Aim. To increase the effectiveness of the classical approach to the therapy of abnormal uterine bleeding by the phased use of personalized treatment regimens in conjunction with the methods of the physiotherapeutic methods.

Materials and methods. The case maps of the girls of the pubertal period previously treated (archival material) with the verified diagnosis of abnormal uterine bleeding of the pubertal period (AUBPP) were subjected to analysis. A database was created, of which 367 cases were selected; patients were treated in two classical stages. In the second group, 367 girls were selected for treatment and supervision that met the required criteria and agreed to participate in the study. In this group, the rehabilitation stage was carried out using personified schemes, which included non-pharmacological physiotherapy procedures, selected taking into account the type of bleeding.

Results. The applied method of personalized treatment of patients with AUBPP under ultrasound control allowed reducing the number of relapses AUBPP.

Conclusion. The use of personalized regimens for the treatment of abnormal uterine bleeding in the pubertal period supplemented by a complex of physiotherapy procedures, selected taking into account the bleeding peculiarities and conducted under dynamic ultrasound control, showed a significant reduction in the period of restorative treatment and rehabilitation of patients.

Aim. The aim of this study was to investigate the effect of the age of patients on the quantity and quality of their oocytes, quality of embryos and the results of in vitro fertilization and embryo transfer.

Materials and methods. We conducted retrospective analysis of 668 embryo records of couples with women aged from 19 to 43, who were treated by in vitro fertilization and embryo transfer. In this analysis we included the data of the quantity and quality of their oocytes, their fertilization, methods of fertilization and the results of in vitro fertilization and embryo transfer. The efficiency of treatment was estimated by the pregnancy rate.

Results. The amount of elder group of patients (aged 35 years and older) was 25,1%. For this group we observed the decrease of studied parameters: quantity of oocytes, quantity of fertilized oocytes, and quantity of “good” (viable) oocytes. The main indicator of IVF & ET efficiency, the pregnancy rate also declined with the increase of the age of patients.

Conclusion. We analyzed the obtained data and confirmed the decline in efficient treatment of infertility by in vitro fertilization and embryo transfer in the group of patients aged 35 years and older. It is necessary to apply different reproductive methods for the patients of different ages: cancelling of embryo transfer with cryopreservation, transfer of a certain best quality embryo, applying the programs of IVF & ET with donor oocytes.

Aim. The purpose of this research was informational content assessment of the anamnestic data in diagnosing of chronic endometritis before its histologic confirmation and possibility of the timely beginning of complex therapy of pathology.

Materials and methods. To achieve the aim of the retrospective analysis of 303 case reports of patients who underwent endometrium papel biopsy as a part of examination plan before assisted reproductive treatment in 2017. A particular interest, in our case, submitted the special anamnesis including consideration of menstrual, sexual and reproductive functions, past gynecologic diseases and interventions.

Results. In the analysis of the received results the most constant signs of chronic endometritis: disorders of menstrual and seсretory functions; the high index of intrauterine interventions, considerable frequency of identification of endometrium polyps and the cervical channel (40,1%), pathological cervical neoplasia (30,8%) were noted.

Conclusion. Thus, anamnestic data of patients with the verified endometritis, especially extended one, with inclusion of nonconventional, but relevant at the present stage additional signs, have shown high informational content for neoadjuvant diagnosis of pathology of endometrium of inflammatory character. Only against the background of timely initiated complex therapy, numerous endometrial receptivity parameters are restored, which leads to relief of clinical symptoms and lays the foundation for the successful implementation of reproductive function.

Aim. Improvement of the results of surgical treatment of uterine myomas using intraoperative ultrasound navigation.

Materials and methods. 74 women with uterine myomas under supervision were examined and operated with endoscopic access using pre- and intraoperative methods of echographic diagnostics. The control group consisted of 74 patients with uterine myomas who underwent traditional ultrasound examination of pelvic organs before and after the operation.

Results. The use of intraoperative transvaginal and laparoscopic echography reduces the time of surgical revision, reduces the frequency of intra- and postoperative complications, and the frequency of relapses in the postoperative period.

Conclusion. Intraoperative ultrasound navigation is an important research method to clearly define the scope of the surgery, ensure its safety, and also more accurately assess the adequacy of the surgical treatment performed.

Aim. To reduce incidence of mesh-related complications by comparative analysis of the results of vaginal extraperitoneal mesh-vaginopexy with use of trocar and anchoring systems.

Materials and methods. A retrospective analysis of outpatient and hospital charts of 160 patients was performed, who underwent operative treatment of genital prolapse by vaginal extraperitoneal vaginopexy with Prolift, Johnson & Johnson, USA, Pelvix (Lintex, RF), Elevate (AMS, USA) and the Calistar system (Promedon, Argentina). The duration of postoperative follow-up was 3 years. In the 1st group, the patients were operated on using trocar techniques (Prolift, Pelvix). The second group consisted of patients operated on with the use of anchor technologies using the Elevate and Calistar methods. The degree of prolapse of the genitals was determined by the POP-Q system. The index of the influence of genital prolapse on the quality of life (IVQV) was assessed using a validated PD-QL questionnaire. To verify the accuracy of the hypothesis, Chi-square was used. Differences were considered valid for p<0,05.

