of age and previous cognitive deficit. It was noted that delirium in the acute period of coronavirus infection is a significant risk factor for the development of cognitive impairment in the post-COVID period. The proposed mechanisms and risk factors for the neuropsychiatric consequences of COVID-19 are described, while the importance of systemic inflammation as the leading pathogenetic mechanism of post-COVID mental disorders is emphasized.

Background. Withdrawal syndrome (WS) a musculoskeletal pain after discontinuation of tyrosine kinase inhibitors (TKI) in patients with chronic myeloid leukemia (CML) has been described in the treatment-free remission (TFR) studies. The pathophysiological mechanisms and predisposing factors of WS have not been well established. Aim. Our aim was to evaluate clinical features and factors associated with WS in the Russian cohort of CML patients who discontinued TKI therapy. Materials and methods. WS was evaluated in total of 183 CML patients with chronic phase and sustained deep molecular response (DMR). WS was defined as a musculoskeletal pain newly observed after TKI cessation or as a worsening of previously observed symptoms. Results. DMR loss free survival at 36 months was 49% and 43% in prospective and retrospective groups respectively (p=0.96) with mеdian (Me) time of observation 33 months (range 1136). WS was observed in 49 (27%) patients: grade 12 was in 45 (92%) patients, grade 3 in 4 (8%) patients. Me time to WS occurrence was 2 months (range 17), Ме duration of WS was 5 months (range 135). WS was resolved in 14 of 15 patients with molecular relapse after 13 months of TKI re-initiation and was decreased in 1 patient. WS was completely resolved in 31 of 34 patients who continued remained in TFR and decreased in 3 patients. WS was resolved spontaneously or with nonsteroidal anti-inflammatory drugs in 14 (45%) and 17 (55%) patients accordingly. Older age (p0.0001), longer duration of TKI therapy (p0.0001) and presence of locomotion system diseases (p=0.022) were observed in patients with WS. No WS was observed in pregnant patients (р0.001). Survival without DMR loss at 12 months after TKI stop was 66 and 42% in patients with and without WS accordingly (р=0.095). Conclusion. The rate of WS was 27% that is in a good concordance with the data of the other TFR studies. A longer period of TKI exposure, older age and the history of locomotion system diseases were associated with the development of the WS. We found for the first time that WS was not observed in patients with pregnancy. There was no association of WS development and the rate of molecular relapses.

The objective of this study is to evaluate the changes in the motility and kinetic patterns of canine spermatozoa, capacitated and decapacitated, after the addition of seminal plasma protein fractions with different molecular weight. It has been proposed that proteins in seminal plasma support the survival of the spermatozoa and exert a dual effect: capacitation and decapacitation. The seminal plasma from fresh ejaculates was subjected to chromatographic separation and four protein fractions were obtained. Computer-assisted sperm analysis was used to determine the sperm subpopulations with specific motion and kinetic characteristics after incubation with each of the four protein fractions. Two-dimensional electrophoresis of the fractions that exhibit a significant effect on the capacitation and decapacitation was performed. By sperm class analyser, capacitation changes were observed in the sperm subpopulation with a high curvilinear velocity and amplitude of lateral head displacement incubated with the seminal plasma protein fraction with a high molecular weight, which was also reflected in the decreased linearity, straightness, and progressive motility. The sperm subpopulation incubated with the seminal plasma protein fraction with a low molecular weight seemed to undergo a process of decapacitation (decreasing of the curvilinear velocity, increasing of the linearity, straightness and showing progressive motility). Despite their ample panorama of actions, the role of seminal plasma proteins regarding capacitation and decapacitation is still undetermined.

