Traditional serrated adenomas (TSAs) are extremely rare polyps from the group of serrated polyps of the colon. TSAs is no more than 5 % of all colon polyps. A relatively small number of studies have been devoted to this histological variant, at the same time, some aspects of the morphological diagnosis of TSA still remain undisclosed. Purpose: to conduct a clinical and morphological analysis of cases of TSAs.

Materials and methods. The study included 57 cases of TSAs diagnosed in the period from 2021 to 2023. In the cases detected during this period, the results of histological and endoscopic studies were analyzed.

Results. The age of patients ranged from 44 to 78 years and averaged 61.7 years. The ratio of men and women is 1:1.8. Most TSAs were found in the rectum (n = 28) and sigmoid colon (n = 20). In 8 cases, the tumor was localized in the descending part and the splenic flexure of the colon. In 1 observation, a tumor was found in the cecum. The sizes of the polyps ranged from 0.5 cm to 3.5 cm. In 22 cases, the composition of the polyp included tubulovillous adenomas (16 cases) and hyperplastic polyps (6 cases) in addition to TSAs. In 5 cases, foci of highly differentiated adenocarcinoma were detected in the TSAs material.

Conclusion. TSAs has characteristic morphological features with a serrated exophytic growth pattern, cytoplasmic eosinophilia and the presence of ectopic crypts. Due to the difficulties of morphological diagnosis, TSAs in some cases remains undiagnosed. At the same time, due to the increased malignant potential, TSAs requires special vigilance on the part of pathologists and clinicians.

Purpose: to propose a new approach in the morphological diagnosis of colitis using the categories grade and stage to clarify and decipher the diagnosis of chronic colitis and improve the quality of biopsy diagnostics.

Materials and methods. The study included 100 cases of inflammatory bowel disease (IBD) diagnosed between 2017 and 2021 (70 cases of ulcerative colitis and 30 cases of Crohn's disease). The age of the patients ranged from 19 to 53 years. In all cases, the diagnosis was established on the basis of a complex of clinical, laboratory and instrumental diagnostic methods. Multiple biopsies were obtained in all patients during colonoscopy. The processing of the biopsy material was carried out according to the generally accepted method. To evaluate plasma cells, an IHC study with antibodies to CD138 (syndecan-1) (Dako RTU) was additionally performed.

Results. In the course of the study, a gradation of morphological criteria was carried out, which are decisive in the diagnosis of chronic colitis in patients with IBD. The concept of chronic colitis as a process characterized by the grade of severity and stage of chronic inflammation has been revised and re-formulated. Criteria of structural disorders (stage of colitis from 0 to 3) and criteria of severity of chronic inflammatory infiltrate (grade of colitis from 0 to 3) were identified and graded. Additionally, an attempt was made to objectify the selected criteria using an IHC study using antibodies to CD138 plasma cells (syndecan-1). Based on the material of colonobiopsies, the proposed degree-stage approach was tested in the group of colitis in patients with IBD, which showed the possibility of its practical application.

Conclusion. The proposed concept will be able to improve the quality of biopsy diagnostics and avoid unjustified use of the term "chronic colitis" without further elaboration and, accordingly, its frequent unjustified use existing at the moment.

The purpose of the study. To conduct a study of hormonal changes in medical students in different periods of study, taking into account gender differences.

Object and methods. In order to achieve this goal, a study of the main physiological indicators was conducted in 120 volunteer students aged from up 18 to 24 years. The following criteria were used for inclusion in the studies: the absence of acute or chronic diseases, which is confirmed by the availability of health certificates, the presence of the middle of the menstrual cycle (for women), obtaining consent to conduct the study.

Conclusion. Changes in the hormonal background of medical students depend on gender and the course of study, the greatest changes in the hormonal background of students, 1–2 courses, and these changes occur regardless of gender, then, at 3–4 courses, there is some stabilization of the hormonal background, and this is more concerning for female representatives.

