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The training of healthcare professionals must include practical training when they can interact with patients and apply the latest techniques to develop clinical thinking and ethical principles. To ensure the quality of education and the development of the healthcare system as a whole, it is crucial to enable medical students to deepen their skills at various specialized departments. However, one of the problems is the lack of practice and opportunities for independent work in real conditions that can lessen the quality of training outcomes and complicate young doctors’ adaptation to professional activities and environment. The primary objective of clinical practice is to develop professional skills and competencies, such as gathering and analyzing medical information, identifying necessary laboratory and instrumental tests, and evaluating their results. Practical skills, including diagnosing, preventing, and treating illnesses, working with medical documentation, and evaluating the impact of determinants on health status, are also taught. Engagement in carrying out sanitary, hygienic and preventive measures, while considering social and ethical aspects, is equally important. Medical students have practical training in hospitals and clinics across various fields of medicine. For example, they learn to manage physiological pregnancy and take delivery at obstetric or maternity departments, to assess the child development and provide preventive vaccinations in paediatric clinics, as well as to handle emergency medical care in extraordinary situations and military operations. Modern digital technologies and programs, such as e-books, video lessons, and online courses, have made learning more efficient. However, it is still important for students to develop teamwork and leadership skills and proficiency in both Ukrainian and English. By engaging in practical training, medical students can avoid professional mistakes and provide highquality medical care for patients.

Diseases of various joints among adults in Russia are noted in 33 %. Among them, 10 to 15 % of patients require surgical treatment. Endoprosthesis replacement of large limb joints is a highly demanded high-tech operation that significantly improves the functional motor capabilities and quality of life of the patient. The aim of the study: to highlight the problematic issues of fnancing high-tech medical care in the profle «Traumatology and Orthopedics».Materials and methods. On the example of hip and knee arthroplasty, an analysis was made of the realities of fnancing high-tech medical care in a changing fnancial and economic environment.Results. Proposals are presented to bring the costs closer to the cost standards in the provision of high medical care, adjust tariffs, redistribute the burden on federal institutions in the provision of traumatological and orthopedic care.Conclusion. The forthcoming changes in funding sources for knee and hip arthroplasty will increase the fnancial defcit in the provision of these types of care, especially in revision arthroplasty; will lead to a deterioration in the quality and results of treatment – an increase in the number of complications and repeated revision operations. The proposed measures are focused on the optimal use of budgetary resources.

Treating purulent wounds of soft tissues using negative pressure has been in the focus of recent medical studies. Among various biochemical indicators, the dynamic changes in the content of C reactive protein (CRP) have not been sufficiently studied yet, and the correlation between the CRP and the application of physical methods of treatment of purulent wounds is still not studied well. The aim of this study is to investigate the changes in CRP indicators in the blood serum in patients with purulent wounds of soft tissues of various localizations during the treatment using vacuum therapy. Subjects and methods. 89 patients with purulent wounds of soft tissues of various localization participated in the retrospective study. The patients were divided into two groups: I group included patients who received vacuum therapy with instillations of L-arginine under the course of standard treatment (n=44), and II group included patients who received standard vacuum therapy (n =45). Blood samples were taken from patients of both groups to determine the CRP content before surgery and in 5 and 9 days after the beginning of the treatment. Results. At the first stage of the study, CRP values in the blood serum of all patients averaged 90.4±4.73 mg/l, and at the second stage in 5 days after the first course of vacuum therapy, there was a slight decrease in CRP values which on average were equal to 61.9±3.98 mg/l (p>0.05). At the third stage (after the second course of vacuum therapy, in after 9 days of the treatment), the CRP level decreased compared to the first and second stages and was on average 32.91±3.28 mg/l (р=0.01). In I group of patients, the average CRP level at the first stage was 90.14±4.22 mg/l, and in the second group – 95.66±5.03 mg/l (p>0.05). The CRP content at the 2nd stage in the patients of I group was on average 39.85±4.81 mg/l and 84.13±4.58 mg/l in the patients of II group (p>0.05). At the 3rd stage of the treatment, the average level of CRP was equal to: 12.61±3.27 mg/l in patients of I group and 53.22±3.49 mg/l in patients of II group (р

