Objective: to conduct a comparative morphological analysis of helicobacter pylori (H. pylori) and autoimmune gastritis and to determine the significant morphological criteria for differential diagnosis.

Materials and methods. 30 cases of chronic atrophic helicobacter gastritis and 30 cases of chronic atrophic autoimmune gastritis were retrospectively selected for the study. In all cases of helicobacter gastritis, the presence of H. pylori was confirmed by morphological diagnostic methods using Giemsa staining or additionally using immunohistochemistry. All cases of autoimmune gastritis were additionally confirmed by clinical and laboratory diagnostic methods, some patients had a long history of follow-up and biopsy material was taken from them repeatedly. A prerequisite was taking at least 5 biopsies according to the Sydney Protocol.

Results. The main differential diagnostic feature in our study was the detection of H. pylori, as well as the localization of the lesion in the stomach body characteristic of autoimmune gastritis and in the antrum in helicobacter gastritis. The study groups differed by gender (the predominance of females in the group of autoimmune gastritis), the prevalence and activity of inflammation (all cases of helicobacter gastritis had signs of inflammation activity). When studying the content of neuroendocrine cells in cases of helicobacter gastritis in the stomach body, simple hyperplasia of neuroendocrine cells was noted, in cases of autoimmune gastritis, the appearance of chains and nodules was noted, which corresponded to linear and nodular hyperplasia of neuroendocrine cells.

Conclusion. The morphological criteria obtained in the study make it possible to make a differential diagnosis between helicobacter and autoimmune gastritis. This is extremely important because of the differences in treatment approaches and dynamic monitoring tactics in these variants of chronic gastritis.

Introduction. When compiling the final clinical, pathoanatomical and forensic diagnoses, as well as choosing and coding according to ICD-10 the initial cause of death in patients after organ transplantation, difficulties often arise due to the lack of unified recommendations.

Materials and methods. We analyzed 60 protocols of post-mortem autopsies of lethal outcomes in patients after organ transplantation at the Sklifosovsky Research Institute of Emergency Medicine, Moscow for 7 years (from 2016 to 2022).

Results. Based on the results of the analysis, taking into account the literature data, recommendations were formulated on the formulation of the final clinical, pathoanatomical and forensic diagnoses, selection and coding according to ICD-10 of the initial cause of death in patients after solid organ transplantation.

Findings. The developed recommendations on the formulation of the final clinical, pathoanatomical and forensic diagnoses in cases of death of patients after solid organ transplantation can be used in the daily practice of clinical doctors, pathologists and forensic experts.

Introduction. Trophic ulcers are one of the most common medical ailments worldwide. Treatment of patients with trophic ulcers is difficult not only because they often recur, but also because they are difficult to treat.
Purpose. Study the clinical features and present our own results of combined methods of treatment of trophic ulcers of venous etiology.
Materials and methods. The study involved 100 patients with trophic ulcers of the lower extremities of venous, diabetic and atherosclerotic etiology, who had a history and were treated for varicose veins of the lower extremities and post-thrombotic disease. Examination of patients included questionnaires, clarification of complaints, anamnesis data, causes of development, examination and ultrasound diagnostics (duplex examination). The examination of the ulcer included determining the location, size, appearance, base of the wound, the level of exudation and assessment of the condition of the skin around the defect.
Results. The etiological factors in the development of trophic ulcers were: varicose disease with chronic venous insufficiency – 25 patients, post-thrombotic disease – 55 patients. All patients underwent only conservative treatment of trophic venous ulcers with the appointment of a placenta compositum. After the treatment of a group of patients, out of 100 patients with venous trophic ulcers, 89% were cured within 4 months, 8% were cured within 2 years, and in 3 % ulcers did not heal for more than two years. The average duration of the course of ulcers was 12 months. The average size of trophic ulcers based on the results of the analysis was 8 cm². Complete healing of venous ulcers was most often observed in the age group 61–73 years in 30% patients.
Conclusion. The use of the compositum placenta contributed to the acceleration of wound healing, which made it possible to obtain more effective results.

