Objective: to assess (according to the literature data) the role of neuropeptides in the pathogenesis of ligamento- and tendinopathies as well as their possible impact on formation of an abnormal sonographic pattern. Material and methods. Analysis of publications containing information about histopathology and radiation semiotics of injuries of ligaments and tendons which are stored in PubMed resources and the Russian news portal eLIBRARY.RU. Results. The possible role of neuropeptides in formation of changes that may be revealed by imaging methods in ligamento- and tendinopathies has been defined. Conclusion. It is rational to study the role of neuropeptides in the pathogenesis of ligamento- and tendinopathies in the future in order to clarify their role in the formation and dynamics of changes revealed by imaging methods.

The work presents an analytical survey of scientific publications on epidemiology of the most common risk factors contributing to the development of diseases of the circulatory system in the world and in the Republic of Belarus and focuses attention on their impact on mortality of population, first of all, of able-bodied males.

The work presents an analytical review of features of techniques for assessment of the pathogenetic potential of Helicobacter pylori bacterium, an etiological agent of a number of gastrointestinal diseases. The main emphasis is laid on modern molecular and genetic techniques that make it possible to assess not only the pathogenic potential of the bacterium, but also the characteristics of the stomach microbiota and the infected human host`s genotype.

Objective : to carry out comparative assessment of effectiveness of different techniques of combined anesthesia in surgical correction of congenital disorders of the urinogenital system by means of the analysis of changes of integrative hemodynamic parameters. Material and methods . 116 patients were divided into 3 clinical groups depending on the type of ananesthetic aid. In the first group (40 patients), surgeries were performed under multicomponent balanced inhalation anesthesia, in the second group (42 patients) - under common inhalation anesthesia in combination with caudal blockade with solution of local anesthetic and patients of the third group (34 patients) were operated under common inhalation anesthesia with caudal blockade with solution of local anesthetic and an adjuvant.The calculation of the integrative hemodynamic parameters at 8 surgery stages (K-1 and K-2) was made for different techniques of anesthesia. Results. We have revealed statistically significant differences in the studied parameters of hemodynamics at certain stages of the perioperational period corresponding to the beginning of the surgery and its most traumatic stage in both the clinical groups, which reasoned in favor of more efficient blockade of painful sensitivity in the application of caudal analgesia. The technique of combined anesthesia with application of the combination of local anesthetic solutions and an adjuvant during surgical correction of congenital disorder of the urinogenital system in children has appeared to be the most efficient and adequate, which has been indicated by the studied hemodynamic parameters.

Objective: to determine the distinguishing features of the ANS state as the first link of the stress-realizing system in patients with various forms of acute disturbances of cerebral circulation (passing infringements of cerebral circulation and stroke) in the most acute period. Methods . 51 patients with transient ischemic attack (TIA), 25 with cerebral hypertensive crisis (CHC), 71 with lacunar stroke (LS), and 10 volunteers were examined. Besides the standard examinations, the heart rate variability (HRV) parameters, including the standard deviation of consecutive RR intervals (SDNN), percentage of the number of pairs of consecutive RR-intervals differing by more than 50 ms during the recording period (pNN50), mode of intervals RR (Mo), amplitude of the mode (AMO) were tested in all the patients. On the basis of the above parameters the stress index, the reactivity coefficient, the vegetative equilibrium index (IER) and the vegetative index of the rhythm (VIR) were calculated. The correlation, linear, and nonlinear regression analysis of the HRV parameters was performed. Results. A negative effect of the sympathetic tone (AMO, r=0.42, p=0.006) and a favorable effect of the parasympathetic tone of the ANS on severity of clinical manifestations in TIA (ΔX, r=0.66, p=0.026) were determined. The patients with CHC found an inverse relation: (AMo; r=-0.48; p=0.026) and (r=0.55, p=0.009). The group with stroke revealed a negative effect of growing parasympathycotonya after the end of the first decade (pNN50, r=-0.72, p=0.028). In the group of patients with rapid recovery of the neurological deficit (CHC, TIA, LI) there was a negative AMO / Mo dependence. The patients with all variants of stroke detected a positive relation of ΔX / Mo. In the isolation of a group of young patients with stroke, certain patterns were confirmed, and the positive ratio (ΔX / Mo) at the end of the treatment preserved only in patients with a large site of stroke affection. Conclusion. The key difference of the vegetative status of the patients with TIA from the stroke group is predominance of activity of the sympathetic ANS segment with an increase of parasympathycotonya in exercise. The stroke patients irrespective of the size showed an increase in activity of the parasympathetic link of the ANS in response to an increase in the humoral effect.