Results. In group 1, the mean time of surgery was 98±26 min. The frequency of erosions of the vaginal mucosa was 10,9%, in 4,1% of cases, a partial excision of the implant was carried out. In 1,4% there was a wrinkling of the implant, accompanied by a pain relief syndrome, in connection with which the implant was partially excised. Chronic pelvic pain was noted in 11,3% of patients. Dyspareunia de novo was noted in 11,0% of patients. Infection of the implant was observed in 2,7%, the implant was removed. Implant protrusion into the bladder occurred in 1 patient, the implant was partially excised. The frequency of recurrence of prolapse of the genitals was 10,4%. In group 2, the mean time of surgery was 79±32 min. The frequency of erosions of the vaginal mucosa was 3.1%, in 1 case, partial excision of the implant was required. Dyspareunia de novo was noted in 6,1% of patients, in 1 of them the implant was partially excised. Chronic pelvic pain was noted in 3,1% of patients − the pain syndrome was treated conservatively. The frequency of recurrence of genital prolapse in the 2nd group was 9,8%.

Conclusion. Surgical treatment of genital prolapse with the use of synthetic meshes is highly effective, with both trocar and anchoring systems in use. It is advisable to give preference to anchor technologies, given the lower frequency of meshrelated complications.

Aim. A comparative analysis of mertoplasty results for treatment of uterine scar leak by different approaches.

Materials and methods. A retrospective analysis of hospital records of 51 patients was made, which were divided into three groups depending on the surgical approach used: group 1 – laparotomy access, group 2 – laparoscopic access, group 3 – transvaginal access. All patients had hysteroscopic and ultrasound signs of uterine scar leak after cesarean section (thickness of the myometrium in the scar area less than 4 mm, discontinuity of the scar). One month after the surgery, all the patients were examined by an obstetrician-gynecologist, all had a control ultrasound to assess the condition of the uterine scar. To assess the reliability of differences between groups, differences were considered significant at p <0.05.

Results. The mean age of the patients was 30.5±3.4 years. 76.4% of patients had one cesarean section, 23.5% of patients had had two caesarean sections. 11.7% of women had mentioned septic complications in the first 24 hours after cesarean section. The remaining 88.23% of patients had had no complications during postpartum period. Laparotomic access for excision of the uterine scar leak and metroplasty were used in 33.3% of patients, laparoscopic access – in 29.4% of cases, and vaginal access was used in 37.3% of patients. Pain severity after laparoscopy or transvaginal approach for metroplasty was moderate and allowed to use NSAIDs only, while pain severity after laparotomy required using of narcotic analgesics. There were no complications in patients under study. Based on the results of the follow-up examination and ultrasound examination, uterine scar was considered as satisfactory 1 month after the surgery in all patients, pregnancy planning was recommended 4-6 months after the surgery.

Conclusion. Results of metroplasty by vaginal access are comparable with those of laparotomic and laparoscopic access. This access has the following advantages: its use requires no expensive endoscopic equipment, small amount of intraoperative blood loss and low degree of invasiveness, moderate intensiveness of postoperative pain syndrome, short period of vocational rehabilitation.

Aim. To study stress factors influence on labor course.

Materials and methods. 1542 deliveries of term pregnancies were analyzed, in 425 women the assessment of regulatoryadaptive status on parameters of cardio-respiratory synchronism tests have been performed, in 154 of these cases the clinical laboratory parameters have been determined.

Results. The low stress resistance could be the prognostic marker of abnormalities of labor, which is characterized by the regular menstrual cycle and painful menstruation. The rate of operative delivery in abnormalities of labor was 66,88%. The neurocirculatory dystonia takes the lead among the other extragenital pathologies.

Conclusion. The low stress resistance, which was assessed by the dynamics of regulatory-adaptive status, could be one of the prognostic markers of abnormalities of labor. 

Aim. To evaluate anesthesia according to the central hemodynamic, oxygen, acid-base, temperature homeostasis, neuromuscular conduction monitoring the depth of anesthesia and recovery postanesthesia consciousness.

Materials and methods. The research was performed in 78 patients who underwent major abdominal surgery under combined anesthesia. All patients were divided into 4 groups depending on the characteristics induced dynamics of constant potential.

Results. Anesthesia in patients with high cardiovascular and respiratory systems leads to the development of hyperdynamic type of circulation, increased fentanyl consumption, and an increased risk of slow postoperative awakening. In patients of other groups was observed stable during combined anesthesia.

Conclusion. In patients with high cardiovascular and respiratory systems, the use of combined general and epidural anesthesia is advisable. In patients of other groups, the use of combined anesthesia provides adequate protection against operational stress.

Aim. Assess some indicators of cellular and humoral immunity in order to achieve maximum efficacy in the treatment of urogenital chlamydia (UGH) in the combined use of sodium hypochlorite.

Materials and methods. The object of the clinical study was 54 women with verified diagnosis of UGH, 30 of them were included in the treatment regimen, and 24 with furatsilin. Comprehensive examination of patients included: a detailed study of the history, the main complaints and the results of gynecological examination, performing a microscopy of the vaginal smear (on the 1st day of admission, on the 6th day after the vaginal sanitation and at the end of treatment). PCR diagnostics and immunoassay were performed before and after treatment, according to these criteria, the effectiveness of therapy was evaluated.

