Introduction. In acute COVID-19 respiratory infection caused by SARS-CoV-2 coronavirus (2019-nCov), lung damage has a different course, which has not been studied so far. The purpose of the study. To study the variants of the course of COVID-19 viral pneumonia (VP) based on the analysis of the dynamics of lung damage, quantified by computed tomography.

Material and methods. Quantitative analysis of computed tomography (CT) data of the chest of 144 patients with VP was performed using the 3D Slicer software application. Cluster and comparative nonparametric analyses of the severity of lung damage (CT1, CT2, СТЗ, CT4) and the total volume of affected lungs (%) obtained during primary and two repeated CT studies (pCT, 1dCT and 2dCT) in the program "Statistica 12" were carried out.

Results. With a stable course, the total volume of the affected lungs is constant, within one degree of severity: CT1 - in 23.6 %, CT2 - in 14.6 %, CT3 - in 5.6 %, CT4 - in 8.3 %. With a progressive course, the volume of lung damage gradually increases from minimum to maximum CT1-CT2-CT3 in 3.5 %, or increases to the maximum level on the second CT, remaining stable on the third study (CT2-CT3-CT3) - in 4.2 %. With a regredient course, the volume of lung damage varies from the maximum at the primary examination (pCT) to the minimum at the third (2dCT): gradually from CT4 through CT3 to CT2 in 4.2 %, or by one degree of severity CT3-CT2-CT2 in 9.7 %, CT3-CT3-CT2 in 9.0 %. With a progressive-regredient course, the volume of lung damage first reaches a maximum on 1dCT, a minimum on 2dCT - CT2-CT3-CT2 - in 17.4 %. An intragroup comparison of three repeated, dependent indicators of the total volume of the affected lungs and an intergroup comparison on pCT, 1dCT and 2dCT showed a dynamic statistically significant difference between them for variants of the course of VP (p < 0.05).

Conclusions. Cluster analysis of the total volume of affected lungs on a series of three CT studies in dynamics allowed us to identify 5 variants of the course of COVID-19 - stable - light, stable-severe, progressive, regredient, progressive-regredient.

Recently, one of the most pressing issues of modern medicine is pelvic floor dysfunction, which includes pelvic organ prolapse, urinary and fecal incontinence []. The leading role in maintaining the pelvic organs is assigned to levator ani muscle. The study of attachment features of muscle to pelvis, rectum will clarify the pathogenesis of pelvic floor insufficiency and development of incontinence symptoms and pelvic organs prolapse. The use of classical morphological and innovation technologies of «Autoplan» hardware and software complex using MRI data made it possible to identify morphologically denser and sparse zones of the wall of the distal rectum, directly related to the attachment of levator ani muscle fibers to it.

Diseases of the cardiovascular system continue to occupy the first place in the world among all causes of death in the population. One of the leading medical and social factors in the growth of the number of cardiovascular pathologies is alcohol consumption.

The purpose of this work: to study the effect of chronic and acute episodic administration of ethanol on the features of hemodynamic parameters in rats.

Materials and methods. The study was carried out on non-linear mature male rats. The group that underwent acute administration of ethanol every five days (days 1,6, 11, 16, 21) was intraperitoneally injected with a 20 % ethanol solution (5 g/kg).The group subjected to chronic alcoholization was offered 10 % ethanol solution as the only source of liquid for 21 days. Every five days in both groups, hemodynamic parameters such as systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR) were recorded.

Results. With acute use of ethanol, already 30 minutes after administration, changes in hemodynamic parameters were found in the form of a decrease in SBP and DBP by an average of 43 %.60 minutes after the administration of ethanol, there was an increase in SBP and DBP by an average of 11 % relative to the initial data, which at the initial stage of alcohol consumption may be associated with a compensatory reaction of the cardiosystem in response to alcohol poisoning. Under conditions of chronic ethanol use, there was a decrease in the level of SBP, DBP and heart rate by an average of 16 % on the first day of the study, followed by their recovery to the initial values on the 21 st day of the study, which may be a sign of the development of a compensatory reaction of the body and indicate the beginning of the formation of alcoholic dependencies.

Conclusions. Acute and chronic administration of ethanol has a significant, but at the same time multidirectional effect on hemodynamic parameters, which can serve as a trigger for the development of various cardiopathologies.

Anxiety is a natural survival mechanism that helps to cope with potentially dangerous situations. It is accompanied by changes in the functioning of the nervous and endocrine systems, which affect the behavior of living beings. It is possible to establish the level of anxiety and the severity of depression thanks to various behavioral methods, with the help of which it is possible to fix indicators, establish their duration, and then compare data on the emotional state of animals from the control and experimental groups. The purpose of the study: to identify the features of the emotional state of the offspring of rats that received an aqueous plant extract of reddish hellebore. Conclusions: aquatic plant extract of reddish hellebore has a modeling effect that reduces the level of anxiety and depression.

