Aim. This study was conducted to assess the possibility of ultrasound elastometry using the shear wave method in the preoperative assessment of the stiffness condition of the  pancreatic parenchyma in order to predict the risk of complications and the choice of the method for the formation of pancreatoenteroanastomosis in pancreatoduodenal resection.

Materials and methods. The study was performed in 10 patients operated in the volume of pancreatoduodenal resection. All patients  underwent preoperative ultrasound pancreatic elastometry with  transcutaneous shear wave access method. The results were  compared with the intraoperative data obtained by the visual  examination and palpation. Depending on the average "stiffness"  indicators of the parenchyma in comparison with the intraoperative  data, one of two ways of forming the pancreatic intestinal  anastomosis was preferred: either end-to-side or  pancreatoenteroanastomosis with a wide atraumatic peritonization of the pancreas stump cutoff by the jejunum according to the original technique.

Results. The inconsistency of class A pancreatoenteroanastomosis was noted in 2 (20%) patients, it was transient, asymptomatic, did  not require additional medical interventions and did not extend the  duration of the postoperative period. There were no inconsistencies  of classes B and C, pancreonecrosis of the stump, repeated surgical  interventions, and lethal outcomes.

Conclusion. Ultrasound pancreatic elastometry with the shear wave method can be used in the preoperative assessment of the  "stiffness" of the parenchyma in order to predict the risk of the  complications and the choice of the method for the pancreatoenteroanastomosis formation.

Aim. This study was performed to assess the state of health of preschool children from Krasnodar Region rural locality according to the incidence rate.

Materials and methods. The study was conducted on the basis of six municipal preschool institutions in Krasnodar Region rural locality with the coverage of 855 preschool children aged 3 to 7 years.

Results. When dividing children into health groups, it was evident that most of them belonged to I health group. Among children with various health abnormalities categorized as II, III, IV and V  health groups, chronic tonsillitis, reduced visual acuity, and anemia  were more common. Girls more often than boys had chronic  pyelonephritis, bronchial asthma, Type I diabetes mellitus, anemia,  chronic pancreatitis, chronic bronchitis, and cystitis. The boys were more likely to experience reduced visual acuity and tunnel vision.

Conclusion. As a result of the conducted research, it was determined that the majority of children attending preschool institutions in Krasnodar Region rural localities were  almost healthy. In comparison with other regions (according to the  literature), the health indicators of rural preschool children in  Krasnodar Region are somewhat better. The results of the study also  showed gender differences in the morbidity patterns of preschool  children, indicating that girls are at risk.

Aim. This study was conducted to evaluate the caries resistance of hard tooh tissues and the state of the calcium and phosphorus  metabolism in children with type 1 diabetes mellitus given the  mineralizing potential of saliva and antimicrobial protection of the oral cavity.

Materials and methods. There was conducted a general clinical, dental, laboratory examination of 127 children with type 1 diabetes  mellitus aged 7 to 12 years with the endocrinopathy experience from eight months to ten years. The obtained data were compared with  the results of the examination of 37 "healthy" and "practically  healthy" children of this age category. When assessing the dental  status of children, were used the hygienic index (Y.A. Fedorov, V.V.  Volodkina, 1970), the CFE/ cf index (WHO Expert Committee, 1962), the simplified hygienic index OHI-S (Green, Vermillion, 1964). The  intensity of the enamel demineralization processes was assessed  using the enamel resistance test (V.R. Okushko, L.I. Kosavera, 1984)  and vital staining (L.A. Aksamit, 1978). The electrometry of  hard tooth tissues was carried out by the electrodiagnostic apparatus "Dent Est" (V.K. Leontiev, G.G. Ivanova, 1985).The  laboratory diagnostics of the salivary indicators included the study of calcium (total, ionized), inorganic phosphorus, alkaline  phosphatase, osteocalcin, parathyroid hormone, 25-hydroxyvitamin D3, lactoferrin. The microcrystallization and  mineralizing potential of saliva were determined according to Leus  P.A. (1997).

