Objective: to identify the main pedagogical techniques of the organization of an educational environment for indirect and purposeful management of the process of personal and professional development of specialists in a medical school.

Material and methods. The following methods were applied: the methods of theoretical analysis including philosophical, psychological and educational, the method of methodological literature on the problem, problem analysis in existing practice; methods of observation and sociological methods.

Results. In order to ensure successful professional selfdetermination of all year medical students, it is necessary: to specify important professional qualities of general practitioners and the requirements for their competitiveness; to develop a modular program of the development of the students` subjective position and the criterion basis for evaluation of the levels of their professional selfdetermination; to develop programs for personal and professional selfdetermination of students and their pedagogical assistance, to develop methodical recommendations for professors on how to create conditions for successful adaptation of students and their professional selfdetermination.

Conclusion. The developing sociocultural and educational environment of a medical university favors the formation of professionally significant qualities of doctors to be, provided students constantly reconsider their roles in different social groups, their status in the educational process, positions in educational and professional and sociocultural situations, which is inherent from the necessity to communicate and interact with people.

Objective: to systematize the existing techniques of ultrasound-guided percutaneous radiofrequency ablation.

Materials. The research subjects were 34 patients with focal liver malignancies who had undergone radiofrequency ablation at Gomel Regional Clinical Oncology Center from 2014 to 2019.

Results. The data about the existing techniques of ultrasound-guided percutaneous radiofrequency ablation have been systematized. The possibilities to increase the ablation efficiency of the liver tumor foci have been determined. The main components of the treatment algorithm that allow to achieve the best ablation results have been identified.

Conclusion. Strict adherence to the described techniques of radiofrequency ablation which takes into account tumor vascularisation makes it possible to achieve complete necrosis of the foci with no complications in 82.4 % of the patients, and minor complications that do not require therapy in 17.7 % of the patients [9].

Objective: to evaluate the efficiency and extent of endovascular revascularization in patients with multisegment lesions in chronic obliterating diseases of the lower limb arteries.

Material and methods. The outcomes of the endovascular correction of multisegment lesions of the lower limb arteries were analyzed in 10 patients.

Results. After the treatment the patients revealed a statistically significant change (increase of the value) of the ankle-brachial index (ABI) (p = 0.001). The ABI value after the surgical intervention amounted to 0.81 (0.71; 0.87), which was connected with a favourable prognosis for such patients. Аccording to the established criteria, the outcomes of the interventions comprised the decrease of the degree of chronic arterial insufficiency (p < 0.01), all the patients were discharged having no clinical manifestations of critical lower limb ischemia or decreased evidence of intermittent claudication.

Conclusion. The majority of patients with clinically evident ischemia of the lower limbs suffer from multisegment arterial lesion (the number of the segments exceeds 2), which entails the need of multiple corrections in one patient. Meanwhile, the evaluation of the treatment results is possible only in the postoperative period according to the indirect criteria. Therefore, during the operation there arises the need to develop a method of the objective intraoperative evaluation of the extent and efficiency of the performed correction of arterial lesions on each segment.

Objective: to assess the efficiency and safety of an anesthetic technique during the surgical correction of congenital malformations of the lower departments of the urogenital system in children by means of the comparative analysis of laboratory and hemodynamic indices, as well as the course of the early postoperative period, development of adverse effects during the anesthesia.

Material and methods. Depending on the type of anesthesia, all patients (127 boys) were divided into 3 clinical groups: those operated under multicomponent balanced inhalation anesthesia (group 1, n = 37), under general laryngeal mask anesthesia in combination with caudal blockade with a local anesthetic solution (group 2, n = 45), under general laryngeal mask anesthesia with caudal blockade with the combination of a local anesthetic solution and adjuvant (group 3, n = 45).

