Most hematological malignancies are characterized with aberrant functioning of the immune system. The conducted studies indicate an important role in the development of malignant hematopoietic diseases arising from genetic factors, including the genes of intracellular signalling pathways, especially those involved in the implementation of an antitumor immune response. The review presents aggregated data on polymorphism studies of the toll-like receptors signalling pathway molecules of genes whose role in the development and course of various types of hematological malignancies is considered to be proven.

It was found that vaginal hysterectomy has several advantages over the laparotomic, combined and laparoscopic ones: minimum traumatization, favourable cosmetic effect, smooth postoperative and recovery periods, no complications in the late postoperative period, reduced risk of intraoperative complications. The review presents a comparative analysis of the haemostasis methods – bipolar coagulation versus conventional suture ligation in vaginal hysterectomy. The bipolar coagulation with the BiClamp proved superior or similar to conventional suture ligation. Intraoperative blood loss, operating time were less but postoperative pain and complications were the same. Moreover, bipolar coagulation was easier to use and more cost effective. The accumulated experience proves the electrosurgical technique in hysterectomy to be reasonable and efficient, and it requires further research.

Relevance. Over the last decades, such technology substituting inpatient treatment as outpatient treatment has been actively discussed and used in practice. Despite this fact, many problems of outpatient treatment have not been solved in full, no effective leverages contributing to creating economic incentives for increasing the volume and range of medical services in day hospitals have been found in the mandatory medical insurance system.

Objective. Based on an in-depth analysis of medical care provision to women with benign gynaecological neoplasms, to offer measures for improvement of medical care in outpatient facilities, particularly by using technologies substituting inpatient treatment, and to evaluate their effectiveness.

Materials and methods. A comprehensive retrospective evaluation of outpatient and inpatient medical care was conducted in St. Petersburg over the period from 2008 to 2015. The information contained in the database of billed and paid invoices of the obligatory medical insurance system of St. Petersburg was studied. For the total period of eight years, the data on medical care provision to 81 622 women suffering from benign tumors of the female reproductive organs, particularly in day hospitals, were obtained. In the period 2015–2016, medical care provision to patients with benign neoplasms of the gynecological sphere was thoroughly analyzed. In 18 women’s health departments and 19 in-patient facilities in all districts of the city, all cases of treatment of patients in the basic women’s health departments and in-patient facilities were analyzed by experts. By Taking into account the obtained results, an organizational experiment on introducing substituting technologies followed by evaluating the effectiveness of their use was developed and implemented on the basis of the medical institutions in one of the districts of St. Petersburg.

Results. The activeness of outpatient facilities for treatment of women with benign neoplasms of the gynecological organs within the system of mandatory medical insurance has been constantly decreasing: in 2008, the services of outpatient facilities were provided by 26 health institutions, in 2015 - only by 11.The costs for treatment of patients with such diseases were analyzed, and differences were found in the approaches practiced in different districts of St. Petersburg. Low hospitalization levels predetermine active work for early detection, treatment and rehabilitation of patients at the outpatient stage, however, the study showed that in the districts with low incidence of women’s hospitalization, high detection rates are not always the case for these diseases at the outpatient stage. Such cases can result from inadequate tactics for treatment of patients at the outpatient stage, when patients not requiring 24-hour medical supervision get into an inpatient facility. Given the problems identified during the retrospective analysis, in the framework of the research conducted, approaches to arranging the treatment of patients based upon interaction between the inpatient and outpatient lings were suggested. On the basis of the Gynecological Department of a district inpatient facility, 4 outpatient beds were provided. The data analysis of the institutional experiment showed the absence of any significant dynamics in the general hospitalization levels (113.6 per 100 thousand of the adult population in 2012 112.0 per 100 thousand of the adult population in 2016, t < 2). At the same time, the incidence of urgent and and day-to-day hospitalization decreased significantly: urgent hospitalization was 11.6 per 100 thousand of the adult population in 2012 and 9.0 per 100 thousand of the adult population in 2016 (t = 3.9; p < 0.05); the figure of day-to-day hospitalization was 7.0 per 100 thousand of the adult population in 2012 and 5.5 per 100 thousand of the adult population in 2016, t = 2.7; p<0.05).

