A comparative analysis of dental status in individuals engaged in endurance training in active and inactive form has been carried out. We examined 230 male patients aged 25 to 35 years old, 106 of them were engaged in endurance sports. Data from the survey, examination, results of additional research methods and index evaluation of periodontal tissues were recorded. To measure anxiety we used Spilberger-Hanin’s scale, reactive anxiety of the examined patients was considered in the evaluation of the obtained data.As a result of the study, increased anxiety was detected in 32% of the surveyed people who are engaged in endurance sports in an active form. Patients with high moderate reactive and personal anxiety involved in endurance sports in an active form, had significantly higher prevalence of carious and non-carious lesions of hard tissues of teeth: 35.3% of cases showed increased abrasion of teeth, 41.2% - sensitive dentin, 32.3% - wedge-shaped defects, 44.1% - chipped enamel of the teeth. Patients who are engaged in endurance sports in an active form and are in a state of psychoemotional stress had an average value of the CFE index of 15.5±0.8, compared to 5.8±0.5 in patients of the control group.

The group of defects that create increased load on the left ventricle includes stenosis of the left ventricle (LV), valvular and supravalvular aortic stenosis, coarctation of the aorta. Such defects require surgical treatment.Objective is to evaluate the results of surgical treatment of patients with combined obstruction of outflow ways from LV and to optimize the tactics of treatment.Material and methods. From 2012 to 2018 we operated 9 children with multilevel stenosis of the outflow pathways of the leftventricle in age from 3 days to 2.5 years old. In 4 cases coarctation of the aorta with subaortic stenosis was diagnosed, in 4 cases - coarctation of the aorta with valvular aortic stenosis, in one child - valvular and supravalvular aortic stenosis. Patients underwent stage-by-stage correction of defects according to their hemodynamic significance.Results. In 8 cases, the primary elimination of the leading hemodynamically significant stenosis led to a decrease in pressure gradient at this level. In patients who underwent removal of distal narrowing without proximal correction, pressure gradient at the proximal level significantly increased from 28.8 to 35 mm Hg. There was one fatal outcome in the newborn after resection of aortic coarctation with plasty of aortic arch and closure of ventricular septal defect.Summary. 1. Assessment of hemodynamic significance of stenosis at the proximal level with multilevel obstruction of the ways of outflow from LV cannot be made by simple summation of pressure gradient at the proximal and distal levels. 2. We consider pressure gradient at the proximal level of the stenosis ≥30 mm Hg to be hemodynamically significant and requireing simultaneous correction. 3. The use of intraoperative EchoCG may be useful to assess the severity of the proximal obstruction. 4. Surgical intervention for coarctation of the aorta should be performed from the median sternotomy access in case of doubtful hemodynamic insignificance of proximal stenosis.

The aim of the work is to study the clinical state of the lungs and heart in patients with hemorrhagic fever with renal syndrome(HFRS) and to compare it with the data of pathomorphological studies of those who died from HFRS. Material and methods. The study involved clinical examination of 220 patients with HFRS (physical, laboratory, serological methods, pulse oximetry, electrocardiography, chest x-ray), determination of troponin I in 24 patients in dynamics and analysis of19 pathological conclusions of those who died from HFRS . Results. The main clinical and diagnostic and pathomorphological characteristics of lung and heart lesions in HFRS depending on the form of the disease were revealed: cough, shortness of breath, pulmonary infiltration, pleural effusion, acute respiratory distress syndrome, interstitial and alveolar edema, dystelectases of the lung parenchyma, hyaline membranes in the lumen of the alveo-li; signs of overload of the right heart, violations of repolarization on ECG, in isolated cases - increase in troponin I, granular dys-trophy of cardiomyocytes, small foci of myocardial necrosis, myocarditis.Conclusion. The study established the dependence of lung and heart lesions on the form of the disease, their clinical and morphological characteristics.

