Objective: to define the concept and essence of surrogacy, to study the history of its origin and approaches to solution of fertility problems with its help in different countries of the world, to analyze the attitude of modern generation to surrogacy. Material and methods. To achieve the above objective, various literary sources were analyzed. Also, a sociological survey of 60 students of Gomel State Medical University was conducted. Results. The performed analysis has found historical regularities of the use of surrogacy aimed at procreation since ancient times up till now. The retrospective statistical data of primary and secondary infertility in the world have been given. The modern possibilities of assisted reproductive technologies making it possible for childless families to have their own children have been described. The sociological survey has revealed that most boys and girls - 90 % are «for» using assisted reproductive technologies, and also the majority of the respondents think that it is acceptable to bring up a surrogate child by a single woman (85 %) or man (73 %). However, only 47 % of the respondents agree with the fact that a surrogate child may be raised by homosexual parents. Conclusion. Female and male infertility is a problem that is topical worldwide. Surrogacy is an assisted reproductive technology which in many cases is the only option for people to have their genetic children. In modern society, surrogacy is used by single women and men, including homosexuals. The attitude of modern generation to this fact is positive in most cases.

The paper provides a brief review of literature on the problem of retroperitoneal fibrosis and the author`s own observation on the diagnosis and successful surgical treatment of idiopathic Ormond`s disease. Retroperitoneal fibrosis is the development of a nonspecific inflammatory process in the adipose tissue of the retroperitoneal space with the formation of a fibrous lesion around the aorta, vena cava inferior, iliac vessels. The focus of fibrosis can spread towards the ureters and compresses them. One- or two-sided hydrouretheronephrosis leads to a chronic kidney disease. The given observation presents the diagnosis and method of the surgical treatment of a patient with idiopathic retroperitoneal fibrosis with bilateral hydrouretheronephrosis and a chronic kidney disease.

Objective: to identify the localization variants of the intrapelvic branches and anastomoses of the superior gluteal artery (SGA) in individuals of the dolihomorphic somatotype. Material and methods. 27 male dead bodies (at the age from 30 to 75) and 12 female dead bodies (at the age from 34 to 88) were used as the material for the research, the individuals had died as a result of accidental causes not related to pelvic pathology. The vascular injection method, preparation method, and statistical processing of the obtained data were applied to attain the objective. Results. It has been found that the formation of the intrapelvic branches and anastomoses in males and females is most often present in the proximal and middle onethirds of the intrapelvic part of the SGA, rarely - in its distal one-third. Stable hemostasis with high probability can be achieved by excluding from the bloodstream of the proximal and middle one-thirds of the intrapelvic part of the SGA using selective emboli or by ligation. Conclusions. The performed research has demonstrated that the intrapelvic branches and anastomoses of the SGA in males and females have the definite pattern of their origination.

