Introduction. Respiratory support remains the most common procedure performed by neonatal transport team specialists. Non-invasive ventilation is a very common method of respiratory support for newborns, reducing the incidence of chronic lung disease. However, the safety and efficacy of this type of support during transportation remain controversial.

   The aim of the work is to determine the current state of the problem of non-invasive respiratory support in newborns in the initial medical organization, at the stage of pre-transport preparation and during transportation.

   Materials and methods. Literature sources were searched and selected in PubMed and eLibrary. The following queries were used for the search: nasal continuous positive airway pressure, non invasive ventilation, neonate, newborn, patient transportation, transport, transfer. Types of studies considered: retrospective observational studies, prospective studies (randomized, quasi-randomized, non-randomized), systematic reviews, meta-analyses, clinical protocols. Depth of search − 20 years. The total number of publications included in the review was 61, including 29 studies directly related to the use of noninvasive ventilation in interhospital neonatal transport.

   Results and discussion. Non-invasive respiratory support is one of the priority and actively used methods of therapy of respiratory disorders of various genesis in neonatology. Nasal CPAP is used both independently and in conjunction with various methods of surfactant administration, reducing the risk of a combined outcome “death or chronic lung disease”. It is recommended both as a method of starting respiratory support and as an intermediate option to increase the probability of successful extubation. There is limited experience with non-invasive respiratory support during interhospital transport of neonates. The available studies suggest that when patients are selected rationally and reasonable criteria are applied to administer nCPAP en route, this method of respiratory support is safe, effective, maintains the benefits of spontaneous breathing, and reduces the duration of intensive care. The small number and poor design quality of studies in this direction do not allow at this stage to form evidence-based recommendations.

   Conclusion. Medical evacuation of newborns from 1−2 level institutions to level 3 organization with nCPAP is safe and has a number of potential benefits. Existing recommendations are empirical, and there are exceptionally few studies evaluating the validity of such recommendations.

   Introduction. The need for intensive care adjustments to be made by the transport team at the originating medical organization remains an important element of pre-transport preparation, being an indirect indicator that the level of care does not match the needs of the patient.

   The aim of the study is to identify factors associated with the need for therapy adjustments depending on the level of initial medical organization.

   Materials and methods. The one-stage, cross-sectional study included the data of visits of the neonatal transport team of the resuscitation and consultative centre of the Regional Children’s Clinical Hospital (Ekaterinburg) in the period 01. 07. 2014–31. 12. 2018 (n = 2029). The sample was divided into groups: the first group – patients from level 1 organizations (22.8 %, n = 462), the second group – patients from level 2 organizations without paediatric intensive care units (34.9 %, n = 709), the third group – patients from level 2 organizations with paediatric intensive care units (32.5 %, n = 659), the fourth group – patients from level 3 institutions (9.8 %, n = 199).

   Results. The need for therapy adjustment at baseline was dependent on the level of the institution, with a maximum in level 1 organizations and a minimum in level 3 organizations. The odds ratio of need for therapy correction for level 1 organizations compared to level 2 organizations with paediatric intensive care units was 1.4, 95 % CI [1.2–1.7], p = 0.002, and compared to level 3 organizations was 1.6, 95 % CI [1.2–2.3], p = 0.003. Multivariate analysis identified the following factors associated with the need to adjust therapy at the original facility: for level 1 facilities, respiratory support, dopamine administration; for level 2 facilities without paediatric intensive care units, respiratory support, dopamine and epinephrine infusion, sedation; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; and for level 3 facilities with paediatric intensive care units, respiratory support, dopamine infusion.

   Discussion. The need for respiratory support and administration of catecholamines are indicators of the severity of the patient’s condition. Patients in low-acuity healthcare organizations require an increased level of care, regardless of the birth weight and gestational age of the newborn.

   Conclusion. Logistic regression analysis revealed factors associated with the need for therapy correction in patients in the initial medical organizations depending on their level. The following factors played a statistically significant role: respiratory support, sedation, intravenous infusion of catecholamines, patient weight.

