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Abstract Background Standard approaches to the treatment of chronic post-radiation proctitis are associated with a high risk of complications and a high percentage of unsatisfactory results due to the reduced regenerative potential of irradiated tissues. Regenerative surgery techniques using the stromal-vascular cell fraction (SVF) based on the patient’s autologous adipose tissue are a promising direction for study. Clinical case description A 76-year-old patient suffering from chronic post-radiation erosive-ulcerative proctitis, grade 4 according to RTOG–EORTC, complicated by recurrent profuse rectal bleeding, underwent local autotransplantation of SVF into the submucosal layer of the rectum and pararectal connective tissue. The follow-up colonoscopies 1 and 6 months after the surgery and histological examination showed the complete epithelialization of ulcerative defects and a decrease in proctitis activity. There were no bleeding episodes during the 12-month postoperative observation period. Conclusion The proangiogenic, wound-healing, and anti-apoptotic effects of the SVF cell suspension provided reduction of inflammation activity, epithelialization of ulcers, and elimination of defecation-associated hemorrhage, following the SVF injection into the submucosal layer of the rectal wall and pararectal connective tissue in a patient with post-radiation proctitis with ulcers and recurrent bleeding.

The SMC protein family, including cohesin and condensin I/II, plays a pivotal role in maintaining the topological structure of chromosomes and influences many cellular processes, notably the repair of double-stranded DNA breaks (DSBs). The cohesin complex impacts DSB repair by spreading γH2AX signal and containing DNA ends in close proximity by loop extrusion. Cohesin supports DNA stability by sister chromatid cohesion during the S/G2 phase, which limits DNA end mobility. Cohesin knockdown was recently shown to stimulate frequencies of genomic deletions produced by distant paired DSBs, but does not affect DNA repair of a single or close DSBs. We examined how auxin-inducible protein degradation of Rad21 (cohesin) or Smc2 (condensins I+II) changes the frequencies of rearrangements between paired distant DSBs in mouse embryonic stem cells (mESCs). We used Cas9 RNP nucleofection to generate deletions and inversions with high efficiency without additional selection. We determined optimal Neon settings and deletion appearance timings. Two strategies for auxin addition were tested (4 independent experiments in total). We examined deletion/inversion frequencies for two regions spanning 3.5 and 3.9 kbp in size. Contrary to expectations, in our setting, Rad21 depletion did not increase deletion/inversion frequencies, not even for the region with an active Ctcf boundary. We actually observed a 12 % decrease in deletions (but not inversions). At the same time, double condensin depletion (Smc2 degron line) demonstrated high biological variability between experiments, complicating the analysis, and requires additional examination in the future. TIDE analysis revealed that editing frequency was consistent (30–50 %) for most experiments with a minor decrease after auxin addition. In the end, we discuss the Neon/ddPCR method for deletion generation and detection in mESCs.

Objectives. To obtain porous corundum ceramics using an innovative cold sintering process starting from different phase modifications of aluminum oxohydroxide — boehmite γ-AlOOH and diaspore α-AlOOH; to study the phase and structural properties of the resulting materials; and to assess their permeability to water.Results. Cold sintering enables the formation of single-phase corundum ceramics with an open porosity of 47.9% directly from the initial boehmite powder with the addition of 5 wt % corundum in the presence of 20 wt % water at a temperature of 450°C, mechanical pressure of 220 MPa, and isothermal exposure for 30 min. Under the same conditions of cold sintering, a mixture of diaspore and boehmite was transformed into α-AlOOH ceramics. This then turned into corundum with an open porosity of 39% when calcined in air at 600°C for 1 h. The resulting materials had permeability for pure water above 5000 L/(m2∙h∙bar).Conclusions. Cold sintering is a promising approach to producing porous corundum ceramics which can be used in filtration systems. Compared to traditional ceramic technology, the new approach reduces energy, time, and labor costs in the material manufacturing. It also eliminates the need to use auxiliary substances (binders, pore-forming agents, etc.).

Chromatin is not randomly distributed within the nucleus, but organized in a three-dimensional structure that plays a critical role in genome functions. Сohesin and condensins are conserved multi-subunit protein complexes that participate in mammalian genome organization by extruding chromatin loops. The fine temporal regulation of these complexes is facilitated by a number of other proteins, one of which is microcephalin (Mcph1). Mcph1 prevents condensin II from associating with chromatin through interphase. Loss of Mcph1 induces chromosome hypercondensation; it is not clear to what extent this reorganization affects gene expression. In this study, we generated several mouse embryonic stem cell (mESC) lines with knockout of the Mcph1 gene and analyzed their gene expression profile. Gene Ontology analyses of differentially expressed genes (DEGs) after Mcph1 knockout revealed gene categories related to general metabolism and olfactory receptor function but not to cell cycle control previously described for Mcph1. We did not find a correlation between the DEGs and their frequency of lamina association. Thus, this evidence questions the hypothesis that Mcph1 knockout-mediated chromatin reorganization governs gene expression in mESCs. Among the negative effects of Mcph1 knockout, we observed numerous chromosomal aberrations, including micronucleus formation and chromosome fusion. This confirms the role of Mcph1 in maintaining genome integrity described previously. In our opinion, dysfunction of Mcph1 may be a kind of “Rosetta stone” for deciphering the function of condensin II in the interphase nucleus. Thus, the cell lines with knocked-out Mcph1 can be used to further study the influence of chromatin structural proteins on gene expression.

Background. Stressful influences, depending on their severity and duration, can cause the development of pathological conditions. Repeated episodes of stress cause functional and structural changes in the central nervous system and can cause the development of depressive conditions. Depression is one of the leading mental illnesses. One of the most stress-sensitive brain structures is the hippocampus. Objective. To study is to evaluate structural changes in the hippocampus, which is considered as a heterogeneous structure with separate dorsal and ventral regions, to evaluate the expression of inducible nitric oxide synthase, endothelial nitric oxide synthase, serine racemase, synaptophysin in a mild stress model.Methods. A study of the effects of mild stress was carried out on 16 adult male Wistar rats (age 12 months, body weight 350–400 g). After acclimatization, the rats were divided into two equal groups (n = 8): intact (control) and stressed. When keeping animals, modeling and removing them from the experiment, we were guided by the Regulations for Carrying Out Work Using Laboratory Animals and the Declaration of Helsinki. Experimental modeling of depression in animals was induced by mild stress exposure for 7 days (30 minutes daily). Euthanasia was performed in a CO2 incubator. The brain was fixed in neutral buffered 10% formalin. Paraffin sections were made in the frontal plane, stained with hematoxylin and eosin, thionin using the Nissl method and examined at a level from –2.40 to –3.96 mm relative to bregma using an Axio Lab A1 microscope (Carl Zeiss Microscopy GmbH, Germany). Photo documentation was carried out with an AxioCam 105 color camera (Carl Zeiss Microscopy GmbH, Germany). Using the Image Analysis module of the ZEN 1.1.2.0 program (Carl Zeiss Microscopy GmbH, Germany) in the pyramidal layer of the hippocampus. Statistical analysis was performed with Microsoft Office Excel 2016 (Microsoft, USA) and Prism 6 (GraphPad Software Inc., USA). Comparisons of two conditions were made by nonparametric Mann-Whitney-U test to avoid a statistical bias of unequal data distribution. The level of significance was set at p < 0.05. The summarized data were presented as a as mean ± standard error of mean.Results. Functional research methods and assessment of pathological changes in hippocampal neurons are presented. An increase in the relative number of wrinkled hyperchromatic pyramidal neurons in the dorsal cornu ammonis field 3 in stressed rats was noted by 23.6% (p < 0.05) compared to the control. There was an increase in the relative number of inducible nitric oxide synthase-immunopositive neurons in the dorsal cornu ammonis field 3 by 40% ( p < 0.05) and the relative area of inducible nitric oxide synthase-immunoreactive material by 35% (p < 0.05) in the pyramidal layer of cornu ammonis field 3 in stressed rats. A decrease in the relative area of synaptophysin-immunopositive material in stressed rats was found in the ventral cornu ammonis field 3 compared to the control group by 16.8% (p < 0.05); decrease in the relative area of serine racemase-immunopositive material in dorsal cornu ammonis field 3 by 4.3% (p < 0.05) and ventral cornu ammonis field 3 by 7.8% (p < 0.05).Conclusion. The results of the study demonstrate that mild stress is an adequate model of depression in rats. In animals exposed to mild stress, pronounced morphological signs of damage to hippocampal neurons were revealed; motor and indicative exploratory activity decreases. Differences were found in morphofunctional changes in the dorsal and ventral parts of the hippocampus under the influence of mild stress. In cornu ammonis field 3 of the dorsal hippocampus, in contrast to the ventral section, more pronounced signs of damage to pyramidal layer neurons were observed. The increase in the relative number of inducible nitric oxide synthase-immunopositive neurons and the relative area of inducible nitric oxide synthase-immunoreactive material in the cornu ammonis field 3 pyramidal layer in stressed rats indicates an increase in nitric oxide production and the participation of nitrooxide-dependent free radical mechanisms of damage to hippocampal neurons. The decrease in the relative area of synaptophysin-immunoreactive material in stressed rats may contribute to changes in synaptic plasticity. A decrease in the relative area of serine racemase-immunoreactive material in the dorsal and ventral parts of cornu ammonis field 3 is considered to be a sign of a possible decrease in N-methyl-D-aspartate-dependent neurotransmission in the hippocampus under stress.

