The article introduces the method of boron neutron capturing therapy (BNCT) and its potential clinical application for treatment of malignant brain tumors. The analysis and literature review of the use of BNCT in the world, citing statistics on the survival rate of patients with brain tumor after a session of BNCT. Comparative characteristics of various neutron sources used for BNCT in the world. A review of pharmacological agents used in BNCT as a delivery agent 10B. Based on the review of the literature produced outlining the recognized problems of the method. We consider the two challenges for clinical implementation of BNCT - create an independent source of epithermal neutrons and selective delivery of boron-containing drugs to the central nervous system. Analysis of the solution of these difficulties is complemented by the results of development and experimental data of the laboratory of BNCT of Budker Institute of Nuclear Physics.

Review of the literature devoted to the modern view of the risk factors for recurrence of herniation of intervertebral disks after microdiscectomy in the lumbar spine and its prevention methods. There are different views of various authors on the concept of «relapse», methods of examination and treatment of these patients. In this review, the methods of mechanical defects in the fibrous ring closure after removal of the hernia, methods of gene and cell therapy of intervertebral discs are summarized. We describe a method of nonablative laser irradiation of the intervertebral discs, its physical foundations, history and prospects of development as a method of prevention of segmental instability and, thus, hernia recurrence in the postoperative period.

The history of discovery, learning and contemporary data on the efficacy of genetically engineered drugs from the class of inhibitors of tumor necrosis factor are shown. Due to high efficacy these medicines are widely used in the treatment of such serious diseases as rheumatic arthritis, rheumatoid spondylitis, psoriasis, Crohn>s disease, etc. The spectrum of adverse effects of inhibitors of tumor necrosis factor is less than that of other classes of drugs, and in a number of positions is not different from the population one. Some diseases, such as spondyloarthritis group, have no alternative effective treatment of tumor necrosis factor inhibitors. Can these drugs claim to be the ‘gold standard’ in the treatment of rheumatic diseases? The authors express their point of view on this issue. Keywords: rheumatic arthritis, inhibitors of tumor necrosis factor, infliximab, methotrexate.

Intervertebral disc degeneration is an urgent problem of modern medicine. The most frequent symptom associated with intervertebral disc degeneration is back pain with leads to early disability of patients. Cell death, reduction of synthesis of extracellular matrix proteins and destruction of the basic substance due to activation of matrix metalloproteinases are one of the main chain link of intervertebral degeneration which is progressed with the contribution from the proinflammatory cytokines. Modern therapy of intervertebral disc degeneration is aimed not only in reducing the pain, but also in restoration of the functions of the disc through a variety of methods of biological therapy. Different approaches currently under development are targeted at activation of the regenerative processes in the intervertebral disc using injections of bioactive proteins, different types of cells or cell populations, and the stimulators of extracellular matrix production, as well as methods of gene engineering. These methods of biological treatment of degenerated intervertebral discs are promising and could be translated into clinical practice.

Background. The study of the state of higher mental functions in children suffering from dysarthria allows developing a program of remedy, contributing to the harmonious personality development. Methods. 30 children, aged 5-7, having suffered from mild dysarthria, were examined. Clinical and psychological and neuropsychological methods of diagnostics were used. Results. Most children had higher mental functions that were formed within the age norm, however it was detected the aborted articulation praxis, which were followed by slurring. Unfavourable climate in a family caused internal stress in a child, physical signs of it were muscle tension of the upper limb and strengthened the dysarthria. Conclusions. Early diagnosis will allow building the neuropsychological rehabilitative management program for preschool children suffering from mild dysarthria.