Results. The performed analysis of the parameters of hemodynamics, levels of cortisol, glucose, lactate and interleukin-6 (IL-6), as well as the quality, duration, depth of anesthesia and the necessity for an inhalation anesthetic, the assessment of complications and the adverse effects have revealed statistically significant differences indicative of a more effective blockade of the pain sensitivity in the combined application of general and regional anesthesia.

Conclusion. The technique of combined anesthesia with the application of the combination of 0.25 % bupivacaine solution and adjuvant to 0.1 % morphine has shown the best efficiency and safety during the surgical correction of congenital malformations of the lower departments of the urogenital system in the children.

Objective: to assess the effectiveness of the diagnosis of sleep apnea syndrome by the methods of respiratory monitoring and polysomnogaphу.

Material and methods. 40 patients were examined (19 men and 21 women, their average age was 54 ± 14. All the patients underwent respiratory monitoring and polysomnography.

Results. The comparative analysis of the parameters of sleep disordered breathing obtained by the methods of respiratory monitoring and polysomnography has revealed no significant differences in such main diagnostic indicators as index apnea/ hypopnea, apnea index, hypopnea index, snoring index, desaturation index, average SPO2 (p> 0.05). In the diagnosis of sleep apnea syndrome, the method of respiratory monitoring has showed a sensitivity of 96.7 %, specificity of 70.0 %, accuracy of 83.3 %, positive predictive value of 90.6 and negative predictive value of 87.5.

Conclusion. Respiratory monitoring is comparable to polysomnography in terms of the main significant diagnostic indicators of sleep disordered breathing and taking in account its cheapness and easiness of performance may serve as an alternative to polysomnography.

Objective: to determine the topography variants and quantity of the extraorganic anastomoses of the middle rectal artery.

Material and methods. 206 cadavers of males (aged 22-82) and 113 cadavers of females (aged 32-93) who had died of accidental causes not related to pelvic pathology were used as the research material. The vascular injection, preparation methods, and statistical analysis of the obtained data were used to achieve the aim of the research.

Results. It has been found out that most often the extraorganic anastomoses of the middle rectal artery are formed in the proximal and middle thirds of the artery, significantly rarely - in its distal third. A linear correlation between the sizes of the diameters of the internal pudendal artery and the sizes of the diameters of its extraorganic anastomoses has been detected in the males and females.

Conclusion. The performed research has demonstrated that the extraorganic anastomoses of the middle rectal artery in males and females have a definite pattern of origination.

Objective: to describe the possible types of the interrelations of the small saphenous vein and popliteal vein within the area of the popliteal fossa, as well as to study the distribution of the types among patients of both the genders and different somatotypes.

Material and methods. 163 patients (326 extremities) of both the genders without signs of vascular pathology were examined by the method of duplex ultrasound scanning. According to Chernorutsky`s classification, the patients were divided into three groups: dolihomorphs, mesomorphs, brachymorphs. The percentage of different types of the topography of the small saphenous vein was calculated among the examined patients.

Results. The term “saphenopopliteal pattern” has been introduced to characterize the anatomical interrelation of the small saphenous vein and popliteal vein within the area of the popliteal fossa. Five basic saphenopopliteal patterns were described including rare ones when the small saphenous vein opens into the gastrocnemius veins. It has been found that the patterns with the saphenopopliteal junction prevail (65.6 %), and in 28.3 % cases the small saphenous vein did not have any connection with the popliteal vein. The gender factor does not have any effect on the pattern type (р = 0.311) but the somatotype factor does (р = 0.038). It has also been determined that there is no direct connection between the small saphenous vein and popliteal vein in one thirds cases in the dolihomorphic and mesomorphic patients (34.5 % and 35 %, respectively), whereas the saphenopopliteal junction develops in 85.7 % cases in the brachymorphic patients.

Conclusion. The proposed classification of the types of the topography of the small saphenous vein within the area of the popliteal fossa could be applied for the evaluation of the venous beds of the lower extremities by the method of duplex ultrasound scanning.

