The present paper analyses genetic predictors of various endotypes and phenotypes of bronchial asthma in children. The review of data on the structure and prevalence of single-nucleotide polymorphisms of interleukin genes demonstrates their correlation with the risk of virus-induced and allergen-induced phenotypes of bronchial asthma. Significant differences in genotypes correlate with aberrant production of interleukin and the risks for developing various phenotypes of the disease. The studies into genetic factors indicate the significance of functional polymorphisms of interleukin genes as predictors associated with phenotypes and risk of the disease.

Morphogenetic and growth molecules, a key participant in reparative dentinogenesis, determine viability of the dentin-pulp complex (DPC), periodontium and dentogingival junction. They are secreted in microvessels, nerve fibers and connective tissue cells of the dental pulp, exerting homeostatic influence on the immediate surrounding. The present paper reviews the data on the localization of growth factors and signaling mechanisms that control histogenesis and reparative processes in the DPC. The paper points out the significance of these factors in the regulation of proinflammatory and immunocompetent cells in caries, periodontitis and osteoinductive processes in the alveolar outgrowth. The study of growth molecules appears crucial in the development of the latest clinical strategies to maintain the viability of the DPC and to integrate artificial materials in dental tissue restoration.

Iliopsoas abscess comprises a frequently missed and late-diagnosed pathology that can be encountered by specialists of various profiles. Depending on the etiology and pathogenesis, iliopsoas abscess can be primary, if the infectious process initially develops in the iliopsoas muscle, or secondary, if the infection spreads from another inflammatory focus. The disease often has non-specific clinical manifestations and, in secondary abscesses, may be masked by symptoms of the underlying disease. The most informative diagnostic methods include CT scanning and magnetic resonance imaging. In the case of early detection and adequate treatment, the prognosis is generally good. Untimely treatment can lead to such serious complications as purulent leakage into neighboring areas, severe sepsis, septic shock, and persistent functional disorders. Without treatment, the mortality rate reaches 100%. To date, no uniform approaches to the management of patients with iliopsoas abscess has been developed.

The variant anatomy of the biliary tract and its sources of blood supply causes technical difficulties and increases the risk of damage to these main structures in the area of the porta hepatis and hepatoduodenal ligament during hepatobiliary operations, especially laparoscopic cholecystectomy. The main structures form a single topographic formation – the Calot’s triangle, with possible multiple anatomical variations, considered in the literature review.

The paper presents a critical analysis of the data on incidence and etiology of pneumonia among patients with human immunodeficiency virus (HIV). The features and prospects of differential diagnosis for various types of pneumonia are considered. The paper emphasizes the urgency of highly sensitive methods for diagnostics of pneumonia and its features in HIV-positive patients.

Objective. To evaluate the vascular endothelial growth factor A and brain-derived neurotrophic factor in the oral fluid of mature and elderly patients with chronic periodontitis and oral lichen planus. Materials and methods. The study involved 56 participants. The control group consisted of healthy volunteers aged 18–44 (n=10). The comparison group included relatively healthy elderly people aged 60–74 (n=12). The distinguished groups of patients with age-associated dental diseases included: moderate chronic periodontitis mature patients of 45–59 years (n=10) and elderly patients (n=14), as well as elderly patients with oral lichen planus (n=10). The patients underwent dental examination. The content of neurotrophins and vascular endothelial growth factor A in saliva (BDNF/ NGF beta/ VEGF-A Human ProcartaPlex Simplex Kit, Invitrogen, USA) was determined by the multiparametric fluorescence analysis with magnetic microspheres (xMAP, Luminex 200, USA) in compliance with the manufacturer protocol. Results. The groups reveal no differences in the level of brain-derived neurotrophic factor and nerve growth factor beta. The elderly patients with oral lichen planus were found to obtain the highest angiogenesis factor, which diagnostic value was assessed by ROC-analysis. The test appears moderately accurate (AUC=0.875). Conclusion. Vascular endothelial growth factor A can be considered for laboratory monitoring of elderly patients with oral lichen planus.