Conclusions. Improvement of outpatient medical care provision to patients with benign tumors of the female genital system is possible through an active use of technologies substituting inpatient modalities, such as outpatient treatment. The experiment showed that effective monitoring of patients is possible only with close cooperation between medical institutions at all levels and building trust relationship between the doctor and the patient.

Introduction. The problem of limited accessibility and quality of ophthalmic medical care remains one of the leading ones in the national healthcare. This article presents results of the survey conducted among ophthalmologists about the effect of large-scale equipment of all medical institutions in the Leningrad Region with modern ophthalmologic devices over the recent years.

Objective is to determine the contribution of the health care modernization program to equipping the medical institutions of the Leningrad Region with modern ophthalmologic medical devices, and to identify the main areas for improving the ophthalmologic care for residents of the Leningrad region with cataracts.

Materials and methods. According to a specially developed questionnaire, 105 ophthalmologists from the Leningrad Region were interviewed. The survey was conducted among physicians working both in out-patient medical facilities and in medical facilities with in-patient modalities.

Results. The results of the study confirmed positive changes that occurred in recent years as a result of equipping medical institutions with modern medical devices. Almost two-thirds (59.9%) of respondents noted that equipping with modern medical devices had a significant impact on the quality of the medical and diagnostic measures carried out in healthcare facilities of the region.

Conclusions. The equipment had a significant impact on the diagnosis and treatment of all kinds of diseases of the eye and its appendages, especially such eye disease which is so common among the population of the Leningrad Region as cataracts (75.0 per 100 ophthalmologists surveyed). At the same time, in spite of these efforts, the standard for equipping ophthalmologic departments in individual medical institutions has not been fully provided. Only every fifth (20.9%) ophthalmologist noted during the survey that the list of available ophthalmic devices was sufficient, and that they all worked properly.

The role of transcription factors in the pathogenesis of pituitary adenomas is extremely controversial.

The aim of the study was to investigate the role of the transcription factor Neuro D1 in various types of pituitary adenomas.

Materials and methods. A comparative clinico-morphological study was carried out with immunohistochemical analysis and confocal microscopy of the expression of the transcription factor NeuroD1, six adenohypophysis hormones and Ki-67 in 40 pituitary adenomas and 9 normal pituitary glands.

Results. NeuroD1 was expressed in all cases and types of adenomas. The expression level of the transcription factor in adenomas was significantly different from that in the normal pituitary gland (p = 0.006). The average number of cells with expression of NeuroD1 in all tumors was higher than in the normal pituitary gland.

Conclusion. NeuroD1 plays one of the key roles in the pathogenesis of pituitary adenomas, regardless of their hormonal status.

Objective. The influence of chronic stress (CS) on increase in thickness of the intima media complex (IMC) of common carotid arteries as a sign of asymptomatic disturbance of the target organs in atherosclerosis was explored.

Materials and methods. 160 railroad engineers (RRE) and 100 healthy volunteers were examined. The activity of the stress systems was measured by the level of stress hormones in the blood (adrenocorticotropic hormone, cortisol, corticosterone). The secretory function of vascular endothelium was measured by release of nitrogen oxide and endothelin-1. The condition of inflammatory activity processes (concentration of high-sensitivity C-reactive protein), total cholesterol and its fractions were studied among the factors affecting the endothelial function. The IMC thickness was measured by duplex scanning. Blood pressure (BP) was measured by Holter monitor.

Results. The effect of CS was accompanied by an increase in stress hormones, development of endothelial dysfunction (ED), progression of inflammatory processes, occurrence of dyslipidemia due to an increase in the content of low-density lipoprotein (LDL), increased BP. Against this background, the IMC thickness increased at a faster rate among RRI.

Conclusions. The effect of the CS factors leads to appearance of ED, which promotes an increase in the thickness of the CMM as a factor of vascular atherosclerosis.

