It is noted that the desire to be immortal is the most important, strongest and oldest, alas, unrealizable dream of a person. A brief review of the history of the fight against human aging in different countries in different eras is given, as well as an analysis of the theoretical justifications for the causes and mechanisms of aging, the development of means and methods for combating old age. It is noted that the universal "geroprotector" is systematic work in its various physical and intellectual variants. It is shown that only the combined efforts of society, the state and the individual can optimally solve the problem of longevity of the country's population.

Primary health care in modern socio-economic conditions is given special attention. This type of medical care makes up a large part of the volume of the entire healthcare system in our country, but the least expensive compared to inpatient care. Practically up to 80 % of all available domestic healthcare resources are annually distributed to provide medical care to citizens in stationary conditions. While in modern conditions it is possible to use the available resources more economically and more efficiently. The introduction of hospital-replacing technologies into the practice of medical organizations, both outpatient and inpatient types, is an undoubted advantage of the development of domestic healthcare. During the COVID-19 pandemic, when most of the hospitals are being converted into infectious diseases hospitals, day hospital treatment has become of paramount importance as the main form of hospital-replacing technologies. At the same time, the day hospital is an intermediate link between the outpatient and inpatient networks. Day hospitals in our country appeared relatively recently, but they have received significant development from the standpoint of the greatest medical, social and economic efficiency of treating patients compared to round-the-clock hospitals under the same conditions. During the pandemic, this circumstance was undeniably proven.

The new coronavirus infection remains a significant medical and social event in the world, and only active immunization of the population with the achievement of the target level of vaccination coverage of at least 60% is able to stop its spread.

Objective: to study the preliminary results of vaccination against a new coronavirus infection caused by the SARS CoV-2 virus in the Samara region.

Materials and methods. The material of this study was the results of statistical monitoring of the incidence of a new coronavirus infection caused by the SARS CoV-2 virus in residents of the Samara region and data on the vaccination campaign. Statistical analysis included descriptive, comparative and interval estimation, as well as correlation analysis.

Results. As of October 2022, 62.6% of the total population in the Samara region has been vaccinated against a new coronavirus infection caused by the SARS CoV-2 virus. Women predominated among those vaccinated – 60.51%. When analyzing the results of the vaccination campaign, statistically significant negative relationships were revealed between the proportion of vaccinated in a certain month and the incidence in the next three months, as well as between the accumulated percentage of vaccinated and the incidence in the next few months. At the same time, morbidity and vaccination in a normalized form for the population does not depend on the size of the population.

Conclusions: Vaccination reduces the risk of a new coronavirus infection caused by the SARS CoV-2 virus in the Samara region by an average of 7.4 times. With the development of a manifest form of a new coronavirus infection caused by the SARS CoV-2 virus, in residents of the Samara region who have undergone a full course of vaccination, the risk of developing severe and extremely severe forms decreases by an average of 1.65 times, and deaths – by 1.71 times.

From the modern point of view, dyslipoproteinemia and its clinical manifestation – atherosclerosis – is a complex multifactorial process, which is based on inflammation, and, as a consequence, oxidative stress.

The aim of the study was to identify the dynamics of the concentration of diene conjugates and malondialdehyde in the blood and liver of rats of different ages under oxidative stress caused by modeling dyslipoproteinemia with subsequent mechanical injury of skeletal muscle.

Materials and methods. The study was carried out on white mongrel healthy male rats 24 months old (120 individuals) and 6 months old (120 adults). All old and young animals were divided into four subgroups within their group, 30 animals each. The animals of the first subgroup in the groups of old and young rats are intact rats. Animals of the second subgroup in each group had a mechanical dissection in the area of the middle third of the calf muscle of the hind limb. Animals of the third and fourth subgroups of each group were subjected to dyslipoproteemia modeling. After the specified time, the animals of the fourth subgroup of both groups were injured in the middle third of the calf muscle of the hind limb.

Conclusions. Mechanical injury of the calf muscle in combination with dyslipoproteemia is characterized by intense oxidative stress and leads to an increase in the concentration of malondialdehyde and diene conjugates in the liver and blood tissues of rats, and in old animals these processes are more pronounced than in young ones.

