The academic potential of the Kuban State Medical University has been formed as a result of close interaction between university and academic science. Such collaboration encourages the development of highly qualifi ed academic and teaching staff, increases the importance of conducting fundamental studies and forms an information basis for boosting research and educational processes in the university. Over a century, academicians and corresponding members of the Russian Academy of Sciences (RAS) have contributed to the development of the Kuban State Medical University by taking part in fundamental research projects and creating scientifi c schools. The Kuban State Medical University has received ongoing intellectual support from representatives of academic science both in the formation of long-term developmental strategies and implementation of individual scientifi c projects. The collaboration between RAS and the university has been carried out under different socio-economic and political conditions. The Kuban State Medical University will continue implementation of fundamental research projects in close interaction with the Russian Academy of Sciences (RAS) in the foreseeable future. This article presents a brief biography of 15 RAS academicians and corresponding members having made a signifi cant contribution to the development of the Kuban State Medical University, which is celebrating its 100th anniversary this year.

Background. The steadily growing number of hearing-impaired patients incited epidemiological research into the etiopathogenesis of sensorineural hearing loss.

Objectives. To conduct a screening survey of hearing-impaired adults to identify early sensorineural hearing loss in patients with chronic general somatic pathology in the Republic of Adygea.

Мethods. We used a screening method for auditory function disorder diagnosis based on surveying patients with no primary hearing complaints. A total of 6,346 patients with variant chronic general somatic pathology were surveyed anonymously. Statistical analysis and interpretation were performed with Statistica 10.0 and MS Excel 2010.

Results. A point–based assessment survey of the patient’s psycho-emotional state in various classroom settings identifi ed the sensorineural disorder risk groups among the visitors of district and municipal outpatient units. Subclinical auditory function disorders were revealed in 16.5% (1045 of 6346), and putative hearing loss of various degree — in 36.2% (2295 of 6346) of the patients. In 47.3% (3006 of 6346), no evidence of hearing loss was observed in the survey. Accentuated analysis revealed early and severe hearing disorders among patients with cardiovascular, endocrine, nervous, excretory, respiratory and other diseases.

Conclusion. We show the applicability of screening surveys for detecting early sensorineural hearing loss in patients with chronic general somatic pathology. Acceptance of adapted surveying by family physicians, neurologists and adult endocrinologists will facilitate preclinical identifi cation of risk groups among patients requiring specialised audiological care.

Background. Effective drug therapy for resistant arterial hypertension is among major problems in modern medicine. The actual prevalence of resistant arterial hypertension is unknown, and its pathogenetic mechanisms are actively investigated. Among its important components is salt-sensitivity of the patient. At the same time, effi cacy of combined antihypertensive therapy in relation to salt-sensitivity of patients with resistant arterial hypertension is not fully understood.

Objectives. Effi cacy assessment of personalised drug therapy in salt-sensitive and salt-resistant patients with resistant arterial hypertension.

Мethods. We conducted a non-randomised controlled study with the observation time of 48 weeks. All patients had ambulatory blood pressure monitoring (ABPM) in the onset and past 48 weeks of treatment. Prior to therapy, the patient’s salt-sensitivity was determined with ABPM in salt loading (V.I. Kharchenko’s test). Two cohorts were formed with respect to the test results to include salt-sensitive (n = 67) and salt-resistant (n = 54) patients. Both cohorts received a combined therapy: enalapril 10 mg twice a day, amlodipine 10 mg/day, hydrochlorothiazide 12.5 mg/day, aliskiren 150 mg/day. If a target blood pressure was not observed in 3 weeks, aliskiren was elevated to 300 mg/day. Therapeutic effi cacy was assessed with ABPM after 48 weeks. Non-parametric statistical analysis was performed using Statistica 6.10 (StatSoftInc, USA).

Results. The study included 121 patients with resistant arterial hypertension, median age 63 [58;67]. With background therapy, the target blood pressure was observed in 29 (43.4%) patients in cohort 1 and in 38 (70.4%) — in cohort 2 (intergroup p < 0.05). Statistically signifi cant lower ABPM values were registered in both cohorts after 48 weeks. Daily blood pressure normalised with therapy in 62.1% of patients in cohort 1 and in 68.4% — in cohort 2. The salt-resistant cohort exhibited a more pronounced reduction in ABPM values compared to salt-sensitive patients.

