Purpose. Conducting a comparative analysis and assessment of the dynamics of endemic goiter and iodine deficiency in the population of boys of the Republic of Dagestan at the age of 11–13 years for the period 2002–2013, living in different ecological and geographical zones.

Patients and methods. 3457 adolescent boys 11–13 years old, living in different ecological and geographical zones, were surveyed. Methods of investigation were: determination of daily excretion of iodine in urine, palpation and ultrasound examination of the thyroid gland.

Results. It was revealed that during the period of preventive measures there was an improvement in iodine supply regardless of the area of residence. However, against the background of preventive measures in the lowland zone, iodine deficiency decreased not evenly, and in some cases the aggravation occured.

Conclusion. The incidence of endemic goiter and the severity of iodine deficiency in boys aged 11–13 years in the mountain and foothill ecology and geographical zones of the Republic of Dagestan are generally comparable to those of iodine deficiency and endemic goiter in the general population of the Republic of Dagestan. On a flat ecogeographical zone, endemic goiter in boys 11-13 years is less common than in the general population in this region. Preventive measures to combat iodine deficiency have led to a decrease in the frequency of endemic goiter, but constant monitoring is required. As a result, there was no correlation between the incidence of endemic goiter and the severity of iodine deficiency.

Osteoarthritis (OA) is the most frequent rheumatological pathology of the joints. Standard medical treatment does not always allow to stop the pain syndrome. The alternative method of pain treatment causes by OA is orthovoltage X-ray therapy (OVRT). It was used from 1970. The maximum dose by OVRT lies on the skin surface. Based on the modern methods of diagnosis, choosing the appropriate radiation energy, it is possible to reduce the amount of irradiation of the knee joint.

The purpose. Is to present the technique of radiation planning in patients with gonarthritis and compare it with OVRT by dosimetry criteria.

Materials and methods. Comparison of dose distribution plans of the orthovoltage beam was carried out according to the two-dimensional axial plan in the area of the isocenter for the energy of 200 kV from two tangential fields and a megavoltage energy beam of 6 MeV for a three-dimensional conformal radiation therapy using 3-and 6-fields isocentric irradiation techniques. To describe amounts of radiation were applied to the CTV (clinical target volume) and PTV (planning target volume). To estimate the volume distribution of the dose, bones forming the knee joint were contoured separately. The indent on the PTV was 3 mm.

Results. The application of the 6-fields technique allows achieving 95% dose distribution at 93% of the volume, and 90% of the planned dose of 45 SGR covers 97% of the PTV. The average dose on the skin and the neurovascular bundle are of 150 and 240 cGy, respectively. The average radiation dose per course in critical anatomical areas is 280 cGy and 150 cGy. It can be considered that the target coverage for the compared methods is similar as for OVRT, and for 3D conformal radiation therapy plans for dose distribution of the orthogonal beam in the axial plane in comparison with dose distributions for conformal radiation techniques.

Conclusion. The technique of three-dimensional conformal radiation therapy of the knee joint in OA with progressive pain syndrome can potentially lead to an increase in the analgesic effect due to greater coverage with a dose of bone elements of the joint, which are a potential source of pain. Three-dimensional conformal radiotherapy megavoltage beam allows reducing the radiation load on the skin in 2.5 times, which can reduce the frequency of delayed adverse effects.

Aim. To study the effect of non-selective inhibitor of NO-synthase N-nitro-L-arginine methyl ester (L-NAME) and substrate of nitric oxide synthesis L-arginine on the activity of cathepsins B, L, H and its subcellular distribution in liver, kidney and lung tissues.

Materials and methods. The object of study – male rats Wistar line, the material was the cytoplasmic and lysosomal fraction of homogenates of liver, kidney, lung tissues. A non-selective inhibitor of inducible NO-synthase N-nitro-L-arginine methyl ester (L-NAME) was applied at a dose of 25 mg/kg, the substrate of NO synthesis L-arginine – at a dose of 500 mg/kg. Activity of cathepsins B, L, H was defined separately in the cytoplasmic and lysosomal fractions by spectrofluorometry quantitative determination of the specific substrate cleavage product 7-amido-4-methylcoumarin.

