Introduction. The prevalence of mental disorders, especially anxious and depressive calculi, among cardiac patients is significant. There is no doubt that it affects the cardiovascular system. The objective of the study was to analyze the prevalence of anxiety and depressive disorders among patients with cardiac pathology in the large hospital; and also to assess the provision of patients with this pathology with psychosomatic beds. Material and methods. In the course of the study, a questionnaire was conducted among 264 patients in the large cardiology department in St. Petersburg. The respondents were asked general and specialized (HADS questionnaire – screening for anxiety and / or depression) questions. With the help of special formulas on the basis of the received data, the required number of psychosomatic beds and regular positions of psychotherapists for the treatment of psychosomatic pathology for the city of St. Petersburg was calculated. Results. The findings confirmed the presence of a significant proportion of anxiety and / or depressive disorders among patients with diseases of the circulatory system. In addition to objective data, a significant percentage of interviewed patients associate the development of the underlying disease with emotional stress. Special attention is required by the age group of 60–75 years and older; men and women equally. It is important to note that the specific weight of clinically expressed forms is significant. This group of patients needs psychotherapeutic treatment in addition to the therapy of cardiac disease, which the respondents admit. Conclusions. Despite such a significant relevance, the organization of medical care for these patients in St. Petersburg is not enough. The perspectives of solving the problem were determined: an increase of stuff psychotherapists in multidisciplinary hospitals, integration of psychotherapeutic care into the outpatient stage of treatment.

Introduction. One of the conditions for the provision of quality medical care is the involvement of all categories of medical personnel in the quality assurance process, which is impossible without clear knowledge of the theoretical aspects of this concept, including modern notions of conditions, structure, components, and criteria for assessing the quality. A sufficient level of awareness will allow the heads of medical organizations to build properly a quality assurance strategy with active involvement of employees, what is now recognized as one of the main principles of the quality management methodology. Unfortunately, until now the preparedness of medical workers on these issues is insufficient. Moreover, only single studies are devoted to the analysis of this problem, including among obstetrician-gynecological specialists. Research objective is to study the level of preparedness of maternity hospital doctors in the quality of medical care, their opinion on the level of quality and to develop a system of measurements to quality improvement. Material and methods. On the basis of one of the maternity hospitals of St. Petersburg, 95 doctors were questioned using a specially developed questionnaire. The questionnaire included self-assessment by doctors of their preparedness on quality issues, their assessment of the level of the quality in the basic organization, as well as questions to assess the real level of doctors’ knowledge. The correctness of the answers reflecting the current theoretical ideas about the structure, components, criteria for assessing the subjects of control was evaluated by experts of the Quality Service of the Organization. Data processing was carried out on a personal computer using the Statistica 6 software package. Based on the results of the study, recommendations were developed to optimize the training of personnel in the maternity hospital on the quality of medical care and to improve the quality management in the Organization. Results. Assessment of the level of knowledge of medical personnel of the maternity hospital on the quality of medical care showed that 51 respondents (53.7 %) considered themselves sufficiently prepared; 24 (25.2 %) found themselves not quite prepared; 19 (20.0 %) could not assess the level of knowledge on this issue; 1 (1.1 %) refrained from responding. None of the interviewed employees indicated a lack of such knowledge. Answering the special questions (quality criteria, statistical indicators of the maternity hospital, subjects of quality control), some of the respondents could not give the correct answer. The main source of information about the quality of medical care are conferences (62.1 % of respondents noted), thematic cycles of professional development (53.4 %), self-training (41.8 %). The average mark of the assessment of the quality in the basic hospital was 4.2±0.87 (on 5-point grading system). The main suggestions of respondents on quality improvement were: reduction of workload and increase in the number of personnel, improvement of the system of material incentives for employees, material support of the institution. Conclusions. According to the results of the study, the measurements aimed at improving the level of doctor’s knowledge in such subject as medical care quality and stimulating employees to constant work to improve the quality are presented.

