Aim. To study reasons behind the resistance of medical workers to changes while implementing the federal project “Creation of a New Model of a Medical Organisation Providing Primary Health Care”, as well as to develop guidelines on change management on the basis of Goldratt’s theory.

Materials and methods. Changes in the process organisation of medical institutions are necessitated by the implementation of the federal project “Creation of a New Model of a Medical Organisation Providing Primary Health Care” developed by the Ministry of Healthcare of the Russian Federation with the methodological support of the Rosatom Production System. A new model of a medical organisation is based on continuous improvement (kaizen) using lean tools, which requires a different approach to managing changes and overcoming the resistance of medical workers to their implementation. The study sample included the employees of the Central City Hospital in Goryachy Klyuch (Krasnodar Territory). The research took the form of an anonymous questionnaire survey drawing on Goldratt’s theory.

Results. Basic recommendations on the management of changes associated with the transitioning to the new model suggested in this work allow heads of healthcare institutions to evaluate employees’ readiness to changes comprehensively, as well as to transform the existing model of a medical organisation effectively and gradually.

Conclusion. These guidelines on change management when transitioning to the new model may be used by heads of medical institutions in order for the organisation to achieve effective transition to the continuous process optimisation with the use of lean tools, aiming to meet the criteria of the new model.

Aim. To study the morphological changes in the tooth pulp of experimental animals when modelling acute partial pulpitis using calcium silicate modified with light-cured resin and calcium hydroxide.

Materials and methods. An experimental model of acute partial pulpitis was applied including the formation of a cavity on the lingual surface of the tooth, which corresponded to advanced caries in terms of depth, followed by a slight perforation up to the tooth pulp with a sharp probe. This model of acute partial pulpitis was reproduced for 32 teeth in four sexually mature rams. The teeth were extracted together with the surrounding sockets 15, 30 and 90 days after the modelling of pulpitis, followed by their fi xation in 10% solution of neutral formalin. Decalcification was performed in 25% solution of Trilon B. The material was poured into celloidin; histological sections were stained with hematoxylin and eosin according to Masson’s trichrome procedure.

Results. The histological examination of pulp from the main group (calcium silicate modified with light-cured resin) revealed the formation of a biological barrier from secondary dentin in the area of the cavity and perforation up to the pulp chamber on the 90th day after the experiment started. The tooth pulp revealed no signs of an inflammatory process. On the 90th day after the experiment started, no pronounced morphological changes in the main substance and dentinal tubules in the area of the cavity walls were noted in the coronal pulp of experimental animals from the comparison group (calcium hydroxide). A focal chronic inflammatory process was noted in the tooth pulp.

Conclusion. It was established that the use of calcium silicate modified with light-cured resin in the experimentally created model of acute partial pulpitis was accompanied by the formation of a biological barrier and a well-developed zone of reparative dentin in the area of the cavity and perforation up to the pulp chamber, as compared to the group where calcium hydroxide was used. Thus, the study results confirmed the efficay of using calcium silicate modified with light-cured resin within the biological method for treating acute partial pulpitis, which shortens the functional recovery of tooth pulp.

Aim. To analyse the level of oxidative stress markers and the value of dental indices characterising the state of periodontal tissue in patients with generalised periodontitis (GP) both without somatic pathology and with bronchiectasis.

Materials and methods. Over the period from 2015 to 2017, a total of 90 GP patients were examined, including 40 patients without somatic pathology and 50 patients with bronchiectasis. The control group consisted of somatically healthy individuals with intact periodontium (n=40). The following indices were calculated for all examined individuals: PMA, PI, Muhlemann and OHI-s. The level of oxidative stress markers in oral fl uid was determined: total superoxide dismutase (SOD) of all three types (Cu/Zn-SOD + Mn-SOD + Fe-SOD), products of advanced protein oxidation and malondialdehyde.

