Intranasal immunotherapy with M2 macrophage soluble factors in post-COVID hyposmia: A pilot study.

Olfactory dysfunction is an early marker of COVID-19 infection. However, individuals may develop chronic olfactory impairment for more than six months in 1-10 % of cases. The study's objective is to evaluate the efficacy and safety of intranasal immunotherapy using bioactive substances produced by M2 macrophages for the treatment of people with long-term post-COVID-19 hyposmia. Seven individuals with long-term persistent hyposmia (7 to 24 months), associated with PCR-confirmed coronavirus infection were evaluated for olfactory function at baseline, one, and six to twelve months after therapy. The intranasal inhalation of M2 macrophage conditioned medum (one time per day for 28-30 days) was well tolerated. Furthermore, olfactometry demonstrated that the patients restored their capacity to perceive (Kruskal-Wallis H test 14.123, p = 0.0009) and recognize odours (H = 11.674, p = 0.0029). In addition, the subjective evaluation of smell significantly improved (H = 11.935, p = 0.0026). At the 6- to 12-month follow-up, the majority of patients (5/7) reported extremely high levels of satisfaction with the outcomes, and the remaining two patients also felt generally positive about the therapy's success. Overall, our study showed that the use of intranasal inhalations as a method of delivering bioactive factors and the conditioned medium of M2 macrophages as a therapeutic agent are both safe, well tolerated and, according to preliminary data, clinically effective in the treatment of patients with long-term post-COVID-19 hyposmia.

[One-stage reconstructive jejunogastroplasty after previous multiple abdominal surgeries for left-sided diaphragm rupture complicated by gastric incarceration and necrosis]. / Odnomomentnaya rekonstruktivnaya eyunogastroplastika u bol'nogo posle mnozhestvennykh operatsii na bryushnoi polosti po povodu razryva levogo kupola diafragmy s ushchemleniem i nekrozom zheludka.

Acute gastric necrosis is a rare event requiring organ resection. Delayed reconstruction is advisable in patients with peritonitis and sepsis. The most common complication of gastrectomy with reconstruction is failure of esophagojejunostomy and duodenal stump. In case of severe esophagojejunostomy failure, appropriate surgical approach and timing of reconstructive stage should be analyzed. We report one-stage reconstructive surgery in a patient with multiple fistulas after previous gastrectomy. Surgery included reconstructive jejunogastroplasty with jejunal graft interposition. The patient underwent previous several unsuccessful reconstructive procedures complicated by failure of esophagojejunostomy and duodenal stump with external intestinal, duodenal and esophageal fistulas. Nutritional insufficiency, water and electrolyte disorders due to significant loss of proteins and intestinal juice through the drain tubes deteriorated clinical status. Surgical procedures finished reconstruction, provided closure of multiple fistulas and stomas and restored physiological duodenal passage.

Resolution estimation in different monolithic PET detectors using neural networks.

PURPOSE: We use neural networks to evaluate and compare the spatial resolution of two different simulated monolithic PET detector elements. The effects of mixing events with single photoeffect interactions and multiple Compton scatterings are also studied. METHODS: Two PET detector models were used in this study. The first one consisted of a LYSO crystal plate with 19.25 × 19.25 × 12 mm3 dimensions and 256-channel photomultiplier with parameters modeled after a Hamamatsu S-13615-1050N-16 SiPM. The second model used a larger LYSO crystal (57.6 × 57.6 × 12 mm3) and a 64-channel Sensl ARRAYC-60035-64P-PCB photomultiplier. A feed-forward neural network was used to reconstruct the point of 511 keV gamma interaction. The number of layers and the number of neurons per layer were varied. RESULTS: The best resolution was achieved with the 57.6 × 57.6 mm2 detector model, with an average of 0.74 ± 0.01 mm for the XY plane and an average 1.01 ± 0.01 mm for the Z coordinate (depth of interaction). CONCLUSIONS: Neural networks can be a powerful tool that can help to determine the optimal parameters for a design of an experimental device. This study demonstrates how neural networks can be used to evaluate the performance of two detector variants while not being dependent on specific signal and noise functions.

