Aim. To evaluate clinical significance of the N-terminal fragment of the brain natriuretic peptide precursor (NTproBNP) in hemorrhagic fever with renal syndrome (HFRS).Material and methods. The serum concentration of NTproBNP was evaluated in 48 patients with HFRS in the oliguric and polyuric period. The results obtained were analyzed in conjunction with traditional clinical and laboratory parameters, and echocardiographic data in the polyuric period of the disease.Results. The concentration of NTproBNP in the oliguric period was higher than in the polyuric period (635.3 [246.55;1189.0]pg/ml and 79.6[33.0;183.5] pg/ml, respectively, p˂0,001). The concentration of NTproBNP in healthy people of the control group was 20.09 [16.72;29.17] pg/ml, which was less than in patients with HFRS in the oliguric (p˂0,001) and polyuric (p˂0,001) periods. In the oliguric period, the concentration of NTproBNP in patients with severe HFRS was 910.0 [325.9;1375.0] pg/ml, with an average degree- 248.3[82.2;834.3] pg/ml (p=0.016). The concentration of NTproBNP correlated with daily diuresis (r=-0.411, p=0.004), systolic (r=-0.398, p=0.005) and diastolic (r=-0.352, p=0.014) blood pressure, proteinuria (r=0.353, p=0.014), creatinine (r=0.377, p=0.008) and urea (r=0.353, p=0.014) in the oliguric period; with the time of deceleration of early diastolic transmitral blood flow (r=-0.421, p=0.041), the average global peak longitudinal systolic strain of the left ventricle (r=-0.465, p=0.022), the Simpson left ventricular ejection fraction (r=-0.552, p=0.005) in the polyuric period.Conclusion. The oliguric period of HFRS is characterized by an increase in NTproBNP. In 66.67% of cases, type 3 renocardial syndrome developed a combination of acute kidney injury and acute heart failure.

Acute kidney injury (AKI) is one of the most frequent and complex categories of complications after radical cystectomy (RCE), ranging from 4.7 to 38.2%. Matrix metalloproteinase-9 (MMP-9) is one of the promising markers for the early diagnosis of AKI.Material and methods. The study included 186 patients with muscle-invasive bladder cancer (RMP) T2a-3aNoMo after RCE. Urine samples for measuring the concentration of MMP-9 were obtained in the postoperative period after 6, 12 and 24 hours, as well as 3, 7 and 30 days.Results. In the early postoperative period, there were slight changes in the concentration of MMP-9, and no significant differences were found between the groups with and without AKI. 3 days after cystectomy, there is an increase in the concentration of MMP-9 in the urine in the group with AKI by 4.5 times, the high level of the marker remains on the 7th and 30th days of observation, in the group without AKI, there are no changes in the indicator at the specified time. The area under the ROC curve for urinary MMP-9 after 3 days when predicting the development of chronic kidney disease (CKD) 6 months after cystectomy was 0.848 (threshold value of 146.31 ng/ml, sensitivity of 84.1% and specificity of 73.7%), after 7 days - 0.845 (threshold value of 113.70 ng/ml, sensitivity of 83.5% and specificity of 68.2%), after 30 days - 0.745 (threshold value of 96.17 ng/ml, sensitivity of 78.3% and specificity 62.4%).Conclusion. To predict the development of CKD in patients with oncourological profile after radical surgical treatment, in addition to the generally accepted diagnostic tools, it is recommended to use the marker of renal damage and extracellular matrix remodeling (ECM) - MMP-9.