Conclusion. Salt-sensitivity is a factor for personalising antihypertensive drug therapy in patients with resistant arterial hypertension due to specifi city of mechanisms for maintaining high blood pressure. Combined antihypertensive therapy with aliskiren is statistically more effective in salt-resistant than in salt-sensitive patients.

Background. Anticoagulant and haemostatic drugs are used to prevent thrombosis and bleeding after arthroplasty. Combined therapy with these divergent agents, especially in comorbid patients, is not regulated in relevant clinical guidelines and may lead to a reduced effi cacy.

Objectives. Assessment of the effect of time interval (TI) in variant combined settings of haemostatic and anticoagulant drugs and concomitant pathology on the development of thrombohaemorrhagic complications after hip or knee arthroplasty.

Мethods. In a retrospective study, we analysed patients’ somatic status, haemostatic and anticoagulant drug regimes and their combined impact on the development of thrombohaemorrhagic complications in early postoperative period.

Results. We analysed 253 case histories with total replacement of main lower limb joints. Two cohorts were defi ned with respect to TI between haemostatic and anticoagulant drug applications. TI was 17 h or less (n = 145; 57.31%) in cohort 1 and 18–24 h (n = 108; 42.68%) — in cohort 2. A total of 29 drug combinations were tested. Thrombohaemorrhagic complications were observed in 27 (10.67%) patients, with 22 (81.48%) in cohort 1. Thromboses in regimes with tranexamic acid developed in cohort 1 (p = 0.038) at a 2.2-folds higher rate than in cohort 2 (p < 0.05). Thrombosis development was infl uenced by grade 2 obesity (relative risk = 8.75, p = 0.037), type 2 diabetes (relative risk = 21, p = 0.00001), myocardial infarction (relative risk = 16.875, p = 0.00002), venous pathology (relative risk = 8.1, p = 0.045) and the patient’s age over 75 (relative risk = 6.8, p = 0.029). Age over 75 years increased the risk of bleeding by a factor of 12 (relative risk = 12, p = 0.015).

Conclusion. After main joint arthroplasty, differential measures to prevent thrombohaemorrhagic complications include a minimal 18-h TI between haemostatic and anticoagulant agent applications, especially in tranexamic acid regimes, and the consideration of concomitant risk factors, such as grade 2 obesity, type 2 diabetes, myocardial infarction in history, venous pathology and age over 75 years.

Background. Epidermolysis bullosa defi nes a clinically and genetically heterogeneous group of severe orphan disorders manifested with a congenital propensity for bullae (blisters) propagation on skin and mucous membranes of oesophagus, intestine, respiratory and urogenital systems. In the Russian Federation, its incidence rate is 1 per 50 –300 thousand of people. The actual disease prevalence in Krasnodar Krai is undefi ned. The genetic basis of this hereditary pathology has been studied insuffi ciently.

Objectives. Epidemiological description of epidermolysis bullosa in Krasnodar Krai and detection of its chemical DNA signatures.

Мethods. The prevalence of epidermolysis bullosa in Krasnodar Krai was studied with a relevant patient sample selected in an electronic archive of primary physician visits during 2010–2018. Chemical DNA signatures were detected as levels of blood serum 8-oxoguanine, a common marker of oxidative lesion. The 8-oxoguanine concentration was determined in ELISA assays with monoclonal antibodies. Statistical signifi cance was estimated with the chi-square and Mann–Whitney U test criteria for small samples.

Results. A retrospective study revealed the total incidence rate of epidermolysis bullosa in Krasnodar Krai as 0.96 per 100,000 population, with prevalence in people aged under 30 years (75.5% of all patients, p < 0.01). In Krasnodar Krai, epidermolysis bullosa simplex accounts for 54.7% of total observed cases. Lethal form was diagnosed in 13.2%, and dystrophic type — in 5.7%. Diagnosis was incomplete as per type in 26.4% of patients. Serum 8-oxoguanine concentration in pathology comprised 14.8 ± 1.9 ng/mL, which exceeds 1.9-fold the control values of 7.7 ± 1.3 ng/mL (p < 0.01).

Conclusion. The epidemiological profi le of epidermolysis bullosa in Krasnodar Krai was described. The disease prevalence, areal occurrence, predominant types and high-risk population groups were determined. A quarter of all patients had incomplete diagnosis as per the disease type. Elevated levels of 8-oxoguanine, the main product of DNA oxidation, indicate both genomic lesion and oxidative stress associated with epidermolysis bullosa.