[Medical rehabilitation in patients with anal incompetence after surgery for stage IV hemorrhoids]. / Konservativnaya reabilitatsiya patsientov s nedostatochnost'yu anal'nogo sfinktera posle khirurgicheskogo lecheniya gemorroya IV stadii.

The choice of medical rehabilitation in patients with anal incontinence is impossible without diagnostic data revealing the mechanism of fecal incontinence. The most promising are programs of comprehensive physiotherapeutic rehabilitation based on biofeedback training. The rate of anal incompetence (AI) after hemorrhoidectomy is 1.3-12.5%. However, in addition to the organic cause (surgical trauma), functional disorders of the external sphincter and pelvic floor muscles may contribute to the pathogenesis of anal incontinence, aggravating the incontinence symptoms after surgery. Therefore, these functional disorders should be diagnosed before surgery. However, medical rehabilitation programs for anal incontinence after hemorrhoidectomy are not standardized, and functional outcomes have not been studied. OBJECTIVE: To evaluate the outcomes of comprehensive rehabilitation in patients with AI after hemorrhoidectomy to improve quality of life after surgery. MATERIALS AND METHODS: A retrospective study was carried out on 46 patients (mean age 53.8±15.4 years) after hemorrhoidectomy with fecal incontinence, 13 (28.3%) males and 33 (71.7%) females. The main group included 25 patients who received comprehensive rehabilitation, including biofeedback training and tibial neuromodulation (TNM) for 15 days. The control group consisted of 21 patients who received TNM at home also for 15 days. The severity of fecal incontinence was determined using the Wexner score. The functional state of the sphincter before and after surgery was assessed using the anorectal manometry (sphincterometry) (WPM Solar, the Netherlands). RESULTS: Comprehensive rehabilitation resulted in a statistically significant clinical improvement: a decrease in the Wexner score in both males and females. No significant differences in manometry results were observed: the anal sphincter tone increased by 16.0% in females and 10.6% in males, and contractility increased by 17.7% and 15.1%, respectively. Monotherapy with TNM in control group patients improved tone indices by 8.7% in females and 6.8% in males, and contractility by 6.2 and 5.4%, respectively, which was lower than in the main group. CONCLUSION: Contraindications to physiotherapeutic procedures based on electrical stimulation, extracorporeal magnetic stimulation, and magnetic translumbosacral neuromodulation determine the only possible choice of medical rehabilitation, which is the combination of biofeedback training and TNM (as superior to TNM monotherapy). If out-patient medical rehabilitation is not feasible, patients are recommended to complement the home course with a specially designed set of exercises for anal incontinence treatment.

[Non-occlusive mesenteric ischemia in reconstructive digestive tract surgery]. / Neokklyuzionnaya mezenterial'naya ishemiya v rekonstruktivnoi khirurgii organov zheludochno-kishechnogo trakta.

OBJECTIVE: To analyze the mechanisms of non-occlusive mesenteric ischemia (NOMI) after digestive tract surgery. MATERIAL AND METHODS: NOMI occurred in 10 (0.4%) patients after reconstructive digestive tract surgery between 2015 and 2021. There were 4 women and 6 men aged 29-92 years (67 [60; 71]). Patients differed from each other in the nature of baseline disease and surgical approach. All patients underwent standardized surgical interventions. There were no intraoperative complications. RESULTS: Median of surgery time was 372.5 (246.25; 548.75) min, blood loss - 450 (200; 725) ml. These parameters conformed to the type of surgery. There were no specific clinical signs of NOMI. Lactic acidosis (>4 mmol/L) occurred in 7 patients after 1-3 postoperative days. In 6 patients, fulminant NOMI developed after 1-2 postoperative days with subsequent multiple organ failure syndrome and septic shock. All patients underwent emergency redo surgery. Multivisceral gastrointestinal necrosis occurred in 5 patients, gastric conduit necrosis - 3, colon necrosis - 1, gastric stump necrosis - 1 patient. Mortality rate was 80%. Two patients survived. CONCLUSION: NOMI manifested as a septic shock in 60% of patients that was due to fulminant development of multivisceral necrosis after 1-2 postoperative days. Timely diagnosis of reversible NOMI in these cases was impossible. Extensive visceral necrosis in early postoperative period is probably associated with intraoperative critical ischemia of digestive organs.