Objective. To analyze the levels of antioxidant enzyme superoxide dismutase (SOD) and glutathione peroxidase (GP) against the background of diabetic ketoacidosis (DKA) in type 1 diabetes mellitus (DM) children and adolescents. Materials and methods. The study involved examination of 74 children: 50 DKA children (study group) and 24 relatively healthy children (control group). The study group children were divided into two subgroups: subgroup 1 included children with DKA against the background of type 1 DM onset (n=27), subgroup 2 consisted of children with DKA against the background of chronic type 1 DM (n=23). SOD and GP concentrations in blood plasma were determined in all children by enzyme immunoassay. The reliability between the data was estimated using the Mann-Whitney test, Kruskal-Wallis test and Spearman coefficient. Results. A significant decrease in SOD and GP in children with DKA was revealed as follows: 13130 [13005–18255] Pg/ml and 50.085 [42.02–70.325] Ng/ml, compared to controls: 16415 [13370–19935] Pg/ml and 84.695 [52.49–144.5] Ng/ml, respectively. Minimal SOD and GP were noted in patients with DKA at the background of chronic type 1 DM, compared to DM onset children. The study indicates a reliable correlation between age, duration of the disease, number of DKA in the history and low values of SOD and GP. Conclusion. Decreased antioxidant capacity was found in children with DKA in type 1 DM. SOD and GP can be considered in pediatric practice as markers of oxidative stress in DKA. In addition, an early detection of SOD and GP contributes to the efficient therapy of DKA in children and adolescents.

Objective. To evaluate an etiologic significance of S. maltophilia in the development of orthopedic implant-associated infections. Materials and methods. The study involved a retrospective analysis of the frequency of excretion of S. maltophilia in patients with periprosthetic infection and osteomyelitis, using the Microbe-2 program in period of 2005–2020. Clinical isolates were excreted according to standard methods. Identification was performed via Microlatest panels using iEMS Reader MF. Antibiotic susceptibility was studied in accordance with EUCAST. Results. Over 16 years 69 strains of S. maltophilia have been identified, comprising 0.33% of all isolated pathogens (n=20631). 50% of isolates were excreted from tissue biopsies, 30% – from wound exudates. In 89% of cases, S. maltophilia was isolated in microbial associations, including 65% of cases together with Grampositive bacteria, 18% with other non-fermenting Gram-negative bacteria, and 6% with other pathogens. 63% appeared sensitive to trimethoprim/sulfamethoxazole and 25.5% of isolates were resistant. The proportion of cultures sensitive to this drug was found to increase from 63% in 2011–2014 to 81% in 2015–2019 (p = 0.08). Conclusion. S. maltophilia should be considered as a causative etiologic agent of severe chronic orthopedic infections.

Objective. To analyze genetic markers of endothelial dysfunction in chronic obstructive pulmonary disease. Materials and methods. The study involved an examination of 285 patients with chronic obstructive pulmonary disease aged 67.12 ± 1.82, including males (73.68%) and females (26.32%). A control group consisted of 70 respondents, including 45 relatively healthy people, among whom males constituted 64.3% and females 35.7%. Polymorphisms of endothelial nitric oxide synthase NOS3 (C786T), endothelin-1 EDN1 Lys198Asn genes were examined by PCR method. Results. The cohort of COPD patients revealed a prevalence of pathological homozygous genotype 786SS NOS3 (χ2=12.84, df=1, p=0.0003). Carriage of heterozygous variant of LysAsn polymorphic marker Lys198Asn of EDN1 gene in COPD patients was detected in 32.5%. Conclusion. Manifestation of endothelial dysfunction in COPD patients is due to genotypic predisposition associated with carrying polymorphisms 786SS of NOS3 gene (OR 7.01, 95% CI 1.59-30.81) and Lys198Asn of EDN1 gene (OR 2.53, 95% CI 0.69-9.22)

Objective. To assess the rehabilitation potential of patients with cerebrovascular disorders for prospective follow-up and effective medical rehabilitation. Materials and methods. The study group included patients with cerebrovascular diseases (n=20) and acute cerebrovascular accident (n=22). Integral assessment of the state of health was carried out using diagnostic complex “Computer dermograph for the topical diagnosis of pathology lesions of internal organs” (DgKTD-01). Following studying the baseline indicators, a comparative analysis of the study group and the control group (n=10) was carried out. The patients of the study group had their state of health corrected by means of the Computerized corrector ANKF-01 using low-intensity electromagnetic field for normalization of functional activity of the central and peripheral nervous system. The course consisted of 10 sessions weekly with preliminary functional and topical diagnostics using the DgKTD-01 complex. Results. Patients with acute cerebrovascular accident revealed a functional restructuring of autonomic regulation with a greater severity of activation of the sympathetic link, patients with cerebrovascular diseases – of the parasympathetic one. The determining factor in cerebral circulation disorder consists in the indices of basic functions F2 and F3. The study identified a model for predicting the likelihood of acute recurrent disorders of cerebral circulation, as well as additional diagnostic criteria for differential diagnosis. Purposeful change of excitatory (inhibitory) potentials in cortical-subcortical relations changes vegetative balance, stimulates microcirculation, muscle-tonic function, neurotrophic regulation. These effects stabilize and improve the condition of patients. The effectiveness of rehabilitation measures using ANKF-01 is considered to be higher in patients with acute cerebrovascular accident. Conclusion. Patients with cerebral circulation disorders have specific features of the adaptive capabilities of the body. This indicates the differentiation in the formation of the functional status of the body, taking into account the characteristics of the disease, individual resources and compensatory capabilities. Rehabilitation based on the use of ANKF-01 increases the effectiveness of measures aimed at preventing organic changes in the brain, and can significantly improve the prognosis and reduce the percentage of disability in this category of patients.