Background. To investigate outcomes associated with nonablative laser irradiation of the intervertebral discs as a method of reduction of recurrent disc herniations after lumbar microdiscectomy with 3-8 years follow-up. Methods. A total of 257 patiens were treated for herniated lumbar discs from 2005 to 2010. 159 patients after first-time microdiscectomy were treated in the presence of the nondestructive laser irradiation of the operated intervertebral disc. Patient self-reported measures included visual analogue scales for leg and back pain, Oswestry Disability Index. Subsequent reherniation surgical procedures were documented. Preoperative outcome measures were compared with follow-up visits. Results. The more frequently recurrent herniations were observed in the late postoperative period (2 years).There was no significant effect of gender and age of patients in the recurrence rate. Patient symptoms were improved after surgery in an equivalent manner in both study groups. In the overall study analysis, the rate of reherniation surgery was lower for laser irradiation patients (5,6 and 10,2 % respectively). Conclusions. Nonablative laser irradiation of the intervertebral discs has shown high efficiency at an eight-year follow-up.

Background. Research objective: to identify main cardiac risk factors in patients of health centers. Methods. 4421 records been studied, 2010-2012 (3416 women and 1005 men). Patient records have been randomly brought from 9 health centers of Irkutsk region. Results. The most common cardiac risk factors in women appeared cholesterol level above 5 mmol/L (59,6 %), overweight (59,4 %), physical inactivity (58,4 %), hypertension (27,8 %), smoking (14,5 %) and hyperglycemia (2,8 %). The most common cardiac risk factors in men: physical inactivity (54,5 %), overweight (53,5 %), cholesterol level above 5 mmol/L (48,5 %), smoking (34,2 %), hypertension (33 %), hyperglycemia (1,9 %). Conclusions. Received results justify the importance of main cardiac risk factors and the need for early detection including health centers.

Background. In rheumatoid arthritis, progression of atherosclerosis caused not only by hypercholesterolemia, and also by immunological mechanisms underlying the pathogenesis of this disease. Methods. The clinical and laboratory parameters were examined, including the levels of DAS28, cytokines and metalloproteinases in 42 rheumatoid arthritis patients with hypercholesterolemia before and after 6 weeks of treatment with atorvastatin (20 mg/day). Results. The use of atorvastatin in addition to basic therapy resulted a reduction in the activity of rheumatoid arthritis and levels of clinical and laboratory markers. Conclusions. The given results determine the prospects for the use of statins for the prevention of hypercholesterolemia, cardiovascular complications and early mortality in patients with rheumatoid arthritis.

Background. The role of immune and metabolic changes in the development of the menstrual dysfunction in overweight girls in adolescence was studied. Methods. 170 overweight girls in adolescence caused by hypothalamus dysfunction were examined. Results. The menstrual dysfunction was detected in overweight girls such as oligomenorrhea (67,1 %) and amenorrhoea (32,9 %). The length of late menstrual period had a positive correlation with a body-weight index and waist circumference. The concentration of proinflammatory cytokines was raised in the blood serum and caused insulin resistance in 93,5 % of patients. Conclusions. Consistent influence on the hypothalamic-hypophysis-ovarian axis of immune and metabolic changes in obesity lead to menstrual dysfunction.

Background. Any surgical interference, conducted because of urinary bladder, changes significantly the condition of lower urinary tract. Methods. On the basis of non-invasive urofluometric monitoring it was conducted the analysis of catamnesis of 77 trocar implantation of trans-vaginal taping in women. Results. Initially the urina flows were registered in the meantime it was noted the reduction of functional bladder capacity. In postsurgery period it was emerged the reduction of urina flows with the formation of urination structure similar to obstructive one. Further it was noted the recovery of speed rate of urinary bladder emptying. Conclusions. The data of domestic urofluometry can be used in assessment of urodinamics of lower urinary tract. The best possible medicines for conservative treatment are α₁-adrenoreceptor blocking agents and m-anticholinergic drugs, that enable to recover safely and quickly the urodinamics after the synthetic sling.

