Introduction. An important problem of modern obstetrics is the development and improvement of methods for predicting fetal growth retardation (FGR) and pregnancy outcomes in this pathology, since there are no proven effective treatments for FGR.
Purpose of the study — to develop prediction criteria for newborn hypotrophy and cumulative adverse perinatal outcome in pregnant women with FGR.
Objective. To identify key predictive factors for adverse perinatal outcomes in pregnancy complicated by FGR.
Material and methods. A case-control, cohort-based study was conducted that included 155 pregnant women with FGR, who were divided into two groups after delivery: Group 1 included 90 patients with neonatal hypotrophy and Group 2 included 65 patients without neonatal hypotrophy. A comprehensive analysis of clinical and anamnestic, laboratory and instrumental data, peculiarities of the course of pregnancy and perinatal outcomes was performed. FGR was determined on the basis of ultrasound fetometry.
Results. Factors associated with neonatal hypotrophy and unfavorable perinatal outcome were: impaired blood flow in the uterine arteries and/or umbilical artery, early preeclampsia and scarcity of water. Protective factors were antibacterial therapy for intrauterine infection, administration of low-molecular-weight heparin in the first trimester, and acetylsalicylic acid starting from the 12th to 16th weeks of gestation.
Conclusion. The most promising measures in the prevention of FGR and adverse perinatal outcomes in this pathology may be timely prescription of antithrombotic correction and treatment of genital infections.

Introduction. It is known that COVID-19 occurs more often in adult patients, especially if they have concomitant somatic diseases, children are at less risk of developing it.
The aim of this work is to evaluate and compare immune response parameters in new coronavirus infection COVID-19 in children and adults.
Materials and methods. The results of the examination of 56 adults 19-55 years old and 57 children 14-18 years old were included in the work. The examination results of COVID-19 patients were compared with similar data in practically healthy individuals of the corresponding age groups. All patients underwent laboratory tests to determine the following parameters: presence of SARS-CoV-2 RNA, general blood test parameters, major lymphocyte subpopulations, level of total immunoglobulins (IgM, IgG, IgA), number of CIC, absorbance and bactericidal activity of leukocytes.
Results. The proportion of positive findings for SARS-CoV-2 RNA in different age groups ranged from 13.6% to 25.8%. General and specific patterns of immune response in patients of different age groups were established. Common features were an increase in the number of circulating immune complexes and activated T-lymphocytes. Differences were noted in the level of serum immunoglobulins IgM and IgG, neutrophil uptake activity, the number of monocytes, as well as in the level of different subpopulations of lymphocytes.
Discussion. In adults, changes in the adaptive immune response, including the cellular level, are predominantly expressed. In children, there are signs of inefficiency of innate mechanisms of immune responses.
Conclusion. The dynamics of the number of examined and positive findings correlate with similar figures in Russia and have a two-wave pattern. Increased number of circulating immune complexes and activated T-lymphocytes is typical for all patients with new coronavirus infection COVID-19 regardless of age, which is a sign of acute infection-inflammatory process development and insufficiently effective elimination of antigen (pathogen).