Results. Chronic course of the disease is recorded in 100% of women, in the anamnesis of 37% of patients – chronic adnexitis, metroendometritis and colpitis of various etiologies. Of the women who turned to us for help (100%), 82% of the patients complained of abundant vaginal discharge, 27% – of dyspareunia, 19% of dysuria and itching of the external genitalia. Only 8% of the women examined did not make any complaints. 76% of the 30 patients who were initially examined had hyperemia of the vaginal mucosa. In the vaginal smear of women suffering from chlamydia, a significant proportion of leukocytes was found (the minimum value is 15,3 in n/sp, the maximum – 19,2 in n/sp). Scheme of treatment for chlamydia is provided for intravaginal sanitation with sodium hypochlorite. In all the examined patients, its tolerance was positive, as a result, the microbiocenosis of the vagina improved due to the elimination of pathogenic and opportunistic microorganisms. The reliability of the clinical effect was confirmed before antibiotics were prescribed.

Conclusion. After the combined use of the sodium hypochlorite in the treatment of chlamydia, the total number of neutrophilic granulocytes and T-lymphocytes, the immunoregulatory index, the relative concentration of cells expressing the activation markers and the normalization of the total content of the main classes of immunoglobulins increase, which indicates the processes of functional recovery in the main parts of the immune system.

Aim. To reveal the peculiarities of microcirculatory disorders in persons in early and late recovery periods of ischemic stroke using the method of laser Doppler flowmetry. 

Materials and methods. We examined 58 patients aged 43 to 75 years, diagnosed with ischemic stroke with motor deficiency. The functional state of microcirculation was studied in dynamics-in the early and late recovery periods of ischemic stroke by laser Doppler flowmetry (LDF).

Results. All patients with ischemic stroke along with central hemodynamic disorder had peripheral microcirculatory disorders both on paretic and on healthy limbs correlated with the degree of paresis. Disorders of the сentral hemodynamics were revealed in the form of stenosing and non-stenosing atherosclerosis vessels of the carotid basin, hypertensive angiopathy. Violations of peripheral hemodynamics were established in all patients in both early and late recovery periods of ischemic stroke, coarser on the side of the paresis. More often, more severe forms of microcirculation disorders were observed in the paretic extremity both in the early and late recovery periods, accompanied by signs of a sharp decrease in blood flow, an increase in vascular tone with the phenomena of blood stagnation. In the presence of positive dynamics on the part of the motor sphere, patients in the late recovery period showed positive changes in the parameters of the microcirculation, both on the side of the paresis and on the healthy limbs.

Conclusion. The established features of microcirculation disorders make it possible to recommend to patients with ischemic stroke both in the early and late recovery periods active use of drugs that improve arterial blood flow, remove vascular spasm, disaggregants, peripheral vasodilators, vegetative correctors, massage, physiotherapy, reflexology, physiotherapy involving Sick, and healthy limbs, which contributes to the improvement of rehabilitation potential in this category of patients At different stages of recovery.

Aim. Improvement of the analytical approach in the evaluation of the ratios of odontometric parameters and basic linear parameters of dental arches in the physiological occlusion of permanent teeth in people with different types of face.

Materials and methods. A survey of 207 people aged 18-25 years with a full set of permanent teeth, physiological occlusion and various types of face and dental arches was carried out. To determine the dental type of face (normodontia, macrodontia, microdontia), the diagonal dimensions of the facial head were evaluated between the cephalometric points "t" (tragion) and "sn" (subnasale). When establishing the gnathic type of face (mesognathy, dolichognathy, brachygnathy), the gnathic index was calculated, calculated as the percentage of diagonal and transversal dimensions of the facial part of the head. Transversal dimensions represented the width of the face between the goat-bearing landmarks "t-t". Gnathic variants (mesognathy, dolichognathy, brachygnathy) of dental arches (Dmitrienko SV, 2015) were determined taking into account the dental index calculated as the ratio of the half-sum of the width of the crowns of 14 teeth to the width of the dental arch between the second molars. The types of the dental system (normodontia, macrodontia, microdontia) were determined from the results of summation of the width of the crowns of the upper teeth.

Results. The value of the index ratio characterizing the correspondence between the sizes of the upper and lower teeth is 1,065±0,005 for all types of dental arches. The ratio of the sum of the width of the crowns of incisors and canines of the upper jaw to the sizes of the antagonists is 1,3±0,02, and corresponds to the indices calculated by the Bolton method. The ratio of half the value of the sum of 14 teeth to the size of the front-distal diagonal is 1,065±0,005 both on the upper and lower dental arch. The ratio of the diagonal dimensions of the upper dental arch, to the analogous dimension of the lower arch, is, on average, 1,065±0,01 for all types of dental arches.

