The review provides up-to-date data on pathogenetic mechanisms, opportunities of diagnosis, and organizational and medical measures concerning autoimmune thyroiditis (AIT). AIT is a polyetiological disease which is mainly caused by environmental factors, genetic predisposition and disorder in immune regulation. Primary AIT incidence in the Republic of Belarus in 2017 is 58 cases per 100,000 population in the overall structure of the thyroid gland pathology, the AIT accounts for up to 40 %. The upward trend in the number of autoimmune diseases of the thyroid gland, including that in ecologically unfavorable regions, is explained not only by the true increase in the number of patients with AIT, the consequences of stress, but also by the overdiagnosis. There is contradictory data on the correlation of the level of iodine sufficiency of the population with the AIT development; there is no convincing evidence of the role of radiation factors in increasing the risk of AIT. The review analyzes the correlation of AIT with an imbalance in a number of microelements involved in the synthesis of thyroid hormones and affecting the iodine exchange. The article presents the study results that determined the nature of immune disorders in AIT and hypothyroidism in such forms as disorders of lymphocyte subpopulations, proinflammatory and anti-inflammatory cytokines, changes in the apoptosis mechanisms, which were proposed for use as predictors of the severity of thyroid immune inflammation and hypothyroidism. The criteria for selecting patients with an increased risk of developing AIT complications remain unclear, that necessitates the development and implementation of additional organizational and medical measures for following-up of such patients and assessing their quality of life.

The choice of optimal graft is the basis for successful spine fusion formation. In article reviewed different graft with their positive and negative features.

According to the postulates in biology and medicine, an irreversible violation of any of the elements of a functional system inevitably leads to senescence and destruction of its entire integrity. At the same time, the phenotypic manifestation of the final stages of degradation is similar and due to the peculiarities of the structural and functional organization of living species. Based on this, the established list of symptoms describing age-related changes in the human body is currently applied in medical practice, which allows determining both the physiological status of patients and the development of necessary therapeutic measures. At the same time, the use of any universal approach to diagnose the occurrence and genesis of the processes of senescence is ineffective, which is associated with a wide range of factors and mechanisms causing this type of pathogenetic disorders. For this reason, for many decades, one of the main tasks of gerontology has been a comprehensive analysis of the process of senescence. The result of such large-scale studies was the emergence of a significant number of theories explaining the causes and mechanisms of aging. This review considers a number of theories of aging that have received extensive experimental confirmation and recognition in world practice: free-radical, telomeric, apoptotic, and genetic.

Objective: to develop a landmark suitable for fast image acquisition of the sacroiliac ligament in the longitudinal section. Material and methods. The position of the longitudinal axis of the sacro-ligamentous ligaments relative to the line of the spinous processes on the sonograms of 36 patients (the age range was 27-80) and 33 cadavers (the age range was 50-75) has been determined. Results. The obtained data allow to trace the image of the sacrotuberous ligament in the longitudinal section quickly (using the ischial tuberosity as a landmark and orienting the scanning plane of the sensor at an angle of 19-25° according to the line of the spinous processes).

Objective : to estimate the efficiency of the application of extremely high frequency electromagnetic radiation in patients with oncologic pathology of II, III and IV clinical groups undergoing rehabilitation in the conditions of a palliative care unit at different stages of the development of the disease regardless of the stage of the treatment. Material and methods. The examination included 30 patients diagnosed with oncologic pathology - 13 (43 %) women and 17 (57 %) men. They were divided into 2 groups. The main group comprised 15 people aged 45-79 who were undergoing a rehabilitation course of ten 10-minute sessions of extremely high frequency electromagnetic radiation of millimetric wave band. The study was conducted with the help of the device «Pramen M14T-Z» with a frequency of operating radiation of 42.194 ± 0.015 GHz (wavelength of 7.1 mm). The control group included 15 patients at the age of 34-84. The efficiency of the therapy was estimated by means of the standard questionnaires: the Rivermead Mobility Index (F. M. Collen of 1991), Beck Scale, Wakefield Self-Assessment of Depression Inventory, Hamilton Depression Rating Scale (HAM - D), DN4 and also the assessment of the general blood test before and after the treatment. Results. All the patients who had completed the rehabilitation course in the conditions of the palliative care unit with the application of extremely high frequency electromagnetic radiation of millimetric wave band (Shan Zhong point of VC.17) revealed a decrease in the neuropathic component of pain. Other positive clinical changes of varying degree were observed in both the groups. Conclusion. The application of extremely high frequency electromagnetic radiation is a perspective way of treatment in the complex rehabilitation of patients with oncologic pathology in the conditions of the palliative care unit.