Occlusive lesions of the main arteries of the extremities are a common and severe disease that leads to disability and has a high rate of death [1]. Many different drugs are known for the treatment of this pathology, however, despite the large number of pharmacological drugs and conservative treatment methods, surgical methods of treatment are the most effective in terms of saving the limb [3, 4]. However, methods of conservative therapy continue to be the most important component of the treatment of arterial limb ischemia, which requires the development of more effective methods. As a result of the use of intravenous administration of a 0.01 % solution of nitroglycerin for the treatment of arterial ischemia of the extremities in patients with coronary artery disease, it was possible to obtain good immediate results in an average of 57.3 % of cases.

Abstract. Taking into account the conflicting data on the effect of the systemic inflammatory response on the structural and functional changes in the myocardium in clinical forms of tuberculosis, we conducted an echocardiographic study and an assessment of pro- and anti-inflammatory cytokines in the blood serum.

The purpose: to study the relationship of structural and functional changes in the myocardium with markers of systemic inflammation IL-6, IL-10, VEGF-A in patients with various forms of pulmonary tuberculosis.

Materials and methods. The study included 77 patients with a confirmed diagnosis of pulmonary tuberculosis, who are on inpatient treatment in a tuberculosis dispensary. During the study, patients were randomized into 3 groups, cavernous form of pulmonary tuberculosis, (n = 15). The mean age of the patients was 44.2 ± 5.3 years and had no statistically significant differences between the groups. The control group consisted of 10 healthy individuals. The mean age of the control group was 42.4 ± 2.3 years. The concentration of IL-6, IL-10 and VEGF-A in blood serum was assessed by ELISA and В-mode echocardiography.

The results obtained. The severity of systemic inflammation was associated with the clinical form of pulmonary tuberculosis: the maximum value of IL-6 was observed in the infiltrative form, and the minimum, but significantly higher value compared to the control group, in the fibrous-cavernous form of pulmonary tuberculosis (25, 7 ± 16.5 vs 10.3 ± 4.24). High levels of interleukin IL-6 were accompanied by higher levels of VEGF in blood serum, regardless of the form of pulmonary tuberculosis, while the highest concentration of both was observed in patients with infiltrative form of tuberculosis . A significant increase in the structural and functional values of the myocardium of the right and left parts of the heart was established both in relation to the control group and in comparison with the group of patients with an infiltrative form of pulmonary tuberculosis, despite lower levels of VEGF-A (391.43 ± 241.0 vs 274.50 ± 158.30).

Conclusions. Pulmonary tuberculosis is accompanied by varying severity of systemic inflammation associated with the clinical form of the disease. Structural and functional changes in the myocardium of the right and left parts of the heart in pulmonary tuberculosis are associated with the clinical form of pulmonary tuberculosis. The most pronounced changes are observed in the fibrous-cavernous form, the minimum - in the infiltrative form. There is no direct relationship between the severity of the systemic inflammatory response and structural and functional changes in the heart.

Relevance. Coronary artery transplantation operations are an effective method for the treatment of developmental anomalies and pathologies of the coronary arteries, which lead to a cascade of negative consequences. Pathologically altered coronary arteries cannot fully function normally and this condition leads to myocardial ischemia. Ischemic heart disease (CHD) is a chronic inflammatory disease that quickly leads to functional disorders in the body. CHD is mainly caused by atherosclerosis of the arteries and is the leading cause of death in most developed countries.

The purpose of study. To study the operational possibilities of coronary artery transplantation.

Materials and methods. In the course of this study, a review of foreign literature on the problem of surgical interventions on the coronary arteries was carried out, in addition, data from randomized controlled trials and controlled clinical trials were analyzed, which reported on various approaches to the treatment of pathologies of the heart vessels.

Results. Coronary artery bypass grafting is most often performed in coronary heart disease caused by a sharp narrowing or occlusion of the lumen of the coronary artery. Coronary artery bypass grafting (CABG) is a major surgical operation, which consists in restoring blood circulation bypassing the stenotic area of the coronary artery using venous or arterial bypasses (grafts). At the same time, blood flow to the ischemic myocardium is restored, which leads to the restoration of the function and viability of the heart muscle. Coronary artery bypass grafting, as mentioned above, is a frequently performed surgical intervention, with almost 400,000 CABG surgeries performed annually, which proves its effectiveness in the treatment of coronary artery disease.

Conclusion. This study proves the importance of coronary artery transplantation in the treatment of pathologies and anomalies of the arteries of the heart. There are several types of surgical interventions, and therefore it is necessary to approach each individual case individually and find the optimal solution. An important role in preventing postoperative complications and sudden cardiac arrest is played by careful preoperative diagnostics, including coronary angiography, echocardiography, computed tomography, and other methods. With careful preoperative diagnosis, a well-chosen operation strategy and postoperative prevention, it is possible to avoid repeated cardiac revascularization and achieve complete recovery of the patient with no complications for decades.