Background. Gastroduodenal bleeding is one of the most dangerous complications of ulcer and it makes up 60 % of all bleedings from upper digestive tract. Methods. It was conducted the retrospective analysis of treatment results of 418 patients with acute ulcer gastroduodenal bleedings for 2007-2012 in 2 Vladivostok clinical hospital. Assessing the hemostasis it was used the classification of J.A. Forrest (1974). Results. 58 patients (13,9 %) were admitted to hospital with the bleeding of group Forrest I, the bleeding recurrence was detected in 15 of them (25,9 %); of group Forrest II - 213 patients (51 %), recurrence - in 21 (9,8 %); of group Forrest III - in 147 patients (35,1 %), recurrence - in 5 (3,4 %). 46 patients were undergone the surgery (11 %): 38 (9,1 %) - emergency surgery, 8 (1,9 %) - elective surgery. The rate of mortality after emergency surgery was 10,6 %. There was no mortality after elective surgery. 19 patients of 418 died 19 (4,5 %): at gastric ulcer - 9 of 166 (5,4 %), at peptic ulcer - 10 of 234 (4,3 %). Conclusions. The usage of combined methods of endohemostasis and conservative antiulcer and hemostatic therapy enable to reduce the risk of bleeding recurrence, to reduce the number of emergency surgery (to 9,1 %) and mortality at continuous pathology (to 4,5 %).

Background. Research objective is a comparative analysis of bone tissue regeneration in vivo after implantation original calciumphosphate materials. Methods. In the experiment on male rats, the samples of hydroxyapatite and strontium-substituted hydroxyapatite were implanted on the surface of the created defect of tibia. Histological examination of the material was held in a month. Results. It is found that using these materials allows full substitution of bone defect, boost the formation and differentiation of bone tissue, strengthen mineralization of newly formed osteons, and caused minimal destructive reorganization in intact areas. Conclusions. The studied materials can be considered as promising inorganic structures for regenerative medicine.

Background. Endothelial dysfunction is one of the main cardiovascular effects of chronic obstructive pulmonary disease (COPD). Research objective is the assessment of the influence of phosphodiesterase-4 inhibitor on the function of vascular endothelium in patients with COPD. Methods. 39 patients aged 43-72, having suffered from COPD, group D, were examined. 20 patients took medicines of the 2nd scheme of pharmacological therapy of COPD (GOLD, 2013), 19 patients in addition to the given scheme took roflumilast (500 mkg/ day, during a month). There were determined concentrations of endothelin-1 (ET-1), L-homocysteine (Hc) and interleukin-6 in the blood serum. Results. In COPD patients the function of vascular endothelium significantly suffered because of hyper-producing of vasoconstrictive substances (ET-1) and disturbing factors (Hc). The level of interleukin-6 was above the norm, and also it was determined direct correlation between serum concentration Нс and interleukin-6. Conclusions. Correlation between inflammation markers (interleukin-6) and endothelial dysfunction (Hc) proofs the entity of system inflammation mechanisms and vascular endothelium damage in COPD. The research results show the positive influence of roflu-milast on blood serum concentration Hc and ET-1 in patients with COPD, group D, and widen the pathogenic views about phosphodiesterase-4 inhibitors influence on systematic symptoms of pulmonary disease.

Background. Study objective is an analysis of the composition and antibacterial drugs sensitivity of conjunctiva microflora in patients having cataract surgery. Methods. 185 patients (246 eyes) were examined, who had surgery in 2014-2015. Evaluation of composition of microflora conjunctival sac was performed prior to surgery. The sensitivity of microorganisms to antibiotics was determined by disk diffusion method. Results. In most cases 155 eyes (63.1 %) inoculation was positive. Most often distinguished Staphylococcus epidermidis (68 cases) and Staphylococcus aureus (44 cases). Only 36.9 % of patients (91 eyes) inoculation proved sterile. S. epidermidis showed resistance to oxacillin, lincomycin, clarithromycin and azithromycin, showing sensitivity to ampicillin and cephalosporins. Of the drugs used locally, it was increasingly resistant to tetracycline, chloramphenicol, gentamicin, and tobramycin. The sensitivity to antibiotics of S. aureus was significantly higher than the epidermal one. This microorganism showed 100 % sensitivity to oxacillin and lincomycin. Conclusions. The findings make it necessary the pre-operative antibiotic therapy for the prevention of infectious complications in the early postoperative ophthalmic surgery. The least resistance is allocated to own material microflora awarded to ciprofloxacin and levofloxacin, it is necessary to consider the appointment of antibiotics in perioperative accompanied by cataract.