One of the most productive strategies for finding the functions of proteins is to study the consequences of loss of protein function. For this purpose, cells or organisms with a knockout of the gene encoding the protein of interest are obtained. However, many proteins perform important functions and cells or organisms could suddenly lose fitness when the function of a protein is lost. For such proteins, the most productive strategy is to use in ducible protein degradation systems. A system of auxin-dependent protein degradation is often implemented. To use this system, it is sufficient to introduce a transgene encoding a plant-derived auxin-dependent ubiquitin ligase into mammalian cells and insert a sequence encoding a degron domain into the gene of interest. A crucial aspect of development of cell lines engineered for inducible protein depletion is the selection of cell clones with efficient auxin-dependent degradation of the protein of interest. To select clones induced by depletion of the architectural chromatin proteins RAD21 (a component of the cohesin complex) and SMC2 (a component of the condensin complex), we propose to use the morphology of metaphase chromosomes as a convenient functional test. In this work, we obtained a series of clones of human HAP1 cells carrying the necessary genetic constructs for inducible depletion of RAD21 and SMC2. The degradation efficiency of the protein of interest was assessed by flow cytometry, Western blotting and metaphase chromosome morphology test. Based on our tests, we showed that the clones we established with the SMC2 degron effectively and completely lose protein function when induced by auxin. However, none of the HAP1 clones we created with the RAD21 degron showed complete loss of RAD21 function upon induction of degradation by auxin. In addition, some clones showed evidence of loss of RAD21 function even in the absence of induction. The chromosome morphology test turned out to be a convenient and informative method for clone selection. The results of this test are in good agreement with flow cytometry analysis and Western blotting data.

Objectives. To examine the general principles and recent advances in the synthesis of high-purity and high-homogeneity barium titanate powders in the manufacture of electronic components.Results. The main publications regarding the synthesis of barium titanate powder, including the works of recent years, were analyzed. The technological advantages and disadvantages of various synthesis methods were identified. Groups of methods based on solid-state interaction of reagents and methods of “wet chemistry” were also considered. The possibilities of producing barium titanate particles of non-isometric shapes for creating textured ceramics were discussed separately.Conclusions. Barium titanate is a well-known ferroelectric with a high dielectric constant and low dielectric loss. It is used as a component in ceramic electronic products, for example, capacitors, memory devices, optoelectronic devices, and piezoelectric transducers. The possibilities of producing functional ceramics based on barium titanate powder largely depend on its state and morphological characteristics, determined during the synthesis stage. The most important factors affecting the functional characteristics of ceramics are the purity and morphology of the powder raw materials used.

The problem of osteoarthritis (OA), the most common chronic rheumatic disease, is usually considered in relation to three groups of joints – knee, hip and hands. However, OA can affect any joints of the human body, causing pathological changes characteristic of this nosological form: destruction of joint tissue associated with mechanical stress, chronic inflammation and degenerative processes (neoangiogenesis, fibrosis, heterotopic ossification). This review examines 5 “atypical” OA localizations – shoulder, acromioclavicular, elbow, ankle and foot. The defeat of these joints is observed quite often: shoulder – about 15%, ankle – 3–5%, foot joints – 17% of the inhabitants of the modern population. The main risk factors for this disease are injuries, repeated significant stress, instability and deformities of the joints. The clinic is typical for OA and is manifested by “mechanical” and “starting” pains, stiffness, increasing dysfunction, crunching and deformation. In some cases, persistent synovitis is noted, accompanied by pain at rest and at night. Generally recognized criteria for OA of “atypical” localization have not yet been developed, therefore, its diagnosis is based on the presence of characteristic complaints, typical radiological changes (narrowing of the articular gap, subchondral sclerosis, osteophytes) and the exclusion of other pathology that can cause joint damage. Treatment of this pathology should be complex and include the combined use of non-drug methods (orthosis, physical therapy, physiotherapy) and pharmacological agents, such as nonsteroidal anti-inflammatory drugs, slow-acting symptomatic agents and local injection therapy (intra-articular administration of glucocorticoids, hyaluronic acid, platelet-enriched plasma). When conservative therapy is ineffective, a wide range of surgical interventions is used, from arthroscopic chondroplasty to total endoprosthetics.

Involvement of axial skeletal in psoriatic arthritis (PsA) is often associated with inflammatory changes in peripheral joints and is asymptomatic or minimally symptomatic, and changes in the spine and sacroiliac joints are often found only on X-ray. The article, which is based on numerous studies, compares the characteristics of axial skeletal lesions in patients with the axial form of psoriatic arthritis (axPsA) and in patients with ankylosing spondylitis and discusses the possibilities of their diagnosis using radiography and magnetic resonance imaging (MRI), including modern methods such as diffusion-weighted imaging, contrast-enhanced dynamic scanning and whole-body MRI.The main difficulty in diagnosing axPsA is that there is no universally accepted terminology or standardized diagnostic criteria, making it difficult to clearly distinguish axPsA from other forms of axial spondyloarthritis. Determining the first symptoms of axPsA not only helps to make a timely diagnosis and prescribe appropriate treatment, but also to monitor the activity of the disease and the dynamics of structural changes, which allows appropriate adjustment of the therapy needed to improve the quality of life of patients.

Gout is the most common chronic autoinflammatory disease, the development of which is associated with persistent hyperuricemia caused by both environmental and genetic factors, which leads to the deposition of sodium monourate crystals in various tissues and organs of the human body. Gout is more common in men than in women of childbearing age, due to the uricosuric effect of estrogen, however, after menopause, the incidence of gout in women increases significantly. At the onset of the disease, the first metatarsophalangeal joint, ankle and knee joints are most often involved in the pathological process. However, there are isolated reports in the literature about a rare gout lesion of the axial skeleton, for example, the sacroiliac joint, in which the nature of the pain syndrome, magnetic resonance imaging, and X-ray picture can mimic spondyloarthritis. The article presents a rare case of damage to the axial skeleton in a 57-year-old patient with gout, manifested by acute inflammatory back pain and arthritis of the lower extremities.

A new approach for assessment of the spawning stock of walleye pollock in the northern Okhotsk Sea on the data of ichthyoplankton surveys is proposed. To estimate the actual number of spawned eggs, average age of eggs at each stage of development was determined and the eggs mortality was estimated in dependence on age. For the spring ichthyoplankton surveys in 2019–2023, the eggs mortality was evaluated as 27 % for stage I, 57 % for the stage II, 74 % for the stage III, and 86 % for the stage IV – these portions of the spawned eggs were not caught and counted. So, the number of counted eggs was in 1.7–2.1 times lower that the actual number of spawned eggs. The spawning stock biomass was amounted as 12.9 . 106 t in 2019–2023, on average, on the base of the actual number of eggs determined taking unto account the eggs mortality (while the biomass calculated from the counted number of eggs only would be 6.9 . 106 t). Results of the spawning stock estimation with this new method are comparable with the stock assessments by trawl surveys. The eggs number correction through mortality is recommended for calculation of the spawning stock for walleye pollock in the Okhotsk Sea using the ichthyoplankton method.

Purpose of the study. Evaluation of the safety and effectiveness of single-port thoracoscopic thymectomy in comparison with traditional three-port thymectomy in patients with stage I and II thymic epithelial tumors.Patients and methods. The results of 50 thoracoscopic thymectomies performed from January 2019 to May 2023 on patients with stage I and II thymic epithelial tumors without the presence of myasthenia were analyzed. The age of the patients ranged from 20 to 75 years, with a median of 44 years. There were 28 (56 %) women, 22 (44 %) men. The minimum size of the removed thymoma in the study was 20 mm, the maximum was 165 mm. Out of the 50 patients who underwent singleand three-port thoracoscopic thymectomy, 42 (84 %) had tumor diameters of 70 mm or less, and 8 (16 %) had tumor diameters greater than 70 mm. Tumor size was significantly larger in the three-port thymectomy group (43 mm [35 mm; 55 mm] vs. 60 mm [38 mm; 78 mm], p = 0.044).Results. The analysis noted a statistically significant increase in the duration of the operation in the group of three-port thoracoscopic thymectomies (duration of operations – 107.5 minutes [70 minutes; 132.5 minutes] versus 70.0 minutes [57 minutes; 79 minutes] in the group with a single-port approach). A statically significant result was also obtained in terms of drainage of pleural cavity drainage and, as a consequence, in duration of postoperative bed rest. Patients operated through a single-port approach stayed in the hospital for 3 to 5 days on average (4.0 days), while those with a three-port approach stayed from 3 to 13 days on average (5.0 days). A comparative analysis revealed a significant reduction in the length of hospital stay in patients who underwent single-port thoracoscopic thymectomy, in contrast to those undergoing three-port surgical interventions.Conclusion. This study is the first in Russia to compare oneand three-port techniques for removing thymic tumors in a number of patients sufficient for statistical calculations. It has been shown that for thymic tumors up to 5 cm, single-port thoracoscopic thymectomy compared to three-port does not lead to prolongation of the operation or an increase in intraand postoperative complications. Therefore, in our opinion, it is the preferable option.

Purpose of the study. To evaluate the levels of metabolic markers in patients with prostate cancer (PCa) in comparison with patients with benign prostatic hyperplasia (BPH).Patients and methods. 108 patients were included in the study. The majority of patients had comorbidities: coronary heart disease, hypertension, and almost one third of patients had type 2 diabetes mellitus. Median (Me) age was 67 (64–74), body mass index was 25.9–34.7. The main study group included 54 patients with histologically verified prostate cancer, the comparison group consisted of 54 patients with benign prostatic hyperplasia (BPH). The level of basic biochemical parameters, glomerular filtration rate, lipidogram, total prostate-specific antigen (PSA), total testosterone was determined in all patients.Results. When comparing anamnestic and biochemical parameters, the groups were not statistically significantly different. When comparing the groups by lipid status, it turned out that in the group with RPW, in contrast to the group of patients with BHP, statistically significantly higher levels of total cholesterol (5.13 (3.3–10,4) and 4.60 (2.5–6.3)) mmol/L, respectively, p = 0.023), low–density lipoproteins (2.93 (0.8–5.9) and 2.60 (0.9–4.2) mmol/L, respectively, p = 0.035), triglycerides (2.10 (1.0–8.0) and 1.70 (0.5–7.3) mmol/L, respectively, p = 0.048). In case of dyslipidemia, an increased risk of developing PCa was identified. Correlation analysis revealed a direct moderate relationship between total PSA levels and total cholesterol concentration (r = 0.51).Conclusion. Our study revealed that in the PCa group, there was a higher level of total cholesterol, low-density lipoproteins, and triglycerides, in contrast to the group of patients with BPH. Additionally, in the group of patients with BPH, dyslipidemia was a risk factor in the development of PCa, which should be taken into account in PCa prevention and diagnosis.