The purpose of the work is to determine the changes of homocysteine blood level in patients with HFRS of varying severity in the dynamics of the disease in order to evaluate the necessity of homocysteine correcting treatment. Material and methods. 93 male patients with HFRS of various severity (aged 18-50) were observed. To reduce the blood level of homocysteine, the composition of vitamins «Angiovit®» was used.Results. The study showed that in HFRS of various severity (moderate, severe and severe with complications) the blood homocysteine level significantly increased with the peak observed in oliguric period. The strong correlations between blood levels of homocysteine and thrombomodulin, homocysteine and cystatin C were found. The used vitamin composition reduced the level of homocysteine in the blood and duration of oliguria. Conclusion. Increased homocysteine level in patients with HFRS, depending on the severity and period of the disease, was revealed. The prognostic significance of homocysteine as an early marker of endothelial dysfunction and acute kidney injury in HFRS was established. The use of vitamin composition «Angiovit®» in combination with standard therapy for HFRS can reduce the duration and degree of oliguria.

Objective: to evaluate the influence of strontium ranelate on bone mineral density (BMD) of the lumbar spine and femoral neck in men with bronchial asthma (BA) in combination with osteoporosis (OP).Material and methods: the study was performed in 2016-2017. 39 men aged 51 to 70 were included in an open controlled non-randomized prospective observational one-year study. The main group consisted of 27 male patients with bronchial asthma combined with osteoporosis; the control group consisted of 12 almost healthy men.Results. The average age of patients with BA in combination with OP was 64.6±1.2; the duration of BA was 20.1±9.8 years. Pa-tients with BA in combination with OP received basic therapy of BA, strontium ranelate, calcium and vitamin D. 12 months of treatment showed a significant increase in BMD in the lumbar spine by 6.6% and femoral neck by 1.9%. During the follow-up, the number of patients with back pain decreased from 57 to 35%, which is probably due to increased daily activity and exercise therapy, since the examined patients did not use non-steroidal anti-inflammatory drugs. So, 55.56% of men rated daily activity as excellent or good after six months of treatment, and after a year - 66.67% of patients.

Immunotherapy of hepatocellular carcinoma (HCC) is a promising trend in oncology. HCC takes up to 85% of all liver tumors. Sorafenib therapy is a standard treatment for HCC. This article analyzes the results of treatment of the study group who received immunotherapy with durbalumab (26,6%) and its combination with trelimumumab (26,6%). The control group included patients who received sorafenib 800 mg per day (46,6%). On the basis of on Republican Clinical Oncological Centre 15 patients with confirmed progression of hepatocellular cancer took part in the study. The main point of including patients in the study is the immunohistochemical conclusion on the presence of VEGF, PDGF and CTLA4 receptors in tumor samples. We evaluated the overall survival, progression-free survival. The average life expectancy was 4.5 months. Progression-free survival was observed in 4 patients (26,6%), 1 patient is currently actively receiving therapy.Immunotherapy allows for increased progression-free survival, but does not increase overall survival. Standard therapy with sorafenib shows the best results for metastatic HCC therapy.

The herb of melilotus officinalis has a rich set of biologically active substances with a variety of pharmacological action. Meli- lotus officinalis is widely used in folk and official medicine only in the form of infusions and decoctions, and is also a part of various teas. This work is devoted to the study of the melilotus officinalis herb, oil extract and ointment obtained on its basis. In the course of experimental studies by pressing with pre extraction of soybean oil oil extract of melilot was obtained; the optimal composition was developed and the rational technology of semisolid dosage form - ointment based on it was proposed. A «cross - cutting» standardization in the series «medicinal plant raw materials - intermediate product-dosage form» was carried out. The data obtained as a result of the experiment indicate the feasibility of heat treatment in the preparation of oil extract of melilotus officinalis, increasing the content of the main active substances in the finished product. The content of carotenoids in the proposed ointment was 3,88 % with a relative error of ± 1,87 % (spectrophotometric method). It is proved that the ointment has sufficient osmotic activity, absorbing almost twice the amount of water with little noticeable change in consistency; satisfactory spreading ability; good bioadhesion.