Objective: assess the parameters characterizing the structural and functional features of the cardiovascular system in patients with arterial hypertension (AH) with signs of diastolic dysfunction of the left ventricle (DDLV), to determine the dynamics of changes in the heart and vessels from the unchanged spectrum of transmitral bloodstream (USTB) to diastolic dysfunction (DD) in AH patients. Material and methods. An open prospective study of patients with essential AH and USTB (n = 34) and with DDLV signs (n = 45) was organized in the state institution «Republican Research Center for Radiation Medicine and Human Ecology». The examined individuals are comparable in terms of sex and age features. Standard transtoracal echocardiography with the determination of standard indices, ultrasonic examination of the extranial department of the brachyocephalic arteries (BCA) with the determination of the thickness of the intima-media complex (CIM), duplex scanning of the arteries of the upper and lower limbs with the determination of the ankle-shoulder index and endothelium-dependent were performed in all the participants of the study. In addition, global longitudinal deformation was evaluated by two-dimensional tracking of the grey spots of the ultrasonic image scale (speckle tracking), parameters of the movement of the fibrous ring of the mitral valve into systole and diastole with the determination of the myocardial index by the method of tissue dopplerography. Results. The examination of the heart by the method of standard transtoracal echocardiography has revealed that AH patients with DDLV (2^nd group) in comparison with AH patients with the unchanged spectrum of transmitral bloodstream (1^st group) detected higher values of interventricular partition (12 mm versus 9 mm, р = 0.001), relative wall thickness (0.41 versus 0.35, р = 0.033), the index of myocardial mass (65 g versus 58.5 g, р = 0.015). The isovolumetric relaxation time of the PG (81 ms versus 67 ms, p = 0.043), the rate of tricuspidal regurgitation and systolic pressure in the pulmonary artery were significantly higher in the group of AH patients with DDLV (p = 0.005). The analysis of the movement of the fibrous ring of the mitral valve by tissue dopplerography has showed that in the second group of the patients (AH with DDLV), there are signs of regional systolic dysfunction of the medial part of the fibrous ring of the mitral valve (0.08 cm/s versus 0.09, p = 0.047). E/Em was higher in the second group, a statistically significant difference was found for the lateral portion of the fibrous ring of the mitral valve (5.7 vs. 7, p = 0.019). The ultrasonic duplex scanning of the extranial part of the BCA revealed that in the AH patients with DDLV compared to the AH patients with the unchanged spectrum of transmitral bloodstream, the value of the thickness of the CIM is reliably higher (right 0.8 mm versus 0.65 mm, p = 0.001, left 0.8 mm versus 0.7 mm, p = 0.001). The study of the endothelium function has revealed that the second group of the patients compared to the first one, recorded reliably lower values of endothelium dependent vasodilation (10 % versus 14 %, p = 0.009). The analysis of subclinical lesion of the arteries of the lower limbs has revealed that in the group of patients with DDLV compared to the group of the AH patients with the unchanged spectrum of transmitral bloodstream, the ankle-shoulder index value is reliably higher (right 1.1 versus 1.07, p = 0.013, left 1.1 versus 1.07, p = 0.05). Conclusion. The protocol method of research - standard transthoracic echocardiography - does not allow to estimate fully the functional changes of cardiac muscle in AH patients with DDLV in comparison with AH patients with the unchanged spectrum of transmitral bloodstream. The application of additional diagnostic techniques (TDG and speckle tracking) makes it possible to get missing data. Pathologic transformation of transmitral bloodstream occurs when signs of systolic and diastolic dysfunction of the left ventricle already exist. The appearance of signs of diastolic dysfunction of the left ventricle during standard echocardiography is accompanied by pathologic remodeling of the vascular system.

Objective: to identify the most effective and affordable method to diagnose various types of fetal cleft lip and palate, the use of which is possible in the majority of specialized obstetric care facilities. Material and methods. The study included the results of ultrasound examination of fetuses (59 cases) in various modes with cleft lip and palate of various types within gestational periods from 16 to 36 weeks. Results. The sensitivity indices of the generally accepted method of two-dimensional B-mode ultrasound have been determined for diagnosing all types of clefts, which amounted to 81.3 %, and the sensitivity for diagnosing cleft palate and cleft lip and palate amounted to 80.3 %. The sensitivity indices of the newly developed diagnostic method (ultrasound elastography of the palate) have been determined, which amounted to 89.8 % in the diagnosis of all types of clefts, and 90.2 % in the diagnosis of cleft palate and cleft lip and palate (46/51). Demonstration of the image of the fetal face obtained during the three-dimensional B-mode reconstruction to its future parents helps the family to make a more balanced and correct decision on further pregnancy tactics. In cases of cleft palate, a new visualization diagnostic criterion has been defined - tongue bifurcation. MRI of the fetal head is not an effective and affordable method for the diagnosis of facial clefts, which can be widely used in practice. Conclusion: It is advisable and necessary to conduct an obligatory study of the karyotype in fetuses with crevices identified during imaging examination at any gestational age. As a new diagnostic criterion for cleft palate, detected by B-mode ultrasound, tongue bifurcation can be used. The utilization of the EN method in combination with the developed coloristic criteria for RHN and RN increases their prenatal detection in general population by 9.9 %. At the same time, the detectability of all types of crevices increases by 8.5 %. In order to objectify the explanations about the essence of revealed defects of the face and structures of the oral cavity, it is necessary to demonstrate a three-dimensional sonogram of the fetal face obtained during three-dimensional B-mode reconstruction to its future parents. MRI of the fetal head cannot be recommended as an effective and affordable method for diagnosing facial clefts due to the impossibility to obtain a satisfactory image in most cases.

