Aim. To assess the effect of cytoflavin on the dynamics of the blood and oral fluid prooxidant-antioxidant system in patients with maxillofacial area phlegmons.

Materials and methods. 55 patients were included in the study. The patients were divided into three groups: control group (group 1, n = 20); comparison group (group 2, n = 15); patients with phlegmons of the maxillofacial area (group 3, n = 20). As part of therapy, the patients in group 3 were additionally receiving cytoflavin (10 ml cytoflavin in 200 ml saline solution, 1 time per day, for 6 days). The treatment and monitoring was performed over the period of 6 days, during which the blood and oral fluid indicators were estimated 4 times (day 1, 2, 4 and 6).

Results. Cytoflavin had a positive effect on the state of the prooxidant-antioxidant balance in patients with maxillofacial area phlegmons. In comparison with the control group, patients in group 3 demonstrated a lower content of oxidative modifi cation products and a higher antioxidant activity of blood plasma. Cytoflavin therapy also led to an increase in the activity of glutathione peroxidase and reductase, as well as an increase in the concentration of glutathione at the last stage of the therapy.

Conclusion. The obtained data indicate the potential of cytoflavin as part of complex metabolic therapy for patients with purulent inflammatory processes of the maxillofacial area. 

Aim. To experimentally evaluate the efficacy of multi-layer chitosan-based wound dressings developed for dental purposes.

Materials and Methods. Over the period from 2018 to 2019, an experimental study was conducted to evaluate the efficacy of multi-layer chitosan-based wound dressings developed for dental practice. Two types of dressings (No. 1c and 2c), the central part of which was modified with the introduction of a 10% iodopyron solution, were compared with the widely-used wound dressings Alvostaz (NKF Omega-Dent LLC, Russia) and Gelatamp (Roeko, Germany). The work involved 26 male Chinchilla rabbits, ten months old and weighing 2500 (±50) g. Evaluation of the efficacy of the wound dressings under study was carried by modelling the conditions of both aseptic and purulent-inflammatory processes (a total of 8 series of experiments). In experiments modelling the purulent-inflammatory process, a Ps. aeruginosa bacterial culture at a concentration of 109 CFU/ml was introduced into the alveolar socket after tooth extraction, 3 days before the application of a wound dressing sample. The dressings under study were applied on the wound for the period of 7 days. During the observation postoperative period, the animals were provided with free access to water and food. The sampling of the material for the study was carried out in the operating room on day 7.

Results. According to the experimental results, chitosan-based wound dressings (No. 2c in particular) demonstrated high efficacy in experiments on animals (rabbits). The developed wound dressings perform mechanical protection and exhibit fuse effects, as well as are characterized by biodegradability and the ability to deliver medical agents contained therein to the damaged tissue.

Conclusion. The proposed chitosan-based wound dressings showed sufficient efficiency on the modelled wound process in the alveolar socket of an extracted tooth. Dressing No. 2c was recognised to be optimal for infected and purulent wounds. This dressing has a dense outer layer, which structure retains frame functions for a long time, thus providing proper drainage of the pathological focus. Dressing No. 1c was established to be promising in cases without inflammatory processes in the extracted tooth socket, where high adhesion to surrounding tissues is initially required for ensuring the tightness and preservation of a blood clot in the wound. 

Aim. To study the dimensional accuracy of dentition models produced by digital and conventional methods using an experimental model and digital technologies.

Materials and methods. This article presents an assessment of the dimensional accuracy of jaw models created using an Asiga Max UV 3D printer from digital images of dentition created by an iTero Cadent intraoral scanner and plaster jaw models obtained from one-stage two-layer A-silicone impressions. The DentalCAD software and the Meshlab computer program were used to study the dimensional accuracy of the as-obtained digital images. The nonparametric Wilcoxon rank test was used for statistical analysis of the obtained data.