Results. Suppression of nitric oxide synthesis by non-selective inhibitor of NO-synthase L-NAME (25 mg/kg, 7 days) in the kidney tissue leads to a decrease in the activity of cathepsins В, L, H in lysosomal fraction with a parallel increase in non-lysosomal activity of cathepsin L, in the liver tissue leads to an increase in lysosomal activity of cathepsin H and a decrease in non-lysosomal activity of cathepsin L. The substrate of nitric oxide synthesis L-arginine (500 mg/kg, 10 days) only causes increased activity of cathepsin L in non-lysosomal fraction of liver tissue, leads to increased lysosomal activity of cathepsin H in kidney tissue, the lung tissue shows a significant increase in the activity of the all studied cathepsins in non-lysosomal fraction, accompanied by an increase in lysosomal activity of cathepsins B and H. The revealed changes are associated with the signs of changes in the ratio of pro-enzyme and active forms of cathepsins.

Conclusion. The effects of non-selective inhibitor and substrate of nitric oxide synthesis on the total activity of cathepsins B, L and H in parenchymatous organs and its subcellular distribution are tissue-specific and multidirectional in some cases and are accompanied by signs of changes in the ratio of pro-enzyme and enzymatically active forms mainly due to an increase of pro-enzyme forms.

In recent decades, significant progress has been made in understanding the mechanisms of platelet function and platelet hemostasis correction. Platelets are considered as the most important participants of both normal, and pathological thrombotic process characteristic of the most different diseases and states. In the present review pathophysiological mechanisms of platelet synthesis of various mediators with paracrine effects, which can influence the function of other cells, are consecrated. The physiology of platelets was considered in detail. The leading role of platelets in pathogenesis of the majority of diseases of cardiovascular system as modulators of inflammatory reactions of the immune response which are considered as the leading mechanism of development of atherosclerosis was shown. The ability of platelets to encode inflammatory proteins allowing them to influence adaptive immunity functions was discussed. The role of platelets as a key component of the innate immune system was presented, which is confirmed by the presence of Tolllike receptors (TLR) and glycoproteins, such as integrin αIIbβ3, glycoprotein Ib-IX and FcγRIIa, involved in interaction with bacterial cells. The pathogenesis of the formation of platelet-leukocyte aggregates due to the rapid reversible interaction of P-selectin (CD62P) on the platelet surface with ligand-1 glycoprotein P-selectin (PSGL-1) on the plasma of leukocytes and the mechanism of extracellular neutrophil traps (NETs), as well as the influence of platelets on the function of lymphocytes was presented. The role of platelets in cancer progression, metastasis and thrombosis is considered, and the interrelation of thrombosis and metastasis in malignant diseases was analyzed. The efficiency of the use of antithrombotic drugs in the prevention of thrombosis and, as a consequence, in the prevention of cardiovascular diseases and cancer was discussed.

Providing a high quality of life for a man after performing radical prostatectomy for prostate cancer is currently one of the topical problems of urology and andrology. Nervous-protective radical prostatectomy is one of the high-tech operations in urology and the surgeon’s task is not only to remove the tumor of the prostate gland, but also to ensure a high quality of life for the patient. The importance and urgency of this problem is evidenced by the fact that most of the issues that arise in patients in conversation with a surgeon before surgical intervention are devoted to it.

The National Institute of Health of the USA shows that the incidence of prostate cancer is about 9.5% per year, and the localized form began to occur in younger men. In this regard, the surgeon faces the task not only to cure the patient of malignant education, but also to maintain the erectile function and the continent’s indicators, thereby improving the quality of life.

At the present stage, diagnostic methods make it possible to detect early prostate cancer much more often, so that the identification and treatment of such patients become more accessible and allows the use of this operation. However, for the preservation of the neurovascular bundle, it is mandatory to know the anatomical features of this zone.

Over the past few decades, anatomical studies have been conducted that described the neuroanatomy of the prostate and the adjacent tissue. This article summarizes the latest results of studies of neuroanatomical studies, some of which contradict the established consensus on pelvic anatomy.