The aim of the work was to evaluate the GABA neuroprotective properties and its structural analogues in old animals after seven months of hyperglycemia.Materials and methods. Diabetes mellitus was modeled in white outbred male rats (12 months old) by the administration of a streptozotocin (65 mg/kg) and nicotinamide (230 mg/kg) combination. After 6 months, the animals with a postprandial glycemia level between 11 and 18 mmol/l were selected for the study. After the groups had been formed, the animals were administrated with GABA and GABAergic compounds (Compositions МРВАand PPC), respectively, for 1 month, the control group animals were administrated with saline. After the treatment, an oral glucose tolerance test and a set of behavioral tests aimed at studying sensory-motor (Open Field, Adhesion test, Rotarod) and cognitive functions (New Object Recognition and Morris Water Maze), as well as the functional state evaluation of the endothelium were performed. Further on, sampling of blood and brain tissues for a biochemical and enzyme immunoassay (the level of glucagon-like peptide-1 (GLP-1) and TNF-α in serum and the level of Klotho protein, BDNF, Nrf2, NF-κB and malondialdehyd (MDA) in brain homogenates), as well as a morphological analysis of changes in CA1 and CA3 neurons of the hippocampus and somatosensory cortex, was carried out.Results. GABA and compositions with its derivatives had a pronounced neuroprotective effect in old animals with prolonged hyperglycemia. The hypoglycemic effect of the studied compositions was accompanied by an increase in the production of GLP-1. In the animals with DM, after 6 weeks of the test substances administration, higher rates of sensory-motor and cognitive functions and a less structural damage to the sensory-motor cortex and the brain hippocampus were recorded. These effects may be due to higher levels of the Klotho proteins, Nrf2 and BDNF, as well as lower levels of NF-κB, which may underlie the suppression of the oxidative stress, the reduction of MDA and inflammation (TNF-α).Conclusion. After 6 weeks of the administration, GABA and its compositions in old animals (19 months old) significantly improved sensory-motor and cognitive functions, reduced negative structural changes in the hippocampus and somatosensory cerebral cortex.

Introduction. Currently, there is a small number of studies devoted to the differences in the manifestations of axial spondyloarthritis (axSpA) in men and women, and there are no studies assessing the frequency of coxitis in axSpA in patients of different sexes. The purpose of the study is to compare the main manifestations of coxitis in axial spondyloarthritis in men and women. Material and methods. The study was conducted on the Moscow Cohort of Early SpondyloArthritis (CoRSAr), which currently includes 175 patients. Their age at the time of inclusion in the cohort was on average 28.5±5.8 years, the duration of the disease was 24.1±15.4 months. 92.6% of patients were positive for HLA-B27 (human leukocyte antigen B27). All patients were assessed for pain in the hip joints (HIP) using a numerical rating scale (NRS) (0–10), and pelvic radiography, magnetic resonance imaging (MRI) and ultrasound examination of the Hip joint were performed. An increase in the cervical-capsular distance (NCD) of more than 7.0 mm was considered a sign of coxitis according to ultrasound data. When analyzing MRI results, signs of coxitis were considered to be synovitis and/or osteitis of the femoral head or acetabulum. X-ray changes in the hip joint were assessed using the BASRI-hip index (Bath Ankylosing Spondylitis Radiology Hip Index). Results and discussion. Among the 175 patients, there were 97 (55.4%) men and 79 (44.6%) women. At the time of inclusion in the study, women were older than men (p0.05). According to ultrasound data, coxitis was detected in 15 (18.9%) women and 27 (27.8%) men; NCD averaged 6.2 mm in men and 5.9 mm in women (p>0.05). In men, signs of damage to the hip joint according to MRI were more common than in women (in 27.8% and 15.1% of cases, respectively; p

Аim: to present two clinical cases of successful surgical treatment of patients with a combination of complete transposition of internal organs and cancer of the biliopancreatoduodenal zone.Key points. A 65-year-old man underwent gastropancreatoduodenal resection for cancer of the large duodenal papilla. In addition to the situs vicserum inversus, this patient revealed a special variant of vascular anatomy, namely: separate separation of the left and right hepatic arteries from the ventral trunk. A 70-year-old man, in addition to complete transposition of internal organs, had a combination of cancer of the terminal part of the common bile duct and heterotaxy syndrome in the form of polysplenia, aplasia of the hepatic segment of the inferior vena cava, agenesis of the dorsal pancreatic rudiment (“short” pancreas), intrapancreatic course of the right hepatic artery extending from the superior mesenteric arteries, rotational abnormalities of intestinal development. This patient underwent a total pancreatectomy. In both cases, the main difficulties in mobilizing the pancreatoduodenal complex arose due to anatomical disorientation and the absence of standard (familiar) topographic and anatomical landmarks for the surgeon.Conclusion. In all patients with tumors of the biliopancreatoduodenal zone, a detailed assessment of the vascular anatomy of this area is required before surgery, with the study of the course of the main visceral vessels and their large branches using multispiral computed tomography in vascular mode. If heterotaxy syndrome is suspected, additional examination is necessary to identify hidden developmental anomalies, which allows surgeons to be prepared for an unusual situation. Gastropancreatoduodenal resection or total pancreatectomy in situs viscerum inversus is a technically complex intervention and should be performed in large multidisciplinary medical institutions, and the operating team should have extensive experience in operations on the organs of the biliopancreatoduodenal zone.

Coxitis is one of the characteristic clinical manifestations of ankylosing spondylitis (AS). Hip joint (HJ) involvement in AS is considered an un-favorable prognostic factor. Early detection of coxitis is of great importance, since with the timely initiation of adequate treatment, the risk of developing irreversible changes in HJ can be reduced.The lecture discusses the issues of clinical and instrumental diagnosis of coxitis in AS and presents an algorithm for its early detection developed by the authors.

Objective – to analyze whether axial psoriatic arthritis (axPsA) patients meet classification criteria for axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS).Subjects and methods. 104 patients (66 men and 38 women) with PsA according to CASPAR criteria were examined, all patients had back pain. Patients were evaluated for presence of inflammatory back pain (IBP) by ASAS criteria. Back pain not meeting the ASAS criteria was taken to be chronic back (chrBP). Patients underwent hands, feet and pelvis, cervical spine and lumbar spine X-rays. Erosions, osteolysis, and periarticular osteo-proliferative lesions were evaluated. Radiographically significant sacroiliitis (r-sSI) was defined as bilateral grade ≥2 or unilateral grade ≥3. 19 patients without r-sSI underwent sacroiliac joints MRI. 93 patients underwent HLA B27 examination. The number of patients who met the criteria for axSpA (ASAS) and the modified New York (mNY) criteria for AS was determined.Results. IBP was identified in 67 (64.4%), chrBP in 37 (35.6%) patients; 31 (29.8%) patients were of advanced age (over 40) at the onset of IBP/chrBP; 57 (58.8%) cases had r-sSI; 6 (31.6%) patients had MRI-SI; syndesmophytes were detected in 57 (58.8%) cases. Among 40 patients without r-sSI, 19 (47.5%) had syndesmophytes. In 38 (39.2%) out of 97 patients r-sSI was detected along with syndesmophytes, while 19 (19.6%) out of 97 patients had isolated r-sSI without spondylitis, and 19 (19.6%) out of 97 patients had isolated syndesmophytes without r-sSI. HLA B27 was present in 28 (30.1%) cases. 51 (55.4%) patients met criteria for axSpA. 41 (44.6%) patients didn’t meet criteria for axSpA, however 27 (65.9%) of them had syndesmophytes. 48 (48.5%) PsA patients met mNY criteria for AS.Among these patients a set of specific features was revealed: 18 (37.5%) had no IBP, 18 (37.5%) were of advanced age (over 40) at the onset of IBP/ chrBP, 34 (70.8%) had dactylitis, 38 (79.2%) – erosive polyarthritis, 23 (48.8%) – periarticular osteo-proliferative lesions, 14 (30.2%) – osteolysis, 23 (48,9%) – “chunky” non-marginal syndesmophytes, 40 (82,6%) – nail psoriasis, 28 (66,6%) patients were HLA-B27 negative.Conclusion. 45% of axPsA patients don’t meet criteria for axSpA. Characteristic features have been identified to differentiate axPsA from AS.

Advanced glycation end-products play an important role in the development of diabetic complications, so slowing down of glycated proteins’ cross-links formation have been suggested as a potential therapeutic option for the treatment of vascular diabetic complications and preventing their progression.The aim of the work was to assess the influence of novel anticrosslinking agent DF-5 on the renal advanced glycation end-products and collagen contents, body weight, blood glucose and glycated hemoglobin levels and the development of early renal disease in streptozotocin-induced diabetic rats.Materials and methods. 40 male Sprague-Dawley rats were used in the study. Two months after inducing diabetes, the study substance was administered intragastrically once a day for 28 days (12.5 mg/kg). Measurements included the assessment of blood glucose and HbA1c levels, the evaluation of the renal function, and the results of histology and immunohistochemical staining of kidneys.Results. A repeated intragastric administration of DF-5 for 30 days significantly reduced the level of HbA1c in the blood, but did not affect the level of fasting blood glucose. DF-5 compound significantly reduced proteinuria and prevented kidney damage in experimental animals by limiting damage of the glomeruli and tubules. It was found that DF-5 inhibits the progression of an early renal dysfunction in rats with streptozotocin-induced diabetic nephropathy. This was associated with a decreased accumulation of advanced glycation end-products in the kidney, accompanied by the improvement of both renal morphology and function.Conclusion. The results obtained provide investigators with additional therapeutic options for the treatment of diabetic nephropathy and possibly other complications of diabetes.

