Introduction. Fetal macrosomy is associated with the risk of maternal and fetal trauma, shoulder dystocia, increase frequency of cesarean section, and obstetric hemorrhage. Prediction of large fetal size at the antenatal stage remains an urgent issue, definitively unresolved even with the use of modern medical imaging techniques. Materials and Methods. A total of 819 women were examined, of whom 365 (the study group) gave birth to a baby weighing more than 4000 grams, and 454 (the control group) gave birth to a full-term baby within the gestational weight norm. At 32–34 weeks of gestational screening in the third trimester, all women underwent an ultrasound examination followed by calculation of estimated fetal weight using the Hadlock formula. The inclusion criteria were fetal anthropometric data at 32–34 weeks' gestational age within the normal range, i.e. within the 10-90th percentile corridor. Results. There was a difference between the groups, the fetal weight in women in the main group in the third trimester, calculated by the Hadlock formula, was significantly higher and was 2123 grams (Q1; Q3 – 1948; 2278) compared to the control group, in which the weight was 1990 grams (Q1; Q3 – 1844; 2101), p < 0.001. ROC-analysis revealed a low, but statistically significant diagnostic value of this parameter for the prognosis of fetal macrosomia. Discussion. The practical importance of determining the risk of fetal macrosomia cannot be overestimated. Using prognostic methods, it is possible to take measures to prevent maternal and fetal trauma and to prevent perinatal morbidity. Our results show that even the isolated use of the estimated fetal weight estimation by the Hadlock method, performed in a Level III institution, allows us to identify a group of pregnant women at risk for fetal macrosomia with acceptable sensitivity and specificity. The threshold fetal weight at 32–34 weeks is 2032 grams. Obviously, ultrasound at 32–34 weeks remains essential as a selective screening technique, e.g. in the presence of known risk factors for fetal macrosomia. Conclusion. Antenatal 2D ultrasound sonography to determine the risk of fetal oversize fetuses performed as part of third-trimester prenatal screening is a tool for selective screening. The development of integral multifactorial prognostic models of fetal macrosomia based on the calculation of estimated fetal weight using the Hadlock method at 32-34 weeks seems to be a promising direction that will significantly improve the quality of perinatal care.

Introduction The article presents the results of the study of communicative patterns that have developed in everyday obstetric and gynecological practice, as well as a comparative analysis of the representation of patients and doctors about them. The purpose of the study was to study and compare the opinions of doctors and patients of obstetric and gynecological profile on communication issues. Materials and methods. A total of 491 obstetrician-gynecologists and 975 patients treated in obstetrician-gynecological hospitals and antenatal clinics were interviewed. The data were statistically processed using the SPSS v 24.0 software package. Qualitative data were expressed as fractions (%), for which the 95 % confidence interval (95 % CI) was calculated by the Wilson method. Significance of differences between groups with nominal variables was assessed using the χ2 test (differences were considered significant if p ≤ 0.05). Results. It was revealed that 3.1 % of patients and 25.3 % of physicians always face communication difficulties. In the case of patients, 67.5 % of patients and only 8.8 % of doctors were in favor of greater involvement in the decision-making process regarding treatment tactics. Physicians experience communication difficulties much more often than patients, and rarely satisfy patients' need to receive information about their health condition in full. Discussion. Patients nowadays increasingly want to participate in discussions about their diagnosis and treatment tactics on an equal footing with their physician. The novelty of this study is the comparison of responses to the same questions from patients and physicians, which allows us to assess the two perspectives of communication participants. Conclusion. Physicians are more likely to have difficulty communicating with patients and are unable to meet patients' need for full information about their health status. More widespread implementation of modern technologies in the communication process is needed, and the identified communication patterns and opinions of the main participants in the communication process should be the basis for the development of measures aimed at improving its effectiveness.