Objective: to assess the results of the microbiological study of wounds in patients with diabetic foot syndrome (DFS).

Material and methods. The microbiological study of the wounds of 76 patients with the neuroischemic form of DFS having undergone inpatient treatment at Gomel Regional Diabetic Foot Center from 2016 to 2019 was performed.

Results. The range of the microbial flora of the wounds of the patients with the neuroischemic form of DFS has been identified, the antibiotic susceptibility of the detected bacteria to antibacterial drugs has been analyzed.

Conclusion. The microbiological profile of the wounds of the patients with the neuroischemic form of DFS was characterized by the variety of bacteria and included Enterococcusfaecalis (29%), Staphylococcusaureus (19%), as well as representatives of Enterobacteriaceae family (25%). The detected bacteria were most sensitive to glycopeptides, aminoglycosides, carbapenems, which makes it reasonable to prescribe these groups of antibiotics as the start antibacterial therapy.

Objective: to evaluate the effectiveness of palliative care in patients with malignant neoplasms of II and IV clinical groups in terms of the changes of the quality of life indicators regardless of the stage of the development of the disease and the degree of its malignancy.

Material and methods. 61 patients of the Palliative Care Ward suffering from malignant neoplasms of II and IV clinical groups were examined at the beginning (day 2) and at the end of the treatment course (day 14). The patients' psychoemotional condition, characteristics of pain syndrome and clinical mobility were analyzed. The effectiveness of the palliative care course was evaluated using the standardized questionnaires and scales: visual-analog pain scale, DN4, Pain Detect, Rivermid Mobility Index, Beck Depression Inventory, Spielberger-Hanin Anxiety Scale (assessment of situational and personal anxiety). The Garkawi Adaptation Intensity Index was used to calculate the body's reactivity to the disease at the beginning and upon completion of the palliative care course. The Calf-Caliph leukocyte index was calculated twice to assess the dynamics of endogenous intoxication.

Results. The course of the inpatient palliative treatment has showed its effectiveness by improving the category of clinical mobility on the Rivermid scale and the psychological condition of the patients with malignant neoplasms of II and IV clinical groups: there was a decrease in anxiety and depression, some decrease in the degree of pain syndrome. The Garkawi and Calf-Caliph indices were not effective tools for the assessment of the short treatment course.

Conclusion. Inpatient palliative care for patients with malignant neoplasms of II clinical group reduces undesirable effects of radical treatment, thus improving the quality of life, and it relieves the suffering in the patients of IV clinical group in whom the application of radical methods is not possible.

Objective: to assess the value of the psychoemotional state of pregnant women in the development of a prolonged second period of labor.

Material and methods. 76 pregnant women were examined. In 26 women, childbirth was complicated by a prolonged second period of labor, and they constituted the main group. The control group included 50 women who had physiologic birth. The psychoemotional state was analyzed using the Spielberg test and the test of a pregnant woman's attitudes.

Results. There were some differences between the groups in terms of the tendency in the levels of personal anxiety and occurrence of high situational anxiety. The Spielberg test has revealed more «positive» affirmative answers than «negative» ones. 46.1 % women in the main group do not «feel a sense of inner satisfaction», which is statistically significantly higher than in the control group - 24.0 % (p = 0.04). In the main group, in contrast to the control group, the women are more often not «worried about possible failures». During the study of the types of the psychological component of the gestational dominant, mixed types were mainly observed, and the distribution in the groups did not have statistically significant differences. The women with a prolonged second period of labor had a tendency to form the predominantly euphoric type of the psychological component of the gestational dominant.

Conclusion. During pregnancy, the patients with a prolonged second period formed a coping strategy in the form of a predominantly euphoric attitude to pregnancy associated with elevated situational anxiety.

Objective: to study the morphological features of subcutaneous tissue in response to the implantation of a polypropylene mesh endoprosthesis (PSE) modified with a polycaprolactone solution by the method of electrospinning.