Conclusion. Optimization of diagnostic methods, in order to improve the effectiveness of orthodontic treatment, adult patients with anomalies of the dentoalveolar system, it is advisable to revise the conventional traditional diagnostic schemes for determining the shape and size of the dental arches. The ratios between odontometric parameters and basic linear parameters of the dental arches of the upper and lower jaws are informative, diagnostically significant values that are of an applied nature in the clinic of orthodontics. Interpretation of these indices can be used to characterize physiological occlusion, to determine the correspondence of the base dimensions of the dental arches of both jaws, and also to predict the shape and size of the dental arches in the treatment of patients with anomalies of occlusion in order to achieve an optimal functional and aesthetic result.

Aim. To evaluate the dynamics of metabolic status features in highly trained hockey-players during contest season.

Materials and methods. 33 highly trained hockey-players were examined. Their mean age was 26.4±0.8 years old. The study was performed during contest season. The blood samples were taken 3 times: after 2.5, 4 and 6 months from the beginning of the games. Blood samples were analyzed with the use of standardized reagent kits and automatic biochemical analyzer “Konelab-20” company "Thermo Fisher Scientific Inc" (Finland). Ferritin, myoglobin, erythropoietin, testosterone and cortisol were detected using ELISA. Anabolism index was calculated for integrated evaluation of body status. The statistical data processing was conducted with the use of statistical program StatEX-2004.2.

Results. High levels of cortisol in hockey-players provided evidence about psychoemotional strain during hockey season. Performed biochemical analyses showed unfavorable changes of metabolism in functioning of hockey-players’ organisms. The sportsmen were overtrained during the most part of competition period. The catabolic processes in sportsmen are typical during overtraining; these processes promote to maximum optimization of energetic processes in human body. The decrease of total protein level, increase of concentration of protein degradation products (urea and uric acid up to pathologic values), misbalance of normal mechanisms of lipid metabolism provided evidence on these processes. High physical and mental loads lead to cardiac muscle fatigue. A deficiency of magnesium may aggravate the processes and causes muscular weakness and cardiovascular diseases. It should be noted that pathologic values of lipid metabolism are risk factors of cardiovascular pathologies.

Conclusion. The revealed unfavorable features of metabolic processes in highly trained hockey-players during contest season cause the need to correct them by measures aimed to support cardiac muscle and optimize its work, to decrease atherogenesis and to correct the nutrition of sportsmen.

Aim. To study the features of renal arterial blood flow in patients suffering from rheumatoid arthritis, its interaction with visual markers of atherosclerosis in the presence of comorbid hypertension.

Materials and methods. 113 patients with rheumatoid arthritis (RA) were enrolled into this study. Depending on the comorbidity of hypertension the patients were divided into two groups: without (n=53) and with hypertension (n=60). The comparison group consisted of 41 patients with arterial hypertension without RA. Clinical characteristics and blood biochemistry of all the patients were measured. Renal arterial resistance index (RI), presence of atherosclerotic plaques (ASP) in the carotid arteries were assessed by ultrasound scan.

Results. In this investigation we report the correlation of the of renal resistive index (RI) and ultrasound signs of carotid atherosclerosis with hypertension in patients with RA. It was found out that there is the increase of RI in RA associated with the age of patients, the onset of the disease at a later age, the presence of atherosclerotic plaques in the carotid arteries and hypertension. In addition, patients with RA had a high frequency of bilateral RI increase by more than 0.7 (64%). Patients with bilateral high RI had a two-fold increase in the registration rate of atherosclerotic plaques in both group of patients with RA.

Conclusion. Increased renal arteries RI in patients with RA is a factor associated with the comorbid hypertension and accompanied by more significant atherosclerotic changes in the carotid arteries in the form of an increased incidence of atherosclerotic plaques.

Aim. The aim of this investigation was to establish the degree of saturation of the pharmaceutical market of Krasnodar Krai with antioxidants and antihypoxic drugs and to determine manufacturers of pharmaceutical substances for their production.

Materials and methods. In the process of the study, a content analysis, comparative and assortment analyzes were used.

Results. Marketing research conducted on the basis of 8 wholesale and 181 pharmacy organizations showed that 66.7% of international non-proprietary names of antioxidants and antihypoxic drugs from those registered in Russia are available on the pharmaceutical market of Krasnodar Krai. For their production, pharmaceutical substances of 21 domestic and 18 foreign factories of manufacturers are used.

Сonclusion. Assortment saturation of antioxidants and antihypoxants in the pharmaceutical market of Krasnodar Krai is incomplete. Pharmaceutical substances used for the production of pharmaceuticals are 53.8% domestic.

Aim. To assess the functional state in the recovery of erectile function in men after the treatment of cancer by HIFU, the parameters of cardiopulmonary synchronism and their derivatives.

Materials and methods. Observations were performed on 24 patients aged 45-56 years, who were referred to the increase in the level of the prostatic specific antigen for inpatient treatment in the urological department. At their inspection the cancer of a prostate of I-II stage has been diagnosed. Patients underwent a cardiac-respiratory synchronism test and determined the regulatory-adaptive status index and regulatory-adaptive capabilities by its parameters. After diagnosis, patients were assigned tumor destruction by transrectal high-intensity focused ultrasound ablation. After the operation, the patients were discharged from the hospital the next day and further follow-up was conducted in an outpatient setting with a visit to the hospital at 1, 3, 6, 12 months. After 6 months, the sample of the cardiopulmonary synchronism was repeated. According to questionnaires subjective assessment of the international index of erectile function ICEF-5, the QOL index assessment of quality of life. Statistical analysis of the results of the study was carried out using the programs: "STATISTIKA 6.0 for Windows". After establishing the normal distribution of the variant, significant differences were used in comparing the mean values in paired comparisons, taking the t-test of Student for p <0,05.

