Introduction. The laboratory should have a quality management system for laboratory research.
The objective was to analyze the requirements of regulatory documentation related to the accreditation of medical laboratories in the National Accreditation System for compliance with GOST R ISO 15189-2015.
Methods and materials. A retrospective analysis of the requirements of national and industry standards related to medical laboratories was carried out.
Results. The policy management of the activities of the National Accreditation System is based on strict compliance with the requirements of international rules. The provisions of the regulations of the Ministry of Economic Development are a priority for the Federal Accreditation Service. Applicants must comply not only with GOST R ISO 15189-2015, but also with the accreditation criteria of the National Accreditation System. Failure to comply with the requirements related to the traceability of measurement results, measurement uncertainty during calibrations and rules for registration of protocols, entails refusal of accreditation or suspension of its validity.
It is mandatory to provide information on the results of activities, including information on issued reports (protocols) with the attachment of an electronic document «in the form of an electronic image (scanned copy) of the document» using the Federal State Information System, about changes in the composition of its employees and their competence, changes in technical equipment in the field of accreditation, about the temporary absence of an employee. Work experience in the field of employee accreditation needs to be documented. Participation in qualification verification programs in the field of accreditation is a criterion of laboratory competence and confirmation of the reliability of measurement results issued by laboratories. It is important to observe strictly defined deadlines for submitting documents to confirm competence. Submitting an application outside of school hours leads to refusal.
Conclusion. It is necessary to recommend participation in voluntary accreditation for laboratories conducting research at the interstate level. It is necessary to form a state policy in the field of quality of laboratory diagnostics based on GOST R ISO 15189-2015 and formulate it in the format of a federal law. The formed chain of metrological traceability should include reference, calibration and routine laboratories. It is necessary to introduce changes and clarifications into the regulatory framework of the National Accreditation System, taking into account the peculiarities of medical laboratories.

Introduction. In view of the course of the disease, patients suffering from pancreatic adenocarcinoma go through all stages of medical care in St. Petersburg. To date, in the available literature, there are no works devoted to the analysis of the types, volumes and outcomes of medical interventions performed in this category of patients. The data obtained from such an analysis can become the basis for the development of algorithms and programs for optimizing the provision of care for patients suffering from this pathology.
The objective of the study was to analyze the types of medical interventions for patients suffering from pancreatic cancer in hospitals in St. Petersburg for the period from 2014 to 2020.
Methods and materials. The study group consisted of a continuous sampling of data from 2414 cards of patients diagnosed with pancreatic adenocarcinoma who applied to medical organizations in St. Petersburg in the period from 2014 to 2020. The provided medical interventions were divided into the following types: radical, symptomatic and palliative treatment.
Results. In 69.4 % of patients in the study sample during the initial visit, stage III and IV of the disease were diagnosed. The volumes and methods of treatment differed for different localizations of the tumor node. In patients with a tumor lesion of the head of the pancreas, «symptomatic treatment» was most often used, in patients with localization of the neoplastic process in the body of the pancreas, «diagnostic surgery» was most often performed, in the case of damage to the tail of the pancreas, the main method of treatment was «radical surgery». In federal medical organizations, «symptomatic treatment» was most often performed. In specialized oncological medical organizations of the city, «radical», «symptomatic» and «diagnostic» interventions were performed in the same way. In city multidisciplinary hospitals, «symptomatic treatment» was most often performed.
Conclusion. The data obtained should be taken into account when improving and developing new programs for the detection of pancreatic adenocarcinoma at early stages. Further monitoring of medical interventions in this category of patients is required.

Introduction. Bronchial fistula often occurs after lung surgery. This is an extremely severe complication with high mortality. Despite the variety methods for the treatment of bronchial fistula, the results are not always effective. In our paper, we presented a method of preventing the development of bronchial fistula based on the cell therapy.
The objective of the study was to evaluate the effects of the cell therapy on the regeneration of damaged bronchial tissue in an experiment on non-human primates.
Methods and materials. The study was performed on 6 non-human primates. Laboratory animals were divided into 2 groups: experimental and control. The left pneumonectomy with the formation of a stump of the main bronchus was done in each primate. In the experimental group, a regenerative product was introduced into the stump; in the control group, 0.9 % NaCl solution was used. The regenerative product consisted of autologous platelet-rich plasma activated by thermal lysis and the suspension of the xenogeneic fibroblast’s culture. The primates were observed for 7, 14 and 21 days, the peripheral blood was taken to study the dynamics of biologically active substances. A histological examination of the autopsy material was performed at the end of the follow-up time.
Results. On the early postoperative period, a typical inflammatory reaction was observed and resulted by the intraoperative tissue damage. Then the morphological changes were different in both group. The inflammatory were mild, the restoration of the natural function of the mucous membrane and the formation of scar tissue were earlier in the experimental group than in the control group. An analysis of the dynamics of plasma mediators in the postoperative period revealed an earlier dominance of regenerative processes in the experimental group.
Conclusion. The results of the study showed that the cell therapy stimulates the tissue regeneration, thereby preventing the failure of the bronchial stump suture.

