The paper analyzes the trajectory of development of the scientific periodical "Bulletin of the Medical Institute 'REAVIZ': Rehabilitation, Doctor and Health", examining the key challenges and problematic aspects faced by the journal's editorial board in the course of its current work. Overall, attention is paid to the systematic correction of the main vectors of improving editorial policy in accordance with the best international practices of publishing scientific journals, issues of improving the quality of published materials, deepening the review processes and strict selection of articles for publication, attracting authors from various regions of Russia and foreign countries, analyzing the prospects for developing the practice of publishing accompanying digital data and resources along with textual materials, increasing citation and indexing of the journal in authoritative databases, as well as promoting an open access policy. Based on the results of the analysis, specific plans for the further progressive development of the journal "Bulletin of the Medical Institute 'REAVIZ'" are formulated. 

To date, a number of studies have been carried out to investigate the role of polymorphisms in estrogen receptor (ESR) and aromatase (CYP19A1) genes in knee osteoarthritis. However, the obtained results are contradictory and are not sufficient to formulate final conclusions.
Purpose of the study: to investigate the associations of the rs2234693 and rs9340799 polymorphisms in ESR1 gene and the rs2414096 and rs936306 polymorphisms in CYP19A1 gene with knee osteoarthritis in postmenopausal women.
Material and methods. Molecular genetic studies were performed in 157 postmenopausal women with knee osteoarthritis. The control group consisted of 326 women of the same age without signs of joint disease.
Results. A comparative analysis of the results showed an association of the AA genotype of the rs2414096 polymorphism in CYP19A1 gene with increased susceptibility to knee osteoarthritis (p = 0,022). For the second polymorphism in CYP19A1 gene (rs936306), as well as for two polymorphisms in ESR1 gene (rs2234693 and rs9340799), no association with osteoarthritis was established (p > 0,05).
Conclusion. The obtained results indicate the need for further larger-scale studies of genes role involved in estrogen metabolism in the development of knee osteoarthritis in postmenopausal women.

Purpose: To provide a morphological characterization of dysplasia occurring against the background of inflammatory bowel disease (IBD), considering the new classification of dysplasia.
Materials and methods. A retrospective analysis was conducted, and biopsies were reviewed from 257 patients with IBD treated at Sechenov University clinics from 2018 to 2023. Patients' ages ranged from 19 to 63 years. Diagnosis was based on a combination of clinical, laboratory, and instrumental methods. Multiple biopsies were taken during colonoscopy, processed using standard metods.
Results. Non-traditional dysplasia was diagnosed in 5 patients, accounting for 1.95% of cases over a 6-year period. Two cases involved hypermucinous dysplasia in patients aged 35 and 43 with ulcerative colitis, with disease durations of 12 and 9 years, respectively. crypt cell atypia/dysplasia was diagnosed in two patients aged 40 and 30, with ulcerative colitis durations of 5 and 10 years, respectively. In a 51- year-old patient with Crohn's disease for over 15 years, dysplasia resembling a dentate lesion was found in the ascending intestine. Dysplasia diagnosis was confirmed using immunohistochemical (IHC) staining with TP53 antibodies (clone DO-7 Leica RTU, Germany), showing positive staining of tumor cell nuclei, indicating TP53 gene mutation. Two out of five cases exhibited total colon involvement in inflammatory process, and one ulcerative colitis case was combined with primary sclerosing cholangitis.
Conclusion. Before the appearance of the latest classifications of dysplasia in IBD, we rarely diagnosed dysplasia in biopsies from IBD patients. We now understand that the spectrum of potential neoplastic precursor lesions of colorectal cancer in IBD patients is much wider and this understanding can ensure that clinically important but rare lesions will not be undiagnosed. Future studies of their natural course may eventually determine that some lesions are more clinically important than others.

The article presents an analysis of scientific literature devoted to the study of surgical anatomy of the ligamentous apparatus and metatarsal bones of the human foot. The literature covers the issues of macroanatomy and histology of the ligaments and metatarsal bones of the foot quite fully. At the same time, issues related to the same shape and size of bones, the relative position of ligaments, their histotopographic features are contradictory, which is associated with high variability, individual and age variability in combination with a number of social factors and features of the regions of residence. The work shows that at present, the data of domestic and foreign scientific literature on the anatomy and topography of the bones and ligaments of the metatarsal bones of the human foot are presented either by sectional studies or by the results of clinical observations using diagnostic equipment. The existing studies do not provide a comprehensive picture of the surgical anatomy of the ligamentous apparatus and metatarsal bones of the human foot. The article reflects the need for widespread use in fundamental anatomical studies of ligaments and metatarsal bones using the histotopographic method of research, quantitative and qualitative assessment of morphological parameters, which open up new possibilities for diagnosing pathological processes and developing new surgical techniques.