Results. Before treatment in a group of 24 patients, regulatory-adaptive capabilities were assessed as satisfactory. After treatment of prostate cancer with the method of transrectal high-intensity focused ultrasound ablation, the level of the prostatic specific antigen was sharply reduced from 6,81±0,32 to 0,70±0,01 ng/ml (p<0,001), the tumor volume from 39,8±0,4 to 8,5±0,3 cm3 (p<0,001). Six months after the treatment of prostate cancer, the synchronization range increased by 22,5%. The duration of synchronization development decreased by 39,1%. This led to an increase in the regulatory-adaptive status index by 100,6%. Regulatory adaptive capabilities varied from "satisfactory" to "good". Six months after the treatment of prostate cancer in patients, part of the prostate gland was preserved and ejaculation was possible. Erectile function resumed 6 months after surgery, when regulatory and adaptive capacities were restored. And in 16 people, whose index of regulatory-adaptive status was 77,9±0,4, the international index of erectile function was 23,8±0,1 points. This indicates that the state of erection is normal. The index of quality of life assessment QOL they had 0,9±0,1 points, which corresponds to a good quality of life. In 8 patients with a regulatory-adaptive status index of 44,6±0,4, the international index of erectile function was 18,2±0,3, indicating mild erectile dysfunction. The index of QOL quality of life was 2,1±0,2 points, which corresponds to a satisfactory quality of life.

Conclusion. The positive dynamics of the range of cardiopulmonary synchronism, a decrease in the duration of synchronization at the minimal border, an increase in the index of regulatory-adaptive status and regulatory-adaptive capabilities integrally reflect the consequences of effective treatment of prostate cancer and, consequently, the preservation of erectile function.

Aim. Increase of efficiency of pharmacological correction of hypertensive neuroretinopathy using a new dimethylaminoethanol (DMAE) derivative 7-16.

Materials and methods. Modeling of hypertensive neuroretinopathy was carried out by introducing a nonselective inhibitor of NO-synthase N-nitro-L-arginine-methyl ester in a dose 12.5 mg/kg within 28 days and increasing intraocular pressure to 110 mm Hg by exerting mechanical pressure on the anterior chamber of the eye. To study the fundus of experimental animals, direct ophthalmoscopy (ophthalmoscope Bx a Neitz, Japan) was used. To zoom a lens Osher MaxField 78D model OI-78M has been used. Electroretinography was performed immediately after ophthalmoscopy. The ERG was recorded in response to a single stimulation. The induced biopotentials were amplified, averaged and presented graphically on the screen with the help of Biopac-systems MP-150 with the program AcqKnowledge 4.2 (USA). To assess the degree of development of functional damage to the retina, the ratio of the amplitudes of the b- and a-waves of the ERG, the coefficient b/a, was estimated.

Results. The expressed protective properties of the DMAE derivative 7-16 in a dose 25 mg/kg/day, exceeding its effect in a dose 12.5 mg/kg/day, were found, which resulted in a decrease of development of neuronal damage and vascular changes in the retina on the background of hypertension, which were noted in control group; an increase in the coefficient b/a in groups with the correction of pathology, which is caused by the restoration of the positive wave b on the ERG and indicates the preservation of the electrophysiological function of the bipolar and Müllerian cells.

Conclusion. The search of new ways to reduce the damaging effect of ischemia formed in hypertensive neuroretinopathy in the experiment is a vital task of pharmacology, which can be solved by using a new DMAE derivative 7-16.

Aim. To study the course of pregnancy and labor in women suffering from myopia.

Materials and methods. A comparative analysis of pregnancy outcomes among 100 women with myopia was held. There were 48 women in the study group who had a retinal laser correction within the period of pregnancy. The control group was represented by 52 women who did not undergo the correction.

Results. We noted that the peripheral laser retinopexy made possible labor through natural birth canals for women of the study group. While the control group of women underwent abdominal delivery.

Conclusion. The problem of myopia during pregnancy remains the focus of attention of obstetricians and ophthalmologists, since it is very important to choose the optimal method of delivery. In this case it is necessary to take into account not only the degree of myopia, but also the state of the retina. Peripheral vitreochorioretinal dystrophic changes (PVCDC) are indication for cesarean section. It was found that the timely use of LRP for retina makes possible reducing the percentage of surgical delivery, and thereby reduces the risk of post-surgery complications.

Aim. The aim of our work was to study characteristics and results of surgical treatment of patients with wounds and cicatricial deformities who underwent tube flaps grafting.

Materials and methods. The analysis of the treatment of 15 patients aged 9 to 58 was made. All patients were treated in the Burn Unit of the Scientific Research Institute – S.V. Ochapovsky Regional Clinical Hospital №1 with thermal, electrical and mechanical injuries and their consequences in 2005-2017 years.