The article presents a case of tick-borne encephalitis (TBE) with the development of acute disseminated encephalomyelitis (ADEM). The development of ADEM in a patient is indicated by a characteristics of neurological symptoms (ascending CNS lesion), the presence of characteristic changes in neuroimaging (multiple foci in the subcortical structures of the brain), as well as rapid positive clinical and morphological dynamics of the disease in response to treatment with glucocorticoids.

The article presents a rare case of a combination of skin manifestations of erythema exsudativum multiforme with acute submandibular lymphadenitis and epididymitis.The aim of the work is to inform specialists about a possible triad of symptoms with erythema exudativum multiforme.To date, the etiology of erythema exudativum multiforme has not been established, the disease, which was described by the Austrian dermatologist Ferdinand von Gebra in 1860. This disease is considered to be polygenic and to have multifactorial reasons for its development.In the available literature there is no description of the combination of skin manifestations of erythema exsudativum multiformewith acute submandibular lymphadenitis and epididymitis. Perhaps this is due to the fact that the patient usually does not want to make public information of an intimate nature.Erythema exudativum multiforme is diagnosed only by clinical signs (pathognomic lesions in the form of targets, morphological elements on mucous membranes) and, according to the authors, does not need to be confirmed by additional research methods. The study of gender revealed the prevalence of men.The nosotropic therapy allowed to stop the inflammatory process with the elimination of skin elements.

The review article presents literature data showing the prevalence of pulmonary embolism in different countries of the world - Europe, the USA, Russia, Africa, and Asia. This problem is considered to be rather urgent for many years. It is associated with an increase in the number of venous thromboembolism around the world, the lack of accurate epidemiological data even in developed countries and no analysis of risk factors in different regions. The paper reveals main risk factors for venous thromboembolism, the structure of morbidity and mortality depending on age in obstetric, surgical and clinical practice. In the analysis of risk factors, somatic diseases leading to pulmonary embolism, mutations of genetic thrombophilia, and other features predisposing to venous thromboembolism are considered in more detail.

Obstetric hemorrhage is one of the leading causes of maternal mortality (MМ), with more than 2/3 of obstetric hemorrhage being postpartum hemorrhage (PPH). PPH is a blood loss of more than 500 ml after vaginal delivery or more than 1000 ml after operative delivery. It is known that the risk of PPH increases significantly during operative delivery. According to the existing clinical recommendations of the Russian Federation (2018), the main etiopathogenetic mechanism of PPH is «4T» causes: tonus (in 90% of cases), trauma (7%), tissue and thrombus (3%). Hypo-and atony of the uterus occupy a leading place in the proportion of the PPH, and they are caused by such risk factors as: irrational use of oxytocics, tocolytics, NSAIDs and others. Today medical history, physical examination, laboratory diagnostics and instrumental diagnostics are recommended for the diagnosis of PPH. Despite all theМедицинский вестник Башкортостана. Том 14, № 6 (84), 201954provided technologies, there is no decrease in the number of PPH, and in the Russian Federation obstetric hemorrhage takes occurs in more than 20% of cases in the structure of MM.

Lung cancer is the most common disease among cancer pathology. According to statistics, every year more than 2 million of new cases are registered around the world, of which about 60 000 in Russia. There is also a tendency of growth of the disease. According to various sources, approximately 85% of all lung cancers are non-small cell carcinomas (NSCLC). Tactics of its treatment and prognosis, in relation to the quality of life of the patient, depends on the accuracy and time (on the early stages) of detection of the disease. Radiation research methods are important in the diagnosis and staging of lung cancer. The treatment standards for NSCLC patients are based on the 1998 meta-analyses, which do not take into account the possibilities of modern radiotherapy, therefore, there is a need to reconsider the existing treatment standards, as mentioned in many articles by various authors.The development of clinical radiology is progressing rapidly. Every year the technology and efficiency of radiotherapy is improved, the total radiation load on the body is reduced. This, in turn, improves the quality of postoperative local control and increases overall and relapse-free survival. This review presents the most promising trends in NSCLC therapy.

