Background. Malignant neoplasms are widespread, and the ambiguous relationship between them and hyperglycemia emphasizes the importance of studying them. On the one hand, diabetes mellitus and prediabetes increase the risk of developing malignant tumors. On the other hand, malignant tumors and drugs intended for their treatment can lead to hyperglycemia. Regardless of the origin, diabetes mellitus and prediabetes may develop diabetic nephropathy. Aim of study: to analyze the functional state of the kidneys in patients with diabetes mellitus and prediabetes with kidney neoplasms.

Object and methods. There was a study of 141 patients with a kidney tumor who underwent nephrectomy. For histological examination, a fragment of the kidney parenchyma was taken at a distance of at least 4 cm from the tumor. Histochemical stains, immunofluorescence reaction and electron microscopy were performed. Assessment of laboratory parameters was carried out before the surgical treatment, 3 days, 3 months, six months and a year after the operation. Parameters such as the level of protein in the urine, the presence and number of altered erythrocytes in the urine, and the glomerular filtration rate were assessed using the CKD-EPI formula.

Result. Diabetic nephropathy was detected in 44 patients (31.2%). Diabetes mellitus was previously diagnosed in 10 patients (22.7%), prediabetes was diagnosed in 34 patients (77.3%). After nephrectomy, patients with prediabetes and type 2 diabetes mellitus showed a sharp decrease in glomerular filtration rate (GFR). In the subsequent period, in patients with type 2 diabetes, there is a stable decrease in GFR. In patients with prediabetes, hyperfiltration is observed within six months, however, a year after the operation, GFR decreases again.

Conclusion. Widespread diabetic nephropathy in patients, it is advisable to jointly manage patients with an oncologist, nephrologist, endocrinologist, clinical pharmacologist.

Acutality: Heart rate variability, allows you to assess the state of the autonomic nervous system, which is useful for studying the condition of athletes, including endurance athletes, for example, ski racers. The stress index indicator is often used to assess the impact of stress on a person. It is shown that the stress index is closely correlated with the intensity of metabolism and with the indicators of energy consumption of the body.

Objective. To provide information on the values of the stress index for athletes depending on a number of factors, including their sports specialization, and for ski racers on the volume and intensity of the training load during the preparatory, competitive, transitional periods of the ski season.

Materials and methods. The literature analysis in the Pubmed database for the last 10 years in English and Russian languages has been carried out.

Conclusion. A review of the literature on the magnitude of the stress index showed that athletes who train for endurance, this indicator is low, especially among ski racers, if it is compared with the magnitude of the index in representatives of other sports, as well as with healthy people who do not play sports. There is no information about the value of the stress index in athletes in foreign literature, but there is such information in the domestic literature, which allowed us to present this review, which also includes the results of our research.

According to 2022 statistics from the Federal State Budgetary Institution National Medical Research Center for Endocrinology, the incidence of type 2 diabetes mellitus in Russia is 92.4% (4.49 million) of patients, and every tenth inhabitant of the Earth already suffers from diabetes mellitus.

Purpose of the study: to analyze the dynamics of superoxide dismutase and catalase activity at the systemic and local levels in rats of different ages when modeling type 2 diabetes followed by mechanical injury to skeletal muscle.

Object and methods. The study was conducted on white outbred healthy male rats 24 months old (120 individuals) and 6 months old (120 individuals). All old and young animals were divided into four subgroups within their group, 30 animals in each. Animals of the first subgroup in groups of old and young rats are intact rats. Animals of the second subgroup of the group in each group had a mechanical dissection in the area of the middle third of the gastrocnemius muscle of the hind limb. Animals of the third and fourth subgroups of each group were subjected to modeling type 2 diabetes mellitus.After the specified time, the animals of the fourth subgroup of both groups were injured in the middle third of the gastrocnemius muscle of the hind limb.

Conclusions. Mechanical injury to the gastrocnemius muscle in combination with type 2 diabetes mellitus is characterized by an intensification of lipid peroxidation and leads to an increase in superoxide dismutase activity in the liver tissue and blood serum of rats, and in young animals the increase in superoxide dismutase activity is more intense than in old ones.

Relevance. Studying the adaptive potential of students is an important way to assess the level of health and early career guidance of future doctors.

The purpose of the study is to study the adaptive potential of the cardiovascular system among second-year medical university students.

Object and methods. The study involved 507 students of both sexes studying in their second year at Samara State Medical University. At the first stage of the study, anthropometric parameters were studied in all subjects. At the second stage, an analysis of the adaptive potential was carried out by calculating the following indicators: index of functional changes, adaptive potential according to the equation of L.A. Konevskikh, Robinson index.