Relevance. Surgical care for mechanical jaundice under conditions of liver damage is extremely risky and can lead to the death of the patient. Postoperative mortality in such patients can reach 5.6-6.3%. In this regard, it is necessary at the first stage of treatment to ensure adequate decompression of the bile ducts by surgical, endoscopic or antegrade percutaneous methods. Among the latter, percutaneous transhepatic X-ray endobiliary methods of treatment are widely used. These methods refer to minimally invasive surgery, which can significantly reduce the frequency of postoperative mortality.The aim of the study was to compare the results of X-ray endobiliary decompression of the biliary tract in mechanical jaundice, performed by the traditional interventional method and the new method developed by us.Material and methods. To prevent ascending cholangitis, we developed a method for external-internal drainage of the bile ducts in patients with mechanical jaundice caused by the proximal block of the bile ducts, without lowering the drainage into the duodenum. Decompression of the biliary tract was performed in 75 patients with mechanical jaundice. In 69 cases, the traditional interventional method was used. A new method was used to drain the bile ducts in 6 patients with a block of the proximal part of the bile ducts.Conclusions. The proposed method provides passage of bile into the duodenum without destroying the Oddi valve. The preserved sphincter of Oddi fully fulfills its function and prevents the spread of ascending infection, and as a result - helps to reduce the frequency of regurgitation cholangitis during external-internal drainage of the bile ducts.

Purpose: to study the biological age and the rate of aging, taking into account the nature of disorders in the biliary system and the duration of the disease.Material and methods. The main group is represented by the following subgroups: patients with biliary dysfunction - 52 people, patients with chronic non-calculous cholecystitis - 76 people and with cholelithiasis - 54 people. The control group consisted of 49healthy people with no biliary pathology. The biological age of the surveyed contingent was determined by the "outpatient" methodaccording to the method of V.P. Voitenko et al.Results and discussion. Significant changes according to the criteria of biological age were revealed in patients with biliary pathology, in whom the duration of the disease was ten years (11,19±1,04 years). The value of biological age in this group is higher than that of individuals from the control group by 4,62-0,7 U (p<0,001). It was revealed that the studied results of biological age are interconnected with disorders in the biliary system of the patient.Conclusions. The study of the criteria for the biological age and the rate of aging of patients with diseases of the biliary system showed a relationship with the duration of the disease and with the degree of damage in the biliary system of the patient.

The article presents a retrospective analysis of the course of pregnancy and perinatal outcomes in patients with meconium-stained liquor.Objective: to study the features of the course of pregnancy and perinatal outcomes with meconium-stained liquor.Material and methods. A retrospective analysis of 108 birth histories and prenatal records of women aged 18 to 38 was carried out. The subjects were divided according to the presence of meconium in the amniotic fluid into the main group with meconium amniotic liquor and the control group with light water, respectively. When analyzing the medical records, a large number of anamnestic, clinical, laboratory and instrumental factors were identified that were related to the formation of meconium amniotic fluid.Results and discussion. The study revealed that meconium staining of amniotic fluid can be a marker of intrauterine fetal hypoxia, indicating the increase in the proportion of children with a low Apgar score at birth, who, as a rule, need respiratory support.

Aim: to compare electroencephalogram (EEG) changes in the treatment of West syndrome (WS) with and without tetracosactide.Material and methods. In 150 patients with WS, EEG was evaluated before and 6 months after the start of treatment. Group I consisted of 90 children who received tetracosactide for the relief of infantile spasms, and group II included 60 children who were treated with any other antiepileptic drugs without the use of hormones. Indicators of the risk ratio were calculated using the RevMan5.3 program. Favorable treatment outcomes were considered: clinical remission-relief of seizures and the disappearance of hypsarrhythmia on the EEG.Results. After 6 months from the start of treatment, seizures in group I were arrested in 77%, and in group II - in 60%, p = 0.04.In group I, after 6 months from the start of treatment, changes in the EEG in the form of hypsarrhythmia remained in 3% of patients who had hypsarrhythmia before treatment, while in group II hypsarrhythmia persisted in 20%, p = 0.02.Conclusions. Treatment of WS with the inclusion of tetracosactide is more effective in reducing hypsarrhythmia and infantilespasms than therapy without it.

