Objective. To present the results of surgical treatment of patients with multifocal atherosclerosis based on a differential approach of surgical strategy.

Materials and methods. During the period of 2014–2021 in the S.G. Sukhanov Federal Center for Cardiovascular Surgery, Perm, we operated 243 patients with combined atherosclerosis of coronary and carotid arteries; 104 (42.8 %) patients underwent a one-stage coronary and carotid artery surgeries, and 139 (57.2 %) patients underwent a staged correction of pathology. Critical lesion of the coronary arteries was revealed in 16 (6.6 %) patients, single-vessel critical lesion – in 24 (9.9 %), two-vessel and three-vessel critical lesion was detected in 87 (35.8 %) and 79 (32.5 %) patients, respectively. 145 (59.7 %) patients had a critical lesion of the carotid arteries, and 16 (6.58 %) had a bilateral critical lesion. We have developed an algorithm for choosing treatment tactics in patients with concomitant atherosclerotic lesions of the coronary and carotid arteries. Depending on our differential approach, we selected 104 (42.8 %) patients who underwent a one-stage surgery, and 139 (42.8 %) patients who were subjected to a staged treatment.

Results. A total hospital mortality was 0 %. In the staged group, 1 case of transitory ischemic attack (TIA) (0.7 %) was recorded, in the group of combined interventions there was no TIA. In the group of combined interventions, there were 3 (2.9 %) cases of the perioperative stroke and 1 (0.9 %) case of myocardial infarction. In the group that underwent staged interventions, there were 2 (1.4 %) cases of perioperative stroke and 2 (1.4 %) cases of myocardial infarction. Both groups had similar combined results (death, acute MI, stroke) – 5 (3.6 %) for the staged group and 4 (3.8 %) for the combined one. There was no significant difference in any of the endpoints.

Conclusions. The proposed approach to the choice of techniques for treatment of combined lesions of the carotid and coronary arteries based on the differential approach is safe and permits to adequately eliminate the lesions.

Today, cesarean scar pregnancy is a rare type of ectopic pregnancy (1:1800–1: 2200). Moreover, the mortality rate in cesarean scar pregnancy is 191.2 per 100 000 cases, that 12 times exceeds the mortality rate in tubal pregnancy. In this article, we present a clinical observation of a rare case of cesarean scar pregnancy, as diagnosed by ultrasonography, in a 23-year-old patient after the cesarean surgery. The diagnosis was based on clinical, biochemical and ultrasound studies. Ultrasound played a crucial role in the determination of the fetus localization. Pathological pregnancy was eliminated by means of excision of the “old scar” and restoration of the uterine wall integrity. Such cases are becoming more common in connection with the increase in the frequency of caesarean sections, the improvement of technology, continuing medical education and professional development in the field of ultrasound. Knowledge of differential diagnosis can save the patient's life since the outcomes of cesarean scar pregnancy include severe complications with a possible loss of patients’ fertile function and immediate risk of death.

The article is devoted to the outstanding surgeon, MD, PhD, Professor, Head of the Department of Normal, Topographic and Clinical Anatomy, an excellent lecturer, scientists and teacher Vladimir Nikolaevich Perepelitsyn. He is always in our hearts.

The Severe Acute Respiratory Syndrome caused by Coronavirus-2 (SARS-CoV-2) has a destructive impact on the population all over the world. In this scenario, the extent, to which the disease will affect more vulnerable individuals, such as pregnant women, is a major concern. Since pregnancy can be a risk factor for respiratory viral infections, there are significant differences regarding the severity of COVID-19 between pregnant and non-pregnant women. In these circumstances, there arises a serious problem associated with the possibility of harm to the health and neuropsychiatric development of the posterity of infected mothers. The acute inflammatory response observed during the disease can lead to several types of nervous system disorders in the newborn. In the light of neuroimmune interactions on the mother-fetus hematoplacental relationship, a clinical case is described that reflects the consequences for the nervous and psychoneurological development of the newborn from SARS-CoV-2 infected mother.

The article describes the clinical observation of a patient operated on for obstructive jaundice with the localization of a stone in the lobar and common hepatic ducts. In anamnesis, there was cholecystectomy for acute cholecystitis 10 years ago.

Objective. To assess the levels of viral load, immune status as well as labor outcome depending on the absence or presence of pregravid preparation with the partner and without the latter.

Materials and methods. This cohort study included 90 women of reproductive age with stages 3 and 4A HIV infection. To compare the groups, Kruskal – Wallis, Mann – Whitney tests and correlation analysis were applied.

Results. The pregravid preparation of HIV-infected women without a partner was detected to three-fold decrease a viral load in the I trimester of pregnancy (p = 0.001), two-fold – in the II trimester (p = 0.02) and three-fold – in the III trimester (p = 0.002); with a partner – a two-fold decrease in the I trimester (p = 0.0018). The pregravid preparation of HIV-infected women reduces the probability of giving birth to a child with low body mass (p = 0.023); with a partner – it decreases the risk for the preterm labor (p = 0.02).