Emergency operations for perforated gastroduodenal ulcers are associated with a high incidence of postoperative complications.  A number of studies have examined the impact of perioperative risk factors and comorbidities on postoperative morbidity after abdominal surgery, but only a few have looked at their role in perforated peptic ulcer disease.

Aim. To determine possible associations between postoperative complications, comorbidity and perioperative risk factors for perforated gastroduodenal ulcer.

Materials and methods. This study includes the anamnesis of 142 patients who underwent surgery for perforated gastroduodenal ulcer (PGD). In 74 cases (52.1 %), minimally invasive suturing operations were performed, in 68 cases, laparotomy suturing (47.9 %), in three cases, gastric resection was performed (2.3 %). Comparative studies between groups have not been conducted. Clinical data regarding patient characteristics, surgical techniques, and complications were collected retrospectively.

Results. Postoperative complications associated with operations for perforated gastroduodenal ulcers amounted to 26.8 %, or 38 cases. A univariate analysis showed that prolonged open surgical time in female patients≥60 years of age, as well as a high American Society of Anesthesiologists (ASA) score, and the presence of preoperative shock were significant perioperative risk factors for postoperative complications. Significant comorbid risk factors included hypertension, diabetes mellitus, and lung disease. Multivariate analysis showed that long operation times, open surgery, high ASA scores, and preoperative shock were independent risk factors for postoperative complications in perforated gastroduodenal ulcer.

Conclusions. High ASA, preoperative shock, open surgery, and long operative times of more than 148 minutes are high risk factors for morbidity. However, there is no association between postoperative complications and comorbidity in patients with perforated ulcers.

This review demonstrates the possibilities of photodynamic therapy in treatment of non-tumor pathologies using dimeglumine chlorin E6 as a photosensitizer. Initially, the method was invented for the treatment of cancer and demonstrated its effectiveness and safety. In present photodynamic therapy successfully used in the treatment of the bronchus, skin, stomach, cervix, larynx cancer. In addition to the treatment of different localization tumors, various studies demonstrated other positive effects of photodynamic therapy: antimicrobial, antimycotic, autoimmune, reparative. In the presented review, dimeglumine chlorin E6, which is a derivative of chlorin e6, acts as a photosensitizer. It demonstrates safety, high selectivity of accumulation in tissues, and is characterized by a short period of excretion from the body. Using of dimeglumine chlorin E6 cans significantly reduce the number of side effects associated with long-term skin phototoxicity.

Objective: to show the effectiveness of simultaneous surgical treatment of patients with tuberculosis of multiple localizations: tuberculosis of the lungs and the lumbar spine.

Materials and Methods. Simultaneous surgical treatment was performed in 24 patients. Evaluation of the effectiveness of treatment was carried out according to the signs of the early and later (after 12 months) postoperative period. Operational material for detection microbiologically and morphologically to determine its causative agent, drug sensitivity and inflammation activity.

Results: the effectiveness of simultaneous surgical treatment was 87.3 %. The number of complications in the early postoperative period was 8.4 % (n = 2), in the late 4.2 % (n = 1). According to the results of the examination of the surgical material, tuberculosis was confirmed in 20 patients (83.3 %), both in the bone structure and in the lung tissue. In 4 (16.7 %) patients, nonspecific inflammation of the bone structure was noted.

Conclusion: Simultaneous surgical treatment of tuberculosis of the lungs and lumbar spine is a highly effective method of treating tuberculosis of multiple localizations. It is possible to recommend the use of simultaneous surgical treatment for simultaneous sanitization of foci of infection, both in the lung tissue and in the spine.

Relevance. About 800 thousand people die every year as a result of injuries and their consequences, in the Russian Federation the frequency of injuries is 12 %. Fractures of the humerus diaphysis account for 1-5 % of the total number of traumatic injuries of the skeleton, at the same time, there is no tendency to reduce injuries in modern society, therefore, the number of surgical interventions aimed at restoring the integrity of the bone does not decrease. Among the reasons for the unsatisfactory results of osteosynthesis, iatrogenic ones are distinguished: inconsistency from a biomechanical point of view, the choice of an unsuitable metal structure, insufficiently correct comparison of the ends of bone fragments and neglect of contraindications to the use of submerged structures with increased contamination of the wound with open fractures. Non-infectious complications of primary osteosynthesis include false joints, improperly fused fractures, untenable osteosynthesis, as well as fractures and migrations of implanted metal structures. The described complications are the basis for repeated (revision) surgery, or rheosteosynthesis. The purpose of this study is to analyze the historical aspects of the development of osteosynthesis and rheosteosynthesis methods, as well as to determine the prospects for their further development.

Materials and methods. In the process of writing the article, the analysis of data from literary sources published in the period from 2016 to 2023 was carried out.