   Introduction. The novel coronavirus infection (COVID-19) pandemic has been a major challenge to the global healthcare system, affecting more than 32 million patients worldwide. Unprecedented anti-epidemic measures carried out in hospitals allowed clinicians to hope for a decrease of hospital infection, however, the pandemic exacerbated the problem of the spread and circulation of multidrug-resistant bacteria in hospitals.

   The goal of study to conduct a comparative assessment of changes in the microbial landscape and the level of antibiotic resistance of the main pathogens of lower respiratory tract infections in ICU patients who were in different epidemiological conditions during the COVID-19 pandemic in comparison with the “pre-Covid” period.

   Materials and methods. A multicenter retrospective observational cohort study was conducted, which included the ICU of 4 hospitals in Yekaterinburg, which were in different epidemiological situations during the COVID-19 pandemic, as well as a comparative analysis of the length of stay of patients in the ICU, the frequency and duration of mechanical ventilation, the resuscitation mortality rate, and also the results of microbiological examination of sputum with an assessment of the structure of pathogens and the level of their antibiotic resistance.

   Results. The structure of pathogens in sputum in ICU patients of the “green zone” has not fundamentally changed. In the “red zone” there was an increase in the number of documented infections of the lower respiratory tract and blood flow, while hospitals showed differences in changes in the microbial landscape. The microbiological situation in the ICU of the “red zone” was characterized by a decrease in the number of isolated strains of Enterobacterales and non-fermenting Gram-negative bacteria by the end of the pandemic, as well as a significant increase fungi in sputum. In hospitals, where there was an alternation of periods of work in the “red” and “green” zones, there was a decrease of Enterobacterales, an increase in non-fermenting Gram-negative bacteria and a fungi. Among the microflora isolated by bacteriological methods in patients with COVID-19, gram-negative bacteria and fungi predominated, mainly Klebsiella pneumonia, Acinetobacter baumanii and fungi of the Candida spp. A significant increase in the proportion of fungi in sputum was noted in ICU patients in infectious diseases hospitals during the pandemic period. An increase in the level of antibiotic resistance of the main pathogens of lower respiratory tract infections was revealed with the appearance of multi-resistant and extremely resistant strains of Klebsiella pneumoniae and Acinetobacter baumanii. Discussion. Changes in the microbial landscape may indirectly reflect the features of immune damage in patients with a new coronavirus infection COVID-19, which, combined with the severity of the disease and the characteristics of its therapy, led to an increase in complications in the form of a secondary bacterial infection. The reasons for the increase in HAI cases include: an increase in the number of patients with severe comorbidities in an artificial closed ecosystem - the “red zone”; features of the methods of treatment (glucocorticosteroids, genetically engineered biological products - IL-6 inhibitors, etc.); high frequency of unreasonable use of antibacterial drugs; increase in the duration of
use of various invasive devices and mechanical ventilation; changing the structure and practice of staffing hospitals, increasing the number of inexperienced medical workers and volunteers; inadequate hand hygiene, use of unsuitable individual protection means with a lack of developed methods for their processing in the new conditions.

   Conclusion. The results obtained indicate the importance of the work of a multidisciplinary with a microbiologist, epidemiologist, clinical pharmacologist in order to improve the quality of care for patients, especially in a difficult epidemiological situation. Surveillance over the spread of HAI pathogens should be attributed to the most progressive form of anti-epidemic activity. Microbiological monitoring and its results can serve as the basis for making managerial decisions to combat and prevent hospital infections. It is the main method for assessing the etiology, phenotype, mechanisms of resistance to antimicrobial drugs, allows you to identify epidemiological relationships between diseases, reasonably prescribe antibiotic therapy, and conduct targeted purchases of drugs (antibiotics) for the needs of this hospital.

   Introduction. Lead contamination is continuing worldwide. The development of new effective drugs for lead poisoning is an urgent task.