The population of Russia, as well as the population of the developed countries, is steadily aging. Atherosclerosis in elderly patients is most often manifested by acute and severe forms, such as heart attack and stroke. With age, there is an intensification of oxidative processes and a decrease in the activity of antioxidant enzymes. Creation of experimental model of dislipoproteinemia followed by skeletal muscle mechanical trauma in rats will allow to reveal the regularities of oxidative homeostasis changes and use the data obtained in therapy of elderly patients with atherosclerosis.

Aim of the investigation: to study the dynamics of catalase activity in blood and tissues of aged rats under oxidative stress caused by modeling of dyslipoproteinemia followed by mechanical injury of skeletal muscle.

Materials and methods. The investigation was performed on 120 white non-pedigreed healthy male rats aged 24 months (old rats) weighing 230–250 grams. All animals were divided into four groups, 30 rats in each. The animals in the first group were intact rats, to which no treatment was applied. The animals in the second group had a mechanical dissection in the middle third of the hind limb calf muscle. Animals in groups one and two were on a standard vivarium diet and had free access to water and food. The animals of the third and fourth groups were subjected to simulated dyslipoproteinemia for 63 days and received a high-carbohydrate and high-fat diet with an increased fat content up to 30% by weight of dry matter and replacement of drinking water by a 20% fructose solution. After a certain period of time, the animals in the fourth group underwent injuries of the middle third of the hind limb calf muscle.

Conclusions. Mechanical trauma combined with dyslipoproteemia in aged rats is characterized by intense oxidative stress and leads to the decrease of activity of the antioxidant enzyme catalase in blood and liver tissues. 

The purpose of this study was to evaluatey the effect of dark deprivation of various durations on the course of the metabolic syndrome (MS).

Material and research methods. To achieve this aim, based on WHO criteria, we selected patients with MS and disturbed circadian rhythms – a total of 102 people (all men) from among people who constantly work at night, in whom a decrease in melatonin levels was recorded at a preliminary stage. In accordance with the tasks set, 102 patients (all men) of working age (young age according to WHO criteria) were divided into three groups of 33, 37 and 32 people, respectively, according to the criterion "duration of work at night and duration of history of MS": 0–5, 5–10 and over 10 years. In the first group, the mean age was 30.1 ± 1.4 years; in the second group, the mean age was 36.5 ± 1.5 years; in the third group, the mean age did not exceed 40.3 ± 0.9 years. As a control group, 45 patients with MS were examined, comparable with the main groups in terms of background pathology and age and different duration of MS history.

Results. It was found that the main symptom of MS - abdominal type of obesity (waist circumference more than 80 cm for men) was detected in 100% of patients of the main and control groups of observation. At the same time, it was found that the severity of abdominal obesity is combined with an increase in body mass index (BMI) and tends to increase in patients in the main groups, compared with patients from the control group. In the control group, 35.5% of the examined patients had grade 1-2 hypertension, and another 15.6% had elevated normal blood pressure.

Conclusions: In patients with MS, against the background of violations of regulatory mechanisms, the disease is more severe than in patients with a similar history of MS, but without violations of circadian rhythms. The severity of the course of MS against the background of a decrease in the level of melatonin increases with the duration of the violation of regulatory mechanisms. 

The aim is to study the microbiological picture of purulent inflammation of superficial local burns in the center of thermal lesions of Samara.

Material and methods. The etiological structure of local burn infection was analyzed in 29 patients with limited, borderline burns of I-II degree in all phases of the wound process. The collection of wound material was carried out in accordance with the requirements of the Methodological Guidelines of MU 4.2.2039-05 "Technique of collecting and transporting biomaterials to microbiological laboratories". The material was delivered to the laboratory in test tubes with a transport medium under isothermal conditions at a temperature of 20–22 °C within a day after collection.

Results. The analysis of the etiological structure of burn infection showed that staphylococcus (St. aureus, St. warneri, St. gallinarium, St. spp, St. epidermidis) plays a leading role in microbiological examination – in 26 patients (89.6 %) and E. coli (E. coli) in 11 (37.9 %). There were no significant differences in the studied signs in the comparison groups (p > 0.05, p = 0.55, χ² = 3.841).