Introduction. Hypertensive disorders during pregnancy are one of the main causes of maternal mortality in the world. Both premature detachment of the normally located placenta, which led to massive bleeding on the background of placental insufficiency, according to the theory of placental ischemia, and disruption of compensatory mechanisms, leading to multiple organ failure, can lead to an unfavorable outcome. The pathogenesis of lung damage in preeclampsia is based on the activation of lipid peroxidation. Therefore, one of the components of complex therapy of severe lung damage may be the use of venovenous extracorporeal membrane oxygenation (ECMO), which is a method of extracorporeal support of gas exchange function in patients with life-threatening acute respiratory failure, accompanied by severe arterial hypoxemia and hypercapnia. The aim of the work is to demonstrate the possibility of using extracorporeal membrane oxygenation in the complex therapy of severe lung damage in a patient with multiple organ failure caused by severe preeclampsia. Materials and methods. A clinical observation of the nature of the course of multiple organ failure and lung damage in a laboring woman with severe preeclampsia is presented, her life history, diseases, diagnostic and treatment methods used are analyzed. Results and discussion. The described clinical case demonstrates the possibility of successful application of extracorporeal membrane oxygenation in combination with early renal replacement therapy, respiratory therapy and nutritional support in a patient with severe lung damage against the background of multiple organ failure caused by severe preeclampsia. Conclusion. It is necessary to use extracorporeal replacement techniques of vital functions replacement as early as possible in patients with severe lung damage against the background of multiple organ failure caused by severe preeclampsia.

Introduction. Habitual pregnancy failure (HPF) has long been a pressing problem of modern medicine and is characterized by multiple pathogenetic mechanisms of early pregnancy termination. The aim of the study was to examine the expression of estrogen, progesterone, progesterone-induced blocking factor and stromal cell factor-1 receptors in endometrial biopsy specimens from patients with HPF. Materials and methods. Histological and immunohistochemical studies were performed on 75 endometrial biopsies: 50 endometrial biopsies were taken from patients with HPF and chronic endometritis with no more than three pregnancies, and 25 endometrial biopsies were taken from conditionally healthy patients. Endometrial biopsy was performed on days 19 to 22 of the menstrual cycle. Histological examination of endometrial biopsy specimens was performed according to the standard technique with hematoxylin and eosin staining. The expression of estrogen receptor (ER), progesterone receptor (PR), progesterone-induced blocking factor (anti-PIBF), and stromal cell factor-1 (anti- SDF-1) was assessed by immunohistochemistry. Results. In patients with HPF, the endometrium corresponded to the middle stage of the secretion phase in 32 % of cases. Immunohistochemical study in patients with HPF verified multifocal decrease of estrogen and progesterone receptor expression in the stromal component in 82 % of cases. Assessment of PIBF and SDF-1 expression in the glands and stroma of the endometrial mid-stage secretion phase in patients with HPF revealed a statistically significant decrease compared to the control group. Discussion. The presence of chronic endometritis in patients with HPF leads to impaired endometrial secretory transformation, decreased expression of estrogen and progesterone receptors in the endometrial stroma, and decreased expression of PIBF and SDF-1 in the glands and endometrial stroma. The results of the study suggest the need for pathogenetic therapy of chronic endometritis and pregravidarial preparation in patients with HPF. Conclusion. Regardless of the completeness of endometrial transformation, desynchronosis of the receptor profile, altered expression of immunological markers (PIBF and SDF-1) against the background of chronic endometritis, and structural and molecular disturbances serve as factors of early pregnancy loss.

Introduction. The processes of free radical oxidation play a significant role in the pathogenesis of inflammatory bowel diseases. The aim of the work was to study the clinical status, the content of lipid peroxidation products, oxidative modification of proteins in the lesion of the colon in oxazole-induced colitis (OIC) under conditions of intraperitoneal application of ozone. Materials and methods. Wistar rats were modeled for OIC using oxazolone solution. Ozone-oxygen mixture (OX) was injected intraperitoneally once a day for six days. The clinic was assessed by disease activity index (DAI), the content of products of lipid peroxidation (LPO) and oxidative modification of proteins (OMB) was determined in colonic homogenate. Results. Under OIK DAI increases, the level of primary and secondary products in the heptane phase increases in the colonic homogenate; the level of secondary products and end products increased in the isopropanol phase. Under conditions of intraperitoneal application of ozone, DAI decreased, the level of isopropanol-soluble primary, secondary, final LPO products increased in colon homogenate on the 2nd day, the level of heptane- and isopropanol-soluble primary, secondary, final LPO products decreased on the 6th day, early and late LPO products decreased on the 4th, 6th day. We found a moderate and significant relationship on the Cheddock scale between DAI and the content of LPO and OMB products in the colonic homogenate mainly on day 6 of OIC under conditions of intraperitoneal application of ozone. Discussion. The increased content of LPO and OMB products in the lesion of the colon after the use of ozone is probably due to its mediated action (through the activation of ROS) and its ability to act as an oxidant of lipids and proteins of the cells of the mucosa of the colon. Conclusions. The positive effects of intraperitoneal application of ozone in OIC are the basis for further research in studying the mechanism of the protective effect of ozone with the possibility of further application in clinical conditions in inflammatory bowel diseases.