The article describes the technique and results of the method of single-stage nasal ala reconstruction based on a modified puzzle-flap. The developed method has been applied for nasal ala reconstruction in 10 patients after malignant tumor excision. The anatomical and functional outcomes of the reconstruction were evaluated with the use of NAFEQ questioning and visual analogue scale. The external skin, internal nasal lining, and cartilage support of nasal ala were restored in a single-stage procedure in all the cases. The natural appearance and contour of neoala were achieved with a minimal correction in the donor area. Partial necrosis of a flap was observed in one case. The anatomical outcome of the reconstruction was evaluated as completely satisfactory or satisfactory in 9 out of 10 patients (90%) according to NAFEQ. The average evaluation of the results of the reconstruction by the VAS scale was 81.0 ± 6.8 (100-point scale), the minimal value - 70 points, the maximal one - 95 points. Nasal function was not disturbed in any case. The proposed method of nasal ala reconstruction allows to achieve acceptable functional and anatomical results in a single-stage procedure.

Objective: to perform the comparative analysis of the parameters of the autonomic nervous system (ANS) in patients with ischemic forms of brain damage that are associated with atrial fibrillation. Methods. 19 patients with transient ischemic attack (TIA), 9 with lacunar stroke (LI), and 10 volunteers were examined. In addition to the tests stipulated by the existing treatment protocols, all the patients were done testing of the parameters of heart rate variability (HRV) including the standard deviation of consecutive RR intervals (SDNN), percentage of the number of pairs of consecutive RR-intervals differing by more than 50 ms during the recording period (pNN50), mode of intervals RR (Mo), amplitude of the mode (AMo), on the basis of which the stress index (IN), the reactivity coefficient were calculated. Correlation, linear, and regression analyses were performed among some HRV parameters. The effect on the form of cerebral ischemia was determined by means of nonlinear regression analysis. Results. The patients with TIA revealed differences in the ANS functioning which are associated withcardiac rhythm disturbances in the form of a significant increase in heart rate variability (SDNN₁ (p = 0.05) preserved after the stress test (SDNN₂, p = 0.036) due to the increased influence of the parasympathetic part of the ANS activity (ΔX₂, p <0.001). The influence of the autonomic part of the ANS in the TIA patients exceeded that of the LI group: at rest (pNN50₁, p = 0.046) and after orthostasis (pNN50₂, p = 0.008). The stress index in the TIA patients was the lowest and tended to differ from the control one (IN₁, p = 0.082). SDNN (r = 0.57, p = 0.02), pNN50 (r = 0.6, p = 0.02), and ΔX (r = 0.59, p = 0.021) were found to cause a negative effect on the severity of face asymmetry in the TIA patients and on the sympathetic stress index (IN, r = -0.59, p = 0.021). The group of the patients with TIA in combination with atrial fibrillation revealed no significant AMO/Mo dependence, but a sanogenetic feature was determined in the form of a negative influence of Mo on the activity of the parasympathetic part of the ANS (ΔX/Mo, p = 0.015). There is no reliable relation between AMO/Mo and ΔX/Mo for the LI patients. The factor causing a transient form of cerebral circulation or LI was ΔX₂ after an orthostatic test (OR = 131.6, χ² = 4.7, p = 0.031). Conclusion. The patients with TIA associated with atrial fibrillation in contrast to the general TIA group revealed prevalence of the activity of the parasympathetic part of the ANS with the preservation of the sanogenetic reserve in the form of a negative dependence of parasympatheticotonya on the growth of humoral influence. The latter fact caused an increase in the activity of the autonomous part of the ANS in response to the stress and determined the dilemma of the formation of a brain necrosis focus.