Results. The average frequency of this method use was 1 time per year. Remoteness of the affected area from the site of tube flap preparation determined the number of migrations and the terms of treatment of patients. With the localization of the recipient zone on the upper extremities, migration of one of the supply legs was immediately combined with partial grafting, and the total number of migrations was two. The duration of treatment of patients from the moment of tube flap preparation to the completion of plastics averaged 134±36 days. In those cases when it was required to move a tube flap prepared on the trunk to the head or lower extremities, there were 3-4 migrations, and the treatment time was 312 to 644 days, on average 481±86 days. The total area of the replaced defect was from 40 to 220 cm2. Out of 15 operated patients, complications occurred in 3 (20%) cases when the tube flap was migrating. At the control examinations during the first year after grafting flap tissues were viable, adapted, without trophic disorders. In term from 1 to 6 years after grafting skin was elastic and well taken into the fold. There were insignificant differences in the pigmentation of displaced flaps from the surrounding tissue. Cicatricial deformities associated with the harvesting, transport of the flap and grafting, were not observed.

Conclusion. Tube flap proposed more than one century ago is primarily of historical significance and is rather rare in modern clinical practice, but sometimes it is the optimal method for recovering lost or scarred skin.

Aim. To study changes in antimicrobial and osteotropic oral fluid mediators during pregnancy in women with chronic generalized periodontitis (CGР) of mild and moderate severity, taking into account the factor of steroid regulation by cortisol.

Materials and methods. Among the 62 pregnant women (age 18 to 35 years), depending on the presence or absence of inflammatory periodontal diseases, the main group (n=31) with moderate and moderate CGР and control group (n=31) with no disease were formed. In addition, 32 healthy non-pregnant women (age 18 to 30 years) examined the oral fluid in the same diagnostic volume. In the oral liquid, the amount of catelicidin LL-37, osteoprotegerin and cortisol was determined using a solid-phase immunoassay method. Laboratory studies were conducted in I (8-12 weeks), II (13-27 weeks) and III (28-40 weeks) trimester of pregnancy.

Results. In pregnant women with a physiologically pregnant pregnancy and in the absence of dental diseases in the oral fluid with a consequent increase in the concentration of cortisol, there was a decrease in the content of catelicidin LL-37 1 trimester followed by an increase in the 2nd and 3rd trimesters of the antimicrobial potential of the oral biological environment, an increase in the concentration of osteoprotegerin that inhibits the activity of osteoresorption in the alveolar bone. In pregnant women with CGR of mild and moderate severity, a marked increase in the concentration of cortisol in the oral fluid was accompanied in the first two terms by an increased content of cathelicidin LL-37 and activation of antimicrobial congenital mechanisms of resistance to pathogenic bacteria, followed by a decrease in the antimicrobial factor to the third trimester of the gestation period, a consistent decrease in the content of osteoprotegerin in mixed saliva.

Conclusion. The presence of CGР of mild and moderate severity in pregnant women leads to a dissociation of the connection between cortisol mixed saliva and immune defense factors, osteotropic mediators in contrast to women who do not suffer from dental pathology during the gestational period. 

Aim. To develop a methodology for quantification of compound VMU-2012-05 (1-[2-(2-benzoylphenoxy)ethyl]-6methyluracil) in tablets.

Materials and methods. The method of capillary electrophoresis (CE) was used to develop and validate the procedure for the quantification of VMU-2012-05 (1-[2-(2-benzoylphenoxy)ethyl]-6-methyluracil) in the form of tablets. It is shown that if 10 mM sodium borate is used as the leading electrolyte with a pH of 11.0, it is possible to assure an analysis time of up to 6 minutes. The experiment parameters were as follows: quartz capillary (diameter 75 μm, WL/Lef = 60/50 cm), voltage +20 kV, temperature 25°C, detection at 256 nm, sample entry at 150 mbar × s.

Results. The validation assessment of the developed methodology for indicators specificity, analytical area, linearity, accuracy and precision indicates that the methodology is specific, and in terms of indicators, the analytical area and linearity meet the requirements of the GF XIII edition. In addition, it is shown that the technique yields results free of systematic error (the correctness of the technique), and the precision is at a sufficiently low level (RSD = 1,53%). Also, for the developed and validated methodology, the parameters of the system suitability for the parameters were determined by the number of theoretical plates of the VMU-2012-05 peak, the resolution of the VMU-2012-05 peak and the EOS signal and the VMU-2012-05 peak symmetry factor.

Conclusion. The developed rapid method of quantitative determination of VMU-2012-05 in tablets will allow further study of the substance 1-[2-(2-benzoylphenoxy)ethyl]-6-methyluracil as a promising in the treatment of HIV-1.

Aim. Development of the dissolution test method of 11-deoxymisoprostol tablets.