Breast cancer is the most frequent and socially signifi cant malignant tumor disease of the female popula on of the Russian Federa on. At present, for the treatment of this pathology, the methods of the organ-preserving surgical manual allowing to achieve the maximum cosme c eff ect along with the observance of the principles of cancer safety are ge  ng more and more developed,. In recent decades, researchers from diff erent countries demonstrate the feasibility and technical safety of various mini-invasive methods of thermal abla on of early stages of breast cancer, characterized by rela ve simplicity of implementa on, excellent cosme c results, short-term rehabilita on of pa ents. These include hyperthermic techniques (radiofrequency, microwave, laser abla on) and hypothermic method (cryoabla on). Each technique has unique characteris cs of impact on the tumor and is performed under the control of ultrasound, computer tomography or magne c resonance imaging. The technical success of these abla on techniques is achieved in 93–98% of cases. Complete tumor necrosis a er radiofrequency abla on is observed in 76–100% of pa ents with breast cancer, laser abla on – in 13–76%, microwave abla on – in 0–8%, cryoabla on – in 36–83%. The frequency of development of specifi c complica ons of local thermal destruc on is 4–13%. To date, there is only one method of noninvasive extracorporeal thermal abla on of tumors of diff erent localiza on – high-intensity focused ultrasound therapy, the eff ec veness and safety of which as a method of local destruc on of benign and malignant tumors of the breast demonstrated by many authors. Like all methods of thermal abla on, high-intensity focused ultrasound therapy has its limita ons, complica ons and disadvantages. This ar cle presents a literary review that highlights the possibili es of this method of local destruc on in pa ents with malignant tumors of the breast.

This ar cle discusses the use of EGFR inhibitors in the treatment of pa ents with colorectal cancer. The mechanisms of their ac on, specifi c manifesta ons of toxicity are considered. A review of current literature data on the use of both approved for clinical use (cetuximab, panitumumab) and an -EGFR an bodies at the stage of clinical trials is presented. EGFR inhibitors are one of the main groups of targeted drugs used to treat pa ents with colorectal cancer. The correla on between toxicity and effi  cacy of these drugs is discussed separately. The scope of their applica on is limited to the treatment of disseminated forms of the disease, but in the future the number of available an -EGFR an bodies may grow, the possibility of their use in new condi ons, including in the framework of chemoradiotherapy.

The article analyzes the data of 414 patients with scrotal and testicular injuries treated in 2008–2017 by the forces of urgent andrologic service in Moscow.
More than 90% of patients who applied for injury to the scrotum and testicle were under the age of 60 years. In peacetime, in the conditions of the metropolis (Moscow) in the vast majority of cases there is a blunt (without breaking the integrity of the skin) injury of the scrotum and testicle (a total of 89.4%). Of these, 77.3% are blunt sports and domestic injury of the testicle of varying severity with a pronounced predominance of relatively light injuries, in particular, the bruise of the testicle. Open injuries are relatively rare-a total of 10.6%. Among open injuries, ruptures of the scrotum without damage to its organs are predominate (63.6% of the total number of patients who applied for open wounds of the scrotum and its organs).
The need for emergency surgical interventions in scrotal injury was unexpectedly low-53.1%, which is due to the predominance of mild trauma options – scrotal injury and testicular injury (a total of 61.4% in the frequency of urological care), in certain situations allowing the possibility of conservative treatment or even dynamic observation.

Purpose. The goal is to determine the real possibili es of assessing the fetal condi on in the ante- and intranatal periods according to the data of cardiotocography.

Paents and methods. 73 pa ents with physiological pregnancy at 24-40 weeks were prospec vely examined. The prac cal signifi cance of the g6b plus General MEDITECH automated fetal monitor, which allows to determine the condi on of the mother and fetus at the same  me, was evaluated.

Results. The average blood pressure in the examined women was 127.2 ± 3.6 by 73.7 ± 2.3 mm. gt; pillars, pulse – 76 ± 1,5 beats/min. As for the contrac le capacity of the uterus, 47 (64,4%) pregnant women in 24–30 weeks. associated with diagnosis, and 19 (26%) – are harbingers of the forthcoming birth. The average SpO₂ was 99.12 ± 0.11%. Regardless of the gesta onal age, in 7 (9.6%) pregnant women – 97%, 40 (54.8%) – 99% and 21 (28.8%) – 100%. In order to assess the fetal condi on by the nature of his heartbeat, we performed an automated CTG analysis according to W. Fisher, D. Redman, FIGO: according to W. Fisher, depending on the gesta onal age of 6–7 points, 12 (16.4%) pregnant women in 25–26 weeks and 9 (12.3%) – 40 weeks, which according to the ball scale corresponds to a suspicious type. The Doze–Redman criteria were met in 47 (64.4%) pregnant women and were not met – in 26 (35.6%). Interpreta on according to FIGO guidelines as normal was detected in 64 (87.7%) pregnant women and in 9 (12.3%) – doub ul. Depending on the period of pregnancy, this group consisted of the same 9 (12.3%) pregnant women in a period of 40 weeks.