   The aim of the work is to evaluate the effectiveness of dry aqueous extract of spruce cones in lead poisoning.

   Materials and methods. The experiment was carried out on 24 white mongrel rats of both sexes. Animals of the studied groups were administered aqueous solution of lead acetate. The animals of the third group were treated with the extract of cones of common spruce (extract) by intragastric administration 3 times a week for a month. Animals of the fourth group were treated with polypheman by intragastric administration 3 times a week for a month. The elemental composition of tissue samples of animals of the studied groups was determined on energy dispersive X-ray fluorescence spectrometer QUANT’X. The free radical reaction with 2,2-diphenyl-1-picrylhydrazyl was used to determine the antioxidant activity of the extract.

   Results. In groups of animals injected with lead acetate solution and treated with the extract and the comparison preparation polyphepan, a decrease in lead content in bones and brain tissues was observed compared to the content in animals injected with lead acetate solution without treatment. No effect of the extract on the motor function of the intestine was revealed. When determining the antiradical activity, it was found that the extract showed a pronounced ability to bind free radicals, comparable to the known antioxidant rutin.

   Discussion. The use of the extract allows effective excretion of lead and prevents its deposition in bone tissue. Due to the ability of procyanidins to penetrate the blood-brain barrier, the extract is effective in brain damage caused by lead. The extract will also be effective in relieving oxidative stress resulting from lead poisoning.

   Conclusion. The dry aqueous extract of cones of common spruce shows the ability to reduce the lead content in bones and brain tissues in comparison with the group that did not receive treatment for lead acetate poisoning. The extract is able not only to effectively reduce the lead content in the body, but also to fight the consequences of poisoning, due to its pronounced antiradical activity.

   Introduction. Therapeutic monitoring of antiretroviral drugs (ARVs) is necessary in routine practice, both to objectively monitor adherence and to ensure a personalized approach to patient treatment. Most methods of quantitative determination of ARVP, in particular, ritonavir and lopinavir, are carried out using high-performance liquid chromatography with a tandem mass-selective detector (HPLC-MS/MS) or in combination with UV detection (HPLC-UV), with a single quadrupole detector (HPLC-MS). However, these methods provided for the use of a large range of expensive solvents of a high degree of purification, a long time of analysis and sample preparation, which prevented the introduction of these methods into routine practice.

   The aim of the study to evaluate the effectiveness of the developed technique for quantifying the concentration of Ritonavir and Lopinavir in blood plasma by HPLC-UV.

   Materials and methods. The following drugs were used in the study:
Ritonavir and Lopinavir. Efavirenz was used for the internal standard. Randomly selected blood samples with anticoagulant from patients who did not take antiretroviral drugs were used as test samples. Chromatographic separation and detection were performed by HPLC-UV. The chromatographic separation process was controlled and the chromatographic analysis results were processed using the OpenLab CDS Chromatographic Data System software. The calibration curves were calculated using a linear regression mathematical model based on the least square’s method. Statistical data processing was carried out using the software product “Statistica v.12” (StatSoft Russia).

   Results. The linear range of plasma concentration determination was 1-50 µg/ml for Ritonavir and 2-100 µg/ml for Lopinavir. Due to the short retention time – less than 7 minutes, the technique allows you to examine up to 7.5 samples per hour on one device.

   Discussion. Most of the methods of quantitative determination of Ritonavir and Lopinavir for therapeutic monitoring of ART are carried out using HPLC-MS/MS or HPLC-UV, however, all of them provided for the use of a large range of expensive solvents of a high degree of purification, a long time of analysis and sample preparation, which prevented the introduction of these methods into routine practice.

   Conclusion. The developed technique for quantifying the concentration of Ritonavir and Lopinavir in blood plasma using high-performance liquid chromatography with an ultraviolet detector (HPLC-UV) has a sufficiently wide linear range of concentration determination and high performance for further validation and implementation into clinical practice.

   Introduction. One of the ways to improve the quality of intensive therapy in severe forms of acute alcohol poisoning is the inclusion in the complex of measures of means capable of reducing the manifestations of oxidative stress.