Background. Abdominal aortic aneurysm – is a widespread disease, which in some cases does not have any specific clinical symptoms, but possible complications of this pathology are characterized by high mortality. Aortic aneurism rupture is an extremely serious condition that requires emergency surgical treatment. A timely diagnosis of abdominal aortic aneurysm’s rupture risk remains extremely important, since the patient mortality rate is up to 7 times higher when performing an emergency surgery, than when performing a planned surgery.
Aim of study: to improve the diagnosis of abdominal aortic aneurysms instability by creating an assessing scale of aortic rupture risk according to computed tomography data.
Materials and methods. CT studies were performed by a 160-slice CT scanner and included the native and arterial phases of the scanning. The MSCT data of 179 patients with diagnosed abdominal aortic aneurysm were retrospectively studied, in 46 of whom the condition was complicated by an aortic rupture. CT scans can reveal a number of specific structural changes in the aorta and also surrounding tissues, which can be regarded as aortic wall rupture prediction. That specific structural changes were stratified by severity and the preliminary results were compared with the treatment tactics and the outcome of the disease.
Results. The MSCT data of 179 patients with diagnosed abdominal aortic aneurysm shows that the minimum and sufficient set of abdominal aortic aneurysm rupture predictions are: aneurysm size, a sickle sign, aortic wall draping sign, paraaortic fat induration, the thickness of parietal thrombotic masses. The obtained parameters give the possibility to predict the risks of AAA rupture. The prognostic scale is represented by a 4-point scale for assessing aneurysm parameters. Depending on the influence degree of each parameter, it is assigned a number of points corresponding to the level of prognostic significance. The maximum number of risk factors is 17 points.
Finding. The assessing scale of the abdominal aortic aneurysm rupture’s risk according to computed tomography data was developed.

Сarotid atherosclerotic disease increase the risk of ischemic stroke, with various clinical manifestations from asymptomatic to fatal. Cerebral blood flow depends not only on the degree of stenosis, but also on the patency of the collateral tract, affecting the severity of the clinical picture. Criteria for the hemodynamic significance of carotid artery stenosis and, based on them, indications for surgical treatment have been developed. But there is a group of patients with asymptomatic carotid stenosis and borderline values in assessing the hemodynamic significance of atherosclerotic plaques, who remain at risk of ischemic stroke. Thus, there is a need to assess the collateral cerebral circulation, and the impact of the degree of stenosis on cerebral perfusion. Also of interest is the assessment of hemodynamics at the site of carotid stenosis and the assessment of cerebral autoregulation during exercise testing. This will help in selecting patients with asymptomatic carotid stenosis who are at increased risk of stroke and who would benefit from revascularization.

The frequency of purulent arthritis of the sternoclavicular joint is less than 1 % of all joint infections. As a rule, the cause is the hematogenous spread of a generalized infection or trauma.

Material and methods. The result of treatment of 24 patients (18 men, 6 women, mean age 38.4 years) with purulent arthritis of the sternoclavicular joints in the period from January 1, 2012 to December 30, 2022 is presented. The causes, clinical manifestations, options for surgical intervention and treatment outcome.

Results. Most patients (20 people) complained of pain and tissue swelling in the area of the affected joint. In 4 patients, the main symptom was pain and limited mobility of the arm on the side of inflammation, while no external manifestations of the infectious process were detected. The main laboratory indicators of the inflammatory process were leukocytosis (mean (12 ± 1.6)·10⁹/l) and an increase in CRP from 4 to 86 mg/l (mean 22 ± 4.2 mg/l). 50 % of patients had type 2 diabetes. In 14 patients, in addition to the destroyed sternoclavicular joint, there was damage to the rib/ribs, sternum. In 5 patients, the infectious process was bilateral. Each patient underwent resection of the clavicle and sternum together with the sternoclavicular joint; if the ribs were affected, they were resected. Intraoperative complication was registered in 1 case – erosive bleeding from the right subclavian vein. All patients were treated in two stages. The main pathogen was Staphilococcus aureus. After cleansing the wound, it was closed with local or displaced tissues. Histological examination of removed macropreparations in 18 patients revealed signs of acute osteomyelitis. 5 patients needed intensive care, of which 4 patients died: from progressive sepsis against the background of multiple organ failure and from progressive heart failure against the background of pulmonary edema. Recurrence of the infectious process in the surgical area occurred in 1 patient.