Megakaryocytes of the Spleen in Experimental Amyloidosis and Effect of Red Wine.

Amyloidosis was modeled in young mice by administration of aqueous solution of soy cream substitute and then, amyloidogenesis was corrected by oral administration of dry red wine. In mice with amyloidosis, the area of megakaryocytes decreased by 1.69 times, the relative content of oxyphilic forms of megakaryocytes increased by 4.33 times, and ploidy did not change in comparison with the corresponding parameters in intact mice. Administration of red dry grape wine against the background of formation of systemic amyloidosis changed the reaction of megakaryocytes: the content of polychromatophilic forms was comparable to the level of intact control, the content of oxyphilic forms decreased by 3.11 times, the RNA and DNA content in megakaryocyte nuclei decreased proportionally, and the ploidy decreased. Thus, red grape wine reduced the response of the megakaryocyte genome to the external supply of amyloidogenic substance.

[Rehabilitation program for patients with low anterior resection syndrome]. / Reabilitatsionnaya programma dlya bol'nykh rakom pryamoi kishki s sindromom nizkoi perednei rezektsii.

Surgical treatment of rectal cancer and sphincter-preserving low anterior resection results to evacuation disorders («low anterior resection syndrome¼ - LARS). There are no clinical recommendations for the treatment of patients with LARS as well as a rehabilitation program for them. OBJECTIVE: To develop a rehabilitation program for patients with low anterior resection syndrome. MATERIAL AND METHODS: The investigation was performed at 2 stages. During the first stage, 29 patients with LARS (17 (58.6%) men, mean age of the participants' 61.5±9.5 years), 12 (41.4%) women (mean age 61.2±7.8 years) were examined and received the course of conservative treatment with the use of biofeedback-therapy performed by the standard protocol. On the second stage, 17 patients (mean age 61.4±12.7 years) - 9 (52.9%) men, 8 (47.1%) women received biofeedback therapy in combination with tibial neuromodulation (TNM). Functional state of the rectum and the locking apparatus in all patients were evaluated by anorectal manometry: sphincterometry and studies of the reservoir function of the rectum before and after treatment. RESULTS: The developed complex of rehabilitation measures led to improved treatment results for patients with rectal cancer by improving the quality of life after low anterior resection, reducing the manifestations of LARS (by 47.8%). Stable positive results of treatment were maintained in 36.4% of patients, positive dynamics from the treatment according to the LARS scale decreased slightly in 54.5%, deterioration of indicators in 3-6 months after conservative rehabilitation was registered in 9.1% of cases. At the first stage maximal squeeze pressure improvement was reached in the whole cohort (p=0.047), at the second stage these trend was seen only for women for the pressure values at rest (p=0.01) and during squeeze (p=0.025). The data obtained allowed us to recommend a repeat course of treatment to 63.6% of patients. The authors modified and optimized a special complex of physical therapy for the rehabilitation of patients both in a medical institution and at home. These exercises are aimed at improving the functional state of the pelvic floor muscles and sphincter apparatus. CONCLUSION: Rehabilitation program for patients with low anterior resection syndrome should include: 1) biofeedback therapy to improve the holding function; 2) biofeedback therapy aimed at improving the reservoir function and sensitivity of the rectum to filling; 3) tibial neuromodulation. This program may help improving the contractility of the anal sphincter and reservoir function of the rectum, as well as the appearance of the urge to defecate.

