№1, 2019, volume 15

Objective: to evaluate the outcomes of various methods of surgical interventions and functional properties of lower extremities in patients with complicated ankle fractures. Material and Methods. Clinical outcomes of 140 surgically managed patients with unstable bimalleolar and trimalleolar fractures were studied. 80 patients were managed with external fixation devices applied by original method (main group) and 60 patients were managed with submersible structures (comparison group). Results. Compared to submersible structures, the use of transosseous metalosteosynthesis has led to 100% ankle fracture unions. In early postsurgery period the index of average anatomic and functional result reached values of 93.4% corresponding to "good" and 6.6% corresponding to "satisfactory". Conclusion. It has been established with rheovasography data that transosseous osteosynthesis contributed to restoration of blood microcir-culation in the damaged segment of lower extremity in 8 weeks period after surgery and submersible structures in 6 months period.

 Literature review is devoted to the analysis of scientific findings about extraosseous effects of vitamin D on the immune system of the periodontal tissues. It was found that the biological functions of vitamin D (VD) in the body are diverse.Along with the detailed study of the effect on metabolic processes in bone tissue, VD makes a significant contribution to a large number of processes that ensure the activity of the immune system. In addition, VD increases the production of "endogenous antibiotics". This allows us to consider VD as a therapeutic agent that prevents the development of inflammatory and destructive changes in the periodontal tissues in population with simultaneous slowing of bone loss and preservation of bone mass of the dentofacial system. Currently detected hidden hypovitaminosis VD in almost majority of the population is considered a leading factor in the development of periodontal disease and its prevention and treatment is one of the most important tasks of therapeutic dentistry.

Leukemia in children (leukemia) is a systemic hemoblastosis, accompanied by a violation of bone marrow hemato- poiesis and replacement of normal blood cells with immature blast cells of the leukocyte series. Acute megakaryoblastic leukemia-one of the rarest forms of acute leukemia (1-3% of all leukaemias), which is characterized by the presence in the blood and bone marrow, along with undifferentiated blasts also megakaryoblasts, ugly megakaryocytes and platelet clusters. The work presents a clinical case of congenital acute megakaryoblastic leukemia in the child S., combined with the mosaic form of Down syndrome and a congenital heart defect.

Purpuse: to research the gender-specific features of cardiovascular disease in the group of patients with chronic obstructive pulmonary disease (COPD). Material and Methods. We conducted a cross-sectional retrospective research of 419 patients hospitalized with exacerbation of COPD to the Pulmonology Department of Saratov Clinical Hospital №8 from 2015 to 2017 By the method of independent target sample, taking into account gender and multimorbidity 169 patients with COPD and cardiovascular disease were included into the research. Results. Relation between the nosological forms and the frequency of occurrence of cardiovascular pathology in the group of patients with COPD is gender- dependent. Gender features of heart remodeling in the group of patients with COPD and cardiovascular pathology are revealed. Women have more therapy adherence. Conclusion. The data that we obtained indicate the characteristics of the formation and course of the cardiovascular pathology in patients with COPD gender-dependent. Research of the features determines the optimal tactics of treatment, improves the prognosis and quality of life of co-morbid patients.

This article aims to provide an analytical review of existing organizational and methodological approaches to the prevention and control of chronic kidney disease (CKD) in the Russian Federation. Various aspects of the current situation of CKD in the Russian Federation are considered and national institutional mechanisms applicable to this state are analyzed. Despite the obvious positive developments in the prevention of noncommunicable diseases in the Russian Federation, the problem of CKD in Russia is not sufficiently covered as a result of this situation there is personnel and methodological deficit, weak interdisciplinary interaction of health care organizations, as well as underreporting of specific nephrological risks of CKD progression.

The review of literature is devoted to the problem of cervical intraepithelial dysplasia in pregnant women. For the analysis, publications in the PubMed from 2013 till 2018 database were used.