The article addresses the issues of judicious choice of the most efficient aircraft for regional aviation of Russia for the purpose of eliminating transport discrimination of the population of the Russian Federation regions in terms of local traffic. Due to the high financial costs, the development of regional aviation is viable only in those constituent entities of the Russian Federation where the development of low-cost ground transportation is not feasible: most of these Russian Federation regions are attributed to the remote territories of the North-Western, Ural, Siberian and Far Eastern Federal Districts of Russia, therefore, this concern may affect the perspectives of up to 14 million people. The problem of minimizing the total costs to develop an advanced air transport system of local transportation (including airport infrastructure costs) is considered by selecting a well-targeted fleet of operated aircraft, taking into consideration the requirements for the quality of passenger service. The maximum local travel time is regarded as a quality criterion of local transportation. The calculation results for three- and four-type aircraft fleets are given. It is shown that the use of modern high-technology aircraft similar to the Pilatus PC-12NG allows us to reduce the level of transport discrimination almost to zero values, including sufficiently strict restrictions regarding the maximum local travel time of “2 hours”. At the same time, the increase of cruising speed up to more than 400 km/h is relevant specifically for aircraft with a capacity of no more than 9 passengers. For larger aircraft (type L-410), the issue of increasing speed is rather minor, since these aircraft are operated on flight distances of no more than 800 km. Concurrently, the total fleet of air transport vehicles in service amounts to 250–300 aerial vehicles. The obtained results can be used to specify the requirements for the advanced aircraft of local airlines.

The research is focused on a comprehensive analysis of digitalization as a prerequisite for higher education modernization. The authors of this article consider the digital divide as a component of information inequality, which has a technological nature and presupposes unequal opportunities for access, use, and production of information and knowledge or new technologies for their effective use in practice. The authors determined the digital divide is intensifying under pandemic and quarantine restrictions when the preference is given to blended learning technologies, collaborative learning, integrated learning, flipped classroom technology, storytelling, inquiry based learning (IBL), and project based learning (PBL). The research result is a unified information and communication ecosystem developed, which unites the scientific, technological, and educational potential of the network educational digital environment. The ecosystem also provides for the transformation from a lineal to a cluster model of competence cultivation, the formation of digital skills, growth in the volume of information, and creation of digital products.

Evolution of the approaches to diagnostics of DUI as the evidentiary base in law violations is traced; parallelism in the development of scientific beliefs on the nature of acute alcohol intoxication, scientific and technological achievements – on one hand, and legislation in the field of traffic safety, on the other is described Two principles of diagnostics are compared – clinical and chemical-toxicological, their advantages and disadvantages. Author’s point of view concerning optimal principles of diagnostics and legislation in Russia is formulated.

Introduction. Today, there is an increase in the risks of involving minors in various forms of deviant behaviour, among the varieties of which addictive behavioural models are particularly dangerous. In this regard, proactive preventive measures are becoming particularly relevant, among which one of the key areas is the timely identification of potential addicts, including among students of educational organisations.Aim. The aim of the study was to identify the actual socio-psychological characteristics of the personality of underage students who are prone to addictive behaviour.Methodology and research methods. The comparative-analytical method of working with scientific literature presented in eLIBRARY.RU, Scopus, Web of Science and Google Scholar databases was used as the main theoretical method. When organising the study, the authors relied on a number of methodological provisions: the structural method, when the research material is interpreted in accordance with the specific characteristics of the object of study; the method of comparisons, which consists in comparing individual results with each other. The main empirical method was the testing method. To obtain the results of the study, the authors employed a unified methodology of socio-psychological testing aimed at the identification of the risk of formation of addictive behaviour in minors. For mathematical and statistical data processing, the Statistics SPSS 19.0 package was applied: the Kolmogorov-Smirnov Dmax criterion (for boys and girls separately and jointly), the Mann-Whitney U test, regression analysis, analysis of averages, confidence and percentile intervals. Also, the factor analysis method was used – the principal component method, Varimax rotation. The stability of factors was calculated using the Lewandowski’s method. The study was conducted in different regions of Russia in 2019–2020. The sample consisted of 6,300 people.Results. Based on the analysis of scientific sources, the authors described the epidemiological picture of various forms of addictive behaviour of minors, the differences between male and female samples (young men demonstrate a greater desire for leadership, protest reactions, rivalry, and girls are more anxious, frustrated, focused on internal experiences), the interrelationships between the scales of the methodology and the poles of the selected factor structure from the point of view of asociality and prosociality of juvenile behaviour (desire for risk, social maladjustment, avoidance of conflict and others).Scientific novelty. The scientific novelty of the results is due to the receipt of relevant data on the specifics of the socio-psychological characteristics of modern adolescents and young men prone to addictive behaviour.Practical significance. The practical significance lies in the fact that the identified socio-psychological characteristics of the behaviour of a person prone to addictive behaviour can become the main planning work on the early detection of a tendency to addictive behaviour, organisation of preventive work with imperfect-year-olds, as well as for the organisation of psychological work with students at risk.

Objectives. To obtain experimental data on the effect of activating additive type on the cold sintering process of (MnFeCoNiCu)3O4 high-entropy ceramic. The following substances were used as activating additives: ammonium acetate (CH3COONH4), acetic acid (CH3COOH), ammonium chloride (NH4Cl), potassium fluoride dihydrate (КF·2H2O), lithium fluoride (LiF), sodium fluoride (NaF), and sodium hydroxide (NaOH).Methods. Synthesis of the initial powder by low-temperature self-propagating method; investigation of the powder particles size distribution by laser diffraction method; analysis of the particle shape and compacted sample microstructure by scanning electron microscopy; investigation of the phase composition by X-ray phase analysis; high-entropy ceramic sample consolidation by cold sintering process. The density of the initial powder and the relative density of cold sintered samples were determined by the Archimedes method.Results. Samples with a relative density of over 0.70 were obtained using distilled water, CH3COONH4 and NaOH during cold sintering at 300 °C, with a holding time of 30 min and pressure 315 MPa.Conclusions. For the first time, the effect of the type of activating additive on the relative density of high-entropy ceramics (MnFeCoNiCu)3O4 samples obtained by cold sintering process has been experimentally demonstrated. The samples microstructures have pronounced differences: 20 wt % distilled water does not lead to grain growth, with only their compaction to 0.71 relative density observed; however, the addition of 0.1 wt % CH3COONH4 and NaOH increases the average grain size when reaching similar relative densities (0.70 and 0.71, respectively). X-ray diffraction analysis showed that the cold sintering process does not lead to a change in the phase composition of the initial (MnFeCoNiCu)3O4 powder, confirming the preservation of the high-entropy structure.

Objective. Inflammation in rheumatoid arthritis (RA) leads to the development of local and generalized bone loss. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACCP) are believed to play a negative role in the radiological progression of RA. The use of such antiresorptive therapy as denosumab – monoclonal antibodies to RANKL (receptor activator of nuclear factor kappa-B ligand), reduces the activity of osteoclasts, increases bone mineral density (BMD), and also potentially affects the erosive process at RA. The aim of the study is to evaluate the effect of denosumab therapy on BMD and erosion count in patients with RA and osteoporosis (OP) in consideration of the positivity in the RF and ACCP in serum and the baseline RA activity. Materials and methods. The 12-month prospective study of the efficacy of denosumab therapy (60 mg subcutaneously every 6 months) in patients with RA and OP included 66 postmenopausal women; age – 59.4±7.5 years, duration of RA – 17.8±10.6 years, RF-positive – 47 (72%) patients, ACCP-positive – 48 (74%) patients. At baseline and after 12 months, dual-energy X-ray absorptiometry was performed with an assessment of BMD in the lumbar spine (L1– L4), proximal femur (hip neck and total hip), distal forearm; X-ray of the hands and distal parts of the feet in direct projection, followed by assessment of erosive-destructive changes according to the Sharp/van der Heijde method. Results. A significant increase in BMD was established in all studied sites of the skeleton despite the positivity of the RF and ACCP (for the hip neck p=0.05), while a significant increase in BMD in the RF- and ACCP-negative group was detected only in L1–L4 site. The progression of the increase in erosion count was noted in the RF- and ACCP-positive group while in the RF- and ACCP-negative group this indicator did not change. Regardless of the baseline activity of RA (by DAS28 (Disease Activity Score 28)) the BMD of most parts of the skeleton were stabilized. In patients with moderate RA activity, BMD increased significantly in L1–L4 in both groups: RF- and ACCP-positive and -negative , as well as in the total hip – in RF- and ACCP-positive group. The dynamics of the erosion count in RA patients did not depend on the baseline degree of DAS28 activity, no significant changes were detected in the analyzed groups. Conclusions. RF and ACCP positivity in serum in patients with RA and OP treated with denosumab did not have a negative effect on the dynamics of BMD, while the number of erosions increased. The baseline RA activity level did not affect the dynamics of the erosion count and the dynamics of BMD in most subgroups – BMD levels have been increased or stabilized.