Results. Speaking about the choice of osteosynthesis technique, it should be noted that no recommended and maximally described techniques will be able to fully cover the variety of situations that arise during osteosynthesis operations, therefore, first of all, a positive outcome depends on the experience of the surgeon and his ability to make situational decisions. Each of the methods used has both advantages and disadvantages, and which treatment tactics the surgeon would not prefer - there is always a risk of complications and, as a result, an unsatisfactory result. In such cases, patients undergo revision operations of osteosynthesis (rheosteosynthesis), minimizing or completely eliminating bone defects. The complexity of correcting the consequences of injuries of the humerus diaphysis is due to the variety of conditions leading to the development of various kinds of bone defects or false joints, as well as in a limited number of techniques that can fully repair the damage in a short time. Taking into account the rather long periods of consolidation of fragments, rehabilitation of patients with this type of pathology implies the use of devices capable of providing stable fixation and the possibility of early restoration of upper limb functions for fastening bone fragments. As a rule, revision surgical interventions include excision of scars from the interfragmental area or corticotomy, removal of deformation (if present), rimming of the medullary cavity and intramedullary osteosynthesis, to which, in rare cases, fixation with a short plate may additionally be applied. The range of revision surgical interventions may include rheosteosynthesis in combination with: segment elongation and corrective osteotomies, bone alio- and autoplasty, with bone elongation on a nail in an external fixation device.

Conclusion. The development of modern technologies of osteosynthesis and osteosynthesis of the diaphyses of long tubular bones in general, and the humerus in particular, has passed a serious evolutionary path. In recent decades, methods and technologies of osteosynthesis have been actively developing and improving. With the development of knowledge in the field of the mechanism of bone fusion, implant designs and installation technologies are changing, new modifications of operative accesses are being developed. When choosing the method of fixation of bone fragments, minimally invasive osteosynthesis techniques are becoming increasingly popular. Currently, combinations of different rheosteosynthesis methods are being actively introduced, which significantly expands their capabilities, in comparison with their application separately.

Relevance. Multiple sclerosis is accompanied by rapid progression of the disease, the development of early disability and a violation of the patient's quality of life. In recent years, advances in understanding the etiology and pathogenesis of this disease have led to the expansion of therapeutic approaches, it has become possible to influence the course of the disease. Objective - to study the effectiveness of the use of drugs that change the course of multiple sclerosis in patients registered at the center of multiple sclerosis of the Udmurt Republic.

Materials and methods. The statistical analysis was performed on 45 patients of the neurological department of the "First Republican Clinical Hospital" of the Ministry of Health of the Udmurt Republic, diagnosed with multiple sclerosis, using immunomodulatory or immunosuppressive therapy.

Results. At the beginning of the study, the group of patients using immunomodulatory therapy included 31 patients (68.89 %), the group of immunosuppressors -14 patients (31.11 %). The average time from the onset of the disease to the start of therapy was 1.64 ± 5.71 months. 42 patients (93.33 %) out of 45 included in the study started therapy with an immunomodulator. The average time from the start of therapy to inclusion in the study was 113.00 ± 47.52 months in the immunomodulatory therapy group. 11 patients (78.57 %) out of 14 taking immunosuppressive therapy at the start of the study switched to it after previous immunomodulatory therapy. 3 patients (6.67 %) out of 45 included in the study started treatment with immunosuppressive therapy. In the immunosuppressive therapy group, the duration of treatment was 62.57 ± 74.52 months. Progression of the disease from the moment of initiation of therapy to inclusion in the study was observed in 19 patients - 42.22 %. An increase in the EDSS index was recorded by an average of 1.82 ± 0.31 points. Improvement of clinical condition was observed in 6 patients - 13.33 %. A decrease in the EDSS index was recorded by an average of 0.91 ± 0.22 points. The difference in the EDSS index in the groups of immunomodulators and immunosuppressors is insignificant. There was no dependence of the patient's clinical condition on the number and activity of foci of demyelination.

Conclusions. The objective clinical condition of the patient has no significant difference in the groups of immunomodulatory and immunosuppressive therapy, which suggests that the correct selection of a particular drug by the attending physician and its constant use by the patient is important in order to reduce the risks of complications, slow down the progression of the disease and preserve the quality of life of the patient.

The aim of the study was to examine the schemes proposed in the clinical guidelines and to compare them with inpatient treatment methods.

Materials and method, the case histories of 40 patients of cardiology department of Saratov medical preventive institution were analyzed. Men and women, aged from 50 to 80 years, with functional class (FC) II to IV, with reduced left ventricular ejection fraction (< 40 %) and with such diseases in anamnesis as arterial hypertension, coronary heart disease, atherosclerosis, diabetes mellitus were in the inclusion group. The exclusion group included patients with noncardiac diseases, pediatric patients, patients under 50 and over 80 years old, patients with I class, preserved and intermediate LV ejection fraction (> 40 %). The results of immunochromatographic analysis of NT-proBNP marker were studied, the identity of prescribed drugs to a certain group and their frequency of use, as well as the similarity of prescribed regimen to clinical guidelines were determined.

