2023, volume 19

Objective: identification and characterization of the stages of formation of new follicles, as well as the frequency of folliculogenesis in various parts of the thyroid gland in the norm and in the experiment. Material and methods. The experiment was carried out on 36 mature white rats divided into three groups: control (I), 60-day exposure to sodium benzoate at a dose of 1000 mg/kg (II) and administration of mexidol at a dose of 50 mg/kg against the background of 60-day administration sodium benzoate (III). The stages of folliculogenesis were studied using light microscopy followed by a statistical analysis of its frequency. Results. The formation of a new follicle begins with the proliferation of thyrocytes on the wall of the mature follicle, after which a cavity is formed between the cells, into which they begin to secrete the colloid. In the process of follicle growth, the height of thyrocytes decreases, and the size of its cavity and the amount of colloid increase. In group II, signs of folliculogenesis were detected in the center of the organ by 1,7 and 1,4 times, and on the periphery — by 2 and 1,2 times less than in group I, and in group III — by 1,3 and 1,6 times more often in the center and 1,3 and 1,3 times in the periphery, compared with group II on the days 3 and 24 of the experiment. Conclusion. In the process of folliculogenesis in the thyroid gland, focal proliferation of thyrocytes develops in the wall of one of the follicles with further formation of the cavity of the newly formed follicle and its growth. In norm the frequency of new follicles formation is higher in the centre of the organ than in the periphery and decreases in both zones in the group of rats with sodium benzoate administration. In the group of rats where sodium benzoate administration was corrected by mexidol administration, the number of cases with the formation of young follicles increased, but the indicators did not reach the control figures.

Objective: to determine the relationship between adherence to treatment in patients undergoing penetrating keratoplasty (PKP) and corneal graft survival over a 12-month follow-up period. Material and methods. A retrospective analysis of 56 patients who underwent "high risk" PKP was performed. Patients were divided into 2 groups according to their compliance. The full compliance group included those with more than 90% of visits within the first year after the intervention; the poor compliance group included those with more than 10% of missed visits. Results. The high adherence group was characterised by a higher proportion of women (p=0.033), a mean 7 years younger age of the patients (p=0.021) and a predominance of higher education (p=0.014). One year after PKP, patients with complete compliance (74%) were more likely to have a favourable outcome than those with incomplete compliance (48%) (p=0.046). The calculation of the odds ratio (OR 3.52; Cl: 1.1362-10.88; p=0.045) indicated a statistically significant role of treatment adherence as a factor in keratoplasty efficacy. The high compliance group had a visual acuity gain of 2 lines at 12 months (p=0.003). Conclusion. Compliance after corneal transplantation has a significant impact on graft survival and clinical outcome. The development and implementation of a set of measures to increase adherence could significantly improve the safety and efficacy of this high-tech treatment for patients with disabling corneal pathology.

Objective: development of organizational technology for improving intersectoral interaction on public health protection at the regional level in the context of the COVID-19 pandemic. Material and methods. The modeling method was used, which is implemented in the form of flowcharts summarizing obtained materials devoted to the study of the characteristics of the sectors of the state and society interested in protecting public health, the determinants of health, the design of an automated method for multi-vector evaluation of the success of intersectoral interaction in the conditions of COVID-19. Results. The technology of intersectoral interaction on public health protection at the regional level in the conditions of the COVID-19 pandemic has been developed and the algorithm of its implementation has been substantiated. At the same time, two modules have been identified, one of which allows to form preventive programs, the other — to improve health care based on the results of a multi-vector assessment of the success of this process. Conclusion. The developed organizational technology makes it possible to contribute to the improvement of intersectoral cooperation on public health protection at the regional level in the context of the COVID-19 pandemic.

Objective: to present an analysis of the data presented at the present stage in the scientific specialized literature on the main trends in the provision of specialized medical care to children with chronic viral hepatitis В, С and D. Review writing methodology. The study was based on publications in the databases PubMed/Medline, eLibrary under the keywords: "chronic viral hepatitis", "hepatitis B", "hepatitis C", "hepatitis D", "treatment of chronic hepatitis in children", published during the period from 2012 to 2023. We additionally studied international acts and the regulatory framework of the Russian Federation regarding the provision of specialized medical care to the child population with chronic viral hepatitis (total number of sources — 41). Conclusion. At present, the main approach in providing specialized medical care to children with chronic viral hepatitis is the appointment of etiotropic therapy with the possible delayed prescription of specialized drugs in order to reduce the risk of their side effects. Research is being actively carried out on the development of new pharmacotherapeutic agents that are effective against this group of infectious diseases, as well as the possibilities of preventing infection in infants through early diagnosis and treatment of pregnant women.