Objective: to evaluate clinical and instrumental characteristics of axial lesion in psoriatic arthritis (PsA) in real-life clinical practice.Subjects and methods. Examination were made in 52 patients (32 men and 20 women) with back pain recorded either at the time of their admission or in their medical histories. The inflammatory back pain (IBP) was diagnosed according to the Assessment of SpondyloArthritis international Society (ASAS) criteria. Back pain lasting over three months without meeting the ASAS criteria was taken to be chronic back (chrBP). Hands, feet, pelvis, cervical spine (CSP) and lumbar spine (LSP) were X-rayed. Erosions, osteolysis, and periarticular osteo-proliferative lesions were evaluated applying PsA-modified Sharp/van der Heijde score (SHS). Sacroiliitis (SI) was considered radiologically significant (r-sSI) when it was bilateral grade II or higher, or unilateral grade III or higher by Kellgren. 15 patients without r-sSI had their sacroiliac joints (SIJs) scanned using magnetic resonance imaging (MRI). Syndesmophytes, paravertebral ossifications, constriction and ankylosis of the CSP zygapophysial joints were considered to be radiological signs of psoriatic spondylitis. HLA-B27 typing was performed in 45 patients.Results and discussion. IBP was identified in 34 (66.7%), chrBP in 17 (33.3%) patients; 15 patients (28.8%) were of advanced age (over 40) at the onset of IBP/chrBP; 30 cases (57.7%) had r-sSI; in 18 cases SI was not detected. 13 out of 30 r-sSI patients (43.3%) didn’t suffer IBP. Erosions were detected in 38 (76%) patients, osteolysis in 13 (26%) and osteo-proliferative lesions in 18 (36%) patients. Average SHS was 82.79±64.77 correlating with the presence of r-sSI (r=0,46; p˂ 0,05). Correlation of r=0.35 was found between r-sSI and the spine limited mobility according to Bath Ankylosing Spondylitis Metrology Index (BASMI); r-sSI was detected with much higher statistical significance in the presence of periarticular osteo-proliferative lesions than in the absence of such (р=0.02). In PsA patients having periarticular osteolysis, axial lesion in the form of asymmetric syndesmophytes was detected ten times more frequently than in those not having it (OR=10; 95% CI: 1.63–61.327). In CSP, syndesmophytes developed two times more frequently than in LSP (p=0.01). Discrete CSP lesions in the absence of any LSP changes was observed in 30% of cases. SI was MRI detected in 2 (13.3%) patients. In 9 (18.0%) patients axial lesions were observed without SI. 15 patients (33.3%) were HLA-B27 positive. A set of specific PsA axial skeletal involvement features were revealed: possibility of oligosymptomatic clinical presentation; patient’s advanced age at the back pain onset; association with severe destructive peripheral arthritis; and more pronounced CSP lesions as compared to LSP. An alternative phenotype patient group (18%) without X-ray or MRI SI but with spine involvement was identified.

There is a clinical report of successful oral intraluminal laser lithotripsy with subsequent lithoextraction of a large concretion of the common bile duct in a patient with choledocholithiasis and mechanical jaundice. For the intraluminar lithotripsy a tulium laser "Urolaz" was used with energy modes 0,025-0,05-0,1 J, up to a maximum of 0.5 J. The average power is 6-10 W. Laser exposure was carried out by pulses in an aqueous medium in order to prevent carbonation of the light guide and smoke. The effect of exposure to the concretion was manifested in its fragmentation and the formation of small particles without damage of the mucous membrane of the common bile duct. The total duration of the intervention was 45 minutes. The method is effective and safe, thus it avoids the need of endoscopic papillosphincterotomy and violation of the anatomical integrity and physiological function of the Oddi sphincter.

Objectives. A frequently used method for obtaining Pareto-optimal solutions is to minimize a selected quality index under restrictions of the other quality indices, whose values are thus preset. For a scalar objective function, the global minimum is sought that contains the restricted indices as penalty terms. However, the landscape of such a function has steep-ascent areas, which significantly complicate the search for the global minimum. This work compared the results of various heuristic algorithms in solving problems of this type. In addition, the possibility of solving such problems using the sequential quadratic programming (SQP) method, in which the restrictions are not imposed as the penalty terms, but included into the Lagrange function, was investigated.Methods. The experiments were conducted using two analytically defined objective functions and two objective functions that are encountered in problems of multi-objective optimization of characteristics of analog filters. The corresponding algorithms were realized in the MATLAB environment.Results. The only heuristic algorithm shown to obtain the optimal solutions for all the functions is the particle swarm optimization algorithm. The sequential quadratic programming (SQP) algorithm was applicable to one of the analytically defined objective functions and one of the filter optimization objective functions, as well as appearing to be significantly superior to heuristic algorithms in speed and accuracy of solutions search. However, for the other two functions, this method was found to be incapable of finding correct solutions.Conclusions. A topical problem is the estimation of the applicability of the considered methods to obtaining Pareto-optimal solutions based on preliminary analysis of properties of functions that determine the quality indices.

Pigmented villonodular synovitis (PVNS) is a rare disease, its diagnosis has certain difficulties. This is due to the absence of characteristic etiological factors and clinical manifestations of PVNS, as well as the insufficient level of knowledge among doctors. The article presents a review of the literature on the diagnosis and treatment of PVNS, as well as a clinical case, which peculiarity is the late diagnosis of this disease, despite the presence of its certain clinical and morphological manifestations.

Objective: to analyze preliminary data on 5-year clinical and radiographic outcomes in patients with early psoriatic arthritis (PsA) observed as part of the Treat to target (T2T) strategy.Patients and methods. We examined 37 patients (18 men and 19 women) with early PsA who met the CASPAR criteria (2006), who received treatment according to the principles of the T2T strategy for 24 months. The mean age of the patients was 43.3±11.7 years, the median (Me) of PsA duration was 72 [60; 90] months, psoriasis – 120 [88; 180] months, follow up – 62 [51; 81] months. After completion of participation in the T2T strategy, patients were followed up in a real clinical setting. Most of the patients used methotrexate, biologic disease modifying antirheumatic drugs and non-steroidal anti-inflammatory drugs. In the dynamics after 5 years, PsA activity was determined by the DAPSA index and the achievement of the minimum disease activity (MiDA). In 16 (43%) patients, a dynamic assessment of radiographic changes in the joints of the hands and feet was performed using the Sharp quantitative method modified for PsA (m-Sharp/vanderHeijde).Results and discussion. By 24 months of therapy (the end of the T2T study), DAPSA remission was registered in 19 (52%) patients, in the same number of cases (16%) low (LDA), moderate (MDA) and high (HDA) disease activity was noted. Me DAPSA was 3.85 [0.67; 21.76], MiDA was detected in 22 (59.5%) patients. After 5 years of observation, Me DAPSA was 7.67 [2.2; 14.5]. Remissions according to DAPSA were achieved in 13 (35%) patients, LDA – also in 13 (35%), MDA – in 5 (14%), HDA remained in 6 (16%), MiDA – in 20 (54%). No significant differences were found when comparing disease activity at 24 months (at the end of the T2T study) and after 5 years of follow-up (p=0.41). In 11 (69%) out of 16 patients after 5 years, a negative trend was recorded in the assessment of radiological progression.Conclusion. After 5 years of follow-up, 70% of patients with PsA treated at an early stage of the disease as part of the T2T strategy achieved remission or LDA, and 54% of patients remained in MiDA. In 69% of patients, despite the achievement of remission and MiDA, there was a negative radiological dynamic in the hands and feet.

Abstract Transgenic animals are an important tool in biotechnology, including the production of recombinant proteins in the milk. Traditionally, expression constructs are based on hybrid vectors bearing mammary gland specific regulatory elements from the α-casein (Csn1s1), β-casein (Csn2), whey acidic protein (WAP), or β-lactoglobulin (BLG) genes. Overexpression from the randomly integrated vectors typically provides high levels of expression, but has drawbacks due to unpredictable genome localization. CRISPR-Cas9 targeted transgene integration into the endogenous casein locus could alleviate the need for extensive animal screening to achieve high and reproducible expression levels. We decided to evaluate such a “precise” integration approach, placing the human granulocyte–macrophage colony-stimulating factor (hGMCSF) gene under control of the mouse endogenous alpha-S1-casein (Csn1s1) promoter. We designed two types of transgene integrations: a knock-in in the second exon of the Csn1s1 (INS-GM) and a full-size Csn1s1 replacement with hGMCSF (REP-GM) which was never tested before. The INS-GM approach demonstrated low transgene expression and milk protein levels (0.4% of Csn2 transcripts; 2–11 µg/ml hGMCSF). This was probably caused by the absence of the 3’-polyadenylation signal in the hGMCSF transgene. REP-GM animals displayed high transgene expression, reaching and slightly exceeding the level of the endogenous Csn1s1 (30–40% of Csn2 transcripts), but yielded less hGMCSF protein than expected (0.2–0.5 mg/ml vs 25 mg/ml of Csn1s1), indicating that translation of the protein is not optimal. Homozygous inserts leading to the Csn1s1 knock-out did not have any long standing effects on the animals’ health. Thus, in our experimental design, site-specific transgene integration into the casein locus did not provide any significant advantage over the overexpression approach.

