Objective: on the basis of a literature review, to select the most convenient method of a diagnostic block of the superior and middle cluneal nerves that can be used in wide clinical practice.

Material. Publications that are deposited in PubMed resources and information portal eLIBRARY.RU and contain information on the application of diagnostic blocks of the superior and middle cluneal nerves were studied and analyzed.

Results. The most important aspects dealing with the prospects of the application of diagnostic blocks in neuropathy of the superior and middle cluneal nerves have been selected.

Conclusion. There is a variety of approaches to nerve block techniques and assessment of its results. Therefore, it is necessary to develop a step-by-step method for conducting diagnostic and therapeutic blocks in neuropathy of the superior and middle cluneal nerves that is convenient for use in wide clinical practice.

Objective: to present modern views of the professional medical communities of the USA, Europe and Russian Federation on the issue of eosinophilic esophagitis (EoE) published in the form of clinically approved recommendations and guidelines for the treatment of patients with this pathology.

Material and methods. To achieve the above objective, we analyzed modern literary sources dealing with this issue.

Results. We have reviewed the main clinical guidelines on this topic taking into account the comparison of methodological aspects, recommendations and their results, and highlighted the main problems associated with the diagnosis and treatment of patients with eosinophilic esophagitis.

Conclusion. Over the past years, the study of EoE has reached a qualitatively new level. However, the pathogenesis of eosinophilic esophagitis, as well as the methods of its diagnosis, treatment and prevention, are still at the stage of their deep study and improvement. The issue of eosinophilic esophagitis should be considered as an interdisciplinary one, since it involves the interaction of a pediatrician and/or therapist, allergist, gastroenterologist, nutritionist, endoscopist, and pathomorphologist.

Viruses belonging to the Papillomaviridae family have been isolated from mammals, birds and reptiles. The analysis of the genome structure of more than 240 different types of papillomaviruses has made it possible to better understand their evolutionary path. The existing data indicate that many diverse evolutionary mechanisms have influenced their phylogenetic tree. For more than 400 million years, papillomaviruses have occupied various ecological niches. Niche sorting was followed by extensive periods of host-parasite co-evolution. Adaptation to different host tissues, as well as to changing environmental conditions can explain some features of the members of the Papillomaviridae family, one of which is human papillomavirus (HPV), having an important clinical significance. The study of the driving mechanisms of the evolution will help to change the notions about HPV virulence, character of its spread, epidemiology, as well as the pathogenesis and the course of oncologic diseases caused by it. This review highlights some moments of the evolutionary history of papillomaviruses which created a background for the development of oncogenic features of certain HPV types.

Objective: to perform a comparative analysis of postoperative complications and hospital stay terms of in-patients with malignant liver tumors after atypical liver resection and locoregional radiofrequency ablation of liver metastases.

Material and methods. We analyzed the data of 295 patients with malignant liver tumors who had undergone surgical resection or radiofrequency ablation of tumor nodes.

Results. We have systemized the direct results of locoregional radiofrequency ablation under sonographic control and liver resection. 45 patients (17.8 %) after liver resection and 1 (2.3 %) patient after radiofrequency ablation developed grade III–IV complications according to the Clavien-Dindo classification. The frequency of complications is statistically significantly lower after radiofrequency ablation. The duration of hospital stay after radiofrequency ablation therapy was 4.5 ± 2.5 days. After surgical liver resection, patients stayed in hospital for 10.7 ± 2.3 days.

Conclusion. Locoregional therapy provides a statistically significant reduction in the incidence of complications and reduces the duration of hospital stay compared to liver surgery.

We have reviewed scientific publications dealing with the problem of the use of tissue-engineered materials in vascular surgery. The review presents the pros and cons of applicable conduits, describes in detail the biomechanical properties of tissue-engineered vascular conduits. However, the functioning of conduits depends on their ability to mimic the mechanical and biological behave our of the artery. The article describes the transmission of infection to vascular conduits, as well as presents the pathogenetic mechanisms, possible pathways of infections and their concomitance with the description of possible infectious agents, analyzes the ways and methods to improve the functional characteristics of existing tissue-engineered vascular conduits.

Objective: to determine a necessity to use grafts of biological origin in patients with acute arterial insufficiency.

Material and methods. A retrospective analysis of 212 medical records of patients with acute arterial insufficiency of the lower limbs undergoing in-patient treatment at the Vascular Surgery Ward of the institution «Gomel Regional Clinical Cardiology Center» from 2007 to 2019 has been carried out. Statistical processing of the study results has been performed using GoogleSheet, Statskingdom. Differences between groups were considered to be statistically significant at p < 0.05.