Results. The study established the intensifi cation of oxidative stress in GP patients without somatic pathology and with bronchiectasis. Patients with comorbid pathologies demonstrated a greater severity of oxidative stress. The analysis revealed a significant correlation between the values of dental indices (PMA, PI, Muhlemann, OHI-s) and the level of oxidative stress markers both in GP patients without somatic pathology and with bronchiectasis. Furthermore, this correlation is stronger in patients with comorbid pathologies.

Conclusion. The presence of comorbid pulmonary pathologies in the form of bronchiectasis in patients with generalised periodontitis can act as an aggravating factor in the development of periodontal lesions.

Aim. To compare the efficiency of removable mini-implant retained dentures using different types of attachment.

Materials and methods. The study included 51 edentulous patients. The patients were divided into three groups according to the attachment type and abutment shape: 1) ball-and-socket attachment, ball abutment (n = 26); 2) locator attachment, equator abutment, XiVE LOCATOR system (n = 14); 3) bar attachment (n = 11). Removable dentures were made of ordinary acrylic plastic. The placement of intraosseous dental implants with their sublingual engraftment was performed according to the traditional two-stage delayed-load procedure. The efficiency of implants was evaluated using the method of M.Z. Mirgazizov and the eponymous index. The dynamics of vertical bone resorption around implants was determined using dental panoramic radiography (6 months, 1 and 2 years after the treatment). A periotest was performed 6 months after the end of the orthopaedic treatment.

Results. The one-year survival rate of implants reached 96.2% in group 1, amounting to 100% in groups 2 and 3. The two-year survival rate came to 92.3% in group 1, reaching 92.9% and 100% in groups 2 and 3, respectively. Inflammatory phenomena characteristic of peri-implantitis were noted one year after the implant placement in 7.7% (n = 2) of patients in group 1 and in 7.1% of patients in group 2, with no inflammatory phenomena being observed in group 3. Two years after the implant placement, peri-implantitis was observed in 19.2% and 21.4% of patients in groups 1 and 2, respectively, coming to 9.1% in group 3. The periotest revealed that six months after the placement, implant stability was higher in group 3 for both the lower and upper jaw (in comparison with groups 1 and 2), as evidenced by the shift in periotest values towards the negative part of the scale.

Conclusion. The study revealed that bar attachment, as well as locator attachment (equator abutments), of removable dentures supported by mini implants is more efficient as compared to the ball-and-socket attachment.

Aim. To study the morpho-molecular mechanisms underlying the formation of microscopic colitis (MC), as well as to identify features of its two forms – collagenous and lymphocytic.

Material and methods. We studied biopsy samples from 23 patients exhibiting a clinical picture of irritable bowel syndrome; the material was obtained at the Endoscopic Department of the Region Clinic Hospital No. 2. The material was sampled from the five zones of the large intestine specified in the guidelines (Clinical Guidelines — Diagnosis and treatment of patients with digestive diseases, Appendix No. 3). The material was fixed in 10 % formalin, processed and embedded in paraffin. Sections were stained with hematoxylin and eosin (according to Mallory and Masson), as well as with picrosirius red, followed by the examination of these sections in polarised light. The immunohistochemical study was performed in line with the guidelines using monoclonal antibodies. Abcam antibodies (England) were used to detect type I and type III collagen; Cell Marque antibodies to CD4⁺ T and CD8⁺ T-lymphocytes (USA) were used to characterise lymphocytes.

Results. It has been established that fi broblasts in the lamina propria play a key role in the pathogenesis of collagenous MC. This cell population synthesises extracellular matrix and forms layers of collagen fibres in the area under the surface epithelium. Pericryptal fibroblasts are also activated. Their differentiation occurs simultaneously with the migration of epithelial cells to the surface of the crypts with a possible change in their cellular composition. Intercryptal fi broblasts provide an increase in the synthesis rate of type III collagen. In the case of lymphocytic colitis, the pathogenetic mechanism is based on the relationship between lymphocytes and the cells in the lamina propria. The outcome is determined by the type of activated lymphocytes. CD8⁺ lymphocytes infiltrate the epithelial lining, causing a reaction to the luminal component, whereas CD4⁺ lymphocytes act as helpers and populate the lamina propria in the area under the epithelium.