Results. At the early stages of type 1 diabetes mellitus development children have a compensated and subcompensated form of the  carious process, the increase in the enamel permeability, a slight  predominance of the demineralization processes over the  remineralization processes in solid tooth tissues. It indicates that  self-regulation of the mineral metabolism mechanisms takes place  while maintaining the physiological remineralizing properties of  saliva. At a late stage of type 1 diabetes mellitus development a high intensity and decompensated form of the carious lesions are  established as well as low structural and functional enamel  resistance and pronounced processes of hard tooth tissues  demineralization. The emergence of this complex in children with the experience of endocrinopathy for more than five years indicates the depletion of salivary gland functionality, the disturbance of  mobilization salivary systems in response to the occurrence of the  cariogenic situation in the oral cavity, the change in calcium  homeostasis, the decrease in enamel resistance to organic acids and the absence of saliva crystallization.

Conclusion. The growing positive dynamics of index growth in children with long-term type 1 diabetes mellitus, indicating the  deterioration of the dental status, requires adherence to the  principles of rational nutrition, quarterly professional caries preventive measures using modern and effective oral care  products, the introduction of active forms of hygienic training and education taking into account the mineralizing potential of saliva as well as careful monitoring of the acquired manual skills.

Aim. This study was designed to develop the mathematical prediction model of adenomyosis spread stages according to the results of clinical examination using the classification tree statistical method.

Materials and methods. During this study we conducted the sampling of 84 patients with adenomyosis. By means of nonparametric correlation analysis we identified the indicators  which were interconnected with the disease stage and prediction  according to the results of clinical examination of the patients by  means of the classification tree statistical method.

Results. We managed to build a suitable classification tree that helped to reach the compromise between the tree complexity and  the amount of false classifications. This method allows us to define  to role (significance) of the predictors in the classification model.

Conclusion. The creation of software applications automatizes the classification procedure and makes it possible for medical staff who don’t have specialized training in data analysis sphere to use it.

Aim. To evaluate the performance of some pro-inflammatory and anti-inflammatory cytokines in patients with various forms of  papillomavirus infection (PVI), to conduct a clinical evaluation of the  effective application of the drug containing a complex of sodium deoxyribonucleate with iron.

Materials and methods. The examination of women with a latent course of PVI and a mild case of intraepithelial lesions of the cervix  L-SIL (Lowgrade Squamous Intraepitelial Lesions) was conducted  using a liquid-based Cytology ThinPrepR, colposcopy, biopsy of  cervix, detection of HPV 16 and 18 in the cervical smear by DNA  techniques (PCR in real time). Also, cytokines (IFN-gamma, IL-2, IL- 10, TNF-alpha) were quantified at the systemic level by the  immunoenzyme method. The repeated examination was carried out  after a course of treatment with a drug containing a complex of  sodium deoxyribonucleate with iron in 3 and 6 months.

Results. After 6 months of HPV therapy PCR was not detected in 94% of patients with a latent course of PVI and 75% of patients with L-SIL. Patients with a latent course of PVI showed a significant  increase in the levels of IFNγ, TNF-α and IL-10 before the treatment.  Patients with L-SIL showed less significant increase in  IFNγ and TNF-α before the treatment, the levels of IL-10 and IL-2  had no significant deviations. After 3 months of the treatment  patients with a latent course of PVI showed a decrease in the  concentration of IFNγ, TNF-α and IL-10 to the indicators of  conditionally healthy women. Patients with L-SIL showed a slight  decrease in the concentration of TNF-α and a decrease in the  concentration of IL-10 to the indicators of conditionally healthy  women. The level of IFNγ and IL-2 remained almost at the same  level as before the treatment.