Background. Free radical oxidation underlies many morbid processes in various organs and tissues, including skin. A major antioxidant preventing the free radical impact is superoxide dismutase (SOD). A particularly valued SOD-containing agent is recombinant human SOD, Rexod, possessing a wide spectrum of medical applications in form of lyophilisate. Marketing of a new Rexod® injection preparation in form of solution requires research into its properties, including the impact on blood microcirculation in skin, especially with the lack of relevant clinical trials.

Objectives. Evaluation of anticipated positive effects of the new injection form of Rexod® on blood microcirculation in rat skin.

Мethods. The new Rexod® preparation impact on blood microcirculation in skin was studied with laser Doppler fl uometry by recording the following non-oscillatory parameters of the basal blood fl ow: microcirculation (MC), mean squared deviation (MSD) and coeffi cient of variation (CV). Blood fl ow fl uctuations were measured in a wavelet analysis at different frequency bands: 0.0095–0.02, 0.02–0.046, 0.07–0.15, 0.15–0.4 and 0.8–0.16 Hz corresponding to endothelial (Ae), neurogenic (An), myogenic (Am), respiratory (Ar) and pulse (Ap) rhythm amplitudes, respectively.

Results. The new Rexod® injection preparation at a dose of 8000 U/kg after 15 min of intraperitoneal administration in rats caused a statistically signifi cant (p < 0.05) increase in the blood fl ow fl uctuation amplitudes Ae (43.1%), An (43.4%), Am (60.8%), Ar (58.3%) and Ap (32.0%) compared to the control group. Because the Ae fl uctuations coincide with nitric oxide (NO) emission episodes, such a growth indicates an elevated NO excretion by endothelial cells leading to endothelium-dependent vasodilation. The observed changes in blood microcirculation in skin are also associated with higher integral values of the basal blood fl ow, MC (33.4% increase), MSD (14.0%) and CV (27.6%), although only MC and CV values were statistically signifi cant (p < 0.05). The results obtained suggest that the new injection form of Rexod® stimulates endothelial NO excretion, exerts adrenergic relaxation in smooth muscle cells of arteriolae and arteriovenular anastomoses, reduces precapillary sphincter and arteriolar contractility through Ca²⁺-dependent muscle relaxation, affects respiratory modulation of the venular blood microcirculatory compartment and vegetative cardiac support, intensifi es arterial blood fl ow by increasing the cardiac output.

Conclusion. Application of the new Rexod® injection form improves blood microdynamics in rat skin via stimulating endothelium-dependent and independent vasodilatation and endothelial metabolism, decelerating adrenergic vasomotor activity and peripheral microvascular resistance. These processes in coupling improve blood fl ow to nutritive microvascular bed and normalise venular outfl ow. Our results provide further insights into pharmacodynamics of recombinant human SOD (Rexod).

Background. Uterine fi broids is a highly prevalent gynaecological disease affecting 30–35% of reproductive age women and twice as many beyond this age, according to various sources. Uterine fi broids are diagnosed in 25–27% of infertile women. According to the American Society of Reproductive Medicine, this disease causes infertility in 2–3% of the cases.

Objectives. A prognostic assessment of recovering fertility after treatment for uterine fi broids, outlining a comprehensive strategy for successful in vitro fertilisation after variant organ-preserving treatment for uterine fi broids.

Мethods. Publication records were mined in the PubMed, Elibrary, Web of science and Cyberleninca databases under the search depth of 7 years. The query terms were: uterine fi broids, in vitro fertilisation, myomectomy, uterine artery embolisation, myomectomy and pregnancy, uterine artery embolisation and pregnancy, uterine fi broids and in vitro fertilisation.

Results. We analysed 105 records and selected 32 for review. Many sources suggest that the putative pathogenetic mechanisms of a reduced in vitro fertilisation success in uterine fi broids comprise: abnormal circulation and receptor apparatus; abnormal uterine blood fl ow, venous stasis, vascular changes; local infl ammation; abnormal endometrial morphology, distortions of the uterine cavity with submucosal and large interstitial fi broids, continuity between endometrium and myometrium, subendometrial thickening; local nodal oestrogen/progesterone imbalance. Clinical data on the impact of uterine fi broids in assisted reproductive technology trials are multitude but ambiguous. Submucosal and intramural fi broids distorting the uterine cavity are commonly considered for resection due to their signifi cant negative impact on the pregnancy success rate with assisted reproductive strategies.

