Purpose. The effectiveness of classical and eversion carotid endarterectomy (CE) in patients with cerebral ischemia in atherosclerotic stenosing carotid artery disease (ICA) was compared in the article.

Material and methods. The examination and analysis of data of 122 patients with more than 60% ICA stenosis was held: men — n = 92 (60.1%), women n = 61 (39.9%). The average age was 52.3 years (ranged from 34 to 74 years). All the patients were symptomatic. 92 patients underwent an eversion endarterectomy (CE), 30 patients underwent classical CE.

The effectiveness of surgical treatment was assessed by the dynamics of the neurological status, the change in the parameters of duplex and transcranial studies before the operation, on day 10, at 1, 3, 6, 9 months, 1, 1.5, 2, 3 years.

Results. In patients who underwent eversion CE, in the early postoperative period, a significant decrease in the asymmetry coefficient was revealed in the study of background LSC valuesdue to an increase in the blood flow velocity in the ipsilateral middle cerebral artery (MCA) and a decrease in the linear velocity of the blood flow (LVBF) in the posterior cerebral artery (PCA) on the side of the initially stenotic ICA on the background of improvement of hemodynamic conditions in all cases (p < 0.05). In patients, a significant increase in the reactivity factor for the hypercapnic load from the initial value was noted against the background of approaching the normative indices of the pulsation index. The latent period of vascular reactivity was shortened to 24.3 ± 3.7 seconds. In patients who underwent classical CEAE n = 30, in early terms of up to 1 month, a decrease in the coefficient of asymmetry of LVBF was noted due to the normalization of the velocity characteristics of cerebral blood flow in all the main cerebral vessels of the carotid and vertebrobasilar basins. Comparative analysis of the spectral expansion (SE) values obtained initially and recorded in groups with different types of surgical intervention revealed a significant difference in the resulting data (p < 0.05). Restoration of SE parameters to normative ones was registered in the group of classical CEA in 26.7% (n = 8) and 79.3% (n = 73) with an eversion EAE for 1 month. The maximum rate of positive dynamics was traced during the first month after cerebral revascularization, complete recovery was recorded at the end of the 18th month in the group of eversion CE and 24 months in the group of classical CE. There were no significant differences in the resultant indices of regression of neurological disorders in the postoperative period of an eversion EAE and classical EAE (p > 0.05).

With the eversion CE, the total number of complications was n = 9 (9.8%), and 1 (1.1%) case — restenosis in the reconstruction zone. In the case of classical CE, the total number of complications was n = 10 (33.3%), of which n = 1 (3.3%) cases of hyperperfusion syndrome were observed; in n = 2 (6.6%) patients, development of a stroke, 1 (3.3%) developed myocardial infarction. Restenosis in the reconstruction zone was formed in n = 2 (6.6%) patients, peripheral nerve damage was in n = 4 (13.3%) patients.

Conclusions. Classic and eversion CE are both effective. Short- and long-term clinical and hemodynamic results of surgical treatment by the method of eversion of the CE are somewhat better than the results of classical one.

Classical CE is indicated in cases of extended plaque, eversion of the CE is indicated in the cases of short local plaques. 

Purpose. Investigation of the effect of the Metronizatol on the biological effect of Doxirubicin.

Materials and methods. The studies were performed in the CBA/Lac males and C57Bl/6 females mice grafted with melanoma B16 and mucinous ovarian cancer CaO‑1. Metronidazole and Doxorubicin were used in the work. The antitumor effect was assessed by tumor volume and inhibition of tumor growth.

Results. The data obtained indicate that Metronidazole used in oncologic practice for the treatment and prevention of infectious complications, and as a radiosensitizer, can enhance the antitumor effect of Doxorubicin, but this effect is accompanied by a significant increase of the cytostatic toxicity. These effects are leveled by increasing the interval between injections of Metronidazole and Doxorubicin up to 4 hours.