Introduction. Vitamin D deficiency may be a natural predictor of the onset of coronary heart disease (CHD) and myocardial infarction (MI) at a young age. The results of studies of the various variants association of the vitamin D receptor (VDR) gene with the risk of CHD are contradictory, which leads to the study of genetic variants of the VDR gene as predictors of the onset of the disease at the age of 45 years and younger in the Russian population.
The objective was to determine the distribution of TaqI, BsmI and ApaI genotypes of the VDR gene variants and the level of vitamin D sufficiency in CHD patients with different age of onset of the disease and myocardial infarction, among residents of St. Petersburg.
Methods and materials. The study included 410 CHD patients and 320 examined patients without CHD clinical signs of comparable age (p>0.05). All patients with CHD underwent coronary angiography. Typing of VDR gene variants was carried out by polymerase chain reaction and subsequent restriction analysis. Determination of the level of 25(OH)D blood serum was carried out by enzyme immunoassay.
Results. The level of 25(OH)D in the blood serum of CHD patients was lower than in the control group (15.61±0.52 ng/ml and 20.82±0.69 ng/ml respectively; p=0.001). Severe 25(OH)D deficiency was detected more often in CHD patients and was associated with an increased risk of CHD (23 % and 8 % respectively; p=0.001, OR=3.54 (1.88÷6.67)). The normal level of 25(OH)D sufficiency was more often detected in patients from the comparison group than in CHD patients, and was associated with a decrease of CHD risk (16 % and 4 % respectively; p=0.0002, OR=OR=0,21 (0,09÷0,48)). The presence of the aa genotype and the a allele (ApaI), the bb genotype and the b allele of the VDR gene (BsmI) is associated with an increased risk of CHD and the onset of the disease and MI at the age of 45 years and younger.
Conclusions. Severe 25(OH)D deficiency is typical for CHD patients and was associated with an increased risk of CHD. The presence of the aa genotype and the a allele (ApaI), the bb genotype and the b allele of the VDR gene (BsmI) is associated with an increased risk of CHD and with the onset of the diseases and myocardial infarction at a young age. The TaqI variant of the VDR gene is not associated with the risk of CHD.

The objective was to study the clinical features of symptomatic hypertrophic cardiomyopathy (HCM) depending on the form (familial / non-familial), the age of onset and the presence of arterial hypertension (AH).
Methods and materials. During 6 years, we examined 250 HCM patients, 100 patients with symptomatic HCM aged from 18 to 86 years were included in the study.
Results. Patients with the clinical manifestations onset at a young age more often had a familial form of the disease, an autosomal dominant type of inheritance, an asymmetric HCM with reverse curve interventricular septal morphology. On the contrary, patients with the clinical manifestations onset at the age of ≥45 years had non-familial form of the disease and asymmetric HCM with basal interventricular septal hypertrophy. The young HCM patients with associated AH more often were obese, had CHF of III–IV functional class (NYHA), larger anteroposterior left atrial diameter than patients without AH and more often needed interventricular septal reduction. HCM patients and associated AH with the disease onset at the age of ≥45 years significantly more often had angina syndrome. Absolute indications for interventricular septal reduction in HCM patients with the disease onset ≥45 years of age were determined only for HCM patients and associated AH. At the same time, 50 % of HCM+AH patients both at a young age and in the older group, had obesity.
Conclusions. The interventricular septal morphology differs significantly depending on the age of clinical manifestations onset. Co-existing AH and obesity are predictors of the progressive HCM course and an increase in the proportion of patients with absolute indications for interventricular septal reductions regardless of the age of clinical manifestations onset.