This is a systematic literature overview concerning contemporary approaches to the gap between randomized clinical trials (RCT) results and the evidence within real world medical practice («efficacy-effectiveness gap, EEG»). The overview includes 18 articles and 1 publication by regulatory expert community. 13 articles describe the EEG using particular evidence and 5 articles discuss the issue systematically. According to the results of the observations, the authors of 16 articles concluded that this discrepancy exists, and the authors of 2 articles concluded that in their studies this discrepancy was not found. Upon current review it was concluded that the factors providing EEG can be divided into the following groups: subjective factors coming from healthcare system organization processes and the caregiver-patient intercommunication principles; objective factors coming from essential RCT limitations as a scientific method; and the artificial limitations always made within RCT taking intermediate position.

The objective is to study the technologies of AM portal ACL-R and antegrade outside-in ACL-R, to give a description and scientifically grounded recommendations for their clinical application. Material and method. 114 operations were analyzed. AM portаl ACL-R was performed in 39 cases (34.2 %) (1a subgroup) and antegrade outside-in ACL-R was performed in 37 cases (32.5 %) (1b subgroup).Transtibial ACL-R was performed in 38 cases (33.3 %) (group 2). Results. In the 1 group, stability and knee function was higher, the vertical graft position, its postoperative destruction or dilatation of the bone channels was less often observed (p<0.01). Nevertheless, the intraoperative time in the 2nd group was less (p<0.05). Conclusions. The anatomical ACL-Rs make possible to obtain greater reliability in achieving excellent and good results in comparison with the transtibial technique.

Introduction. Steroid-refractory graft-versus-host disease (srGVHD) is one of the most severe and life-threatening complications of allogeneic hematopoietic stem cell transplantation. Currently, there is no standard treatment for this complication. In addition, there is no data on the pharmacoeconomics of various methods in the Russian Federation. The objective is to compare the effectiveness and cost of treatment of acute and chronic srGVHD, as well as the use of different approaches in therapy. Material and methods. We have conducted a pilot study in 12 srGVHD patients treated with ruxolitinib and in 24 patients of wellmatched historical control, who treated with etanercept for the acute srGVHD and with extracorporeal photopheresis for chronic srGVHD. Results. The 6-month therapy of acute GVHD was associated with significantly higher cost than therapy of chronic GVHD (4.138±2.672 vs 1.862±1.122 thd. rub., р=0.004). The major factors driving up the costs were bacterial infections (р=0.022), opportunistic viral infections (р<0.001), severity of GVHD at the start of a therapy (р=0.013) and GI involvement (р=0.006). There was no difference in 1-year failure-free survival in acute (50 % vs 67 %, р=0.9) and chronic GVHD (87.5 % vs 87.5 %, р=1.0) between ruxolitinib and the control group, although the overall response was faster in ruxolitinib group (100 % vs 71 %, р=0.035, when assessed at 28 days in acute and 12 weeks in chronic srGVHD). The mean 6-month overall costs in the ruxolitinib were higher compared to the control group (1534 thd. rub. higher for acute and 541 thd. rub. higher for chronic GVHD), however this might be attributed to higher number of previous lines in the ruxolitinib group. Conclusions. It is revealed that the treatment of acute srGVHD requires significantly higher economic costs than chronic srGVHD. The power of this study does not allow to draw conclusions regarding the efficacy of different methods. Further studies are required to determine the optimal therapy of srGVHD.

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is one of the most widespread pulmonary diseases. The important feature of conditions of emergence of COPD is long influence of etiological factors and risk factors. Detection of risk factors is urgent and necessary for well-timed diagnosis, purpose of adequate treatment, improvement of scheduled maintenance. The objective is to show the negative impact of individual etiological factors and of risk factors of COPD among adult population in one of the regions of the Komi Republic for the 2013–2016 period. Material and methods. Materials of medical examination among the adult population in the urban-type settlement Zheshart of the Komi Republic for the period of 2013–2016. The patients were divided into three age groups: from 21 to 36 years, from 39 to 60 years, from 60 years and older; men and women. Among the unfavorable etiological and risk factors a special attention was paid to climate, smoking, low physical activity, irrational nutrition. Results. The Komi Republic is characterized by a cold and severe climate. The adverse climatic factors promote development of COPD, especially in patients with genetic predisposition to pulmonary diseases. The percentage of smokers is high among the population and male smokers on average by 40.6 % more than women smokers. Smoking is mainly common at the age from 21 years old up to 36 years old. The number of patients with low physical activity remains at steadily high level. The number of women with low physical activity exceeds number of men in two and more times. Most of all patients with low physical activity (as well as with irrational nutrition) are noted at the age of 39–60 years. An alarming tendency is prevalence of an irrational nutrition. The number of the women eating irrationally exceeds the number of men in 1.5 -2 times. The number of patients with irrational nutrition is less at the age of 21–36 years. Conclusions. The serious risk factors of COPD are negative climatic conditions, low physical activity, smoking, irrational nutrition. Pulmonary rehabilitation is necessary for patients with COPD. A basis of pulmonary rehabilitation is the physical exercises. Identification and accounting of risk factors of COPD is important for improvement of scheduled maintenance, early diagnostics and purpose of adequate therapeutic treatment.