Background. Medicines, purchased under the program of providing benefit-entitled citizens of Primorsky territory with demandable medicines in 2014, were analyzed. Methods. It was carried the ABC/VEN-analysis of purchase structure of medicines. Results. It was found that the 25 Group A medicines was spent 80 % and 42 Group B medicines - 15 % and 83 Group C medicines - 5 % of funds. 24 Group A medicines (96 %) belonged to class V of the 25 medicines, according to the criteria VEN-analysis, and only one medicine - to the class E. In the Group B 33 of the 42 medicines (78.6 %) belonged to class V, 5 medicines (11.9 %) - to the class E and 4 medicines (9.5 %) - to the class N. In Group C 55 of 83 medicines (66.3 %) belonged to the class V, 19 medicines (22.9 %) - to the class E medicines and 9 (10.8 %) -to the class N. Conclusions. VEN-analysis showed that the class V (Vital) includes 112 medicines (74,7 %) of 155, the class E (Essential) includes 25 medicines (16,7 %), and the class N (Non-essential) includes 13 medicines (8,6 %). The results of ABC/VEN-analysis allow enhancing efficiency of decision-making process in provision of medicines. The data of the analysis can be used in the process of planning the list of medicines for benefit-entitled citizens.

The article presents current approaches to creation and implementation of a corporate e-system of the university under challenges implementation of the strategic plan of the university according to the Federal law No. 273 dated 31 December, 2012 “On education in the Russian Federation”. Perspective ways of e-management of educational institute is analysed. It was attempted to calculate the effect of automation implementation in medical university.

The paper presents a clinical case of occlusive hydrocephalus form on the basis of the colloid cyst of the third ventricle. The peculiarity of our case is so late onset of symptoms of intracranial hypertension at the age of 46 years. In world literature describes cases of clinical manifestations of colloid cyst of the third ventricle in such a late age. Given the nature of nosology and its flow, neuroendoscopic patients underwent intervention in the volume - thirdventriculocisternostomy with a partial resection of the cyst wall. The patient was discharged from hospital in a satisfactory condition.

The paper presents a clinical case of uncomplicated unstable compressive fragmented fracture of the L1 vertebral body with kyphotic deformation (AII) after katatrauma which was successfully treated by new method of surgical fusion using intervertebral telescopic prosthesis XRL placed through the minilumbotomy approach and percutaneous pedicle screw system Viper II. Minimally invasive transvertebral stabilization and percutaneous transpedicular fixation can significantly reduce the level of vertebrogenicpain, effectively eliminate kyphosis, lead to significant correction of the kyphosis angle and permits early mobilization.

The paper presents a clinical example of a successful surgical treatment of patients with extramedullary mass lesions of the spinal canal at the level of the facet joint L_iv-_lv, combined method of microsurgical reconstruction of the spinal canal, total removal of the bulk of education and pedicle fixation L_IV-L_V segments system Viper II. Using the optical zoom, surgical instruments, minimally invasive ultrasound destructors, open transpedicular fixation technique significantly reduces surgical aggression, allow to perform the total removal of the bulk of education, avoiding iatrogenic damage to neural tissue and implement an effective stabilization of the operated vertebral-motor segment.

Purulent spinal epidurit is a rare pathology, clinical picture which is not pathognomonic symptoms, and therefore the diagnosis is difficult. As an illustration presents 2 cases of suppurative spinal epidurit with the analysis of the diagnosis, clinical presentation and treatment. In both cases, surgical treatment was performed in a volume of laminectomy, incision and drainage of an abscess. The postoperative period was uneventful. This method of treatment has allowed to achieve a speedy recovery and to minimize of the serious consequences.