Introduction Borderline personality disorder (BPD) has a significant presence in outpatient psychiatric practice worldwide, but data on the clinical features of patients with BPD in Russia are limited. Clinicians experience a number of difficulties in diagnosing BPD, which is also due to the high comorbidity of BPD with other mental disorders (affective, anxiety, other personality and addictive disorders). Objectives The aim of this pilot study was to investigate clinical characteristics of mental health care for patients с BPD in real clinical practice in community in Saint-Petersburg, Russia. Methods Fifty patients (72% female; n=36; mean age 22.4±4.3) who were treated in an outpatient community care were included in the study. Diagnosis was made according to the ICD-10 criteria (F60.31), as it does in clinical practice in Russia. Research methods included a clinical-catamnestic method. Results The age of onset of BPD symptoms was 14.9±2.7. It was found that 50% of patients had previously received inpatient (20%, n=10) and outpatient (30%, n=15) psychiatric care unrelated to the current mental condition, that is, not due to the BPD. 16% of patients (n=8) referred for the first time for psychiatric care in adolescence. The vast majority of patients (86%; n=43) were not diagnosed with BPD when they first consulted a psychiatrist. Prior to the diagnosis of BPD, patients were diagnosed with mental disorders due to organic brain injury (4%), affective disorders (44%), schizophrenia spectrum disorders (12%), anxiety disorders (20%) and other personality disorders (6%). On average, it took 7.5±4.0 years from the date of first psychiatric assessment before the diagnosis of BPD was confirmed. At the time of inclusion in the study, patients were diagnosed with the following comorbid mental health conditions: affective disorders (12%), anxiety disorders (6%), eating disorders (4%), and addictive disorders (2%). Conclusions The hypodiagnosis of BPD in the early stages of the disorder has been identified, making it challenging to obtain high quality mental health care in a timely manner. The frequent comorbidity between BPD and other mental disorders has been confirmed. The study demonstrates the relevance of introducing programs (including education) to improve the diagnosis and study of comorbidity of BPD in real clinical practice. The pilot study results provide the basis for a project to investigate approaches to differential diagnosis and evaluation of treatment strategies for patients with BPD. Disclosure of Interest None Declared

The aim of the present study was to examine the characteristics of early career psychiatrists’ (ECP) work in Russia and to assess the prevalence and severity of burnout in them. Material and methods. The Early Career Psychiatrists Council of the Russian Society of Psychiatrists conducted an anonymous online survey of ECP in Russia in July-August 2019, consisted of a structured survey and screening for professional burnout using the Maslach Burnout Inventory (MBI). The final sample consisted of 165 people. Results. A high level of burnout according to at least one of the MBI scales was revealed in 79 (78.2%) women and 39 (60.9%) men (p=0.017). Mean values of the MBI Emotional Exhaustion scale corresponded to 23.33±8.97 and 17.97±8.49 (p=0.003), the MBI Depersonalization scale — 10.46±4.81 and 9.16±4.22 (p=0.083), and the MBI Personal Accomplishment scale — 33.02±5.98 and 35.32±5.75 (p=0.026) for women and men, respectively. The following risk factors for professional burnout were identified: female sex, overlapping of several working positions, difficulties in work due to changes in documentation requirements introduced since the start of professional career. Protective factors of burnout development were: work in private clinic, satisfaction with work atmosphere, subjective estimation of quality of life as above average or as good as possible. Conclusion. Burnout was established in 71.5% of ECP in Russia, which corresponds to one of the highest burnout rates in psychiatrists according to international and national studies. Further research is needed to assess the prevalence and severity and ways to prevent burnout in psychiatrists in Russia.

The article provides a review of the scientific literature devoted to postcoid conditions. The concept of postcovid syndrome, its structure, and epidemiology are disclosed. The article contains the results of 2 meetings of experts (psychiatrists, psychotherapists, neurologists) from different regions of Russia who had experience in providing care to persons with postkovid syndrome. Particular attention is paid to postcovid depression, its clinical characteristics, and the experience of therapy. It was noted that the severity of the post-coV syndrome did not depend on the severity of the infectious disease suffered. The leading variants of depressive syndromes observed in SARS-CoV-2 patients were: astheno-depressive, apato-depressive and anxious-depressive syndromes. Anhedonia, anxiety, cognitive disorders, insomnia, and hypochondria occupied a significant place in the structure of postcovid mental disorders. It is emphasized that persons with postcovid syndrome, as a rule, initially found themselves in the field of vision of internists, therefore, their training in the diagnosis of postcovid mental disorders is relevant. Clinical experience has demonstrated the feasibility of antidepressant therapy for postcovid depression and the high efficacy and safety, including the risk of drug interactions, of using vortioxetine, including prescribing the drug to the elderly and the somatically impaired. The article is illustrated with clinical examples.

Composites based on Al-Fe alloys and reinforced with three-layer graphene sheets were synthesized “in situ” under a layer of molten salts. Composites containing 0.12 wt.% graphene were subjected to severe plastic deformation via high-pressure torsion. SEM and TEM were used to study the morphological and size characteristics of the composite structure in the as-cast and deformed states. Herein, it is shown that severe plastic deformation leads to the deformation-induced dissolution of iron-containing aluminides with the formation of a supersaturated Al solid solution with a submicrocrystalline structure. The hardness and electrical properties of the graphene composites were measured in different structural states and compared to the characteristics of the matrix alloy.

