Eugene I. Schwartz (1940–2003), the first head of the Department of Molecular Genetic Technologies of the Research Center of the Pavlov University, a well-known geneticist, stood at the origins of molecular medicine in Russia. The results of the research work of E. I. Schwartz are introduced now in the work of many clinical centers. He also created one of the first course of medical genetics for physicians in our country. This article reflects the main milestones of the scientific and pedagogical way of E. I. Schwartz, and discusses the achievements of his teams.

The article analyzes the practice of applying innovative models of primary health care system management in the framework of the Belgorod region project «Health Management». The special place is given to the evaluation of innovative models of primary health care organization on the Belgorod region’s territory. The experience of medical care for adults and children in urban and rural areas by general practitioners (family doctors) is presented. Changes in the structure of primary care physician admission in regional medical institutions are shown. The expediency of innovative modeling is confirmed by the presence of organizational and medical-demographic effects.

The article is devoted to an actual problem-the choice of categories of the International classification of functioning in the medical rehabilitation of patients with chronic obstructive pulmonary disease. An analytical review of the Russian and foreign literature was conducted, the categories of ICF included in the complex and brief set of ICF for obstructive pulmonary diseases, recommended by WHO in work with patients with COPD were carefully studied, which showed the relevance of the problem, unsolved problems and prospects for research on this topic.

The article represents a description of the individual features of the arterial network of the elbow joint and comparing results of the investigation with data of Russian and foreign anatomical schools of the USA, Canada, India and Great Britain. The investigation of the arterial network of the elbow joint of two male and two female dead bodies was implemented on the basis of the Anatomy Table. The screenshots was taken after extracting the arteries of this area. The graphic figures allowed to identify individual features of the arterial network of the elbow joint.

Introduction. Despite the evolution of antipsychotic drugs, the problem of the therapy effectiveness and safety of schizophrenia spectrum disorders and comorbid conditions is very acute. The dopamine receptor D2 gene (DRD2) is one of the key targets of modern pharmacogenetic studies of mental disorders.

The objective of the study was to analyze the DRD2 mRNA level in peripheral blood lymphocytes and to identify genetic variations of –141С Ins/Del as potential biomarkers for antipsychotic therapy prognosis.

Methods and materials. The study included 112 patients with mental disorders: 61 – with a diagnosis of schizophrenia spectrum disorder, 51 – with a comorbid disease course with alcohol dependence syndrome, and 112 people as a control group. Psychometric evaluation was carried out using PANSS scale. The material was peripheral blood lymphocytes (PBLs). The DRD2 mRNA level was determined by real-time polymerase chain reaction with TaqMan probe. Genotyping –141С Ins/Del was performed by the restriction fragment length polymorphism assay.

Results. –141C Ins/Del DRD2 genetic variations are not associated with a risk of mental disorder development, and they did not affect the DRD2 mRNA level in PBLs. There were no significant differences in the gene expression of DRD2 in the control group and patients (p=0.194). Despite the improvement of the mental state in all patients included in the study, the studied DRD2 parameters did not affect either the mental disorder symptoms or the normalization of the patient status against the background of antipsychotic therapy. Ins/Ins genetic variation of –141C Ins/Del was significantly associated with an increase weight gain of more than 7 % on the 28th day of antipsychotic therapy.

Conclusion. Ins/Ins genetic variation of –141C Ins/Del can be considered as a biomarker for the prognosis of antipsychotic-induced weight gain. 

Introduction. The modern development of technologies of ACL-R allows us to take a fresh look at the methods for recovery of anterior and rotational knee instability of the knee joint, which were used in the middle of the XX century.

The objective was to evaluate the non-free tendon grafts while maintaining their anatomical attachment point for the isolated and complex ACL-R.