Conclusion. The enhancement of the antitumor activity of Doxorubicin under the influence of Metronidazole depends on the interval between the administration of these drugs. When Metronidazole is used in cancer patients, the possibility of enhancing the toxic effect of cytostatics should be considered when they are simultaneously exposed. Patients receiving chemotherapy should be administered antitumor drugs no earlier than 4 hours after exposure to Metronidazole. 

Objective. Assessment of the rectal cancer (RC) incidence and stage structure trends in the Arkhangelsk region (AR), Russia before and after implementation of national programs for health system reforming based on population data of the Arkhangelsk Regional Cancer Registry (ARCR) over the period 2000–2015.

Materials and methods. Anonymized data on all cases of RC (C19.0‑C21.0) in the AR in 2000–2015 were extracted from the database of the ARCR. Over the study period, 3721 cases of the RC were selected. Age-standardized (ASR) RC incidence rate was calculated. Population number and its age distribution were taken from the Regional Bureau of Statistics, Arkhangelskstat. Time trends were analyzed using segmented regression.

Results. Over the period, an incidence (ASR) of RC in AR increased from 11.5 to 14.2 per 100000. The incidence rates in the male population were higher than in women: 20.3 vs 12.6 in 2015. The growing trend of male incidence was stable. The ASR of RC incidence in female increased significantly by 4.6% per year in 2011–2015. RC ASRs for both urban and rural populations were growing, 12.3 and 20.4 per 100000 in 2015, respectively. StagesI, II, III and IV were established in 14%, 50%, 9% and 21% of cases, however, the stage I in urban residents was detected 4% more often. The proportion of stage I non-significantly varied from 10.6% to 13.3% in 2000–2015. After the introduction of the National Project “Health”, the proportion of the stage IV non-significantly decreased by 5.4% per year, same after the introduction of the All-national Dispensarization it non-significantly increased by 5.4% per year.

Conclusion. Implementation of national programs for health system reforming didn’t provide significant improvement in earlier detection of RC. Introduction of national screening programs is necessary. A higher incidence rates among males and rural population require detailed analysis. 

In this review we continue the publication of data on the problem of malignant neoplasms (MN) associated with human papillomavirus (HPV), in Russia. In a previous publication (Research’n Practical Medicine Journal 2016; 3(1): 66–78. DOI: 10.17709/2409-2231-2016-3-1-9) we at the first time presented the data on the incidence of malignant tumors associated with HPV in the Russian Federation for the period from 2009 to 2014. This article presents updated data on the incidence of in 2015, as well as data on mortality from the MN associated with HPV in Russia with the analysis of trends in men and women in different age groups. The statistics used in the article is calculated according to the annual state reporting documentation of the statistical form of the Ministry of health No. 7 and No. 35, forms 5 and Rosstat data, the combined database of the state of the cancer register of the Russian Federation.

The article discusses modern ideas about the immune therapy of cancer — methods of treatment of oncological diseases based on immunological reactions of the organism to the appearance of malignant cells in it. This area is actively studied in clinical practice in the last decade, and some therapy has already been approved for use by regulators after promising results of clinical trials 3 phase.

Immune therapy is based on antitumor immune cycle — the cascade of processes responsible for the immune system’s response to tumor cells. Involved regulatory mechanisms are targets for various therapies, the overall goal is to restore proper functioning of the cycle and to achieve the elimination of cancer cells.

Currently, the most studied two types of immune therapy — checkpoint inhibitors and adaptive cell therapy. Checkpoint inhibitors increase the activity of body immune cells, reducing the inhibitory influence of the tumor microenvironment and the tumor cells themselves, which allowed them to get out from under the pressure of the immune system during the development of the disease. Adaptive cell therapy, in turn, allows to compensate the lack of active immune against tumor cells.

Mechanisms of action determine the effectiveness of various therapies for different diseases, and for patients inside of one diagnosis. To determine the effectiveness of other treatment prior to a particular patient it is necessary to use the latest achievements in precision medicine, based on the search for new biomarkers and analyzing each patient separately. This approach will significantly reduce costs and save precious time for the patient. 