Depressive disorders are one of the leading problems of modern health care. Their prevalence in the world ranges from 4.4 to 20 % of the population, and in Russia the incidence of depression reaches 20 %. The study of depressive disorders is relevant not only from the point of view of psychiatry and behavioral therapy, but also occupies a leading place in neurological practice, since more than a quarter of the population with chronic neurological diseases suffer from depression. Currently, most basic biomedical research on depressive disorders is carried out using laboratory animals. However, the protocols for experimental modeling and analysis of behavioral patterns are very diverse, which creates certain difficulties in planning research. This review is aimed at describing, analyzing, comparing and systematizing possible approaches to creating experimental models of depression in animals, and also contains criteria for model validation and a description of behavioral tests to assess anxiety-depressive disorders.

The purpose of the study: to analyze the parameters of the electroencephalogram in individuals with different levels of anxiety when performing non-verbal tasks.

Object and methods. The study was conducted on 20 female students, aged 18 to 22 years. All studies were carried out on a voluntary basis, confirmed in writing, in compliance with bioethical standards governing the conduct of observations on humans. The level of situational anxiety was determined using the Spielberg-Khanin test.The spectral power of the electroencephalogram rhythms was recorded using the NVX 36 digital DC EEG neurovisor using a cap with a set of electrodes that were placed on the head of the subjects according to the international 10–20 system. The EEG recording lasted 1–2 minutes before and during the performance of nonverbal tasks. As non-verbal tasks, the subjects were asked to complete the Portsus maze test and the Cattell intellectual test. The results obtained were statistically processed. Differences were considered statistically significant at p < 0.05. All data obtained are presented as arithmetic means ± standard errors of the mean, as well as changes in average values in %.

Research results. It was found that the dynamics of EEG parameters in the performance of nonverbal tasks in students depends on the level of their situational anxiety. In persons with a low level of situational anxiety, when performing nonverbal tasks, an increase in the spectral power of the EEG parameters of beta2 and gamma waves in the frontal, parietal, occipital, and central leads is observed.In subjects with an average level of anxiety in the conditions of performing non-verbal tasks, the EEG parameters of beta2 and gamma waves in the frontal, occipital, and parietal leads noticeably increased. Persons with a high level of anxiety are characterized by an increase in the spectral power of alpha, beta2 and gamma rhythms in the frontal, central, parietal and occipital leads.

In the modern world, the nature of human nutrition is becoming more relevant. This is due to the spread of diseases such as diabetes mellitus, cardiovascular diseases and metabolic disorders. The health of a person and his offspring comes to the fore. In this regard, high-protein, low-carbohydrate diets are becoming popular at the moment.

The aim of the study was to identify the effect of a high-protein, low-carbohydrate diet of pregnant and lactating female rats on the development of their offspring.

Object and methods. The experiment was carried out on the offspring of female rats. The female rats of the control group received normal nutrition, and for the experimental group a special high-protein, low-carbohydrate diet was compiled, which was maintained throughout pregnancy and in the first week after delivery. As a result of the study, it was revealed that a diet with an increased protein content has a beneficial effect on the development of baby rats in delayed terms: they have a more pronounced weight gain, increased research activity and are less prone to anxiety.