The article provides an overview of recent studies on acute kidney injury (AKI) after surgical treatment of various diseases. The data on epidemiology, risk factors, and mechanisms of development of postoperative AKI are presented. The paper reveals problems of timely diagnosis and treatment of renal damage taking into account the early reversible and delayed persistent negative consequences of AKI.

Introduction: Adipose tissue stem cells (ASCs) are being actively used in regenerative medicine, as well as in autologous adipose tissue transplant operations. However, at the present stage, ASCs are of great interest, since there has been revealed mutual interaction between the progression of the tumor, its stromal microenvironment and highly differentiated mesenchymal stem cells are found.The aim of the work is to study literature data on the effect of the tumor microenvironment on ASCs, new cancer therapy methods based on the use of ASCs and to determine the safety of stem cells.Material and methods: We analyzed scientific literature by studying 60 articles over the past 5 years on the investigation of stem mesenchymal cells using the following foreign sources: MEDLINE, Ovid Medline, Web of Science Core Collection, Scopus.Results and discussion: At the moment, the possibility to stimulate tumor progression by stem cells of adipose tissue has not been proven by clinical studies. Nevertheless, some preclinical in vitro and in vivo studies have shown that ASCs can act as a potential tumoractivator and can support tumor growth and can invade surrounding tissues due to activation of some intracellular signals. The moststudied mechanisms for realizing the pro-oncogenic potential of ASCs are the interaction of ASCs with the microenvironment of the tumor and remodeling of the extracellular matrix, exosomal release of pro-oncogenic factors, and the induction of epithelial-mesenchymal transformations. However, it is worth noting that ASCs also demonstrated the ability to quickly find cancer cells in the body, which makes them a suitable «carrier» for the delivery of antitumor drugs. With the help of nanotechnology, new methods of antitumor therapy appear, which consist in the release of intracellular nanoparticles from ASCs, which can more effectively destroy tumor cells by accumulating high local concentrations of pharmacological drugs, minimizing systemic side effects of drugs.Conclusion: Further study of the interactions between ASCs and a tumor microenvironment is required. The study of possible therapeutic approaches in antitumor treatment based on the use of ASCs is also of great importance.

The article is devoted to the modern understanding of the pathogenesis, clinical picture and treatment of onychomycosis in patients with impaired glucose tolerance. According to the literature, onychomycosis is very common in the world, and its treatment is very long and not always effective, especially when combined with a violation of carbohydrate metabolism. To date, a thorough study of the etiological structure of fungi involved in the development of diseases of the nail plates in patients with impaired glucose tolerance is required for further development of complex therapy.

The article presents the results of the analysis of the physical and economic availability of drugs used for dyspepsia, which is one of the priority indicators characterizing the adequate functioning of the country's drug supply system. The key 8 drugs included in the 2018 edition of the List of Essential Medicines of the Kyrgyz Republic, the prices of drugs used for dyspepsia syndrome according to the price lists of retail pharmacy institutions and data of the National Statistical Committee of the Kyrgyz Republic on the wages of the population were taken as objects of study.As a result of the study, it was found that in the Bishkek, Talas, Jalal-Abad and Batken regions, the physical availability of 8monitored drugs was 100%. Analysis of drugs used for peptic ulcer in accordance with the guidelines approved by the Ministry of Health of the Kyrgyz Republic «Clinical Guidelines for the diagnosis and treatment of uncomplicated peptic ulcer in the active phase at the primary level of health care in the Kyrgyz Republic» showed that a 30-day course of therapy with proton pump inhibitors under the trade names Nolpaza, Omez, Stamik, Pantap and Ulsepan, which have high turnover ratios, cost significantly more than the minimum daily wage and are economical inaccessible. And only the use of Nolpase is affordable for patients in relation to the average daily wage.