Conclusion. The use of a drug containing a complex of sodium deoxyribonucleate with iron during a latent course of PVI can help to  prevent its transition to subclinical and clinical forms. The clinical  efficacy of the drug Ferrovir was confirmed, manifested in the fact  that 6 months after the treatment the virus DNA ceased to be  determined in 94% of cases in patients from the group with a latent  course of papillomavirus infection. There was a lack of immune  response to HPV in L-SIL, as well as less pronounced clinical efficacy of Ferrovir in this group. It can be assumed that a more pronounced clinical effect in the treatment of patients with L-SIL can be obtained  by using the complex therapy, including the appointment of the drug Ferrovir and destructive methods of treatment of the cervix or  an additional prescription of the targeted therapy, aimed at the treatment of already affected and altered cells of the cervical epithelium.

Aim. Visualization of the excitation process in the frog's nerves.

Materials and methods. Observations were carried out on 30 immobilized frogs. Vagosympathetic trunks and sciatic nerve were  allocated from the frogs. Ligatures were placed on the right  vagosympathetic trunk crossing it. A scanner of the gas discharge  visualization camera of the CELSY device, which created a high- frequency electromagnetic field (1024 Hz), was installed above the  nerves. The scanner with a highly sensitive camera shot a 60-second video (the frequency of frame-by-frame shooting to 1000 frames per second), during which the edge luminescence (Kirlian effect) and the  glow spots were recorded inside the nerve. The  electrocardiogram (ECG) was synchronously recorded in the I  standard lead. The processing of the obtained results was carried out according to the area of the glow spot, the area of the highest luminescence brightness, the direction of the movement of  the foci of the luminescence, and the linear velocity of the movement of the glow foci.

Results. Foci of the internal luminescence appeared only in the high-frequency electromagnetic field in the sciatic nerve of the frog  when the nerve was stimulated by electrical impulses, which resulted in the contraction of the frog's foot. Glow foci of the brain  synchronous to the heart rhythm and preceding the tooth of the V- wave on the frog’s ECG were observed at the central end of the cut  of the frog’s vagosympathetic trunk.

Conclusion. Visualized foci of luminescence in the nerve reflect the neural activity.

Aim. This study was conducted to assess the compliance of patients with duodenal ulcer disease during the dispensary observation.

Materials and methods. We carried out an examination and a prospective observation of 1896 patients with uncomplicated duodenal ulcer and 43 people with sub- and decompensated scar-ulcerative stenosis of the duodenum.

Results. The analysis confirmed that the compliance of patients with duodenal ulcer depends on the professional employment of patients,  their gender, the level of education, presence of comorbidity,  absence of undesirable effects of the taken medication, contact  establishment with the patient, and presence of non-adaptive types  of attitude to the disease.

Conclusion. The interaction between different factors affecting the compliance should be taken into account when planning the tactics  of dispensary observation of patients with uncomplicated duodenal ulcer and after eliminating the complications as wel.

Aim. To assess anxiety-depressive disorders and indicators of quality of life in men.

Materials and methods. The study included 540 men with hormonal disturbances in the form of an age-related androgen deficiency, 270 men, aged 44-54 years (mean age  51.1±2.3), including 150 with "-" and 120 with "+" variant,  biological age and 270 men aged 55-64 years (mean age 59.2±2.4),  of which 150 with "-" and 120 with "+" version of  biological age. All patients, depending on the proposed variant of  nutritional support and physical activity, were divided into three  groups: the 1st (standard recommendations), the 2nd (standard  recommendations, Scandinavian walking and daily walks for at least 30 minutes), the 3rd (standard recommendations,  Scandinavian walking, daily walks for at least 30 minutes and  nutritional support). Assessment of the degree of depression was  carried out on the basis of the Beck scale. The quality of life was determined by the «SF-36 Health Status Survey», a visual  analogue scale for assessing the anxiety-depressive syndrome.

Results. On the scale of assessing the level of depression, the level of anxiety-depressive syndrome in men, we obtained data on  improving this indicator when using nutritional support. The  maximum difference was noted in older persons with the "-" variant  of BV, which confirms the fact that nutritional support reduces the  degree of depression and the parameters of the anxiety-depressive  syndrome. On the scale of assessing the level of psychological  health, we obtained data on improving this indicator with nutritional  support, but a significant difference was found only in comparison  with patients who received neither nutritional support nor physical activity.