Acute pancreatitis, according to different authors, occupies up to 25 % in the structure of emergency surgical pathology of the abdominal organs. Remains quite high postoperative mortality. At present, the search for more effective approaches to determining the tactics of treating such patients and new effective, least traumatic surgical technologies continues. This review has been prepared in order to summarize information of modern approaches to the surgical treatment of acute pancreatitis. The review is based on the study and analysis of sources included in the electronic databases elibrary.ru, cyberleninka.ru and electronic versions of specialized publications that are freely available on the Internet. All authors state the need, along with general clinical studies, to use various methods of abdominal cavity imaging as early as possible. The use of ultrasound, magnetic resonance imaging and computed tomography, including with contrast, is recommended. The use of visualization allows to quickly clarify the diagnosis and choose the best tactics. Currently, most authors prefer percutaneous minimally invasive interventions performed under the control of various imaging methods. A combination of percutaneous and endoscopic technologies is also offered. These techniques allow, in most cases, with high efficiency to reduce the number of complications. Laparotomy has become much less commonly used, however, this access cannot always be refused. The tactics of treatment, including the choice of the method of operation, is carried out depending on the phase of the disease, the location of the focus, its delimitation from the surrounding tissues, the presence of concomitant pathology and complications. Staged surgical treatment with the initial use of minimally invasive techniques is preferred.

Ultrasound (US) is the first imaging modality for thyroid parenchyma evaluation. In the last decades, the role of ultrasound has been improved with the introduction of new US software, such as contrast-enhanced ultrasound and US-elastography. US-elastography is nowadays recognized as an essential part of the multiparametric ultrasound examination. More controversial is the role of contrast-enhanced ultrasound in thyroid evaluation, due to its high variability in sensitivity and specificity. We have therefore drawn up an updated representation of the current evidence in the literature for thyroid nodule multiparametric ultrasound evaluation with particular regard to US-elastography and contrast-enhanced ultrasound.

Aim: creation of a method for predicting the development of varicose veins of the lower extremities and its recurrence.

Object and methods. 2 independent studies of patients with C2-C6 varicose veins of the lower extremities (CEAP-classifier) were conducted. In the first, with ultrasound diagnosis of the main veins of the lower extremities and genomic analysis of blood samples, 75 participants (men 20, women 55), mean age 43.7 ± 5.9 years. All patients were randomized into two groups: group I (n = 17) – with recurrent varicose veins; Group II (n = 58) – applied with varicose veins for the first time. The 2nd study involved 44 (men 10, women 34), mean age 55.5 ± 2.7 years. Similarly, patients were divided into groups – I (5) and II (39 people). All patients of the first stage of the study underwent real-time PCR with allele-specific primers to determine the A82G mutation in the MMP-12 gene (matrix metalloproteinase-12) and the second stage C634G in the VEGF-A gene (endothelial fibroblast growth factor – A).

Results of the study. In patients of both groups I and II, having the MMP-12 gene in the heterozygous variant, dilatation of the tibial and popliteal veins was present (6.4 ± 0.3 mm and 10.7 ± 0.24 mm, respectively) with the presence reflux and slowing down the evacuation of blood from the deep venous system. In patients of group I, the MMP-12 gene was found in 80 % of cases, as A/A (homozygous) and A/G (heterozygous variation), while in group II only in 33.3 % of cases. Pearson's goodness-of-fit criterion χ2 = 10.4 (the critical value of the criterion is 6.63), p < 0.01. The frequency of recurrence of varicose veins and mutation of the MMP-12 gene according to the Spearman test was 1.0 with the number of degrees of freedom 23, p < 0.05. In the 2nd study, a correlation was found between groups I and II of patients with the C/C genotype (Pearson's coefficient χ2 = 0.79, p < 0.11) and a correlation in the duration of the disease between groups of patients with the C/C genotype (homozygous variation) and C /G (heterozygous variation) – Pearson correlation coefficient χ2 = 0.92 (p < 0.01).

Conclusion. The revealed relationship between the MMP-12 gene polymorphism and the frequency of varicose vein recurrence is a predictor of the development of structural changes in the vein wall, and a mutation in the VEGF-A gene occurs with a long history of the disease.

Introduction: in the world orthopaedic practice, attention is increasingly paid to surgical interventions that improve the patient’s quality of life. One of these interventions is joint arthroplasty. The most common reason for this operation is osteoarthritis. It is known that coxarthrosis and gonarthrosis have a a high incidence in the world and there is a dynamic increase in the amount data pathologies. However, behind all the advantages of joint arthroplasty here is most formidable complication – periprosthetic infection, which can be fatal for the patient. According to opinion of domestic and foreign experts, for a successful treatment of patients with this complication, intervention is needed by specialists of a narrow profile in combination with a multidisciplinary approach, however patient routing an unresolved problem to this day.