Results. NT-proBNP level over 125 pg/ml was revealed in 21 out of 40 patients, arterial hypertension, atherosclerosis, ischemic heart disease were in the anamnesis testifying to high probability of CHF. Perindopril (80 %) and fosinopril (20 %) were the main angiotensin-converting enzyme inhibitors (ACEIs). Spironolactone (a К + -saving diuretic), thorasemide, furosemide (a loop diuretic) and indapamide (a thiazide-like diuretic) were used as diuretics. Among blockers, metoprolol (20 %), nebivolol (30 %), bisoprolol (50 %) were prescribed. Patients suffering from CHF and with a history of atherosclerosis were prescribed statins (rosuvastatin, atorvastatin) in addition to the main groups of drugs in all cases. Warfarin (9.5 %) and rivaroxaban (23.8 %) were present in 7 of 21 cases (33 %). In addition, 17 patients (81 %) were prescribed acetylsalicylic acid as an antiaggregant. Those with a history of diabetes mellitus (19 %) received metformin for glycaemic control, as an adjunctive therapy to the main combinations of drugs.

Conclusions. The inpatient regimen used to treat patients with CHF is more in line with the clinical guidelines.

Relevance. Coronary artery bypass grafting (CABG) is one of the main methods of surgical treatment of coronary heart disease and is performed in order to restore perfusion and improve the functional state of the myocardium. According to the literature, CABG has a high percentage of neurological complications. About 80 % of patients in the postoperative period have mild or moderate brain damage, which is manifested primarily by cognitive decline. One of these complications is an acute violation of cerebral circulation (ONMC).

Study aim. To compare patients with ONMC after CABG and patients with ONMC, which were based on other reasons for the leading impaired cognitive functions and to assess cognitive impairment.

Material and methods. The severity of cognitive impairment in patients with a history of CABG was studied using the MoCA test scale, comparing the results obtained with the data of stroke patients without CABG.

Results. Significantly more often patients (ONMC with CABG) tests on visual-constructive skills, on the skills of "Delayed reproduction" performed worse. Memory".

Conclusion. In patients with ONMC with CABG in the anamnesis, visual disturbances were observed 2 times more often. Based on the data obtained, it can be concluded that CABG surgery significantly affects the degree of impairment of visual-constructive skills and delayed reproduction (memory) in ONMC, which is the basis for further, more in-depth study of this problem.

Purpose of the study: to investigate changes in markers of endothelial dysfunction and hemostasis system in patients with different forms of CHD on the background of treatment and before it.

Materials and methods of the study. In order to fulfill the set tasks, 60 patients with different forms of CHD: stenocardia and myocardial infarction (according to the classification of the Canadian Association of Cardiology (L. Cam-peau, 1976)), 60 patients with different forms of CHD were examined during the study. Campeau, 1976), VNOC (2004), recommendations of the European Society of Cardiology (2007)), aged from 50 to 75 years (mean age 62.6 ± 3.5 and 65.1 ± 3.6 years, respectively) and 20 practically healthy individuals (without signs of CHD), comparable in age (mean age 62.7 ± 3.7 years), who constituted the control group. For comparative analysis of the results before and after treatment the subjects were divided into three groups: Group I - control group, respondents without CHD; Group II - patients with stable angina II and III functional classes (FC); Group III - patients with postinfarction cardiosclerosis, i.e. those who had undergone Ml.

Results and their discussion Several risk factors were identified in the majority of hospitalized patients. CHD of II and III FC was more often registered in women (60%); men who had undergone myocardial infarction accounted for 63.3%, the indices were statistically insignificant (p >0.05). The main cardiovascular risk factors (obesity, arterial hypertension, body mass index and total cholesterol) were significantly higher (in % ratio) in patients of groups ll-lll compared to group I (p<0.001), but the cholesterol content and body mass index were on average higher in group II (4.5 ± 1.0 and 33.0 ± 1.3, respectively) than in group III (4.2 ±1.1 and 30.6 ± 2.6, respectively). As for the duration of the disease, group III patients were characterized by a longer history and a higher frequency of heart failure, i.e. patients in this group had a more severe clinical status (p > 0.05). It should be noted that of the total number of patients (n = 80), rural residents accounted for 46.25% and city dwellers for 53.75%.