Aim: to reveal the dependence of the effectiveness of therapy for West syndrome (WS) with various antiepileptic drugs (AEDs)on the timing of treatment initiation and the age of onset of WS.Material and methods. 150 children with West syndrome treated at the Children's City Hospital No. 8 for the period 2000-2015 were examined. The children were divided into subgroups depending on the early or late start of treatment and the age of onset of the disease. Group I included 90 patients who received tetracosactide in combination with other PES, and group II was representedby 60 children who received other PES without the use of hormones. The risk ratios were calculated using Resman 5.3 to evaluatethe effectiveness (follow-up of patients for at least a year). A favorable outcome of treatment was considered clinical remission - the absence of seizures.Results. The efficacy of tetracosactide after 2 weeks, 2, 6 and 12 months in group I is the same regardless of the time of initia-tion of therapy (p> 0.05). A greater number of seizure-free children were found in group I, in whom WS began at the age of 6-12 months (p <0.05).Conclusions. The effectiveness of WS therapy with the inclusion of tetracosactide does not depend on the timing of the initia-tion of therapy and it is higher in the event of infantile spasms at the age of 6-12 months with short-term follow-up.

According to the IV universal definition of myocardial infarction (MI), it is currently recommended to distinguish between five types of disease, depending on the mechanism of development of the pathological process. Type 2 myocardial infarction (T2MI) often occurs due to a mismatch between oxygen delivery and consumption. Important criteria for BMI2 are high troponin levels, acute myocardial ischemia, and absence of complications in the form of fibrous plaques on the vessel wall.The aim was to determine meaningful diagnostic criteria for T2MI based on clinical and morphological comparisons. Material and methods. This work is based on a clinical and morphological study of 112 people with various forms of myocardial infarction at the age of 50-70 years od.Results. The main diseases with T2MI were diabetes mellitus, hypertension, cerebrovascular diseases, cancers, others less often. Basically, myocardial infarction was of a transmural nature. Subendocardial location of the infarction zone was often observed, which was more characteristic of T2MI. During the study, it was possible to establish the features of vacuolar degeneration of cardiomyocytes, which are mainly found in individuals with T2MI.Conclusion. With this type of myocardial infarction, the data of anamnesis, clinical and laboratory, functional, instrumental research methods, autopsy results largely indicate the feasibility of searching for the underlying disease. Subendocardial localization is more common in type II MI. Pathohistological examination often reveals vacuolar dystrophy and necrobiotic changes in cardiomyocytes near the necrosis zone, which is typical for this type of disease in conditions of organ hibernation.

The results of a prospective study of 40 patients aged 21 to 45 years old who underwent atraumatic tooth extraction followed by filling the socket with osteplastic xenogenic materials are presented in the article.The aim of the study was to assess the effectiveness of the use of domestic xenogeneic cancellous bone blocks for augmentation of the hole after surgerical removal of a tooth.Material and methods. Patients were divided into 2 groups depending on the material used. The first group consisted of 20 patients who were implanted with imported osteoplastic material « Bio-OSS Collagen «(Geistlich, Switzerland), patients of group 2 (20 patients) were implanted with domestic osteoplastic material - spongy bone blocks» Bio-Ost CUBE Collagen «(Cardioplant LLC, Russia).Results. It was found that the formation of bone tissue in the defect zone was faster and of higher quality in group I patients. The use of domestic osteoplastic material was accompanied by a lower rate of filling of the bone cavity but the dynamics of reparative osteogenesis and the resulting volume of newly formed bone indicate sufficient effectiveness of the clinical use of domestic osteoplastic material «Bio-ost CUBE Collagen» for further complex implantological treatment.Conclusion. The results of the study allow us to conclude that the domestic xenogenic osteoplastic material (spongy bone blocks «Bio-Ost CUBE Collagen») can serve as the biomaterial of choice for the augmentation of the hole after the tooth extraction.