The purpose of the work: to propose a model for routing patients with periprosthetic joint infection in Moscow.

Results. As a result of the work carried out it was found that the main problem of routing patients with periprosthetic joint infection in Moscow is the stage and timing of the disease. Often the patient with lat periprosthetin infection is hospitalized in a hospital in a city that has a department of purulent surgery, but the specialists of the department have not the necessary equipment and skills to provide effective and qualified care as a result of which patient wastes time that could be spent more rationally.

Conclusion. For more efficient routing of patients with periprosthetic joint infection in Moscow it is necessary to create specialized centres for the treatment of advanced perprosthetic infection. In cases of early periprosthetic infection the patient can undergo sanitizing surgical mixing in the conditions of the department of purulent surgery of any hospital in Moscow.

Obesity, type 2 diabetes mellitus and cardiovascular diseases associated with these conditions remain one of the largest global health problems. According to statistics, at least 90 % of patients with type 2 diabetes mellitus are obese or at least overweight (BMI > 25). Very often, the cause of death in this cohort of patients is the development of a cardiovascular catastrophe. Currently, there is a gradual rejection of the exclusively glucose-centric concept of type 2 diabetes mellitus therapy in favor of an organoprotective one. In this article, we examined the possibility of using various groups of incretinomimetics (DPP-4 inhibitors and GLP-1 agonists) in the primary prevention of cardiovascular diseases in patients with type 2 diabetes mellitus in perimenopause, and comparing their effects with traditional metformin therapy.

The aim of the study was to evaluate the effect of non – insulin antidiabetic drugs from the class of incretinomimetics on risk factors for the development of cardiovascular diseases in patients with type 2 diabetes mellitus in perimenopause.

Object and methods. A dynamic examination of three groups of patients was carried out. The first group (n = 22) received therapy with the GLP-1 agonist semaglutide, the second group (n = 30) metformin therapy and the third (n = 19) with the DPP-4 inhibitor linagliptin. All patients, in addition to general clinical examination, assessment of the dynamics of weight loss and insulin resistance, underwent a dynamic study of triglyceride levels, low – density lipoprotein cholesterol, as well as markers of general inflammation – C-reactive protein and interleukin-6.

Results. The results of the study showed that semaglutide and metformin were equally effective in reducing body weight, but metformin and linagliptin did not significantly affect the level of atherogenic fractions of the lipidogram, unlike semaglutide. Nevertheless, both semaglutide, linagliptin, and metformin reduced the level of markers of general inflammation.

Conclusions. The results of the study allow us to discern a certain cardioprotective potential not only in agonists of GLP-1, but also in representatives of the class of DPP-4 inhibitors, which requires further research.

Introduction. The most frequent complication of endoscopic papillosphincterotomy (EPST) is acute pancreatitis. This complication is supposed to be based on mechanical, chemical, hydrostatic, enzymatic and thermal impact on pancreatic ducts and parenchyma. According to different literature data, the incidence of post-EPST pancreatitis (PEP) varies from 30 to 40 %, and the mortality rate is 2–10 %.

The aim of the investigation was to expand information about peculiarities of early diagnostics and prevention of post-EST pancreatitis at the present stage.

Materials and methods. To reach the set goal we analyzed 559 case histories of patients with diagnosed cholelithiasis, 319 of them underwent EPST.