Supply chain management is a critical aspect of conducting any business. In this article, we provide an overview of some the methods for supply management and their use in animal husbandry. In this paper, we introduce a version of Wilson`s model. The illustration of the proposed model, showing economic effects to the farm, reducing its expenses (by 2.5%) compared to farms that do not utilize this model.

Short food supply chains have the potential of improving local food production and provide the population with high quality fresh food. The sustainability of these chains has come under question last year (2020) due to the disruption caused by the pandemic and the lack of preparation for it. The goal of this study is to analyze the sustainability of short food supply chains in Bulgaria and identify the main sources for their disruptions. In order to achieve this goal, the following tasks must be solved: to analyze the state of short food supply chains in Bulgaria; to evaluate the level of sustainability of these chains, and to discover and present the main sources for disruptions of short food supply chains in Bulgaria.

Introduction The question of the involvement of inflammatory and autoimmune processes in schizophrenia pathogenesis has become the most relevant in the last decade and yet is not fully understood. Objectives The study included 60 patients with paranoid schizophrenia (age 18 - 55 y.o.) and 30 healthy control group participants. Patients were in a stabilization state without a history of organic brain disorder or another verified somatic disease in the exacerbation phase. Methods Research methods included follow-up method, neuropsychological (PANSS, BAC-S), laboratory (enzyme immunoassay, flow cytometry), and statistical. Results Patients with schizophrenia had significant structural disorders of thinking, passive, apathetic withdrawal, negativism, impaired attention, psychomotor speed, volitional impulses. Cognitive impairment was detected in all study participants. Severe impairments are noted in the executive functioning, hand-eye coordination, attention, psychomotor speed. The severity of cognitive impairments correlated with the severity of clinical symptoms. Patients with schizophrenia had a significant decrease in central memory T-regulators levels, and an increase in Th1 and Th2 subsets, «double-positive» and «сlassic» Th17, Tfh2, «classic» Tfh17, and in Tfh17.1 (Pic.1). Picture. 1. T-helper subsets in patients with schizophrenia. They also had high levels of CCL20, IL-10, IL-12, IL-1β, IL-27, IL-31, IL-4, IL-13, IL-6, IL-9, TNFα in comparison with a control group. A significantly decreased levels of IL-17A, IL-17F, IL-2, IL-22, and TNFβ were also described in this group of patients. Conclusions Patients with schizophrenia may be characterized by the presence of an inflammatory process and a high chance of autoimmunity. Aknowledgement. This work was supported by the grant of the Russian Federation Government, contract 14.W03.31.0009 Disclosure No significant relationships.

Introduction The majority of researchers agree that transgender people have an increased burden of mental disorders compared to the general population. However, it is strongly suggested that transgender people still do not receive mental health care that they need. Objectives To assess the mental health care needs of transgender people living in Russia. Methods An anonymous online survey was conducted throughout November 2019. 588 transgender adults living in all Federal Districts of Russia (mean age 24.0±6.7) were included in the final analysis. Results It was found that 308 respondents (52.4%) had visited mental health professional prior to gender transition. 150 people (25.5%) reported to had been diagnosed with a mental disorder before gender transition, and a further 77 respondents (13.1%) indicated that they had been diagnosed with a mental disorder after transition began. 157 people (26.7%) received treatment from a mental health professional. 222 respondents (37.8%) had experience of taking medication off-prescription to improve mental wellbeing. 464 people (78.9%) reported being in need of psychological care. 289 people (49.1%) indicated that they were experiencing barriers in obtaining psychiatric (psychotherapeutic, psychological) care, which was associated with a perceived need for psychological support (OR=4.33 [95% CI: 2.49;7.80], p

Introduction Clinical practice has shown that SARS-CoV-2 viral infection increases the likelihood of developing mental disorders.Clinical practice has shown that SARS-CoV-2 viral infection increases the likelihood of developing mental disorders. Objectives To analyze clinical indicators of patients with COVID-19 with mental disorders and to identify predictors of adverse outcomes associated with mental state on its basis. Methods The study included 97 patients, 41 men and 56 women (62.3±15.3 years of age). During the observation period, 26 people died and 71 people recovered. Data collection was carried out using a questionnaire (109 variables). Binary logistic regression and Cox proportional hazards regression were used. Results In the study group, death occurred on average after 11.5 days. In this group, the mental state of patients was more severe with a predominance of cases of delirium. With age, the probability of a fatal outcome increased by 1.03 with each year of life. The severity of mental disorder had a greater impact on the risk of death compared to age (p=0.003). Improvement of the mental state of patients during psychotropic therapy was associated with a reduction in the risk of an unfavorable outcome of coronavirus infection by 11.11 times. The greatest contribution to the unfavorable outcome was made by the severity of infection: the risk of death increased by 33.17 times. Conclusions A severe or extremely severe mental state increased the risk of death by 4.55 times. The most significant factor in predicting mortality was associated with the severity of the underlying disease. Disclosure No significant relationships.