Methods and materials. From 2014 to 2018, 128 patients were operated on the isolated ACL injuries (102 patients – 79.7 %) and complex ACL injuries (26 patients – 20.3 %). 26 (20.3 %) patients were operated on the rupture of a previously installed ACL graft. There were 72 men (56.3 %) and 56 women (43.7 %). The average age was (34.7±2.5) years. The average body weight was (82.7±1.6) kg; 24 (18.8 %) patients weighed over 85 kg. In 87 (68.0 %) cases, an anatomic single bundle ACL-R was performed by non-free graft either from the tendon of semitendinosus or in combination with the gracilis tendon. In 41 (32.0 %) cases, ACL-R was supplemented by LEAT (non-free iliotibial tract or free gracilis tendon grafts).

The results were evaluated clinically, radiologically, and using the 2000 IKDC, KOSS and Lysholm Knee Scoring Scale integrated scales. In all cases, high stability of the knee joint was noted. Lachman and the pivot shift test recorded only 0 and 1 degrees. By the KOSS scale: «pain» was (86.7±2.3) points, «pathological symptoms» – (88.5±1.6) points, «daily activity» – (93.1±2.8) points, «sports activity» – (73.9±2.1) points, «quality of life» – (84.6±1.9) points. The average values of knee function by the Lysholm Knee Scoring Scale was 95.1±2.1. According to the 2000 IKDC, 117 (91.4 %) patients were included in group A, and 11 (8.6 %) in group B. Patients with moderate or severe impaired knee function (C and D) were not observed. The average time of the ACL-R was (82.1±2.4) min., ACL-R and LEAT – (94.7±6.9) min. The mean hospital stay was (3.2±1.8) days and (3.8±1.3) days, respectively.

Conclusion. Non-free grafts for ACL-R and LEAT have an anatomically reliable fixation point, which allows to achieve high functional results of the knee joint. The proposed techniques can be reproduced with standard instruments and implants, taking into account the average operating time and blood loss, and without significant infection complications, persistent synovitis, contractures and hypotrophy of the thigh muscles.

Introduction. Exudative tumor pleurisy affects up to 100 000 people a year in Russia, up to 400 000 people a year in Europe. Inpatient treatment of such patients is associated with certain costs, and there are also queues for treatment in oncology hospitals. An outpatient pleurodesis can reduce these problems.

The objective was to compare pharmacoeconomic parameters for inpatient pleurodesis and outpatient pleurodesis to determine the most cost-effective treatment option.

Methods and materials. 179 patients in the clinic of the Federal State Budgetary Institution Scientific Research Center for Oncology named after N. N. Petrov of the Russian Ministry of Health underwent pleurodesis using various methods (talc, bleocin, combined). The effectiveness of the methods and the direct medical costs of treatment were evaluated. The effectiveness of a stationary thoracoscopic pleurodesis was evaluated according to foreign literature, and the direct medical costs of treatment were calculated. Based on the obtained results, the pharmacoeconomic indicators of CER and ICER were calculated.

Results. Direct medical costs for stationary thoracoscopic pleurodesis amounted to 35056.4 rubles with an efficiency of 89 %. Direct medical costs for outpatient pleurodesis were: for talc pleurodesis – 8051.7 rubles, for bleocin and combined pleurodesis – 11799.2 rubles. CER amounted to: for a thoracoscopic pleurodesis in the hospital – 393.9, for talc pleurodesis – 115.35, for bleocin pleurodesis – 188.7, for combined pleurodesis – 155.8. ICER in relation to stationary pleurodesis was 1406.4 for talc pleurodesis, 877.6 for bleocin pleurodesis, 1748.6 for combined pleurodesis.

Conclusion. CER was almost 3 times lower with outpatient pleurodesis, which makes it the most cost-effective option for the treatment of tumor exudative pleurisy. ICER was maximal in combined pleurodesis, which makes it preferred among outpatient pleurodesis options. Based on the obtained data, it can be argued that the use of ambulatory pleurodesis as an initial stage of care for patients with tumor exudative pleurisy is economically justified.

Introduction. Glioblastoma (GBM) is one of the most malignant tumors. Currently, treatment options for GBM are limited, and patient survival rates over the past decades have not changed significantly.