Conclusion. The pathogenesis of collagenous MC is based on the mechanism exhibited by the fibroblasts in the colon lamina propria, whereas the pathogenesis of lymphocytic colitis is determined by the dynamics of CD4⁺ T and CD8⁺ T-lymphocyte subpopulations.

Aim. In this study, the authors set out to find the correlation between the data of cone beam computed tomography (CBCT) and the levels of inflammatory markers in patients with chronic generalised periodontitis (CGP), both without somatic pathology and with bronchiectasis.

Materials and methods. The study included 90 CGP patients and 40 somatically healthy individuals with intact periodontium. CGP patients were divided into two groups: CGP patients without somatic pathology (n = 40) and CGP patients with bronchiectasis (n = 50). Using ELISA, the authors determined the level of the following inflammatory markers in oral fluid: transforming growth factor beta 1 (Tgfß-1), interleukin -8 (IL-8), lactoferrin (LF) and C-reactive protein (CRP).

Results. The analysis of CBCT data and the levels of inflammatory markers (Tgfß-1, LF, IL-8 and CRP) revealed that more pronounced changes in their values were observed in CGP patients with bronchiectasis. In addition, the revealed correlations between CBCT data and the levels of inflammatory markers in CGP patients without somatic pathology and CGP patients with bronchiectasis indicate a relation between the severity of inflammatory reaction and the clinical manifestations of CGP. Furthermore, this correlation is stronger in CGP patients with comorbid pathology than in CGP patients without somatic pathology.

Conclusion. The presence of comorbid pathology in the form of bronchiectasis in CGP patients has a negative impact on the periodontium, which should be considered when managing patients.

Aim. The present article studies the effect of balneotherapy with Uvinskaya mineral water on the microbial spectrum of urine in patients with type 2 diabetes.

Materials and methods. The study was carried out at the Endocrinology Department of the First Republican Clinical Hospital (Izhevsk). A total of 56 patients with type 2 diabetes participated in the study, which involved collecting medical history and complaint data of patients along with performing general and system-based examination, urinalysis, urine culture prior to and following the course of therapy, as well as kidney ultrasound aimed at excluding the presence of calculi. Urine cultures (morning sample) were plated onto 5% blood agar, as well as Endo’s medium for detecting bacteria from the Enterobacteriaceae family using the Gould method. Urine cultures were incubated for 24, 72 and 144 hours at a temperature of 37 °C. The significance of differences was determined using the t-test for independent and paired samples.

Results. Changes in urinalysis were observed in all examined patients, which included changes characteristic of urinary tract infections: a large number of bacteria per field of view; a large amount of mucus; the presence of leukocytes in urine; alkaline pH shift; as well as disorders typical of diabetes mellitus (glycosuria, proteinuria). E. coli predominated in urine cultures. Following a 30-day therapy with Uvinskaya mineral water, the number of bacteria and leukocytes, as well as the amount of mucus, detected in the urine reduced significantly, which indicates urinary tract sanation. Positive dynamics among patients who underwent balneotherapy treatment is confirmed by the Student’s t-test (p < 0.05). In addition, no urinary sanation was observed in the group of patients who did not receive balneotherapy.

Conclusion. Drawing on the study results, the authors recommend using Uvinskaya natural mineral water in the combined treatment of patients with type 2 diabetes for urinary tract rehabilitation.

Aim. To assess the cytokine profile and the level of endothelial dysfunction in patients with coronary artery disease (CAD) and different outcomes of coronary artery bypass grafting (CABG).