Introduction. The aim of the study was to evaluate the effect of hybrid organotin compounds bis(3,5–di–tert–butyl–4–hydroxyphenylthiolate) dimethylol (Me3) and ((3,5–di–tert–butyl–4–hydroxyphenylthiolate) triphenylolol (Me5) on the level of markers of oxidative stress and apoptotic processes in the mitochondria during acute and subchronic intragastric administration to Wistar rats (females) in the maximum tolerated dose.
Materials and methods. The objects of study were hybrid organotin compounds, the administration was carried out at the maximum tolerated dose of 2000 mg/kg (Me3) and 750 mg/kg (Me5) with a single and multiple intragastric administration. The study was conducted on 60 Wistar rats (females) weighing 190-210g. The concentration of cytochrome C (ng / g protein), caspase-9(ng / g protein), 8-hydroxy-2' — deoxyguanosine (8-OHdG) (ng/g protein), malondialdehyde (MDA) (nM / g protein)was determined in mitochondrial liver samples using test systems by enzyme immunoassay; by the biochemical method-the amount of protein (mg / ml) — by the biuretic method.
Results. Me3 in both series of the experiment showed itself as a more pronounced antioxidant than Me5, which did not show its antioxidant properties. In group I animals, there were no statistically significant differences in the level of MDA and Cit C in relation to the control group, no mitDNA damage was detected, but K9 activity increased by 17%. With the introduction of Me5, the value of the MDA indicator increased by 55.5%, 8 — OHdG by 12.4% and Cit C by 66.2%. In group IV, the amount of MDA as the final product of lipid peroxidation (POL) increased by 13.6%, in group V by 22.5%. With the introduction of Me3, the level of Cit C was reduced by 23.5%, with the introduction of Me5, on the contrary, it was slightly increased. K9 activity was reduced in both experimental groups, by 9.6% and 17.3%, respectively.
Discussion. Hybrid OOS containing a fragment of 2,6-di-tert-butylphenol have a dual structure. The tin-containing component is prooxidant, and the radical of the spatially hindered phenol, on the contrary, is antioxidant. It is the different ratio of the described fragments in the molecules of the substances under study, in our opinion, that led to the appearance of different degrees of influence on the metabolism of mitochondria.
Conclusion. Both substances that modulate changes in oxidative stress and the activity of apoptotic processes are recommended for further research as antitumor medicinal agents.

Introduction. The viral antigenic load can influence the nature of the infectious response, leading to elimination of the virus or to chronicity of the process, and in some cases to the progressive course of the disease. The aim of the study was to investigate the relationship between the types of viral load of human papillomavirus and the age of a patient with cervical cervical intraepithelial neoplasia grade I.
Material and methods. 86 patients with cervical papillomavirus-induced cervical intraepithelial neoplasia grade I by liquid oncocytology were examined. The frequency of human papillomavirus genotypes of high carcinogenic risk in this group of women was analyzed taking into account the viral load by polymerase chain reaction with real-time hybridization-fluorescence detection. The correlation between the viral load of the human papillomavirus and the age of the patient with further prediction of the regression or progression of cervical pathology was studied.
Results. This study found that female patients under 30 years of age with cervical intraepithelial neoplasia grade I associated with papillomavirus infection showed a decrease in viral load after 12 months of follow-up in 30.2%, and in patients with cervical intraepithelial neoplasia grade I of older age — in 9.3%.
Discussion. The management tactics for grade I cervical intraepithelial neoplasia associated with papillomavirus infection depends largely on the age of the patients and the degree of viral load. In young patients with immediate reproductive plans, a wait-and-see approach with dynamic observation for 12 months without drug therapy is possible in view of the probable spontaneous elimination of the human papillomavirus within a year. The results of the study suggest a higher rate of human papillomavirus elimination in cervical intraepithelial neoplasia grade I in women under 30 years of age.
Conclusion. In cervical intraepithelial neoplasia of degree I in women under 40, infection with several types of the human papilloma virus (16, 18, 31, 51) with a clinically significant viral load (over 4.69±0.07 HPV per 100,000 cells) was found most frequently. In the group of the older reproductive age (40-49 years old), HPV HCC is less frequent in 6.90%. And the predominant role belongs to type 16, which was spread in 69.7% of cases.