Introduction Despite the long history of burnout studies, the problem of burnout among psychiatric specialists in Russia is insufficiently studied. The risk of burnout is the highest among psychiatrists in the first 10 years of their career. Objectives To assess the prevalence and severity of burnout in early career psychiatrists (ECPs) in Russia. Methods An anonymous online survey of ECPs in Russia was conducted in July-August 2019 with a screening for burnout using the Maslach Burnout Inventory (MBI). The final sample consisted of 165 people (61.2% women; mean age 31.05±3.88). 95.2% of respondents lived in urban areas. Results A high level of burnout according to at least one of the MBI scales was revealed in 71.5% of ECPs: in 79 (78.2%) women and 39 (60.9%) men (χ2(1)=5.74; p=0.017). Mean values of the MBI Emotional Exhaustion scale corresponded to 23.33±8.97 and 17.97±8.49 (U=1999.5; p=0.003), the MBI Depersonalization scale – 10.46±4.81 and 9.16±4.22 (U=2598.5; p=0.083), and the MBI Personal Accomplishment scale – 33.02±5.98 and 35.32±5.75 (U=2409.5; p=0.026) for women and men, respectively. The following risk factors for professional burnout were identified: female sex (OR=3.54 [95% CI: 1.96; 6.39], p

Objective: to discuss problems of diagnostics and psychopharmacotherapy of associated depressive disorders and anxiety circle disorders.Material and methods. The article is an analysis of a clinical case with the use of clinical and catamnestic method.Results. Diagnostics of Generalized Anxiety Disorder, issues of its comorbidity with other mental disorders including anxiety and depressive disorders are discussed. The principles of panic disorder diagnosis are analyzed. Diagnostic criteria of associated anxiety and depression in ICD-10, DSM-5 and ICD-11 are considered. Modern approaches to the choice of therapeutic tactics in comorbidal anxiety and depression are given. The analysis of the patient’s treatment is carried out with the justification of the choice of drugs. The possibilities of combined therapy of associated anxiety and depression disorders using vortioxetine are demonstrated. Achievement of qualitative remission of mental disorder without residual symptomatology and full restoration of social functioning of the patient with associated depressive and anxious disorders is shown.Conclusion. The clinical case demonstrates a characteristic chronic fluctuating course of GTR both in combination with different depths of depression and with other anxiety disorders (panic attacks). Diagnostic difficulties and therapeutic possibilities of a patient with double diagnosis: Generalized Anxiety Disorder and Depressive Episode have been analyzed.

Dioxygen protein sensors undergo structural distortions upon binding, but the role of heme distortion in allostery is unclear. Here heme distortion in a bacterial dioxygen sensor is studied using picosecond time-resolved electronic absorption spectroscopy and shown to control the allosteric equilibrium.

This paper reviews the authors’ theoretical and empirical views on the factors influencing wine production. The theoretical framework indicates the presence of many factors affecting the vine growing and winemaking enterprises. The indicators are summarised in terms of terroir, the competitiveness of the enterprise, its ability to innovate, the production quality and the quality of wine product intended for the market. The analysis assists in highlighting the following more important conclusions: evolution of the object of study from an enterprise to a whole supply chain; regarding the subject of study, many factors that affect the object, combined into leading factors and indicators characterising the factors, can be identified; the terroir and the human factor are the main factors influencing the quality of the wine produced.

This article discusses case reports of treatment with paliperidone palmitate in comparison with data from recent publications. Second-generation long-acting injectable antipsychotics have been shown to provide better control of psychiatric manifestations, reduce the severity of negative symptoms, improve social functioning and quality of life of patients and relatives, and reduce the burden of disease for both the healthcare system and the caregivers. The case reports presented in this article demonstrate better quality of remission in schizophrenia patients treated with one- monthly and three-monthly paliperidone palmitate formulations, due to higher effi in preventing relapses, better safety and good tolerability regardless of patient age.