Objective. To determine the marker function of fatty acid binding protein (FABP) concentration in seminal plasma (SP) in order to assess ejaculate fertility used in in vitro fertilization (IVF) treatment of infertility in couples. Materials and methods. The study involved semen samples of 96 men of reproductive age: the study group (n=63) – patients with a decrease in concentration and/or total content of spermatozoa in ejaculate, the comparison group (n=33) – men with normal concentration and number of spermatozoa in ejaculate. The content of FABP in SP was determined by enzyme-linked immunosorbent assay using the test system “FABP – ELISA – BEST” (A-9102, Vector-Best, Russia). In order to determine the informative value of using the concentration of FABP in SP as a criterion of ejaculate fertility of men of the study group, the predictive value of positive and negative IVF results was determined by calculating the diagnostic sensitivity, specificity and efficiency. Results. The content of FABP in SP accounted for 1.29 ± 0.24 ng/mL, the median and interquartile range comprised 1.23 [1.13–1.35] ng/mL, ranging from 1.08 to 2.79 ng/mL. The study revealed statistically significant intergroup differences (Mann-Whitney test U=79.00; p=0.000016), a weak correlation between the level of FABP and the concentration of spermatozoa (R=0.578008) and their number in ejaculate (R=0.583599). The diagnostic sensitivity of the test for FABP in SP of the men of the study group accounted for 81.82%, specificity – 78.95%, efficiency – 80.95%. Conclusion. Seminal plasma FABP can act as a marker of spermatogenesis disorders. The study of this protein in ejaculate provides the accuracy of predicting the outcome of in vitro fertilization.

Objective. To evaluate the effectiveness of treatment of breast cysts with an ozone-oxygen mixture using ultrasound guidance. Materials and methods. The methodology included a retrospective analysis of the ultrasound-guided treatment of breast cysts. Treatment was carried out according to clinical recommendations using a conservative method and involved outpatient ultrasound-guided removal of cystic content without sclerosant and with introduction of ozone-oxygen mixture. Results. 445 patients with fibrocystic mastopathy were treated. The age of the patients ranged from 18 to 55 years. The detected cysts up to 2 cm represented regular-shaped, rounded anechoic masses with clear even contours and homogeneous structure. Cysts larger than 2 cm were sometimes irregular in shape with anechoic, homogeneous content. In most cases, the multilocular cysts had an irregular shape with anechoic contents, without intracavitary parietal inclusions. The average size of the cysts comprised 2.8±0.9 cm. The analysis showed the effectiveness of the treatment methods. The best effect was obtained with the use of an ozone-oxygen mixture. Complications of the procedure were observed in 6 (2%) patients (hematoma and recurrence). Conclusion. The findings of the study showed that treatment of breast cysts with an ozone-oxygen mixture using ultrasound guidance proved to be a highly effective, low-traumatic, and safe method. This technique is performed on outpatient basis, does not require the administration of anesthetics, is well tolerated by patients, has a selective effect, has no serious complications and risk of cosmetic defects.

Polyorchism is a rare congenital anomaly defined as the incidence of more than two testicles. This pathology is considered to be extremely rare and may remain asymptomatic for a long time. The disease is detected predominantly during the examination of other urologic pathologies such as inflammation, hydrocele, testicular torsion, inguinal hernia, male infertility, and malignant changes. The reported case of polyorchism was confirmed during surgery for left testicular hydatid torsion in a 17-yearold boy. The abnormal testis had its own tunica vaginalis testis, epididymis, common deferent duct, and shared blood supply with the left testis. The testes were preserved during surgery. No impaired spermatogenesis was detected in the patient.