Conclusion. The obtained results of the etiological structure of purulent inflammation of limited burns are statistically reliable and can be used in the development of antibacterial agents for the treatment of burn infection. 

The aim of the study – to accelerate the repair of the damaged brachial plexus using cells of the stromal vascular fraction isolated from adipose tissue.

Materials and methods. The study was carried out in 62 patients using stromal-vascular fraction cells from adipose tissue and classical methods of treatment for brachial plexus injury. The effectiveness of regeneration was evaluated using electromyographic examination and positive recovery of motor and sensory function.

Results and discussion. Assessment of the results of surgical treatment with stromal vascular fraction cells from adipose tissue after brachial plexus neurolysis revealed the restoration of early M3-M5 and S3-S4 functions in 90 % of patients, and in the comparison group – 68 % respectively. The number of patients with M4-M5 functions in the group using the stromal vascular fraction for brachial plexus neurotization was 85 %, while in the control group it was 64 %, respectively. Electroneuromyography data also indicated an increase in the average number of motor units by 30 % after using cells of the stromal-vascular fraction from adipose tissue, in contrast to the comparison group.

Conclusion. Stromal vascular cells isolated from adipose tissue appear to be promising stimulants of brachial plexus injury repair.

The purpose of this study was to investigate the incidence of additional cases of malignant neoplasms (MN) in a comparative aspect between the settlement living next to a radioactive waste disposal facility (RWDF) and the indicators of an environmentally clean area of the same territorial unit (region). Evaluation of radiation situation on the residential territory adjacent to the RAW disposal facility in settlement 1, and in settlement 2 (comparison settlement), as well as interpretation of the obtained data was performed in strict compliance with the requirements of regulatory documents specifying requirements to the research object. When performing measurements, the methodology described in the regulatory documents establishing these rules was used: MU 2.6.1.2398-08 "Radiation Monitoring and Sanitary-Epidemiological Assessment of Land Plots for Construction of Residential Buildings, Public and Industrial Buildings with Respect to Radiation Safety". The residents of the settlement 1 were found to be exposed to 3.7 mSv/year, i.e. 54.2% more than the average whole-year exposure dose received by the residents of the settlement 1 from natural background (2.4 mSv/year), which results in excessive risk of MHC development compared to the ecologically clean region. This indicates that excessive risk of MNS can occur even in conditions of radiation background within the considered safe dose of not more than 5 mSv/year. However, this risk is much lower than that from high doses of radiation. This makes it urgent to search for solutions that would allow implementation of the recommendations of the Chief State Sanitary Doctor of Russia regarding reduction of total radiation dose to 1 mSv per year or to develop measures allowing to neutralize harmful effects of radiation exposure on the human body.

Melanoma is an aggressive malignancy of the skin and mucosa of neuroepithelial nature, heterogeneous both in phenotype and molecular genetic characteristics, with a high risk of progression and a steadily increasing incidence of about 5% a year. The development of melanoma is due to both external (UV exposure) and internal factors, the main ones being mutations in oncogenes and tumour suppressor genes. Hyperactivation of RAS/RAF/MEK/ERK signalling pathway is observed in 75% of skin melanoma cases, and one of its key factors is serine threonine kinase encoded by BRAF gene. Oncogenic mutations of BRAF mimic the phosphorylation of the activation loop of the protein, which results in BRAF being in a permanently activated state. Subsequent operation of the MAPK signalling pathway in a non-stop mode and loss of BRAF negative feedback leads to uncontrolled cell growth and proliferation. The most common mutations in the BRAF gene are p.V600E (valine replacement for glutamic acid), which accounts for up to 95% of all BRAF-mutant melanomas, and p.V600K (valine replacement for lysine), which can account for up to 20% of cases or more. Development of non-selective and selective inhibitors of mutant BRAF protein make mutation in this gene a predictive marker of response and efficacy of targeted therapy.