Material and methods. The object of the study was modified polypropylene mesh endoprostheses implanted in experimental animals. The animals were removed from the experiment on the 3rd, 7th, 60th day of the experiment. Subcutaneous fatty tissue along with the implanted material and regional lymph nodes were fixed in a 10 % solution of neutral formalin, followed by histological posting according to the standard technique and filled with paraffin. Histological sections 3-4 μm thick were stained with hematoxylin and eosin. The morphological assessment of reactions to the implantation of the materials was carried out by means of the calculation of the cellular elements of inflammatory and connective tissue origin along the periphery of the implants (neutrophilic leukocytes, phagocytic neutrophilic leukocytes, degenerating neutrophilic leukocytes, eosinophilic leukocytes, lymphocytes, plasmacytes, histiocytes, macrophages, fibrocytes, fibroblasts, multinucleated giant cells).

Results. The study of the cellular composition has showed a statistically significant increase in the content of fibrocytes (p = 0.002) and fibroblasts (p < 0.001) on the 7th day of observation around the modified PSE. On the 60th day, the number of neutrophilic leukocytes at the periphery of the modified PSE was lower than that of the control sample (p = 0.004). The enhancement of the fibroplastic properties of the samples modified with polycaprolactone by electrospinning was characterized by a less pronounced inflammatory reaction of the peripheral tissues.

Conclusion. The obtained data are indicative of the fact that the modification of PSE with polycaprolactone reduces the reactive properties of endoprostheses and make it possible to recommend to introduce this method of PSE modification in clinical practice.

Objective: to identify clinically significant functional interactions between the autonomic nervous system and personal emotional sphere.

Material and methods. 105 patients with cardiovascular diseases were examined. Using a clinical role-playing game, the states of the psycho-emotional arousal of modalities: «anger», «fear», «sadness», and «joy» with some intervals of relaxation between them were successively induced in the patients, and the intensity of the psycho-emotional arousal was also recorded. At the same time, the parameters of heart rate variability were registered using the KP-01 Holter monitoring system. The patients were divided into two groups depending on the presence of a high direct relationship between the recorded indicators.

Results. It has been found that a high direct relationship (r_s[9] = 0.70, p = 0.018) of the power spectral density in the low frequency range, the total index of autonomic disequilibrium, and the intensity of emotional responses is associated with a 3-4 risk of arterial hypertension, coronary heart disease , cardiosclerosis, chronic heart failure.

Conclusion. The presence of these correlations is associated with cardiovascular disease and is an independent risk factor for its development.

Objective: to establish the features of the organism`s adaptation of female obstetrician-gynecologists to the existing working conditions .

Material and methods. The features of the organism`s adaptation of female obstetrician-gynecologists (main group, n = 64) of in-patient and maternity welfare clinics, therapists of local territorial out-patient clinics (comparison group, n = 31), as well as female employees of health organizations with higher education not providing medical care (control group, n = 31) to the existing working conditions were evaluated on the basis of sociological, hygienic, and statistical research methods.

Results. The obstetrician-gynecologists worked in harmful working conditions: class 3.3. - in the in-patient hospitals and class 3.2. - in the out-patient clinics. Almost half of the examined female obstetrician-gynecologists revealed decreased adaptive reserves of the organism, whose degree of manifestation was reliably different from the women of the control group (p ˂ 0.05).

Conclusion. The harmful working conditions at the workplaces of female obstetrician-gynecologists lead to the breakdown of the organism`s adaptive mechanisms and create a professional risk for the subsequent development of a wide range of somatic pathologies.

Objective: to study the changes of the somatometric parameters of city school children of Belarus aged 8-16 over time in the period from 1925 to 2010-2012.