Objective: to identify the most practical method for diagnosing bilateral renal agenesis in a fetus during prenatal ultrasound screening. Material and methods. The study included the results of ultrasound screening of 50 fetuses, which initially, were presumptively diagnosed with bilateral renal agenesis using the generally accepted method of ultrasound screening. The sonographic characteristics and visualization features of the structures of the urinary system of the fetuses were analyzed. Results. The sensitivity indices of the basic methods for diagnosing bilateral renal agenesis in a fetus (87.5 %), specificity (93 %) and general accuracy (92.2 %) have been determined; a method for prenatal diagnosis of bilateral renal agenesis in a fetus has been developed, which consists in assessing the possibility of ultrasound imaging of the fetal bladder after an administration of furosemide to the pregnant patient, which has increased the sensitivity and specificity of the method up to 100 %. Conclusion. The developed method of prenatal diagnosis of bilateral renal agenesis in a fetus, which consists in assessing the possibility of ultrasound imaging of the fetal urinary bladder after an administration of furosemide to the pregnant patient, improves the quality of the diagnosis of congenital malformations of the fetal kidneys and minimizes unreasonable psychoemotional stress in the pregnant patient resulting from the false positive diagnosis, which is a fundamental question for appropriateness of prolongation of her pregnancy.

Objective: to study the results of autopsies of patients with liver cirrhosis, to analyze the frequency of diagnosing «hepatorenal syndrome» (HRS) and its conformity with diagnostic criteria. Material and methods. A retrospective cohort analysis of 130 autopsies of patients with liver cirrhosis was performed. HRS was detected clinically and/or pathologically in 43.8 % of the patients. Clinical data and autopsy protocols of 27 patients with liver cirrhosis were analyzed in detail for compliance of the diagnosis of HRS with diagnostic criteria. The data were recorded and analyzed in MS Excel 2010. Results. The frequency of the diagnosis «hepatorenal syndrome» significantly exceeds the real prevalence of this pathology; its diagnostic criteria are often not followed; HRS is not considered to be the diagnosis of exclusion; the type of HRS is not indicated; for healthcare specialists there is often equality in the terms «hepatorenal syndrome» and «hepato-renal failure». Conclusion. To improve the quality of medical care for patients with liver cirrhosis, it is necessary to adhere more strictly to the clinical protocol «Diagnosis and treatment of patients with diseases of the digestive system», to introduce more accurate additions to it, and to increase knowledge of healthcare specialists in the field of HRS diagnosis.

Objective: to evaluate the effectiveness of the application of beta-blockers for primary prevention of bleeding esophageal varices in patients with liver cirrhosis. Material and methods. A retrospective study included 46 patients with liver cirrhosis of various etiology having II-III stage esophageal varices. All the patients were divided into two equal groups. The basic group was made up of 23 (50 %) patients who were prescribed beta-blockers at recommended dosages continuously over the observation period from 2009 till 2018 for the purpose of primary prevention of bleeding esophageal varices. The control group included 23 (50 %) patients with liver cirrhosis in whom the primary prevention of the bleedings was not performed. Results. The assessment of the effectiveness of beta-blockers was performed with two indicators: the frequency of bleeding esophageal varices and their mortality. The application of beta-blockers made it possible to reduce the bleeding frequency from 34.8 % to 13 % (р = 0.10) and the mortality from 21.7 % to 0 % (р = 0.02). Conclusion. In order to detect early stages of esophageal varices, endoscopic screening should be performed for all patients with liver cirrhosis. The presence of II-III stage esophageal varices requires primary prevention of the bleedings. The drug-of-choice are non-selective beta-blockers. Timely and adequately prevention reduces the risk of the bleedings and their mortality.

Objective: to assess the presence of glycemic variability in patients with diabetes mellitus type 2 (DM Type 2), as well as to identify the risk factors which affect the degree of expression of the variability indices. Material and methods. Glycemic variability indices were assessed in 92 patients with DM Type 2 receiving different hypoglycemic therapy regimens. Results . It has been found that glycemic variability in 78 % of the examined patients with DM Type 2 was expressed and depended on the regimen of hypoglycemic therapy. The use of insulin therapy in the treatment regimen in patients with DM Type 2 and a BMI of less than 28.6 kg/m² is a risk factor that increases glycemic variability. Postprandial hyperglycemia (2 hours after breakfast) is caused by high variability regardless of the regimen of hypoglycemic therapy. SD variability indices and glycemic amplitude are the assessment criteria for the degree of glycemic variability in the postprandial period of time. Conclusion . Glycemic variability in patients with DM Type 2 is expressed and depends on the regimen of hypoglycemic therapy. Calculation of glycemic variability indices in glycemic self-control will improve individual target glycemia values and it will make it possible to correct the tactical scheme of hypoglycemic therapy on an outpatient basis.