Purpose: to characterize changes in the colon crypts in colitis and to assess their significance in the morphological diagnosis of inflammatory bowel diseases (IBD).
Materials and methods: colon biopsies were retrospectively reviewed in patients with IBD (30 patients with ulcerative colitis (UC) and 30 patients with Crohn's disease (CD)) and in 30 patients where the diagnosis of IBD was not confirmed (self-limiting colitis not related to IBD (non-IBD)). The age of the patients ranged from 19 to 53 years. In all cases, the diagnosis was established based on a combination of clinical, laboratory, and instrumental diagnostic methods. Multiple biopsies were obtained from all patients during colonoscopy. The processing of the material was carried out according to generally accepted methodology. All cases were scanned using the Aperio TC histological preparation scanner (Leica, Germany) and re-examined with an emphasis on crypt changes.
Results: the crypt characteristics found during the study were divided into the following groups. The most frequently detected changes included inflammatory and destructive changes (98% of cases of IBD and 80% of cases of non-IBD). Atrophic changes in crypts were more often found in patients with non-IBD colitis compared with cases of IBD (30% in IBD and 53.3% in non-IBD; p=0.03). Significant differences in frequency were observed when dysregenerative changes in crypts were detected (76.7% of cases of colitis in IBD and 13.3% of cases in non-IBD; p<0.001). Crypt budding was more pronounced in patients with UC compared with CD (92% in UC versus 70% in CD), and a special variant of crypt changes, which we termed "serpentine," was found exclusively in patients with CD.
Conclusion: crypt changes found only in patients with IBD, such as budding crypts, can serve as an important differential diagnostic criterion for the diagnosis of IBD. In the IBD group, the discovered serpentine crypts can help in making a differential diagnosis between UC and CD. Inflammatory and destructive changes are found with equal frequency in both cases of IBD and non-IBD colitis and therefore cannot be considered specific diagnostic signs.

In the third decade of the XXI century, HIV infection and viral hepatitis C remain urgent problems of modern medicine. Only in the Russian Federation in 2023, more than 1.6 million HIV-infected people and about 2 million patients with chronic viral hepatitis C are registered. Patients with a combined course of these diseases are of particular concern. However, insufficient coverage of etiotropic therapy for patients with chronic viral hepatitis C due to its high cost leaves pathogenetic therapy as the only available method of treatment for many of them.
Material and Methods. Clinical data of patients hospitalized in the day hospital of the state budgetary health care institution "Samara Regional Clinical Center for AIDS Prevention and Control" were used. Physical, virological, immunological, biochemical and general clinical methods, elastometry of liver tissue were used for examination of hospitalized patients. Statistical processing of the results was performed using the application program "Statgrarhics Plus for Windows". Pathogenetic therapy was carried out in a two-week course in accordance with the "Recommendations for the diagnosis and treatment of adult patients with hepatitis C" (2013) and included (along with protective regime and therapeutic nutrition) the use of detoxification and metabolic therapy. Antiretroviral therapy with 3–4 drugs was carried out in 68% of the patients.
Results. It was shown that the prescribed course of pathogenetic therapy of chronic viral hepatitis C did not have the expected effectiveness in the majority of patients referred for treatment according to the dynamics of changes in the values of "liver tests", despite the fact that the "right subcostal syndrome" was eliminated in 75.7% of persons with stage 3 and 66.7% with stages 4A and 4B of HIV infection. Statistical studies of the relationship (linear, rank and canonical) did not reveal its presence between the results of the conducted treatment and the complex of initial clinical and clinicallaboratory data obtained during hospitalization of the examined persons.
Discussion. The presence of cytolysis syndrome and "right subcostal syndrome" is not a valid criterion for referral to a two-week course of pathogenetic therapy of chronic viral hepatitis C in order to obtain a positive result in the majority of patients with stages 3, 4A and 4B of HIV infection. Other baseline data (virologic and immunologic indices, degree of liver tissue fibrosis, indices of general and biochemical blood analysis) had no reliable correlation with the results of treatment, which did not allow their use for predicting the effectiveness of the prescribed treatment. Antiretroviral therapy was not associated with the results of pathogenetic therapy of chronic viral hepatitis C according to the indicators of cytolysis syndrome and "right subcostal syndrome", despite the fact that most of the prescribed drugs had a hepatotoxic effect.