Caseins are major milk proteins that have an evolutionarily conserved role in nutrition. Sequence variations in the casein genes affect milk composition in livestock species. Regulatory elements of the casein genes could be used to direct the expression of desired transgenes into the milk of transgenic animals. Dozens of casein alleles have been identified for goats, cows, sheep, camels and horses, and these sequence variants are associated with altered gene expression and milk protein content. Most of the known mutations affecting casein genes’ expression are located in the promoter and 3’-untranslated regions. We performed pronuclear microinjections with Cas9 mRNA and sgRNA against the first coding exon of the mouse Csn1s1 gene to introduce random mutations in the α-casein (Csn1s1) signal peptide sequence at the beginning of the mouse gene. Sanger sequencing of the founder mice identified 40 mutations. As expected, mutations clustered around the sgRNA cut site (3 bp from PAM). Most of the mutations represented small deletions (1–10 bp), but we detected several larger deletions as well (100–300 bp). Functionally most mutations led to gene knockout due to a frameshift or a start codon loss. Some of the mutations represented in-frame indels in the first coding exon. Of these, we describe a novel hypomorphic Csn1s1 (Csn1s1c.4-5insTCC) allele. We measured Csn1s1 protein levels and confirmed that the mutation has a negative effect on milk composition, which shows a 50 % reduction in gene expression and a 40–80 % decrease in Csn1s1 protein amount, compared to the wild-type allele. We assumed that mutation affected transcript stability or splicing by an unknown mechanism. This mutation can potentially serve as a genetic marker for low Csn1s1 expression.

Axial involvement in psoriatic arthritis is quite common. There is no data on the use of tofacitinib, an oral Janus kinase inhibitor, in psoriatic arthritis patients with axial involvement, nor is there any data on its effect on active MRI sacroiliitis.The aim of the study was to assess the effect of tofacitinib therapy on the dynamics of active MRI sacroiliitis in psoriatic arthritis patients.Materials and methods. 41 patients with active psoriatic arthritis fulfilling the CASPAR criteria were included. Median age was 41.0 [34; 50] years old, median disease duration was 6.0 [3; 10] years. Apart from a standard clinical examination, 40 patients underwent sacroiliac joint MRI on scanner Siemens General Electric 1.5 TESLA. Bone marrow edema on MRI (STIR) with one lesion on two consecutive slices or at least two lesions on a single slice, was considered active MRI sacroiliitis. Tofacitinib was given in 5 mg tablets twice a day with a possible dose increase up to 10 mg twice a day after 12 weeks of therapy. At the end of study, over a period of 24 weeks, sacroiliac joint MRI examination was repeated in 35 patients.Results. Prior to tofacitinib therapy, active MRI sacroiliitis was detected in 14 of 40 (35%) patients: bilateral – in 9 patients, unilateral – in 5 patients. At the end of 24 weeks therapy, active MRI sacroiliitis was detected in 4 of 35 (11.4%) patients observed: in 1 patient with baseline bilateral MRI sacroiliitis and in 2 patients with unilateral MRI sacroiliitis. 1 patient showed negative dynamics, that is, development of active MRI sacroiliitis (absent at baseline). The decrease in number of active MRI sacroiliitis patients is statistically significant (p=0.017). At baseline, inflammatory changes were detected in 23 of 80 (28.8%) sacroiliac joints, after 24 weeks of therapy they were found in 5 of 70 (7.1%; p=0.001) sacroiliac joints observed. During the treatment period, there was a significant decrease in the initially high activity of spondylitis. After 24 weeks of treatment, median BASDAI decreased from 6.0 [4.2; 7.0] to 1.4 [0.6; 3.2], median ASDAS-CRP from 3.8 [2.8; 4.4] to 1.5 [1.0; 2.1] (p=0.001 for both comparisons). Prior to tofacitinib therapy, high activity according to BASDAI was observed in 90.2% of patients, low activity – in 9.8%; at the end of study – in 13.5% and 86.5% of patients, respectively (p=0.001). At baseline, very high activity by ASDAS-CRP was detected in 61% of patients, high activity – in 29.2%, low activity – in 9.8% of patients. At the end of study there weren’t any patients with very high activity by ASDAS-CRP (p=0.001), high activity remained in 23.1%, moderate and low activity – in 30.7% and 46.2% of patients, respectively (p=0.001 for both comparisons). Significant differences between baseline symptoms in patients with MRI sacroiliitis and without it were defined by number of digits with dactylitis – 2 [0; 4] and 0 [0; 2] (p=0.04) and by ESR values – 47 [26; 76] and 20 [6; 37] mm/h (p=0.02). These parameters were higher in MRI sacroiliitis subgroup. By the end of study, these differences leveled out: the number of digits with dactylitis decreased to 0 [0; 0] and 0 [0; 0] (р=0.48), ESR – to 12 [6; 16] and 8 [6; 16] mm/h, respectively (p=0.78).Conclusion. Tofacitinib therapy shows high efficacy in reducing active MRI sacroiliitis and decreasing activity of axial involvement in psoriatic arthritis patients. The use of tofacitinib in patients with active MRI sacroiliitis as well as dactylitis and increased ESR levels demonstrated its high efficacy.

To ensure the quality assurance of CT-examinations, it is necessary to obtain the high-quality diagnostic information and maintain the optimal exposure levels of patients and medical staff. This paper is focused on the requirements and main aspects of quality assurance of CT-examinations, which include quality control of the equipment, methods of CT-image quality control, optimization of radiation protection, as well as management of the unintended and accidental medical exposure. The paper contains recommendations on quality control of diagnostic equipment, methods for monitoring the quality control of CT-images, values of diagnostic reference levels for the detection of abnormally high patient doses and optimization of the radiation protection of patients, as well as the recommendations for management of radiation and non-radiation accidents. All main sections of the paper represent an unified quality assurance system in computed tomography.

This paper is an interview with Andrey V. Smirnov, Director of the Institute of Philosophy, Russian Academy of Sciences. The interview was dedicated to the broad set of issues that can all be characterized as relative to the umbrella topic of cultural patterns, the indispensability of cultural difference between nations and civilizations and the roots of such phenomena. Expressing the idea of specific mindsets and inherent value orientations, Andrey V. Smirnov adheres to the theoretical approach designed to underline these elements. The panhuman (vsechelovecheskoye) serves for these ends as well as the collective cognitive unconscious. The visions of panhuman oppose to the universalist paradigm (obshechelovecheskoye) and express concern about the drawbacks of cultural unification. Each culture shares one of these two approaches to a certain extent, and the viability of such cultures can be accessed with the view to the interests, goals and projects such cultures or nations nurture. All such phenomena stem from collective cognitive unconscious. Language as its signifier illustrates innate logical structures that also vary: while, for instance, the Arab thought runs on process-based logic that focuses on actions, European one represents substantial logic — that of the existential feeling. In this way all intercultural communication should take others’ visions and adopt to them, which is important not only for translators and interpreters, but also in the political sphere. Advocates of globalism and supranationalism are driven by ideas generated in the West and remain ignorant of the practices that are actually relevant in localities other than the USA or Western Europe. Many examples can be found in the societal shifts that Russia faces. The seemingly non-alternative modernisationalist initiatives that fall within the universalist liberal model are inadequate for the thought style and the corresponding institutional, authority and educational system. The most obvious examples of this deal with the digital sphere, but the cyber transformations as such are not imposing the universalist vision. Rather, it is the underlying culturally-rooted effects of the leverage the United States as the IT leader have and make use of. The questions on how these intercultural communications function now, what form should they take and the very transformations that burden self-sufficient cultures should be analyzed by philosophers. The realities of modern civilizations suggest that those who are set aside in the periphery raise voices and realize national subjectivity.

Aim of the study was to clarify the body composition in patients with early rheumatoid arthritis before starting therapy with synthetic basic anti-inflammatory drugs, genetically engineered biological drugs and glucocorticoids using dual-energy X-ray absorptiometry and to assess the effect of inflammation and metabolic syndrome on body composition.Material and methods. The study included 37 patients (31 women and 6 men) with early rheumatoid arthritis. The control group consisted of 19 healthy donors without rheumatic diseases. Patients with rheumatoid arthritis and the control group were measured by waist size, height and weight, and body mass index was calculated. Body composition was determined by means of dual-energy X-ray absorptiometry using the “Whole Body” program on the HOLOGIC device (USA). The presence of metabolic syndrome was assessed according to the criteria of the International Diabetes Federation (IDF).Results. Patients with early rheumatoid arthritis had less lean tissue mass, which was negatively correlated with inflammatory markers (ESR and C-reactive protein levels). Overweight and obesity were diagnosed in 24% and 27% of patients with early rheumatoid arthritis, respectively. Patients with rheumatoid arthritis and metabolic syndrome had a higher body weight, body mass index, waist size, and adipose tissue mass than patients without metabolic syndrome. With the help of instrumental methods, it is shown that in rheumatoid arthritis there is a redistribution of fat mass in the body, its predominant accumulation in the trunk area and a parallel decrease in the volume of muscle tissue.Conclusion. Rheumatoid inflammation and metabolic syndrome affect body composition of patients with early rheumatoid arthritis before the start of antirheumatic therapy.

The diagnosis of coxitis remains one of the most difficult problems in the management of patients with axial spondyloarthritis (axSpA). In Russia, almost every two patients with axSpA were found to have hip joint (HJ) damage. However, until a certain time, there have been no methods to estimate the rate of progression of radiographic HJ changes in clinical practice. We have previously developed a formula for calculating the rate of coxitis progression, which simplifies the assessment of radiographic HJ changes and allows a physician to make a timely decision about changing therapy if rapidly progressing coxitis is detected.Objective: to estimate the rate of radiological progression of coxitis during a 24-month follow-up of patients with early axSpA.Patients and methods. Examinations were made in 38 patients (20 women and 18 men) who had been followed up for at least 2 years without radiographic and ultrasound signs of HJ joint involvement. The patients' mean age was 28.8±5.5 years; the disease duration was 22.7±15.7 months. HLA-B27 was positive in 35 (92%) patients. The summary stage of radiographic coxitis (ssRC) was used to assess HJ damage; the previously developed formula was applied to estimate the rate of radiological progression of coxitis (R-rpC).Results and discussion. The median cervical-capsular distance (CCD) was 5.2 mm at baseline and 4.9 mm at 2 years (p7 mm increase in the CCD. The mean ssRC was 0.34±0.75 scores at base line, 0.86±0.78 scores at 1 year; and this indicator increased up to 1.24±1.36 scores at 2 years (p=0.004). During 2 years of follow-up, there was no coxitis progression (the difference between ssRC2 and ssRC1 was 0) in 24 (63%) patients; ΔssRC increased by 1 score in 5 (13%); by 2 scores in 6 (16%), and by 4 scores in 3 (8%). On patient inclusion to the investigation, R-rpC averaged 0.5 (it was conventionally assumed that patients had no signs of HJ damage at the disease onset (ssRC=0). During therapy for the underlying disease, the mean R-rpC was 0.3 and 0.2 score/year within the first and second years, respectively. The mean R-rpC in the ΔssRC >0 group was as many as 0.85 score/year at one-year follow-up and 0.53 score/year at two-year follow-up.Conclusion. The developed procedure for estimating the progression of coxitis using ssRC is easy to use and can identify patients at high risk for coxitis progression.

