There is an increase in the incidence of multiple sclerosis in the world. Only in half of the cases, standard therapy allows for a short time to achieve control over this disease. High-dose immunosuppressive therapy and autologous hematopoietic stem cells transplantation is a promising and effective method of treating autoimmune diseases, including multiple sclerovsis. Over the past 20 years, progress has been made in understanding the immune mechanisms of the method. At present, the frequency and severity of adverse events of therapy significantly decreased by reducing the intensity of conditioning regimens. The objective of this review was to analyze scientific publications on the effectiveness of the method, and the data on the optimal conditions and criteria for its use in multiple sclerosis.

Snake venoms have been fervently studied for decades for two reasons: 1) high death rate due to snake bites; 2) numerous components of snake venoms prove useful in medicine and treatment of diverse pathologies. Snake venom phospholipases A₂ are among the most aggressive toxic proteins often playing the main role in immobilization and killing of snakebite victims. These enzymes catalyze the hydrolysis of glycerophospholipids to produce lysoglycerophospholipids and free fatty acids. But the diversity of phospholipase A2 effects is not limited to their catalytic action. In this review (Part 1), we describe the features of the structure and properties of Viperidae snake venom phospholipase A₂ .

Introduction. The development of life-threatening complications in chronic hepatitis C (CHC) is based on progressive fibrogenesis. The developing of liver fibrosis is provided by intercellular interactions, first of all, of lymphocytes, macrophages and stellate cells (SC), the patterns of mutual influences of which have not been sufficiently studied at the moment.

The objective was to study the features of intercellular interplay of nonparenchymal liver cells at different histological activity, at different stages of CHC fibrosis, and at different genotypes of the hepatitis C virus (HCV).

Methods and materials. The object of the study was 64 liver biopsies of adult patients with natural course of CHC. Нistological, immunohistochemical and immunohistomorphometric methods were used.

Results. The increasing histological activity is accompanied by an increase in the number and size (area) of CD68 + macrophages and SMA-alfa + SC. Correlation relationships of intercellular interactions at low and moderate histological activity had significant differences. In mild fibrosis, a relationship was found between the number of CD8 + lymphocytes, the number and area of CD68 + macrophages and SMA-alfa + SC. HCV genotype 1 is characterized by a predominance of the interactions between the number of CD8 + lymphocytes, the number and area of CD68 + macrophages in the liver, for genotype 3 – between the number of CD8 + lymphocytes, the number and area of SMA + SC.

Conclusions. The maximum activation of SC and macrophages occurs even with moderate histological activity and persists with an increase. The consolidation of the immunopathological nature of the intercellular interplay between lymphocytes, macrophages and SC occurs at the stage of mild fibrosis. Intercellular interactions have significant differences depending on the HCV genotype, which can determine a poor prognosis of the disease.

Introduction. The novel coronavirus infection COVID-19 (NCI COVID-19) caused by the COVID-19 virus, which occurs in the most severe forms, is accompanied not only by the development of respiratory failure and acute respiratory distress syndrome, but also by other equally dangerous complications such as covid-associated coagulopathy.

The objective was to study the clinical and laboratory features of the development of endothelial dysfunction as the main component of covid-associated coagulopathy in the context of its most common manifestation – thrombotic events.

Methods and materials. The medical records of 947 patients with confirmed novel coronavirus infection COVID-19 hospitalized at the Center for the Treatment of Patients with NCI COVID-19 of Pavlov University of the Ministry of Health of the Russian Federation during the so-called «2nd wave» of the pandemic from November 2020 to March 2021.

Results. All thrombotic complications were detected only in patients with severe coronavirus infection (561 patients). Predisposing factors for the development of thrombosis in our patients were: advanced age, duration of hospitalization for more than 1 week, comorbidity in the form of coronary artery disease. Standard screening tests of the hemostasis system (platelet microscopy, coagulogram screening) do not reveal any significant features in the presence of thrombotic events, which requires the development of new studies to assess prothrombotic potential in patients with severe NCI COVID-19.

Conclusion. The development of thrombotic events is one of the most formidable complications in the severe course of NCI COVID-19, which in turn leads to an increase in respiratory failure due to increased tissue hypoxia, and subsequently to death. The same patients have an increased risk of hemorrhagic events as a possible side effect of the therapy.

Introduction. Elderly and senile patients are a special category of patients and standard methods in breast cancer treatment are not suitable due to the frequent presence of serious comorbidities and personal preferences and concerns about treatment options. Аn available treatment option for these patients with hormone-receptor positive breast cancer may be the primary endocrine therapy (PET).

The objective was to assess the quality of life of patients treated by PET or surgical treatment with adjuvant endocrine therapy (ET) and identifying the reasons of choosing a conservative treatment strategy.

Methods and materials. Our study included 65–89-year-old patients with hormone-receptor positive breast cancer with stages I–II, some of whom received only endocrine therapy (ET) (n=20), and others are prescribed adjuvant ET after surgical treatment (n=20). Quality of life was assessed by analyzing the EORTC QLQ C-30 and QLQ-BR23 questionnaires filled in by patients at different stages of treatment. An analysis of outpatient records was carried out to identify the reasons for choosing a conservative treatment strategy.

Results. The choice of conservative treatment strategy was justified by the presence of a serious concomitant pathology in 65 % of cases. Performing breast surgery was associated with a decline in the quality of life in the postoperative period.

Conclusions. PET is an alternative treatment option for some of the elderly patients with hormone-receptor positive breast cancer, since it has similar results in overall survival compared to standard complex treatment (surgery + adjuvant ET), but also does not make the quality of life worst during treatment.