The life quality estimation of dental patients, especially with total adentia, before and after implant treatment is highly topical. A direct or immediate implant prosthodontics contributes to prompt restoration of impaired aesthetic and functional standards while urgently converting patients from a disability level to a high life quality category. However, mistakes and complications occurring in this treatment stage often result in patients’ discomfort and worsen their physical and psycho-emotional state. All these are not conductive to securely provided favourable results of dental implant prosthetics, and thus require further improvement of the clinical and conceptual approaches aimed at further optimization of the above specialized medical care. The authors succeeded in improving efficacy of immediate implant prosthodontics with extended orthopaedic constructions by means of optimizing the diagnostic and therapeutic resources, as well as the hygiene protocol.

Activation of angiotensin-converting enzyme (ACE) is observed in lung tissues, induced sputum (IS), and, to a lesser extent in blood serum. Vascular hypertension is noted in 40 % of patients with chronic obstructive pulmonary disease (COPD). Therefore, many COPD patients receive ACE inhibitor therapy. Studies of ACE production by specific protein levels or ACE1 gene expression may represent sufficient clinical interest in COPD and upon its treatment using hypotensive drugs.

The objective of the work was to study the normal ACE1 expression in control persons and COPD patients, and to assess correlations between the АСЕ1 genotypes and clinical parameters in patients with COPD.

Materials and methods. The study included 124 patients with grade II-III COPD. ACE1 activity in blood leukocytes was determined by means of qPCR using fluorescent probes. As a reference gene for data normalization, the GAPDH gene was selected. The data on gene expression were evaluated according to the ∆∆Cq method. The insertion/deletion (I/D) polymorphism of the АСЕ1 gene was determined with standard PCR technique according to the amplicon length after their detecting in agarose gel.

Results. We have found a significantly increased AСЕ1 gene expression among patients with COPD upon exacerbation and after treatment, compared to control group. Frequencies of I/D genotypes and АСЕ1 gene alleles did not differ significantly between total group of patients and comparison groups, thus showing no association between this polymorphism and COPD risk. In combined sample group (95 tests), the D/D genotype has shown a moderate, but significant correlation with ACE1 mRNA expression in peripheral blood leukocytes.

Monoclonal gammopathy of undetermined significance represents a number of conditions, the development of which is based on functional impairment of B-lymphocytes, which results in permanent pathological secretion of a single clone of immunoglobulins or their constituent chains. One of the leading and often the only clinical manifestation of monoclonal gammopathy is peripheral neuropathy associated with paraproteinemia. The article presents a clinical case of severe peripheral neuropathy associated with monoclonal gammopathy of undetermined significance. The diagnosis was confirmed on the basis of a comprehensive diagnosis, including screening paraproteinemic proteins in serum and a single urine sample is a method of immunofixation. Polyneuropathy was treated by using intravenous human immunoglobulin, as well as non-drug methods of rehabilitation (local cryotherapy, physical therapy and stabilometry). The therapy made a positive effect in reducing the symptoms, primarily the sensory and neuropathic components and polyneuropathy.

Over the recent years, a number of publications on the central nervous system (CNS) damages associated with anti-Ro/SS-A and anti-La/ SS-B antibodies has increased, which can signify an increase in the incidence of neuroimmunopathological conditions. Two cases with isolated central nervous system (CNS) impairment and anti-Ro/SS-A and anti-La/SS-B antinuclear antibodies are discussed in the article. In the first case, the CNS impairment with increased rates of anti-Ro/SS-A and anti-La/SS-B antibodies preceded the clinical manifestations and pathomorphological signs corresponding to the diagnostic criteria of Sjogren’s syndrome (SS). In the second case, the paraneoplastic CNS disorder was associated with an increase in the rate of such antibodies and was followed by the oncological process disseminaton. The described studies demonstrate possible heterogeneity of neurologic manifestations of immunopathologic processes. Further research is needed for the immunological targets of anti-Ro/SS-A and anti-La/SS-B antibodies, as well as for the pathophysiological mechanisms of associated neurological disorders.