Conclusion. Automated analysis allows for the correla on between the main indicators of the well-being of the maternal organism (SpO₂, blood pressure, pulse, body temperature, ECG) and fetal CTG parameters (Fisher scale, Dowz Redman criteria and FIGO guidelines) to develop obstetric tac cs for each specifi c pa ent during pregnancy and childbirth.

Purpose. Determine the survival of the auto-fat gra  a er lipofi lling in the process of reconstruc on in pa ents with breast cancer.

Paents and methods. The study included 60 pa ents who underwent lipofi lling both at the fi rst stage of recons tu on and at its fi nal stages. The ar cle describes the procedure for performing the lipofi lling procedure, monitoring and evalua on of the degree of survival of the autologous transplant.

Results. As a result of the study, we determined the average survival rate of adiposessue in the recipient zone, which was 76.50% (p <0.00001), which further posi vely aff ects the subsequent stages of reconstruc on and the fi nal result as a whole.

Conclusion. Given the good survival of the auto-gra , lipofi lling is part of the surgical rehabilita on of pa ents a er combined / complex / surgical treatment. The procedure is applicable in the fi rst stage of delayed reconstruc on, with the replacement of the  ssue expander with a silicone endoprosthesis and as a correc ve method at the fi nal stage of reconstruc on.

In the last 10 years there has been a revolu on in the fi eld of computer image analysis and pa ern recogni on. Modern algorithms of computer vision equaled and even in some problems surpassed human capabili es. This jerk is largely due to the emergence and development of the technology of deep convolu onal neural networks.

Recent developments in the fi eld of image processing and machine learning open up the prospect of crea ng systems based on ar fi cial neural convolu onal networks, superior to humans in problems of image classifi ca on, in par cular, in solving problems of analysis of various medical images. Among the most promising applica ons: automated recogni on and classifi ca on of skin diseases, detec on of pathologies on X-ray, CT, MRI, ultrasound imaging. In the proposed project, we will focusour a en on on the diagnosis of human skin diseases.

At the moment, melanoma is one of the most dangerous types of malignant tumors of the skin with a lot of deaths due to rapid metastasis, which is difficult to treat. The development of computer vision technology has allowed the development of technical vision systems that allow detec on and classifi ca on of skin diseases with a quality that is comparable and in some cases exceeds the values a ained by man.

In this paper, the authors propose an algorithm for the primary diagnosis of skin melanoma based on deep neural networks, achieving an accuracy of 91% for melanoma in dermatoscopic images. At the moment, the algorithm is implemented programma cally and is used in the test version of the online system for detec ng and classifying skin diseases, available at skincheckup.online.

Thanks to this development, the prospect of a signifi cantincrease in the propor on of people subjected to preven ve examina on for the presence of skin diseases opens up. Along with this, an addi onal source of informa on for specialized professionals can also play a role in seng the right diagnosis.

Planned surgical interven ons account for more than half of all opera ons in the Russian Federa on, of which more than 20–30% are performed for oncological diseases. Characteris c is an increase in the number of operated pa ents in older age groups with severe concomitant pathology and a high percentage of postopera ve complica ons, including due to psychoemo onal pathology, which can be excluded or adjusted at the preopera ve stage.

Purpose. Evalua on of the infl uence of the psychoemo onal state of the oncochirical soma cally burdened patient on the lethality and revealing the possibility of correc on of the psychoemo onal state at the preopera ve stage.

Paents and methods. In the period from 2006 to 2016 in the departments of therapy and oncology of the Regional Clinical Hospital of the City Clinical Hospital No. 40 of the Moscow City Health Department, AI.Burnazyan The FMBA of Russia analyzed the treatment of 958 soma cally burdened pa ents with various oncopathology who underwent opera ve interven on in a planned manner. An analysis of the psychoemo onal state of pa ents before and aft er surgery was performed using Hamilton diagnos c scales.

Results. After a retrospec ve evalua on, it was determined that prac cally all patients of the oncosurgical profi le undergo various psychoemo onal strains of varying strength and dura on, both before and after surgery. This can disrupt the blood fl ow in the organs andssues, and lead to various complica ons, which manifests itself in the form of hypoxia and ischemia, which, in turn, jus fy the development of postopera ve delirium and myocardial infarc on.