The aim of this work is to study the reference and operational spatial memory of animals brood with experimental hypothyroidism and to evaluate the effectiveness of hypothyroidism correction with a new iodinesaccharide complex.The object of the study: two-month-old male rats - the offspring of rats with hypothyroidism (mercazolyl intragastrically 2.5 mg /100 g body weight for 21 days) (experimental group), some of which were on a general food ration for 30 days before mating (comparison group), and some on iodine-enriched - received iodine-saccharide complex iodosteviol glycoside rebaudioside A 2.5 μg iodine / 100 g body weight (main group). In blood plasma, the levels of thyroidstimulating hormone, total and free thyroxine, and total triiodothyronine were determined by enzyme immunoassay. To assess the spatial learning and memory of animals we used thetest «Eight-arm radial maze».The results of the studies showed that mercazolyl hypothyroidism in parents of experimental animals negatively affects the thyroid hormone genesis of the offspring, causes the development of impaired operative and long-term memory, significantly reducing the average score at the testing stages. In the offspring of rats that underwent a 30-day recovery period on general food, the level of thyrotropin in the blood plasma remained elevated, and the level of free thyroxine decreased, indicating the persistence of hypothyroidism. Keeping animals on an iodine-enriched diet promoted the restoration of the functional activity of the thyroid gland in the offspring and an improvement in the indices of reference and operational spatial memory.

The article is devoted to the determination of the content of vitamins, a trace element - iron, flavonoids in the raw materials of Gynostemma pentaphyllum, Carica papaya and the establishment of correlations between the indicators of two signs: the content of ascorbic acid and flavonoids, in terms of rutin.Material and methods. The objects of the study were the herb of gynostemma pentaphyllum and leaves of papaya, introduced on the territory of the South Ural Botanical Garden-Institute of the Ufa Federal Research Center of the Russian Academy of Sciences and on the basis of Limonaria, the educational and experimental farm of the Ufa Forestry Technical College. The mineral composition (iron content) was determined by X-ray fluorescence method, and vitamins, flavonoids, carotenoids - by the spectrophotometric method.Results. In the course of laboratory experiments in plant objects, their absorption spectra of ascorbic acid and rutin were studied,the content of which averaged 1350±1,27 mg/%, 1430±0,29 mg /% and 2100±0,23 mg/%, 3800±0,06 mg/%, respectively. Studies on the content of carotenoids have shown their insignificant content in the leaves of papaya and the herb of gynostemma pentaphyllum, since these morphological groups of raw materials are not concentrators of this pigment.Conclusion. A direct correlation was established between the accumulation of iron and the content of ascorbic acid in the samples under study. The data of an experimental study indicate the promising use of the herb gynostemma pentaphyllum and leaves of papaya as sources of biologically active substances.

The anti-inflammatory drug mesalazine is a leading pathogenetic agent for the conservative treatment of mild and moderate forms of inflammatory bowel diseases. With mesalazine therapy, remission is formed in 60-70% of patients with Crohn's disease. The use of 5-aminosalicylic acid derivatives reduces folate absorption and may lead to folic acid deficiency. The insufficient effectiveness of basic antiinflammatory therapy determines the relevance of the search for new drugs.The aim of the research was to develop the composition of a rectal suspension with two types of granules containing 5- aminosalicylic acid and folic acid.Material and methods. For the selection of excipients, we studied 18 different combinations of 5-aminosalicylic acid and folic acid with auxiliary substances. The method of wet granulation was used. The obtained granules were evaluated for their organoleptic properties, size, and disintegration.Results. During the experiment, the compositions of granules with 5-aminosalicylic and folic acids were optimized, an intestinalsoluble coating for granules was selected, and a dispersed medium for rectal suspension was selected.

Aim. To improve the results of the diagnosis of heart injuries by using diagnostic thoracoscopy.Material and methods. The analysis of diagnostic results of 133 patients admitted with stab wounds of the chest in the heart area from 1998 to 2019 was carried out.Results. The article presents an analysis of the results of diagnostic thoracoscopy in chest wounds with suspected heart damage.Taking into account the lack of clear criteria in the literature for the use of diagnostic thoracoscopy in patients with suspected heart injury, we propose an algorithm for diagnostic research in chest injury with suspected heart injury. Indications and contraindications are presented. If hemodynamics is unstable, patients, not entering the emergency department, are taken to the operating room, where, without performing primary surgical treatment and thoracoscopy, they underwent anti-shock therapy and thoracotomy. In the event that patients with a chest wound in the heart are admitted, and hemodynamics is stable or hemodynamic parameters are reduced, but not critically, it is possible to perform additional research methods, as well as diagnostic thoracoscopy, the refusal of which can be regarded as a diagnostic error.Conclusion. In order to reduce diagnostic errors in patients with chest injuries and suspected heart injury, we recommend using thoracoscopy. For more effective use of this method, a decision-making algorithm has been developed, which includes an assessment of the stability of hemodynamics. The use of this algorithm for chest injuries with suspected heart injury reduces the number of unjustified thoracotomies from 12,6 to 0,7%. At the same time, the diagnostic value of this method is 100%.