Objective: to study changes in the resistance of problem microorganisms to antibacterial drugs in patients with purulent wounds. Material and methods. On the basis of a bacteriological laboratory, within 2006-2007 and 2019-2020, 92 and 99 patients with purulent wounds of various locations, respectively, were examined by the standard bacteriological methods. Results. For the past 13 years, significant changes have occurred in the etiological structure of gram-negative problem microorganisms in patients with purulent wounds. Reliably significant increases were found in the share of K. pneumoniae - about 8 times, and A. baumannii - about 9 times. However, the proportion of MRSA has not changed. The most effective drugs for MRSA were vancomycin, linezolid, tigecycline - 0 % of resistant isolates; for K. pneumoniae - colistin (0 %), tigecycline (8.33 %); for P. aeruginosа - colistin (0 %), doripenem (45.45 %); for A. baumannii - ampicillin + sulbactam (0 %), colistin (0 %). Conclusions. For infections caused by MRSA , glycopeptides (vancomycin) should be recommended as the drug-of-choice, and the reserve drugs - oxazolidinones (linezolid) and glycylcyclins (tigecycline); K. pneumoniae - colistin and tigecycline; P. aeruginosa - carbapenems (doripenem) and colistin; A.baumannii - penicillins or cephalosporins with sulbactam (ampicillin + sulbactam) and colistin.

Objective: to study the dynamics of the indicators of CD3⁺CD4⁺CD8⁺double-positive and CD3⁺CD4^-CD8^- double-negative T-lymphocytes in patients who underwent kidney transplantation. Material and methods. Three groups were formed out of 197 allograft recipients. PGF group consisted of patients with primary satisfactory graft function. PGD group - with primary graft dysfunction. GR group - with primary graft dysfunction and histologically confirmed graft rejection. We studied the CD3⁺CD4⁺CD8⁺ (DP) and CD3⁺CD4^-CD8^- (DN) T-lymphocyte levels before the transplantation, and on the 1^st, 3^rd, 7^th, 30^th, and 90^th days after the transplantation. Results. Within a month after the transplantation we noted a decrease in the relative DN T-lymphocyte level in the PGF group, while in the PGD and GR groups this indicator significantly increased. By the 90^th day, the count of DN T-lymphocytes had remained unchanged in the PGD group, while there had been a statistically significant increase of this subpopulation in the PGF group. The absolute counts of DN T-lymphocytes in the PGF group on the 1^st and 7^th days were lower than in the GR group. On the 90^th day, there was no statistically significant difference in the absolute number of DN T-lymphocytes in the recipient groups. In all the groups, there was a decrease in the number of DP T-lymphocytes on the 1^st day, however, in the PGF group, the relative level was significantly higher. This tendency retained for 3 months. There were no statistically significant differences between the PGD and GR groups. The absolute number of DP T-lymphocytes in the PGF group during the entire observation period was significantly higher than in the PGD and GR groups. Conclusion. We noted a decrease in the indicators of DN T-lymphocytes in the PGF group associated with the increase in the DP T-lymphocyte level within the first three months. In the PGD and GR groups, an increase in the DN T-lymphocyte level was revealed due to a decrease in the indicators of DP T-lymphocytes within 90 days after transplantation.