Conclusions. An analysis of the functional state of the cardiovascular system of medical university students revealed that the majority of students already in their second year have a disruption of adaptation processes, which is associated with low functional capabilities of the body, tension in adaptation mechanisms and disruption in the functioning of regulatory systems.

Relevance. Adenomatous colorectal polyps are associated with a high risk of developing a malignant tumor. They are considered precancerous conditions and can lead to the development of colorectal cancer. To date, colorectal cancer ranks third in the world in frequency of occurrence among all malignant neoplasms.

Objective. Improving the results of diagnosis and surgical treatment of patients with colorectal adenomatous neoplasms by identifying development factors and identifying risk groups for this nosology.

Materials and methods. Analysis of literary data.

Results. Among the factors leading to the development of colorectal polyps, it is worth noting a genetic predisposition, so by immunoblotting, PCR sequencing of the entire exome in cases of patients with familial dentate polyposis, rare variants of the germ line in the WNK2 gene were identified. Functional studies have shown that variants of the WINK2 germ line affect protein function in the context of the MAPK pathway, a molecular trait of this disease. Also, in the course of many domestic and foreign randomized clinical trials, the following modifiable factors for the development of adenomatous colorectal polyps were identified.

Conclusion. The study revealed the factors of development and recurrence of colorectal neoplasms and identified risk groups for this nosology. The study revealed low compliance of patients with respect to changes in certain living conditions (the use of ethyl alcohol and products containing it, tobacco smoking, both active and passive, the fight against obesity and inactivity), which leads to recurrence and increases the risks of malignancy of colorectal polyps.

Introduction. Hernia of the esophageal orifice of the diaphragm, complicated by reflux esophagitis, is one of the most common gastroenterological diseases, occupying the first place among all benign pathology of the cardiofundal zone. Typical complications of this pathology are esophagitis of varying severity, bleeding from the esophagus, peptic stricture and shortening of the esophagus, Barette's esophagus, ulcer and cancer of the esophagus. Indications for surgery include severe reflux esophagitis, the development of complications, and the failure of conservative therapy.

Objective: to evaluate the effect of stem vagotomy on the long-term results of surgical treatment of patients with hiatal hernia complicated by reflux esophagitis.

Object and methods. The long-term treatment outcomes of 130 patients were studied. All patients had increased acid production. The patients were divided into two groups: group I – 77 patients who underwent correction of hiatal hernia in isolation; group II – 53 patients who had correction of hiatal hernia supplemented by stem vagotomy. In group I, anatomical recurrence of hiatal hernia was diagnosed in 14 patients (18.2%), and in group II – in 1 (1.9%) patient. In the long-term postoperative period, none of the patients who underwent stem vagotomy were diagnosed with severe reflux esophagitis. While in patients who did not undergo stem vagotomy, a severe form of reflux esophagitis was found in 10.3% of patients.

Conclusion. In patients with hiatal hernia with increased acid production complicated by reflux esophagitis, it is advisable to supplement the correction operation with a stem vagotomy. This tactic leads to a statistically significant decrease in the number of relapses in the long-term period.

Reducing the risk of infectious complications after hip replacement both in the early and late postoperative period remains an important task. Currently, there is a search for laboratory markers of infection development in the field of surgical intervention with high prognostic significance. Violation of the production of catelecidins LL37 may be a factor contributing to the development of infectious and inflammatory complications. To investigate the concentration of cathelicidin in dynamics in patients with hip replacement and the development of postoperative infectious complications.

Object and methods. A total of 49 people were examined, who were divided into three groups: the first group – 19 patients after hip replacement with no peculiarities during the postoperative period, the 2nd group – 15 patients after hip replacement: with the development of infection in the early stages (n = 6), and 9 patients with late deep complications within 1 year. The third group (n = 15) consisted of clinically healthy individuals. The results of a laboratory study of LL37 catelecidins in peripheral blood and drainage fluid were analyzed.

Results. As a result of the comparative analysis of the results obtained, certain patterns were revealed. Thus, the level of catelecidin in blood serum and drainage fluid in the group of patients with infectious complications was significantly higher than in the group of patients without complications. Blood loss during surgery may be an additional factor contributing to the disruption of the production of antimicrobial peptides. Discriminant analysis revealed that the determination of the level of cathelicidin on the 10th day after surgery and its content in the drainage fluid suggests the development of a postoperative complication in the form of a paraprosthetic infection.

Relevance. A history of core decompression using porous tantalum rods has a negative impact on the course of total hip arthroplasty surgery, the postoperative period and the frequency and nature of postoperative complications. Opinions are contradictory with regard to the effect of other techniques of necrosis decompression on total hip arthroplasty.

Purpose of the study: evaluation of the effect of core decompression of the femoral head on the intraand postoperative parameters of total hip arthroplasty surgery.