Light is a major factor controlling plant growth and development. To assess the impact of the applied light conditions, we aimed to sort out a tool for early diagnostics of the plant physiological state. We investigated the effect of a blue:red:far-red LED light formula recommended for improved plant performance (flowering). High (BR) and low (BRS) light intensity variants were compared to normal (W) and 'shadowed' (WS) white fluorescent controls. The efficiency of the JIP-test to determine changes during early growth of pea plants was compared to additional physiological characteristics (growth parameters, thermal stability of the thylakoid membranes, chlorophyll content, CO2 assimilation, transpiration). Our data showed the onset of growth inhibition under BR light, while BRS light stimulated plants to reach the flowering stage similarly as the W control. We concluded that the JIP-test is appropriate for early, reliable, and nondestructive analysis of light recipes for plant growth and flowering.

One of the major questions in photosynthesis research is related to the role of the ultrastructure of thylakoid membranes in higher plants for their functional performance at optimal and stress environmental conditions. In this work, we compared the drought stress response of pea plants grown at moderate and low light conditions, based on our recent findings that they differ in the extent of grana stacking and in the thermal stability of the major light-harvesting complex of PSII that plays important regulatory role for plant survival. Our data demonstrate that low light-adapted plants are structurally and functionally less affected by the water deficit, strongly suggesting a major role of thylakoid structural organization for drought stress response.

Disturbances in immune and endocrine regulation are closely interrelated with development of psychiatric diseases, including affective disorders. Depression may be a characteristic of at least 23 autoimmune diseases. Negative influence on the depression development have: an increased level of proinflammatory cytokines, impairment of T-regulatory cells, kynurenine pathway shift towards production of its potentially neurotoxic metabolites, overproduction of stress hormones, hyperleptinemia, hyperprolactinemia, hypothyroidism, as well as vitamin D, calcidiol and calcitriol deficiency. In this review we analysed the development and accumulation of ideas and facts regarding the interrelation between autoimmune and affective pathology.

This article presents the data from an analysis of the epidemiological situation on the incidence of syphilis in the Republic of Sakha (Yakutia) (RS(Y)) for the period between 1982 and 2017. The highest incidence of syphilis in RS(Y) was in 1997, 1998, 1999, which coincided with the socio-economic transformations in society. Currently, there is a decrease in syphilis morbidity. Nevertheless, the high rate of late latent forms requires epidemiological monitoring.

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To assess the dynamics of doctors ‘ opinions on continuing medical education (CME) in 2016 and 2018 was conducted an anonymous online survey, which was attended by 52 psychiatrists (in 2016 year, from 14 regions of Russia) and 203 psychiatrists (in 2018 year, from 46 regions of Russia). There is the growth of skeptical views on the feasibility of introducing a new system (in 2016 it was supported by 55,8% of respondents, in 2018 — only by 38,3%). Also in the 2-year term increased the number of difficulties in accessing to attend conferences, increased availability of online modules and has not changed significantly the availability of training in the departments in universities. The most difficult for doctors is to find attending conferences (average score in assessing difficulties 3,6), which requires the search for funds for travel expenses and separation from work, the most convenient — online training (average score in assessing difficulties 3,0). The effectiveness of all three types of educational activities of CME (conferences, online modules and courses in the departments) is estimated at a relative average level (about 3 points on a 5-point scale). The impact of CME on the solution of actual organizational and methodological problems of health care is also rather skeptical.

The world prevalence of chronic kidney disease (CKD) stages 1 to 5 ranges from 11.7 to 15.1%. Incidence of fractures in patients with CKD stage 5 is 5-fold higher than that in the general population, which is related to mineral metabolism disorders, secondary hyperparathyroidism, and osteoporosis. By damaging multiple organs and systems, CKD triggers a whole pathological cascade. There are hematopoietic abnormalities, cell lineages, direct toxic effect on blood cell elements, with simultaneously increased risk of bleeding and a high and extremely high risk of thrombi formation and thromboembolic complications. Calcium and phosphorus metabolism disorders lead to calcification and mineralization of vasculature, myocardium and heart valves; progressive renal dysfunction affects the course of heart and vessel diseases, aggravating their clinical manifestations. Cardiovascular disorders become the main cause of death of such patients, and the development of pulmonary hypertension is associated with increased morbidity and mortality. At the same time, protein and energy deficiencies do occur, with disturbance of the acid-base balance, water and electrolyte balance; uremic toxins exert unhealthy effects on the gastrointestinal tract. Various extra-renal pathologies, specific pharmacokinetics, regimen and frequency of renal replacement therapy needed to maintain an adequate volume status make it necessary to thoroughly prepare the patients for surgery and define special requirement to perioperative management in arthroplasty. Currently, there are no guidelines on the perioperative management of this patient category. In this review article we consider specifics and particulars of preoperative, intraoperative and postoperative management of the end stage CKD patients during knee and hip replacement arthroplasties.