Introduction. Lymphadenectomy in gynecological oncology allows performing adequate surgical staging, determining the need for adjuvant therapy, and reducing the risk of disease recurrence. An increase in the volume of lymphadenectomy leads to an increase in the incidence of postoperative complications — the formation of lymphatic cysts. There are no clear recommendations on the required number of removed lymph nodes in order to identify their metastatic lesions.
The aim of the study was to study the possible dependence of the number of removed lymph nodes and the formation of lymphatic cysts.
Materials and methods. A retrospective study of 219 patients after surgical treatment from 2020 to 2021 was carried out on the basis of GBUZ Chelyabinsk Regional Center of Oncology and Nuclear Medicine. The study included cases of stage I-IV uterine cancer of all histological types, which underwent radical hysterectomy with bilateral pelvic or bilateral pelvic and paraaortic lymphadenectomy; cases of cervical cancer stage IA1-IIA disease after radical hysterectomy II-III type according to the classification of M.S. Piver, F. Rutledge (1974) with performing bilateral pelvic lymphadectomy. Statistical processing of the results was carried out.
Results. The percentage of complications (lymphatic cysts) in the cervical cancer group was 2.06% (N = 2), in the uterine body cancer group 1.72 (N = 2). There was no statistically significant relationship between the removed lymph nodes and their metastatic lesions. Removing more than 27 lymph nodes is a risk factor for developing lymphatic cysts.
Discussion. Lymphadenectomy allows for adequate surgical staging and reduces the risk of disease recurrence. Complicated lymphatic cysts occur in 0.9-34% of cases, which was reflected in our study, but the percentage of these complications is quite low.
Conclusion. The increase in the volume of lymphadenectomy (removal of more lymph nodes) is justified by the desire for accuracy in the surgical staging of the tumor process. Despite this, there is a risk of complications after lymphadenectomy — the formation of lymphatic cysts that occurs when 27 or more lymph nodes are removed.

Introduction. Dynamic monitoring and evaluation of the results of therapy of patients with malignant brain diseases is a complex and urgent problem in modern medicine.
The aim of the study was to assess the reliability of the transcranial magnetic stimulation technique as a tool for neurophysiological monitoring in patients with malignant brain tumors.
Material and methods. Two groups of patients were formed: adults with large focal solitary lesions of the central nervous system (glioma) (n=20), who underwent radiotherapy, and a control comparison group (n=16). All patients underwent diagnostic transcranial magnetic stimulation before and after treatment.
Results. In the main group the application of transcranial magnetic stimulation in dynamics allowed to reveal reliable improvement of conduction along the central motor pathways (increase in amplitude of the evoked motor response). The obtained data of neurophysiological examination correlated with clinical improvement in the patient group.
Discussion. Some parameters of the motor evoked response (MEP) changed reliably, as after the radiation treatment performed. Obtained changes (amplitude of MEP and, especially, its threshold) to the greatest extent reflect functional state of cortical motoneurons, as well as their anatomical preservation in case of organic changes. Before therapy in all cases there was a reliable tendency to a smaller amplitude and a higher threshold of cortical MEPs, which reflects a decrease in the functional activity of motor cortex neurons; a slower central motor conduction time also draws attention. These changes had a universal character and were registered in all patients.
Conclusion. Diagnostic transcranial magnetic stimulation, taking into account age limitations inherent to it as a technique, is a valuable additional neurophysiological technique. It is safe, inexpensive and does not require expensive consumables, and is applicable to a wide range of diseases.

Introduction. Currently, surgical treatment of lung cancer is impossible without the use of tracheobronchoplastic operations, which in advanced specialized clinics take up to 5-10% of all radical operations.
Material and methods. We conducted a retrospective study including 21 patients with centrally located lung cancer who underwent 22 tracheobronchoplastic radical operations between 2000 and 2021. The operated patients included 18 men and 3 women aged 42 to 67 years (mean age 54.5 ± 12.5 years). The morphological structure of the tumors was represented by carcinoid (2) and squamous cell carcinoma (19). The pathological process was located in the right lung in 16 patients and in the left lung — in five patients. Comorbid status was present in 20 patients. Standard lateral thoracotomy was used in 18 cases, and video-assisted minithoracotomy — in three cases. Extended lymphodissection up to D2 was performed in all surgeries. Combined surgeries included resection of adjacent organs: pericardium (2), unpaired vein (2), superior vena cava (1), diaphragmatic and vagus nerves (1), pleura (1).
Results. The average duration of operations was 242.3 minutes (125-345 minutes), the average blood loss was 283.2 ml (50–1000 ml). Complications developed in 5 (22.7%) patients. Mortality was observed in 2 (9.1%) cases.
Conclusion. The use of tracheobronchoplastic operations significantly expands the possibilities of thoracic surgery in treatment of lung cancer both due to technical resectability of the tumor at the transition to the main bronchus and trachea and due to functional operability at low respiratory functions and impossibility to perform pneumonectomy.