Despite advances of modern medical science, the consequences associated with management of complications in type 1 diabetes mellitus (DM1) in children and adolescents represent a serious problem. Common development of microvascular diabetic complications (retinopathy, neuropathy, kidney damage) still remains a sufficient obstacle for achieving high quality of life and social adaptation in the young patients, thus promoting studies of immune mechanisms involved in genesis of microvasculature damage under the conditions of dysmetabolic abnormalities associated with DM1. Our goal was to assess the role of altered cytokine balance in blood serum in development of microangiopathies in adolescents with DM1.140 adolescent patients with type 1 diabetes aged 14-18 years were examined being divided in 2 groups: group I included the patients with glycated hemoglobin (HbA1c) level of > 9.0% (n = 65), and group II which included adolescents with HbA1C level of ≤ 9.0% (n = 75). Each group was divided into subgroups: Ia (n = 50) and IIa (n = 38) included adolescents with diabetic retinopathy, nephropathy or neuropathy, whereas groups Ib (n = 15) and IIb (n = 37) were without microvascular complications. The control group consisted of 36 adolescents with normal body weight, without carbohydrate metabolic disorders, and family history of diabetes mellitus. Determination of TNFα, IL-1β, VCAM-1, fractalkine levels in blood serum was performed by enzyme immunoassay using test systems “RayBiotech” (USA), “BIOSCIENCE” (USA).Development of microangiopathies in adolescents with different glycemic control is associated with increased serum concentration of the factors involved in neoangiogenesis and vascular wall remodeling, i.e., TNFα, IL-1β, VCAM-1, compared with control group (p < 0.05), and a statistically significant decrease in fractalkine level in adolescent patients with either complicated, or uncomplicated DM1. The study allowed us to suggest that occurrence of microvascular complications in adolescents with DM1 is associated with impaired immune response tending for altered cytokine balance towards Th1 type, enhanced intercellular interactions, imbalance of bioregulatory molecules, contributing to development of inflammatory immunoregulatory state. The revealed patterns of laboratory markers, along with assessment of metabolic indices, will enable personalized approaches to early diagnostics of microvascular complications in adolescents with DM1 and prevent their further progression.

In recent years, the incidence of purulent septic soft tissue diseases has decreased insufficiently. In order to improve the results of surgical treatment of purulent soft tissue processes, vacuum therapy with instillations of L-arginine, a nitric oxide donor solution, has been developed. This method is complementary to the complex surgical treatment: it accelerates wound cleaning, reduces microbial contamination, and causes a wound surface decreasing, promotes the development of tissue granulation and epithelisation processes. This article presents the clinical case of successful application of vacuum therapy with the nitric oxide donor (L-arginine) installation in a patient after the drainage of phlegmon in the right thigh. The patient underwent a course of vacuum instillation therapy, which consisted of three changes of sponge and tubes after their use for three days. After a course of local instillation vacuum therapy, the patient's condition became better. Starting from day 3, there was a decrease in the number of leukocytes and erythrocyte sedimentation rate in the general blood test and, accordingly, decreased leukocyte intoxication index, and on day 4 there was no hyperaemia and oedema. When opening the phlegmon from the wound infected by St. aureus, and during vacuum instillation therapy with a solution of donor nitric oxide microbial decontamination the results of intermediate cultures were not observed. The wound was completely cleaned, filled with pale pink granulations, which allowed for 10 days to put secondary sutures on the wound, which were removed on the 7th day in the ambulatory after complete healing of the wound.

The results of the research of somatic chromosomal instability: aneuploidy and polyploidy in the blood cells of high-yield Holstein cows with the productivity of more than 9000 kg have been presented in the article. The research was conducted in JSC Vaganovo, Promyshlennovsky District, Kemerovo Region on the population of Holstein cows. Sample preparation was carried out accord- ing to P. Moorhead et al. Samples were stained using the Romanowsky-Giemsa method. The authors studied 6068 metaphase plates in a group of 30 healthy animals. Aneuploidy was counted according to the practice of N.P. Bochkov et al. The authors also analysed the ecological situation in the area of keeping and breeding cattle. Studies of soil, fodder, organs and tissues in farm animals of different species confirm that heavy metal and chemical pollutants are not contaminated in Western Siberia, and their levels are within sanitary norms. Therefore, the ecological situation in the study area should be considered safe. The study shows that the frequency of polyploidy was 0.59% in the studied sample. Tetraploidy, triploidy, and hexaploidy rates were 0.33; 0.18 and 0.06, respectively, the frequency of true hypoploidy was 0.73, and the number of diploid cells was 84.7%. The data obtained can be tentatively applied as average values and can also be used to evaluate the interior of the animals.