Conclusion. Nutritional support improves the parameters of quality of life in elderly men, especially in terms of general health, depression and social functioning.

Aim. This study was designed to determine the structural and functional features of left ventricle in patients with heart failure, coronary heart disease and thyrotoxicosis.

Materials and methods. 85 patients aged 58.3±5.6 years were divided into 3 groups: the main one – 25 patients with coronary  heart disease (CHD), chronic heart failure (CHF) II-III functional  classes (FC) and thyrotoxicosis, average age –59.23±3.81; the 1st  comparison group – 30 patients with CHD and CHF FC II-III without  thyroid dysfunction, the average age – 57.6±2.73; the 2nd  comparison group – 30 patients with thyrotoxicosis without  concomitant cardiovascular diseases (CVD), the average age –  45.4±3.51. The structure and function of the thyroid gland were  examined in all patients. The echocardiographic (EchoCG)  examination was performed to evaluate the structural and functional  indicators of the left ventricle (LV).

Results. The LV pathologic remodeling in patients of the main group is represented by two types: concentric left ventricle hypertrophy  (CLVH) and eccentric left ventricle hypertrophy (ELVH), CLVH was  more common than in patients without thyroid dysfunction but with  CHF and CHD (84.0%, р=0.01). The LV myocardium contractility  was reduced in patients of both groups with CHF, the values of the ejection fraction corresponded with the intermediate type of HF, there was no significant difference between the indices (p = 0.1).  The main group had significantly more pronounced decrease in the ratio of the blood flow velocity of early diastolic filling of the LV  and the maximal atrial systolic velocity (E / A) − 0.63 and the  increase in the isovolumic relaxation time (IVRT) – 84.69 ms in  comparison with the indicators of the CHD and CHF patients without thyroid dysfunction (p = 0.021, p = 0.034).

Conclusion. For patients with CHF, CHD and thyrotoxicosis, predominance of LV remodeling according to the type of CLVH  (84.0% of cases) is typical as well as a moderate decrease in the  contractility of the LV and a more pronounced diastolic dysfunction.  It determines the structural and functional features of the left  ventricle in patients with CHF with this comorbidity.

Aim. This longitudinal study was conducted to examine the indicators of physical development and physical efficiency of students of the Kuban State Medical University during five years of their study.

Materials and methods. There was carried out a comparative analysis of the anthropometric data dynamics, the indices of physical development proportionality of Erismann, Pignier and Quetelet, and  the physical efficiency level of the students of the Kuban State Medical University during five years of their study.

Results. Physical development of the students almost has not changed by the 5th year of their study. It corresponds with the age standards of the examined group.

Conclusion. For optimizing the educational process during the physical education classes the physical activity of students needs to be increased as well as the amount of training in extracurricular time.

Aim. This study was designed to prove the connection between postcholecystectomy syndrome, chronic disorder of duodenal patency, adhesive disease of the abdominal cavity, and  chronic colostasis and to develop the methods of its treatment.

Materials and methods. During the period from 2004 to 2016 we monitored 140 patients with a clear picture of postcholecystectomy  syndrome which was manifested after the surgeries on the  extrahepatic biliary tract by clinic of passage disorders in the digestive tract.

Results. The results of our study indicate that there are created a number of conditions that cause various pathologies in patients with  colostasis who have unfavorable outcomes after cholecystectomy.  Colostasis can cause functional changes in the biliary tract due to the overstretch of the colon areas by the accumulated contents.  Functional disturbances can be a consequence of the tension of the  mesocolon lowered by the transverse colon or duodenojejunal  ligament narrowing the lumen of the duodenum. The hepatic angle  of the large intestine in high position, deforming the bile duct and duodenum, can also cause postcholecystectomy syndrome.