Results. During the study it was found out, that elevated neutrophils/lymphocytes ratio over 4,96 (p = 0,001), high LDH level over 250 IU/ml (p = 0,01), as well as Creactive to albumin index over 0,180 (p = 0,001) are reliable markers of early diagnosis. Also, indirect diagnostic markers of PEEP are biochemical signs of cholestasis and cytolysis of hepatocytes, as well as hyperglycemia combined with glucosuria. We consider the inclusion of intraoperative injections of papillotomy wound margins with Epinephrine in combination with subsequent Somatostatin administration in combination with rectal Diclofenac and intravenous hydration with Reamberin to be the most effective strategy for PEP prevention.

Conclusions. Thus, we can conclude that despite the ongoing research and the search for effective algorithms for the prevention and early diagnosis of PEP, their data often contradict each other or simply do not confirm their effectiveness. The problem of prevention and diagnosis of PEP remains complex and requires further study. There are discrepancies, sometimes significant ones, in the current literature, which provides grounds for the development and research of new methods of early diagnosis and prevention.

The incidence of appendicular peritonitis (AP) is 3-4 % among all acute surgical diseases in children, and the structure of acute appendicitis in recent decades fluctuates within 10-15 %. Timeliness and informativeness of acute abdomen diagnostics remain important tasks of clinical practice. The use of laparoscopy with its possibility of diapeutic approach allows to diagnose and eliminate the cause of the disease. On the basis of the surgical department of the Children's City Clinical Hospital No. 1 in Nizhny Novgorod. In the period from 2018 to 2022, 126 (11.2%) patients with various types of AP were treated in Nizhny Novgorod. All children were examined with assessment of general and local status, laboratory tests were performed using unified methods developed for practical healthcare. In complicated or doubtful cases, ultrasound of the abdominal cavity organs was performed (Vivid-7 of expert class using high-frequency transducers: convex (frequency up to 5 MHz) and linear (frequency up to 10 MHz). Local forms of AP prevailed – 90 %, of which appendicular abscess was found in 35 % of observations. Data of anamnesis, examination of patients, assessment of purulent-inflammatory markers in complicated and controversial situations were resolved by ultrasound of abdominal cavity organs. Instrumental diagnostics allowed them to detect anechogenic contents (effusion), delimited areas of absceding between the intestinal loops, perforation defect of the appendix wall, periappendicular abscess forming. Within the framework of surgical correction the priority was given to laparoscopy (59.5 %), a modern therapeutic and diagnostic method with a diapeutic approach. Open interventions were used in 51 (49.5%) patients, of which: Sprengel's access was performed in 31 (61%) patients, Volkovich-Dyakonov was used in 19 (37%) cases, midline laparotomy was performed in 1 child. Analysis of the results of bacteriological studies allowed us to identify the leading pathological pathogens belonging to Gram-negative or Gram-positive flora. In the postoperative period, therapy corresponding to the treatment of patients with peritonitis was prescribed. Evaluation of bacteriological examination revealed that Enterobacteriaceae (87%), non-fermenting bacteria (72%) were susceptible to all antibiotics. However, the highest susceptibility (73 %) was noted to cephalosporins. All children were discharged home in satisfactory condition, with an average bed-day of 12.32 ± 2.4.

The review article discusses the issues of studying occupational factors on the reproductive health of female flight attendants. The purpose of the study is to identify a correlation between reproductive health disorders of flight attendants and flight factors. Literature data from the Fundamental Library of the Military Medical Academy named after S.M. Kirov, online sci-hub library «CyberLeninka», e-library and PubMed was analyzed and systematized. Such professional factors as: ionizing radiation, physical stress in flight, work in a plantigrade position, disturbance of the regime of working, resting time and eating patterns, constant change of climatic zones, desynchronosis, – were identified. An analysis of the literature has shown that a number of issues related to flight factors and women's health remain poorly understood. It is advisable to study in detail the flight factors: vibration, noise, acceleration, hypoxia, pressure drops, and their impact on the reproductive system of female specialists working in aviation.

Relevance. Modern methods of diagnosis and treatment of victims with severe combined trauma, the fulfillment of the conditions of the "golden hour" do not solve the problem of a favorable outcome, sepsis and multiple organ failure (PON) remain the main cause of death.