Gd2(WO4)3 and Gd2(WO4)3:0.5% Tm3+, 10% Yb3+ nanopowders have been prepared by the Pechini method and solid-state sintering. According to X-ray diffraction results, the materials prepared by the Pechini method are more uniform in phase composition. Optimal synthesis conditions were defined: t = 900°C and τ = 1 h for Gd2(WO4)3 and t = 950°C and τ = 3 h for Gd2(WO4)3:0.5% Tm3+, 10% Yb3+. The surface morphology of the materials has been studied by scanning electron microscopy. The samples prepared by solid-state sintering have been found to be highly agglomerated, and large agglomerates have been shown to persist even after ultrasonic processing. The average size of the doped and undoped nanoparticles prepared by the Pechini method has been determined to be 44.0 and 47.6 nm, respectively. Luminescence spectra of Gd2(WO4)3:0.5% Tm3+, 10% Yb3+ were measured and compared the intensities of the Tm3+ 1G4 → 3H6, 1G4 → 3F4, 3F1,2→3H6, and 3H4 → 3H6 radiative transitions in the materials prepared by both methods. The data obtained in this study demonstrate that the Pechini process is a preferable and promising method for the synthesis of Gd2(WO4)3 and Gd2(WO4)3:Tm3+,Yb3+ nanopowders.

The authors have studied the genetic value of producers of the aboriginal Kulunda finewool sheep breed based on various analysis methods of the productivity of their progeny. The data on 574 offspring (daughters) received from 16 rams-producers of the “Steptoe” breeding farm of Altai Krai were used in the research. The genotypes of ram progeny were evaluated by the productivity of the rams at one year of age. In assessing the fathers, the number of effective daughters needed to confirm a sufficient number of offspring was calculated. Water, soil, and feed were tested for heavy metals content in the sheep breeding area, which did not exceed the MPC (Maximum Permissible Concentration). The breeding indices of the progeny ranged from 114 to 1562. The live weight of the rams was 120 kg. The live weight of the daughters was 50.0 kg. The sheep (daughters) had a wool gain of 5.7 kilograms per ewe. The authors established a high homogeneity of the genotypes of rams producers in terms of the live weight of daughters. The genetic variability of the fathers was 3.2%. According to productivity indices, the rams-producers (#4452, 26133, 3611, 0125 and 44244) occupied the first five ranks. The effect of the genotypes of ram producers on the daughters’ live weight and wool hair gain was established. The ranking data showed the advantage of daughters in several traits obtained from prepotent producers. The authors suggest that ram sires no. 3611, 0125, 26133 and 44244 should be used extensively to improve breeding efficiency. The authors also applied the Hozo method in the absence of normal distribution of traits. In other cases, data processing by methods of variation statistics was used.

The purpose of the work was to analyze the frequency of chromosomal instability in different species of agricultural animals in Western Siberia on the basis of literature data. The analysis of the literature on the topic of somatic chromosomal instability in agricultural animals has been carried out. Despite the stability of the chromosome set, deviations from it are quite common. It is noteworthy that chromosomal instability is characteristic of almost all individuals in the population and serves as an important indicator for assessing the natural mutability of chromosomes. It has been found if an aberration appeared in one tissue, it is very likely to occur in others. It has been noted that somatic chromosomal instability occurs in animals with reduced reproductive function, as well as those suffering from any pathology. For example, in calves with parakeratosis the increase in the frequency of chromatid and isochromatid breaks has been found. Analysis of the frequency of aberrations in sires, which differ in the level of perinatal mortality of offspring revealed the increased percentage of offspring mortality in fathers with the large number of chromosomal disorders. Therefore, low fertilization, spontaneous abortions and stillbirths may be indications for karyotypic analysis. It has been revealed that the lability of the karyotype is inherent in all animal species, regardless of the species, sex and age, as well as the morphofunctional state. The data on some types of somatic chromosomal instability in different types of farm animals in Western Siberia has been presented. Such indicators as the frequency of polyploidy, the number of cells with fragments of chromosomes, as well as single and paired fragments of chromosomes has been given. Different types of chromosomal instability varied depending on the animal species and climate zone. The presented data can be accepted as a physiological norm and used in veterinary medicine and animal science.