Results. It is established that jaw models made of DETAX Freeprint model UV photopolymer using an Asiga Max UV 3D printer, based on digital impressions obtained by an iTero Cadent intraoral scanner, have a greater dimensional accuracy in comparison with plaster jaw models obtained from single-stage double-layer A-silicone impressions by 31.6% with a signifi cance level p < 0.05.

Conclusion. Jaw models created using an Asiga Max UV 3D printer are characterized by high dimensional accuracy as compared to plaster models. 

Aim. To improve the results of the surgical treatment of patients with ovarian endometriomas using intraoperative echography.

Materials and methods. The results of the surgical treatment of 138 patients with endometrioid ovarian cysts were prospectively and retrospectively analyzed. The main group consisted of 69 patients, who underwent standard ultrasound examination before and after surgery, as well as intraoperative laparoscopic ultrasound imaging. The control group (retrospectively) consisted of 69 patients with endometrioid ovarian cysts, who were not subject to laparoscopic ultrasound examination.

Results. The use of intraoperative transvaginal and laparoscopic echography can reduce the time of surgical revision, reduce the number of intra- and postoperative complications, as well as the frequency of relapses in the postoperative period.

Conclusion. According to the obtained results, intraoperative ultrasound echography has a high diagnostic accuracy of up to 99.2%. This method of intraoperative diagnosis allows the optimal volume and method of surgical intervention to be determined, and the safety and adequacy of surgical treatment to be ensured, thus maximizing the reproductive function. 

Background. One of the most common causes of death is trauma. The World Health Organization predicts a 40 % increase in injuries and injury-related deaths over the next 10 years. Despite the achievements of modern medicine, mortality in spine and spinal cord injuries remains high. This is explained not only by the severity of traumas, but also a large number of secondary complications,.

Aim. To study the frequency of complications and the mortality rate of traumatic spinal cord injuries; to identify factors affecting the outcome of such injuries. Materials and methods. A retrospective analysis covered 322 medical records from patients diagnosed with traumatic spinal cord injury and admitted to neurosurgical departments of Saint Petersburg in 2012–2016.

Results. Secondary complications (outside of the central nervous system) were found in 33 % cases, with the most common and serious being respiratory complications, pressure ulcers and thromboembolism. Complications more often occurred in elderly patients (over 75), as well as in severe injuries at the cervical and thoracic level. Complications developed significantly more frequently in patients with concomitant traumatic brain injury (TBI) and persons with alcohol consumption before injury. Complications noticeably increased the length of hospital stay and increased the risk of death by 43 times. 14 % of the patients died during primary stay in hospital. The spinal cord injury incompatible with life occurred only in 1 % of the patients. The lethal outcome correlated with age, severity, level of injury, concomitant TBI and alcohol consumption.

Conclusion. We have found a high incidence of unfavourable outcomes for traumatic spinal cord injuries (every third patient had at least one complication, every seventh died during the primary hospitalisation). In addition to unmodifiable factors, a statistically significant negative role of alcohol in the frequency of complications and death after spinal cord injury was found. Promoting a healthy lifestyle with low alcohol consumption, optimising preventive and therapeutic measures aimed at reducing the frequency of infectious and thromboembolic complications will improve the outcome of traumatic spinal cord injuries, reduce the length of hospital stay and decrease the economic burden of spinal cord injuries. 

Aim. To analyse the parameters of dental indices and the level of markers of infl ammation and oxidative stress in patients with chronic generalised periodontitis (CGP) with bronchiectatic disease and to develop a mathematical model for assessing the risk of CGP progression in patients with bronchiectatic disease.

Materials and methods. A total of 70 patients with mild and moderate CGP were examined, which were divided into the following groups: patients with CGP without general somatic pathology (n = 33), and patients with CGP and bronchiectatic disease (n = 37). The control group consisted of somatically healthy individuals with intact periodontium (n = 40). Dental indices (PMA, PI, Muhlemann, OHI-s), infl ammatory markers (transforming growth factor beta 1 (TGFβ-1), lactoferrin (LF), interleukin-8 (IL-8), C — reactive protein (CRP)), and oxidative stress markers (malondialdehyde (MDA), as well as advanced oxidation protein products (AOPPs), and total superoxide dismutase (SOD)) were analysed in all patients included in the study. The method of binary logical regression was used to create a mathematical model for assessing the risk of CGP progression in patients with bronchiectatic disease.