Material and methods. To study the somatometric parameters, over 2010-2012 the city school children (1423 boys and 1438 girls) aged 8-16 were examined by the method of V. V. Bunak. The following somatometric parameters were measured in the examined schoolchildren: body length and body weight, chest circumference. To assess the changes in the dynamics of the somatometric parameters of the city school children of Belarus over time, the obtained data were compared to the corresponding data obtained by Р. М. Моnоszоn-Luibina in 1925, by S. A. Lialikov and S. D. Orehovy over 1989-1997.

Results. It has been found that the city school children of Belarus examined over 2010-2012 are characterized by higher indices of the somatometric parameters (body length and body weight, chest circumference) (p < 0.05-0.001) as compared to their peers examined in 1925, and 1989-1997.

Conclusion. The comparative analysis of the obtained data has made it possible to establish the presence of the process of acceleration in the city school children of Belarus aged 8-16 at the beginning of the 21^st century.

Objective: to justify the application of video-EEG monitoring in babies with paroxysmal conditions based on the description of a clinical case of a paroxysmal condition in an 11-monthold baby.

Material and methods. The 11-monthold patient Ilya K. having a paroxysmal condition of unknown etiology was directed to be examined at the Neurological Ward of Gomel Regional Children`s Clinical Hospital. According to the data of video-EEG monitoring prescribed to the patient to clarify the nature of the paroxysmal events, the child had had an attack that had occurred suddenly and had been accompanied by impaired consciousness.

Results. Based on the description of the clinical case of the baby examined on the subject of convulsive syndrome of unspecified genesis, the application of video-EEG monitoring has been proved to be as a highly informative and high-tech method for the diagnosis of paroxysmal conditions in pediatrics and pediatric neurology, which makes it possible to make differential diagnosis of seizures in children, thereby verifying the diagnosis.

Conclusion. The diagnosis of paroxysmal conditions in children remains a difficult task for pediatric neurologists and pediatricians and requires an integrated approach, in-depth examination of patients with the application of modern neuroimaging functional methods for the examination of the brain, and video-EEG monitoring can be fundamental in the diagnosis verification. It is necessary to widely introduce this research method in medicine, in particular in functional diagnostics in pediatrics and pediatric neurology, which will help optimize approaches in the diagnosis and management of patients with paroxysmal conditions. The application of video-EEG monitoring will allow to make high quality diagnosis of the disease, and therefore contribute to the rational choice of therapy, including the timely and adequate prescription of antiepileptic therapy.

The article presents a clinical case of seronegative rheumatoid arthritis (RA) in a 64-year-old man suffering from essential thrombocythemia for 10 years. The diagnosis of RA was verified 6 years ago; the patient has not been taking any disease-modifying antirheumatic drugs and only has undergone the treatment for thrombocythemia (hydroxycarbamide + mercaptopurine + aspirin). During this time, no activity of rheumatic pathology has been noted, which makes it possible to surmise the achievement of stable clinical and laboratory remission associated with the intake of cytostatics provided that the diagnosis is verified correctly.

Multiple myeloma is an incurable malignancy of hematopoietic tissue characterized by lesions of the bone marrow, presence of multiple destructive processes within bone tissue, kidney damage, and infectious complications. Up to 60 % cases of newly diagnosed multiple myeloma debut from monoclonal gammopathy.

Monoclonal gammopathies are a large group of diseases whose distinctive feature is the secretion of pathologic immunoglobulins called monoclonal proteins (synthesized in abundant quantities immunoglobulins of one class or/and type whose chemical structure, molecular mass, and immunological features have been changed). Most often monoclonal protein is a biomarker of clonal cell proliferation. Besides plasma cell tumors paraprotein secretion is often common for other lymphoproliferative diseases, some kidney diseases, systemic diseases of connective tissue, primary amyloidosis, solid tumors, liver lesions, sarcoidosis, Gaucher disease, Sjogren syndrome, cold agglutinin diseases, and some meurologic pathologies.