Objective: to identify the most effective and safest anesthesia technique for prostate puncture biopsy by means of the comparative analysis of the parameters of hemodynamics, postoperative motor block, and anesthesia, as well as the patient's subjective assessment of the quality of anesthesia. Material and methods: 30 male patients were divided into 2 clinical groups depending on the anesthesia technique. In the 1st group (15 patients), puncture biopsies (BP) were done under saddle spinal anesthesia, in the 2nd group (15 patients) - with the application of traditional spinal anesthesia (SA). The comparative analysis of hemodynamic indices, motor block, the efficiency of anesthesia and the patient satisfaction with the quality of anesthesia was performed. Results. No statistically significant difference between the hemodynamic indices, intraoperative anesthesia and subjective assessment of the quality of anesthesia by the patients was revealed, but at the same time the comparison of the postoperative motor block between the study groups found some statistically significant differences.

Objective: to study the influence of surgery on the serum total testosterone level in males with acute infectious pulmonary destruction (AIPD). Material and methods. 60 males aged 29-84 who had been operated for AIPD were examined. The serum total testosterone level was measured with the radioimmunoassay method on the 2^d day after the admission to the ward, the day before and within 1-3 days after the surgery. Testosterone deficiency was diagnosed when the testosterone levels were less than 3.5 ng/ml. Results. The serum total testosterone level was 1.31 [0.55; 3.1] ng/ml in the patients with AIPD upon their admission to the ward. Testosterone deficiency was detected in 46 out of 60 (77 %) cases. 1 patient was not operated, another patient died during the first day after the surgery. After the surgery, the patients with AIPD showed a statistically significant decrease in the serum total testosterone level from 1.33 [0.56; 3.38] to 1.18 [0.66; 2.1] ng/ml (p_Wilcoxon = 0.026) and the number of cases of androgenic deficiency increased from 44 (76 %) to 49 (85 %) among the 58 people (χ² = 1.36; p = 0.24). Conclusion . Surgical intervention in patients with AIPD contributes to low serum total testosterone levels and increases the number of cases of testosterone deficiency in the early postoperative period, which must be considered during the planning of androgen replacement therapy.

Objective: to determine the list of ultrasound criteria for normal development of the fetal lung, the use of which will make it possible to identify lung malformations in the fetus effectively, as well as to predict the development of lung hypoplasia in the newborn. Material of the research. The fetuses of singleton pregnancy in 1570 female patients of Minsk during the gestation period of 20-37 weeks. Results. The minimum list of the ultrasound criteria for the features of the lung development, which should be used for screening ultrasound examinations of pregnant women aimed at the detection of congenital lung malformations of the fetus, has been determined. The work indicates cases which require additional measurement of the lung volume of the fetus, the most optimal method for which is to use the VOCAL software package during three-dimensional sonography or direct measurement by MRI. The measurement data for the percentile values of the fetal lung volume taking into account the regional biometric features, as well as the percentile measurement data for the quantity of amniotic fluid have been determined. Conclusion. The minimum list of the ultrasound criteria for adequate lung development, the use of which during the screening ultrasound examinations of pregnant women will make it possible to detect congenital lung malformations of the fetus with high sensitivity, includes such characteristics as parenchyma homogeneity, diaphragm position, fluid in the pleural cavity, and the presence of fluid movement through the airways. The prenatal prediction of the development of respiratory distress syndrome in newborns requires direct measurement of the lung volume by means of the volumetric calculation program of three-dimensional sonography or MRI, followed by the assessment of the results using the tables of the regional percentile values, developed by the authors. Also, in cases of oligohydramnios, to make such a prediction, it is necessary to assess the quantity of amniotic fluid using the tables of the regional percentile values, developed by the authors.