Results. Dental indices and the level of markers of infl ammation and oxidative stress were statistically signifi cantly higher in all patients with CGP as compared to somatically healthy individuals, as well as in patients with CGP and bronchiectatic disease as compared to patients with CGP without general somatic pathology. Positive correlations of different strength between the studied markers of infl ammation and oxidative stress and dental indices were revealed. Based on the results of the correlation matrix data and using the binary logistic regression method, a mathematical model was developed that can be applied for assessing the risk of CGP progression in patients with bronchiectatic disease. The predictors of progression included in the mathematical model were: PI, TGFβ-1 and AOPPs. 

Conclusion. The data obtained indicate a greater severity of infl ammation and oxidative stress in CGP patients with comorbid pathology in the form of bronchiectatic disease and the infl uence of these processes on the periodontal condition. The proposed mathematical model for assessing the risk of CGP progression in patients with bronchiectatic disease is characterized by a high level of sensitivity and prognostic signifi cance, thus being applicable for use in clinical practice. 

Aim. To assess the expression of vascular endothelial growth factor A for evaluating the functional state of the endometrium in women suffering from infertility and chronic endometritis.

Materials and methods. Endometrium biopsy specimens obtained from 41 patients with uterine factor infertility (experimental group) were examined. A comparison group was composed of 39 women diagnosed with the “male factor” infertility exhibiting no infl ammatory processes of the reproductive organs. An endometrial biopsy was performed in both phases of the menstrual cycle: on days 8–10 of the follicular phase and on days 21–24 of the luteal phase. The expression of vascular endothelial growth factor receptors was evaluated on the basis of immunohistochemical staining of the biopsy specimens using monoclonal antibodies. The results of the immunohistochemical reaction were quantifi ed using the ImageJ software. A quantitative criterion — a stained area coeffi cient (per cent) representing the ratio of the immunohistochemical staining area to that of a biopsy specimen — was proposed for assessing the level of VEGF-A expression.

Results. In the chronic endometritis group, the intensity of VEGF-A expression was found to be 1.4 times higher than that in the comparison group during the proliferation phase (p < 0.001). Expression values of the secretion phase were 1.9 times higher than those in the comparison group (p < 0.01).

Conclusion. Chronic endometritis is characterized by an overexpression of VEGF-A by various endometrium cellular components. Interpretation of immunohistochemical stains using the method of computer morphometry allows quantitative indicators characterizing the intensity of angiogenesis marker expression in the endometrium during the menstrual cycle to be obtained. The level of VEGF-A expression can be used as an additional marker improving the quality of biopsy diagnostics in patients with infertility. 

This article presents a review of available information on asprosin — a hormone of white adipose tissue discovered in 2016. The history of its discovery, as well as its action mechanisms and main targets are examined. Changes in the plasma level of asprosin under some pathological conditions are analysed. The importance of studying asprosin is determined by its functions: asprosin regulates physiological processes during fasting and plays an important role in the development of metabolic disorders, such as insulin resistance. There are relatively few studies concerned with asprosin; however, this hormone can already be considered as a diagnostic marker and a potential target in the treatment of certain metabolic disorders, e.g. diabetes mellitus and obesity.