The purpose of the study. To study the possibilities of complex diagnostics and treatment using combined methods of extracorporeal hemocorrection in patients with PON after severe combined breast injury.

Object and methods. The results of diagnosis and treatment of 20 victims with combined chest injury were analyzed. The criteria for inclusion in the study were as follows: age over 18 years; severe combined closed chest injury: AIS > 2 on the background of combined injuries, ISS 28–34 points, severity of the condition on the ARASNE II scale over 20 points, the use of extracorporeal hemocorrection (MEG) methods.

The results of the study. In patients with severe combined breast injury, the severity of the course of multiple organ failure is shown and the effectiveness of combined methods of extracorporeal hemocorrection (MEG), the features of manifestations of PON and the dynamics of changes in indicators against the background of complex treatment is determined. The main method of diagnosis of PON was a clinical and laboratory picture, taking into account coagulological, biochemical disorders, biomarkers of inflammation and instrumental assessment of CT of the lungs and ultrasound picture of the state of parenchymal organs of the chest and abdomen.

Сonclusions. An integrated approach to the management of victims with PON, including early MEG, helps to reduce intoxication, stabilize the condition and increases life expectancy.

The article assesses concomitant diabetes mellitus as a risk factor for venous thromboembolic complications in patients with covid-19 in hospital settings. We analyzed 123 case histories of patients hospitalized for new coronavirus infection in the first wave of COVID-19. The results showed that diabetes mellitus was not an independent risk factor for venous thromboembolic complications in patients with COVID-19.

The aim of the study was to assess individual indicators of lipid metabolism in patients with novel coronavirus infection with chronic hepatitis C (CHC) depending on the severity of COVID-19 and liver fibrosis stage.

Object and methods. A comparative analysis of the results of laboratory examination of patients of the following groups was carried out: group 1 (n = 147) – patients with COVID-19 and CHC, group 2 (n = 81) – patients with COVID-19, group 3 control (n = 94) patients with CHC without COVID-19. In turn, the patients of the first two groups were divided into subgroups according to the severity of the COVID-19: with moderate (A) and severe course (B). According to the liver fibrosis stage, patients with COVID-19 with CHC were divided into 3 subgroups: F1 (mild fibrosis), F2 (moderate fibrosis), F3 (severe fibrosis). In blood serum, lipid profile parameters (total cholesterol (TC), high-density lipoprotein cholesterol (CHDL), low-density lipoprotein cholesterol (CLDL), triglycerides (TG), apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B)) were evaluated. All parameters were assessed in the acute period, according to the severity of COVID-19 and the liver fibrosis stage.

Results. In 100% of patients with COVID-19 and CHC, a decrease in Apo A1 and an increase in Apo B, the ratio of Apo B/Apo A1 were detected, regardless the severity of disease. In patients with severe COVID-19 with CHC, changes in the lipid spectrum were recorded: an increase in TG, Apo AI, Apo B, Apo B/Apo A1 ratio, and a decrease in CHDL, CLDL, Apo A1. In patients with COVID19 and severe liver fibrosis (CHC), a decrease in LDLC, Apo A1 and increase in CLDL, Apo B, ratio Apo B/Apo A1 was observed.

Orolingual angioedema is a rare, but extremely dangerous complication of systemic thrombolytic therapy with recombinant tissue plasminogen activator, the incidence of which reaches 2.2-5.1 %. Orolingual angioedema is a life-threatening condition, as it can lead to airway obstruction and asphyxia. An analysis of a clinical case of orolingual angioedema as a complication of systemic thrombolytic therapy using a recombinant tissue plasminogen activator is presented, risk factors for its development and treatment methods are presented. Orolingual angioedema is a rare life-threatening complication of systemic thrombolytic therapy with recombinant tissue plasminogen activator. It is necessary to assess the severity of edema every 30-60 minutes after systemic thrombolytic therapy in order not to miss the moment of escalation of the process. For the treatment of orolingual angioedema, antihistamines, glucocorticosteroids and adrenaline are used, in case of progressive edema and impaired airway patency, emergency tracheal intubation is performed, followed by artificial ventilation of the lungs.