   The aim of the work was a comparative evaluation of the effectiveness of drugs Reamberin and Methadoxyl in acute severe ethanol poisoning on rats.

   Materials and methods. Acute severe alcohol poisoning was modeled in Wistar rats by 40 % ethanol solution at a dose 8,6 g/kg. The studied drugs were administered infusively in the volume of 20 ml/kg for 60 min at an average rate of 0.33 ml/min/kg. The comparative efficacy of infusion therapy was evaluated according to the severity of coma and its duration.

   Results. Ethanol caused coma of different severity in animals. At the end of infusion therapy, the death of some animals was observed. The life expectancy of dead animals receiving Reamberin was 4 times higher than that of animals of the control group and animals receiving Metadoxyl. The most significant decrease in the severity of coma and its duration was observed in rats receiving Reamberin. Minimal differences in the frequency of respiratory movements from the background at the end of infusion occurred in the same animals. Discussion Established in acute ethanol poisoning the presence of supportive therapy with Reamberin of neurological status and external respiratory function during infusion is a justification for the inclusion of the drug in the complex of intensive care in this critical condition.

   Conclusions. It was experimentally shown that Reamberin, unlike Methadoxyl, significantly reduced the severity of alcohol coma at the end of infusion administration. Reamberin increased the life expectancy of dead animals compared to the control and rats receiving Methadoxyl, and also caused minimal differences in respiratory rate relative to the background at the end of infusion, which had the character of a trend. Reamberin demonstrated greater efficacy with respect to the course of acute severe ethanol poisoning than Methadoxyl.

   Introduction. Chronic exposure to uranium compounds causes adverse cytotoxic and immunopathological effects in the body.

   The aim of the work was to evaluate the therapeutic efficacy of S-adenosylmethionine when administered intragastrically with respect to hepato-, nephro- and immunotoxic effects in chronic intoxication
with uranyl acetate dihydrate (UAD).

   Materials and methods. Chronic intoxication was modeled by injecting 85 male rats with UAD solution (5.0 mg/kg/day by element) for one month. S-adenosylmethionine was administered to animals at a dose of 72.7 mg/kg for 21 days.

   Results. In chronic poisoning with UAD, 65% lethality, decrease of liver mass ratios (MR) and increase of renal MR were observed. Decrease in alkaline phosphatase activity, glucose level, lactic acid, number of CD4+ T-lymphocytes, increase in lactate dehydrogenase activity and creatinine level, number of CD8+ T-lymphocytes and apoptotic cell death, formation of catabolic pool of low and medium molecular weight substances (LMSMS) of blood plasma were registered. The results of urine analysis revealed the development of hyposthenuria, signs of glucosuria, hematosuria, proteinuria and leukocyturia, appearance of bilirubin in the urine. S-adenosylmethionine contributed to the decrease in the degree of target organ damage (reduction of fibroplastic and dystrophic changes in the liver and kidneys), normalization of immune system parameters (increase in CD4+ T-cells, decrease in CD8+ T-cells and frequency of apoptotic death of lymphocytes in immunocompromised animals) and endotoxicosis (decrease in the level of LMSMS from the catabolic pool area).

   Discussion. According to the totality of all revealed pathological changes, UAD poisoning led to the development of tubulointerstitial nephritis, metabolic disorders of detoxification functions of the liver. The causes of animal death during the first week of the experiment were acute kidney damage or confluent pneumonia. The appearance of bilirubin in the urine was associated with porphyrin metabolism disorders. In the remote period of intoxication an imbalance of the T-cell link of the immune system developed, as well as, probably, a decrease in nonspecific resistance, which led to the development of pneumonia in rats.

   Conclusion. S-adenosylmethionine therapy of hepato-, nephro- and immunotoxic effects in chronic UAD intoxication contributed to a decrease in the degree of damage to target organs, normalization of immune system parameters and endogenous intoxication.