Conclusion. Long-term results of the surgical treatment of the pathological conditions after cholecystectomy depend not only on the condition of the organ which surgery was performed on but also on  other physiologically related organs and body systems. The biliary  and enteroenteric connections are very important in this case.  Psychosomatic disorders of the patient are also crucial while  assessing the long-term results of the surgical treatment of this type of patients. The results of the surgical treatment of the duodenal  patency chronic disorders depend on the selected type of surgery.  Thus, the exclusion of the duodenum from the food passage gives  better results than the surgeries aimed at improving the passage of  food through the duodenum. The choledochojejunostomy and  duodenoenterostomy are not effective. In the most severe cases of  duodenal patency chronic disorders two sided exclusion of the  duodenum with duodenenterostomy can be the only effective  method of its correction but the development of post-resection syndrome cannot be ruled out.

Aim. The research was carried out to create and evaluate the effectiveness of the rehabilitation algorithm of children who underwent a surgery on the colon and anorectal area.

Materials and methods. We have experience in rehabilitation of 245 patients aged from 8 months to 15 years with anorectal  agenesis and Hirschsprung's disease. To assess the effectiveness of  the proposed algorithm of rehabilitation measures we formed 2  identical groups according to age, sex and nosology indicators. The  main group consisted of 136 children with abovementioned  pathology. Rehabilitation measures were carried out according to the developed algorithm. It included early bougienage, general and local  physiotherapy, correction of intestinal dysbiosis by selective  decontamination, relief of water-electrolyte and metabolic disorders. The control group consisted of 109 patients. Rehabilitation was carried out according to the traditional methods.

Results. When comparing the results of rehabilitation, the following data were obtained: therapeutic and preventive bougienage was  carried out for 18.34±1.29 months in patients of the control group  and for 9.56±0.94 months in children of the main group. The  duration of anal sphincter insufficiency treatment in the control  group was 23.48±1.95 months and only 11.29±1.07 months in the main group. The timing of the correction of dysbiosis in patients of the control group was 36.25±2.17 months and 14.36±1.14 months  in children of the main group. The duration of electrolyte disorders  and metabolic disorders correction in the control group was 14.16±0.57 months and 6.34±0.28 months in the main group.

Conclusion. The application of the developed algorithm of rehabilitation measures made it possible to reduce their duration by  more than 2 times according to all the studied criteria. It allows us  to recommend the created rehabilitation algorithm for wide clinical application.

Aim. This study was designed to evaluate the effectiveness of sequential prescription of drugs for anti-recurrent therapy of the uterine fibroids (UF) and combined oral contraceptives (COC) in pregravidal preparation.

Materials and methods. There was conducted a prospective, nonrandomized and controlled cohort study of 150 women with UF  who are planning a pregnancy after the organ-preserving treatment  of uterine fibroids by means of myomectomy with laparoscopic  access and pregravidal preparation. The immunohistochemical (IHC)  study of the intensity expression of Ki 67, p53, Bcl-2 was performed  for the differential diagnosis of reactive proliferation from dysplasia  in the distant fibroid node and the selection of anti-recurrent therapy.

Results. The duration of the UF disease does not depend on the intensity of expression of p53, Ki-67 or Bcl-2, the level of expression  of the progesterone receptors in the distant fibroid node. A negative average correlation between the level of hemoglobin  before myomectomy, the duration of the disease (r = -0.3867) and  the number of nodes (r = -0.5389) was revealed. After the end of  the anti-recurrent treatment in women who underwent organ- preserving treatment of uterine fibroids, the prescription of COC is connected with a further decrease in the size of fibroid nodes remaining after myomectomy from 15.81±0.22 mm to 8.94±0.45  mm (p<0.05), the number of fibroid nodes from 2.25±0.08 to  0.91±0.06 (р<0.05).

Conclusion. The combination of anti-recurrent therapy with the subsequent prescription of the COC for prevention of the UF growth  in women planning a pregnancy after myomectomy with endoscopic  access is highly effective.