ConclusionsThe presence of a higher degree of endothelial dysfunction is observed in patients who underwent myocardial infarction, in contrast to the stable form of angina pectoris without myocardial infarction in the anamnesis. The progression and deterioration of vascular endothelium is mostly associated with the presence of hyperhomocysteinemia, and the most pronounced changes in endothelial function are determined in patients with a combination of cardiovascular risk factors. In different forms of CHD the increased content of DEK and homocysteine in blood serum, increasing in parallel with the severity of clinical course, their level correlates with the degree of endothelial dysfunction. A direct correlation between hemostasis markers (von-Willebrand factor, fibrinogen and platelets) and DEK was revealed. The greatest changes in vascular-thrombocytic and coagulation hemostasis are observed in patients with IMI than in patients with stenocardia.

Osteoporosis is often referred to as a "silent epidemic" because the decrease in bone mass is often asymptomatic until a fracture occurs. One of the most severe manifestations of the disease is osteoporosis of vertebral bodies, the fracture of which leads to disability. In spinal osteoporosis, the main cause of pathologic compression fractures is a fall due to impaired balance. The dynamics of balance dysfunction after surgical treatment of vertebral body compression fractures remains insufficiently studied. We performed a stabilometric study in 103 patients with osteoporosis of the spine complicated by compression fracture at the thoracic and lumbar levels in the age range from 44 to 79 years. All patients underwent puncture vertebroplasty. It was demonstrated that patients with osteoporosis of the spine still have pronounced changes in the stabilogram parameters despite their positive dynamics. The most significant changes were noted in the energy expenditure index, 60% power spectrum level in the sagittal plane and dispersion of the deviation of the center of pressure in the horizontal plane. The persisting pronounced changes in stabilometric indices in the distant postoperative period make it necessary to perform rehabilitation to restore balance and gait.

Amoebic liver abscess is one of the forms of invasive amoebiasis. With untimely treatment, this disease can be complicated by peritonitis, dissemination of the pathogen with the development of sepsis. This article presents a clinical case of amoebic liver abscess in patient V., 40 years old with the results of a biopsy examination of the surgical specimens

Introduction. Ischemic stroke (IS) remains one of the significant problems of modern medicine to this day. Cardioembolic stroke (CEI) accounts for 20 % of all cases of IS and is characterized by acuteness, severity of the disease and high mortality.

Aim of study. An observation is presented in patient Sh., 51 years old, who was urgently transferred from another medical institution on the 3rd day after the development of acute recurrent anterior myocardial infarction with ST segment elevation complicated by early post-infarction angina pectoris. During the additional examination, in addition to severe multifocal atherosclerosis and multivessel coronary artery disease, a floating thrombus in the cavity of the left ventricle was detected. At the stage of preparing the patient for coronary artery bypass grafting, the patient developed stroke. Thrombextraction from the basilar artery (BA) was performed urgently. As a result, a complete regression of neurological symptoms was achieved. This made it possible to continue the preparation and successfully perform coronary artery bypass grafting. The patient was discharged on the 10th day after the operation, the entire hospitalization period was 28 bed-days.

Discussion. In the presented case, a patient with a clinic of unstable angina pectoris, severe multifocal atherosclerosis, and multivessel coronary artery disease was in a specialized multidisciplinary hospital at the time of the development of stroke. The well-coordinated work of the multidisciplinary team, the possibility of performing thromboaspiration in the shortest possible time allowed not only to save the patient's life and achieve complete regression of neurological symptoms, but also to improve the quality of life through surgical treatment of coronary heart disease.

The article provides a brief overview of the frequency and prevalence of Pair syndrome, the causes of its development, the clinical picture and diagnosis of this form of splanchnoptosis, the tactics of surgical treatment depending on the stage of the disease. There are 2 clinical cases of successful surgical treatment of chronic constipation in patients with Pair syndrome. At the same time, in the classical picture of the disease, left-sided hemicolectomy with a thick-colonic anastomosis "end to end" was performed, in a patient with concomitant diverticular disease - an extended hemicolectomy. All patients are discharged with recovery, all have an independent regular stool every 1-3 days

Progressive ischemic stroke is the most frequent form of stroke with neurologic deterioration. The pathogenesis of progressive ischemic stroke is based on the expansion of the brain infarction zone and reduction of the "penumbra" zone in the area of focal ischemia. The leading role in maintaining the balance between irreversible and reversible ischemia belongs to cerebral collateral blood flow. Being a multifactorial phenomenon, collateral blood flow is caused by both morphological and functional characteristics of the collateral arterial channel and systemic factors, among which hemodynamics is of great importance. The tactic of purposeful increase in blood pressure to improve cerebral perfusion is called drug-induced arterial hypertension. A number of experimental studies have demonstrated the safety and efficacy of this method, but the small number and heterogeneity of data in the studies do not allow us to conduct a meta-analysis and form an optimal protocol for drug-induced arterial hypertension. In this article we want to describe the clinical observation of a patient with ischemic stroke on the background of critical stenosis of stroke-related internal carotid artery and atrial fibrillation, in the treatment of which we applied drug-induced arterial hypertension.