Objective: to give the clinical and functional characteristics of the cardiovascular system in children with diseases of the circulatory system. Material and мethods. The study involved 188 children aged 8-16 with different cardiovascular diseases (CVD) examined at the Cardiology Ward of Gomel Regional Children`s Hospital. Depending on the profile of their diseases, the children were divided into five main groups: group 1 - children with minor anomalies of heart development, group 2 - children with congenital heart diseases, group 3 - children with rhythm disorders, group 4 - children with autonomic dysfunction, group 5 - children with arterial hypertension. Along with the clinical examination the children were performed an electrocardiogram (ECG) and underwent Holter monitoring (HM). Results. The polymorphism of complaints was typical of the children of all the groups, according to the ECG data, conduction disturbances were the most common in the children of the first and second groups, and excitability disorders were typical of the children of the third group. Normal ECG was most often recorded in the children of the fourth and fifth groups. By the НM data arrhythmia (II Lown class and higher) was most frequently detected in the children of the first and third groups, arrhythmia of V class prevailed in the second group of the children. Conclusion. The cardiologic examination found that the children with CVD had various complaints and different arrhythmia classes, while the ECG of the majority of the children with autonomic dysfunction and hypertension detected mild arrhythmias, which is indicative of prognostically favorable disease outcomes. Clinically significant arrhythmias were revealed most frequently in the children with minor anomalies of heart development, cardiac rhythm disorders and congenital heart diseases.

Objective: to evaluate the nature of histomorphometric changes in bone tissue within the area of the entheses of the ileo-lumbar ligaments in different age periods. Material and methods. The ileo-lumbar ligaments, fragments of bone tissue from the attachment sites of the named ligaments, fragments of bone tissue from the body L_IV obtained at autopsies of 20 men (the average age was 64.7±8.7) and 15 women (the average age was 54.5±9.5). Results. The work has revealed a close relationship between the indicators that determine the severity of osteoporosis, and indicators reflecting the intensity of dystrophic changes of the ileo-lumbar ligaments (R = -0.60-0.70 among men and R = -0.77-0.78 among women). Statistically significant (p < 0.05) difference between the severity of osteoporosis in the L_IV body (age-dependent changes) and the severity of osteoporosis in the area of the enthuses of the iliac-lumbar ligament was found. Conclusion. Local osteoporosis in the entheses of the ligaments is above all a sign of functional overload of the ileo-lumbar ligament. Osteoporosis within the area of the entheses of the ileo-lumbar ligaments may indicate the presence of dystrophic changes.

Objective of the study. Analysis of the volume of bone resections performed during surgical access on the lumbosacral spine according to the data of preoperative computer calculation. Materials and methods. The study group included 100 patients operated on for degenerative-dystrophic pathology of the spine at the lumbosacral level. An analysis of the resection volume above and the underlying arches of the vertebra, the upper and lower articular processes, and the yellow ligament was carried out. Results. In segments of the L_III-L_IV level a wider resection of the upper and lower articular processes was require compared with L_IV-L_V L and L_V-S_I (p < 0.05). The smallest volume of medial facetectomy was performed at the L_V-S_I level in segments with herniated disc without stenosis - in this case, the lower articular process was kept intact in 53.9 % of cases, the upper - in 64.1 % of cases. At the two most frequently operated L_IV-L_V L and L_V-S_I levels, surgical approaches prevailed, at which the overlying arch remained intact or resected in the volume of less than ½ of the total length. Significant differences in the volume of resection of the arcs between stenotic segments and segments with herniated disc without stenosis was not detected (p > 0.05). Conclusion. Computer calculation of surgical access with localization of the lateral border of the bone window 5 mm from the edge of the dural sac and / or spinal nerve is aimed at maintaining stability in the segment, achieving sufficient visualization of the herniated disc and proper decompression in cases of dystrophic stenosis. The identified statistical differences (p < 0.05) in the volume of resection of the structures of the posterior support complex between the studied levels underscore the importance of taking into account individual anatomical features of the vertebral segment during planning surgical access.