To date, the search for the most informative diagnostic and prognostic echocardiographic criteria for pulmonary embolism is relevant.
Aims. To conduct a critical analysis of the generally accepted echocardiographic criteria for pulmonary embolism in order to establish the most significant of them in determining the severity and outcomes of the disease.
Materials and methods. The study included 42 patients with fatal pulmonary embolism, 51 patients with hemodynamically unstable and 193 with hemodynamically stable course of the disease. The prevalence of generally accepted echocardiographic criteria for overload of the right heart was assessed, followed by their significance for determining the severity of the disease and predicting its outcomes.
Results. It was found that among the generally recognized echocardiographic criteria, the most significant for determining the severity of pulmonary embolism and its outcomes are: an increase in the ratio of basal sizes of the right and left ventricles more than 1.1, an increase in systolic pressure in the pulmonary artery more than 55 mm Hg, dyskinesia of the free wall of the right ventricle, flattening of the interventricular septum, a decrease in systolic excursion the plane of the tricuspid valve is less than 1.6 cm. However, all of them, except the last one, do not have high sensitivity and specificity. The significance of the currently underestimated cardiac stroke volume as a prognostic indicator of echocardiography has been established. It was determined that its decrease of less than 45 ml correlated with hemodynamic instability of the course of the disease, and less than 35 ml was associated with a fatal outcome. This indicator had high diagnostic characteristics.
Conclusion. A decrease in the systolic excursion of the tricuspid valve plane of less than 1.6 cm and a decrease in the stroke volume of the heart of less than 45 ml are the most significant indicators of echocardiography in assessing the severity and prognosis of pulmonary embolism.

Breast cancer (BC) is the most common malignant neoplasm in women in the Russian Federation. Today, biological markers that characterize the individual characteristics of the tumor, such as the tendency to metastasize, hormonal sensitivity, are of great importance for the diagnosis and treatment of patients with breast cancer. Among the genes associated with hereditary breast cancer, there are genes with high penetrance (BRCA1, BRCA2, MLH1, MSH2, STK11, PTEN, TP53 and APC) and genes with moderate penetrance (CHEK2, ATM and PALB2). All of the listed above genes are responsible for DNA repair by homologous recombination, and they represent a group of HRR genes (homologous recombination-related genes). Mutations in the BRCA1 and BRCA2 genes can also initiate cancer of the ovaries, pancreas, and prostate. Understanding of the molecular and genetic nature of an oncological disease allows applying targeted drugs to therapy of a disease.

Intestinal malrotation is a rare congenital anatomical anomaly that results from an abnormal bowel rotation at 10–12 weeks of embryonic development. Clinical manifestations depend on age. In children, intestinal malrotation is manifested by a midgut volvulus (Ladd syndrome). In adults, the presence of intestinal malrotation increases the risk of acute intestinal obstruction. This article presents a case of asymptomatic intestinal malrotation in a 52-year-old female patient. 

The paper describes the results of clinical testing of an apparatus for dosed traction of brachial plexus trunks. It is shown that in the presence of a 5 cm diastasis, it is possible to connect the nerve fragments and perform neurorhaphy without tension by bringing the shoulder to the head and bring the shoulder to the physiological position two and a half months after the reconstructive surgery.

The uniqueness of this clinical case is due to a rare combination of peritalar luxation of the talus with a fracture of its body and posterior process. No description of the same clinical case was found in the literature, however, it has been proven that such injuries have an unfavorable prognosis and are fraught with multiple complications. Also, the limited information associated with the low incidence of this type of severe injury puts practitioners in front of the difficulties of diagnosis and treatment. A 35-year-old man was injured while playing basketball. Upon admission, computed tomography (CT) revealed a fracture of the body of the talus with displacement of the distal fragment and its dislocation in the talonavicular, subtalar and talo-tibial joints, as well as a fracture of the posterior process of the talus. After an unsuccessful attempt at closed reduction, open removal of the dislocation and reposition of fragments were performed, followed by osteosynthesis of the fracture of the body of the talus. In the postoperative period, additional immobilization in the ANF was performed, followed by replacement with a functional orthosis. 6 months after the injury, the patient restored the level of his daily activities almost completely, the control CT showed no signs of post-traumatic arthrosis of the subtalar and ankle joints, how-ever, there were signs of the development of partial aseptic necrosis of the talus. This injury is unique, and despite its severity, the use of the correct treatment tactics can provide a satisfactory clinical and functional outcome.