Currently, there is an increase in the number of patients with nodular formations of the thyroid gland (TG), which requires preoperative diagnostics, which allows to detect in a timely manner follicular neoplasia and highly differentiated forms of cancer, colloid goiter with compression of the neck organs, nodular and diffuse toxic goiter (DUS) [5]. Most often, the nodes are located in the thyroid gland, but there are cases with atypical localization. Ectopia of the thyroid gland, or thyroid ectopia (from the Greek “ektopos”, i.e. “displaced”) is the presence of its atypical tissue in a place that is not characteristic of normal localization. This pathology develops due to a violation of the migration of progenitor cells of the thyroid gland during its embryonic development. The prevalence of thyroid ectopia is 1 per 100,000–300,000 people, 1 case per 4–8 thousand patients with thyroid pathology. Among the sick in 65–80 % of cases are women. According to the studied literature, thyroid ectopia can become a source of malignancy, so timely diagnosis and surgical treatment is necessary to prevent the development of life-threatening conditions. An analysis of a clinical case of atypical location of a thyroid nodule with a suspected oncological neoplasm in case of recurrence after hemithyroidectomy was carried out.

Relevance. Anomalies of the position and attachment of the colon in the abdominal cavity includes a large number of options. In some cases, the pathology is not limited exclusively to the mobility of the cecum, but is combined with a violation of the fixation of the ascending colon, the absence of attachment of the hepatic and splenic angles, omission of the right half of the colon or total colonoptosis.

Results. There is surgical pathology associated with abnormal position and attachment of the circumferential intestine in the abdomen and a case of abnormal position dependency and an anomaly of the attachment of the right side of the circumferential intestine, depending on body type, which have certain clinical manifestations. Clinical manifestations of this pathology, methods of diagnosis and treatment with favorable results are described in the article. Also own surgical treatment methods depending on the anatomical variant of the pathology are presented in the article.

Conclusion. The anatomical restoration of the correct position of the intestine in the abdominal cavity is operative. The proposed operation is performed taking into account the anomaly variant.

Introduction. Hamstring tendon injury is a rare high-energy injury.

The aim of the work is to demonstrate a rare clinical case of simultaneous damage to the distal tendon of the semimembranous muscle and the distal tendon of the biceps femoris.

Object and methods. The patient is 55 years old, fell on the ice and sat in the "splits" position. Immediately after the injury, there was a sharp pain, the absence of active flexion of the right shin. She was treated conservatively. However, the pronounced pain syndrome and the lack of active movements forced the patient to do an MRI and consult a traumatologist.

Results and discussion. After performing an MRI and examination by a traumatologist, damage to the distal tendons of the semi-webbed and biceps femoral muscles was diagnosed. Surgical interventions were performed – tendon suture and tenodesis. Immobilization with a sharshnir splint with a bending angle of 80 degrees. After immobilization, a dosed extension of the knee joint with a hinge system with a frequency of 5 degrees per day was performed for 6 weeks. After carrying out a full complex of medical rehabilitation using physiotherapy and the Arthromot apparatus, the volume of movements is 0/0/180.

Conclusion. Early surgical treatment and competent rehabilitation measures allow you to fully restore the lost functions. Even with such rare injuries.