Atrial fibrillation and fluttering are the most common cardiac arrhythmias, which progressively affect the quality and duration of life, causing thromboembolic complications and an increase in heart failure. This article presents the result of studying and analyzing modern ideas about the epidemiology, etiology, pathogenesis, clinical manifestations, course options, complications and outcomes of atrial fibrillation and flutter with the establishment of urgent unresolved issues of this pathology.

Introduction. Renal dysfunction is increasingly recognized as a key mediator of the association between metabolic risk factors and cardiovascular disease (CVD). Therefore, rather than simply viewing cardiorenal (CR) syndrome and cardiometabolic (CM) diseases as separate conditions, it is clear that we need to consider them as the broader concept of cardiovascular-renal-metabolic syndrome (CVMS). Purpose of the study: Studying the differences in the influence of SSMPS and separately metabolic (MS) on the course of coronary heart disease (CHD).
Materials and methods. The study included 116 patients - 69 (59.5 %) men and 47 (40.5 %) women who were treated at the RCH Hospital No. 2 from 2022 to 2023. The patients were divided into two groups, the 1st group included n = 52 with cardiovascular-renal-metabolic syndrome, the 2nd group included n = 64 with metabolic syndrome. The duration of the study is 18 months.
Results. Primary indicators of low-density lipoproteins (LDL) in the 1st group were 2.9 ± 3.6 in the 2nd group 2.6 ± 4.0 p < 0.05, and upon re-examination, the ratio of values was as follows - 3 .2 ± 2.8 to 3.0 ± 3.3 p > 0.05. Patients with type 2 diabetes mellitus (DM2) increased by the end of the examination in both groups, but not so significantly in relation to the total weight of 2.6 % to 3.4 % p < 0.05. During the repeated examination, the indicators of arterial hypertension (AH) of the 2nd degree prevailed (34.6 % to 32.8 %) p < 0.05, and there was also an increase in patients with hypertension of the 3rd degree (25.0 to 25.0) p < 0.05, mainly due to patients of the 1st group with kidney disease. Re-admission to the hospital occurred more often in patients with SSPMS than in the group with MS 9.5 ± 7.2 and 12.6 ± 6.8 months, p < 0.05. In-hospital mortality from acute myocardial infarction (AMI) slightly prevailed in group 1 upon re-admission to hospital, ratio n = 3 (5.8 %), in group 2 n = 1 (1.6 %), p > 0.05.
Conclusions. In conclusion, our nonrandomized prospective study showed that patients with cardiovascular-renal-metabolic syndrome are at a higher risk of developing cardiovascular events than patients with metabolic syndrome alone. Analysis of lipid metabolism in the group of cardiovascular-renal-metabolic syndrome showed that in a short time after discharge from the hospital, from 6 months to 1.5 years, the indicators of total cholesterol, triglycerides and lowdensity lipoproteins progress negatively to the time of relapse of angina pectoris.

Aim: to study the relationship between clinical and morphological parameters of skin melanoma and the BRAF status of the tumor in patients with stage I of the disease.
Materials and methods. The study was retrospective and included 200 patients with stage I skin melanoma (pT1-2aN0M0), of which BRAF status was assessed in 88 patients. All patients underwent clinical data analysis, an extended morphological study and a molecular genetic study to determine the BRAF V600E mutation in the primary tumor.
Results. The median age of patients in the total sample was 61.5 years. Mutation in the BRAF V600E gene was detected in 25 patients (28.4%). Patient age, tumor location and Breslow thickness were recognized as independent predictors of BRAF status of stage I skin melanoma. With an increase in the patient's age by 1 year, the chance of having a BRAF V600E mutation decreased by 3.4% or 1.04 times (OR = 0.966; 95% CI = 0.935–0.999; p = 0.045). When melanoma was localized in the lumbar region, the chance of having a BRAF V600E mutation increased by 15.311 times (95% CI = 1.239–189.142; p = 0.033). With a tumor thickness according to Breslow of more than 0.7 mm, the chance of having a BRAF V600E mutation increased by 2.939 times (95% CI = 1.031-8.376; p = 0.044). With a threshold value of the logistic function of 50%, the sensitivity and specificity of the proposed model were 28.0% and 93.7%, respectively. When the threshold function value is reduced to 25.3%, the sensitivity of the model increases to 68% with a simultaneous drop in specificity to 61.9%.
Conclusion. Younger age, greater tumor thickness according to Breslow, and tumor localization in the lumbar region in patients with stage I skin melanoma increase the chance of having a BRAF V600E mutation, while other morphological parameters of the tumor are not associated with BRAF status. However, moderate sensitivity does not allow for a sufficiently accurate determination of the presence of a mutation, thereby strengthening the belief in the need for molecular genetic testing.