Results. Surgical interventions were performed on the arteries of the lower limbs in 22.4 % of patients having acute thrombosis in their medical history. In 97.1 % of the cases, repeated surgery was required on the arteries of the same lower limb. Autologous veins were used as conduits in 26.3 % of the cases, and synthetic explants were used in 73.7 % of the patients. Among the total number of surgeries, autologous materials were used as plastic material in 40 % of bypasses, and synthetic explants were used in 60 % of the cases.

Conclusion. The study has shown the necessity to use materials of biological origin as plastic material for the treatment of acute arterial insufficiency.

Objective: to evaluate the results of correction of lower extremity arterial disease using invasive intraoperative hemodynamic monitoring of peripheral circulation and to assess the influence of this method on selection of surgical tactics.

Material and methods. The outcomes of revascularization were compared in patients of two comparable groups: the patients of the first group had undergone interventions under intraoperative hemodynamic monitoring of peripheral circulation in addition to angiography, and for the patients of the second group a decision about the extent of correction had been made on the basis of angiography without intrapeorational functional evaluation.

Results. The application of the above method made it possible to decrease the length of the performed reconstructions: 90 mm (80; 125) in the first group vs. 70 mm (112.5; 247.5) (p = 0.018) in the second group with a comparable satisfactory outcome. The postoperative ABI values after the interventions in the first and second groups amounted to 0.86 (0.78; 1) and 0.8 (0.7; 0.86), respectively, which was associated with a favorable clinical prognosis in these patients.

Conclusion. The use of invasive intraoperative hemodynamic monitoring makes it possible to decrease the extent of reconstructions in multisegment lesions with the achievement of a satisfactory clinical outcome.

Objective: to establish sonographic criteria allowing determining the stage of the pathologic continuum in lumbosacral ligamentosis.

Material and methods. The sonographic data were compared with the results of the morphological studies of the samples of the iliolumbar ligaments, long dorsal sacroiliac ligaments, and sacrotuberous ligaments in 100 corpses. The age range of the studied subjects was 25–90 years. Among them, there were 64 men (average age 62.4 ± 11.8 years) and 36 women (average age 58.8 ± 15.1 years). Sonography of the ligament samples was performed in Bmode and using Multi-Slice View technology (Voluson 730 Expert and Toshiba Aplio XG ultrasound scanner, scanning frequency — 16–18 MHz).

Results. A sonographic pattern inherent in the stage of adaptive changes, the stage of potentially reversible changes, and the stage of irreversible changes has been determined.

Conclusion. Sonography can be used for a sufficiently accurate assessment of the stage of the pathologic continuum in lumbosacral ligamentosis.

Objective: to test and optimize a method for detecting clustered DNA lesions with an assessment of the quantitative characteristics of hepatic changes using an experimental model of acute toxic hepatitis.

Material and methods: Laboratory C57Bl/6 mice at the age of 10 weeks were used for the study. Acute toxic liver injury was induced by means of a single intraperitoneal injection of 30 % CCI4 solution in olive oil. The withdrawal of the animals from the experiment was made after 72 hours. For the detection of clustered DNA lesions, a liver fragment was resected.

Results. The electrophoretic parameters which are the most optimal for obtaining primary data for the subsequent calculation of the number of clustered DNA lesions have been proposed. The number of clusters in the DNA samples from the animals of the control group is significantly lower than in the experimental group and amounts to 54.80 [37.65; 59.24] and 76.82 [60.95; 92.41] APE1 clusters per million bp., respectively.

Conclusion. Successful testing and optimization of the OCDL method for the detection of clustered lesions in liver DNA have been performed. The study has shown an increase in the number of APE1 clusters and double-strand breaks in the DNA of the C57Bl laboratory mice with induced acute toxic hepatitis, which indicates significant derangement of DNA integrity and a high risk of developing progressive liver diseases in its toxic damage.

Objective: to study the effectiveness of leukotriene receptor antagonists in the treatment foratopic pathology in children.

Material and methods. 224 children with allergic diseases were prescribed to take montelucast for 3– 6 months.

Results. Taking montelucast has lead to positive clinical dynamics in 75 % of the cases.A significant reduction of the eosinophil count was achieved on days 10–15 of the therapy. The Cys-LTC4/D4/E4 indices came to normal after a one-month course of montelucast therapy in 40.3 % of cases in children with bronchial asthma, in 63.3 % of cases in children with allergic rhinitis and in 60.5 % of cases in children with atopic dermatitis.