Objective: the study aimed to reveal the daily periodicity of labor, the nature of melatonin metabolism, and the outcome of childbirth in women with a physiological and complicated pregnancy, depending on the sex of the fetus.Materials and methods: to study the chronophysiological characteristics of birth outcomes depending on fetal sex, 1 980 birth histories and stories of newborns were analyzed. The neonates were born between January 1 and December 31, 2016, in a maternity ward of the Federal State Budgetary Educational Institution of Higher Education “RostGMU” of the Ministry of Health of Russia. Melatonin production was identified by the level of urinary excretion of 6-sulfatoxymelatonin (6-SM) (its main metabolite) examining the morning portion of the urine of women by the ELISA method (at 8 am 3 ml of urine were collected in Eppendorf tube).Results: it was revealed that fetal sex modulated the activity of the central regulatory mechanisms responsible for the daily period functional processes in the female body and the initiation of labor. The largest number of spontaneous births by male fetuses occurred in the early evening before midnight when daily illumination was decreased, while the birth of girls was observed more often in the period from midnight to early morning. At the same time, mothers of boys had lower production of melatonin compared to that of girls’ mothers.Conclusions. The peculiarities of labor and birth complications associated with the sex of the fetus were identified.

A study of the impact of service factors on Ti-6Al-4V alloy hydrogenation at temperatures close to climatic is performed on the example of a failed hydrogen compressor. It is established that under high gas pressure conditions and possible metal heating hydrogen saturation of Ti-6Al-4V alloy can reach significant values that surpass those acceptable by one to two orders of magnitude. Hydride phases are determined in the alloy by X-ray phase analysis. Temperature programmed desorption provides identification of phase transitions occurring during hydrogen evolution from the metal.

Research of hydrogen diffusion in VT6 alloy is carried out considering different types of heat treating and hydrogen charging. The influence of microalloying on the susceptibility to hydride formation and embrittlement of titanium alloys is analyzed, and also effects of an oxide film on hydrogen charging during heat treatment without protective atmosphere, are studied.

Background Added sugars' deleterious effects have been established for several chronic diseases, leading food industries to turn towards high-intensity sweeteners. Their safety is debated and findings remain contrasted regarding their role in the etiology of various diseases. In particular, their carcinogenicity has been suggested by several experimental studies but epidemiological data are lacking. Thus, our objective was to investigate the associations between sweetener intakes (total from all dietary sources, and most frequently consumed: acesulfame-K e950, aspartame e951 and sucralose e955) and cancer risk (overall and by sites). Methods Overall, 102,046 adults from the French NutriNet-Santé prospective cohort (2009-2021) were included. Consumption of sweeteners was obtained by repeated 24h-dietary records including brands and commercial names of industrial products. Associations between sweeteners and cancer incidence were assessed by multi-adjusted Cox hazard models. Results Compared to non-consumers, high-consumers had higher risk of overall cancer (n = 2527, hazard ratio=1.12, 95% confidence interval=1.00-1.25, P-trend=0.005). In particular, acesulfame-K (HR = 1.18 [1.04-1.34] P = 0.003) and aspartame (HR = 1.20 [1.05-1.38] P = 0.001) were associated with increased cancer risk. Similarly, higher risks were observed for breast (n = 723, HR = 1.25 [1.02-1.53] P = 0.01, HR = 1.39 [1.11-1.74] P = 0.003 and HR = 1.33 [1.05-1.69] P = 0.007 for total sweeteners, e950 and e951, respectively) and obesity-related cancers (n = 1509, HR = 1.16 [1.00-1.33] P = 0.02, HR = 1.23 [1.04-1.45] P = 0.01 and HR = 1.22 [1.02-1.45] P = 0.01 for total sweeteners, e950 and e951, respectively). Conclusions These results suggest that artificial sweeteners (especially e950 and e951), which are found in > 12,000 foods and beverage references worldwide, may be associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of sweeteners by the European Food Safety Authority. Key messages In this large-scale prospective cohort of French adults, intake of high-intensity artificial sweetener intake (especially acesulfame-K and aspartame) was associated with higher risk of cancer. These results provide novel insights to feed EFSA’s expertise for the ongoing risk assessment of artificial sweeteners.