Objective: assessment of the contribution of genetic determinants to the formation of pathogenetic and clinical phenotypes of bronchial asthma as well as their association with the response to the therapy. Material and methods. Polymerase chain reaction, restriction analysis, electrophoretic detection, analysis of anamnesis and clinical data, statistical method. Results. Statistically significant (p <0.05) differences have been found between the control group and the group of patients with therapy-resistant asthma in the incidence rate of genotype CC and TT (MDR1 gene rs1045642). No significant differences have been revealed in the incidence of all the genotypes of the genes ADRB2 (rs1042713) and IL-13 (rs20541) between the control group and the group of patients with controlled asthma, and between the groups of patients with therapy-resistant and controlled asthma. Conclusion. The association of the genotype СС rs1045642 of the MDR1 gene has been shown with the necessity for higher doses of inhaled glucocorticosteroids alone or in combination with systemic glucocorticosteroids.

Objective : to assess sensitivity of K. pneumoniae clinical isolates with different levels of antibiotic resistance to commercial bacteriophage preparations. Material and methods . We have performed re-identification and determination of the sensitivity to antibiotics and bacteriophage preparations of 109 K. pneumoniae clinical isolates isolated from patients hospitalized in medical institutions of three regions of Belarus. The presence of carbapenemase genes has been deteсted by real-time PCR. Results . The study has shown awidespread prevalence of extreme antibiotic resistance among K. pneumoniae associated with the production of NDM and OXA-48 carbapenemases and has found an insufficient lytic activity of bacteriophage preparations against K. pneumoniae strains. The preparation «Sextafag», which lysed with a high activity of 28.4% of Klebsiella isolates possessed the widest spectrum of activity. Conclusion . Bacteriophage preparations can be considered as a possible alternative to antibiotics in the treatment of infections caused by extremely antibiotic-resistant K. pneumoniae isolates.It is necessary to supplement the composition of commercial preparations with phage strains that are active against Klebsiella isolates producing carbapenemases.

Objective: to design an experimental model of liver cirrhosis in rats and to compare it with the carbon tetrachloride model of liver injury. Material and methods. White Wistar rats (n=30) were used as objects for modeling of toxic liver injury. The modeling was performed by the designed toxic-alimentary method (experimental group, n=15) and by means of the carbon tetrachloride injection (control group, n=15). The animals were sacrificed at different terms (8, 12 weeks after start of the modeling and 3 months after termination of the modeling), and the morphological and morphometric state of the liver was studied. Results. The designed toxic-alimentary model of liver injury leads to liver cirrhosis 8 weeks after start of the modeling (reproducibility - 93.3 %). The reproducibility of liver cirrhosis in case of using the carbon tetrachloride model 8 weeks after start of the modeling is 26.7%, which is proved by statistically lower thickness of connective-tissue septa in the liver in the control group in comparison with the experimental group (p=0.016, Mann Whitney U test). The designed toxic-alimentary method ensures shorter timing of the modeling of liver cirrhosis (from 12 weeks in the control group to 8 weeks in the experimental group) and also lower reversibility of liver fibrosis signs 3 months after termination of the modeling in comparison with the carbon tetrachloride model of liver injury. Conclusions. The designed toxic-alimentary model of liver injury leads to liver cirrhosis 8 weeks after start of the modeling. The developed model ensures shorter timing of the modeling of liver cirrhosis, increased reproducibility as well as lower reversibility of liver fibrosis signs 3 months after termination of the modeling in comparison with the carbon tetrachloride model of liver injury.

Objective: to analyze cases of childhood tuberculosis in Gomel region over the last 12 years. Material and methods. We have conducted a retrospective study of tuberculosis cases in children aged 1-14 over the period 2006-2017. Results. The ratio of childhood tuberculosis was 0.7% (0.5-0.8) among all new cases of the disease. A high level of microbiological confirmation of tuberculosis (26.7%, 16.0-39.6) was observed. Contact with a tuberculosis patients was found in 53.3% (40-66.3). The Mantoux test remains relevant in the diagnosis of childhood tuberculosis (the size of the papule is 12.3 ± 4.8 mm). More than a third of the sick children were in a socially dangerous situation. HIV-associated tuberculosis in the children was 18.3%. Most of those children lived in families being in contact with tuberculosis patients. Conclusion. A low rate of childhood tuberculosis has been recorded in the region. A high incidence rate of tuberculosis in children in contact with tuberculosis patients indicates a low grade of measures against the exposure to tuberculosis infection. The prevention and detection of tuberculosis among HIV-positive children are a topical issue.