The paper presents a clinical example of a successful surgical treatment of patients with degenerative spinal stenosis at the level of L_V-L_VI method transforaminal interbody fusion Cage T-pal with pedicle fixation system Viper II and facet stabilization Facet Wedge with the contralateral side. Minimally invasive combined facet and transpedicular fixation with interbody spondylodesis can significantly reduce the level of pain, improve quality of life and implement an effective stabilization of the operated motion segment.

Factors that should considered in the assessment of the risks and benefits of different treatment options, including an analysis of cumulative risk of aneurysm rupture during the life expectancy are described. Surgical technique is presented in the illustrative case of a patient with an unruptured anterior communicating artery aneurysm. Skill of sharp arachnoidal dissection by micro-scissors in different directions is an important component of operative technique for opening of arachnoidal cysterns and dissection of arachnoid membrane adhesions that allows to perform adequate brain relaxation by removing the liquor, as well as producing a bloodless exposure to areas of interest, access to the proximal and distal vascular branches for temporarily clipping. Sharp dissection is important for identification and protection of perforating and exiting arterial branches, dissection of aneurysm neck without tension of aneurysmal sac walls by arachnoid adhesions.

Background. Despite using of various medicines, erysipelatous inflammation recurrences are common, and are registered in 20-45 % of cases. Methods. It was described an original technique for securing drugs complexes on the surface of the endothelium of the lymphatic vessels. According to it 47 patients aged 26-74 with recurrent erysipelatous inflammation of lower limb were held the endolymphatic therapy with cefoperazon. Results. The number of erysipelatous inflammation recurrences after endolymphatic antibiotic therapy reduced from 16.9 to 2.6 %. Conclusions. The method efficiency is apparently explained by early sanitation of centers of streptococcal infection in the lymphatic system.

Background. It was suggested the way of laparoscopic transmesenterial nephrectomy at left side. Methods. It was carried out the analysis of treatment results of 59 patients, having been had the laparoscopic nephrectomy at left side, 30 of them were operated transmesentrially, and 29 of them - in standard way. Results. Intrasurgery complications were not registered at transmesenterial surgery (they were registered twice at the standard surgery). The duration were nearly the same in both groups: average - 115 and 110 minutes. The duration of hospital admission were the same - 6 days. Under transmesenterial interference from the beginning of surgery to clipping the renal artery runs an average of 15 minutes, whereas in the standard nephrectomy -40 minutes. Conclusions. In our opinion, in many cases transmesenterial way has obvious advantages over the standard one and may be considered as an alternative way.

Kidney transplantation from a living donor is the best alternative for patients with end-stage renal failure. Development of a technique donor kidney is on the quest for minimally invasive procedures, while maintaining maximum safety for the donor. Plays a leading role as the quality and composition of the resulting renal transplant since it can influence its function depends on the longterm and, accordingly, the recipients health. The above requirements have led to the creation of a unique in its kind, the operation - laparoscopic nephrectomy from a living donor. Standard fence kidney at the moment in the world of laparoscopic donor nephrectomy is a «hand-assisted» technique. However, in some cases, possibly a delayed introduction of «hand-port» or laparoscopic nephrectomy without manual assisted with the introduction of the hand into the abdomen to extract the kidney at the final stage. The purpose of this article is to identify the indications for possible delayed installation manual port.

During the clinical examination it was shown the possibilities of bipolar transurethral enucleation conduction of benign prostatic hyperplasia of big sizes (aden extent - 440 sm3). The surgery were conducted in Nizhniy Novgorod in the urologic center of Road clinical hospital at the Gorkiy station of JCS ‘Russian Railways’. In the near future as clinical experience will be gathered it will be possible to prove the clinical effectiveness and advantages of this surgical method over the traumatizing open adenomectomy that enables to boost the wide implementation in the urological practice.