Relevance. According to statistical data, fractures of the scapula are quite rare, accounting for approximately 3-5% of all shoulder girdle fractures and less than 1% of the total number of fractures. Because of the high-energy nature of scapula fractures, 80% to 95% of cases are associated with additional traumatic injuries.
The aim: to analyze the technique of performing surgical intervention in a fragment fracture of the right scapula with displacement of the fragments on the example of a clinical case.
Object and methods. Patient G., 21 years old, on 12.10.2023 applied to the trauma center № 114 after a wind-driven tree fell on his right forearm area. A fracture of the right scapula with displacement of the fragments was detected, the patient was referred to the emergency room of the R.R. Vreden Research and Development Center for further examination and treatment. On admission to the department, the patient's right supraclavicular region was longer than the left one, the right supraclavicular region at the acromial end was swollen and painful, without visible deformity.
Results. The study presents traumatologic pathology, namely, fractures of the articular and clavicular processes of the scapula with displacement of the fragments, as well as fracture of the acromial process of the scapula with minimal displacement of the fragments and cranial subluxation of the acromial end of the clavicle. The causes, diagnostic methods and surgical treatment of this pathology are described.
Conclusions. Due to the growing amount of data on satisfactory postoperative results in patients with scapula fractures, there is still interest in surgical trends in the treatment of these patients. However, it is worth remembering that postoperative complications after repositioning and fixation of bone fragments continue to be an urgent problem.

The cardiovascular system during pregnancy undergoes a number of compensatory and adaptive changes, such as an increase in heart rate, cardiac output and total peripheral resistance, which causes an increase in the load on the myocardium. Peripartum cardiomyopathy is a serious polyetiological complication of pregnancy and the postpartum period, as well as an important cause of disability and mortality for both mother and fetus. The non-specificity of complaints and the paucity of clinical symptoms in the early stages of the disease lead to delayed diagnosis and significantly increase the frequency of unfavorable outcomes. In the article we present our own clinical observation of the acute development of severe peripartum cardiomyopathy in a multipregnant woman at 36 weeks of gestation, complicated by cardiogenic shock and antenatal fetal death.

Introduction. Currently, diabetes mellitus occupies a leading position in terms of prevalence, disability, mortality and it is a medical and social problem. Microvascular and macrovascular diabetic complications negatively affect the quality and duration of sleep with detrimental effects on metabolism and weight regulation. The cognitive sphere is more impaired in type 2 diabetes mellitus in the form of a decrease in the speed of reaction to external stimuli and the ability to concentrate for a long time, so thinking becomes slower, and clinically significant cognitive impairments leads to work and social maladaptation and a decrease in adequate glycemic control.
Aim of the study: to study the nature of diagnosed cognitive impairments and variants of dissomnias in chronic cerebral ischemia and to evaluate the features of identified dissomnias in the development of early dementia in type 2 diabetes mellitus.
Object and methods. During the period from 2017 to 2023, 207 patients with chronic cerebral ischemia and neurological deficits of varying severity were examined. All patients underwent a comprehensive clinical and neurological examination using specialized scales to study the cognitive sphere and sleep level, laboratory and instrumental methods of examination. The study applied non-inclusion, inclusion and exclusion criteria and selected 147 patients with chronic cerebral ischemia and type 2 diabetes mellitus. The data has been processed statistically.
Results. Cognitive impairments (95,1 ± 2,4%) and dyssomnia (88,9 ± 3,5%) develop in patients with type 2 diabetes mellitus with chronic cerebral ischemia, and their combination is significant (p < 0,05) prevailed (82,7 ± 4,2%) with dysmetabolic signs. At the same time, moderate (43,2 ± 5,5%) and severe (34,6 ± 5,3%) cognitive disorders with moderate dyssomnia (63,0 ± 5,4%) and increased sleepiness (64,2 ± 5,3%) with episodes of obstructive sleep apnea (16,0 ± 4,1%) and narcolepsy (6,2 ± 2,7%) compared with patients without type 2 diabetes mellitus (p < 0,05).
Conclusions. The presence of type 2 diabetes mellitus increased the risk of developing dyssomnia and cognitive disorders, and the identification of dyssomnia led to an increased chance of a deterioration in the intellectual-mnestic level to the degree of moderate and severe impairments. Neuropsychological testing in combination with dyssomnia questionnaires and quantitative assessment of the severity of cognitive dysfunction is absolutely necessary.