The Far Eastern Federal District comprises an epidemic focus of hemorrhagic fever with renal syndrome (HFRS), where the incidence is determined by two orthohantaviruses: Hantaan (including its variant Amur) and Seoul. In Primorsky Krai, the average long-term incidence rate for 13 years (2011–2023) accounted for 2.7% (in some years up to 4.4% per 100 thousand population), and the mortality rate comprised 3.2% (9.1% in 2018). The distribution of clinical forms of the disease over the past 13 years revealed the prevalence of its moderate forms (66%), severe forms accounted for about 30% of all cases. The study presents a clinical case of severe course of HFRS with lethal outcome in a young male with no concomitant pathology.

Neurological disorders are widely recognized as the most frequent and dangerous complication of neglected forms of spinal tuberculosis, typically leading to disability. Since tuberculous spondylitis remains free from pathognomonic clinical symptoms, the disease should be suspected in case of ineffective treatment of a non-tuberculous disease with a particular form of spinal tuberculosis to be behind. The diagnostic algorithm, being implemented from the initial stage of tuberculous osteitis formation, involves timely anti-tuberculosis treatment and correct management of patients, thereby making the basis for preventing the neurological disorders and disability of patients. The presented clinical cases indicate the advantage of an integrated approach in the diagnosis of this pathology in terms of establishing the tuberculous etiology of spondylitis.

Recurrent abdominal pain in childhood and adolescence may be indicative of chronic mesenteric ischemia with median arcuate ligament syndrome as a result of compression of the celiac artery by the median arcuate ligament of the diaphragm and its internal crura, neurofibrous tissue of the celiac plexus. The presence of symptoms characteristic of various diseases of gastrointestinal tract organs, absence of pathognomonic signs and complex approach in diagnostics of abdominal cavity vascular system, insufficient awareness of specialists of children’s outpatient clinics determine the urgency of timely diagnostics and treatment of patients with this pathology. Median arcuate ligament syndrome, or Dunbar syndrome, is more often a congenital malformation. This syndrome can be considered as an acquired pathology in the case of compression of the celiac artery by enlarged lymph nodes and neurofibrous tissue of the celiac plexus. In addition to hemodynamically significant disorders of blood supply to the gastrointestinal tract, Dunbar syndrome in children and adolescents is also accompanied by psycho-emotional disorders due to the presence of unstable stools, recurrent abdominal pain, and often repeated ineffective requests for medical care. Clinical observation, methods of diagnosis and surgical treatment of median arcuate ligament syndrome in a 14-year-old patient are presented in the study.

The study presents a clinical case of complex treatment of a patient with high comorbidity (Charlson comorbidity index = 6 points) who had severe sepsis (SOFA score = 8 points) with multiple foci of pyogenic infection (spinal epiduritis, paravertebral and subdural abscesses, purulent meningitis, bilateral lower lobe pneumonia). The syndrome-based approach with the use of minimally invasive approaches in the early stages (no later than 12 hours from the onset of clinical manifestations of the disease) ensured a favorable outcome. Based on the results of surgical treatment, a conclusion was made about the tactics of surgical treatment in patients with spinal infection against the background of sepsis.

Purulent-inflammatory diseases of the maxillofacial region (MFR) refer to frequent complications of odontogenic inflammatory processes. The successful treatment of this pathology is based on adequate drainage of the pustule, complete evacuation of wound exudates and effective local therapy of the wound. The paper presents the flow-vacuum-washing isolation device as an effective method of comprehensive treatment for MFR abscesses and phlegmons caused by antibiotic-resistant strains of microorganisms and in patients with poor immunologic resistance.

The study reveals the great importance of open educational resources (OER) in the field of medical education and scientific activity. Objective. To develop an “OER navigator for medical community”, containing metadata of information resources with open free access. These resources are intended for use in curricula at all stages of medical education, in scientific activities and self-education. At the present stage, the social significance of education in terms of the world concept of “sustainable development” is defined as the most important component and means of survival for civilization (UNESCO). In medicine, with its special mission to preserve the health of the population, the urgent task consists in the training of highly qualified personnel. Close connection of the future of mankind with the processes of digitalization determines the availability of information resources and the use of modern technologies as key aspects of the organization of educational processes. The analysis of the scientific literature and the study of the experience of OER application revealed that OER represent an important tool in the information support of the scientific and educational sphere. OER contribute to forming a personal educational environment, learning continuously and improving skills worldwide, in perpetuity and regardless of financial capabilities. The amount of data presented on the Internet is huge, therefore, the search for necessary information takes a significant amount of time. The developed Navigator (http://lib-os.ru/obrazovatelnye-resursy/navigator-oor-medicinskogo-soobshhestva/) provides meta-data of information resources with open free access, thereby allowing representatives of the medical community at all levels of education and research to quickly and effectively find reliable scientific data and peer-reviewed sources of information.