Object and methods. The study included 44 patients with osteonecrosis of the femoral head who underwent total hip arthroplasty. The first group consisted of 30 patients with osteonecrosis of the femoral head (ARCO grade II-IV) who had no previous hip surgery – primary total hip arthroplasty. The second group included 14 patients with osteonecrosis who had undergone the core decompression on the same joint (secondary total hip arthroplasty) 6–24 months earlier in stage II of the disease. The duration of surgery, blood loss volume, complications in the postoperative period, pain syndrome dynamics and hip joint function were assessed.

Results. Comparative analysis showed the absence of significant technical intraoperative complications in total hip arthroplasty: duration of operations in group I – 85 ± 25 minutes, in group II – 80 ± 20 minutes, that is, almost identical; volume of intraoperative blood loss: 300 ± 100 ml in both groups. Survival rate of the hip replacement was 100 % in both groups. Superficial inflammation of the operating wound was diagnosed in 3.3 % of group I patients and in 7.1 % of group II patients (%). Dislocation of the hip replacement was observed in one patient in Group I (primary total hip arthroplasty). Twelve months after THA, osteolysis around the hip replacement element was detected by X-ray in 6.7 % of group I patients.

Conclusion. Total hip arthroplasty in patients with a history of the core decompression of the femoral head is not accompanied by intraoperative technical difficulties and is a relatively safe surgical intervention. Prior core decompression is not an additional risk factor for intraand postoperative complications of total hip arthroplasty.

Relevance. People involved in professional sports quite often encounter injuries. Thus, one of the main problems of modern traumatology and rehabilitation medicine is sports traumatism, which accounts for 2 to 7 % of all injuries.

Objective: to analyze the available and modern methods of rehabilitation of athletes with fractures of the bones of the lower extremities.

Materials and methods. In the course of the present study, we reviewed the literature data reflecting the current views on the problem of rehabilitation of athletes with fractures of lower limb bones.

Results. Successful recovery of athletes and early return to the training process is largely determined by optimally selected rehabilitation measures. There is no unified algorithm in rehabilitation of athletes; the choice of tactics depends on a number of factors, such as localization and severity of the fracture, surgical and conservative treatment performed, individual characteristics of the athlete, and the desired result. The optimal algorithm is a combination of classical rehabilitation measures, which include therapeutic physical training, diet therapy, psychotherapy and physical therapy procedures such as massage, taping, low-frequency magnetic therapy, UHF in low-heat doses, electrophoresis of analgesics, calcium and phosphorus drugs and thermotherapy.

Conclusion. All rehabilitation measures are aimed at gradual increase of physical load on the injured limb and strengthening the musculoskeletal system by improving tissue trophism, muscle tone, activation of metabolic processes as well as pain reduction and stimulation of regeneration of injured tissues. The adaptation basis of rehabilitation is the model of control of movements ("control-chaos continuum"), which provides the prevention of complications and re-injuries. Rational nutritional therapy contributes to increasing muscle mass and preventing the accumulation of fat mass. When choosing rehabilitation measures, the nature of the chosen treatment and objectives are taken into account, so that the choice of rehabilitation measures is made on an individual basis, in order to achieve the best possible results in a short period of time. Adequately chosen rehabilitation measures allow athletes to safely return to their original physical performance and reduce the risk of re-injury.

Introduction. Autologous plastic tissues (muscles and greater omentum) are preferable in the reconstruction of chest wall defects in infectious and inflammatory diseases of the chest wall. Extended and deep defects can be eliminated by flaps of the rectus abdominis muscle.

Aid. To study the effectiveness of various options for the use of flaps of the rectus abdominis muscle in plastic surgery of chest wall defects of infectious and inflammatory origin.

Object and methods. A retrospective analysis of the results of treatment of 34 patients with osteomyelitis of the sternum and ribs of various etiologies was carried out for the period from January 1, 2012 to May 30, 2023. In 32 patients, the main diagnosis was poststernotomy mediastinitis, 2 patients had post-radiation osteomyelitis of the sternum and ribs after combined cancer treatment. mammary gland. The majority of patients (n = 29) underwent a two-stage approach to treatment using vacuum therapy at the stage of relief of acute inflammation. All patients underwent plasty with a flap of the rectus abdominis muscle. The options for surgical intervention and the outcome of treatment were studied.