The paper analyzes heavy zinc metal accumulation in the wool of descendants obtained from the Romanov stud rams. The experiment was conducted in the Kuzbass region at OAO “Vaganovo” on the Romanov sheep populations. Zinc concentration in sons’ wool samples was determined by means of applying inverse voltammetry method on TALAB voltammetric analyzer. In the zone of sheep breeding, the researchers used the materials of the Institute of Soil Science and Agrochemistry of the Siberian Branch of the Russian Academy of Sciences for analyzing zinc concentration in the environment. They observed. there was no zinc excess in all the samples. The study of soil, fodder, organs and tissues of agricultural animals of different species confirms that in Western Siberia there is no heavy metal pollution outside the sanitary protection zones. The authors found out the impact of the Romanov stud rams’ genotype on the accumulation of zinc in the wool of the offsprings. The differences in the phenotypic variability of zinc concentration were revealed in the offspring of different fathers. The article demonstrates that the zinc concentration of some fathers’ sons’ wool was 1.6 times higher (97.2 mg/kg) than that of descendants of other stud rams. A group of semi-sibs was found, which were characterized by low hereditary predisposition to zinc accumulation in wool. Due to the lack of data on zinc concentration in the wool of Romanov animals in Siberia, the obtained data can be applied as a physiological standard.

The aim of the study is to develop and scientifically justify a new method for treating patients with gingival recession using autologous mesenchymal stem cells of adipose tissue. Objects and methods. A complex treatment was conducted in 93 patients with an anatomical recession of the gums in combination with dentoalveolar anomalies at the age of 20 to 34 years. Patients were divided into 3 groups (1st, 2nd and 3rd groups) depending on the treatment used. All patients underwent periodontological treatment. In the second group, patients included periodontological treatment including orthodontic equipment, in the third group, orthodontic treatment and the use of a cell transplant on the basis of a mixture of autologous mesenchymal stem cells and sterile bioplastic collagen material “Collost”. Results and discussion. A comprehensive assessment of the periodontal tissue of the three groups showed that among the patients who received the standard treatment complex, a good condition of the periodontal tissues 1 to 2 years after treatment was noted only in 16.7% of the patients of the 1st group. Inclusion of orthodontic treatment made it possible to obtain good results in 25% of patients in the 2nd group, which is 8% more than in the 1st group. At the same time, good results of treatment were revealed in 94% of patients in group 3, who included periodontological and orthodontic treatment using autologous mesenchymal stem cells, which confirms the need for measures aimed at normalization position of teeth, dentition and bite with the use of small orthodontic long-acting forces, improving microcirculation of periodontal tissues and restoring the contour of the marginal gum. Conclusions. Inclusion of autologous mesenchymal stem cells in the complex treatment of patients with gingival recession is accompanied by a 1.6-fold decrease in the prevalence and gum recession (1.15 mm), and tissue volume increased 2.6-fold, stimulation of periodontal microcirculation processes (in terms of capillary the periodontal pressure was 1.1 times and the intensity of periodontal microcirculation was 3.1 times), as well as the normalization of the position of teeth, dentition and occlusion, which allowed to obtain good long-term results in 94% of patients.

First results are presented of reconstructing the evolution of magnetospheric configurations through the full cycle of isolated substorms. The modeling covers the low- and mid-latitude magnetosphere in the range of radial distances from 2 to 20 Re and is based on a synthesis of (1) a high-resolution representation of the magnetic field by cylindrical basis functions, (2) the ever largest pool of magnetospheric and interplanetary data spanning the last quarter century (1995-2019), (3) an archive of concurrent ground-based indices and their temporal trends, quantifying the geomagnetic activity over the full range of latitudes, including the low-latitude ring current SMR-index, the midlatitude positive bay MPB-index, the auroral SML-index, and the polar cap PC-index, (4) the data-mining nearest-neighbour (NN) technique of the data selection and weighting in the geometric and parametric spaces. The obtained successive diagrams of magnetic depression/compression, electric current, and field line maps demonstrate all the typical features of the substorm cycle: the initial relatively slow stretching of the nightside tail during the growth phase, followed by its sudden collapse associated with a dramatic disruption of the tail current at R~11-16 Re, and finally a gradual recovery of the configuration after the expansion phase is over.

