Introduction. The etiology of malignant neoplasms (MN) of the hepatobiliary system is multifarious, so when assessing the impact of ionizing radiation on the occurrence of tumors of this localization, non-radiation factors should be considered. The aim of the study was to describe cases of hepatobiliary system disease in the cohort of employees hired at the main plants of FSUE Mayak Production Association (PA «Mayak») in 1948-1982, who were exposed to occupational chronic radiation. Materials and Methods. The cohort under study included 22,377 persons (25% were women). The frequency of individual risk factors was compared among morphologically confirmed cases of hepatobiliary cancer and among workers who had not been ill with tumors of the indicated localization. Results. Up to December 31, 2018, the cohort had 59 cases of liver MCC (59% hepatocellular carcinoma, 17% cholangiocarcinoma, 25% hemangiosarcoma, and 2% anaplastic cancer) and 34 cases of gallbladder and biliary tract MCC (100% adenocarcinoma). The incidence of chronic diseases of gallbladder and biliary tract, cholelithiasis was statistically significantly higher among cases of hepatobiliary MNS in comparison with uninfected workers. In addition, there was a higher share of persons who had contact with harmful industrial factors before employment at PA «Mayak», as well as those with chronic liver diseases, excessive body weight and obesity among liver cancer patients. Doses of occupational exposure were highest in workers with liver hemangiosarcomas. Discussion. The data were obtained testifying to a possible role of non-radiation factors and ionizing radiation in the development of hepatobiliary cancer in the workers of the cohort under study. A peculiarity of the cohort is a high proportion of hemangiosarcomas in the structure of hepatic cancer. Conclusion. The non-radiational factors that, along with occupational exposure, could influence the incidence of hepatobiliary cancer among PA «Mayak» workers have been singled out. An analysis of risk caused by radiation and non-radiation factors is required to clarify the results of the study.

Introduction. Climacteric syndrome (CS) significantly reduces the quality of life (QOL) of peri— and postmenopausal women. Along with sex steroid deficiency in KS, there is a change in the synthesis of the epiphysis hormone melatonin (MT), which leads to the formation of perimenopausal melatonin deficiency syndrome (SPDM) (Patent 2019118500/14(035525) of 16.05.2020). The aim of the work was to evaluate clinical efficacy and QOL dynamics in women against the background of personalized treatment of CS in combination with SPDM. Methods and Materials. The study included 163 women. Groups 1, 2, 3 and 4 consisted of patients with CF and SPDM, control group 5 consisted of women with a normal course of the menopausal period and the absence of clinical manifestations of MT deficiency. After collecting medical history, determining the degree of CS severity with the help of the modified menopausal index (MMI) (H. Kuppermanetal. 1959, modified by E.V. Uvarova 1983), CS was assessed by the SF-36 general questionnaire and special women's health questionnaire (WHQ). The presence of MT deficiency was determined by the MT deficiency test-questionnaire and the WHQ scales. According to the «Stratification Algorithm for Women in the Menopausal Transition and Postmenopause with CS in Combination with SPDM for Selecting Differentiated Therapy» that we developed, Group 1 patients received MT monotherapy, Group 2 — synthetic gynestein, Group 3 — menopausal hormone therapy in combination with MT, and Group 4 — synthetic gynestein with MT for 5-6 months. The data were statistically processed using SPSSv13.0 software. The χ² criterion was determined at baseline and the Wilcoxon test was used for dynamic follow-up. Results. Patients in groups 1, 2, 3, and 4 experienced relief of both the clinical manifestations of    CS and SPDM and an increase in the physical and psychological components of QOL according to the SF-36 general questionnaire and the vast majority of the scales of the special WHQ questionnaire. Discussion. We hypothesized that the lack of complete efficacy of CS therapy in peri— and postmenopausal women is associated with the absence of a differentiated approach based on the active detection of SPDM. In the course of the study, it was proved that individual selection of CS therapy taking into account the presence of MT synthesis deficiency allows to achieve a 100% positive result of treatment in women of all four groups. Conclusions. Against the background of personalized treatment of CS in combination with SPDM in women, not only CS has been stopped, but also the level of QOL has been increased.