Osteoporosis, according to the World Health Organization, ranks fourth among the causes of death and disability after cardiovascular, oncological diseases and diabetes mellitus. Among residents of Russia over the age of 50, osteoporosis occurs in about one in three women and one in four men. This pathology has a high social significance, since it often causes a high level of disability of the adult population. From the point of view of reducing the incidence of mortality and disability of the able-bodied population from osteoporosis, the problem of its prevention and early diagnosis, including using radiation research methods, is paramount. Information on this issue is quite scattered today, requires systematization and generalization. The study and analysis of the available literature on the possibilities of radiation diagnosis of osteoporotic changes were carried out. Summarizing the available information on the radiation diagnosis of osteoporosis, we should talk about the need to introduce a preclinical examination for this pathology, since there is data on the results of opportunistic screening in some groups of patients. The vast majority of such cases are asymptomatic, which once again confirms the need for a preventive approach to this problem. Taking into account the variety of existing methods for diagnosing osteoporosis in the early stages, the most reliable, with some of its disadvantages (the presence of radiation exposure, the high cost of equipment), are still dual-energy X-ray densitometry and quantitative computed tomography, the analogue of which, with limited resources to provide equipment for medical institutions, is ultrasound densitometry.

Relevance. Some achievements related to liver transplantation in the field of infectious complications, rejection treatment and surgical tactics have also contributed to improving patient survival. Nevertheless, it is true that the huge progress made in the field of transplantation is mainly due to the emergence of safe and effective immunosuppressive drugs. But complications from immunosuppressive drugs are still a significant problem and the ability to give up immunosuppressants altogether or significantly reduce the dose will help solve it.
Aim: to present a review of the literature and to analyze the main aspects of immunotolerance in immunosuppressive therapy after liver transplantation.
Materials and methods: Foreign and Russian literature on the topic of immunotolerance and immunosuppressive therapy was used. The search for literary data was carried out in international databases (PubMed/MedLine, ResearchGate), as well as in the scientific electronic library of Russia (eLIBRARY.RU ) for the period 2019– 2024.
Conclusion. Undoubtedly, the rejection of immunosuppressive therapy is a brilliant prospect for recipients not only of the liver, but also of other donor organs, therefore, with the future development of interdisciplinary and multifactorial research, the use of various new experimental methods may provide more opportunities and theoretical guidance to find a way to achieve tolerance in liver transplantation.

Today there is no unified personalized approach to the selection of construction materials in orthopedic dentistry, hence it is necessary to introduce and further study the effect of construction materials on the microbiota of the oral cavity. In particular, principles of microbial adhesion to various construction materials, development of biofilm and bacterial colonization of concrete construction materials need to be analysed. The article provides a review of literature devoted to the description of the adhesive properties of oral microbiota to orthopedic materials from the groups of polymers, metals and ceramic constructions as well as the development of the negative impact of the construction material on the microbiota of a particular group of teeth and the general condition of the microflora of the oral cavity, increase of the risks of dental plaque formation, biofilms formation and a shift of microflora towards the predominance of cariogenic one.