Results. The area of the defect to be repaired in patients ranged from 50 cm2 to 270 cm² (mean 143.1 ± 15.3 cm2). There were no intraoperative complications in the patients. The postoperative period was complicated by various wound complications in 9 patients. Marginal necrosis of the skin part of the graft was revealed in 3 patients with full-thickness permanent graft plasty. In 3 patients, despite wound drainage, postoperative seromas were detected. Reoperations were performed in 2 patients: in one case, bleeding from the vein of the fullthickness flap was stopped, in the other case, partial necrosis of the full-thickness flap was detected, which required a second operation and revision of the flap. In 1 patient, the hematoma was emptied 3 days after the operation. The average duration of inpatient treatment of patients was 19.3 ± 2.8 days (range 17 to 38 days). There were no lethal outcomes in patients with muscle plasty with a permanent graft flap. In 1 patient, a postoperative hernia was formed in the region of the anterior abdominal wall. Recurrence of osteomyelitis of the ribs was diagnosed in 1 person 16 months after surgery.

Conclusions. The rectus abdominis muscle as an isolated and full-thickness flap is the optimal plastic material for eliminating defects in both the lower part of the sternum and extensive defects in the anterior and lateral surfaces of the chest wall.

Relevance. Breast carcinomas (BC) remain one of the most actual problems of modern oncology. According to statistics, the incidence of BC is steadily increasing, making it the most common cancer pathology among women. In this situation, the aspect of diagnosing BC at early, non-invasive stages, is certainly important, which still reduces mortality, increases the possibility of organ-preserving treatment, duration and quality of life of patients.

The purpose of study. The purpose of study is to investigate and perform a comparative analysis of imaging techniques for the diagnosis of non-invasive breast carcinomas.

Materials and methods. Modern Russian and foreign literature about the diagnosis of non-invasive breast carcinomas was analyzed. Publications not older than 7 years published in specialized medical editions were taken into account Results. Not only main, but also new, promising imaging modalities that are not currently part of routine practice were analyzed. The main imaging patterns in non-invasive breast carcinomas (DCIS, LCIS and Paget's breast cancer), feasibility and prognostic value of certain diagnostic methods in different nosologies of this disease were also discussed.

Conclusion. The statistics provided explain the importance of breast carcinomas problem, as well as the relevance of its diagnosis at non-invasive stages. According to the authors, the issue of accurate diagnosis of breast cancer in situ is subject to further discussion and study, but we would like to note that when non-invasive breast carcinoma is suspected and doubtful imaging results are obtained, one should not limit oneself only to routine methods of imaging studies, but expand further diagnostic tactics until accurate results are obtained and a final diagnosis is made.

Relevance. In the treatment of the early stages of the femoral head osteonecrosis core decompression is widely used, which reduces intraosseous pressure and increases blood flow to the femoral head. To increase the efficiency of the core decompression the use of various bioadjuvants, including concentrate of autologous bone marrow cells is needed, the appropriateness of which is actively discussed.

Purpose of the systematic review: evaluation of the effectiveness of autologous bone marrow cells in core decompression in the treatment of the early stages of the femoral head osteonecrosis according to the literature.

Material and methods. Articles with clinical data in full text in English or Russian available in the Internet (PubMed and elibrary databases) were included in the study. Articles containing actual data on the stage of osteonecrosis, the number of femoral heads operated on, the use of autologous bone marrow cells as an adjunct to the core decompression of the femoral head, the number of ineffective surgical interventions after which total hip arthroplasty was required were included.

Results. Sixteen original articles (2011–2022) were analyzed, and the results of 1135 femoral heads treatment (892 with autologous bone marrow cells, 243 without autologous bone marrow cells, control group) were evaluated. Patient follow-up periods ranged from 9 to 120 months, averaging 45 months. When using autologous bone marrow cells, the need for total hip arthroplasty was observed in 168 of 892 patients (18.8 %); when core decompression was used without autologous bone marrow cells, the rate of total hip arthroplasty was 27.2 % (p > 0.05). Only 2 articles out of 16 authors did not consider autologous bone marrow cells to be reasonable in the core decompression of femoral head.

Conclusion. The use of autologous bone marrow cells concentrate as a bioadjuvant in the core decompression slows the progression of osteonecrosis. According to the overwhelming number of authors, the core decompression using autologous bone marrow cells is highly effective, significantly reducing the intensity of pain syndrome and improving the function of the hip joint. The results will be more encouraging with the further development of regenerative medicine, which will provide new samples of cellular preparations for bone tissue structure restoration.

Polypous rhinosinusitis is a widespread disease, which, according to scientific publications, affects about 5% of the world's population. In Russia, the incidence of this disease is on average 4.9 per 10 thousand population. The identification of key risk groups, as well as regions that require closer attention from specialist doctors, is the basis for the prevention of the disease, and also leads to an improvement in the quality of life of patients with polypous rhinosinusitis.

Purpose: to study the prevalence of polyposis rhinosinusitis among the population of the Samara region for the period from 2017 to 2021.