Conclusions. Clear distinctions between the anxiety severity in groups on outcomes of hospitaliza on of the oncosurgical patient were determined, and the tendency of the rela onship between the level of the anxiety state and the postopera ve complica ons that had been ridden in the early postopera ve period in soma cally burdened pa ents was determined. Patients of the oncosurgical profi le without fail are shown psychopharmacotherapy in the pre- and postopera ve periods, depending on the revealed pathology.

The presented clinical observa on of a 41-year-old pa ent with an autosomal dominant form of osteopetrosis type II is interes ng not only from the point of view of the complexity of diagnosis of a rare genetic disease complicated by spinal stenosis, but also to determine the tactics of treatment. The patient was examined and treated by phthisiatricians. Histological examina on of the material obtained with trepanobiopsy showed dystrophic changes in bone tissue and poor infi ltra on with lymphocytes; data for tuberculosis of the spine was not revealed. Taking into account the pronounced neurological disorders on the background of spinal cord compression, as well as the instability of the spine, the patient was carried out pallia ve surgery (open biopsy with decompression of the spinal canal, posterior laminar fi xa on of Th_VIII—LII and anterior fi xa on of Th_VIII–XII combined  tanium implant).  Histological examina on of tissues obtained by open biopsy allowed to suspect a rare disease and fi nally verify the diagnosis after genetic examina on.

The authors present to your a en on a rare clinical case of complete intersec on of the superior mesenteric artery in laparoscopic radical nephrectomy. This complica on emerged in the process of learning the technique of laparoscopic radical nephrectomy, before reaching the “plateau” of the learning curve, in condi ons of poor vision and in the interposi on of tissues due to paratumorous infitiltra on. This type of injury has a high risk of total necrosis of the small intestine. However, due to the concerted ac ons of the surgical service and the readiness of surgeons to complete the vascular suture of the main vessels, a successful reimplanta on of the superior mesenteric artery into the aorta was performed. This is confi rmed by postopera ve observa on and examina on, which included CT angiography. It should be noted that descrip ons of cases of aor c reimplanta on of the superior mesenteric artery are extremely rare in the world and national literature, except for cases of mesenteric ischemia. This case contributes to the description of rare cases of aor c reimplanta on of the superior mesenteric artery and shows the correctness of the selected surgical tactics.

Purpose. The defi ni on of structure of visits to doctors in the city policlinic.

Materials and methods. According to the results of doctors interviewing, a form for registra on of pa ents visits was designed. 2531 visits to the therapists, urologists and surgeons were registered.

Results. The propor on of visits not related to the medical care was: therapists – 46%, surgeons – 23,4%, urologists –26,9%. The reasons for visits not related to the medical care were: for preferen al prescrip ons; the doctors opinion for medical and social examina on, for health resort card, for providing to other ins tu ons, cer fi cates; for referral to take tests, research and obtaining their results, for consulta on, hospitaliza on in other ins tu ons.

Conclusion. In the structure of visits to doctors of the city polyclinic, a high propor on of visits are not related to the medical care.

Based on the analyses of normative-legislative documents related to medical activities in RF published between 1990 and 2017 the classification of medical facility legal risks has been formed. The usage of the classification enables building systematic approach for legal protection.

The right for health protection is ensured also by providing paid medical services according to the Federal Act on Public Health Care. It doesn’t follow from Russian legislation that this right could be exercised only in private medical institutions, which makes public medical institutions legitimate participants of the process. However, in accordance with the Government Resolution No. 1006, there is range of restrictions for public medical institutions in case they provide paid medical services. For instance, they must justify charging by informing consumers about their rights guaranteed by the State guarantees program.

The analysis of normative-legislative documents that ensure regulation of public medical services caused the classification of legal risks. The violation of the Consumer Protection Act and of the Civil Code (contractual risks) appeared to become the most common ones.

There is no clear notion of “medical error”. That’s why it is almost impossible to make a distinction between patient irresponsibility, staff negligence or low doctor’s professionalism. This is the reason for patients’ rights as well as medical personnel responsibility to be regulated by the state.

The analysis that is been made shows that risks and sanctions in the provision of Paid Medical Services by State institutions occur in cases of misconduct while providing Paid Medical Services. The most typical cases of misconduct while providing Paid Medical Services come when: medical services could be provided under the State guarantees program; failure to provide medical care occurs; violation of medical and contractual documents in the provision of Paid Medical Services takes place; violation of patient’s rights to receive complete and reliable information related to medical care takes place.