Introduction. Inflammatory bowel diseases are a serious medical and social problem due to the increase in morbidity and disability among the young, able—bodied population. The aim of the study was to investigate the effect of intraperitoneal and rectal ozone therapy on the morphology and morphometry parameters of the damage zone in oxazole-induced ulcerative colitis in the dynamics of the experiment. Materials and Methods. The study was performed on 97 male Wistar rats. Experimental colitis (EC) was modeled using oxazolone (Sigma-Aldrich; USA). The first stage included skin sensitization by applying 150 ml of a 3% alcohol solution of oxazolone to the interscapular area of the animal, the second stage was a rectal injection of 150 ml of a 3% alcohol solution of oxazolone per rectum to a depth of 7–8 cm. Zoletil-100 (INN: tiletamine hydrochloride) (VirbacSanteAnimale; France) was used for anesthesia at a dose of 20 mg/kg. Morphometry was performed using ImageScope M program (Russia). Colon tissue damage was assessed using tissue damage index (TDI). The content of neutrophils (NF), lymphocytes (LC), eosinophils (EO), histiocytes (HC), plasma cells (PC), fibroblasts (FB) per 1 mm2 was determined in the focus of colorectal damage. Ulcerous defect diameter (in μm) on a PrimoStar microscope (CarlZeiss, Germany), with a Pro150ES morphometric unit (Pixera Corporation, USA). Results. At EC on the second, fourth and sixth days DAI increases, in the lesion of the colon an ulcerous defect is fixed, TDI, the content of NF, LC, EF, PC, HC, FB increase. The intraperitoneal application of ozone was shown to have a positive effect on the tissue morphometry indices of the lesion focus; on the second day and in dynamics on the fourth and sixth day the significant limitation of the ulcerous defect area with the parallel gradual decrease of the tissue damage index (TDI) in comparison with the similar indices in group II was registered. In the rectal variant of ozone application the dynamics of changes in the inflammatory infiltrate composition was also characterized by the significant increase of all parameters on the second, fourth (except for EF), sixth (except for NF, EF) day in comparison with the group of intact animals. The size of the ulcerous defect and tissue damage index after rectal application of ozone on the second day was significantly smaller than in the group with EC and in the intraperitoneal ozone application group, but did not reach the values of the intact group, i.e. there was no complete recovery. Discussion. In experiments on rats it was demonstrated that intraperitoneal injection of ozone at a dose of 150 mg/kg reduces streptozotocin-induced pancreatic damage by increasing the amount of glutathione transferase in the gland tissue, activation of Nrf2-dependent transcriptional pathways, increase in serum insulin and leptin levels. Under clinical conditions the hepatoprotective effect of O3 was shown, as well as an increase in the effectiveness of traditional hepatoprotectors when the latter are combined with O3. Conclusions. Application of ozone therapy in oxazolone-induced ulcerative colitis revealed a positive effect of ozone on the morphological picture of the lesion area and the dynamics of changes in the cellular composition of the inflammatory infiltrate. A more pronounced positive effect of local application of ozone in the form of rectal ozone therapy on morphometry parameters was recorded: normalization on the sixth day of the neutrophil count, more pronounced reduction of the ulcerous defect area, reduction of the tissue damage index.