Materials and methods. for a comparative assessment of the PRS of the population of the Samara region, a retrospective analysis of information on the number of diseases registered in patients living in the service area of a medical organization was carried out based on the data of the annual reporting form No. 12, No. 14 for 2017–2021. The results of the analysis showed that the number of patients with newly diagnosed polyposis rhinosinusitis decreased over the period from 2017 to 2021, with prevalence among the urban population. The most common form of the disease, nasal polyp, was identified, which is confirmed by the results of the analysis of statistical forms. Also the analysis made it possible to identify areas with the highest prevalence of pathology.

Currently, there is a negative trend in the increase in the incidence of uterine fibroids, often diagnosed at a later date, requiring more invasive laparotomic myomectomy, up to hysterectomy. It was also revealed that the patients had an aggravated premorbid background in the form of obesity and related diseases.

The purpose of the study. To study domestic and foreign studies. To identify the features of the course of uterine fibroids in patients with hypersthenic and normosthenic body types.

Materials and methods. Anonymous and voluntary questionnaire survey with an in-depth collection of food history, interviews of 260 patients and analysis of their case histories with uterine fibroids who underwent laparoscopic and laparotomic myomectomy were carried out, dividing them into 2 groups according to BMI.

Results. In both groups, there was the following distribution according to the presence of pregnancies: 0 – 4 % and 5 %, 1 – 86 % and 84 %, 2 – 10 % and 11 % for groups I and II, respectively (p = 0.041 criterion). 25 % in group I and 31 % in group II had a history of surgery – caesarean section. The presence of inflammatory diseases of the pelvic organs in both groups was 89.3 % and 91.6 %, respectively. Also noted was a high consumption of beef and pork by 10 and 23 %, potatoes by 8 % and 13 %, white cabbage by 12 % and 11 %, bakery products by 21 % and 26 %. Low consumption of seafood and fish products by 35 % and 56 %, dairy products by 44 % and 47 %, absolutely low content of olive oil in the daily diet. The above data are presented for groups I and II, respectively. (criterion p = 0.029-0.054).

Сonclusions. Obesity plays a role as a risk factor for the development of uterine fibroids, acting either through hormonal or inflammatory mechanisms. Obesity can contribute to the development of insulin resistance and hyperinsulinemia, which can directly or indirectly influence the development of fibroids by promoting the proliferation of myometrial smooth muscle cells and increasing circulating levels of ovarian hormones.

Introduction. The treatment of combined pathology of posture and feet remains an urgent problem of the child population.

Target. To study the effectiveness of using an individually made wedge-shaped corrective heel pad for each foot in the treatment of grade I-II scoliosis with pelvic bone distortion due to asymmetric mobile flat-valgus deformity of the feet for 3 years.

Object and methods. A comparison group and a main group were formed from 39 children and adolescents aged 3 to 15 years with grade I-II scoliosis with skewed pelvic bones and mobile flat-valgus deformity of the feet; patients underwent orthopedic examination every 6 months, radiography of the spine with pelvic bones, photoplantography, measurement of the pronation angle of the calcaneus, the study of quality of life indicators.

Results. There was a decrease in clinical symptoms in 54.2 % of patients of the main group with regression of the II degree of scoliosis to the I degree, the pronation angle of the calcaneal bones decreased by 4.25 ± 0.78 ° with the preservation of minimal asymmetry after 3 years, a decrease in the difference of the iliac crests by 3 .64 ± 1.59 mm and the angle of scoliotic deformity of the spine on radiographs by 5.22 ± 1.36°. Correlation analysis showed a statistically significant strong and moderate direct relationship between the pronation angle of the left calcaneus and the angle of scoliotic spinal deformity on radiographs in the 1st and 3rd years of the study, as well as with the difference in the iliac crests throughout the study. The quality of life of patients of the main group with correction of the asymmetry of foot hyperpronation improved by 15.5 %, in the comparison group by 2.9 %.

Conclusions. The results of the study confirmed the effectiveness of the use of individual wedge-shaped corrective heel pads for each foot in the treatment of grade I-II scoliosis with skewed pelvic bones due to asymmetric mobile flat-valgus deformity of the feet.

Relevance. One of the tasks of modern surgery is to provide high-quality medical care with a significant impact on the patient, which should lead to an improvement in the quality of life. Quality of life assessment is becoming increasingly relevant in healthcare and is associated with improved decision-making, higher satisfaction and better treatment outcomes.

The purpose of the study. To identify criteria for an objective assessment of the quality of life of patients in the postoperative period.

Materials and methods. In the course of this study, the most relevant domestic and foreign literary sources were analyzed, reflecting the problem of assessing the quality of life of patients in the postoperative period.