The article presents the results of the analysis of the main parameters of the investment sphere development over the past twelve years. The base year for comparison is pre-crisis 2007. We considered the main trends in the development of investment activity both for the full range of enterprises and organizations, and for large and medium-sized enterprises (without small businesses and the volume of investment that is not observed by direct statistical methods). We concluded that it is advisable to base further research on data collected by Rosstat for large and medium-sized enterprises., We grouped economic activities into 14 homogeneous industry complexes to identify areas of activity in the investment sphere. We carried out the analysis of sources of financing for investment activities in the context of own and attracted funds. The specific section of investments is linked to the investigation by economic sectors since it is the nature of the industry and its functionality that determine its specific structure. As a result of the analysis of the investment sphere, the authors have established the extreme instability of investment dynamics in recent years, identified problem points in the field of investment, the solution of which will contribute to the growth of investment activity in the country.

The phenomenon of whistleblowing has always attracted scientific attention and received quite a definitive interpretation. However, the popular evaluation of whistleblowing remains ambiguous: it ranges from extremely negative to demands to legalize it as a social institution, which makes related studies highly relevant. Law, phenomenology, sociology, and behavioral studies have their own definitions of this phenomenon. As a result, its overall understanding still remains multifaceted, as each science focuses on its own epidemiological and etiological factors and proceeds from its own methodology in assessing the consequences of whistleblowing as negative or positive. The authors analyzed numerous scientific sources and revealed a lack of empirical research about the whistleblower as a personality, e.g. personal dispositions, components, structure, motivations, social consequences, etc. The paper introduces some materials that partially fill this gap. The authors used a specialized projective diagnostic technique (BUK-MIF v.7.2) to study various manifestations of human personality. The first stage of the research involved a handwriting analysis of denunciation samples dated 1826–1988. After that, the results were compared with the data of similar psychographic diagnostics in control groups and groups of respondents with addictive behavior. The authors used data factorization, regression, variance, and graphical data analysis to identify the psychological symptom cluster of a whistleblower as a personality. After defining its stability and differentiating properties, the authors built an empirical model of motivation for the act of whistleblowing and described its intentional, regulatory, cognitive, dispositional, and beneficial components.

Introduction. Expanding the scope of application of rare-earth metal compounds that are unique in their properties increases the interest of many researchers in studying the impact of rare-earth metals and their compounds on human health and the environment. One of the most relevant and modern methods for assessing the safety of the studied media for a biological test object is bioassay.Problem Statement. The objective necessity of determining the combined effect of rare earth metals and their compounds on human health and the environment involves the use of biological systems. Modern methods of bioassay are extremely sensitive, which is sufficient to determine sub-threshold concentrations of hazardous substances in accordance with international standards. Thus, the use of these methods can make it possible to determine the index and the degree of toxicity of rare earth metal compounds with high accuracy in order to prepare a package of necessary documentation on industrial safety of products.Theoretical Part. Based on the studied toxicological effects of rare earth metals, the authors proposed to conduct a toxicity assessment based on the concept of biotechnical systems. The object of research was oxides and carbonates of rare earth metals. The results of the study to determine the index and the degree of toxicity of rare earth metal compounds, as well as to assess the lethal concentration of LC50 (24 h) by biotesting using test organisms Paramecium Caudatum were used to write a safety data sheet for cerium oxide and carbonate.Conclusion. The studies have shown that a certain modification of the technical solutions embedded in the devices of the Biotester series makes it possible to correctly solve the problem of assessing the toxicity of rare earth metals and their compounds. Based on the research results, the safety data sheets were developed.

Wide used method of digital filters design consists in transformation of analog filter-prototype with required performances into digital filter. This method is applicable if the transformation preserves optimality of filter performances under specified set of quality indexes (QI). It was denoted earlier that such situation is possible when gain-frequency response (GFR) and phase-frequency response are optimized simultaneously. The task of simultaneous optimization of digital filters GFR and step response (SR) is also important but yet a little explored. Alternative method of this problem solving consists in search of digital filter transfer function (TF) which is optimal under GFR and SR QI’s. To investigate capabilities of the first method we found examples of analog filters Pareto-optimal under rise time and transient duration. Other QI’s of these filters fulfilled specified constraints. Then these filters were transformed into digital filters. Bilinear transformation and transformation with invariant impulse response were applied. Further we did the search of digital filters optimal under the same set of QI’s. In either method the hybrid heuristic algorithm was applied for search optimal solutions in the space of TF poles and zeroes coordinates. The results of investigation demonstrated that digital filters developed via search are superiorly under specified set of QI’s then digital filters developed via transformation of analog filters. Accordingly Pareto-optimality for QI of GFR and SR is not preserved during such transformation and direct search must be applied to optimized digital filters simultaneously in frequency and time domains. Further in some cases analog filters developed via reverse bilinear transformation of the found optimal digital filters are superiorly under the same set of QI’s then analog filters developed using search. In such cases using of digital filter-prototypes for design of analog filters is practical.

The main issue the paper concerns is the theoretical and cultural interpretation of the 1940- 1950s social realist art depicting the Soviet school. The study advocates for a closer attention of cultural studies to the intertwining phenomena of Soviet mundanity and politically-charged painting. Hypothetically, the interconnection could be attributed to the transformation of the Soviet culture as a whole, with the pedagogical model of Soviet school as one key institutional elements. As Soviet art represented the state political project, each topic and body served some ideological needs. Thus, the paper aims at clarifying the cultural functions school art played. The analysis is dedicated to the post-WW2 canvases, to the period of the late 1940s‒1950s in particular due to the basic shifts in socialist realist painting both in terms of form and essence, which paralleled social and political transformations. The visual studies’ approach to artistic objects adopted by the authors serves as methodological contribution to cultural studies closely connected to political history, as it highlights the ideological sources of Soviet school painting and implicit pedagogical strategies designed to implement the Soviet social policy. The article provides the examples of the most significant paintings concerning the issue. The study has revealed that the era of school art combined a significant feature of early Soviet art – monumental pathos (however, deprived of motifs connected with the Great patriotic war and the 1917 revolution) – with micro-level mundane topics, mostly labour episodes. What is particular about school as such a topic is the role this institution played in the Soviet anthropologic project. As early stages of education are proved to be the most efficient in accelerating a new type of a socialist person, a future Soviet worker, the school realm was the base of value and practices indoctrination. The state policy translated the societal needs and purposes into the art. Having examined the key ideological concepts of the Soviet culture being inherent in Soviet school painting, certain functions were discovered. School is firstly depicted just as a background of state apotheosis. Secondly, it is perceived as a sacral locus where one becomes a Soviet person is both rituals and practices. Thirdly, school art is used to explain the novel principles of constructing a new person – personal approaches combined with growing group responsibility. And, finally, all that contributes to depicting the character traits which pupils was supposed to develop at school.

Monoclonal gammopathy of renal significance (MGRS) is a new nosology in modern nephrology and oncohematology. MGRS is defined as kidney injury due to nephrotoxic monoclonal immunoglobulin produced by the B-cell line clone which does not reach the hematological criteria for specific treatment initiation. Monoclonal proteins pathological effects on kidney parenchyma result in irreversible decline of kidney function till the end stage renal disease that in line with the position of International Consensus of hematologists and nephrologists determinates critical necessity for clone specific treatment in patients with MGRS despite the absence of hematological indications for treatment initiation. Main challenge of MGRS in Russian Federation is an inaccessibility of an in-time diagnostic and appropriate treatment for the great majority of patients due to the following reasons: 1) limited knowledge about the MGRS among hematologists and nephrologists; 2) lack of necessary diagnostic resources in most health-care facilities; 3) lack of approved clinical recommendations and medical economic standards for treatment of this pathological entity. Consensus document comprises the opinion of experts leading nephrologists and hematologists of Russian Federation on the problem of MGRS including the incoherence in nosology classification, diagnostics approach and rationale for clone specific treatment. Consensus document is based on conclusions and agreements reached during the conference of leading nephrologists and hematologists of Russia which was held in the framework of symposia Plasma cell dyscrasias and lymphoproliferative diseases: modern approaches to therapy, 1516 of March 2019, Pavlov First Saint Petersburg State Medical University. The present Consensus is intended to define the principal practical steps to resolve the problem of MGRS in Russian Federation that are summarized as final clauses.