Objective: to evaluate the connection between plasma levels of transforming growth factor-β1 (TGF-β1), soluble ICAM-1 и Е-selectin (sICAM-1 и sЕ-selectin) and features of esophageal mucosa damage in patients with gastroesophageal reflux disease (GERD) and obstructive sleep apnea/hypopnea syndrome (OSAHS). Materials and methods. 120 patients have been examined. Patients were undergone esophagogastroduodenoscopy with biopsy of the lower third of the esophagus with further histological study, somnological investigation. Enzyme linked immunosorbent assay was provided in 80 patients for detection of studied cytokines in blood plasma. Results. High concentrations of TGF-β1 (р = 0,002), sICAM-1 (р = 0,009) and sЕ-selectin (p = 0,041) were obtained in patients with GERD and OSAHS in contrast with comparison group. Positive correlation between apnea/hypopnea index and plasma levels TGF-β1 (r = 0,4, р < 0,05), sICAM-1 (r = 0,42, р < 0,05) and sЕ-selectin (r = 0,32, р < 0,05) were revealed. Conclusion. Patients with GERD and OSAHS are characterized by high levels of TGF-β1, sICAM-1 и sЕ-selectin in plasma, which may accompanied by the development of sclerotic changes and microangiopathy in esophageal mucosa in this group of patients.

The experiment on male Wistar rats has demonstrated that the exposure to modelled chronic stress for 10 days causes disturbances of spermatogenesis processes and exerts influence on the decrease of the relative number of Leydig cells in the rats` testis. It has been found that after 10 days of the chronic stress modelling by Ortiz J., the number of active forms of the Leydig cells decreases and the number of non-active forms of steroid-producing cells increases in the interstitial tissue of the testis of the Wistar rats.

Objective: to determine the types of localization, frequency of occurrence and quantity of the intrapelvic anastomoses of the inferior gluteal artery. Material and methods. 117 cadavers from men (at 35-78 years of age) and 31 cadavers from women (at 32 to 90 years of age) who had died of accidental causes not related to pelvic pathology were used as the material for the research. The vascular injection method, preparation method, and statistical method were used to achieve the aim of the research. Results. It has been found out that most often in men and women the intrapelvic anastomoses of the inferior gluteal artery develop in the middle one-third of the intrapelvic part of this artery, significantly more rarely - in its proximal one-third, and very rarely - in its distal one-third. The research has found no linear correlation between the sizes of the diameters of the inferior gluteal artery and the sizes of the diameters of its intrapelvic anastomoses. Conclusion. The performed research has demonstrated that in men and women the intrapelvic anastomoses of the inferior gluteal artery have the definite regularity of origination.

Objective: to assess the state of the cardiovascular system of young men at different types of self-regulation of blood circulation, studying in medical university. Materials and methods . 58 medical students, whose average age was 19 ± 1,13 years, were examined. The study program included recording of electrocardiogram (ECG), registration of central hemodynamic parameters, as well as determination of systolic (SAP) and diastolic (DAP) arterial pressure, heart rate (HR). The parameters of the cardiovascular system in students at three types of self-regulation of blood circulation (TSC): cardiac, cardiovascular and vascular. Results . It was found that the parameters of students with cardiac TSC were characterized by a significant increase of HR (р < 0,001), shortening of R-R (р < 0,01), QT (р < 0,01), QTc (р < 0,01) intervals, increased values of cardiac output (р < 0,001), cardiac index (р < 0,001) and reduced total peripheral resistance (р < 0,001) in comparison with the parameters of the boys with cardiovascular TSC. Young people with vascular TSC had significantly high values of SAP and DAP (р < 0,05), total peripheral resistance (р < 0,0001), significantly low values of cardiac output (р < 0,0001), cardiac index (р < 0,0001), without changing of the examined ECG parameters in comparison with boys with cardiovascular TSC. Conclusion . Statistically significant differences in the parameters of the cardiovascular system in students with different types of self-regulation of blood circulation were established.