Introduction. Despite the annual increase in infectious pathologies, including trichomoniasis, there is still insufficient study of the key processes of their development and progression, as well as the complexity of diagnosis and treatment. The aim of the study was to evaluate the role of the cellular and humoral component of the immune system in trichomonad infection against the background of metronidazole administration. Materials and methods. One hundred patients with trichomoniasis who received metranidazole for seven days were examined. Patients in the first group (n=50) received 500 mg twice daily. Patients in the second group (n=50) received 2 g once daily. Clinical and laboratory methods were used in the study. Results and discussion. It was found that early term trichomonad infection caused by T. Vaginalis, is accompanied by pronounced changes in the structure of the immune system in the form of activation of both cellular (reliable increase in CD3+, CD4+, CD8+), and humoral (reliable increase in phagocytic activity of neutrophils, inhibition — IgG and IgA, activation of IgE) immune links. The above changes were associated with the applied metranidazole regimen. It was found that the administration of this drug by 500 mg orally twice a day was more effective than by 2 g once a day. It was found that the imbalance of the immune system in the first group was reversible, the studied parameters approached the norm on the seventh day, and in the second group — persistent (most parameters exceeded the reference level at the end stage). Conclusion. The body's immune cascade, consisting of cellular and humoral components, in patients with trichomonad infection should be considered as an object for further scientific search for effective ways to manage it.

Introduction. Living in urban and rural areas can affect the risk of developing and the course of alcohol dependence and comorbid conditions. The aim of the work was to evaluate the degree of depressive symptoms and socio-demographic characteristics of patients with alcoholism in the Republic of Dagestan, depending on the territorial features of residence. Materials and methods. The study involved 104 patients aged 51.2±9.9 years (27 to 74 years), registered in the State Budgetary Institution «Republican narcological dispensary» of the Republic of Dagestan with a diagnosis of alcohol dependence. The patients were divided into 2 groups depending on the territorial features of their residence: 62 (59.6%) patients residing in urban areas and 42 (40.4%) residing in rural areas. In order to evaluate socio-demographic characteristics all patients were questioned. The degree of severity of depressive symptoms was assessed with the Beck scale. Results. Analysis of alcohol dependence characteristics revealed no differences between the groups (p>0.05). The degree of depression was found to be more pronounced in patients living in rural areas than in those living in urban areas: mild depression was 7.3% and 29.0% (p<0.05), moderate depression was 9.8% and 1.6% (p<0.05), and severe depression was 39.0% and 25.8% (p<0.05), respectively. The severity of depression correlated with  the presence of work in patients (r=0.324; p<0.001). Discussion. Alcohol consumption leads to a more severe manifestation of depression, contributing to physiological changes in the body. Conversely, depressed people are more prone to uncontrolled alcohol consumption, which in their subjective opinion alleviates psychosocial suffering. The connection between alcohol abuse and depressive symptoms is bidirectional, meaning that both of these disorders influence the development and course of the other and simultaneously exacerbate the risk of developing the other disorder. Conclusions. Alcohol-dependent individuals living in rural areas of the Republic of Dagestan are characterized by unemployment that correlates with anxiety-depressive symptoms, as well as a more severe degree of depression severity.

Introduction. The leading localizations of malignant neoplasms in terms of detection frequency in Russia are breast cancer (BC) and uterine cancer by women (RTM) — 51.8 and 18.3%, accordingly, by men — lung cancer (RL) and prostate cancer (PC) — 47.4 and 41.4%, respectively. Study objective was the identification of the main reasons of the high level of neglect of cancer of the leading localizations among residents of rural municipalities of the Chelyabinsk region. Material and methods. The study was carried out on the general population of people living in 5 rural municipal districts of the Chelyabinsk region, included by the Ministry of Health of the region in the Magnitogorsk oncological cluster, with malignant neoplasms of the mammary gland and the body of the uterus, lung and prostate gland (total 1696 observation units). Results. During medical examinations in basic rural municipal areas, the detection of breast cancer and RTM  is in the range from 0.1  to 0.3 cases and 0.04 to 0.1 cases per 100 examined women, prostate cancer — 0.04-0.1 per 100 examined men. In medical examination suits, the detection is even lower — from 0.005 to 0.03 cases and 0.007 to 0.02 cases per 100 women and 0.01 to 0.05 cases per 100 men. The levels of cancer detection in rural areas are substantially lower than similar indicators among the urban population. Only when RL is detected, medical examinations of the rural population do not lag behind the indicators of the townspeople in their effectiveness. Discussion. The oncological epidemiological situation in municipal areas of the Magnitogorsk oncological cluster can be characterized as extremely unsatisfactory, due to a lower level of registered morbidity than in the city and to the low efficiency of active methods for detecting cancer. Conclusion. The lower incidence of malignant neoplasms in rural areas compared to urban indicators is due to the low efficiency of active methods for detecting neoplasms. The main way to identify malignant neoplasms of the leading localizations, with the exception of individual years of follow-up, is the independent appeal of rural patients to an oncologist, which causes a high level of neglect.