Aim: to compare the effectiveness of salpingostomy with the subsequent evacuation of the ovum and the resection of a part of the ampulla of the fallopian tube with the ovum and the subsequent neostomatoplasty in the treatment of tubal pregnancy. Material and Methods. A retrospective randomized study of the effectiveness of two techniques of endoscopic organ-sparing surgical treatment of ectopic tubal pregnancy was conducted. Results. The time for performing salpingostomy and resection was 11.8±1.5 minutes and 21±2 minutes, respectively (U[12458]=0, p=0.001). Compared with salpingostomy, the thread did not lead to the appearance of a trophoblast, which was accompanied by a decrease in the degree of adhesions in the pelvis in the third month of observation (PAI showed 2 (2; 2) and 0 (0; 1) points, respectively U =759, p=0.001; R-AFS corresponded to the minimum degree of severity: 2(0; 2) and 0 (0; 0) points, respectively (U4 =1076, p=0.001); according to the modified classification of the degree of adhesions in the pelvis after cesarean section corresponded to the minimum degree of severity: 4 (0;4) and 0 (0;4) points, respectively (U[12458]=2617, p=0.006)and more frequent the operated fallopian tube (30.6% and 58,6%, respectively, p=0.001)was accompanied by a more frequent onset of spontaneous uterine pregnancy by the 12th month of observation (12.9% and 29,3%, respectively, p=0.007) and delivery to 18 months of observation (3.2% and 15.5%, respectively, p=0.001). Conclusion. Despite the higher technical complexity, resection of a part of the ampulla of the fallopian tube with a fetal egg and subsequent neostomatoplasty is an effective alternative to salpingostomy andmay be used in women with an ectopic pregnancy wishing to preserve reproductive function.

Aim: to compare the effectiveness of salpingostomy with the subsequent evacuation of the ovum and the resection of a part of the ampulla of the fallopian tube with the ovum and the subsequent neostomatoplasty in the treatment of tubal pregnancy. Material and Methods. A retrospective randomized study of the effectiveness of two techniques of endoscopic organ-sparing surgical treatment of ectopic tubal pregnancy was conducted. Results. The time for performing salpingostomy and resection was 11.8±1.5 minutes and 21±2 minutes, respectively (U[12458]=0, p=0.001). Compared with salpingostomy, the thread did not lead to the appearance of a trophoblast, which was accompanied by a decrease in the degree of adhesions in the pelvis in the third month of observation (PAI showed 2 (2; 2) and 0 (0; 1) points, respectively U =759, p=0.001; R-AFS corresponded to the minimum degree of severity: 2(0; 2) and 0 (0; 0) points, respectively (U4 =1076, p=0.001); according to the modified classification of the degree of adhesions in the pelvis after cesarean section corresponded to the minimum degree of severity: 4 (0;4) and 0 (0;4) points, respectively (U[12458]=2617, p=0.006)and more frequent the operated fallopian tube (30.6% and 58,6%, respectively, p=0.001)was accompanied by a more frequent onset of spontaneous uterine pregnancy by the 12th month of observation (12.9% and 29,3%, respectively, p=0.007) and delivery to 18 months of observation (3.2% and 15.5%, respectively, p=0.001). Conclusion. Despite the higher technical complexity, resection of a part of the ampulla of the fallopian tube with a fetal egg and subsequent neostomatoplasty is an effective alternative to salpingostomy andmay be used in women with an ectopic pregnancy wishing to preserve reproductive function.

 The aim: to study the content of a-amylase in oral fluid in healthy young people (mean age 18 years), depending on the presence of a predictor of inflammatory diseases of the oral cavity in physiologically adjusted drinking behavior against the background of educational stress. Material and Methods. For three months, we studied three groups: the main group (30 people, consumed water 30-35 ml per 1 kg of body weight treated with the electromagnetic device), a placebo group (30 people used water 30-35 ml per 1 kg of body weight, but consumed water with a placebo device that does not have an electromagnetic base) and a control one (25 people who do not change their water drinking behavior). To identify the features of sAA oscillations, all groups were divided into subpopulations with predictors of inflammatory diseases of the oral cavity (IL-1(3>212 pg/ml) and without such status (IL-1(3<212 pg/ml). The level of a-amylase activity was determined by a colorimetric method on Cobas C111 automated equipment (Roche), the concentration of IL-1J3 was detected by ELISA on an Infinity F50 photometer (Tecan). Results. Secretory alpha-amylase activity by the end of the study decreased in the main group; in the placebo and control groups, baseline values were exceeded. In the subpopulations with predictors of inflammatory dental diseases (IL-1(3<212 pg/ml) of the main group, the sAA activity decreased by 2.5 times; in the subpopulations without predicates of inflammatory changes (IL-1(3 <212 pg/ml), a significant decrease in enzyme activity in the main group was observed and an increase in the control. The percentage of sympathotonics at the end of the experiment in the main group was lower than in the placebo and control groups. Conclusion. A relation was found between a decrease in the level of a-amylase activity in the oral fluid and corrected water drinking behavior in a subgroup of people without predictors of inflammatory diseases of the oral cavity, using water in an amount of at least 30-35 ml/kg body weight that was purified by an electromagnetic method.