In this research are presented the modern approaches to the management improvement in a medical institution for providing high  quality medical services. Here are also presented the main stages and  results of the international ISO 9001 standard implementation. The  purposeful and systematic efforts for maintaining and improving the  quality system management processes allow us to use ISO 9001 as a highly effective instrument for the constant improvement of medical care quality.

Aim. The aim of the study is to evaluate the effectiveness of the modern methods of prenatal diagnosis and treatment of hemolytic  disease of the fetus based on the analysis of researchers’ own clinical material accumulated during 12 years.

Materials and methods. There was performed a prospective analysis of 210 pregnant women with RH-immunization with noninvasive methods of diagnosis and invasive methods of  treatment of HDF. Also there was conducted the analysis of the introduction of the specialized reception and monitoring of the  maximum systolic circulation rate (MSCR) increase in the middle cerebral artery (MCA) in the diagnosis of anemia of the fetus.

Results. The specialized reception of pregnant women with RH-immunization organized at the Perinatal Center in 2005 allowed us to carry out timely diagnostics of the anemic syndrome in the fetus and  made it possible to start the prenatal treatment primarily at the moderate severity stage of anemia. Pregnant women with the  edematous form of HDF entered the PC either with an established  diagnosis or it was determined during the first appointment at the PC.

Conclusion. As a result, we proved the effectiveness of the intrauterine treatment of severe forms of anemia in the fetus and showed the effectiveness of such tactics of management of pregnant women with RH-immunization.

The article discusses modern representation about the mechanisms of development, the results of recently completed and the background for  new studies of methods for treating chronic heart failure with preserved  ejection fraction according to the literature and authors' own works.

Osteoporosis is a metabolic disease of the bone tissue, which is characterized by a violation of the qualitative (microarchitecture  change) and quantitative characteristics (decreased bone mass) of  the skeleton, and, as a result, lowenergy fractures. The medical and  social significance of osteoporosis is due to its consequences:  fractures of the femoral neck, vertebral bodies, radius and other  large bones of the skeleton, which significantly reduces the quality of patients’ lives and entails significant financial costs for treatment and rehabilitation.  Prevalence of diabetes mellitus (DM) significantly  increases in all countries of the world, including the Russian  Federation. Diabetes and osteoporosis were considered to be  individual diseases for a long time. In many prospective large-scale studies it was proved that patients with T2DM have a greater risk of  falls and fractures in contrast with the overall population. Despite the increased risk of fractures in diabetic patients, there is still no risk  stratification in these patients. The link between the classic risk  factors of osteoporotic fractures (such as chronic intake of  glucocorticoids, use of alcohol, tobacco, etc.) and the occurrence of  fractures is similar in patients with both T2DM and without it.  However, it is necessary to take into account other characteristics of  diabetes. The specific risk factors of fractures in T2DM patients are  duration of the diabetes for more than 10 years, diabetes decompensation, the severity of diabetes, obesity, the frequency of  falls, hypoglycemia, insulin, thiazolidinedione, exenatide, sulfonylureas, canagliflozin therapy, and, most likely, the reduction  of 25 (OH) vitamin D, functional hypoparathyroidism, the increase of sclerostin, pentosidine, decreased bone mineral density (BMD) of the hip.

The problem of radiation-induced lesions is becoming increasingly urgent. Studies in recent years show that one of the most vulnerable  tissues is the endothelium when exposed to high doses of ionizing  radiation. The study of the pathogenetic bases of this phenomenon has  shown that damage to endotheliocytes occurs both at the expense of  the direct exposure to radiation and due to the systemic disturbance of  homeostasis which leads to the disadaptation of the executive and  regulatory systems of the organism. In this review we considered the  mechanisms of the development of endothelial dysfunction under the influence of radioactive radiation and possible methods of pharmacological correction of this condition.

The article shows the role of Lukyanov G. N. in providing specialized surgical care in Kuban as well as in the preparation of scientific and pedagogical staff and in teaching students.