Introduction. In the field of aesthetic medicine, there is a lack of psychological research despite the obvious impact of cosmetic defects on the emotional state and social functioning of a person. Only a few studies indicate psychological maladaptation in patients of a cosmetology clinic, which is reflected in the frequency of the occurrence of anxiety, depression and personality disorders exceeding their levels in population.
The objective was to identify psychosocial factors associated with the risk of psychological maladaptation in female patients of the cosmetology clinic.
Methods and materials. To achieve the goal, female patients (n=161, mean age was 39.53±0.86 years) were studied using the author’s structured interview and 7 psychodiagnostic methods: «Neuropsychic Adaptation Test» (NPA), «Social Frustration Level» (SFL), «Visual Analogue Self-Esteem Scale» (VASES), «Semantic Time Differential» (STD), «Perceived Stress Scale» (PSS-10), «Well-Being Index» (WHO-5), «Quality of Life Satisfaction Questionnaire» (QOL). Groups of female patients without psychological maladaptation (group 1, n=74) and those with psychological maladaptation (group 2, n=87), selected on the basis of the final NPA test score were compared.
Results. The results showed a statistically significant predominance in group 2 compared to group 1 of the frequency of emotionally neutral relationships with their own children, of living alone, as well as dissatisfaction in significant areas of life, especially in the material economic sphere, in the sphere of self-accepting as a personality and one’s physical «Ego», in the sphere of attitude to past and present life. In group 2, higher rates of perceived stress and frequency of psychotraumatic situations in anamnesis as well as lower rates of general psychological well-being and satisfaction with the quality of life were revealed.
Conclusion. The factors influencing the psychological maladaptation in female patients of the cosmetology clinic were identified. The prospects of the study associated with the determination of the most informative factors for the prognosis of psychological adaptation based on the analysis on not only psychological but also individual and personal characteristics in female patients of the cosmetology clinic were indicated.

Introduction. Despite the positive trend in recent years, the incidence of road traffic injuries and deaths from it remains high, significantly higher than in developed countries. The economic significance of the problem is determined by the high level of disability among the victims, and by the fact that a significant part of them are people of working age. The following factors contribute to the occurrence and certain outcomes of road accidents: people (behavior, health, psychological state of road users); vehicle condition; environment (road infrastructure); the state of organization of medical care for victims (including the possibility and readiness of participants and witnesses of road accidents to provide first aid).
The objective was to analyze the level of driving culture and the readiness of drivers to provide first aid based on the results of self-assessment.
Methods and materials. The main research method was a sociological survey, which was conducted on the basis of the Google Forms survey administration program. The survey was conducted among the population of St. Petersburg and the Leningrad region. The questionnaire developed for the study included 29 questions. All questionnaires were encrypted and processed using the Excel and Statistica 10 statistical applications.
Results. Assessing their level of knowledge of the rules of the road, most of the respondents considered it as average (45.3 %) and above average (34.0 %). Only 7.5 % considered it as high. Every third (34.2 %) respondent was a participant in an road accident (including 4.9 % – road accidents with victims). 45.3 % of respondents assessed the level of driving culture as average; 39.6 % – rather low; and only 5.7 % – as rather high. The majority (83.0 %) of drivers always used seat belts. Among drivers with children, 11.8 % did not have special child restraints. 10.4 % of respondents did not have a first aid kit in their car. The readiness of drivers to provide first aid was low. Only 26.9 % of the respondents confidently answered that they could provide first aid for the victims.
Conclusions. The problem of preventing road accidents and reducing mortality from them can only be solved using a systematic approach, including optimization of traffic organization, improvement of road infrastructure, condition of vehicles, improvement of the organization of medical care for victims, etc. However, the central place should be given to cultivating the culture of all road users, psychological readiness to comply with traffic rules, providing first aid.

CADASIL-cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy is the most common form of hereditary cerebral angiopathy and is characterized by recurrent subcortical ischemic strokes, migraine with aura, and cognitive impairment. The article presents clinical case of the female patient with newly diagnosed CADASIL syndrome, who was admitted to the clinic for a course of rehabilitation treatment three months after the onset of an acute cerebrovascular accident caused by a combination of congenital and infectious angiopathy. The combination of CADASIL syndrome and coronavirus infection COVID-19 caused by the SARS-CoV-2 manifested by an acute cerebrovascular accident and the occurrence of focal neurological signs. There was a positive trend in the form of a partial regression of neurological signs against the background of repeated courses of rehabilitation treatment, including physical exercises, mechanotherapy, physiotherapy and acupuncture.