Introduction. One of the pressing issues in public health today is the fight against the COVID-19 pandemic, including vaccine prophylaxis, its  possibilities,  necessity  and  safety.  Proper  professional  advocacy  plays  an important role in the success of the vaccination campaign. Medical school students are also part of the professional community, who are as close as possible to the population and can be a source of information    for them to influence their decisions about whether or not to vaccinate. The aim of the work was to study  the attitudes of medical university students, as carriers of special information, toward vaccination against COVID-19. Materials and methods. A questionnaire survey was administered to 151 medical university students from Chelyabinsk and Ekaterinburg, mainly from the 4th to 6th years of medical, pediatric, and preventive medicine faculties. Results. Many of the trainees participating in the study are familiar with the new coronavirus infection (have themselves had an infection, are involved in providing medical care to patients with the new coronavirus infection), and more than 80% have been vaccinated against COVID-19. 63.0% of unvaccinated respondents do not plan to vaccinate in the near future, half of them due to uncertainty about the effectiveness of the vaccine. 44.9% of all respondents were not afraid of adverse effects of vaccination, and a large proportion (55.1%) expected reactions and even complications after vaccinated against COVID-19. They consider vaccination to be effective against COVID-19 47.5%, and 52.5% of those surveyed are not sure about vaccination effectiveness. Discussion. The effectiveness of vaccination for airborne infections is determined by the one-step coverage of a large (at least 70.0%) portion of the population. Most of the students surveyed intend to recommend vaccination against COVID-19 (almost 63%); however, 37.1% are not yet ready to do so. The motivations for their own vaccination are equally understanding of its necessity and fear of administrative restrictions. The study participants form their judgments about the problem under study mainly on the basis of popular publications and mass media appearances, which is confirmed by their low appeal to official statistics and special sources. Conclusion. To date, medical university students have not had a pronounced interest in learning about the new coronavirus infection, so the educational process under the COVID-19 pandemic needs to pay special attention to the problem under discussion.

Introduction. Vitamin D supplementation has been globally reported to be of paramount importance in treating and preventing a wide range of comorbid diseases in postmenopausal women but population-based screening for 25(OH)D levels is not currently part of recommendations. The aim of the study was to assess the low doses cholecalciferol supplementation impact on the 25 (OH) D status, clinical and functional status and comorbidity in late postmenopausal residents of Ekaterinburg. Material and methods. During the period from October 2018 to March 2020, 145 independently living postmenopausal residents of Ekaterinburg were enrolled in a cross-sectional study. Two groups were identified: 32 persons of Group 1 reported taking 400-2000 IU per day cholecalciferol during at least 6 months (n = 32) before enrollement and 113 women of Group 2 reported no previous cholecalciferol supplementation. Serum 25(OH)VitD level was assessed by the ECLIA method. Known comorbid conditions were registered. Modified menopausal index (MMI), HADS anxiety and depression scales, short form for quality of life evaluation (SF36), Mini-Mental State Examination (MMSE), hand dynamometry, 6-minute walk test, standing up test and tandem test were performed. Results. Supplementation of 400 to 2000 IU of cholecalciferol during at least 6 months was associated with significantly higher serum 25(OH)D level (p <0.00001, Mann-Whitney test), but in 46.7% of cases (p <0.001; χ² = 31.49). Carbohydrate metabolism disorders were significantly less frequent in Group 1 (p = 0.038, χ² = 6.548). In this setting, there were no associations of cholecalciferol supplementation with cognitive function, the severity of menopausal disorders, anxiety and depression, and the quality of life in late postmenopausal patients. Discussion. In general, the results obtained are consistent with the data of previous studies in postmenopausal women, but cannot be extrapolated to the general population. Conclusion. 400 to 2000 IU per day cholecalciferol supplementation for 6 months did not ensure adequate serum vitamin D level in 46.7% late postmenopausal women but was associated with significantly higher serum vitamin D level than in a comparison group.