The article is devoted to the problem of search of biomarkers of suicidal behavior and includes literature review, as well as the results of own research of features of suicidal behavior of young age patients with depression (18—27 years) depending on the concentration of calcidiol.

Introduction The prevalence rates of mental health issues, particularly anxiety and depression, is high among transgender people. However, the incidence of anxiety and depression in transgender people living in Russia is unclear until now. Objectives To examine the frequency of anxiety and depression in transgender people living in Russia. Methods The Hospital Anxiety and Depression Scale (HADS) was used for online screening for symptoms of anxiety and depression in transgender people living in Russia throughout November 2019. 588 transgender adults living in all Federal Districts of Russia (mean age 24.0±6.7) were included in the final analysis. 69.6% (n=409) of the survey participants indicated the direction of transition as transmasculine (TM), 23.1% (n=136) – as transfeminine (TW), and 7.3% (n=43) – as other (TO). Results It was found that 45.1% (n=265) and 24.0% (n=141) of transgender people had clinically significant levels of anxiety and depression, respectively (HADS score of 11 or higher). The rates of anxiety (TM=10.21±4.68; TW=8.72±3.91; TO=10.72±4.43) and depression (TM=7.53±4.09; TW=7.40±4.19; TO=7.74±4.33) did not have statistically significant differences within the direction of transition. The anxiety and depression mean scores in all subgroups were statistically significantly higher than in the general Russian population (p

In this paper we analyze the changes in the blood levels of neuron-specific enolase and S100B protein during combined ECT and pharmacological treatment in patients suffering from treatment-resistant paranoid schizophrenia. Correlations between biomarkers’ serum levels, clinical status and characteristics of cognitive functioning are analyzed.

There are researched psychosocial components of hospitalism in elderly patients with affective disorders. We were using clinical and psychological semi-structured interview as a method focused on the investigation of relations in the parent and the relevant families of patients. In addition there were being used personality and family relationships questionnaires, locus of control personality research. According to the survey, there have been found out signs indicating de-emphasis of family, reducing of emotional involvement in family relationships and distancing from relatives in patients with hospitalism compared with the control group.

The consumption and purchasing power of the population are key factors in the development of domestic production and sales and an important indicator of the standard of living of the population. The aim of the article is to investigate the development of the consumption and purchasing power of the population of basic food products. The methods used are systematic and comparative analysis; Method of statistical groupings, expert assessments, inductive and deductive methods for generalizing summaries.

Aim. To assess the results of following up patients with chronic myeloid leukemia (CML) and a deep molecular response (MR) without tyrosine kinase inhibitor (TKI) therapy. Subjects and methods. The reasons for TKI discontinuation in 70 patients with CML and a deep MR of more than 1 year’s duration were adverse events, pregnancy, and patients’ decision. Information was collected retrospectively and prospectively in 2008-2016. Results. The median follow-up after TKI therapy discontinuation was 23 months (2 to 100 months). At 6, 12 and 24 months after TKI therapy discontinuation, the cumulative incidence of major MR (MMR) loss was 28, 41 and 48%, respectively; the survival rates without TKI therapy were 69, 50, and 39%, respectively. MMR loss was noted in 28 (88%) patients at 12 months; it was not seen without TKI therapy at 2-year follow-up. Deaths due to CML progression were absent. The Sokal risk group was a reliable factor influencing MMR loss (p ≤ 0.05). The cumulative recovery rate for deep MR after resumption of TKI use was 73 and 100% at 12 and 24 months, respectively, with a median follow-up of 24 months (1 to 116 months). Deep MR recovered at a later time when the therapy was resumed more than 30 days after MMR loss. Conclusion. Safe follow-up is possible in about 50% of the patients with CML and stable deep MRs without TKI therapy. The introduction of this approach into clinical practice requires regular molecular genetic monitoring and organizational activities. Biological factors in maintaining remission after TKI discontinuation need to be separately studied.