Conclusions. Thus, the presence of pregravid preparation in HIV-infected women, with a partner as well, decreases the probability of giving birth to a child with low body mass and preterm labor.

Objective. To determine the blood serum β₂-microglobulin and α₂-macroglobulin concentration in patients undergoing renal replacement therapy (programmed hemodialysis) for the diagnosis of uremic pancreatitis and / or destructive pancreatitis.

Materials and methods. The study involved 52 patients admitted to the Surgical Unit of Astrakhan "RZhD-Medicine" Hospital and City Clinical Hospital № 3. The blood serum β₂-microglobulin and α₂-macroglobulin concentration was analyzed in patients admitted on an emergency basis with suspicion of uremic pancreatitis and destructive pancreatitis, who receive renal replacement therapy (programmed hemodialysis). The control group included 50 outpatients undergoing renal replacement therapy (programmed hemodialysis). The study did not include patients with suspected pancreatitis who were not receiving renal replacement therapy. The period of the study is 2019–2021.

Results. The concentration of blood serum β₂-microglobulin is statistically higher than normal in all patients, who had received renal replacement therapy (programmed hemodialysis) in anamnesis. The most statistically high concentration of β₂-microglobulin was revealed while studying patients with uremic pancreatitis (n = 34), and was (30.0 ± 2.75 mg/l) compared with the blood serum concentration in patients with destructive pancreatitis (8 ± 0.51 mg / l). The concentration of α₂-macroglobulin was statistically lower in destructive pancreatitis (n = 18) and was 615 ± 161 mg/l compared with uremic pancreatitis (980 ± 216 mg/l). In the control group of outpatients (n = 50) receiving renal replacement therapy (programmed hemodialysis), no statistically significant blood serum concentrations of β₂-microglobulin and α₂-macroglobulin were found.

Conclusions. A clear dependence of the concentration of β₂-microglobulin and α₂-macroglobulin on the severity of uremic pancreatitis and destructive pancreatitis was established. Statistically high values of β₂-microglobulin concentrations were obtained in patients with uremic pancreatitis, and the α₂-macroglobulin level was statistically low in destructive pancreatitis.

This literature review is devoted to one of the topical multidisciplinary problems of modern clinical practice – the development of acute kidney injury after cardiac surgery. The prevalence of this pathology varies on average from 5 to 43 %, while the frequency of early hospital mortality increases significantly in the population of such patients compared with patients without cardiac surgery-associated renal damage. It is assumed that the work of the artificial circulatory system contributes to the development of such complications, but as shown by many studies, the etiology of such kidney damage is multifactorial and cannot be explained by only one pathogenetic mechanism. The article highlights the current understanding of the etiology, pathogenesis and risk factors of acute kidney injury after cardiovascular interventions, describes new markers of early detection of renal dysfunction, and describes some prognostic aspects of the disease. Early identification and stratification of risk groups will allow for a timely preventive strategy, which will significantly improve early and long-term postoperative outcomes in such patients.

The literature data indicate that the impaired expression of some types of metalloproteinases can result from different causes, both endogenous and exogenous. A modern notion of the role of matrix metalloproteinases in the processes of placental angiogenesis is analyzed. There was used literature research method according to the database PubMed for 1994–2021. The study of the activity and function of metalloproteinases in various gestational complications associated with the formation of primary placental insufficiency could have helped to search the diagnostic markers of these disorders.

Objective. To study the effect of galanin on the severity of tremor in Parkinson's disease.

Materials and methods. A comprehensive examination of 73 patients with Parkinson's disease and 16 apparently healthy individuals (control group) was carried out. We used the clinical-anamnestic method, the Hen-Yar scale of movement disorders in Parkinson's disease (PD), the MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Serum galanin content was determined by enzyme immunoassay. Serum galanin was determined by enzyme-linked immunosorbent assay using an ELISA Kit for Galanin (USA). Statistical processing of the material was carried out using the Statistica 10.0 program.

Results. Tremor is one of the main complaints of PD patients. In the main group, the average severity of the disease, subjective and objective manifestations of movement disorders were determined. In patients with PD, a decrease in the quantitative content of blood serum galanin (6.0 [4.3; 10.2] ng / ml) was determined in comparison with the control group (16.9 [9.8; 18.1] ng/ml, p = 0.001). A negative correlation dependence of the galanin content with motor manifestations was revealed in the first (R = –0.8; p = 0, 0001) and second (R = –0.53; p = 0.000002) parts of the MDS-UPDRS, as well as with the severity of resting tremor in the hand (R = –0.81; p = 0.000000) and leg (R = –0.76; p = 0.000001). The dependence of serum galanin on the form of the disease was not obtained in the study.