   Introduction. Gestational hypoxia plays an important role in fetal development, as it causes the development of oxidative stress and delayed psychomotor development.

   The aim of the study was to evaluate the prenatal effect of sodium nitrite on indices characterizing orienting and exploratory activity, mental activity and the degree of hypoxia in rat offspring.

   Materials and methods. Acute hypoxia was modeled by administration of sodium nitrite at a dose of 30 mg/kg intramuscularly to five pregnant rats during 16–19 days of gestation. Five females constituted a control group. In 50 born rats, orientation and exploration activity, cognitive functions, intensity of lipid peroxidation and glycolysis were studied.

   Results. The offspring of females that underwent acute hypoxia significantly lagged behind in the positive dynamics of body weight gain compared to control individuals. Thirty-day-old rats showed a pronounced disorder of the structure of behavioral pattern, learning process and long-term memory, increased content of diene conjugates, malonic dialdehyde and the level of lactate dehydrogenase activity in blood.

   Discussion. It was found that offspring whose mothers suffered acute hypoxia of toxic genesis developed pronounced behavioral disorders of psychomotor agitation and cognitive dysfunction characterized by decreased learning ability and impaired long-term memory. The content of primary and secondary products of lipid peroxidation and lactate dehydrogenase was increased in rats. The development of cellular oxidative stress under conditions of intrauterine hypoxia leads to oxygen deficiency in the fetus and a switch from tissue respiration to glycolysis, which underlies CNS damage.

   Conclusion. It was shown that sodium nitrite administration during the period from the 16^th to the 19^th day of gestation caused hyperactivity, depressed emotional status, and decreased orienting and exploratory activity and the ability to learn and retain a memory trace in rat offspring. Increased levels of diene conjugates and malonic dialdehyde, lactate dehydrogenase activity were observed in rats.

   Introduction. View about hepatic macrophages as key regulators of tissue homeostasis, acting via innate and adaptive immune reactions, stimulated by exogenous and/or endogenous alarm signals of tissue injury or cell stress is substantiated in the review. From one hand, environmental signals determine macrophage polarization and production, but, on the other hand, macrophages affect tissue microenvironment and cells and tissue function at whole.

   The review was aimed to provide recent evidence of macrophage role in maintenance of tissue homeostasis in liver.

   Materials and Methods. Review is based on the 67 scientific articles, devoted to the study and analysis of macrophage role in the maintenance of tissue homeostasis in liver, found in PubMed database. Most of the analyzed articles (40 from 67) were published in 2017-2023.

   Results and Discussion. Information of origin and morpho-functional heterogeneity of hepatic macrophages was summarized in the review.

   Conclusion. The information presented in the review allow to conclude that macrophages are key regulators of homeostasis in the liver due to their ability to perceive many endogenous and exogenous signals in tissues and quickly respond to them in the direction of stabilizing the tissue microenvironment.

   Introduction. Despite all the advances in anesthesiology, postoperative pain syndrome remains a serious problem. The lowest satisfaction with postoperative pain relief was found among gynecological patients. For adequate anesthesia and relief of postoperative pain syndrome in gynecological patients, a clear understanding of the features of pain development is necessary.

   The purpose of the study: identification of mechanisms of development of postoperative pain syndrome in gynecological patients.

   Materials and methods. The search and analysis of literature sources in the databases Scholar Google, Cyberleninka, PubMed, by keywords: physiology of pain, postoperative pain in gynecology, pain syndrome after uterine surgery. Criteria for the inclusion of articles: compliance with the subject of the review and the relevance of the data. The search depth was 33 years. The review includes 59 literary sources.

   Results. The development of pain syndrome is influenced by pathophysiological mechanisms, such as: the formation of hyperalgesia zones, changes in estrogen levels, damage to nerve fibers and genetic factors. To assess the level of pain, specialized scales are used, such as YOURS, CRH, DN4 scale. Psychological factors have a great influence on the formation of postoperative pain. Namely, the level of anxiety and depression, the level of catastrophization of pain, coping strategies used, psychological stability.