Results. To assess the quality of life, various forms of questionnaires for patients are usually used. Questionnaires can be both general and specific for a particular disease. After analyzing numerous questionnaires to determine the quality of life, it became possible to combine and classify objective criteria for the quality of life.

Conclusion. The use of general and special questionnaires makes it possible to perform a full-scale assessment of both the main components of the quality of life and its specific aspects in this disease. At the same time, it is important to take into account the influence of various factors, including gender, age, and the initial quality of life, on the change in indicators over time. This approach is the most correct and corresponds to modern recommendations for analyzing quality of life data that changes over time and is associated with various factors.

Introduce. Patients with a high prevalence of the process and extensive destruction of the pulmonary parenchyma have reduced lung reserves, which limits the use of resection interventions.

Objective. To study the dynamics of respiratory function indicators in patients with bilateral widespread destructive tuberculosis during surgical treatment using staged bilateral extrapleural pneumolysis with silicone plombage (ESP).

Object and methods. The main group consisted of 11 patients who underwent surgical treatment using staged bilateral ESP. The comparison group included 8 patients with bilateral widespread destructive pulmonary tuberculosis who underwent consecutive bilateral lung resections with a volume of more than 3 segments. The dynamics of respiratory function indicators were studied 3–5 weeks after surgery.

Results. In the main group, after stage-by-stage surgical treatment, the FVC index decreased by 0.9 ± 0.6 liters, while in the comparison group by 1.3 ± 0.7 liters (p < 0.01). The index of FEV1 in patients of the main group decreased by 0.5 ± 0.5 liters, and in the comparison group by1 ± 0.3 liters (p < 0.01).

Conclusion. Staged surgical treatment with the use of bilateral ESP is accompanied by a significantly smaller decrease in functional parameters and can be used in patients with widespread bilateral destructive tuberculosis with low respiratory function.

Relevance. Caries of hard dental tissues is one of the most common diseases throughout the world. It affects not only the primary teeth of children, but also the permanent teeth of adults, which can lead to serious consequences for human health. In recent years, the dental community has paid special attention to the possible connection between streptococcal infection and the development of caries, and therefore this topic is extremely relevant and requires detailed consideration. Chronic rheumatoid arthritis (CRA) is one of the most common joint diseases, which is characterized by inflammation of the joint lining and destruction of cartilage. Patients with CPA are also at high risk of developing dental caries, which may be due to many factors, including changes in saliva composition and long-term use of medications.

Purpose of the study: to study the effect of streptococcal infection on the occurrence of caries among patients suffering from chronic rheumatoid arthritis. To assess the incidence of caries complications caused by streptococcal infection among patients who have had COVID-19.

Materials and methods of research. The authors analyzed domestic and foreign literature in order to conduct a literature review regarding the etiology of the occurrence and relationship of streptococcal infection and caries against the background of rheumatoid arthritis. The authors also analyze the incidence of caries complications caused by streptococcal infection as a consequence of COVID-19. Data from 160 patients, 100 men and 60 women, were studied.

Conclusion. From the studies conducted, we can conclude that streptococcal infection is one of the factors influencing the development of caries. However, the exact mechanisms of interaction between bacteria and hard dental tissues have not yet been established. As a result of the analysis, it was revealed that the relationship between streptococcal infection and the occurrence of caries against the background of chronic rheumatoid arthritis is significant. The presence of streptococcal infections in patients with rheumatoid arthritis can lead to deterioration of oral health, which in turn contributes to the development of dental caries. Among patients who have had COVID-19, there is a fairly high percentage of caries, including those caused by streptococcal infection and a general deterioration in the health of the oral cavity and the body as a whole.

Background. Despite the many accesses described in the literature for open Achilles tendon repair, there is no evidence of the benefits of this or that access confirmed by clinical observations.

The aim is to determine and justify optimal access during open Achilles tendon repair.

Material and methods. The article shows the result of the analysis of data from a literary search, experimental work on 12 lower limbs of 6 cadavers, a clinical study based on a retro-prospective analysis of the treatment of 128 people in the Department of Emergency Traumatology N.V. Sklifosovsky Research Institute from 2014 to 2022. The comparison group retrospectively included 47 patients (36.7%) with Achilles tendon injury, who underwent suture of the Achilles tendon from S and Z–shaped accesses from 2014 to 2017. The main group prospectively included 81 patients (63.3%) for 2018-2022, who underwent paramedial tendon access.

Results. The analysis of a retrospective study showed that 3 patients from the comparison group with Achilles tendon injury in the postoperative period had ischemia of the wound edges with subsequent formation of necrosis and skin defect; 1 patient had a hypertrophic painful scar, which ulcerated from the constant traumatization of his shoe back (the total number of complications was 8.5%). In the patients of the main group, there were no complications in the postoperative period in any case. Conclusion. In our opinion, the paramedial tendon access is optimal, because there are no complications from the skin and leads to improved functional results.