Introduction. At the moment in the Russian Federation there are no dosage forms with vitamin D3, allowing effective delivery and local effect on the focus of inflammation and the damaged area of the large intestine in inflammatory bowel disease (IBD). Among such dosage forms rectal suppositories are of the greatest interest. The aim of the study was to carry out a comparative analysis of the effectiveness of local administration of vitamin D3 and 5-aminosalicylic acid in experimental colitis. Materials and methods. Experimental colitis (EC) was modeled with oxazolone solution. Suppositories with vitamin D3 and with 5-ASA were applied per rectum every 12 h. Clinical status (DAI), morphometry, colon tissue injury index (TDI), myeloperoxidase (MPO) and TNF-α expression in the lesion were assessed. Results. In EC, DAI is increases, an ulcerative defect is fixed in the lesion of the colon, TDI, neutrophils (NF), lymphocytes (LC), eosinophils (EF), histiocytes (HC), plasma cells (PC), fibroblasts (FB), MPO and TNF-α expression are increased. Vitamin D3 administration reduces DAI, ulcer defect, TDI, MPO and TNF-α expression, the number of NF, EF, LC and PCs, and increases the number of GCs and FBs. Comparison of vitamin D3 and 5-ASA administration revealed comparable efficacy against DAI. Morphometric evaluation of colorectal lesions showed that under the conditions of vitamin D3 administration, in contrast to 5-ASC, less infiltration, edema, signs of healing and repair of ulcerous defects were fixed earlier in EC; MPO expression increased on the 6th day, TNF-α expression on the 4th day. The TDI index on the 4th and 6th days of EC decreased equally under the conditions of vitamin D3 and 5-ASC application. Discussion. The reduction of clinical severity and morphological signs of damage in the large intestine wall at EC against the background of using rectal suppositories with vitamin D3 could be due to pleiotropic effects of vitamin D3. Conclusion. The effect of vitamin D3 in original rectal suppositories is comparable with local application of 5-ASC at EC, it reduces severity of clinical signs, representation of cells involved in tissue destruction, TNF-α and MPO expression in the colon wall and increases representation of cells mediating reparation.

Introduction. Fucoxanthin is one of the main representatives of marine carotenoids with a wide range of biological activities, including a geroprotective effect. The most common source of fucoxanthin in the food industry is diatomic algae (e.g., Phaeodactylum tricornutum). The aim of the work was to summarize and analyze the data on the mechanisms of geroprotective action of fucoxanthin. Materials and Methods. An analysis of scientific research publications from PubMed, E-Library, Google Scholar, ScienceDirect, UpToDate databases is presented, as well as a review of scientific literature for the period from 2017 to 2022. The results of fucoxanthin use on animal and human cell cultures, where the drug proved to be a potential geroprotector, are reflected. Inclusion criteria: priority was given to review and original articles that presented data on the results of fucoxanthin application. Key words in the search for publications: fucoxanthin, geroprotector, oxidative stress, hormesis. Results and Discussion. In-depth study of fucoxanthin structure revealed its pharmacodynamics as a potential drug. Many positive pharmacological effects of fucoxanthin are realized due to the presence of an allene bond in the chemical structure. The mechanisms of fucoxanthin influence oxidative stress and aging at different levels of organization (molecular, cellular, tissue, organ). Deterioration of vision is often a problem of the elderly and is one of the properties of the aging organism. The hypothesis that fucoxanthin realizes a geroprotective effect due to its cytoprotective potential under oxidative stress is the most popular. The geroprotective effect of fucoxanthin on the whole organism is directly related to the differential expression of genes and changes in the activity of molecular pathways. In the transcriptome analysis of fucoxanthin effects, the activation of mechanisms related to hormesis is evident. Conclusion. Studies have shown the effectiveness of fucoxanthin as a therapeutic agent for the treatment of diseases associated with the aging process.

Introduction. Brain natriuretic peptide (BNP) as marker of higher left ventricular myocardial mechanical stress has a strong prognostic value in patients with heart failure (HF). Elevated BNP levels are associated with the of malignant ventricular arrhythmias. Atrial fibrillation (AF) is known to futher elevate BNP levels and this can influence on BNP prognostic value. The aim of the study was to assess the predictive value of BNP in risk assessment of paroxysmal ventricular tachycardia (PVT) in patients with HF and AF. Materials and methods. Totally, 92 patients with sustained or persistent AF, HF with left ventricular ejection fraction < 50 %. All patients underwent transthoratic echocardiography; 24-hour ECG monitoring to assess the ventricular arrhythmia burden. BNP determination by enzyme immunoassay in venous blood serum. Results. Patients with HF, AF and PVTcompared with patients with HF and AF without PVT have higher levels of BNP (298,8 [149; 500,6] pg/ml versus 152 [145,7; 335,4] pg/ml, р = 0,02). There is a significant positive correlation between the level of BNP and the amount of PVT per 24 hours (r = 0,26; р < 0,05). Increased BNP levels are associated with an increased risk of VPT, OR = 3,71 [95 % CI 1,2 to 13,1]. Discussion. BNP is a novel biomarker to improve risk stratification of sudden cardiac death not only for patients in sinus rhythm but for patients with AF. Conclusions. BNP has a predictive value in risk assessment of PVT in patients with HF and AF.