Materials and methods. The study included 95 people, with 22 of them being practically healthy (without CAD). The CAD patients (73) were retrospectively divided into 2 subgroups according to the presence of complications within the first month after the CABG. The first subgroup consisted of 25 patients suffering from complications after CABG, with 48 people making up the second subgroup (no complications after CABG). CABG was performed on a beating heart; bypass grafts were attached during revascularisation. The serum levels of IL-4 and IFN-γ were determined through the enzyme-linked immunosorbent assay (ELISA) using appropriate test systems manufactured by BCM Diagnostics and a Zenyth 340 microplate photometer (Biochrom Ltd). In order to determine the content of endothelin-1 in blood serum, ELISA test systems manufactured by Biomedica were used. The statistical analysis of study results was performed employing the descriptive statistics module of Statistica 12.0 (StatSoft, USA). The mean (M), its error (m), median (Me) and the interquartile range [Q25; Q75] were calculated. In cases when p ≤ 0.05, the results were considered statistically significant.

Results. It was revealed that, in the preoperative period, CAD patients from both subgroups exhibited increased levels of endothelin-1 (p = 0.0001) and IFN-γ (p = 0.0001), whereas an increase in IL-4 production was noted only in the first subgroup (p = 0.0001), as compared to the control group. The follow-up revealed that CAD patients with complications after CABG exhibited stable high levels of IL-4 (p > 0.05) and IFN-γ (p > 0.05) during the entire observation period, as compared to the initial values. The content of endothelin-1 in both subgroups increased significantly on the 4th day of observation (p > 0.05) and returned to its initial high values after 1 month.

Conclusion. Immune response in CAD patients suffering from complications after CABG develops mainly along the pro-inflammatory pathway and is accompanied by endothelial dysfunction.

The article defines the role of intraoperative neurophysiological monitoring (IONM) in neurosurgery, provides a brief historical background, as well as describes the main methods of IONM — somatosensory and motor evoked potentials. The authors describe electrical stimulation of the cerebral cortex and subcortical structures under general anaesthesia and in the conscious state. IONM is an integral part of neurosurgery, with its importance growing in orthopaedics and cavity surgery, where there is a risk of damaging nerve structures.

Aim. To present an interesting case of treating cholelithiasis in the setting of the Mirizzi syndrome.

Materials and methods. This paper presents a clinical case of patient A. (62 years old) who was admitted to hospital with the following diagnosis: cholelithiasis, cholecysto-choledocholithiasis, obstructive jaundice. Drawing on the medical history and complaints of the patient, as well as on the results of physical, laboratory, instrumental and preliminary examination, the patient was diagnosed with choledocholithiasis in the setting of the Mirizzi syndrome. Endoscopic retrograde cholangiopancreatography (ERCP) was prescribed. The ERCP was performed in four stages. The first stage included a typical endoscopic papillotomy, a retrograde cholangiopancreatography, as well as an attempt at endoscopic mechanical lithoextraction; however, the calculus could not be removed. During the second stage, the calculus was visually localized, and its size was determined. The third stage consisted in performing electrohydraulic lithotripsy (EHL) and mechanical lithoextraction of calculus fragments. The final, fourth stage involved follow-up direct cholangioscopy, which revealed that the common bile duct was patent and there were no calculi.

Results. EHL constitutes a high-tech method of crushing calculi, which provides an opportunity to carry out minimally invasive treatment in patients with complicated cases of choledocholithiasis, when standard methods of mechanical lithoextraction are not effective.

Aim. To describe clinical cases exhibiting a rare combination of dermatoses in one patient in order to prevent iatrogenic errors.

Results. The present article describes clinical cases of patients with polymorbid pathologies, which constitutes one of the current interdisciplinary healthcare problems. The described clinical cases indicate the co-occurrence and overlap of various diseases, which complicates the final diagnosis. Polymorbidity in modern patients turns the diagnostic process into a search for an optimal solution, which frequently requires innovative approaches. A mixed clinical picture leads to iatrogenic errors. A detailed differential diagnostics should be performed when establishing the final clinical diagnosis, which could reduce the frequency of medical-diagnostic and tactical errors. In this connection, a prolonged diagnostic route contributes to the timely detection of interdependent pathologies. The analysis of clinical cases related to managing patients with polymorbid pathologies facilitates the prevention of the progression of each disease, as well as the determination of prognostic aspects.