Relevance. Patients with trauma are at increased risk of venous thromboembolic complications (VTE), which includes deep vein thrombosis of the lower extremities (DVT) and pulmonary embolism (PE). Within surgical and trauma clinics, thromboembolic complications are the most common preventable cause of in-hospital mortality. Numerous studies have shown that the incidence rate of deep vein thrombosis (DVT) in trauma patients without prevention varies from 5 to 80%.

Aim. To analyze the pathogenesis of the development of venous thrombosis and explore existing approaches to prevent VTE in trauma patients.

Materials and methods. In the course of the work, topical literary sources of domestic and foreign authors on a given topic were analyzed.

Results. The mechanism of thrombus formation in trauma involves slowing blood flow, damage to the vessel wall and impaired blood clotting in the form of hypercoagulation. The state of hypercoagulation combined with prolonged immobility increases the risk of VTE. LMWH is the treatment of choice for the prevention of VTE in trauma. Today, there are ongoing studies related to the correction of preventive doses of LMWH and the search for a single standard, depending on numerous factors.

Conclusion. Severity and multiplicity of lesions correlate with severity of systemic inflammation, hypercoagulation, and incidence of venous thrombosis. However, this correlation has not been sufficiently studied in the scientific literature. The search for specific methods for the prevention of deep vein thrombosis leading to PE is an urgent problem of surgery of injuries both peaceful and wartime.

Target. To summarize the available literature data on the methods of surgical treatment of chronic pancreatitis, evaluate their results, identify shortcomings and possible solutions.

Materials and Methods. We conducted a literature review of scientific papers over the past 20 years, using the resources of the search engines PubMed, Cyberleninka and eLIBRARY, on the available methods of surgical treatment of chronic pancreatitis. For this meta-analysis, we used articles containing an evidence-based experimental and clinical base on issues related to long-term and immediate results of surgical treatment.

Results and discussion. We analyzed the immediate and long-term results of the methods of surgical treatment of chronic pancreatitis. In almost all studies, resection-drainage methods made it possible to effectively stop the pain syndrome for a long time. However, exoand endocrine insufficiency in most cases persisted or progressed, regardless of the method used. Another disadvantage of the existing methods was the inability to stop bleeding from the area of pancreatojejunostomy in the early postoperative period, so mortality after the development of these complications ranged from 5 to 60%.

Conclusion. Based on the results studied, we identified the following disadvantages of the known methods of surgical treatment of chronic pancreatitis: 1. A long loop of the small intestine, at least 70 cm, turned off from digestion, leading to a significant decrease in the length of the intestinal tube, and, accordingly, the area of absorption of food nutrients. 2. The features of the reconstructive stage of the operation do not provide the physiological flow of pancreatic secretion into the duodenum and, accordingly, the activation of enzymes, thereby turning off the duodenal phase of digestion. 3. Roux-enabled loop of the small intestine creates favorable conditions for the development of excessive bacterial growth. 4. Lack of endoscopic evaluation of the pancreas to stop bleeding in the early postoperative period. After analyzing the literature data, we came to the conclusion that the elimination of these shortcomings will improve the results of chronic pancreatitis treatment.

Introduction. The number of victims with abdominal trauma over the past 20 years has not tended to decrease due to an increase in the number of road accidents, falls from heights, man-made disasters and natural disasters. Diagnosis of damage to hollow organs should be fast and accurate, since the time factor in providing medical care to such patients is crucial. The delay of surgery for intestinal injury for 24 hours or more is associated with an increase in the mortality rate of up to 30%. In such cases, computed tomography is the method of choice for hemodynamically stable patients with closed abdominal trauma.

The aim is to demonstrate the possibilities of computed tomography in the early detection of damage to the small intestine and mesentery using the example of a clinical case of closed combined abdominal trauma with damage to a hollow organ and multiple injuries of the musculoskeletal system.

Materials and methods. A clinical case of combined trauma of a patient in a traffic accident is described.

Conclusion. In this clinical case, the victim with a combined injury was shown the modern possibilities of computed tomography in early detection of damage to the walls of the small intestine and mesentery, which made it possible to make a timely decision on emergency surgery, avoid serious complications, restore the patient's ability to work and quality of life.

Objective. The use of checklists for quality and safety control of medical care is an effective tool for reducing the frequency of errors, dangers and complications in any section of medical practice.

The aim is to demonstrate the possibilities of minimizing and leveling the potential risks accompanying surgical intervention using the example of routine application of the surgical safety checklist.