Treatment of breast cancer (BC) is a complex multidisciplinary problem. Often, radiation therapy is an obligatory component of treatment of breast cancer patients. Numerous large randomized trials have proved the efficacy of adjuvant radiotherapy in both the standard fractionation regimen in a single focal dose of 2 Gy to a total focal dose of 50 Gy for 25 fractions and in modes of hypofractionation using radiation exposure at a larger daily dose with a reduction in the total treatment time. The presented review summarizes the data of the largest studies on the modes of hypofractionation of postoperative radiotherapy for breast cancer. Most of the studies comparing the standard mode of fractionation of postoperative radiotherapy with the modes of hypofractionation showed comparable results for the main oncological parameters with similar tolerability, frequency of complications and good cosmetic results. It also shows the economic feasibility of applying accelerated regimes in everyday practice. Despite the fact that radiotherapy in the mode of hypofractionation has already become the standard of treatment and is recommended for use by the largest European and American cancer associations, indications for its conduct, the criteria for selection in the studies and the range of recommended single focal doses differ. The obtained results do not give an opportunity to confidently judge the advantage of one or another regime. It is necessary to determine the factors of a favorable and unfavorable prognosis, to clarify the indications for the use of various radiotherapy techniques. Therefore, questions about the optimal mode of hypo-fractionation of adjuvant radiotherapy, the timing of its initiation and the criteria for selecting patients for this type of therapy as part of the comprehensive treatment of breast cancer have not yet been fully resolved. Also open is the choice of optimal single and total doses of radiation, its combination with drug therapy.

In economically developed countries, cirrhosis is one of the six leading causes of death at the age of 35–60 years and ranges from 14 to 30 cases per 100000 population. In the world 40 million people die of cirrhosis each year. At 6% of the population of the Russian Federation there is a diabetes mellitus. The combination of diabetes mellitus in patients with cirrhosis of the liver is a common comorbid pathology. Diabetes mellitusis a risk factor for the development of liver cirrhosis, and the incidence of combination of both diseases is quite high, although the frequency of occurrence varies. About 80% of patients with LC may have impaired glucose metabolism, and 30% have diabetes mellitus. Prospective studies have shown that diabetes is associated with an increased risk of developing hepatic complications and death in patients with cirrhosis of the liver. Diabetes mellitus increases the risk of complications of liver cirrhosis of any etiology (varicose veins of the esophagus, hepatic encephalopathy, hepatic-cell insufficiency) and subsequent survival. The incidence, frequency of hospitalizations and mortality from this combined pathology are very high. There are common mechanisms that provoke metabolic and autoimmune disorders in the development of chronic hepatitis and cirrhosis, leading to steatosis, insulin resistance, impaired glucose tolerance and the development of diabetes mellitus. There are certain features of the evaluation of the compensation of carbohydrate metabolism in patients with cirrhosis of the liver, anemia and impaired protein metabolism. Effective control of glycemia can have a beneficial effect on the treatment of these patients. However, few studies have evaluated the efficacy and safety of antidiabetic drugs and the effect of diabetes treatment on morbidity and mortality in patients with cirrhosis. Previously it was believed that in the presence of cirrhosis the only treatment remains insulin. At present, in connection with the emergence of modern groups of hypoglycemic drugs, as well as new approaches to the treatment of type 2 diabetes, this concept has radically changed. Unfortunately, the issues of correction of carbohydrate metabolism in patients with cirrhosis of the liver are practically not covered in the world literature. This article deals with the correction of carbohydrate metabolism in patients with cirrhosis and hepatocellular insufficiency of insulin analogs, biguanides, drugs with incretin effect — dipeptidyl peptidase‑4 inhibitors, agonists of glucagon-like peptide‑1, inhibitors of sodium-glucose cotransporter 2 diabetes. Particular attention is paid to the development of hepatocellular insufficiency and portal hypertension in patients with cirrhosis and type 2 diabetes, as well as processes for their prevention and insulin alternative correction methods.