Materials and methods. The research was carried out on a "paddle apparatus". The media dissolution temperature is 37±0,5 degrees, the stirring rate is 50 rpm, the sampling time is 45 minutes, the dissolution media volume is 500 ml. The method of quantitative determination of 11-deoxymisoprostol in sample solution – HPLC with UV-detection, reverse phase chromatography. Chromatograph "Shimadzu Prominence LC-20" (Japan) with a matrix photodiode detector SPD20, column Discovery C18 (5 μm; 150 mm x 4.6 mm), mobile phase: water-acetonitrile (50:50), isocratic elution, detection at a wavelength of 195 nm.

Results. All tested tablet samples meet the requirements of the State Pharmacopoeia in terms of "Dissolution test".

Conclusion. A dissolution test method of 11-deoxyimisoprostol tablets has been developed.

Aim. To determine the diagnostic significance of acute phase reactants in mild and moderate dental caries and chronic generalized periodontitis (CGP) in the course of pregnancy.

Materials and methods. 97 pregnant women aged from 18 to 35 were examined. Group 1 (n=35) consisted of pregnant women suffering from dental caries, group 2 (n=31) consisted of pregnant women suffering from mild and moderate CGP, and a control group (n=31) – pregnant women with physiological pregnancy and without dental pathology. The results of the laboratory assessment of oral fluid in 32 healthy nonpregnant female donors aged from 18 to 30 were taken into account. In the oral fluid, the concentration of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) was evaluated using a solidphase immunoenzyme method. The content of C-reactive protein (CRP) in the oral fluid was characterized by a precipitation reaction with a diagnostic serum. Laboratory studies were performed in all the trimesters of pregnancy: I – 8-12 weeks, II – 13-27 weeks, III – 28-40 weeks of gestation.

Results. Only in pregnant women of the group 2, the content of CRP in the oral fluid systematically increased from the 1st to 3rd trimester in the dynamics of the gestational period. During all three trimesters the patients of the 2nd group suffering from moderate CGP demonstrated higher levels of CRP in the oral fluid than the patients with mild CGP. Patients of the control group and group 1 in the course of pregnancy, the level of TNF-α in the oral fluid did not change, and IL-6 consistently grew up. During all pregnancy periods, the level of TNF-α in the oral fluid was higher in group 2 than in the control group and group 1. Especially significant this difference was in the 3rd trimester. Compared to the control group, in patients of group 2 the content of IL-6 in the oral fluid increased 3,5 times in the first trimester (p<0,05), 4 times in the second trimester (p<0,05) and 6 times in the third trimester (p<0,05). Correlation analysis of the concentration of CRP, IL-6 and TNF-α in the oral fluid of pregnant women with mild and moderate CGP, on the one hand, and the PMA index, on the other, revealed a close direct relationship between the indices. In the control group and group 1, the association between the acute phase reactants, the proinflammatory mediators and the CFR index, the PMA index was weak and statistically insignificant.

Conclusion. During pregnancy the concentration of IL-6 in the oral fluid increases from the first to the third trimester. In pregnant women with dental caries, the determination of CRP, IL-6 and TNF-α in oral fluid is not of diagnostic significance for the characteristics of the activity of carious lesions of teeth. The increased content of CRP, proinflammatory mediators IL-6 and TNF-α in the oral fluid of pregnant women with CGP reflects the severity of the dental disease, which allows obtaining additional assessment criteria for characterizing the disease. 

Aim. Improving diagnosis of premorbid skin changes of gas production employees.

Material and methods. 158 employees of male Astrakhan gas processing plant aged from 28 up to 59 years (on average 40,23±0,49 years) which didn't have at the time of survey the demonstrative forms of the somatic and neurologic diseases and 77 clinically healthy volunteers of control group who were constantly living to Astrakhan aged from 25 up to 55 years are examined (on average 38,18±0,99). Average length of service at the enterprise made 9,02±0,29 years. Assessment of a functional condition of a skin by method of laser Doppler flowmetry was carried out on the laser analyzer of a capillary blood flow (LAKK-01) (NPP Lazma, Moscow).

Results. As a result of the examination, occupational skin diseases were not detected, but professional stigma was registered with a high frequency, most often localized on the hands. Of nonprofessional lesions, 56 people (35,44± 0,30%) of foot mycoses were noted.

Conclusion. Disturbances of microcirculation play an important initial-trigger role in the pathogenesis of a number of dermatoses. Identification of early preclinical manifestations of the impact of harmful production factors on the health status of workers in the gas processing industry with a view to predicting the risk of occupationally caused diseases and conditions appears to be an actual area of modern medicine.

Aim. To analyze the literary sources on the surgical treatment of diseases of the periampullary organs and highlight the contemporary and unresolved problems.

Conclusion. At the current stage of medical development, it was possible to reduce mortality after pancreaticoduodenal resection of less than 5%, but the incidence of complications reaches 30-70% and does not tend to decrease. The most formidable complications are the failure of pancreaticodigestive anastomosis and pancreatic necrosis of the stump of the pancreas, the main prognostic risk factor for which is the "soft" parenchyma of the organ. The "softness" of the parenchyma, as a rule, is evaluated intraoperatively by visual examination and palpation. At present, the literature does not report research on the objective and pre-operative evaluation of this criterion. In order to prevent complications, a huge variety of technical solutions for the treatment of the distal stump of the pancreas have been proposed, but none of them can be considered unified.