Objective: to study morphological and morphometric changes in the epiphysis bone in a rat during the intra-articular injection of chondroitin sulfate (CS). Mаteriаl аnd methods. The object of the study was the knee joints of 36 Wistar rats. CS injections at a dose of 0.05 ml were performed once a week into one of the knee joints (experimental joint), and isotonic NaCl solution at the same volume was injected into the opposite joint (control joint). The animals in the number of 12 units were withdrawn from the experiment on the 7^th, 14^th, and 21^st days, which corresponded to one week after one-, two-and three-fold intra-articular injections of HC and 0.9 % NaCl. The isolated knee joints were placed in a decalcifying liquid, then were fixed in 10% neutral buffered formalin. 4 micron histological sections were stained with hematoxylin and eosin. The morphometric analysis assessed the thickness of hyaline articular cartilage, the thickness of the epiphysis growth zone cartilage, and the cell content of the subchondral bone. Results. The study of the thickness of the articular cartilage, the growth zone of epiphyseal cartilage and the cellular composition of the subchondral bone has showed a statistically significant dynamic increase in these indicators after the 2^nd and 3^rd intra-articular injections of CS. The assessment of the thickness of the articular cartilage on the 21^st day found some statistically significant differences between the experimental and control groups (p < 0.0001), the thickness of the epiphyseal cartilage had increased significantly by that time (p < 0.0001), and the cell content of bone marrow showed statistically significant differences (p = 0.002). Conclusion. The obtained data testify to a pronounced regenerative effect of CS, injected intra-articularly into articular cartilage.

Objective: to evaluate the effect of flexion and extension of the body units during ice-hockey players` movements in the sitting position on the location of the joints in relation to the general center of body mass. Material and methods. A group of 14 highly qualified ice-hockey players who performed running movements on skates and proprioceptive movements onto the strain platform in the ice-hockey player`s sitting position. The biomechanical analysis of the movements was conducted with the use of the methods of video analysis, strain gauge, and myometrial method . Results. The most optimal ranges of the articular angles of the knee and hip joints in the in the ice-hockey player`s sitting position have been identified. In particular, in the fixation of the angular position of the knee joint within the range of 80-90 degrees, there was a decrease in the strength of the muscle pull of the quadriceps femoris on the anterior cruciate ligament. The value of this decrease varied within the range of 17-22 % of the average values of the indicator that were obtained when the angular position of the knee joint was less than 80 or more than 90 degrees. Flexion in the hip joint over the range of 42-55 degrees with the optimal position of the knee joint contributed to increased balance in the given position. Conclusion. Flexion and extension of the torso lead to changes in the position of the joints associated with the general center of body mass (GCMB) and subsequent biomechanics of the sitting position. The deviation of the angular positions from the optimal ranges affects the trajectory of the GCMB with vertical vibrations, which, in its turn, negatively affects the speed of movement and stability of the ice-hockey player`s sitting position. Going beyond the boundaries of the postural position zone can lead to a more rigid sitting position, which increases the risk of injury of the anterior cruciate ligament.

Objective: to substantiate adherence to treatment as a form of social responsibility of citizens from the standpoint of the sociology of patients. Material and methods. The work uses the principles and methods of the sociology of medicine. A sociological survey of a representative sample of medical care consumers (880 people) on adherence to treatment was conducted, and a model of compliance ratio as a model for subsequent drug therapy was substantiated. Results and discussion. The performed survey has shown that every second patient learns about their rights from the mass media. Men are significantly less likely than women to follow medical prescriptions (p < 0.01). Women are significantly more likely to trust the doctor's opinion about treatment, if they disagree, they are more likely to turn to another specialist, while men are significantly more likely to simply refuse treatment and other recommendations from the attending doctor. The respondents called their own laziness and / or aversion to taking medications as the main reason for non-compliance with treatment. Conclusion. Low social responsibility of patients for compliance with the doctor's recommendations has been found. The concept «adherence to treatment» has been introduced into the problem field of the sociology of medicine.

Objective: to identify the socio-psychological features of medical students’ attitude toward health. Material and methods. The methods of theoretical analysis of philosophical, psychological and pedagogical literature on the research problem; methods of questioning, observation; statistical analysis of empirical data ( j * - Fisher's criterion, Spearman's rank correlation method) were used. Results. The performed study has made it possible to determine the theoretical bases for the formation of modern notions about health and a healthy lifestyle in medical students. The analysis of the socio-psychological aspects of junior medical students` attitude toward health has showed that mainly stereotyped notions such as («sport is health») and inadequate understanding of the relation of a health status and commitment to a healthy lifestyle are typical for the study participants. Conclusion. In order to ensure high quality of professional medical education, it is necessary to form notions about health and a healthy lifestyle based on the concept of positive health in medical students. Health providers should understand a special importance of healthy lifestyle promotion among population, which will be ineffective if future doctors themselves will not pay enough attention to their health.