Conclusions. Purulent arthritis of the sternoclavicular joint is not an independent disease. Hematogenous damage to this area is associated with a decrease in immunity and the development of a generalized infection. Treatment should be complex, aimed at surgical removal of pathologically altered structures and tissues, as well as intensive therapy to compensate for organ dysfunctions.

Treatment of patients with mechanical jaundice remains an urgent problem of modern surgery. Approximately in a half of patients the cause of this syndrome is the presence of concrements in the common bile duct. Nowadays there are various variants of choledocholithiasis surgical treatment – open surgery on bile ducts and various variants of endoscopic interventions.

Objective: to determine indications for open variants of surgical treatment of the syndrome of mechanical jaundice caused by choledocholithiasis.

Material and methods. The work is based on the retrospective analysis of the treatment results of 78 patients with the syndrome of the mechanical jaundice caused by choledocholithiasis. Patients were divided into two groups depending on the way of the mechanical jaundice elimination. The first group included 20 patients who underwent open surgery, and the second group consisted of 58 patients after endoscopic interventions.

Results. In the 1st group 4 patients died out of 20 patients, the lethality rate was 20%. In Group II 2 of 58 patients died, the lethality was 3%. The difference in the lethality indexes between the groups turned out to be statistically significant (p = 0,028).

Conclusion. Open surgery is indicated in patients with contraindications to pneumoperitoneum application due to the second half of pregnancy or concomitant pathology of the cardiovascular and/or respiratory systems, in unsuccessful attempts to perform endoscopic intervention, and also in concomitant pancreatitis.

The failure rate in arthroscopic reconstruction of anterior cruciate ligament (ACL) is conditioned by irrational aligning of the drilled transosseous canals, different mechanical properties of the synthetic or auto/allografts, and the number of fixators. By now the published studies on the correlation between failure rate and methods of arthroscopic ACL reconstruction are few. The objective of this research was the investigation of the correlation between the failure rate and certain techniques of arthroscopic ACL reconstruction in patients with its complete isolated rapture.

Materials and methods. The study involved 84 patients who in due time underwent single- or double-bundle reconstruction with synthetic implants, or the reconstruction by a semitendinosus and gracilis autografts. The failure rate was estimated in 3, 6, and 12 months by the presence of true clinical signs of the ACL failure along with the patient’s corresponding complaints of the knee joint instability in regular physical load.

Results. No differences were observed in the failures rates after surgeries performed by various arthroscopic reconstruction techniques in all periods of observation revealed by the interpretation of true clinical signs of ACL failure and confirmed by the Fisher's exact test value (р > 0.05) and χ²(р > 0.05) for the three groups overall.

Conclusion. The examination of patients with complete isolated ACL rapture in all periods of observation for the three samples revealed no correlation between arthroscopic ACL reconstruction failure rates and the employed techniques.

To date, arthroscopy is a universal method of diagnosis and treatment of the knee joint. Thanks to arthroscopic visualization, it made it possible to subdivide meniscal ruptures into their morphological types, such as horizontal rupture, longitudinal rupture, radial rupture, watering can handle-type rupture, meniscus root rupture. However, operations that are performed due to meniscus damage are among the most frequent in traumatology and orthopedics. The main and most commonly performed types of arthroscopic operations for meniscal damage are partial resection and reconstruction of menisci by suturing. Currently, the most modern concept is the surgical treatment of meniscal injuries, not only taking into account the morphological type of ruptures, but also the regenerative ability of menisci with the allocation of blood supply zones. At the same time, specialists, even with general information about the anatomy of menisci, morphology of ruptures, diagnostic methods and complications, do not have a common opinion about modern methods of surgical treatment of meniscus ruptures. Therefore, we decided to analyze the data of modern literature and find out what modern methods of surgical treatment of patients with meniscus ruptures exist. Our goal is to introduce readers to modern methods of surgical treatment of patients with meniscus ruptures. In the presented literature review, based on scientific data over the past 10 years from scientific databases NCBI Pubmed, ScienceDirect, Healio Orthopedics, Medline, such methods of surgical treatment of menisci as partial resection, reconstruction of menisci using techniques outside-in, inside-out, everything inside, including using a self-regulating fixator are highlighted, as well as an approach to surgical treatment of meniscus root rupture.