Conclusion. Considering the narrow specialisation of medical institutions, the management of patients with polymorbid pathologies is a challenging problem. The management of such patients requires adherence to a clear clinical diagnostic algorithm and a multidisciplinary approach, which allows diagnostic errors and complications associated with drug therapy to be avoided, thus improving the quality of healthcare services. Polymorbid pathology constitutes an interdisciplinary problem requiring the development of a unified procedure for the management of patients, which should be aimed at the early detection of combined pathology, eliminating polypharmacy, reducing the overall risk of diseases and improving the life quality of patients.

Aim. To consider the possibility of the diagnosis of a rare small bowel tumour complicated by small bowel obstruction and small bowel bleeding, as well as the surgical treatment of this pathology using a minimally invasive surgical approach.

Results and discussion. The authors present a clinical case of associated complication of a gastrointestinal stromal tumour (GIST) of the small intestine in a 48-year-old patient. The patient was admitted to a surgical clinic with small bowel obstruction, episodes of intestinal bleeding and anaemia. The diagnosis was determined using CT enterography. In line with the current trends for minimally invasive surgery, minimally invasive laparotomy was performed drawing on the CT mapping of the anterior abdominal wall. The last stage involved in the morphological verification of GIST, which employs a standard procedure of IHC testing, revealed a malignant GIST, spindle cell variant. The verified histotype of a small intestinal tumour provides the opportunity to choose the necessary variant of adjuvant chemotherapy, as well as to improve general and relapse-free survival.

Conclusion. Minimally invasive operations can be performed in the complicated course of GIST due to the biological properties of this pathology (absence of lymphogenic metastasis and infiltrative growth) without decreasing five-year survival rate. The use of CT helps make a topical diagnosis and plan minimally invasive surgical treatment.

Aim. In this work, the authors set out to perform a historical analysis of Nikolay Petrov’s life journey and scientific work, as well as to demonstrate the importance of the Kuban period in his formation as an individual, a scientist and as a founder of domestic medical deontology.

Materials and methods. In this study, the authors used archival documents; works of Nikolay Petrov; as well as the following methods: historical-descriptive, comparative-historical, problem-chronological, biographical along with the method of monographic description.

Results. The life and professional journey of Nikolay Petrov can be divided into several periods, each of them playing an important role in his formation as an individual and as a scientist. The fi rst period (‘St Petersburg period’) covers his brilliant upbringing, education at the Military Medical Academy in Saint Petersburg, work as a medical resident at the Surgery Department of the Academy, as well as the publication of his first scientific works and the defence of the doctoral thesis in medicine. During the second period (‘abroad period’), Nikolay Petrov completed advanced training at the Pasteur Institute and worked at the clinics of Switzerland, Austria and Germany. The third period (‘teaching period’) covers the time when Nikolay Petrov was simultaneously working as a surgeon and a teacher at the Military Medical Academy; his fundamental works on surgery and oncology were published. The forth ‘military period’ coincided with the years of the First World War when Nikolay Petrov worked as a surgeon at the hospitals of the Russian Red Cross Society while continuing his research. The fifth period (‘Kuban period’) coincided with the years of revolutionary upheavals, civil war and moving to Kuban. In 1917–1922 Nikolay Petrov had to choose between emigration and his motherland. He stayed true to his profession and his homeland. Nikolay Petrov devoted himself to serving the ‘new’ country, actively participated in the organisation of the Kuban Medical University and wrote a number of works on surgery, including the first work on medical deontology in the country. The sixth period is called ‘return to St Petersburg’ where in 1925 Nikolay Petrov organised the Oncology Department at the Mechnikov hospital, which under his guidance became the first research institute for oncology in our country. This period was marked by the recognition of his talent as a doctor and a scientist by the public and government.

Conclusion. Nikolay Petrov‘s ethos as a scientist and a doctor was formed under the influence of his challenging life journey, with the Kuban period being a turning point in his life.