The purpose of the study was to assess the dependence of development of enteral nutrition intolerance on the disease form and condition severity during early AP with severe progression predictors.
Materials and Methods. An open randomized controlled study has been carried out. The study included 64 patients, 31 of them having a severe and 33 — moderately severe forms of the disease. The criteria of enteral nutrition intolerance were: discharge via the nasogastric tube > 500ml simultaneously or > 500 ml/day, compared to the amount fed enterally over 24hrs; aggravation of pain; abdominal distension, diarrhea, nausea and vomiting. Indices possessing a predictive value were identified with the help of logit regression. The null hypothesis was rejected at p<0.05.
Results. The APACHE-II score (OR — 1.134, 95% CI: 1.068-1.2, p=0.01) and CPR concentration (OR — 1.006, 95% CI: 1.005-1.013, p=0.001) affect independently the development of a large gastric residual volume. The fact of surgery predicts large gastric residual volumes (OR — 1.821, 95% CI: 2.529-9.19, p=0.001), nausea and vomiting (OR — 2.077, 95% CI: 1.075-4.012, p=0.021). The SOFA score is associated with large gastric residual volumes (OR — 1.349, 95% CI: 1.18-1.539, p= 0.001), pain (OR — 1.203, 95% CI: 1.065-1.364, p= 0.003), nausea and vomiting (OR — 1.167, 95% CI: 1.028-1.324, p= 0.018). The moderately severe form is accompanied with a lower incidence of large gastric residual volumes (OR — 0.354, 95% CI: 0.201-0.611, p=0.001), pain (OR — 0.475, 95% CI: 0.284-0.795, p=0.004), nausea and vomiting (OR — 0.519, 95% CI: 0.304-0.888, p=0.018), and abdominal distension (OR — 0.342, 95% CI: 0.193-0.607, p=0.001).
Conclusions. The development and severity of early enteral nutrition intolerance during early acute pancreatitis with severe progression predictors depend on the severity of condition (APACHE-II), extent of multiple organ dysfunction (SOFA), the fact of surgery, form of the disease, and C-reactive protein concentration. A combined use of independent factors increases their predictive value.

Introduction. Currently, visualization is recognized as one of the main criteria for the quality of space of the new model of a medical organization providing primary health care. Purpose of the study to establish the features of architectural and planning solutions for visualization systems of medical organizations providing primary health care.
Materials and methods. The object of the study was the visualization systems of 94 medical organizations from seven constituent entities of the Russian Federation, in which all available internal and external visual elements were studied in person. As a basis for assessing visualization systems, the author's checklist was taken according to the ALIDS method of 50 indicators, united by common characteristics in five blocks: architectural planning and design solutions, transmitted information, levels and methods of visualization. The block «Architectural and planning solutions» was represented by 10 parameters. A nominal dichotomous score was assigned for each criterion.
Results. The general architectural and planning solutions of visualization systems of medical organizations providing primary health care are at a satisfactory level (6,3±1,8 points). The greatest correspondence among the architectural and planning solutions of visualization systems of medical organizations was found in the characteristics of safety (93%), cleanliness (88%) and ergonomics of the location (79%) of elements, the least — in the presence of general infographic schemes (9%) and routing (3%). The level of architectural and planning solutions for visualization systems of medical organizations correlates with the complexity of the architectural plan of buildings (r=–0,423; p<0,05) and the patients' assessment of the comfort of the conditions for providing services (r=0,345; p<0,01).
Discussion. Improving visualization systems by improving the architectural and planning solutions of elements can lead to a significant reduction in the main and additional types of losses in lean production both on the part of patients and on the part of medical personnel.
Conclusion. One of the main problems of organizing visualization systems in medical organizations is the lack of common maps with buildings, signs of entrances and other objects of the adjacent territory. The absence of a positioning sign on most schemes leads to a longer orientation in space, and in the case of placing the elements of the visualization system at the decision-making points, the intersection of patient flows and an increase in the risk of security breaches.