A clinical study of the effectiveness of delayed cranioplasty with an autologous bone flap using allogenic bone grafting material was performed. The autograft was preserved, saturated with human collagen type 1, lyophilized and sterilized. Bone-plastic material was used to fill diastases. The patient was followed up in the postoperative period for 24 months. No clinical complications were registered. Radiological and radioisotope analysis showed normal fixation of the autograft after 6, 12 and 24 months. Biopsy analysis after 12 months showed the presence of regenerative processes in the absence of inflammation. The clinical result was assessed as successful.

We carried out electroneuromyography of 78 patients with degenerative-dystrophic cervical and lumbar spine disorders, which were treated at the neurosurgical department of the Irkutsk Scientific Centre of Surgery and Traumatology. The results of the study of late ENMG phenomena such as H-reflex, F-waves and A-reflex were obtained at different stages of the disease using “Neuromyan” neuromyoanalyzer. The predictable changes in late answers at different stages of the process were determined. For example, in patients with radiculopathy, the degree of neurological deficiency was minimal, and in patients with a combination of nerve root syndrome and stenotic changes, the neurological deficiency had the character of a pronounced bilateral pathology. The severity of changes in neurophysiological indicators depends on the degree of spinal stenosis. Determination of N-reflex and F-wave parameters allows us to identify subclinical forms of loss both at the level of peripheral nerves and of spinal cord segments, and the appearance of axon reflex is an evidence of a demyelinizing pathology and chronic process.

Purpose of the study. To reveal the relationship between the serum concentration of vascular endothelial growth factor and the structural and functional state of the myocardium in patients in the post-infarction period at the stage of rehabilitation.

Materials and methods. We examined 94 patients at the outpatient stage of rehabilitation after ad hoc stenting 6 weeks after myocardial infarction, 10 healthy volunteers without somatic pathology. All participants in the study underwent standard transthoracic echocardiography with assessment of thickness of epicardial fat, assessment of the concentration of vascular endothelial growth factor (VEGF) in peripheral blood by ELISA.

Results and discussion. VEGF values above the median values were associated with lower left ventricular ejection fraction and left ventricular fraction shortening, which indirectly may indicate a more pronounced expression of VEGF in patients with left ventricular systolic dysfunction. Assessing the parameters of LV diastolic dysfunction in groups with different levels of VEGF, no significant differences were found in patients after myocardial infarction. Correlation relationships between the content of VEGF and the thickness of epicardial adipose tissue were not found either among patients or in the control group.

Conclusions. Elevated VEGF values in patients with coronary artery disease at the 6th week of rehabilitation were accompanied by left ventricle systolic dysfunction, in contrast to diastolic dysfunction. There was no direct correlation between the thickness of epicardial fat and the concentration of VEGF in the blood serum in patients with coronary artery disease.

The study is devoted to the assessment of the role of immune mechanisms in the development of acute renal failure in HFRS. The material for the study was the blood of 65 patients with HFRS and 17 patients with ALF of toxic nature from the comparison group as models of kidney damage by hantavirus and non-infectious genesis and 15 clinically healthy subjects of the control group. Data were obtained that allow us to consider the cytolytic effects of natural killer cells and cytotoxic T-lymphocytes activated by the NKG2D-dependent method as damage factors, including renal tissue, and a significant increase in the content of regulatory T-cells in the blood as protective mechanisms.