The objective of the study was a comparative study of the expression of proteins Prox1, CD38, and CD133 in GBM in contact (VSVZ+) and not in contact with the ventricular-subventricular zone (VSVZ–).

Methods and materials. Immunohistochemical study with antibodies to Prox1, Ki-67, CD38, CD133 and morphometric analysis of GBM fragments of 10 patients of VSVZ + and 8 patients of VSVZ-.

Results. The median of the number of CD133+ cells in VSVZ+ and VSVZ-GBM was 34.5 % and 10 %, respectively. CD38+ cells were found in all of the VSVZ+ GBM and only in one of the VSVZ– GBM. PROX1 was expressed in 34.6 % of VSBZ– GBM cells and in 79 % of VSVZ+ GBM cells. The median life expectancy was statistically significantly greater in the GBM VSVZ– group than in the GBM VSVZ+ group (6 versus 4 months). Direct correlations were found between the number of CD38+ and CD133+ cells (r=0.596), between tumor localization and the number of CD133+ cells (r=0.760), inverse correlations between life expectancy and tumor localization (r=–0.607), and the number of CD38+ (r=–0.755) and CD133+ cells (r=–0.630). Regression analysis showed that the number of CD133+ cells was associated with a lifespan of linear function.

Conclusions.VSVZ+ GBM have more CD133+ and CD38+ cells and have a lower median survival compared to VSVZ– GBM.

Introduction. The diagnostic possibilities for breast cancer (BC) are expanding. The results of BC patients treatment are also improving. The 5-year survival rate in BC patients is increasing. The number of mastectomy (ME) in BC patients does  not decrease. Therefore, the BC epidemiological data analysis in the female population of Russia is in demand to predict the need of the volumes of the breast reconstruction after ME.

Methods and materials. A retrospective cohort study was conducted. The information on BC cases in St. Petersburg residents in 2011–2018 yr. was analyzed. Statistical processing was carried out using the programs Statistica 12.0 for Windows, «Population cancer registry».

Resalts and discussion. In 2017 yr., in St. Petersburg, the incidence of BC was 60.11 0/0000. The prevalence of BC in the analyzed period is higher than the national indicator by 19.3 %. In 2018 yr., women of working age were diagnosed with BC 16.6 % more often than in 2011. The frequency of the I–II stage BC verification in 2011 – 2018 yr. increased 1.2 times, reaching 72.2 % in 2018 yr. In 2018 yr., the 5-year survival rate in BC patients was 63.4 %.

Conclusion. In connection with the annual increase in the number of BC patients undergoing ME, it is reasonable to expect an increase in potential needs for breast reconstruction, which will necessitate the expansion of the volume of hightech types of medical care provided to BC patients.

The objective was to optimize the topical diagnosis of the inflammatory process in the kidney and bladder in women with urolithiasis

Methods and materials. Examined were 31 women aged 25 to 65 y. o., hospitalized for exacerbation of chronic cystitis with urolithiasis. The comparison group consisted of 15 healthy people without a history of urological diseases. In urine taken  separately from the bladder and ureter, the level of pro-inflammatory interleukin 8 (IL 8) was determined by enzyme-linked immunosorbent assay.

Results. With an isolated exacerbation of chronic cystitis in the urine taken from the ureters, the concentration of IL 8 ((39±7.6) pg/ml) did not go beyond the normal indicators ((35±7) pg/ml), while the content of this cytokine in the bladder exceeded the norm by at least 3 times ((120±3.5) pg/ml). With a combination of exacerbations of inflammation in the bladder and kidneys, the concentration of IL 8 in the bladder was about 10 times higher than the control values ((350±27) pg/ml), and in the ureter from the affected side, no less than 8 times ((280±16) pg/ml).

Conclusions. A comparison of the content of IL 8 in urine from organs (kidneys, bladder) that are supposedly affected by the inflammatory process makes it possible to clarify the localization of the focus of inflammation in the urinary system.