Introduction. At present, in most regions of the Russian Federation there is a shortage of medical personnel in the public health system. The issue is particularly acute in medical organizations providing primary health care, as well as in municipal districts remote from the regional center.
The purpose of the paper is to examine the professional expectations and intentions of medical university students.
Materials and methods. The method of questioning was applied in the study. Questionnaires were taken by 296 students of the fifth year of the specialties «Medicine» and «Pediatrics», studying on the budget and commercial forms of education.
Results. Only 22% of respondents considered primary care as a place of work. Large cities are chosen for work by 90% of respondents, and 42% of them would like to leave their home region and find a job in economically more attractive regions. Only 6% of respondents are ready to go to the countryside, and 4% of respondents are interested in ambulance service. Approximately evenly distributed were opinions on work in public and private health care system, respectively, 54% and 56% of respondents. At the stage of graduation, 16.6% of the students were disappointed in their chosen profession, another 22.3% found it difficult to answer, and 5.7% do not plan to stay in healthcare after graduation.
Discussion. The main reasons for this situation are salaries that do not meet the needs of graduates, especially at the start of their professional career, the social unsettlement of young doctors, mainly in small towns and rural areas, and insufficient practical training.
Conclusion. The solution to the problem lies in the sphere of socio-economic provision of living conditions and stimulation of quality training of specialists, taking into account professional orientation.

Introduction. In recent years, the use of oral anticoagulants for the prevention of ischemic strokes (IS) in patients with atrial fibrillation (AF), as well as the prevention of deep vein thrombosis and thromboembolism has been increasing in clinical practice. According to epidemiological studies, ischemic strokes account for about 85% of all AMI. Cardioembolic strokes (CES), which develop due to embolism to the cerebral vessels from the heart chambers, deserve special attention. The presence of AF is associated with a twofold increase in the risk of death from cardiovascular disease and death from any cause. Timely anticoagulant therapy can reduce the risk of thromboembolic complications and improve the prognosis.
Materials and Methods. The authors present a clinical observation in which a 47-year-old female patient diagnosed with venous insufficiency, who took dabigatran 150 mg twice a day for a year, developed IS with left-sided pronounced hemiparesis. After 170 minutes from the development of the stroke, idarucizumab was administered to neutralize the anticoagulant effect of dabigatran and thrombolytic therapy (TLT) was performed.
Results. Twenty-four hours after TLT, the National Institutes of Health Stroke Scale (NIHSS) score decreased from 16 to 6. A repeat CT scan of the brain revealed a focus of ischemia in the right frontal, parietal, and temporal lobes. On the 19th day of the AI, dabigatran 150 mg 2 times a day was resumed.
Conclusion. The presented observation confirms that in patients with AI developed against the background of dabigatran, the administration of idarucizumab is safe and allows for TLT.

Introduction. Immunotherapy of malignant neoplasms is a dynamically developing field. Diagnostic possibilities in determining the biomarkers of the tumor response to immunotherapy are discussed. The search for new diagnostic «points» of response is being conducted on the basis of detailed studies of carcinogenesis and cellular biological processes in tumor and unchanged tissues.
The aim of this work is to highlight one of the promising points of influence of immunotherapy of malignant tumors of various localizations at the present stage (the PD1/PD-L1 signaling pathway), taking into account the available possibilities of application in practice in the Russian Federation. The analysis of the published activity on immunotherapy with immune checkpoint inhibitors in various malignant tumors was carried out. The search for information research sources was conducted in the open systems E-Library, National Library of Medicine (Pubmed), Cochrane Library for the last 10 years. The article analyzes the progress and prospects in the immunotherapy of malignant tumors of various localizations, including the experience of using the PD-1 inhibitor pembrolizumab in the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine. Information on the use of key diagnostic biomarkers for the prognosis and evaluation of the tumor response to this therapy option is highlighted. The prognostic and diagnostic significance of biomarkers already implemented in practice (PD-L1, MSI) is discussed in the scientific press. Successful immunotherapy has been described in the treatment of uterine body cancer, colon cancer, and colorectal cancer. At the same time, the results of the study of the effectiveness of immunotherapy in uveal melanoma are debatable.
Conclusion. The effect on the PD1/PD-L1 signaling pathway with the use of immune checkpoint inhibitors (pembrolizumab, atezolizumab, etc.) is one of the promising directions in the treatment of ZNO of various localizations. The determination of a number of biomarkers by immunohistochemical method, by PCR (PD-L1 receptor, MSI) allows us to identify those cases of ZNO, immunotherapy of which can give a positive effect. New approaches are being sought to influence the signaling pathways of immune control points through the development of new combined drugs. And research is also continuing to determine the predictivity of already used biomarkers of the response to immunotherapy.