Chronic recurrent aphthous stomatitis (CRAS) is a disease of the oral mucosa, characterized by the appearance of specific round aphthous forms with hyperemic corolla, covered with grayish-yellow plaque against the background of inflamed mucous membrane, which violates the oxidative homeostasis of oral fluid and the body as a whole.

The aim of our study was to reveal the dynamics of free radical processes in oral fluid of patients with chronic recurrent aphthous stomatitis on the background of the first stage of antiseptic therapy with analgesics in order to determine the optimal treatment tactics for this condition. In order to achieve the set objective we had to solve the following tasks: to evaluate the functional activity of free radical processes in the oral liquid of patients with CPAS on the background of antiseptics (chlorhexidine, octenisept, furacilin, myramistine) and anaesthetic (Camistad gel) application for 7 days.

Materials and Methods. During the study the oral fluid of 120 people diagnosed with CPPS was studied, divided into 4 groups equally: Group 1 – control, patients used the antiseptic chlorhexidine for gargling; Group 2 – patients with CPPS therapy with octenisept; Group 3 – patients with CPPS therapy with furacilin; Group 4 – patients with CPPS therapy with miramistine. For pain relief, patients in all groups used Kamistad gel. Analysis of free radical processes in oral fluid of patients was carried out before the study and on the 7th day of therapy by determining products of oxidative modification of biomolecules on the basis of quantitative evaluation of stained complex with thiobarbituric acid (TBA), maximal flash (MVHL) and area (PCL) of H₂O₂-induced luminol-dependent chemiluminescence using LT-01 chemiluminometer ("Horos" "Joint Venture Soviet-Swedish Company"). Concentration of diene conjugates and malonic dialdehyde was also determined to estimate enzymatic part of oxidative homeostasis.

Results of the study. Results of the researches permit to conclude that at chronic recurrent aphthous stomatitis enzymatic activity of an oral liquid changes. According to the presented data the initial values of concentration of TBK-RP, maximal flash of oral chemiluminescence, area of oral chemiluminescence and concentration of MDA and DC in the control group and three experimental groups reliably differ from the data received on the 7th day of the research. Significant decrease of the studied indexes of oral liquid testifies to the efficiency of the first stage of therapy of aphthous stomatitis by antiseptic preparations and decrease of intensity of oxidative processes in oral liquid. Of all the proposed antiseptics the best efficiency is demonstrated by octenisept, reliably worse are chlorhexidine and myramistine and the least effective in the therapy of CPAS is furacilin.

Conclusions: treatment of CPAS with Octenisept in combination with Camistad gel is the most effective in restoration of the disturbed oxilite.

RETRACTED ARTICLE

The aim of the study was to evaluate the relationship between chemotherapy and autoimmune reactions in patients with metastatic colorectal cancer. Cancer and autoimmunity are known to be interrelated, but until now it has been unclear to what extent chemotherapy specifically contributes to autoimmune reactions. We studied immunoglobulin M (IgM) levels in response to the administration of various human tissues before and during adjuvant chemotherapy. Patients received seven cycles of chemotherapy with the FOLFIRI plus cetuximab regimen. IgM levels against the tested tissues increased already after the first cycle of chemotherapy and continued to increase during the second and third cycles. Autoimmune responses then began to decrease from the fourth to seventh cycles, but remained elevated from baseline for most of the study tissues. Our results suggest that chemotherapy can induce a wide range of autoimmune reactions. Monitoring self-reactive IgM responses during treatment may help prevent or alleviate side effects associated with autoimmunity.

Any rare emergency abdominal pathology entails difficulties in diagnosis and treatment tactics, which in retrospect may turn out to be errors and even cause an unfavorable outcome. The potential mood of our medical community of the last decade – "think constantly about cancer" should be quite rightly supplemented among doctors with the thesis – "think constantly about obstruction, and it doesn't matter which one." The choice of the method of surgery for caecal inversions is determined on the basis of well-known traditional principles inherent in tactics for any strangulation intestinal obstruction, and the individualization of the method of interventions should be carefully weighed and reasoned.