Conclusions. The use of montelucast has significantly enhanced the control incidencerate ofallergic diseases in children.

Objective: to identify the variants of the development of anastomoses and their number in the umbilical artery.

Material and methods. 206 dead bodies of men (22–82 years of age) and 113 dead bodies of women (32–93 years of age) who had died of causes not related to pelvic pathology were used as the material for the study. The preparation method, vascular injection method, and statistical method were used to achieve the objective.

Results. It has been established that the anastomoses of the umbilical artery in both the men and women are most often found in the proximal third of the artery, significantly more rarely — in its middle third. We have determined no linear correlation between the sizes of the diameters of the umbilical artery and the sizes of the diameters of its arterial anastomoses on both the sides of the pelvic cavity in the females and on the right side in the males but have found such a correlation on the left side in the males.

Conclusion. The performed study has demonstrated that anastomoses of the umbilical artery in males and in females have a definite pattern of their origination.

Objective: to study the clinical laboratory features of the course of solitary plasmacytoma (SP) and extramedullary multiple myeloma (EMM).

Material and methods. The study included 42 people (22 patients newly diagnosed with EMM and 20 patients diagnosed with SP of various localization). The results were evaluated after 3 years of the study. The median age in the SP group was 61.5 years, in the EMM group — 65 years.

Results. A comparative analysis of the SP and EMM groups in terms of the clinical and laboratory parameters has found no statistical differences in the distribution of immunochemical variants. Significant differences were found in the frequency of determination of the abnormal ratio of immunoglobulin light chains (p = 0.046).

In EMM, extramedullary lesions were the most common for patients with multiple lytic bone lesions of the skeleton. SP was the most frequently detected in lesions of the peripheral skeletal bones and vertebral bodies.

Clinically, EMM was characterized by a more aggressive course if additional factors of an unfavorable prognosis (translocations, mutations) or unfavorable immunophenotypic markers (a combination of signs — expression of markers CD56 > 20 % and CD95 < 20 %) were identified or if the disease had been diagnosed at a young age.

The presence of even a minimal number of tumor or aberrant plasma cells in the bone marrow of SP patients, an abnormal ratio of immunoglobulin light chains, paraprotein detected in blood serum or urine were all poor prognostic factors.

Conclusion. The clinical course of SP and EMM combined with a young age, the presence of translocations or mutations, unfavorable immunophenotypic markers, is characterized by an increased frequency of progression or the development of resistance to the performed therapy.

Objective: to detect changes in the parameters of the structure and mechanical properties of the surface layer of lymphocytes in the blood of a rat after a single action (30 min and 2 h) of an extremely low frequency electromagnetic field (ELF EMF) on the rat`s whole blood in vitro.

Material and methods. We exposed the whole blood of a Wistar rat (4.5 months) to the effect of ELF EMF (50 Hz, B = 0.79 mT), generated by an experimental setup based on a Helmholtz coil. Lymphocytes were isolated from the blood using the Histopaque-1077 density gradient sedimentation method, then were placed on the surface of glass slides and fixed with glutaraldehyde, and finally were dried. We performed atomic force microscopy (AFM) using the atomic force microscope Bioscope Resolve in the PeakForce QMN mode in air.

Results. On the basis of the results of the analysis of the AFM images, we classified the lymphocytes into several morphological types depending on the size of the lamellopodium. We analyzed the mechanical properties of the surface areas sized 250 nm × 250 nm for lymphocytes with the lamellopodium sized 400–1100 nm. The analysis found an rise in the elastic modulus of the lymphocyte surface after a short-term action (30 min) of ELF EMF. When the time of the ELF EMF exposure was increased up to 2 hours, the elastic (elastic modulus) and adhesive properties (the adhesion force between the AFM probe tip and cell surface) of the lymphocytes were significantly weakened.

Conclusion. For the first time using the AFM method we have detected nanoscale changes in the structure and mechanical properties of the surface of the rat`s lymphocytes after a short-term action of ELF EMF (50 Hz, 0.79 mT, 30 min), which are indicative of the activation of the functions of lymphocytes as an immune system component in response to the short-term exposure of ELF EMF.

Objective: to study the features of emotional burnout among mid-level health providers having different hardiness levels.