The problems of optimal participation in labor activity of people of older age groups are considered. The dynamics of demographic aging are characterized by duality: against the background of chronological aging, biological rejuvenation of the world's population occurs, which significantly increases human potential. We must move away from erroneous ideas about older age as a period of “sluggish living”; on the contrary, this age provides a person with the opportunity to live a highly productive life. It can be reasonably argued that the older generation today has become more mobile and socially active. Global trends in the transformation of the labor market demonstrate a gradual shift in the employment structure towards older ages. Labor is the basis for the social self-realization of older people and a condition for prolonging active life. The average life expectancy of pensioners who remain active is significantly higher than those who have stopped working. Labor is the most powerful geroprotector! Protecting the physiological state of intelligence in old age is the main task of gerontology and geriatrics. We need to be very critical of current ideas about the degradation of intelligence in old age. The process of intellectual development of a person of mental labor is fundamentally limitless - this is the main way of his existence as an individual. The level of education has a significant impact on life expectancy. People with higher levels of education have lower mortality rates and longer life expectancy. The dominant models of the social status of older people forcefully pushes the elderly person out into “well-deserved rest.” The introduction of a mandatory retirement (“disabled”) age for everyone means that the legislator declares the experience accumulated by older people to have lost social significance. This attitude is a factor in the growth of social tension and impedes the formation of social cohesion, gives rise to a social trend of age discrimination - “ageism”, which manifests itself, in particular,in difficulties in finding a job and in the reduced level of wages for older people. As a result, over the past decade, the number of working pensioners in Russia and the duration of their period of work after retirement have decreased significantly. It is necessary to create a long-term doctrine of the work activity of older people.

The article discusses the issues of forming an organizational and functional model of assisted living for disabled people on the basis of a scientifically based approach. A comparative analysis of foreign and domestic practices was carried out. General patterns influencing the development of the assisted living system have been identified, its participants and their powers, material and technical base, human resources, and implementation mechanisms have been identified.
The purpose of the study is to develop an organizational and functional model of the system of assisted living for disabled people.
Research materials: The research material was data from the annual monitoring of the development of technologies for assisted living of disabled people in the constituent entities of the Russian Federation, presented by 89 constituent entities as of March 1, 2024. The methodological basis for monitoring was the developed system of indicators reflecting various aspects of assisted living.
Methods: system analysis, qualitative and quantitative content analysis, structural-functional and comparative analysis of regulatory legal documents, statistical analysis.
Research results. According to information provided from 89 constituent entities of the Russian Federation as of March 1, 2024, work is underway in 84 regions (94.4%) to organize accompanied accommodation. The factors influencing the development of the assisted living system are analyzed. An organizational and functional model of the assisted living system for disabled people has been formed, which includes three levels of organization (federal, regional and individual).
Conclusion. The concept of the model includes a comprehensive, systematic and personalized approach that allows the division of powers between federal and regional authorities, the coordination of work on the implementation of technologies and control over all its links, as well as an individual approach to the development of an individual program of assisted living in order to determine the required volume for a disabled person. help.

In the structure of primary disability pathologies of the cardiovascular system hold second position in the Astrakhan region. The article presents statistical indicators of primary and repeated disability of the population in the Astrakhan region due to diseases of the cardiovascular system from 2016 to 2022. Analysis of the structure of primary disability indicates that among the study population in the Astrakhan region there was a higher proportion of disabled people of group III. Elderly disabled people are in first place in the age structure of primary disability due to diseases of the cardiovascular system.

The purpose of this study is to analyze trends in the provision of medical personnel to the state health care system during the implementation of state programs and national projects in the field of health care.
Materials and methods. Statistical collections of the Ministry of Health of Russia for 2012–2023, regulatory legal acts, passport of national project. Methods of descriptive statistics and analytical were used.
Results. A reduction in indicators of the supply of doctors, paramedical personnel and the ratio of doctor/nursing medical personnel and a discrepancy between their target values established in state programs and national projects for the development of healthcare was revealed. Differences in the values of target indicators of state programs and national projects have been identified.
Conclusion. The need to take urgent measures to eliminate the reduction in the supply of medical personnel has been identified. Differences in the dynamics of staffing indicators indicate the heterogeneity of the level of development of regions and their preparedness for events within the framework of state programs and national projects to achieve target indicators. Measures are needed to eliminate territorial imbalances, as well as to search for mechanisms to equalize differences between the constituent entities of the Russian Federation. Differences in the values of indicators for achieving the goals of state programs and national projects complicate their assessment and determine the need to form a hierarchy of state programs and national projects, as well as the development of scientifically based target indicators, taking into account regional characteristics and the needs of the population for medical care.

This clinical protocol delineates the technological requirements for performing kidney and liver transplantation procedures in a multidisciplinary hospital setting. The protocol has been developed based on clinical guidelines from leading international societies and has been approved by the Samara Regional Branch of the Interregional Public Organization "Society of Transplantologists" (Protocol No. 11 dated July 1, 2024). It is recommended for use in assessing a hospital's readiness to implement transplantation programs. The technologies specified in the protocol may be implemented either through the hospital's own resources or via agreements with other healthcare institutions or through outsourcing arrangements.