Nowadays, the one-year survival rate of liver transplant recipients is 80-90 %. In the long term after surgery, there are increased risks of death compared with the general population. At the same time, in the structure of death of recipients, extrahepatic causes prevail over graft pathology. Cancers, cardiovascular diseases, infections, metabolic disorders, and kidney disease are key factors that negatively affect long-term outcomes of transplants. The article provides an overview and summary of current data on the prevalence, structure and prognostic value of various types’ of late post-transplant extrahepatic pathology in liver transplant recipients.

Structural and functional properties of the human tendon tissue complicate process of tendon-based grafts preserving. In the process of preservation, it is necessary to maintain mechanical and functional parameters of the tendon tissue as well as to provide sterility and biological safety of the graft. One could conclude effectiveness of techniques, combining tendon conservation at low temperatures and sterilization with the supercritical carbon dioxide.

Aim of work: to find optimal conditions for allogeneic tendon grafts sterilization with supercritical carbon dioxide.

Materials and methods. Allogeneic tendons were prepared from the tissue donors, following the rules of asepsis and antisepsis. After quarantine and confirmation of the absence of blood-borne infections the tendon grafts were divided into 3 groups: in the control group the tendons were not subjected to cryopreservation and sterilization procedures; in 2 experimental groups tendons were treated with a cryoprotector 10 % dimethyl sulfoxide (DMSO) solution and sterilized with supercritical carbon dioxide with slow gas discharge (group 2) or with fast gas discharge (group 3); the duration of sterilization in both groups varied from 1 to 12 hours. The toxicity of the grafts was assessed in human mesenchymal multipotent stromal cells (MMSC) culture on the 3rd and 7th days. The sterility of the grafts was confirmed on the 7th and 14th day by bacteriological culture on thioglycol medium and Saburo broth. Mechanical tests were performed on testing machine LLOYD Instruments LR5K Plus with the tensile speed 5 mm/min.

Results. Histological analysis showed, that in the group with slow gas discharge collagen fibers retained their integrity and topography and contained only local minor tears; in all terms of treatment, the tendon grafts were sterile and nontoxic. On the contrary, in the group with fast gas discharge there was marked damage of the collagen fibers and growth of bacterial and fungal flora was observed in the culture. The grafts of the control group and the group, where sterilization with supercritical carbon dioxide was performed with slow gas discharge for 1-12 hours, were used to evaluate mechanical characteristics. In the preserved tendons the stiffness and ultimate strain did not significantly differ from the similar values in the control (p > 0.05), on the contrary, the level of ultimate strain in all experimental specimens was significantly reduced by 1.5-2.1 times comparing to the control. Young's modulus and load at rupture in the control grafts and grafts, sterilized for 1 hour, had similar values, whereas in grafts, sterilized from 3 to 12 hours, these parameters were 1.4-2.1 times lower (p < 0.05).

Conclusions. The suggested technique of tendon preservation, using cryoprotector DMSO and sterilization with the supercritical carbon dioxide, allows to obtain sterile and non-toxic grafts. The structure of cells and fibers of the preserved tendons did not significantly disturbed. For supercritical carbon dioxide sterilization of tendon grafts the most optimal processing time is 1 hour.

Relevance. Multiple sclerosis is a global medical and social problem of our time. This is due to a decrease in the number of able-bodied population due to the onset of the disease in 20-40 years, steady progression, the appearance of persistent neurological symptoms and disability. Therapy with drugs that change the course of multiple sclerosis is not always effective for progressive forms of the disease. There are a large number of clinical trials of modern medicines and techniques that affect the main links of pathogenesis, aimed at combating further progression and reducing the existing neurological deficit. One of the promising and potentially effective methods is stem cell transplantation.

The purpose of study. To analyze foreign publications on the use of stem cells for the treatment of multiple sclerosis: to assess the possibility, safety and prospects of using stem cell transplantation in patients with progressive multiple sclerosis resistant to standard therapy.

Materials and methods. In the course of this study, foreign scientific articles were searched in the databases "Elibrary", "PubMed", "Cochrane Library". The analysis and generalization of data on the main etiopathogenetic mechanisms of multiple sclerosis development and methods of influencing them, on alternative methods of treating multiple sclerosis, properties of different types of stem cells, methods of transplantation, results of open clinical trials of stem cell transplantation in patients with multiple sclerosis.

Results. Stem cell therapy can be used as an alternative method of treating progressive forms of multiple sclerosis. Several types of stem cells with individual properties and advantages were considered for clinical use. Autologous hematopoietic, mesenchymal, neuronal, embryonic and induced pluripotent stem cells are distinguished. Mesenchymal and hematopoietic stem cells have demonstrated the greatest therapeutic potential in clinical trials. The safety and good tolerability of transplantation of these cell types have been proven, but the effectiveness remains controversial. Clinical improvements were more often observed in patients of younger age, with a disease duration of less than 10, inefficiency in no more than two previous methods of treatment modifying the disease, and having a lower baseline EDSS score.