The paper describes clinical observation of a patient with a chemical burn of the large and small intestines with necrosis after faulty injection of ammonia into the rectum. Before the injury, the child suffered from arthrogryposis (damage to the lower extremi- ties), chronic constipation. On the second day, the child was operated on - resection of the large intestine, the formation of a colos- tomy. After 4 months the next operation was performed - reconstructive surgery on the large intestine, colostomy closure, lowering the colon to the perineum with the formation of an intestinal anastomosis according to Duhamel. The surgery led to recovery.

Damage of the small intestine by ionizing radiation during radiation therapy of oncogynecological pathology is quite common, it can develop in 16% of such patients. Radiationinduced inflammation leads to fibrosis of the intestinal wall and to the formation of scar stricture. The key to successful treatment of such patients is the earliest possible diagnosis of persistent narrowing of the lumen of the small bowel and the earliest possible operation. Unfortunately, nowadays, the diagnosis of small bowel strictures is a problem, due to the lack of available methods of instrumental diagnosis. There is also a complete lack of methods that can detect the degree of fibrosis in the stricture. The article presents two case reports of the diagnosis and surgical treatment of postradiation small bowel strictures that were formed by accidental damage during radiation therapy for cervical cancer in 2020. There is also a modern review of the literature devoted to the pathogenesis of the formation of narrowing of the intestinal lumen after exposure to ionizing radiation, the problem of diagnosis and treatment of this pathology.

Scientists are actively conducting research to find candidate genes that cause the predisposition to bronchial asthma, as well as affect the pathogenesis and course of the disease. It is possible that their identification and subsequent study will allow predicting the expected response to antiinflammatory therapy, as well as the course of pathology.Objective: to conduct analytical review of the data of domestic and foreign literature devoted to the study of genetic aspects ofbronchial asthma; to study the frequency of distribution of alleles and genotypes of polymorphic markers of genes of the highaffinity receptor for IgE - FceRI and discouraging receptor to IgE - FceRII (CD23), determining their impact on the effectiveness of antiinflammatory therapy and the course of bronchial asthma in children.Material and methods: analysis of foreign and domestic literature.Results and conclusions. The analysis of the review of the literature data on the study of genetic aspects of bronchial asthma in children, allowed us to reveal that most of the research in this area was conducted abroad, unfortunately, there is little information in the domestic literature, which requires further study of such a promising and relevant area of medicine.

Pain in the lower back and neck of a non-specific nature is the leading cause of temporary incapacity to work and disability, which has now acquired the character of a non-infectious epidemic. The effectiveness of treatment of musculoskeletal pain (MS) is largely determined by high-quality and timely diagnosis. Radiography and neuroimaging play a leading role in hardware differential diagnosis, which allows, in most cases, to determine the cause of pain, to determine the degree of dystrophic and biomechanical changes in the spine, the amount of extrusion, congenital anomalies, as well as the presence of osteoporosis. Ultrasound spondylography is also referred to as informative research methods, the main advantage of which is the ability to diagnose not only the joint and ligamentous apparatus, but also the muscular system, as well as to avoid X-ray radiation. Medical infrared imaging helps to reveal local microcirculation disorders, indicating an inflammatory or dystrophic process in the spine.The purpose of this study is to present hardware methods of spinal examination that allow us to identify prognostic and differential diagnostic criteria for MS, which largely determines not only the early detection of the disease, but also the effectiveness of restorative treatment and prevention.