The review article discusses in detail the problem of complications in maternity patients associated with spinal anesthesia and cesarean section surgery. The evidence base demonstrating the risk of complications in pregnant women with the development of acute neurological conditions is presented. The problems of the toxic effect of a local anesthetic (bupivacaine) and the consequences of a coronavirus infection on the body of pregnant women are considered separately.

At this stage in the development of medicine, there are difficulties in establishing the etiology of stroke in young patients. There are few significant risk factors from the group of metabolic hereditary diseases in the development of "young" strokes in the literature. This prompts the publication of our observation. Aim: to describe a unique clinical case of "young" ischemic stroke in a 27-year-old woman whose daughter was diagnosed with type 2 gangliosidosis. To determine the cause of the stroke, the patient underwent DNA diagnostics, which showed a previously undescribed nucleotide sequence. A clinical case of ischemic stroke caused by a previously undescribed nucleotide sequence is presented.

An observation from practice is given – surgical treatment of a patient with widespread destructive pulmonary tuberculosis due to a modified technique of transsternal occlusion of the main bronchus by plastic surgery of the anterior mediastinum with a mesh implant. Patient A., 37 years old, has been suffering from pulmonary tuberculosis for 2 years. She was admitted to the clinic with complaints of shortness of breath during exercise (mrc 3), cough, back pain. On computed tomography of the chest organs: a picture of fibrous-cavernous tuberculosis of the left lung with extensive mediastinal pulmonary hernia. The patient underwent transsternal occlusion of the left main bronchus with plastic surgery of the anterior mediastinum with a polymer mesh implant. The result of the treatment was the stabilization of the process and the clinical cure of the patient.

Introduction. The main historical aspects are considered features of the development of legislation on early assistance to children and their families (next – Early help) in the Russian Federation. The stages of the formation of the legislative process in the formation of Early aid are reflected, the social aspect of the regulatory legal regulation of the provision of early care services in the Russian Federation is also indicated.

Aim. To assess the completeness of legal regulation and the development of Early care, the main directions of further improvement and development are identified.

Materials and methods. Normative legal and methodological documentation, special literature, information systems of federal executive authorities of the subjects of the Russian Federation. Applied general scientific methods (content analysis, analytical, system-structured, comparative) and methodological methods of systematization, comparison, generalization, interpretation, as well as special methods – formal legal, comparative legal.

Object of research: Early care for children and their families.

Subject of research: Regulatory legal regulation of Early care.

Results. There are three stages in the formation of the regulatory legal regulation of early care for children. Stage I (2012–2015), which is characterized by the adoption of the Decree of the President of the Russian Federation and program normative legal acts of the Government of the Russian Federation. At this stage, the term «early assistance» is used for the first time in regulatory legal acts. Stage II (2016–2020), a distinctive feature of which is the adoption of the general program document, reflecting the approach of the Government of the Russian Federation to Early assistance as a system of legal relations. This stage is considered as determining the role and place of Early care in the system of health-saving technologies. Stage III (2021–present). Decree of the Government of the Russian Federation №. 3711-r dated 12.18.2021 approved the Concept of development in the Russian Federation of a system of comprehensive rehabilitation and habilitation of disabled people, including disabled children, for the period up to 2025, which changed the wording of the term «early assistance», and also defined the role and place of Early assistance in the system of comprehensive rehabilitation and habilitation of disabled people. The Ministry of Labor of Russia has prepared a bill that enshrines the term «early aid» and its definition.

Discussion. In 2012, the Decree of the President of the Russian Federation №. 761 dated 01.06.2012 «On the National Strategy of Actions in the interests of children for 2012–2017» was issued, which outlined not only the main issues in the field of protecting the interests of children, but also the ultimate goal of implementing the national strategy in the form of creating a system of early prevention of disability of children. Thus, the preventive aspect of the orientation of the functioning of the early care system is formulated. Early care is mentioned in the context of children's access to quality education and training. An important direction in the field of healthcare is the development of technologies for complex diagnostics and early medical and social assistance to children with developmental and health disabilities, as well as the provision of necessary advisory, legal, psychological and other assistance to families whose children of the target group are being raised. Ensuring equal opportunities for children in need of special care of the State is entrusted specifically to Early care and prevention of disability in children with developmental disabilities.