Preterm premature rupture of the fetal membranes is observed in 30-50 % of premature labors. The frequency of infectious maternal and neonatal complications increases аs a result of a long anhydrous period. The article presents a description of the course of pregnancy and its outcome in a patient with a long anhydrous period.

Acute coronary syndrome is a complex of symptoms which manifests itself as a chest pain. A diagnostic search in cardialgia requires exclusion of a number of diseases including acute surgical pathology. The patient management strategy and the volume of examinations often not only depend on the time from the beginning of an anginal attack till hospitalization but also on a correct interpretation of the results of the patient's clinical examination.

The article describes a clinical case of bronchial cancer without radiologic changes. This is often associated with late diagnosis of the disease and a high mortality rate of this pathology.

The article presents a clinical case of generalized cryptococcosis of the internal organs in a 62-year-old man and describes morphological changes in the internal organs associated with diffuse fungal dissemination. A feature of the case is multiple damage to the internal organs: lungs, brain and pia mater, liver, kidneys, lymph nodes, spleen, adrenal glands and bone marrow.

The article presents clinical cases of posterior reversible encephalopathy syndrome, which complicated pregnancy and childbirth, and describes the clinical course, features of diagnosis, and treatment.

The diagnosis and treatment of acute pancreatitis is the task of surgeons. However, quite often this disease is taking its course in the guise of other surgical or therapeutic pathology. To select the right diagnostic and treatment policy of patient management, it is necessary to keep in mind that there is a possibility of the atypical course of acute pancreatitis.

Objective : to develop a method of molecular genetic analysis for determining the normalized expression levels of COL2A1, COL6A1, MMP-2, and MMP-9 genes in the biological material of patients with gonarthrosis. Material and methods . The biopsy samples of knee joint cartilage of 10 patients with gonarthrosis were used as a biological material for the study. Nucleic acids were isolated from the samples of the biological material using TRIZol Reagent. Reverse transcription was performed using the SuperScript III reverse transcriptase kit, dNTP and Ribonuclease inhibitor (Invitrogen, USA). Results . The usage of VectorNTI software has made it possible to select pairs of primers (forward and reverse) and TaqMan probes for COL2A1, COL6A1, MMP-2 , and MMP-9 genes, and to study the possibility of the use of the selected pairs of primers and probes for the purpose of identification of each of the studied genes. In-house test systems in the multiplex format have been designed for reference and target genes. Conclusion . High specificity (100 %) of the selected oligonucleotide primer sets was confirmed using the online application NCBI/Blast. The developed molecular genetic method can be applied to determine the normalized expression levels of COL2A1, COL6A1, MMP-2 , and MMP-9 genes in knee joint arthropathy

Objective: to determine the possibilities for prediction and diagnosis of congenital fetal malformations and chromosomal abnormalities on the basis of the study of the levels of amino acids and their nitrogen-containing derivatives in blood plasma of pregnant women with pathological conditions requiring artificial termination of pregnancy. Material and methods. The content of free amino acids and their nitrogen-containing derivatives was studied in 104 pregnant women having congenital malformations and chromosomal abnormalities in their fetuses at 13-22 weeks` gestation (group I) and 25 women with physiological pregnancy (group II). The amino acid level was determined by the high-performance liquid chromatography method. Results. The levels of 14 out of the 26 studied amino acids in the blood plasma of the pregnant women of group I were statistically higher than those of the women in group II. ROC analysis was used to determine six amino acids (glycine, α-aminobutyric acid, hydroxylysine, glutamic acid, citrulline, serine) and their threshold values which with high accuracy (85.3 %) allow of predicting congenital fetal malformations and chromosomal abnormalities. A prognostic model making it possible to determine high probability of congenital fetal anomalies based on the determination of the concentration of 5-hydroxytryptophan, glycine, asparagine, and serine in blood plasma of pregnant women has been developed. Conclusion. The study of the levels of amino acids and their nitrogen-containing derivatives in plasma of pregnant women at 13-22 weeks` gestation can be used for prenatal diagnosis of congenital fetal malformations and chromosomal abnormalities, as well as used as an additional criterion for making the decision on the necessity for artificial termination of pregnancy upon fetal medical indications.