Introduction. Statins have a large number of pleiotropic effects, due to which they can be effective in cardiovascular complications of COVID-19. The aim of the study was to evaluate the relationship of regular statin intake with death and the development of new cardiovascular events in patients with cardiovascular pathology in the acute period of COVID-19. Materials and methods. A retrospective cohort study of patients diagnosed with COVID-19 with a history (before COVID-19) of cardiovascular pathologies, in which regular intake of lipid-lowering drugs is indicated, was conducted. Results. The study included 131 patients: 54 (41,22 %) people with a fatal outcome in the hospital; 77 (58,78 %) patients discharged from the infectious diseases hospital. During the period of hospitalization, 9 (16,67 %) cardiovascular events were documented in patients with a fatal outcome, more often in patients not taking statins, p = 0,399. The chance of death among hospitalized patients with COVID-19 with concomitant cardiovascular pathology is 2,62 times lower in patients taking statins, compared with patients who do not use these drugs for the treatment of cardiovascular diseases (OR 0,381; 95 % CI: 0,17–0,84), the differences are statistically significant (p = 0,015). Discussion. The beneficial effect of long-term statin intake observed in the acute period of COVID-19 is probably due to their additional protective effects: anti-inflammatory, antithrombotic, immunomodulatory and reducing endothelial dysfunction. Conclusions. Among patients with cardiovascular diseases hospitalized for COVID-19, only 1/3 takes the necessary lipid-lowering therapy. The use of statins before admission to the hospital and during treatment significantly reduces deaths in patients with cardiovascular pathology.

Background. This study aims to compare clinical outcomes of SCAD patients initially managed with medical therapy (conservative approach) versus intervention strategy. Materials and methods. We identified relevant studies by performing a systematic search in the PubMed, Google Scholar, Web of Science databases available from 1994 until 2021. The search was conducted using PICO tool (Patient, Intervention, Comparison, Outcome). Results and Discussion. 25 studies involving 2577 patients with SCAD were included. Mean age of patients was 49,2 years, 1985 (77,0 %) were female. The primary conservative strategy performed in 1593 (61,8 %) cases. Mean follow-up duration was 28,5 months. The conservative therapy showed benefit when assessing the overall mortality (OR 0,48; CI 0,27–0,86, p = 0,01) and revascularization frequency (OR 0,43; 95 % CI 0,22–0,81, p = 0.01). Statistically significant differences in myocardial infarction (OR 1,05; 95 % CI 0,66–1,66, p = 0,85) or recurrent SCAD (OR 1,1; 95 % CI 0,7–1,72, p = 0,69) were not revealed. Conclusion. The primary conservative strategy of SCAD therapy is associated with lower overall mortality and further revascularization, but not MI and recurrent SCAD. Further research is needed to clarify the best therapeutic approach in patients with SCAD.

Introduction. Due to the lack of criteria for determining the case of immunological non-response to ART, data on the analysis of deaths in this group of patients are heterogeneous. We analyzed the structure of deaths, clinical and laboratory indicators, and also conducted a survival analysis. Materials and methods. We conducted a retrospective study of HIV-infected patients who had a level of CD4+ T-lymphocytes at the beginning of treatment < 350 cl/mcl and further after that. Two groups were formed: the main one-deceased patients – 357 people; control one-surviving patients – 1846 people. Results. Men and older patients significantly prevailed in the main group of patients. Drug-addicted patients were more likely to have a fatal outcome. When comparing the average indicators of CD4+ T-lymphocytes and viral load at the time of the onset of ART, no statistically significant differences were found. When assessing the frequency of deaths in patients with extremely severe immunodeficiency (CD4 < 50 cells/μl.) at the beginning of ART, the chances of death were significantly higher (OR 1.523; 95 % CI 1,236–1,785). The probability of death increased rapidly by the 5-year period (60 months) from the beginning of ART to 26.9 % ± 1.5, and by the 120-month period (10 years) it reached 43.6 ± 6.8 %. The average development period of a fatal case from the moment of the start of treatment was 82 months (95 % CI: 78.87–85.56 months). Discussion. The question is raised about the predictors of adverse clinical outcomes in patients with immunological inefficiency of ART. A prospective study will provide a complete picture of the course of the disease in this group of patients. Conclusion. The high probability of death in patients with immunological non-response to ART in the first 5 years of follow-up from the beginning of ART requires increased attention from specialists in terms of treatment and dispensary management.