Conclusions. In Parkinson's disease, there is a decrease in the quantitative content of the neuropeptide galanin in the blood serum, which is negatively associated with motor manifestations of the disease and is associated with the severity of parkinsonian tremor.

This review analyzes the 20-year application of psychophysical training in pediatrics. The mechanisms of its positive influence on the functional state of the body in children and adolescents are revealed. The role of this health-strengthening technology in the process of pre-school training of graduates of kindergarten preparatory groups and in the adaptation of first-graders to school educational environment is highlighted. The effectiveness of psychophysical training in vegetative dystonia syndrome, postural disorders, arterial hypertension, overweight and tobacco smoking in children and adolescents is analyzed.

Objective. To assess the use, safety and effectiveness of puncture-dilatational tracheostomy (PDT) performed immediately after the tracheal intubation in patients with cerebrovascular accident (CVA) and new coronavirus infection (NCI).

Materials and methods. Patients with CVA and NCI treated at ICU underwent PDT using the Ultraperc kit according to the Ciaglia technique immediately after the tracheal intubation.

Results. The results of treatment of 12 patients with CVA and 21 patients with NCI were investigated, the safety of manipulation, treatment results, and mortality in groups were evaluated.

Conclusions. The puncture-dilatational tracheostomy, performed as early as possible, allows improving disease outcomes in CVA, facilitating patients’ care, and ensuring greater safety of patients and staff.

Objective. To assess the epidemiological manifestations of the incidence of respiratory system diseases (RSD) among the military personnel of the military units of the Central Military Region.

Materials and methods. The morbidity analysis was carried out according to official statistics for 2003–2019 with an assessment of long-term dynamics, structure and spatial characteristics.

Results. Despite the preventive measures taken, the incidence of respiratory diseases in the troops remains high and continues to grow. The conscript servicemen are at risk. In the structure of RSD incidence, acute respiratory viral infections (ARVI) take the leading place, tonsillitis and bronchitis are in the second place, and community-acquired pneumonia (CAP) is in the third place. Differences in the trends of long-term dynamics of morbidity in various clinical forms of RSD were revealed. The Siberian Federal Region is the most favorable regarding RSD incidence.

Conclusions. The incidence of respiratory diseases among conscripts is higher than that in contract servicemen, with downward trend for CAP and growth for ARVI and bronchitis.

Objective. To study and analyze the contamination of environmental objects in the Astrakhan Region (by the example of soil, water, and washout samples from solid household surfaces) based on the results of laboratory studies of the Center for Hygiene and Epidemiology in the Astrakhan Region for 2011–2020.

Materials and methods. The work was carried out on the basis of the Laboratory of Bacteriological and Parasitological Research of the Center for Hygiene and Epidemiology in the Astrakhan Region and in the laboratories of the Branches of the Center for Hygiene and Epidemiology in the Astrakhan Region in 2011–2020.

As a whole, during the analyzed period, the laboratory and its branches conducted laboratory studies of 79 742 samples taken from various environmental objects, and 94 495 studies were performed. The number of samples that do not meet the hygiene standards was 1.01 % (806 samples).

Results. The objects of sampling for the study of their parasitic purity were water, soil and wash-out from solid household surfaces.

The share of water samples in the structure of all the studied samples taken from environmental objects was 7.3 % (5858 samples), of which 172 samples were contaminated with pathogens of parasitic diseases, the extent of invasion was 2.9 %.

The structure of positive findings in the water samples was represented by 6 nosological forms of helminths – 88.0 % (154 samples) and 3 nosoforms of protozoa – 12.0 %.

The share of the studied soil samples in the overall structure of sanitary and parasitological studies of the environment was 11.2 % (8895 samples). The number of unsatisfactory samples in the structure of all positive findings revealed during the study of soil, water and washouts during the analyzed period was 70.4 % (625 samples). The total soil contamination for the period of 2011–2020 was 7.0 % (625 samples).

In most cases, helminth eggs and larvae were detected – 99.8 % (624 samples). The proportion of pathogenic protozoan cysts detected in the soil was 0.2 % (1 sample).

In addition to water and soil samples, the washout samples, taken from solid household surfaces were studied – 81.5 % (64989 samples), of which 0.01 % (9 samples) were unsatisfactory.

All positive findings in the washout samples were represented by two nosological forms of helminthiasis: Enterobius vermicularis eggs – 0.012 % (8 samples) and teniid oncospheres – 0.002 (1 sample).

Conclusions. The presence of helminth eggs and cysts of pathogenic intestinal protozoa in the studied soil and water samples indicates contamination of these objects with the feces of infected persons and/or contamination by sewage runoff resulting from various accidents. The presence of toxocara eggs and strongylid larvae in the soil and water indicates contamination of these objects with the feces of infected animals (dogs, cats). The presence of positive findings in wastewater samples indicates poor-quality disinfection of these objects. The presence of contact helminth eggs in the studied samples of washout samples taken from hard surfaces indicates direct contact of infected persons with these samples.