Aim. To study and analyse diagnostic meaningfulness of the different electromyographic methods applied for the exposure of violations of neuromuscular transmission transmission.

Materials and methods. There are many methods of the researching of the condition of neuro muscular transfer, each of them carries the certain diagnostic importance allowing to define character of a lesion of a neuro muscular synapse, to tap mechanisms of its development not only in clinically affected muscles, but also intact ones, and also at an early stage of a disease, at local forms of a myasthenia. The research of the condition of neuromuscular transmission was carried out with the use of the following electromyographic techniques: stimulation electroneuromyography (ENMG), the decrement test, the jitter-phenomenon, research of density of a single muscle fiber.

Results. The result of the analysis of electromiographic diagnostic opportunities of researching the condition of neuro muscle fiber development is the developing of the clinic-instrumental algorithm of inspection of patients with a myasthenia.

Conclusion. The different neurophysiological methods of study of the state of neuromuscular transmission carry certain diagnostic meaningfulness. Advantages of separate electromyographic methods are shown: research of initial amplitude of M-answer, decrement-test, джиттер-phenomenon. The indexes of ENMG-tests are analysed in detail-tests, and also their change at violation of neuromuscular transmission for patients with myasthenia gravis and myasthenic syndromes.

Aim. To review the literature on the methods of orthopedic oral rehabilitation of patients with partial adentia.

Materials and methods. A study of Russian and foreign literature of recent years in the following databases: RINC, Scopus, Web of Science, Pubmed.

Results. The choice of the design takes into account: the number of abutment teeth, the state of the periodontal tissues of the abutment teeth, the extent and topography of the defect, the tone of the chewing musculature, the type of occlusion, the features of the patient's profession, the size and shape of the toothless sections of the alveolar processes, the pain threshold of sensitivity of the mucosa, the degree of its compliance, allergic reactions to the constituent components of the prosthesis, and the individual characteristics of the particular
patient.

Conclusion. Despite a large selection of orthopedic structures in the arsenal of a dentist, there remains a number of issues that require detailed study.

Heart failure is associated with profound sympathetic overactivation, which initially develops as an adaptive effect that supports cardiac contractile function. Nevertheless, in the long term, sympathetic activation promotes detrimental myocardial changes, and therefore contributes to systolic dysfunction and poor clinical prognosis. The current knowledge about the mechanisms of these maladaptive effects largely stems from the animal studies that utilized a model of heart failure induced by chronic administration of adrenergic agonists. In this model, sustained adrenergic overactivation was found to induce cardiac hypertrophy owing to the increased protein synthesis in cardiac myocytes, and to promote myocardial fibrosis by stimulating collagen production in cardiac fibroblasts. Catecholamines also produce toxic effects leading to the myocyte cell death via necrosis and apoptosis. Systolic dysfunction in the setting of adrenergic overactivation is partly attributed to the eccentric ventricular chamber remodeling, an effect related to the increased activity of matrix metalloproteinases which digest cross-linked collagen, and promote myocyte slippage. At the cellular level, cardiac contractile failure is linked to the impaired calcium handling. Beta-adreneregic stimulation causes hyperphosphorylation of the ryanodine receptor (RyR2) via cAMP-protein kinase A-dependent mechanism, which increases RyR2 open probability, and hence contributes to the calcium leakage, resulting in depleted sarcoplasmic reticulum calcium stores. This change is further exacerbated owing to the decreased SERCA2a expression in failing cardiac myocytes, which impairs sarcoplasmic reticulum calcium uptake in diastole. Overall, myocardial structural changes upon sustained adrenergic overactivation are related to the increased activity of the renin-angiotensin-aldosterone system, stimulation of the myocardial growth factors, and increased expression of cytokines. The adrenergic cellular growth-promoting effects are mediated through the mitogen-activated protein kinase signaling pathway, transient up-regulation of the immediate-early genes, and activation of transcription factors. These effects translate to the increased synthesis of contractile proteins and their assembly into the organized sarcomeric units in cardiac myocytes.

The review analyzes materials devoted to the study of various forms of celiac disease. Particular attention is paid to the systematization of clinical manifestations and features of diagnosis of atypical forms of celiac disease. Data are given on the incidence and mechanisms of progression of disorders in the combination of celiac disease and a number of autoimmune diseases, including type 1 diabetes mellitus. This literature review promotes a better understanding of the problem of celiac disease by specialists, which will improve early diagnosis and determine the rational tactics of managing patients with different forms of the disease.

Aim. To assess the main epidemiological indicators of myasthenia gravis in various countries of the world, as well as in the territory of the Russian Federation.

Materials and methods. Materials of publications on the study of epidemiological and population characteristics of myasthenia gravis of native and foreign authors are studied.

Results. The indicator of the prevalence of myasthenia in the world varies from 0.5 to 20.0 per 100,000. The average primary morbidity of myasthenia gravis in the world is 0.53 per 100,000 population. The indicator varies from 0.17 to 2.13 per 100 thousand of the population.

Conclusion. A fairly large range of epidemiological characteristics of myasthenia gravis in the world is revealed. The high prevalence of this pathology in the territory of the Russian Federation is established, which causes further interest in this type of research.