   Conclusion. Postoperative pain syndrome in gynecological patients is associated not only with the physiological mechanisms of pain development, but also with psychoemotional factors. A multidisciplinary approach is needed to alleviate pain in gynecological patients, including not only adequate multimodal anesthesia and analgesia in the perioperative period, but also collaboration with clinical psychologists, psychotherapists, to evaluate and possible selection of psycho-social therapy.

   Introduction. Alcohol dependence is a condition, the consequences of which are severe in persons with cardiovascular diseases and immunodeficiency.

   The purpose of the study is to evaluate the influence of alcohol dependence on the course of chronic heart failure (CHF) in persons infected with human immunodeficiency virus (HIV).

   Materials and methods. A clinical study including 240 HIV-infected patients, 160 of them were diagnosed with CHF, 72 had alcohol dependence. AUDIIT scale was used for diagnostics of alcohol dependence. All patients underwent echocardiography, NT-proBNP concentration was determined in blood plasma, serum - content of SRB, transferrin, ferritin, iron, potassium, sodium, bilirubin, creatinine, urea, uric acid, AST, ALT, GGTP activity. Statistical calculations: Kolmogorov-Smirnov, Mann-Whitney methods, odds ratios and risks.

   Results. Congestion, lower heart rate prevailed in the group of patients with alcohol dependence. On the background of alcohol dependence in blood serum there was a decrease in the level of total cholesterol, transferrin, potassium, an increase in total bilirubin and GGTP activity, a decrease in the number of platelets. Increase in NT-proBNP concentration was found in blood plasma.

   Discussion. Alcohol is characterized by cardiotoxic effect, and regular ethanol consumption is associated with the development of non-ischemic dilated cardiomyopathy and CHF. Echocardiographic findings suggest a predominance of right atrial and left ventricular dilatation in the group of patients with alcohol dependence among all patients with CHF infected with HIV due to the formation of cardiomyopathy.

   Conclusion. Alcohol dependence is a condition aggravating the course of CHF in HIV-infected patients, which is manifested by higher values of blood plasma NT-proBNP, with CHF more often acquiring a congestive character. The course of CHF in HIV-infected patients against the background of alcohol dependence is accompanied by liver dysfunction - 3.5 times increase the chance of cholestasis development, 2.5 times increase the chances of death within 2 months after admission to hospital.

   Introduction. Febrile seizures (FS) is the most common type of epileptic seizure experienced by young children. Study of methods of intensive treatment (IT) of FS represents a vital area of research in today’s pediatric science.

   The aim of this work: to assess the current approaches to risk factors, clinical manifestations and emergency care for patients with FS in pediatric practice. Materials and methods. The authors performed an analysis of publications that were found in the Cochrane Library, PubMed, eLibrary.ru, and Medscape databases using the following search terms: febrile seizures, children and adolescents, intensive treatment, anticonvulsants. A total of 64 published sources were chosen for review.

   Results and Discussion. The risk factors for FS may be numerous, with the main etiological causes in children being genetic susceptibility, viral infections and vaccination. The clinical presentation of FS is characterized by the development of a generalized tonic-clonic seizure in the setting of a high body temperature (≥39°C). FS are subdivided into three main clinical types: simple, complex and febrile status epilepticus (FSE). History taking and physical examination represent the main diagnostic means for determining the type of FS and discovering the cause of infection. Laboratory tests, electroencephalography, neuroimaging studies and lumbar puncture are used on a limited basis, mainly in children with complicated FS accompanied by a brain infection. Hospitalization for IT is necessary if the child has prolonged febrile seizures or FSE. The drugs of choice for relieving FS are benzodiazepines. Barbituric acid derivatives and valproic acid also possess therapeutic efficacy against FS. Antipyretic agents are effective only in relieving the toxic syndrome, but have no effect on the severity of FS and do not prevent relapses. The main antipyretic medications used for treatment of FS in pediatric practice are paracetamol, ibuprofen and nimesulide. Besides benzodiazepines, IT of FSE involves the use of intravenous fosphenytoin, phenobarbital or levetiracetam.