Graft failure is a group of complications after allogeneic hematopoietic stem cell transplantation, which occurs according to different data up to 30%. The group of complications includes primary and secondary graft failure, primary, secondary and transient poor graft function and graft rejection. Diagnostic difficulties consist in the lack of unified diagnostic criteria accepted in the transplantation community and in the dual interpretation of these complications according to the foreign literature. The purpose of this literature review was to identify the most common criteria of different types of graft failure and determine the tactics of diagnosis and treatment. In this review we analyzed data from various literature sources, gave definitions of graft failure and poor graft function. We analyzed the literature data on the methods used to treat these conditions.

Fulminant liver failure is usually characterized as severe acute liver injury with encephalopathy and synthetic dysfunction (international normalized ratio [INR] ≥1.5) in a patient without cirrhosis or previous liver disease. Management of patients with acute liver failure includes ensuring that the patient is cared for appropriately, monitoring for worsening liver failure, managing complications, and providing nutritional support. Patients with acute liver failure should be treated at a liver transplant center whenever possible. Serial laboratory tests are used to monitor the course of a patient's liver failure and to monitor for complications. It is necessary to monitor the level of aminotransferases and bilirubin in serum daily. More frequent monitoring (three to four times a day) of blood coagulation parameters, complete blood count, metabolic panels, and arterial blood gases should be performed. For some causes of acute liver failure, such as acetaminophen intoxication, treatment directed at the underlying cause may prevent the need for liver transplantation and reduce mortality. Lactulose has not been shown to improve overall outcomes, and it can lead to intestinal distention, which can lead to technical difficulties during liver transplantation. Early in acute liver failure, signs and symptoms of cerebral edema may be absent or difficult to detect. Complications of cerebral edema include increased intracranial pressure and herniation of the brain stem. General measures to prevent increased intracranial pressure include minimizing stimulation, maintaining an appropriate fluid balance, and elevating the head of the patient's bed. For patients at high risk of developing cerebral edema, we also offer hypertonic saline prophylaxis (3%) with a target serum sodium level of 145 to 155 mEq/L (level 2C). High-risk patients include patients with grade IV encephalopathy, high ammonia levels (>150 µmol/L), or acute renal failure, and patients requiring vasopressor support. Approximately 40 % of patients with acute liver failure recover spontaneously with supportive care. Predictive models have been developed to help identify patients who are unlikely to recover spontaneously, as the decision to undergo liver transplant depends in part on the likelihood of spontaneous recovery of the liver. However, among those who receive a transplant, the one-year survival rate exceeds 80 %, making this treatment the treatment of choice in this difficult patient population.

Relevance. Computer simulation is a mathematical modeling process performed on a computer that is designed to predict the behavior or results of a real or physical system. Computer simulation has a number of advantages over classical models of animal experiments: the cheapness of the method (the need to acquire and maintain animals disappears by itself), the speed of obtaining results, the absence of bioethical problems, the ability to change the conditions of the experiment, etc.

he purpose of this study is to review the methods of computer simulation of the wound process, to identify the shortcomings of the models and propose ways to solve them, as well as to select the best existing model for describing wound regeneration.

Material and methods. In the course of this work, an analysis was made of foreign and domestic literature on the problem of computer modeling of the wound process.

Results. After analyzing the relevant literature on this topic, the problem is seen precisely in the insufficiently studied process of wound regeneration, since many different cells, cytokines, growth factors, enzymes, fibrillar proteins, etc. take part in it. The models that currently exist describe wound regeneration only in an extremely generalized way, which does not allow us to apply them in clinical situations. Analyzing literature sources, we came to the conclusion that both numerical approaches, both cellular-biochemical (the first type of models) and phenomenological (the second type) are applicable in the case of wound modeling and can be used very successfully. The problem is that on the basis of one approach it is impossible to display a complete picture of wound healing, in this way it is possible to predict only individual regeneration parameters necessary for certain purposes due to the complexity and versatility of this typical pathophysiological process.