Objective: to substantiate the significance of quality of life indicators in the formation of modern content of personalized rehabilitation of patients with a consequences of traumatic brain injury. Material and methods. The study included 414 respondents of working age (93.6% men). 54% of the respondents had a traumatic brain injury within 1 to 5 years, in 62,0%, cases the traumatic brain injury was of severe degree. Longitudinal sociological study of the quality of life using the WHOQOL-100 questionnaire was carried out. The Dembo-Rubinstein test was used to diagnose the adequacy of self-assessment of the respondents with TBI. The dynamics of the respondents' neurological status and quality of life were assessed annually during 2020-2022. Results. In the annual study, 64.7% of respondents showed clinical deterioration in 96% of cases, which was manifested by increased severity of general cerebral symptoms, cognitive impairment, and asthenic syndrome. In 4.0% of cases new symptoms manifested (posttraumatic epilepsy). In the dynamic of respondents' quality of life, clinical deterioration in parameters "Physical sphere", "Psychological sphere", "Environment" and "General quality of life and health status" was revealed. Conclusion. In the absence of specific laboratory markers in clinical practice and not always sufficient informativeness of neuroimaging methods for the verification of the consequences of traumatic brain injury, the quality of life can be considered as an important criterion of prognosis, which determines the content of personalised rehabilitation of patients with the consequences of traumatic brain injury.

Objective: on the clinical example of the alobar form of fetal and newborn holoprosencephaly, to consider the risk factors for the development of a congenital anomaly and the possibilities of a tactical solution. This clinical case focuses our attention on the complexity of early diagnosis of this congenital pathology, prevention and choosing the right solution to the problem. Differential diagnosis of the alobar form with seven-lobarand other types of holoprosencephaly was carried out. A clinical case of congenital alobar holoprosencephaly was diagnosed prenatally, with a gestation period of 17 weeks. Treatment of this syndrome is symptomatic, surgical correction of some defects is possible. Respiratory and cardiovascular insufficiency predetermine the fatal outcome of the disease. Medical and genetic counseling helps to clarify the risk of the appearance of sick offspring in the future.

A clinical case of cerebral infarction in a adolescent patient complicated by symptomatic epilepsy in a rehabilitation period is presented. Among the possible risk factors that led to the development of acute cerebral circulatory failure, the following are highlighted: genetically metabolic (atherogenic dyslipidemia, burdened heredity), hematologic thrombotic (thrombocytosis, shortened bleeding time, increased international normalized ratio) and the acute infectious disease suffered the day before. There was a later request for medical help (a day after the moment of the disease), underestimation of the severity of the condition upon admission to the hospital.

Objective: to evaluate the association of sequence variants PPARGC1A rs8192678, PPARG2 rs1801282, FTO rs9939609, LEP rs7799039, LEPR rs1137101 with non-alcoholic fatty liver disease (nAFLD) at young adults in Russian population. Material and methods. The case-control study included 100 patients divided into two groups: group 1 (cases) — with nAFLD (n=50); group 2 (controls) without nAFLD (n=50). All subjects underwent a standard ultrasound examination of the liver and ultrasound shear wave elastography (Aixplorer, France) with an assessment of the severity of liver steatosis and fibrosis. Results. We found two sequence variants associated with an increased risk of nAFLD in women: rs9939609 and rs7799039: A/A rs9939609 genotype (OR 5,33; 95% Cl 1,14-24,90; p=0,041) and G/G genotype rs7799039 (OR 7,5; 95% Cl 1,04-54,12; p=0,026). Conclusion. The A/A genotype ofthe rs9939609 gene in young women in the Russian population increased the chance of having nAFLD by 5 times, the G/G genotype ofthe rs7799039 gene increased the chance of having nAFLD by 7.5 times.

Objective: assess an anatomical and topographic parameter of the wound channel formed when using the posterolateral muscular-fascial approach to determine the possibility of its clinical use for performing decompres-sive-stabilizing surgical interventions. Material and methods: on the material of 20 cadavers of both sexes with different body mass index (mean 25.1 ±2.9) aged 54 to 76 years (median 67.5 years), who died from diseases not associated with the pathology of the spine, was modeled the posterolateral muscular-fascial approach to the lumbar spine. During the research were studied wound length, wound depth, wound depth index, access zone and the angle of intersection of the wound edges and the surface of surgical instruments. Results: the average length of the surgical wound during the lateral muscular-fascial approach was 149.75±6.35 mm. The average wound depth was 116.75±8.85 mm. The average value of the index of the depth of the surgical wound with interfascial access is 77.96±5.04. The average area of the intervertebral disc available for removal was 71.2±2.8%. The length of the aperture in the fibrous ring averages 15.8±0.78 mm. The average value of the angle of intersection of the wound edge and the pedicle screw implantation trajectory was 3.15±1.25. Conclusion: the assessment of the anatomical and topographic parameters of the wound channel formed during the posterolateral muscular-fascial approach allows us to conclude that this surgical approach can be used to improve the functional outcomes of decompressive and stabilizing interventions in the lumbar spine.

We present a case of contrast-enhanced ultrasound (CEUS) used in surgery for blood vessels and nerves combined trauma. This case reveals CEUS potential in differentiation of compression-ischemic neuropathy along with perineural fibrosis from intrastem neuroma and complete anatomical interruption of the median and ulnar nerves. CEUS also helped to clarify the vascular lesion — we detected a false ulnar aneurysm and radial artery occlusion. Therefore, the use of CEUS has influenced the surgical management. This method allows expanding the potential for nerve damage diagnostics, and, given further technical progress, has great clinical prospects.