   Conclusion. Improvement of the quality of IT in pediatric practice may improve the therapeutic prognosis in patients with FS and bring down complication and mortality rates.

   Introduction. Vincristine-induced peripheral neuropathies (VIPN) is a current problem in the management of pediatric acute lymphoblastic leukemia (ALL). There are no effective therapeutic strategies for VIPN.

   The aim of the study to present the results of evaluation of neurometabolic therapy in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period.

   Materials and methods. The single-center prospective comparative pilot study involved 69 children with VIPN who were treated in the acute period with the following drugs: group 1 - pyridoxine, group 2 - thioktovic acid, group 3 - inosine + nicotinamide + riboflavin + succinic acid. Clinical and electrophysiological parameters before and after drug treatment were analyzed. Among 10 children with motor deficits in the lower extremities in the recovery period of VIPN, rehabilitation with immersive virtual reality was performed, and the clinical parameters before and after the course were compared.

   Results. A positive effect of the studied drugs on the clinical condition of patients by the 30th day of therapy was revealed. In groups 1 and 3 the total score on the NIS-LL scale correlated with mild polyneuropathy - 4 [2÷8] and 2 [2÷6] points, respectively. Neurologic impairment in each of these groups persisted for 19 [14÷25] and 19 [13÷30] days, which was less in contrast to the duration of symptoms in group 2 (p1-2 = 0.021 and p2-3 = 0.046). In the VIPN recovery period before and after virtual rehabilitation: muscle strength in the lower limbs increased (p = 0.025); the severity of polyneuropathy decreased according to the NIS-LL scale (p = 0.003); balance improved according to the Berg scale (p = 0.017); and patients’ mobility increased according to the Functional Walking Category test (p = 0.025) and walking speed according to the time-recorded walking test (p = 0.008).

   Discussion. Improvement of clinical parameters with neurometabolic therapy and virtual rehabilitation in children with VIPN has been shown.

   Conclusion. Preliminary results of the effectiveness of pyridoxine and inosine + nicotinamide + riboflavin + succinic acid in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period were obtained.

   Introduction. Mechanical injury is the most common cause of violent death in the world, including in Russia.

   The purpose of the study is to analyze scientific, methodological literature and regulatory documents to assess the possibility of using them in substantiating the expert’s conclusions.

   Materials and methods. 85 sources were selected for the scientific review over a period of 26 years, bibliographic databases PubMed, ResearchGate, Elibrary were used. Results and discussion. The patterns of formation and experience of injuries do not change, this allows us to use the results of scientific, methodological and practical activities in forensic traumatology at the present time: methods for describing injuries to the integumentary tissues of a corpse and clothing, rules for the formulation of a forensic medical diagnosis, algorithms for drawing expert conclusions, a comprehensive assessment of biomechanics and characteristics of the main morphological substrates of traumatic brain injury, established patterns of destruction of skeletal bones under various types of mechanical impact, the results of a study of the pathomorphology of internal organs, classification and features of human injury by predatory animals, provisions on the interaction of sharp objects with various tissues from the point of view of injury biomechanics and substantiation of morphological manifestations of injury mechanisms, methodology for solving expert issues of gunshot wounds and explosive trauma, scientifically based morphological criteria for direct causes of death and features of thanatogenesis in mechanical injury, medical essence of qualifying signs of harm to health and threatening the lives of states at different time intervals after causing damage. The prospect of CT studies as one of the types of long-lasting objective physical evidence has been determined for forensic medical examination.

   Conclusion. The study shows that the use of scientific data and methodological works makes it possible in each case of fatal mechanical injury to qualitatively substantiate and argue forensic expert conclusions. The results of clinical diagnostics are evidence in criminal and civil cases, can be preserved for any time period, which determines the prospect of scientific research on the use of clinical diagnostic methods for forensic medical examination.