Introduction. The COVID-19 pandemic has made adjustments to the health care system. Among other things, it has led to shortened hospital stays. In the surgical treatment of patients with colorectal cancer (CRC), the possibility of reducing the bed-day is limited. The aim of the study was to evaluate the results of treatment of CRC patients during and before the pandemic new coronavirus infection. Material and methods. We analyzed the results of treatment of patients with CRC who were treated at the Oppel Hospital Surgery Clinic in 2015 and 2020. Group A included 58 patients treated in 2020, Group B included 44 patients treated in 2015. Patients with stage II disease predominated in both groups: in group A — 31 patients (53.4%), in group B — 19 (43.2%). Results. The average period of hospitalization in the patients of the group A was 12 days, in the group B — 16 days in the patients with uncomplicated postoperative period, in case of complications — 31 days. In group    B 47.7% of surgical interventions were performed using laparoscopic techniques, in group A this index was 74.1%. In Group A complications in the early postoperative period were detected in 8 patients (13.8%). In group B complications were diagnosed in 10 patients (22.7%). The incidence of anastomosis failure tended to decrease in group A. In group B six patients (85.7%) who developed this complication required repeated surgical treatment, and in group A only two patients (50%). Discussion. The results demonstrate the effectiveness of the recommendations for perioperative management of patients with CRC and prevention of anastomosis failure. Conclusion. Based on the results obtained, we can say that the quality of surgical care for patients with CRC was avoided during the pandemic. The implementation of research recommendations in this area has helped to reduce the incidence of serious postoperative complications (anastomosis failure).

The editorial comment to the article «Analysis of Treatment Outcomes of Patients with Colorectal Cancer in the Context of the COVID-19 Pandemic» discusses changes caused by the COVID-19 pandemic in the contingents of patients with colorectal cancer and possibilities of intensification of their surgical treatment in conditions  of temporary shortage of surgical beds. The structure of the patients operated routinely in the conditions of the specialized clinical department does not answer the question whether the structure of colorectal cancer has changed after the pandemic. At the same time the successful experience of the authors concerning the transition to endovideosurgical operations and the «fast-track» protocol testifies to the effectiveness and safety of intensification of colorectal cancer patients care in the conditions of temporary shortage of surgical beds.

Introduction. The article presents a rare observation of a family case of Unverricht-Lundborg disease, a variants of myoclonus-epilepsy characterized by a hyperactive state of cortical-subcortical motor mechanisms that cause stationary myoclonus of subcortical genesis and «trigger» generalized epileptic seizures when it intensifies. Due to the low frequency of occurrence, only single observations of Unverricht-Lundborg disease have previously been published. The aim of this work was to highlight the clinical features of a rare familial variant of Unferricht-Lundborg myoclonus-epilepsy in comparison with the manifestations of single cases described in the literature. Materials and methods. We present a family case of the disease in three siblings, manifesting as they reached the age of disease debut. The family pedigree in several generations is analyzed, and the life and manifestations of the disease in each of the brothers are described. The disease pattern of single siblings and semiology in single cases of myoclonus epilepsy were compared. Results and Discussion. By the example of the description of a family case of the disease, the importance of clinical characteristics is emphasized, which determines the further strategy of diagnostic search and application of instrumental methods of investigation. In addition, the collection of complaints, history, and neurological examination data when diagnosing Unferricht-Lundborg disease allow a specialist to differentiate it from various variants of hereditary myoclonus-epilepsy (up to 15 variants according to the literature), the similarity of symptoms of which may lead to an erroneous diagnosis. Modern lines of supportive therapy of Unferricht-Lundborg disease, allowing to slow down the progressive nature of the incurable pathology, are analyzed, the characteristics of the action of individual drugs are given. Conclusion. There are a number of similarities and differences in the clinical manifestations of Unferricht-Lundborg myoclonus-epilepsy in sporadic or familial variants of the disease. The leading triad of symptoms has chronologically inconsistent initiation in individual patients and different dominance in each individual case, which creates variability in the disease.

Introduction. Endovascular stenting of coronary arteries is an effective, minimally invasive and rapidly developing method of coronary heart disease (CHD) treatment. The question regarding the choice of a drug for adequate and safe monitoring sedation in patients during this type of surgical procedures remains open. The aim of the study was to discuss a clinical case of dexmedetomidine in elective endovascular stenting of coronary arteries. Materials and methods. A clinical case of dexmedetomidine in anesthesia during elective stenting of the right coronary artery and its analgesic effect in the development of right coronary artery (RCA) dissection are described. Results. Patient S., 72 years old, after planned endovascular stenting of the right coronary artery with 3 stents at the time of his admission to the intensive care unit (ICU) had no angina pains and sternal discomfort. The patient was transferred to the specialized department 8 hours after stenting in a stable condition. Serum cardiospecific troponin T level was less than 0.2 ng/ml 6 hours after RCA stenting. No negative dynamics was described on the control ECG after surgical intervention. Discussion. Dexmedetomidine has a proven analgesic effect due to its direct effect on the peripheral nervous system. Conclusion. The use of dexmedetomidine has its place in periprocedural sedation in patients with coronary heart disease during planned endovascular coronary artery stenting, including patients with significant (over 90%) and extended coronary artery stenoses. The clinical use of dexmedetomidine in elective minimally invasive coronary interventions requires closer attention and study.