Chronic diseases of the veins of the lower extremities include vascular pathologies within the venous system and exclude those, in which the veins suffer secondarily (chronic heart failure, iatrogenic damage, tumour occlusion). The main clinical and morphological forms of chronic diseases of the veins of the lower extremities include: varicose veins, post-thrombotic disease and phlebodysplasia. Moreover, according to publications, varicose disease accounts for the main percentage of occurrence, i.e. from about 70 to 86 %. Post-thrombotic disease occurs from 14 to 29 % of cases and develops, as a rule, during the first two years after an episode of deep vein thrombosis of the lower extremities in 20–50 % of patients. These two diseases are the main reason for the development of chronic venous insufficiency with a significant decrease in working capacity and quality of life under the age of 60. Despite the achievements of modern science, the ethiopathogenesis of these diseases is yet to be understood. Instrumental diagnostics allows a pathological retrograde blood fl ow due to the failure of the valves of the venous system of the lower extremities to be determined. However, the issue of what is primary — valvular insufficiency or venous wall deformation — remains open at the present time. This article is devoted to a review of modern theories about the mechanisms underpinning the formation of valvular insufficiency in varicose and post-thrombotic diseases. The review also addresses systemic hemodynamic disorders (heart morphology and hemodynamics) against the background of chronic diseases of the veins of lower extremities.

Aim. To describe a rare hereditary disease — Kallmann syndrome — in a 17-year-old boy.

Materials and methods. A retrospective analysis of anamnestic information, the course of the disease, laboratory and instrumental data and treatment of a 17-year-old patient with Kallmann syndrome was carried out. The patient underwent treatment in a gastroenterological department of the Children’s Regional Clinical Hospital in Krasnodar in March 2019.

Results. Patient K., 17 years old, was admitted to the gastroenterological department of the Children’s Regional Clinical Hospital in March 2019 with complaints of weakness, nausea, “hungry” abdominal pain and decreased appetite. Upon examination, the child revealed duodenal ulcer. However, an in-depth examination found that the boy was lagging behind in physical and sexual development. In this connection, an endocrinological examination was performed, which discovered: a decrease in the concentration of sex hormones relative to the age norm (luteinizing hormone, follicle-stimulating hormone, testosterone), delayed bone age as compared to the passport age, discrepancy between the testicular size and the patient’s age, olfactory bulb hypoplasia according to brain MRI, 1st degree smell disorder, the presence of a mutation in the KAL1 gene. The boy was diagnosed with: Kallmann syndrome, X-linked recessive inheritance. Complications: hypogonadotropic hypogonadism. The chosen treatment included prolonged testosterone esters for parenteral administration of 250 mg once per 3–4 weeks. Following 6 months of therapy, positive signs were observed: an increase in height by 2 cm, an increase in testicular volume by 3 ml, the appearance of single hairs at the base of the penis.

Conclusion. Kallmann syndrome is a rare pathology, whose main manifestations include delayed sexual development and hypo- or anosmia. For a timely diagnosis and treatment, it is of great importance to identify symptoms and conduct a comprehensive examination. Timely initiation of hormonal treatment allows puberty to occur in all cases, thus facilitating social and psychological adaptation of such patients. 

Aim. To describe the results of applying citrate dialysis in the complex therapy of a patient with postpartum sepsis.

Materials and methods. This paper presents an analysis of a case of the successful treatment of patient P. with the diagnosis “Childbirth 3 urgent. Pfannenstiel laparotomy. Caesarean section in the lower uterine segment. Hypotonic bleeding. Relaparotomy: ligation of the internal iliac arteries, hemostasis. Relaparotomy: additional hemostasis, pelvic tamponade, abdominal cavity tamponade. Hemorrhagic shock of fourth category. Extirpation of the uterus with tubes. Sepsis. Septic shock. DIC syndrome”. Citrate dialysis was included as part of intensive care therapy.

Results. Citrate dialysis allowed the patient with multiple organ failure, against the background of complex intensive care therapy, to restore kidney function after 28 sessions of renal replacement therapy. Diuresis was completely restored on day 42. Biochemical parameters, such as urea and creatinine, were normalized on day 45. The duration of treatment in the anesthesiology and resuscitation departments was 47 days, out of which lung mechanical ventilation lasted for 17 days. The total duration of treatment in the hospital was 54 bed days. The patient was discharged in satisfactory condition.

Conclusion. The methods of extracorporeal detoxifi cation can signifi cantly improve treatment outcomes in this category of patients and reduce maternal mortality rates.