Introduction. The Inflammatory Diseases of the Parodont (IDP) of generalized character are closely connected petrogenetically with internal pathology and are a serious factor of its burdening, forming a negative comorbidity. Pro-inflammatory reactions and metabolic shifts, such as oxidizing stress, violation of regulatory participation of the vital minerals at an imbalance of their distribution in biological environments are the inflammatory mechanisms uniting IDP with chronic inflammatory diseases of visceral of different localization. The objective of the study was identification of metabolic factors of pathogenetic community of GIDP and a comorbid chronic focal infection of different localization. Material and methods. The activity of systemic factors of inflammation were studied in the patients with generalized periodontitis (GP) of developed stage on a background of multiple chronic foci of infection: level and ratios of pro- and antiinflammatory cytokines – interleukins 2,6,10, TNF-α, C – reactive protein in comparison with the activity of oxidation of lipids, proteins, low molecular weight thiols, assessment of levels of Zn, Cu, Fe in biological environments and the hepsidin blood level. Results and discussion. Significantly more expressed metabolic disorders in comorbidity multiple chronic foci of infection and GP, than in the absence of periodontium lesions have been shown. Increased lipid peroxidation and free radical oxidation of thiols (p<0.01), increased levels of C – reactive protein level and pro-inflammatory cytokines (TNF-α, IL 6), and imbalance in the distribution of such trace elements as copper, zinc, iron in environments of organism were found in patients with combined pathology of comorbidity multiple chronic foci of infection and GP. Conclusions. Thus, the findings of the study demonstrate that formation of multiple chronic foci of infection in an organism is connected with increase of mediators of system inflammation in blood, disorders of redox metabolism and deficiency of such trace elements as Cu, Zn, Fe which are the key factors of a enzyme link of antioxidant protection.

Introduction. Psychological care as the essence of psychological rehabilitation in оoncology is based on the working with the experiences of patients caused by cancer. The specificity of the patient’s experience is determined by the localization of the tumor and the importance attached to the patient’s diseased part of the body. Gynecological cancer affects important areas for women related to femininity, motherhood, affecting her sexual life and family relations. The objective is the psychological study of the experiences of oncogynecological patients, the specificity of which must be taken into account in the process of psychological rehabilitation. Material and methods. 41 patients aged from19 to 45 years with oncogynecological diseases at different stages of treatment were examined. The data of the clinical and psychological interviews were supplemented by the results of psychodiagnostic tests -TOBOL, Hissen questionnaire of somatic complaints, EQRTCQLQ-C30. Results. Long period of denial of the malignant disease is not characteristic for oncogynecological patients. Disturbing component in patients at the stage of «before operation» and dysphoric component in patients at the stage of «after surgery» were dominated on the background of ergopathic reactions to the disease in the structure of attitude to the disease. The high intensity of complaints of female patients about their health, including non-specific, indicating the psychosomatic component of the patient’s suffering was revealed. The life quality of patients is interconnected with their idea of the types of treatment, their dangers. It is shown that cancer is a psychological crisis not only for the oncogynecological patient, but also for other members of her family, especially her husband. Conclusions. Psychological care for oncogynecological patients in the process of psychological rehabilitation should be based on the account of their deep experiences, which are determined by the self-relationship of women and the adoption of themselves and that patients are not aware, but affect their attitude to the disease and treatment and, thereby, determine their life quality. Psychological care aimed to building new relationships, which are adequate to the situation of the disease, is necessary for the whole family of the patient.