Object and methods. Patient A., 55 years old, was admitted to the emergency department of Samara City Clinical Hospital №1 named after N.I. Pirogov on 24.04.2023. with complaints of pain in the right upper abdomen, nausea, vomiting, general weakness. The diagnosis was Cholelithiasis, acute calculous cholecystitis with the formation of a perivesical abscess. It required laparoscopic cholecystectomy operation. While filling in the surgical safety checklist (SSC) and analyzing possible intraoperative incidents, the attending physician executed an informed voluntary consent for transfusion of donor blood components. The corresponding components were ordered. Having weighted up the potential intraoperative risks specified in the part "Before anesthesia" of SSC, the anesthesiologist installed a catheter into one of the central veins and performed the urine bladder catheterization. Surgical intervention was complicated by bleeding, which required conversion of surgical approach. Upper median laparotomy, cholecystectomy, surgical hemostasis were performed. Total blood loss was 1000 ml, plasma and red blood cell were donated to the patient. The operation was completed by drainage of the subhepatic space and suturing of surgical wounds.

Results. The clinical case describes the importance of a team approach at the stage before the operation, as well as the role of all specialists provided life support and medical care for the patient. It results from attentive work with the checklist which shows a clear liability for each member of the operating team at different stages of preparation and treatment of a surgical patient.

Conclusions. The development of a culture of surgical safety is an important way to minimize the risks associated with surgical intervention for each individual patient and for the institution by optimizing the work of operating units.

Relevance. The choice of biliary anastomosis is the main factor determining the risk of developing biliary complications after orthotopic liver transplantation. The two most common forms of biliary tract reconstruction are choledocholedochostomy (duct-to-duct anastomosis) and choledochoeunostomy (connection of the bile duct to the jejunum). The choice of biliary tract reconstruction is determined by a variety of factors, including the underlying pathology of the liver, the size of the bile ducts of the donor and recipient, previous transplantation or previous biliary tract surgery, as well as the preferences of the surgeon performing the operation. Despite the correctly chosen method of reconstruction, complications such as strictures, lithiasis, biloma, and bile leakage occur infrequently.

Objective: to present a review of the literature on methods of diagnosis and treatment of biliary complications after liver transplantation.

Materials and methods. The analysis of literary sources in English and Russian from 2010 to 2023 on this topic in the databases PubMed, MEDLINE, Google Scholar was carried out. The review highlights clinical studies, as well as literature reviews on similar topics with an emphasis on the treatment and diagnosis of biliary complications.

Conclusion. The problem of biliary complications of liver transplantation remains relevant and unresolved to the end. Noninvasive imaging techniques for complications arising after biliary tract surgery have prospects for development. The tactics of percutaneous, endoscopic and open interventions on the biliary graft tree require further improvement.

Relevance. Prosthetics of the lower limb after amputation restores the patient's ability to move and self-care. Preparation and prosthetics in the early stages after amputation, in the absence of contraindications, improves the physical, psycho-emotional state of patients, reduces the risk of complications due to forced exercise and exacerbation of concomitant somatic pathology, as well as increases exercise tolerance, restores mobility, functioning after amputation.

The aim of the work is to improve the quality of life of patients with mobility disabilities.

Materials and methods. The information base of the study was the normative legal acts of the Russian Federation, standards, clinical recommendations defining the existing system of providing rehabilitation services for prosthetics of the lower limb.

Conclusion. Unsatisfactory prosthetics of the limb after amputation negatively affects the quality of life of the patient. For this reason, the assessment of the rehabilitation service of prosthetics of the lower limb, including using the tools of the International Classification of Functioning, Disability and Health, is both relevant and necessary.

Introduction Clinical simulation learning as an educational tool is recommended in the clinical officers’ training. Upon entry into the workforce, clinicians are expected to respond to a range of clinical situations they may not have experienced during their program.

Methodology. A cross-sectional survey was conducted at Two medical training colleges in Kakamega County, Kenya. This design also enabled testing of causeand-effect relationships of the variables under study. The study employed a systematic way of gathering information. The information gathered described simulation in clinical teaching, specifically a case study of medical training colleges in Kakamega County Kenya.

Results. The results show that 215 (71.2%) of the respondents agreed that assessment in the skills laboratory improved the outcome of the early clerkship, 77 (25.5%) disagreed while 10 (3.3%) of the respondents were neutral. The mean score was 3.14 with a standard deviation of 1.14 which shows that most respondents were in agreement that assessment in skills laboratory improves the outcome of the performance and skills of students. The item mean was below the composite mean of 3.36 indicating a negative influence on the composite mean. The standard deviation for the item was above the composite standard deviation of 0.45 indicating a wider spread in response for the item than the variable.

Conclusion. OSCE is a competency-based tool widely used in clinical teaching.