Objective: to assess the prevalence and structure of hemolytic anemias (HA) in children in the Republic of Belarus over the period 2005-2016. Material and methods . Absolute and intensive indicators (per 100,000 children) were assessed according to the data of official statistical reports: the number of HA cases detected at the age of 0-17, newly diagnosed cases of HA over the current year, the number of children with HA who are on dispensary registration by the end of the year. These indicators were estimated in the Republic of Belarus as a whole and separately by regions and age groups. Results . The average incidence rate of HA in the Republic of Belarus from 2005 to 2016 was 12.9 per 100,000 children, the number of newly registered cases was 1.8 per 100,000 children. From 2005 to 2016 there was an increase in the incidence rate of pediatric HA (average annual growth rate of 2.4% per year, rs = + 0.825, p = 0.001). The highest incidence rates of HA in children were in Vitebsk, Minsk, and Grodno regions. The growth of the morbidity was the most pronounced in Minsk, Gomel, and Vitebsk regions. The highest values of newly diagnosed cases of HA per 100,000 people were recorded in Grodno and Vitebsk regions, and the lowest was in the city Minsk. Most newly diagnosed cases of HA were registered in children of the first year of life (38.4% of cases, incidence of 11.3 per 100,000 people in this age group) and in children aged 1-4 (30.3%, incidence 2.3 per 100,000). In the structure of newly identified cases of HA, hereditary spherocytosis (51.6%), autoimmune HA (18.8%) and thalassemia (12.5%) were predominant. The etiology of HA remains unspecified in 10.9% of cases. The prevalence of hereditary spherocytosis in Belarus is much lower than the expected one, whereas the prevalence of autoimmune HA is higher than that in the European region. Conclusion. The increase in the incidence rate of HA in children and their inadequate record point to the necessity of improvement of HA diagnostic means.

Objective: to analyze information about intellectual property objects of medical purpose created at Gomel State Medical University over 1996-2017. Material and methods .Audit of intellectual property objects of the institution; analytical processing and patent statistics of scientific medical information; visualization of results of patent analysis. Conclusion. The information presented in the article is a result of the analysis of medical scientific information which is contained in the patent portfolio of Gomel State Medical University. It enables to increase efficiency of solutions of problems of intellectual property security and management in the institution and is intended for making management decisions on introduction of innovative solutions into practice, and eventually it is aimed at the promotion of public health and quality of healthcare.

Objective : to study the main stages of development of sanitary transport and the impact of its mechanization on development of the ambulance service in the territory of the Soviet Belarus before the Second World War. Material and methods. The work has studied materials on history of medicine from the funds of state Belarusian and foreign archives. The analysis has been performed with the use of scientific and specialized historical research methods in accordance with the fundamental principles of historicism and objectivity. Results. The analysis has revealed the main factors that contributed to the development of the sanitary transport of the BSSR, as well as the main stages of its formation until the outbreak of the World War II. Conclusion. The most active modernization of the sanitary transport occurred in the second half of the 1930s, which precipitated the approach of professional emergency medical care to the population of the Soviet Belarus.

Objective: to study the parameters of body composition in young athletes engaged in cyclic sports. Material and methods. The differentiated parameters of body composition in young athletes have been revealed on the basis of the examination data of 60 cyclic athletes at the age of 13-15. The bioimpedance analyzer Medass AVS-01 was used for determination of the body composition parameters. Results. The performed bioimpedance analysis confirms specificity of the component body structure of young athletes engaged in cyclic sports. Conclusion. Thus the component body structure of the young athletes has been obtained by the results of the bioimpedance analysis. The majority of the body composition parameters of the examined athletes did not exceed the bounds of the normalized values. Statistically significant gender differences of the body composition features of young athletes doing cyclic sports have been found.