Conclusions. The obtained results of the analysis of the regulatory legal framework of the Russian Federation regulating legal relations in the field of Early care confirm the need for further legislative regulation of the term and its content.

Features of the landscape and geographical conditions of the Samara region, the rich world of flora and fauna create favorable conditions for the existence of natural foci of infectious and parasitic diseases. The high population density, the presence of megacities (Samara, Togliatti), the passion of the inhabitants of the region for country recreation, together with developed agriculture, determine a high risk of infection of people with pathogens of natural focal infections.

Objectives: to analyze the manifestations of the epidemic and epizootic processes of natural focal infections in the Samara region for its zoning according to the degree of danger of infection of the population with actual zoonoses.

Methods. We used information on the incidence of the population (form No. 2 "Information on infectious and parasitic diseases") for the period from 2019 to 2021, data from an immunological examination of residents of municipalities using enzyme immunoassay, results of examination of environmental objects in natural foci (indication of genomes and antigens of viruses and bacteria) in vertebrates and their pellets (litter), arthropods using polymerase chain reaction and enzyme immunoassay. Cluster analysis was performed using the Statgraphics plus for Windows application program for a personal computer.

Results. Territories with high, moderate and low risk of infection of the population of the Samara region with hemorrhagic fever with renal syndrome, viral tick-borne encephalitis, tularemia, leptospirosis, Q fever and West Nile fever were identified. It is shown that the most relevant zoonosis is hemorrhagic fever with renal syndrome.

Discussion. Compiled cartographic mapping of the administrative formations of the Samara region with different risks of infection and disease of people with natural focal infections is relevant for planning preventive measures.

Introduction. Walking on a prosthesis of the lower limb is accompanied by a shock load on the artificial foot, which provokes discomfort when using the product and pain in the stump, increases the risk of trauma to the skin and the formation of arthrosis of the joints of the lower limb. These negative consequences can be reduced by the use of prosthetic modules with shock-absorbing properties. Usually, the artificial foot plays the role of a shock absorber in the prosthesis.

Aim – substantiation of the choice of material for the shock-absorbing module of the artificial foot.

Materials and methods. Bench tests of leaf springs made of steel, carbon and titanium alloy of different thicknesses were carried out by registering changes in their geometric characteristics under a dosed load, as well as full-scale tests of experimental artificial feet with such springs used as a load absorber. The functionality of the feet was determined by the subjective assessment of the comfort of the prosthesis by the patient and the result of the analysis of pressure dynamics under the feet. Results. The results of bench tests showed that leaf springs made of steel 2 mm thick, titanium alloy 3 mm and carbon fiber (carbon) 5.7 mm are unsuitable for use as a shock absorber in the foot of the prosthesis in terms of deflection in the longitudinal and transverse directions under load, in contrast to springs made of 3 mm steel and 4 mm titanium alloy. Field tests of experimental feet with shock-absorbing modules made of steel 3 mm thick and titanium alloy 4 mm showed their suitability for use as part of a prosthesis, which was confirmed by a positive assessment of their comfort by patients, as well as an increase in the symmetry coefficient of the duration of the roll over the artificial and intact feet when walking with experimental foot design compared to industrially manufactured.

Discussion. The 4mm titanium alloy leaf spring outperforms the 3mm steel spring in terms of buckling under load, but biomechanical studies have not shown a clear preference for the experimental foot with one of these materials over the other. At the same time, each of them turned out to be more functional than the commercially manufactured foot chosen for the study. But the high corrosion resistance and low specific gravity of the titanium alloy, higher mechanical strength per unit mass compared to steel, give advantages to this material for the manufacture of shock-absorbing modules in atypical prostheses. The choice of the thickness of the elastic element can and should be calculated taking into account the weight of the disabled person.

Conclusion. The manufacture of elastic elements from titanium alloys is promising when used in artificial feet for atypical prostheses that require high corrosion resistance and mechanical strength with a small mass of the product. A positive factor in the use of titanium alloys for the manufacture of foot shock absorbers in the form of leaf springs is the simplicity and low cost of the design.