Objective of the study was to improve efficiency, safety and ergonomics of laser lithotripsy through both modifying temporal profile of the laser pulses and manipulating various characteristics of the pulse sequence. Specifically, modulating the pulse energy and the peak power (amplitude modulation - AM) as well as modulating the repetition rate (frequency and amplitude-frequency modulation – FM and AFM, respectively) were investigated in vitro using a super-pulse Tm fiber laser . Benefits of AM and AFM (but not FM) for decreasing the treatment time and reducing the retropulsion effect are shown.

During investigation of endogenous fluorescence of different types of cicatricial deformities in vivo unexpected results on fluorescence of lipofuscin were obtained. Increased lipofuscin fluorescence was detected in both scar and intact tissues in patients suffering from the keloid scar.

We compared the cutting and coagulation efficiency of the blue laser, the Tm laser, and the combination of them during laparoscopic partial nephrectomy (LPN). The combination of the blue and Tm lasers provided the most promising results in terms of resection rate and hemostasis.

We conducted a theoretical and experimental study of thermal fields created in bovine knee cartilage in vitro by fractional treatment with an Er fiber laser (1.56 µm). The data were used to identify laser parameters suitable for fractional laser procedure to induce cartilage regeneration.

We conducted an experimental ex vivo study of feasibility using a picosecond (ps) laser emitting at 1030 nm for precise minimally invasive (micro) surgery. The results indicate that plasma generated by the ps laser enables deep and coagulation-free ablation. Thus, ps laser technology can be of high value for dermatology as well as for other specialties requiring precise cutting.

Background Age-related hearing loss is prevalent yet insufficiently addressed by public health research. Subjective hearing loss has been highlighted as a key determinant of reduced quality of life, while chronic low-grade inflammation is an established determinant of adverse age-related outcomes. To our knowledge, this study was the first to investigate the link between the inflammatory potential of the diet and hearing loss. Methods We prospectively studied 3,435 French adults enrolled in the SU.VI.MAX (1994-2002) and SU.VI.MAX 2 (2007-2009) cohorts. The inflammatory potential of the diet was estimated by the Dietary Inflammatory Index (DII) using established methodology and repeated, baseline 24-h dietary records. Subjective hearing impairment was assessed after a median of 12 years by 3 Yes/No items and by a composite score, dichotomized for analyses. We fit multivariable logistic regression models adjusted for pertinent covariates. Results Compared to men, women exhibited higher DII (more pro-inflammatory diet) and less hearing impairment (both p Conclusions The findings among men support the hypothesis that a pro-inflammatory diet could increase risk of age-related hearing loss, whereas the findings among women were unexpected and merit further investigation. Key messages Given rapid population aging worldwide, there is an urgent need for public health research on modifiable risk factors of hearing impairment. The role of diet in hearing impairment is complex and likely sex-specific; a pro-inflammatory diet might be a risk factor for hearing impairment, especially among men.

The digital economy is included in the list of the main directions of strategic development of Russia. IT specialists are the main driving force of this strategy. Existing training systems do not fully solve the problem of their training. Therefore, it is necessary to improve the pedagogical system of introducing students. The following criteria were selected as the main criteria for improving the IT training system: сompliance of the graduate level with the required competencies; сriterion for the maximum development of the student's abilities, regardless of his initial level. IT specials should perform two main types of professional activity – designing systems based on computer technology and maintenance and use of software and automated systems. It should be noted that when teaching students these types of activities, the process of servicing software or technical systems is not difficult for students, designing simple systems causes students big problems because it requires a large amount of additional research on the design object. The author’s technologies for the development of research abilities are designed in such a way that in the learning process the student moves from the reproductive to the productive level: first, the activity is perceived as a research one, then, after accumulating knowledge and skills, it becomes an everyday tool, that is, perceived as a reproductive activity. Designed work programs for IT specialists training and complexes of developmental tasks with correction for changing IT have been used for many years in various universities in Samara.