Introduction. This article is devoted to the description of the method of physical rehabilitation of children and adolescents of 12–17 years old after hematopoietic stem cell transplantation and the analysis of the effectiveness of this method on the indicators of physical, emotional state and quality of life assessment.

The objective of the study was to scientifically substantiate the effectiveness of the method of physical rehabilitation of adolescents who underwent hematopoietic stem cell transplantation.

Methods and materials. The experiment involved 40 adolescents with oncopathology who were admitted for treatment at R.M. Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, of which 16 girls and 24 boys aged 12 to 17 years: experimental group 1 (EG1 ) – 20 patients and experimental group 2 (EG2) – 20 patients. In EG2, classes were held 3 times a week together with an instructor-methodologist of exercise therapy and were taught independently according to a specially developed methodological and video material with filling in a self-control diary.

Results. The application of the developed method of physical rehabilitation of adolescents contributes to: optimizing the physical condition: indicators of the life index improved by 5.5 %; power index by 28.9 %; the level of aerobic endurance by 18.3 %; carpal dynamometry of the right hand by 6.5 %, carpal dynamometry of the left hand by 5.2 %; indicators of vital capacity of the lungs improved by 6.5 %; the time of passage of the straight line by 25.7 %, the improvement of the psycho-emotional state – indicators of anxiety and depressive states decreased by 22.3 %, the improvement of the quality of life: physical, emotional, social functioning improved by 7.4 %; pain and soreness, fatigue and sleep, nausea, anxiety, nutrition, thinking, communication improved by 9.3 %.

Conclusion. Thus, the presented method of physical rehabilitation has shown its effectiveness.

Introduction. The coronavirus pandemic provoked a sharp transition from the classical form of education to distance learning, which has become widespread over the past year and a half. Both students and professors are forced to adapt to the changing conditions of learning and life in general. The current situation of uncertainty caused stress reactions and actualized the adaptive potential of the psyche. There are practically no studies on this topic, which explains the novelty and relevance of this work.

Methods and materials. The article is devoted to the study of adaptive features of medical students in distance learning. To study adaptive features, a multilevel personality questionnaire (MLPQ) «Adaptability» was used (A. G. Maklakov, S. V. Chermyanin, 1993). To study the causes of educational stress in students and strategies for coping with stress, the Lazarus coping test and the test for educational stress (Yu. V. Shcherbatykh) were used. To study the attitude of students to full-time and distance learning, a specially designed questionnaire was used. Statistical processing was carried out using SPSS Statistics 21.

Results. The study was conducted in the spring of 2021. 100 first-year students of Pavlov University participated in it. The average age of the sample was (18.32±1.5); among them: 29 men and 71 women. The leading causes of educational stress were: a large study load (7.32), a large amount of educational material to memorize (7.20), difficulty in understanding the material (6.99) and the presence of working off (6.82), which were introduced to eliminate debt. The leading coping strategies in distance learning were «self-control» (13.29), «problem solving planning» (13.21) and «positive reassessment» (12.99). The most common ways to cope with stress were sleep (17 %), delicious food (15 %), socializing with friends (14 %), outdoor activities (13 %), and support or advice from parents (12 %). Distance learning students had an average level of adaptive potential. Students with a higher adaptive potential in dealing with stress significantly more often (p≤0.01) use the strategies of problem solving planning and positive reassessment, while students with a lower adaptive potential significantly more often (p≤0.05) in a stress situation use «accepting responsibility» and «escape-avoidance» copings.

Conclusions. The conducted study allowed to identify the causes of students’ educational stress, strategies of behavior and coping with stressful situations, which should be taken into account in the organization of the learning process and in the work of a psychological service to increase the acquisition of knowledge and academic success of students. The obtained results made it possible to identify the advantages and disadvantages of full-time and distance learning, which allows us to make an assumption about the optimal combination of both forms in the further educational process.

Introduction. Despite widespread implementation of journal club in medical universities around the world, this activity is lacking in Russia. Currently, there are no publications about the evaluation of journal club at the Russian medical education system as an learning tool and its efficacy.

The objective of this work was to describe the experience of participation in the journal club in order to assess participant’s satisfaction and preliminary efficacy of the meetings as well as to identify opportunities to improve and implement journal club rounds.

Methods and materials. In February–May 2020, we conducted voluntary and anonymous online survey with 14 participants of journal club at Pavlov University. We used semi-structured questionnaire developed by the authors specifically to meet the objectives of the study.

Results. We conducted 7 journal club meetings, of which 6 were online. The total number of completed questionnaires was 10 (out of 66 send by email). We identified several barriers among participants: 1) lack of English knowledge; 2) lack of presentation skills; 3) not sufficient theoretical background. The suggestions for improvement were following: 1) to adapt the debate format and 2) to use the incentives to increase active participation, for example, to provide the extra educational credits which increased student’s rating.

Conclusions. The efficacy of journal club as a learning tool might be increased by providing an additional educational training focused on the research methods, and by the developing the guidelines for helping critically analyzed the scientific paper.

The objective was to improve the efficiency and safety of surgical treatment in elderly patients with morbid obesity.

Methods and materials. The study included 20 patients with morbid obesity aged 60 to 69 years. The following scores and indices were used to assess the comorbidity of patients and the risk of complications from surgery: OS-MRS, Charlson comorbidity index, Caprini score, HAS-BLED score.

Results. The course of the postoperative period in elderly patients with morbid obesity was smooth in 17 (85 %) people and did not differ from that in middle-aged patients, subject to careful preoperative examination and preparation. The factors of the initial comorbid background and the duration of the operation had the greatest influence on the result of bariatric surgery.

Conclusion. Bariatric surgery in elderly patients with morbid obesity should be carried out taking into account careful selection, examination and assessment of the risk of adverse outcome in a specialized surgical center of a multidisciplinary hospital.