Introduction. Despite advances in the treatment of chronic hepatitis C (CHC), its incidence remains high and remains a serious problem for national health systems. The aim of the study was to conduct a comparative assessment of epidemiological features of CHC among servicepersons of the Federal Guard Service of the Urals Federal District (UFD). Materials and methods. To achieve this goal, we studied epidemiological investigation charts of viral hepatitis C cases in 102 female and 203 male servicemen of the Russian Armed Forces who were treated in the infectious disease department of FGKUZ "5 VCG of the Russian Armed Forces" in 2014–2021. Results. Epidemiological peculiarities that differ from the information presented in the modern medical literature describing the epidemic process of CHC in the Russian Federation have been revealed among servicemen of the Rosgvardia of the Ural region, both men and women. Discussion. A study of the epidemiological anamnesis of servicemen in the Urals Federal District revealed data that differ from the literature data describing the routes of hepatitis C virus (HCV) infection in the Russian Federation. Almost 50 % of the patients could not establish the route of HCV infection. The predominance of the sexual route of infection in women (20.6 %) with CHC was detected, while in men the first place was tattooing (38.4 %). Only 1.5 % of men with CHC, according to our data, were infected while injecting drugs. No women with CHC infected by this route were found, while in the Russian Federation as a whole, injecting drug users are close to 10 %. Conclusion. Due to the particularities of troop recruitment, there are peculiarities of the epidemic process that characterize the course of viral hepatitis. If it is possible to establish the route of infection, there are few cases of HCV infection through injecting drug use, the primary route of infection is sexual in women and infection during tattooing in men.

Introduction. Bone morphogenetic proteins (BMPs) are a subgroup of the transforming growth factor-β (TGF-β) superfamily where they play an important role in bone formation and repair. Recombinant human bone morphogenetic proteins (rhBMPs) are currently being clinically evaluated for their effectiveness in enhancing bone tissue regeneration processes after injuries and diseases of the musculoskeletal system. Clinical trials were accompanied by detailed safety assessments using both in vitro and in vivo assays. Concerns were initially raised about the immunogenicity of some therapeutic proteins due to their non-human origin. However, proteins derived from human serum or tissues and products derived from recombinant DNA, such as rhBMPs, identical or nearly identical to native human proteins, have also been shown to be immunogenic. The purpose. of this study is to review the potential immunogenicity of rhBMPs and compare the results of preclinical and clinical studies available to date between rhBMP-2 and rhBMP-7. Materials and methods. Using PubMed, Embase, the Cochrane Database, and Google Scholar, we conducted a comprehensive search for original papers, literature reviews, case reports, and meta-analyses demonstrating possible immune responses to rhBMPs. Results. This study analyzes possible reactions from the immune system when using rhBMPs in both clinical and preclinical studies. Antibody production has been found to be one of the side effects of rhBMPs. However, reported cases of immunogenicity of rhBMPs vary greatly due to the lack of standardization of methods. Conclusion. No immunologically related adverse events were observed in various clinical trials, and antibody formation never adversely affected new bone formation and clinical outcomes.