Introduction. Erythropoietin (EPO) – physiological stimulator of erythropoiesis. It activates the mitosis and maturation of red blood cells from progenitor cells erythroid series. One of the main effects of EPO is the slowdown in the rate of apoptosis of erythroid progenitor cells in the bone marrow. Protective properties of EPO demonstrated in various diseases in clinical and experimental conditions. Previously, it was found that activating EPO-effect on T-lymphocytes (TLC) may result not only to the increase of the number of fluorescent mitochondria in cell (nm/c) with proton potential (Δφm), but also external growth of growth of external membrane potential electric potential of plasma (Δφp). The objective of this work was to investigate the TLC response upon EPO after exposure to specific inhibitors of phosphorylation reactions in the respiratory chain. Material and methods. We studied EPO («Eprex», Cilag) effect on rat TLC in vitro after their deenergization by several inhibitors: dinitrophenol (DNP) - uncoupler of oxidative phosphorylation and ingibitor of respiratory chain), pentachlorphenol (PCP)- uncoupler of oxidative phosphorylation, N,N -dicyclohexylcarbodiimide (DCCD)- of Ca2+- inhibitor of the membranebound part of the mitochondrial membrane ATP-ase with the help of a potential-sensitive vital fluorescent probe-cation 4-(p-dimethylaminostyryl)-1-methylpyridinium (DSM). Rat TLC were isolated from thymuses according to the standard method. The microfluorimetric studies of DSM-stained TLC were performed by means of fluorescent microscope («Lumam I- 2», «LOMO», Russia) with thermostatic table. Fluorescence of 50–70 single cells was measured in each specimen, mean fluorescence intensity of TLC (F ~ ) was calculated. In addition, n _m/c was calculated in each fluorescent cell. Statistical processing of the experimental data was performed by the Spearman’s rank correlation coefficient. Results and discussion. In experiments with TLC from different thymuses, we registered a decrease in F ~ and n m/c after incubation with all used inhibitors. It was found that the difference in decrease velocity of nm/c and of F ~ depended on the type of inhibitor and on the duration of incubation. Maximum reduction of energy of the TLC achieved by incubation with a DNF, after which the EPO does not recover F ~ and _m/c. After incubation with PCP, EPO restores ~ 20–23 % _m/c and F ~ . The reaction of TLC on the DCCD confirms the important role of the ATP-ase in the maintenance of mitochondrial membrane potential. After deenergization of TLC under the action of DCCD, EPO has the maximum effect: restored ~ 42 % n m/c and ~ 38 % F ~ . Conclusions. EPO is able to partially recover the polarization of the mitochondria membranes in TLC violated as a result of exposure to DCCD.

Relevance. Clarifying the sequence and mutual connection of the median arcuate ligamentum syndrome (MALS) and reflux esophagitis (RE) makes it possible to determine the indications and success of the operation. The objective of the study was to compare the results of the examination and operations in patients with the MALS in combination with RE. Material and methods. 198 patients with MALS were examined and operated. Among them, 85 patients was just with MALS, and decompression of celiac trunk was performed for them. 84 patients had MALS and RE, simultaneously decompression of celiac trunk and Nissen fundoplication were performed for that group of patients. 29 patients had MALS and RE, only decompression of celiac trunk was performed for that group. A comparative analysis of the results of examination and surgical treatment of 85 patients with the MALS and 84 in combination with RE was carried out. The average age of the patients is about 30 years, the female gender prevailed. The feeling of heaviness and abdominal pain due to eating and physical activity, neurovegetative disorders was almost in all patients. Daily or weekly heartburn, regurgitation, vomiting and dysphagia as well as edema, erythema and erosion of the esophageal mucosa were observed mainly in patients with MALS in combination with ER. Results. Significant compression stenosis of the celiac trunk was detected in all patients. After the decompression of the celiac trunk in patients with MALS as well as decompression of the celiac trunk and Nissen fundoplication in patients with MALS in combination with ER, most of them received good clinical results and normalization of anatomical and hemodynamic parameters in celiac trunk. Conclusion. In the combined version of the MALS and RE and the corresponding indications it is expedient to perform decompression of celiac trunk and Nissen fundoplication simultaneously.