Material and methods. The study involved 104 mid-level health providers. To identify the features of hardiness and emotional burnout among the mid-level health providers, the method of diagnosing the level of emotional burnout (by V. V. Boyko) and the Hardiness Survey by S. Maddi (modified by E.N. Osin, E.I. Rasskazova) were used.

Results. A considerably larger number of people having marked signs and symptoms of emotional burnout have been revealed in the group of health providers with a low hardiness level than in the groups of health providers having medium and high hardiness levels. The features of emotional burnout among mid-level health providers with different levels of hardiness have been identified.

Conclusion. A high hardiness level will promote and enhance physical and mental health of health providers and is a means of preventing emotional exhaustion during professional activity.

The article deals with the basic principles of the assessment of the quality of a binary classifier using the potential of the ROC analysis and describes a ROC analysis algorithm and the interpretation of the obtained results. The work discusses the methodology for the calculation of the main parameters of the ROC curve, as well as the instructions for the assessment of their statistical significance.

Objective: to analyze the medical and demographic indicators in Gomel Region between 2008 to 2019 in dynamics.

Material and methods. The source of initial information was the materials of the annual reports of the National Statistical Committee of the Republic of Belarus for the period from 2008 to 2019. The calculation and assessment of the demographic indicators were made according to the generally accepted method. The 95 % probability of differences (α = 0.05) was considered to be statistically significant.

Results. The performed analysis has showed that an unfavorable demographic situation still persists in Gomel Region. Thus, the average population in 2019 decreased by 5.8 thousand people compared to 2008 and made up 1409.9 thousand people. The number of urban dwellers in the region made up 1095.4 thousand people and increased by 0.5 thousand people, the rural population decreased by 6.3 thousand people and made up 315.5 thousand people. The share of the rural population in the total population of the region is currently 23.3 %. On the whole, there is a negative natural increase. The natural decline remains stable and long-term, and in the year of 2019 it was — 3.8 ‰. The general mortality rate increased by 3.8 %, and the birth rate decreased by 4.9% compared to the previous year. The mortality rate among the working-age population remains high. The study has found the stabilization and even a decrease of child and infant mortalities over the past years.

Conclusion. The analysis of the demographic processes in Gomel Region between 2008 and 2019 indicates their direct and significant negative impact on the population size and its age and sex structure. This tendency is not temporary, as it is associated with the current historical process. The number of residents in the region is constantly decreasing, which is mainly related to the stable natural decline. Taking into account the current demographic crisis not only in Gomel Region but also in other regions of the Republic of Belarus, health promotion and enhancement among the population should be the most important priorities of the state policy.

Dirofilariasis is the most common transmissible zoonotic nematodosis in Europe, whose clinical manifestations are caused by the migration of immature helminths through human tissues or internal organs. Clinically, it is characterized by slow development and a long-term course, and morphologically — by chronic granulomatous inflammation, often with microabscess.

The work presents the description of a clinical case of dirofilariasis of the pleura, the diagnosis of which was performed only at the stage of the histological examination of the surgical material.

The clinical manifestations of myocarditis may have many variants. At the onset of the disease, it may progress as myocardial infarction. In this regard, the diagnosis of myocarditis is often justified by the clinical picture of the disease, changes in the electrocardiogram, echocardiogram, elevated level of cardio-specific enzymes coupled with the absence of coronary pathology. However, not always data obtained during the examination of patients at the beginning of the disease allow undertaking differential diagnosis between myocardial infarction and myocarditis.

Objectives: to develop a method for management of chronic wounds based on the use of autologous red bone marrow aspirates.

Material and methods. A randomized study of the second phase of the wound healing process was conducted in 72 patients with chronic wounds. The standard methods were used to assess the dynamics of the wound healing process.

Results. The rate of the wound healing process in the main group was Me 6.0 (LQ 5.0; UQ 35.0) % per day, and in the control group — 3.0 (LQ 3.0; UQ 28.0) % per day, which was authentically twice as high in the use of autologous red bone marrow aspirates (p = 0.00036). The duration of the phase of granulation tissue formation and maturation in the main group was Me 5.0 (LQ 3.0; UQ 7.0) days, and in the control group — Me 12.0 (LQ 9.0; UQ 15.0) (p < 0.00001).

Conclusion. The developed method of wound healing acceleration is characterized by its technical simplicity, convenience and cheapness. Its use makes it possible with high fidelity to reduce the duration of the second phase of the wound healing process by 7 days and leads to a two-fold increase in the healing rate of wound defects.