Introduction. The demographic crisis that has taken shape in recent years in the Russian Federation has multifactorial causes. The leading place among the most significant factors of its development is taken by the growing number of infertile couples, including those caused by reproductive limitations in men. The aim of the study was to identify the main problems in the organization of medical care using assisted reproductive technologies (ART) by interviewing patients. Materials and methods. An anonymous survey of 297 men (husbands, partners) participating in ART in medical institutions in St. Petersburg in 2021 was conducted using a specially designed questionnaire. Results. Only 14.2 % of patients had a preliminary examination completed within a time frame of less than six months. One in ten respondents (10.7 %) was diagnosed between 6 months and 1 year. Preliminary examination for more than 1 year was completed by 68.0 % of the men who participated in the survey. The average duration of examination of men when receiving medical care free of charge was significantly longer than that for paid medical services: 13.4 ± 1.2 months and 10.3 ± 0.9 months respectively (t = 4.7, p = 0.02). The main reasons for men to seek medical care for a fee were the following: long waiting period for urologist's consultation and diagnostic examination in the outpatient clinic at the place of residence (31,4 per 100 respondents); lack of possibility to perform all the necessary examinations and consultations at the place of residence for free (26,3 per 100 respondents); queues in the state medical organizations (16,8 per 100 respondents). Only 23.1 % of men did not experience psychological discomfort while receiving medical care. Discussion. Restrictions on the availability of medical care for the examination of men participating in the ART procedure are expressed in the failure to comply with the principles of its free-of-charge nature, the established waiting periods, and the lack of the possibility in some cases to perform the necessary analysis or examination in the medical organization of one's place of residence. Conclusion. The conducted research allowed us to form an idea of the main problems in the organization of medical care faced by men undergoing examination in preparation for IVF procedures.

Introduction. The development of the information component of the health care system, as part of the social security system, is an inevitable process. Since 2018, the possibility of providing medical care using telemedicine technologies has been enshrined at the legislative level in the Russian Federation [1]. The purpose of the study was to determine the regulation of relations for the provision of medical care using telemedicine technologies by the regulations of the Russian Federation. Materials and methods. The authors conducted a system-structural study based on the study of the legislative framework presented in the Consultant Plus system. To ensure the greatest completeness of information by the introduced limitation of the study, a requirement was adopted for the relevance of the action of the legal acts in question. Results. The issues of legal regulation of the provision of medical care using telemedicine technologies at the legislative level are spelled out in detail. The Constitution of the Russian Federation defines the fundamental provisions on medical care and health protection. No. 323-FZ Federal law is a law [9] that regulates the rights of citizens in the field of health care, it contains rules on the use of telemedicine technologies in the provision of medical care [10]. Acts of the Government of the Russian Federation on the provision of medical care using telemedicine technologies can be divided into groups: acts on the management of health care, on the financing of medical care, and acts of a program nature. Discussion. However, the current regulation is not without its shortcomings. Thus, the establishment of many formal requirements for the conditions and procedure for the provision of medical services using telemedicine technologies is seen as ambiguous. Conclusion. The study showed that the system of sources of legal regulation of the provision of medical care using telemedicine technologies: fixed at all levels with the priority of acts of the federal level, regulated by the Constitution of the Russian Federation only in general matters, mainly prescribed by Federal Law No. 323-FZ [1], defined in detail by Order No. 965n [2], needs to maintain the constant relevance of the sources of legal regulation.

Introduction. Benign mammary gland tumors constitute a group of heterogeneous diseases with a complex clinical and morphological structure that complicates timely diagnosis and terminological designation of pathological processes. They are of great interest because of their possible background for oncologic pathology. The most widespread disease is mastopathy, its occurrence rate in the population reaches 40%. The incidence of mastopathies increases by the age of 45 years, and then tends to decrease in the pre- and postmenopausal periods. The purpose of the review was to evaluate and analyze the literature data on the presented problem in recent years. Materials and methods. Publications of domestic and foreign authors on benign breast neoplasms and risk factors of this pathology over the past 20 years have been included in the article. Literature search was performed in the systems Scopus, Web of Science, PubMed, Elibrary. Results and discussion. Etiopathogenetic factors in patients with benign mammary gland tumors play a paramount role, substantiating the necessity of prognostication and prevention of the disease. Risk factors for these diseases include hereditary, hormonal, neuropsychological, reproductive data, age, lactation, inflammation, trauma, smoking, and others. Conclusion. The current dynamic of increasing the incidence of benign mammary tumors has been noted, but no specific risk factors for this group of diseases have been identified, as they are multifactorial, associated with genetic causes, somatic health data, and environmental influences. Not all women are equally at risk of developing breast diseases, the reasons characterizing the individual propensity for this pathology have been identified. The risk factors do not cause the development of the disease, but considerably increase its probability. The study of predisposing risk factors for the development of tumor processes in the mammary glands in order to diagnose them early gives an opportunity to improve the results and prognosis of treatment.