Reconstruction of the penis in transgender operations, amputation of the penis, congenital deformities and anomalies of the penis was and remains today an important issue in plastic surgery of the urogenital region. The only method to restore the penis is phalloplasty. In general, over the past decades, generations of clinicians have different ways and flaps for total fallouretheral reconstruction. Thus was formulated the characteristics of an ideal flap for the formation of neophallos, which should be safe, sensitive, without hair, and with long leg. However, despite the fact that the characteristics of a perfect flap, nowadays there is no “gold standard” in the formation of neophallos, as phalloplasty is a fairly complicated surgery, and the choice of method depends on many factors. The choice of methodology is determined by the plastics surgeon and to each patient is individual, depends on the etiology of the disease and the possibility of choosing the form of the donor’s transplant. This article presents a literature review devoted to the historical aspects of phalloplasty. In the article, in chronological order reflected the evolution of the different forming methods neofallos, phallourethrоplasty, describes their advantages and disadvantages.

Distant metastasis of thyroid cancer are founded in 10% of all metastases. Bone metastases are founded in 23% of distant metastasis. Complications associated with metastatic skeletal involvement often lead to a deterioration in the overall condition and a decrease in the quality of life of patients. Surgical treatment, chemotherapy are less effective, provide a higher injury rate and toxicity. This is a reason of increasing of cost of treatment. Bisphosphonates are a class of drugs that prevent the loss of bone mass, which can prolong the time to releasing bone complications: bone fracture, spine column fracture with spinal medulla compression, which decrease the QoL. Surgical treatment and chemotherapy have worse outcomes, higher injury rate, toxicity and increase cost of treatment. Bisphosphonates decrease the level of pain syndrome. Bisphosphonates are used in treatment of oncological patients since 1990. First medication was Fosamax (Aledronat). Later more medications with better efficacy and more useful were synthesised. The last one was Zoledronic acid. Rezorba (zoledronic acid) was synthesised in 2006 in Russia. Rezorba has a same efficacy with other bisphosphonates, it was shown in clinical studies with groups of breast cancer and prostatic cancer. Clinical case of 67 y.o. male patient with diagnosis: Thyroid cancer IV c st pT1bN1bM1, right neck, paratraсheal, bone and lung metastasis. Complex treatment (surgery + radioiodine therapy + 5 courses of Rezorba) was presented. After 3 courses the level of pain was decreased from 3 to 1,5. After 5 courses the ECOQ score was decreased from 2 to 1 point. Inclusion of Resorba in complex treatment of patients with bone metastasis after thyroid cancer at all stages of treatment decreases the score of pain syndrome and bone tissue reparation.

Extensive liver resections are the main method of treatment of patients with primary and metastatic liver cancer, which allows the noticeable prolongation of life. In patients with a reduced functional reserve of the liver or a missing volume of the remaining liver parenchyma, these interventions become impossible because of the increased risk of postresectional acute hepatic insufficiency. One of the most modern and promising ways to overcome this obstacle is the use of minimally invasive methods of tumor destruction. This article presents two observations of the clinical application of the laser ablator “Echolaser X4”: open laser ablation of the metastatic focus with subsequent atypical liver resection and percutaneous laser ablation of the metastasis of the neuroendocrine tumor into the liver. The presented experience testifies to the justification of using laser destruction of metastatic malignant liver tumors and demonstrates the possibilities of laser thermoablation therapy in patients who can not perform radical surgical treatment.

Results of sociological research of problem questions of regulation of personnel processes in the medical organizations are presented in this article. The problem of reforming medical organizations is characterized. Proposals on the solution of currently important problems of personnel regulation in medical organizations are formulated.

The purpose of the research is to substantiate the directions of improving the management of personnel processes in modern medical organizations based on the sociological analysis of personnel processes and relations in medical organizations.

Materials and methods. The paper presents the results of a sociological study of the condition and problems of regulation of personnel processes in medical organizations. The survey involved 240 respondents from among the employees of medical organizations and 97 qualified medical experts.

Results. It is proved that the successful functioning of medical organizations is possible with a scientific approach to the management of personnel processes and relations, including analysis of personnel policy issues, sociological support of personnel processes regulation, development of human resources technologies in modern medical organizations.