Introduction. Cystic adenomatous malformation (CAM) is a congenital lung malformation resulting from abnormal morphogenesis of lung branching at different stages and in different parts of the tracheobronchial tree, with formation of cysts. The incidence of CAM is one case per 8,300-35,000 live births. The modern classification distinguishes four types of CAM. The aim of the work was to analyze the features of the course of the disease and radiological signs that can help the doctor to suspect the presence of congenital lung malformations in   the newborn in the early stages of  manifestation,  justify  additional diagnostic  methods, and timely  choose an appropriate treatment tactic. Material and methods. The article presents the clinical observation of a newborn infant with type II CAM and concomitant disease «early neonatal sepsis». Medical documents are used, where the results of clinical examination, instrumental (X-ray, ultrasound, CT) and laboratory methods  of investigation are presented. Data of histological examination of biomaterial obtained intraoperatively are presented. Results. An analysis of the clinical and radiological dynamics is given. Based on the examination, congenital malformations were detected, and surgical treatment was performed. The child was discharged from the hospital on the 35th day of life in a satisfactory condition. A detailed analysis of diagnostic limitations at each stage of the child's life was conducted. Discussion. Diagnosis of CAM in the early stages was difficult not only because of the nature of the malformation, but also because of the clinic of sepsis, which was the leading one in the first days of life. The morphology of the malformation leads to problems with its prenatal diagnosis and the lack of a clear radiological and ultrasound picture in the postnatal period. Conclusion. In any case of recurrent air leak syndrome, differential diagnosis of congenital pulmonary malformations and the use of CT or MRI for accurate imaging seems reasonable.

Introduction. Arterial hypertension is the most common somatic pathology in pregnant women. Arterial hypertension is a factor of high risk for the development of severe preeclampsia, placental insufficiency, intrauterine growth restriction, premature birth, maternal and perinatal mortality, nervous disorder and vascular heart disease of newborns and women’s distant cardiovascular disorders. The pathogenesis of gestational complications is associated with pathology of placentation, endothelial dysfunction and a decrease in vascular elasticity. The pathogenesis has not studied yet. Nowadays there are no tests with enough sensitivity and specificity ensuring early diagnostics and risk identification at development of great obstetric syndromes. Aim of the study was to improve our understanding about a clinical and prognostic role of vascular wall elasticity in pregnant women with arterial hypertension. Materials and Methods. We searched publications and analyzed literature using various scientific databases, including Index Medicus, PubMed/MEDLINE, Embase, Cochrane Library and Russian scholarly journals related to obstetrics, gynecology, cardiology for the last 9 years. Results and Discussion. Today changes in the elastic properties of arteries is a modern marker of a high risk of cardiovascular events in patients with essentialhypertension. Endothelial dysfunction develops already in the early stages of arterial hypertension and initiates structural changes in the vascular wall and   an increase in arterial stiffness. High activity of the sympathetic nervous system is the cause of changes in the elastic properties of arteries in pregnant women with arterial hypertension. Conclusion. The role of vascular wall elasticity in pregnant women with arterial hypertension is of tremendous importance and deserves close attention. The study of elastic properties of vessels is relevant for assessing the risk of gestational complications in pregnant women with arterial hypertension.

The aim of the study was to highlight modern approaches to the dietary correction of metabolic syndrome   in patients who have decided to perform abdominoplasty. Materials and methods. The keywords driven search for scientific references was carried out in the PubMed, Google Scholar and elibrary.ru databases for the period from 2000 to 2020. 38 sources were selected from 159 received links. Results and Discussion. Current approaches to dietary therapy of obese patients who have decided to perform abdominoplasty, taking into account the comorbidity of patients, is provided. Particular attention is drawn to the subjects’ nutritional status periodical reassessment, the identification and comprehensive correction of carbohydrate and lipid metabolism disorders both at the stage of preoperative preparation and throughout subsequent life. The principles of calculating the daily caloric content and the nutrition planning are considered. A personalized interdisciplinary approach to patient management within the wide specialties spectrum (internist, endocrinologist, cardiologist, gastroenterologist, nutritionist, psychotherapist, plastic surgeon) cooperation and the application of digital technologies for remote life-long monitoring and counseling is discussed. Conclusion. A unified algorithm of actions of an interdisciplinary team of specialists, taking into account the personal characteristics and  needs of patients, the possibilities of digital technologies, allows to reduce the risk of developing comorbid pathology, improve the results of abdominoplasty, the quality and life expectancy of the patient and ensure the best therapeutic and aesthetic result, as well as prevent relapses of weight gain during long-term follow-up of patients after abdominoplasty.