Purpose: to distinguish the main gender-age patterns and nosological units leading to disability among children with syndromes and diseases manifested by short stature. Materials and methods . The object of the analysis was medical documentation for 2197 children with short stature. Results . It has been established that girls have a higher risk (p < 0.001) of disability than boys, while children living in rural areas are higher than in the city (p < 0.05). There is a linear increase in disability to the senior school age (33.2 ± 2.0 %). A pituitarism caused disability most often (49.8 ± 2.1 %). Conclusion. The structure of disability in children with syndromes and diseases associated with short stature depends on the gender and age differences of patients and is due to the presence of certain diseases.

Aim: to study the prevalence of hypercalcemia among adults in the Gomel region. Materials and methods. The results of a selective study of the prevalence of hypercalcemia among residents of the Gomel region are presented. The study involved 1366 people (884 women, 482 men) from 20 to 71 years old, who passed tests of blood for serum calcium by the arsenase method. Results. The median age of patients was 32.0 [32.0; 54.0] years. Hypercalcemia was detected in 41 people of 3.0 (2.16-4.0) % and was significantly higher in men (4.0 (2.55-6.0) %) compared with women (2.0 (1, 48-4.0) %), p = 0.07. There were no significant differences in the prevalence of hypercalcemia in persons over 45 years old (3.6 (2.2-5.5) %) and younger (2.6 (1.6-3.9) %) (p = 0,33). At the same time, statistically significant differences were observed in women between the age groups of 30-39 (1.2 (0.4-2.7) % and 40-49 years (10.7 (2.3-28.2) %), p = 0.01. Conclusion. The result we obtained indicates quite big proportion of people with a high content of calcium in the blood in the population of the Republic of Belarus. This may indicate that they have a certain hidden pathology.

Objective: To study the possibilities of the method of determining the 16S rRNA gene of bacteria in the determination of the bacterial spectrum of acute exacerbation of chronic obstructive pulmonary disease (COPD) using a protected material sampling Materials and Methods: 68 Hospitalized patients with acute exacerbation of COPD were prospectively evaluated. Molecular genetic determination of the 16S rRNA gene of bacteria and cultural microbiological techniques from sputum and a bronchial tree material obtained using a protected brush biopsy were used. Results: Bacterial agents were detected in 91,2 % of cases of acute exacerbation of COPD. Pseudomonas aeruginosa was detected in the biopsy material 1.8 times more often than with the use of routine methods. Patterns of COPD with frequent exacerbations, infectious exacerbations and Pseudomonas etiology of exacerbations were determined. Conclusion: Using the method of molecular-genetic determination of the 16S rRNA gene allows to verify the bacterial spectrum of acute exacerbation of COPD.

Objective: to determine the spontaneous and induced level of cytokine gene expression in mesenchymal stromal cells (MScs) and macrophages during their joint cultivation as a model for studying the immunomodulatory properties of mesenchymal stromal cells. Materials and methods. C57Bl/6 cell cultures of laboratory mice were analyzed: isolated short-term intact cultures of mesenchymal stromal cells and macrophages were studied as control groups. The cultures of mesenchymal stromal cells and peritoneal macrophages at their joint cultivation under conditions of Escherichia coli lipopolysaccharide stimulation in concentrations of 1 and 5 µg/ml acted as experimental groups. Results. Statistically significant differences (p < 0.05) in the value of normalized expression of TNF-α and IL-1β genes between control groups and groups of mesenchymal stromal cells stimulated by lipopolysaccharide in concentrations of 1 and 5 µg/ml were found, which indicates differences in spontaneous and mitogen-induced production of biologically active mediators. Conclusion. Statistically significant differences (p < 0.001) were found, which were characterized by a decrease in the normalized expression of TNF-α and IL-1β genes between the control groups (intact MSc cultures and peritoneal macrophages) and the groups of MSc stimulated by lipopolysaccharide in concentrations of 1 and 5 µg/ml. The studies performed allow us to propose mesenchymal stromal cells and macrophages as cells that regulate the immune response in diseases associated with the risk of chronization of the inflammatory process. In the long term, the results of the study will be used to create a model that allows extrapolating in vitro conditions to the processes occurring in the inflammation zone in a living organism.