Conclusion. Computer modeling of wounds is still a controversial and complex topic. Existing models are not intended to describe all the processes occurring in a healing wound. It is much more productive to describe the various phenomena during healing separately. This is due to the fact that many elements are involved in the regeneration of the skin, which are almost impossible to take into account in full. The available models are of exclusively scientific value, consisting in attempts to understand all complex processes and interactions. Practical application is difficult, since existing models require specific input data that require highly specialized equipment. If we abstract from all this, then the best existing model of the first type is the model of the authors Yangyang Wang, Christian F. Guerrero-Juarez, Yuchi Qiu and co-authors, in addition to it, any of the described phenomenological models will do. 

The aim of the study is to construct a mathematical model of the kinetics of multiple ethanol intake based on the kinetic equation of zero-order ethanol elimination with absorption and irrevocable first-order absorption deficiency, as well as its implementation in the format of a computer program. Analytical mathematical modeling of the kinetics of multiple oral administration of ethanol is performed on the basis of this kinetic equation. In the course of modeling, a kinetic summation method was developed that allows to perform a mathematical description of the dynamics of ethanol content in the body in the case of repeated intake of alcoholic beverages of any volume and strength, separated by time intervals of any duration. The developed computational algorithm is implemented in the format of the Alcohol Calculator V 3.0 computer program. The conclusion is made about the expediency of using the developed information and computing technology in the forensic assessment of the quantitative alcohol content in the body at a legally relevant time.

Three-dimensional printing opens up many opportunities for use in traumatology and orthopedics, because it takes into account personal characteristics of the patients. Modern methods of high-resolution medical imaging can process data to create threedimensional images for printing physical objects. Today, three-dimensional printers are able to create a model of any complexity of shape and geometry. The article provides a review of the literature about three-dimensional digital modeling in shaping implants for osteosynthesis. Data search was carried out on the Scopus, Web of Scince, Pubmed, RSCI databases for the period 2012–2022. The effectiveness of three-dimensional printing for preoperative modeling of bone plates has been confirmed: implants perfectly corresponds with the unique anatomy of the patient, since the template for it is based on the materials of computed tomography. Individual templates can be useful when the geometry of patients' bones goes beyond the standard, and when improved results of surgery are expected due to better matching of implants to the anatomical needs of patients.

Introduction. Currently, assisted living technologies are actively developing in the Russian Federation. When receiving social services, education, promotion of employment, disabled people need to be accompanied. The effectiveness of these measures depends both on the conditions for the provision of services, the qualifications of accompanying persons, determining the required amount of support, on the ability of a disabled person to live independently and work, and on the readiness of the disabled person to be accompanied when receiving services, including a joint venture.

Target. Rationale for the use of the International Classification of Functioning, Disabilities and Health in assessing the degree of readiness of persons with disabilities to be accompanied when receiving services, including accompanied accommodation.

Materials and methods. Analysis of the results of monitoring the development of joint venture technologies, presented by 85 constituent entities of the Russian Federation for the period 2020–2021 on a wide range of issues, including the organization of employment of people with disabilities who are on a permanent SP and employed people with disabilities, social employment of people with disabilities, training of people with disabilities who are on a permanent accompanied accommodation, organizing a accompanied accommodation in stationary social service institutions, etc., using the ICF in determining the readiness of people with disabilities to be accompanied.

Results. The number of disabled people receiving services within the framework of accompanied accommodation was studied based on materials submitted from 85 subjects of the Russian Federation as of 01.10.2022. The monitoring analysis showed that in 80 subjects of the Russian Federation (94.1 %), work is underway to organize accompanied accommodation. In 2022, there is an increase in the number of disabled people receiving services within the framework of accompanied accommodation to 6649 people, of which 4245 people are on educational (training) accompanied accommodation, 2404 people are on permanent accompanied accommodation.

Discussion. Using the methodology of the ICF, questionnaires were developed, as well as a methodology for assessing the readiness of persons with disabilities to be accompanied when receiving services, including accompanied accommodation, carried out using them.

Conclusions. The developed criteria and methodology for their use make it possible to quantify the degree of readiness of persons with disabilities and children with disabilities to be accompanied when receiving services, including accompanied accommodation, and be used in the preparation of an individual support program.