The article presents the main clinical and pathologic features of monoclonal gammopathy and multiple myeloma and describes clinical cases indicative of complicated diagnosis of multiple myeloma and the necessity for continuous monitoring of patients with monoclonal gammopathy.

Currently, West Nile Fever (WNF), which is characterized by a variety of its clinical forms, severity, and high mortality, is becoming common in many countries. There is an increase in the WNF incidence in the countries of the former Soviet Union. The trend of a gradual increase of the WNF incidence in the countries of the European Union (EU) and neighboring countries, which began in 2015, led to an epidemic increase in the incidence, and both imported and local cases of the disease are recorded. The article describes a clinical case of WNF. Due to the lack of awareness and focus on the WNF detection by most doctors, general information about this disease is also provided.

The article presents the report of a clinical case of conjoined twins, provides the data on ultrasound diagnostics, and describes morphological changes in this pathology.

The article presents a clinical case of infectious endocarditis, the debut of which was cerebral symptoms. The history of the disease, its clinical manifestations, laboratory and instrumental features, and the methods of the therapy are described in detail.

Objective: to assess the structural and functional features of the cardiovascular system in patients with arterial hypertension (AH) and normal spectrum of transmitral blood flow (NSTBF).

Material and methods. An open prospective study of patients with essential hypertension (n=31) and healthy volunteers (n = 10) was organized at the state institution «Republican Research Center for Radiation Medicine and Human Ecology». The examined individuals were comparable in terms of sex and age features. All the participants of the study underwent transthoracic echocardiography (EchoCG) with the determination of the standard parameters, ultrasound of the extracranial part of the brachiocephalic arteries (BCA) with the determination of the thickness of the intima-media complex (CIM) and carotid plaques, duplex scanning of the arteries of the upper and lower extremities with the measurement of the ankle-brachial index (LPI) and endothelium-dependent vasodilation (EDVD). In addition, we assessed the global longitudinal deformation by the method of two-dimensional speckle tracking of the gray spots of the ultrasound image, the indicators of the movement of the fibrous ring of the atrioventricular valves into systole and diastole with the determination of the myocardial index by tissue dopplerography (TDG).

Results. In comparison with the healthy volunteers, the patients with AH and NSTB have detected reliable changes in the anteroposterior size (38 mm versus 32.5 mm; p = 0.001) and volume (45 ml versus 31.5 ml; p = 0.002) of the left atrium (LP) and volume (37.5 ml versus 29.5 ml, p = 0.005) of the right atrium (PP), measured by means of standard transthoracic echocardiography. Using the method of two-dimensional tracking of the speckle spots of the gray scale of the ultrasound image we have recorded lower values of the global longitudinal strain (-17.5 versus -21.6; p < 0.001) in the study group compared with the control group, which indicates a violation of the biomechanics of the myocardial contractions of the left ventricle (LV). The study of the movement of the fibrous rings of the atrioventricular valves using tissue dopplerography (TDG) has showed that in the second group of the patients there are regional disorders of diastolic function, primarily this concerns the medial part of FC MK (1.3 versus 1.1; p = 0.05) and the lateral part of FC TC (1.3 versus 0.8; p = 0.028). In addition, in comparison with the healthy individuals we recorded higher values of the myocardial index for the lateral (0.51 versus 0.43; p = 0.001) and medial parts (0.59 versus 0.44; p = 0.001) FC MK, lateral part (0.58 versus 0.44; p = 0.001) FC TC. The patients of the study group, in comparison with the control one, have revealed signs of the pathological remodeling of the vascular wall. In the first group of the examined individuals, in comparison with the second one, the thickness of the intima-media complex (CIM) was slightly higher (p = 0.061 on the right, p = 0.08 on the left) and cases of the presence of atherosclerotic plaques (ASB) were recorded.

Conclusion. The protocol research methods do not allow the comprehensive evaluation of the functional features of the heart in patients with AH, which requires additional diagnostic methods: TDH and speckle tracking.