Conclusion. Uterine fi broids pose an acute persistent challenge in gynaecology and reproductive medicine aggravated by the lack of a unifi ed strategy for patient management and reproductive life planning. Various aspects of the uterine blood fl ow diagnosis, treatment for uterine fi broids, pregravid preparation, long-term management of in vitro fertilisation protocols and pregnancy in this pathology require further detailed studies.

Background. Provided stronger demands of people towards healthcare systems, changes in the legal framework and increasing competition, medical institutions are seeking new approaches and mechanisms for improving comfort of medical care services. Navigation support as part of the visualisation system in a medical unit should comply with certain standards of colour design and its comfortable presentation to patients.

Objectives. To formulate basic principles for effective colour navigation support in medical facilities using best national and foreign practices of colour design for navigation and visualisation solutions in healthcare.

Мethods. Relevant publications were mined in Scopus, Web of Science, MedLine, the Cochrane Library, Elibrary and PubMed. Search depth by time was limited to 10 years. Main keyword queries were «lean production» [«бережливое производство»], «lean healthcare» [«бережливое здравоохранение»], «lean medicine», «navigation» [«навигация»], «visualization» [«визуализация»], «бережливая поликлиника», «квалиметрия». The obtained data were interpreted using legal, historical, descriptive analytical methods, content analysis.

Results. Colour solutions in the Russian healthcare system are implemented in a variety of ways to support data visualisation. As part of a visual and tactile navigation system, the colour solutions serve to highlight individual navigation objects, pattern space, order and structure navigation elements, emphasise and manage relevant textual information. Incorrect colour navigation support can lead to wastes of lean principles in the main, auxiliary and maintenance processes in a medical facility. The Russian federal legislation does not currently regulate colour solutions for visualisation support in medical institutions.

Conclusion. Colour solutions being part of navigation support systems should be regulated by federal and regional legal acts to allow qualimetric assessment and improvement of navigation and visual systems in medical facilities. A high-quality design of navigation support requires detailed information about the managed institution.

Background. Severe combined trauma is a pressing issue in modern medicine. Victims with a severe combined trauma receive constant monitoring for the severity of their condition. There is no commonly adopted uniform model for assessing the severity of injuries.

Objectives. To review existing scoring methods for assessing the severity of combined craniofacial trauma.

Мethods. A search of Russian and foreign publications in the PubMed and Elibrary databases at the depth of 10 years was conducted. The query terms were: injury severity, trauma severity [тяжесть травм], trauma severity score [шкалы оценки тяжести травм], cranio-facial trauma severity [тяжесть черепно-лицевой травмы]. The record selection was based on its scientifi c value in this research topic.

Results. This systematic review covered 49 scientifi c papers reporting methods for assessing the severity of combined craniofacial trauma. Depending on the main applied principle, the severity scoring methods were classifi ed into 3 groups: anatomical, physiological and combined. Along with the history of creation, main advantages and disadvantages of the methods in terms of scoring performance in combined craniofacial trauma were outlined. Severity scoring models in isolated maxillofacial trauma were described in detail.

Conclusion. There is no generally accepted best clinical practice for trauma severity scoring, including craniofacial trauma. The majority of scoring models are developed for survival chance estimation. At the same time, dynamic monitoring in hospitals most commonly relies on non-specifi c methods for the general severity estimation in trauma victims.

Background. Oncological diseases are the major challenge in modern medicine. This is explained, on the one hand, by a growing number of such patients, changes in the morbidity structure, higher mortality rates and clinical complications. On the other hand, new diagnostic methods and improved therapeutic protocols appear that help save lives, health and fertility of patients. Breast cancer is the most prevailing cancer in reproductive age and pregnant young women, which identifi es its priority in oncology, obstetric gynaecology and reproductive medicine.

Objectives. Assessment of pregnancy likelihood, its course and outcome in women with breast cancer in history.

Мethods. Publication records were mined in Scopus, Web of Science, MedLine, Eliibrary and PubMed under the search depth of 10 years. The query terms were: breast cancer [рак молочной железы], infertility [бесплодие], pregnancy [беременность], preimplantation genetic diagnosis [предимплантационная генетическая диагностика]. Content analysis and descriptive analytics were employed as research tools.