The pathogenetic relationship of kidney damage and an aberrant clone of the B-cell line producing nephrotoxic monoclonal immunoglobulin underlies the concept of “monoclonal gammopathy of renal significance” (MGRS). Herein the aberrant clone does not reach the criteria necessary for initiating antitumor therapy according to oncohematological indications. MGRS is a new nosology in modern nephrology and oncohematology. Monoclonal protein’s pathological effects on kidney parenchyma result in irreversible decline of kidney function till the end stage renal disease that in line with the position of International Consensus of hematologists and nephrologists determinates critical necessity for clone specific treatment in patients with MGRS despite the absence of hematological indications for treatment initiation. Main challenge of MGRS in Russian Federation is an inaccessibility of an in-time diagnostic and appropriate treatment for the great majority of patients due to the following reasons: i) limited knowledge about the MGRS among hematologists and nephrologists; ii) lack of necessary diagnostic resources in most health-care facilities; iii) lack of approved clinical recommendations and medical economic standards for treatment of this pathological entity. In order to overcome these limitations, leading oncohematologists and nephrologists of the Russian Federation on behalf of professional communities at the end of 2019 published a conciliation document: “Monoclonal gammopathy of renal significance: Consensus of hematologists and nephrologists of Russia on the establishment of nosology, diagnostic approach and rationale for clone specific treatment”. Consensus document comprises the opinion of experts – leading nephrologists and hematologists of Russian Federation – on the problem of MGRS including the incoherence in nosology classification, diagnostics approach and rationale for clone specific treatment. Consensus document is based on conclusions and agreements reached during the conference of leading nephrologists and hematologists of Russia which was held in the framework of symposia “Plasma cell dyscrasias and lymphoproliferative diseases: modern approaches to therapy”, 15–16 of March 2019, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia. Consensus is intended to define the principal practical steps to resolve the problem of MGRS in Russian Federation that are summarized as final clauses which we present here.

A sensor based on the electrodynamic microwave resonator has been developed to determine the antibacterial activity of antibiotics using amoxicillin as an example. Microbial cells immobilized on the polystyrene film surface were used as a sensitive element of the sensor. The optimal conditions for the immobilization of Escherichia coli Xl-1 microbial cells on the surface of a thin polystyrene film modified in high-frequency argon discharge plasma and deposited on a lithium niobate plate were determined. The effect of amoxicillin on immobilized microbial cells was studied using the developed sensor. It has been established that the increase in con- centration of amoxicillin from 5 to 50 μg/ml leads to a significant change in the reflection coefficient S11 at the resonance frequency from the lithium niobate plate in the range of -12.6 dB — -15.1 dB. It has been shown that the developed sensor allows determining the antibacterial activity of drugs in the studied concentration range with an analysis time of 15 min.

Various research has shown that non-melanocytic malignant skin lesion is one of the most common post-kidney transplant neoplasms. Multiple lesions and a more aggressive clinical course are more common in kidney transplant patients than in the general population. This paper presents a case of malignant skin neoplasms in a patient 10 years after cadaveric kidney transplantation. The patient received standard 3-component immunosuppression with satisfactory graft function (serum creatinine level remained at 157–178 μmol/L). Scalp neoplasm was removed. Histological examination revealed a morphological picture characteristic of basal cell carcinoma with squamous differentiation. Subsequently, a relapse of the skin neoplasm of the temporal region, as well as new lesions in the frontal region and the skin of the anterior chest wall, were discovered. Despite surgical treatment and close-focus x-ray radiation, the disease rapidly progressed and eventually led to death. Squamous cell carcinoma can progress very rapidly in patients after solid organ transplantation, despite ongoing combination treatment. Perhaps in such cases, it is worth cancelling immunosuppressive therapy completely and removing the kidney graft in order to control progression of the malignant tumor process.

Recently, various visualization techniques have been used to study spondyloarthritis (SpA); indices are also being elaborated to assess the progression of radiographic changes in the spine and sacroiliac joints. Most studies dedicated to the problem of coxitis in SpA have shown that its progression parallels with a spinal inflammatory process; however, no indices for assessing the time course of changes in the hip joints (HJs) have been developed.Objective: to develop a method for assessing the radiographic progression of coxitis in early axial SpA (axSpA).Subjects and methods. Examinations were made in 175 patients (mean age, 28±6 years) with axSpA who met the 2009 ASAS criteria and had an inflammatory back pain duration of no more than 5 years. The analysis included 62 patients who had been followed up for at least 2 years and had plain pelvic bone X-ray films at the inclusion in the cohort and at 2 years after starting the follow-up. The sum of stages of radiographic coxitis (ssrC) was used to assess HJ injury progression. During the study, a formula was developed to assess the progression rate of radiographic coxitis.Results and discussion. The median difference in ssrC (ΔssrC) was 0.78 [0; 4] at baseline and at 2 years. During the study period, 63% of the patients showed no progression of ssrC; the latter increased by 1 score in 7 (11%) patients, by 2 scores in 11 (18%), by 3 scores in 1 (2%), and by 4 scores in 4 (6%). The ssrC averaged 0.54±0.79 at baseline and increased by 0.78 up to 1.32±1.34 (p=0.06) at 2 years. At baseline, the coxitis progression rate averaged 0.45 per year (it was conventionally accepted that the patients exhibited no signs of HJ injury at onset of the disease: ssrC was zero); that was 0.54 and 0.1 per year at 1 and 2 years of follow-up, respectively.Conclusion. The proposed calculation procedure is easily feasible and applicable in real practice, does not lead to additional investigations, and is economically feasible. This procedure allows monitoring the rate of radiographic coxitis progression in patients with axSpA throughout the course of the disease.

Prototype filters have wide usage for the design of filters with required quality indexes (QI) of gain-frequency response (GFR). The designed filter is obtained from a prototype filter b means of frequency transformation, which preserves these QI. But most of employed frequency transformations result in variations of QI of phase-frequency response (PFR). In this paper we proposed to use prototype filters that are Pareto-optimal for QI of GFR and PFR. Transfer functions of these filters may be found by means of heuristic optimization algorithms. This method will be efficient if the frequency transformation preserves the optimality of filters. It was shown that frequency transformation has this feature if it preserves the result of QI comparison (more or less) for filters with equal orders. Compliance of this criterion was checked for bilinear transformation of analog low pass filters (LPF) into digital LPF and for Konstantinidis transformation of digital LPF into other digital LPF. The analysis showed that Pareto-optimality for QI of GFR and PFR is preserved if the delay-frequency characteristic of the filter has a minimum at zero frequency and has a maximum at the upper boundary of the pass band. These conditions are complied for LPF with sufficiently small unevenness of GFR in the pass band and sufficiently fast decline of GFR at higher frequencies. Examples confirming these conclusions are given.

Erosive osteoarthritis (EOA) of the hand is an osteoarthritis (OA) phenotype that is characterized by central and marginal erosions of the articular surfaces in the distal and proximal interphalangeal (DIP and PIP) joints and in some cases by a fairly aggressive course with obvious pain syndrome and a high level of functional impairment. Diagnostic criteria and management tactics for EOA patients are still under investigation.Objective: to evaluate the nature of the changes detected by hand joint magnetic resonance imaging (MRI) in patients with EOA and non-erosive OA (NEOA) of the hand.Subjects and methods. Examinations were made in 61 females meeting the American College of Rheumatology (ACR) diagnostic criteria for hand OA; the patients' mean age was 66.34+5.79 years; the median age at disease onset was 50 [45; 56] years; the duration of pain was 15 [11; 20] years. All the patients underwent MRI of the second-fifth DIP, PIP, and metacarpophalangeal (MCP) joints of the right hand. The patients also filled out the AUSCAN questionnaire. EOA and NEOA were detected in 30 and 31 patients, respectively.Results and discussion. The patients with EOA and those with NEOA were matched for gender, age, and disease duration. The DIP joints in patients with EOA were found to have significantly more frequently and a greater number of large osteophytes (OPs), (53 and 16%, respectively), joint space narrowing (JSN) (73 and 35%), degenerative collateral ligament changes (DCLCs) (93 and 55%), subluxations (47 and 13%), and bone marrow edema (BME) (57 and 19%) than in those with NEOA. Synovitides and subchondral cysts occurred with approximately the same frequency in EOA and NEOA. The PIP joints in patients with EOA significantly more frequently showed BME (37%) and DCLCs (97%) than in those with NEOA. Subluxations in the PIP joint of the right hand were encountered exclusively in patients with EOA. Their incidence was 17%. Degenerative symptoms (small, less often moderate sizes of OPs, JSN, and DCLCs) were identified with approximately the same frequency in both groups (p>0.05). The PIP joints in patients with EOA were significantly more often found to have BME (53 and 26%, respectively; (p0.05). Large OPs in the PIP joint were found relatively rarely. Subluxations in the PIP joints were undetected in both groups.Conclusion. The symptoms of active inflammation are predominant and degenerative changes are more pronounced in patients with EOA unlike those with NEOA. Articular surface defects in the PIP joints in patients with hand OA differ from erosions in those with rheumatoid arthritis. These CDs in EOA are much more common than those in NEOA; however, the nature of their occurrence is unclear; therefore, the patients in whom they have been found need dynamic monitoring.

It is known that multivisceral resections (MVR) are associated with significant numbers of post-operative complications. However, the effectiveness of MVR in increasing the patients' life expectancy remains a matter of debate. Are the risks of extended volume resections justified? It has been previously assumed that the removal of adjacent organs could improve the prognosis of the disease, even in the absence of direct invasion. However, in the era of the big potential of chemoand radiation therapy, the implementation of an over-extensive surgical volume in the absence of tumor invasion is doubtful. In the presence of regional lymphatic nodes metastases, MVR do not improve prognosis, compared to that after palliative resections. If the patient has distant metastases, or the operation has been obviously not radical enough, MVR worsen the prognosis. In grade T4b invasion and with the absence of life threatening complications, it is optimal to start with neoadjuvant or perioperative chemotherapy. In the case of intraoperative suspicion of adjacent anatomical structures involvement, with no distant metastases, en bloc resection in combination with D2 lymphodissection is indicated. In approximately 30–60% of cases, invasion is not confirmed by histology. The only way to improve the results of surgical treatment of gastric cancer patients is to carefully assess the extension of the disease at the preoperative stage, select patients and team work of surgeons with chemotherapists, radiologists and specialists in diagnostics.