Introduction. In recent years, there has been evidence not only of the widespread prevalence of the obstructive sleep apnea (OSA) in the population, but also of the progression of the disease in the dynamic follow-up of patients.
The purpose of this review article is to analyze the current state of etiopathogenesis, clinics of obstructive sleep apnea and to identify more promising treatment approaches and risk factors for its development.
Materials and methods. The analysis of publications was performed for the period 2016-2021 on the basis of data from Elibrary, the Federal Electronic Medical Library of the Ministry of Health of the Russian Federation, the bibliographic database of medical publications MEDLINE, created by the US National Library of Medicine. Sixty-one sources were selected for the review.
Results and discussion. Obstructive sleep apnea is widely represented in the group of sleep disorders and is correlated with a number of clinical conditions: cardiovascular diseases (acute cerebrovascular disease, resistant arterial hypertension, coronary heart disease, heart rhythm disorder), endocrine system (diabetes mellitus, hypothyroidism, metabolic syndrome, obesity), ophthalmological pathology (neurooptikopathies), sudden death, etc. Severe daytime sleepiness due to OSA is not only a medical but also a social problem due to increased injury rates, accidents at work and on the road, and decreased labor productivity.
Conclusion. The introduction of a comprehensive interdisciplinary approach to diagnostic standards will improve the detection and treatment of obstructive sleep apnea and improve the quality of life of patients. Change of lifestyle and use of PAP-therapy in patients with OSA is currently the most adequate direction in the treatment of this pathology. High prevalence, serious consequences for the nation's health and economy dictate the need for further study of markers of this disease for early prediction and primary prevention of cardiovascular diseases and diseases associated with obstructive sleep apnea.

Introduction. The prevalence of cerebral vascular diseases is steadily increasing worldwide. Cerebral stroke represents the most serious of them, being one of the leading causes of mortality and disability of the population. Reduction of morbidity and mortality from stroke can be achieved by improving preventive measures aimed at the correction of risk factors. The review presents domestic and foreign literature data on the risk factors of ischemic stroke and the system of primary prevention of acute ischemic brain lesions.
Materials and methods. Data from eLibrary, MedLine, Scopus, Springerlink, and the scientific electronic library «Cyberleninka» were analyzed.
Results and Discussion. The authors give an overview of pathological conditions that can lead to the development of cerebral vascular accident. Methods of primary prevention of ischemic stroke are considered in accordance with the European guidelines on stroke management. Current views on the correction of modifiable risk factors (arterial hypertension, diabetes mellitus, hyperlipidemia, heart and vascular pathology, etc.) are presented. Recommendations on lifestyle and body weight reduction are given. In addition to the well-known information, the authors present the data of new studies on the role of vitamin D in the ischemic cascade and consider the possible pathogenetic mechanisms of this effect. The review also provides information on the association of vitamin D deficiency with other pathological conditions that are the causes of ischemic stroke and the effect of vitamin D on the volume of ischemic lesions, the severity of the outcome and the risks of repeated vascular accidents.
Conclusion. The study of risk factors for ischemic stroke and the development of primary prevention methods is one of the priority areas of modern neurology, since it will improve the system of care for patients with cerebrovascular disease.