The results of a long – term observation from practice are presented, which showed the gradual formation of the destruction cavity in a patient with limited focal and peribronchial fibrosis of the lung tissue. Patient H., 54 years old for more than twenty years, was observed by a pulmonologist at the place of residence with a diagnosis of chronic bronchitis with frequent annual exacerbations. She was admitted to the clinic of the FSBSI "CRIT" with complaints of pronounced weakness, fatigue, shortness of breath, prolonged subfebrile temperature mainly at night, cough with difficult-to-separate mucus of a mucous nature. A retrospective analysis of computed tomography of the chest revealed a consistent transformation of local focal peribronchial compaction in the middle lobe of the right lung into a limited area of bronchiectasia and the formation of a small cystic cavity with widespread zones of bilateral pneumonic infiltration. This observation shows the practical significance of CT research in understanding the mechanisms of formation of bronchiectatic cystic cavity in non-tuberculosis mycobacteriosis of the lungs.

An observation from practice is given – a staged surgical treatment of a patient with widespread destructive pulmonary tuberculosis with preXDR MBT against the background of severe bullous lung dystrophy after prolonged exogenous exposure to fine particles of coal dust in the anamnesis. Patient M., 42 years old, smoker, has been working as a loader at a railway station since the age of 20, unloading wagons with bags of coal at high temperatures without using personal protective equipment. He was ill with pulmonary tuberculosis 12 years ago, the original form: infiltrative tuberculosis of the upper lobe of the right lung in the phase of decay and insemination. He was treated with positive dynamics, was removed from the register 10 years ago, the real changes were revealed during a routine examination when applying for a vertebral hernia. According to computed tomography of the chest organs, a picture of fibrous-cavernous tuberculosis of the right lung with a system of polymorphic caverns with multiple foci of dropout in the left lung against the background of pronounced emphysema of both lungs was noted upon admission. He was admitted to the clinic with complaints of shortness of breath at rest (mMRC 3). The patient was selected therapy based on sensitivity data and individual intolerance. The patient underwent EC installation at the mouth of the upper lobe bronchus on the right, successfully, then at the mouth of the bronchus B6, the blocker was coughed up. Against the background of treatment, tuberculomas formed in the left lung. S1-2 resection of the left lung was performed. The patient suffered SARS CoV-2. After that, spontaneous pneumothorax occurred on the left, and therefore the pleural cavity was drained. Against the background of the lack of dynamics, a month after drainage, the patient was taken for revision of the left pleural cavity with suturing of defects, partial pleurectomy and decortication of the left lung. After 3 months, the patient had a bronchoblocker removed from the mouth of the ULB on the right and a combined resection of the right lung (upper lobectomy with S6) was performed, after which, in order to reduce the right hemithorax and reduce the overstretch of the right lung, thoracoplasty was performed with resection of the I-IV ribs on the right. Histological examination confirmed pulmonary tuberculosis against the background of exogenous exposure to fine particles of coal dust (by the type of hypersensitive pneumonitis of chronic course). As a result of treatment, the patient's symptoms of shortness of breath (mMRC 1) decreased, the patient was steadfastly abaculated and returned to a normal lifestyle.

The work is devoted to the analysis of modern literature data and approaches in performing repeated liver transplantation. The most frequent causes of liver graft loss are PNFT, HAT, recurrent initial disease and chronic rejection. The leading indication for retransplantation in children is HAT. The one-year survival rate after retransplantation is approximately 75%. Reducing the cost of organ retransplantation and the cost-effectiveness of the procedure are controversial issues. Mathematical modeling has identified several significant recipient and donor factors affecting the outcomes of retransplantation. Despite ethical and economic considerations, retransplantation is the only option for transplant patients whose grafts have failed to engraft. The decision to retransplant should be made with some caution, with full multi-type approach in large multidisciplinary transplant centers.

Describes the relevance of the use of fixed orthopedic structures in prosthetics of patients with partial absence of teeth. Clinical features of orthopedic rehabilitation of a patient with this pathology are revealed. The results of a computational experiment on choosing the optimal sizes of the supporting parts of a three-part bridge prosthesis are presented. The technology of manufacturing a bridge prosthesis is described and the nearest clinical results of treatment of this disease are given.