Conclusions. Successful functioning of medical organizations is possible with a scientific approach to the management of personnel processes and relations, including analysis of personnel policy issues, sociological support of personnel processes regulation, development of modern personnel technologies in medical organizations. Achievement of effective management of personnel processes in medical organizations requires the development and implementation of scientifically sound human resources policy in the health care system, improving the regulatory and organizational support for the regulation of personnel processes, enhancing the role of self-regulatory organizationsin the management of personnel processes in medical organizations. 

The relevance of the study is determined by the need to attract private investment in the field of municipal health care with the aim of improving the system of outpatient urological care.

Purpose. To determine the vectors of development, planning, the basic conditions for the implementation of municipalprivate partnership (IMPP) in the system of municipal outpatient urological care.

Materials and methods. To achieve this goal, general scientific methods of analysis, synthesis, generalization, interpretation of scientific data, as well as systemic and structural-functional approaches were applied in the work.

Results. The article provides the scientific substantiation of the role of municipal-private partnership in the development of municipal outpatient urology. Methodical approaches to the formation of the outpatient center of urology with the mechanisms of the mixed economy, developing business processes involving private investor resources in the reproduction processes and increasing the efficiency of the municipal system of outpatient urological care are outlined.

Conclusions. The article defines the vectors of development, planning, the main conditions for the implementation of municipal-private partnershipsin the system of municipal outpatient urological carein order to attract privateinvestments and develop an outpatient urology system. 

The purpose of the study. The study of morbidity with temporary disability of working officers of the Navy, retired and resigned, as well as affecting the level of certain factors.

Materials and methods. A sociological survey of 574 officers of the Navy, who were dismissed from the Armed Forces to the reserve (resignation), was held. 32.7% of them at the time of the survey have been working.

Results. 48.8% of respondents rated their health at the time of the survey as a good for their age. The level of morbidity with temporary disability (MWTD) in 100 operating reserve (retired) officers amounted to 94 cases. The number of days of temporary disability was equal to 867 days per 100 employed military pensioners. Most long-term treatment (up to 47 days) were required for patients with blood diseases. Analysis of the structure of diseases of reserve (retired) officers leading to temporary disability, showed that the bulk of the cases (63.7 per cent) were diseases of the respiratory organs, in second place were diseases of the circulatory system (24,5%), the third — diseases of the genitourinary system (4.3%). The average number of existing diseases to working military retirees less than idle: 1.9 vs 2.1. The average number of diseases at the single soldiers discharged was significantly more than that of living in family.

Conclusion. The features of level and structure, as well as risk factors of MWTD should be considered in the development and adoption of administrative decisions directed on preservation and strengthening of health of reserve (retired) officers. 

Purpose. Assessment of the received emergency medical services (EMS) in patients with cardiological profile in the South Kazakhstan region.

Materials and methods. A sociological study was carried out among three compared groups: group 1 — patients of the regional cardiological center (312); 2nd — those who applied to rural outpatient clinics, polyclinics, hospitals (244), and the 3rd — who applied to the central district hospital (228).

Results. The analysis showed that 65.1% of the respondents applied for EMS over the diseases of the circulatory system, mostly they did it 1–2 times a year (44.9%), less often several times a month (15.1%). Several times a week 5.1% of patients were called to EMS. It was found that in 65.5% of cases there was a rapid arrival of the EMS, less than 20 minutes. It should be noted that a long wait for the arrival of the EMS (45 minutes or more) took place in 10.2% of cases. The waiting time, as the reason for the dissatisfaction of the EMS, was more often called the respondents of the 2 nd and 3 rd groups — 94.1% and 93.9% versus 76.5% in the 1st group (p < 0.05). Inattentive attitude of the staff was more often noted by the patients of the 3rd group, and the low availability of free medication was most often indicated in the 1st group.

Conclusion. The received characteristic of the EMS and its assessment by patients with diseases of the circulatory system should be taken into account when developing a package of measures to optimize cardiac care in the region.