Conclusion. Stem cell transplantation is indeed a promising method and can revolutionize the treatment strategy for neurodegenerative diseases. Clinically proven safety and efficacy make it possible to change the approach to therapy in relation to the progressive course of multiple sclerosis, to conduct large multicenter clinical trials to include the method in the treatment standards. The opportunity to stop the progression and prolong the relapse-free period makes it possible in the near future to eliminate the need to take drugs that change the course of multiple sclerosis, reduce their side effects on the body and return patients to their former lives. The full clinical effect of transplantation has yet to be demonstrated by further studies.

Hepatocellular carcinoma (HCC) is the third cause of cancer-related mortality worldwide, accounting for more than 800,000 deaths annually. Surgical removal of the neoplasm remains the most effective treatment option. Partial liver resection is an adequate solution for patients without cirrhosis or with well-compensated cirrhosis, orthotopic liver transplantation is necessary in patients with early stage HCC on the background of cirrhosis. Tumor recurrence remains a major limitation of long-term survival of patients after liver transplantation. Posttransplant immunosuppression reduces the body's antitumor defense, which is provided by natural immunity. This contributes to the development and progression of the tumor process. Purpose of the study: to analyze domestic and foreign publications that present treatment options for HCC recurrence after liver transplantation. Literature sources were searched in PubMed, Scopus, Web of Science, MEDLINE, eLibrary databases. The search was conducted in Russian and English by keywords: hepatocellular carcinoma, tyrosine kinase inhibitors, immune checkpoint inhibitors, therapy of HCC relapse, orthotopic liver transplantation, RETREAT index, regorafenib, nivolumab. The authors presented a review of the data on the use of tyrosine kinase inhibitors and immune checkpoint inhibitors to prevent HCC recurrence. The results of the analysis of literature sources showed that the issue of post-transplant immunosuppression is relevant. The large number of studies and clinical case reviews leaves hope that an effective way of immunosuppression for recurrent HCC patients after liver transplantation will soon be found.

The aim of the study is to build a kinetic model of ethanol distribution in biological body fluids, as well as its implementation in the format of computer programs. Analytical mathematical modeling of ethanol kinetics in body fluids after single and multiple oral alcohol intake was performed. An equation for the distribution of ethanol in internal media and other body fluids has been developed based on a kinetic model of zero-order elimination with absorption and irrevocable absorption deficiency, as well as achieving an equilibrium state with first-order blood plasma. On the basis of this kinetic model, computational algorithms are constructed for estimating the concentration of ethanol in body fluids at a given time, the peak concentration of ethanol and the time of its achievement, the time of complete removal of ethanol, the beginning and end of the false elimination period. Solutions to the problem of determining the amount of ethanol taken by its concentration in the biological fluid and the level of etholemia at this point in time with the possibility of calculating their maximum absolute errors are obtained. The constructed kinetic model is generalized to any number of ethanol receptions separated by time intervals of any duration. The developed computational algorithms are implemented in the format of the computer programs 'Alcohol Calculator V 7.0" and "Alcohol Calculator V 6.0", which are recommended for use in the forensic medical expert assessment of acute alcohol intoxication.

Introduction. The marital status of the patient is an important factor that affects his behavior, attitude to health and the healthcare system. Family relationships can have a positive or negative impact on the level of self-esteem, general psychological stability and readiness for treatment. For example, many people in stable relationships are more likely to monitor their health, visit doctors regularly and receive the necessary medical care. However, there are also negative aspects of marital status that can affect the patient's attitude to the healthcare system. For example, some patients may experience fear and embarrassment when seeking medical care without their spouse or partner. There are also cases when a patient's unwillingness to go to doctors is due to the fact that he does not want financial or emotional help from his family, but prefers to cope with his problems on his own. Thus, marital status is an important factor that must be taken into account when analyzing the attitude of patients to the healthcare system. Studying this problem can help medical institutions develop more effective service strategies and increase patient satisfaction.

Materials and methods. For the analysis, 495 patients of medical organizations in Moscow were obtained by questioning. Two comparison groups were formed, the main group (the presence of marital relations) 292 people, the control group (the absence of marital relations) 203 people. Taking into account the nonparametric distribution of the primary data, the criterion of the reliability of differences χ² was used to compare the groups, and the association coefficient was used to determine the dependence K_a.

Results. According to the results of the analysis, taking into account the literature data, data on different approaches to the assessment of the medical care management system in patients with different family status were obtained.

Conclusions. Family patients are more critical of the organization of the activities of individual departments of the polyclinic, but their criticism does not lead to a significant decrease in the overall assessment of the medical organization. Lonely patients make fewer specific claims, but reduce the overall assessment of the medical organization's activities.