Results. We analysed 94 records, mainly from Scopus, PubMed and Elibrary, and selected 38 publications presenting a structured content analysis of current standards in assessing the likelihood of pregnancy and labour in women with breast cancer in history. The pregnancy likelihood was found to depend on the course of cancer, treatment regimen, female age and basic ovarian reserve. Breast cancer in history was shown to likely incite various obstetric and perinatal complications. Pregnancy scheduling optimal in this female cohort, as well as current approaches to induced termination of pregnancy, have been described.

Conclusion. Pregnancy can be successful with malignant history, including breast cancer, provided an optimal choice of modern treatment settings for minimising the long-term risk of infertility, specialised medical counselling for effective egg and embryo preservation, full pregravid preparation and optimal post-treatment pregnancy scheduling. According to European and American research, no conclusive rationale exists for induced abortion in women having breast cancer during pregnancy or one year after delivery.

The online learning, which is now widely implemented owing to the constraints imposed by COVID-19 pandemic, offers many advantages when compared to the traditional teaching. The online teaching course is available to student any time and can be accessed from any location, providing there is a connection to the Internet, which allows remote learning at home using a fl exible and convenient study schedule that does not disturb other daily activities. The online course contains more informative learning materials, because the multimedia software enables to combine a variety of diverse elements within a given teaching unit, such as texts, PowerPoint presentations, computer animations, video clips, and audio fi les. The amount of time needed to go through the topics of the online course can be variable for different students, depending on their basic knowledge and motivation for learning, thus supporting more personalized learning experience. In contrast to the traditional teaching, that applies a teacher-centered approach, with online teaching the students become independent learners taking the main responsibility for the knowledge acquisition. Therefore, the students’ ability to succeed with online learning is critically determined by the self-discipline, rational time management skills, and monitoring the individual progress. While traditional teaching is largely based on passive learning through memorization of information by student, the online course offers multiple opportunities for self-directed, active learning, including questions for self-assessment, the web links to the relevant learning resources, and the interaction with peers using text messengers, discussion forums and web chats. The weak points of the online learning approach are that the self-studies are easy to procrastinate when the student is not strongly motivated to learn, and that it limits social contacts, leading to the feeling of isolation. Importantly, when developing the online learning course, the computer technology is supposed to be just a technical instrument, whereas the main emphasis is placed on the quality of teaching materials and their relevance to the objectives of the medical curriculum.

Background. ANCA-associated systemic vasculitis is a rare childhood disease. Antineutrophil cytoplasmic autoantibodies (ANCA)-related vasculitises include microscopic polyangiitis, granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis. Their rarity often leads to a late diagnosis, rapid disability and high mortality in patients due to aggressive respiratory, pulmonary lesion and renal failure.

Clinical Case Description. The patient suffered from a recurrent bronchoobstructive syndrome with signs of respiratory failure, obscure origin fever and chronic rhinitis with nasal bleeding for 6 months. The patient was diagnosed with obstructive bronchitis (putative bronchial asthma debut), received antibacterial therapy and inhalation bronchodilators without stable improvement during the entire period. Skin haemorrhages and arthralgia stimulated diagnostic research to establish ANCA-associated systemic vasculitis (presence of proteinase 3-specifi c ANCAs in titre 1/80). CT lung scanning revealed frosted glass foci of reduced pulmonary pneumatisation and signs of bilateral bronchoobstruction. Immunosuppressive therapy with glucocorticosteroids (methylprednisolone pulse therapy No. 3, 1000 mg intravenously on alternate days, subsequent per os administration of 1 mg/kg/day) and cyclophosphamide (500 mg intravenously once per 28 days) was prescribed. This led to the positive dynamics with eliminated fever and skin haemorrhages, as well as essentially reduced signs of respiratory failure.

Conclusion. Diagnosis of systemic vasculitis is often complicated and long-term due to commonly non-specifi c debut symptoms of autoimmune disorders. In the described case, the fi rst 6 months of illness displayed intoxication and bronchoobstruction with signs of respiratory failure. Haemorrhagic rashes, arthralgias and the presence of ANCAs are proxy to vasculitis. Standard immunosuppressive therapy for ANCA-associated vasculitis improved the patient’s condition.