Objective :to estimate the radiation doses of Scotch pine in a distant area of the Chernobyl accident. Material and methods. The annual equivalent dose rate from external γ-radiation (MEAD) was estimated using the data obtained by measuring the rate of the equivalent of the ambient dose of photon radiation at the reference points of the distant area of the Chernobyl accident over the period 1991-2016. Results. It has been established that the annual reduction of the annual equivalent dose rate from external γ-radiation since the 1990s is 3.5-5 % and the half-life period is 9-10 years. The equivalent dose of pine sprouts, tree-layer and generative organs of Pinus sylvestris from external γ-radiation is 1.6-3 times as little as that in 1991. The absorbed dose of external γ-radiation of Pinus sylvestris in 2005 was in the range of 1.3 × 10^-2 Gy / year and now has decreased by another 25-30 %.

Objective: to carry out the comparative analysis of the age dynamics of somatometric parameters of school children in various areas of residence. Material and methods. School children of comprehensive schools of Gomel aged 7-17 were the objects of the study. The program of the study included the measurement of body length, body mass, and chest circumference. The obtained material was compared to the corresponding literature data on the results of the examination of school children residing in other cities. Results. As a result of the study of the regularities of growth processes of the school children of Gomel, it has been found out that the periods of the maximum growth rates of body length, body mass, and chest circumference in boys were revealed before the onset of their puberty and by its end and in girls - only at the beginning of puberty in comparison with their peers in other areas of residence. Conclusion. The age dynamics of somatometric parameters of city school children depends on the area of their residence.

The high frequency of complaints from the local population on the appearance of reflex and vegetative reactions associated with chemical pollution of the atmospheric air makes actual the effectiveness of establishing sanitary protection zones around the agro-industrial enterprises in accordance with existing regulatory documents. Thereby raises the need to search new approaches and methods for establishing the safety of such enterprises. Conducted field studies of pollutant concentrations in the atmospheric air at the border of the sanitary protection and residential areas from the industrial squares of pig farms with a 30,000 head capacity before and after the conversion of manure storage facilities, as well as further comparison of the obtained results indicate a change in the level of contamination of the ground atmosphere layer by emissions of certain chemical agents in dynamics. Whereas a repeated feature of the pollution increasing near the residential area, which adjoins the industrial squares, was noted. The exceeding of odor limen for certain polluting chemical agents is noted in the absence of excess of its state hygienic norm in the atmospheric air. The results obtained after the realization of engineering, constructive and environmental solutions and usage of limit values for odors made it possible to adjust the standard sizes of the sanitary protection zone for the production area of the pig farm at the southeastern direction.

Ewing's sarcomas are rare neoplasms which comprise about 1% of all sarcomas. Сortical bones are usually affected. Cranial bones are rarely involved and are 1-6% of all Ewing's sarcoma cases. The article presents a case of a rare pathology - Ewing’s sarcoma of the temporal bone in a 36-year old woman and describes the morphological changes in the flat bones of the skull and the adjacent soft tissues of the head and their interconnection with data of clinical and laboratory and instrumental methods of investigation. Complexity of the lifetime diagnosis verification without histological and immunohistochemical confirmation has been shown on a concrete example.

Vascular Ehlers-Danlos syndrome is a rare inherited autosomal dominant disorder of connective tissue caused by a mutation in the procollagen III gene (COL3A1 gene). Among all the types of the disease the vascular type involves ~5-10% of cases. The diagnosis is based on clinical criteria and mutations in the COL3A1 gene. The treatment of Ehlers-Danlos syndrome is symptomatic, there is no specific treatment.

Objective: to study the opportunity of using the localization features of the Ki-67 proliferation marker in tumor samples with delayed fixation as an indicator of poor-quality fixation in breast cancer. Material and methods . The material of the study was 9 tumors diagnosed with breast cancer removed during surgery which were divided into 3 parts. One piece was for control, in the two other pieces fixations were delayed for 6 and 12 hours. The standard immunohistochemical study of HER2, ER, PR and Ki-67 with DAKO reagents (Denmark) was carried out. Result. Ki-67 appeared in the stroma in the form of small granules and artificial fissures were present in the invasive component of the tumor in the 6-hour delayed fixation. In the 12-hour delayed fixation, these changes were more pronounced. A decrease in the degree of HER2 expression was observed in all the cases of the delayed fixation. Changes in the quantitative indices (%) of ER and PR expression were less unambiguous. Conclusion. The presence of Ki-67 in the mammary tumor stroma can be a sign of poor-quality fixation in the testing of the material received for the immunohistochemical examination. Poor-quality fixation distorts the results of the immunohistochemical study of the surgical material.