[Redo reconstruction of the digestive tract after gastric surgery]. / Povtornye rekonstruktsii pishchevaritel'nogo trakta posle operatsii na zheludke.

OBJECTIVE: To formulate the concept of physiological reconstruction of the digestive tract during redo gastric surgery. MATERIAL AND METHODS: There were 52 patients who underwent redo gastric surgery after previous resections, drainage and antireflux procedures in 2011-2017 at the Vishnevsky National Research Surgical Center. Redo resection of the stomach with Billroth-1 and Hofmeister reconstructions were performed in 5 (9.6%) and 1 patient (1.9%), respectively. Roux-en-Y reconstruction was performed in 4 (7.7%) patients after gastric remnant extirpation. Jejunogastroplasty was used in 30 (57.7%) patients. A segment of the transverse colon as the reconstructive material was used in 2 (3.8%) patients, left colon - in 8 (15.4%) after esophagectomy. One (1.9%) patient underwent extirpation of 'small' stomach and thoracic esophagus after previous gastric bypass. Gastric remnant was used as an isoperistaltic tube for subtotal esophagoplasty. Reconstruction was not possible in only 1 (1.9%) patient after advanced visceral resection for recurrent cancer within esophagojejunostomy due to deficit of visceral material. RESULTS: Postoperative complications were observed in 5 (9.6%) patients. Partial failure of esophagojejunostomy and duodenojejunostomy occurred in 2 (3.8%) and 1 patient (1.9%), respectively. Colon transplant necrosis was noted in 1 (1.9%) patient that required resection followed by colo- and esophagostomy nutrition. One patient died on the 1st postoperative day from progressive multiple organ failure. At the end of the study, 44 (86.2%) out of 51 patients were under follow-up. Good results were revealed in 26 (59.9%) patients, satisfactory outcomes - in 12 (27.4%) patients. Redo surgery was not effective in only 6 (13.7%) patients. CONCLUSION: Evaluation of our results demonstrates complete alleviation of pathological postoperative syndromes after gastric surgery in the majority of patients. Therefore, redo surgery with gastroplasty and restoration of duodenal passage are advisable.

Hepatic Mast Cells in Mice with Experimental Amyloidosis.

We studied the response of mast cells in mouse liver to experimental amyloidosis modeled by administration of aqueous solution of soy cream substitute and its correction by spontaneous dry red wine intake per os. Mast cells in mice with amyloidosis and intact mice were presented by α-ortho- and ß1-metachromatic non-degranulating forms. In mice with amyloidosis, the relative content of ß1-metachromatic mast cells in the capsule and parenchyma of the liver was by 1.8 and 1.5 times higher than in intact animals, respectively. In mice with amyloidosis receiving dry red wine, the proportions of mast cells with different degrees of metachromasy and degranulation were similar to those in intact mice, but the relative content of ß1-metachromatic mast cells in the liver parenchyma in these animals was by 1.6 times higher than in intact mice. Therefore, mast cells respond to amyloidosis development by changes in both the metachromasy and degranulation degree; dry red wine can be considered as a factor of amyloidosis prevention.

Near-surface structure of Nafion in deuterated water.

The swelling of a polymer ion-exchange membrane Nafion in water with various heavy isotope contents (D2O) was studied by photoluminescent UV spectroscopy. The photoluminescence arises because of the presence of sulfonic groups attached to the ends of the perfluorovinyl ether groups that form the tetrafluoroethylene (Teflon) backbone of Nafion. The width of the colloidal region, which is formed near the membrane surface as a result of the outgrowth of Nafion microfibers toward the bulk liquid, varies non-monotonically with D2O content, displaying a narrow maximum in the low concentration region. A significant insight into the unexpected isotopic effects revealed in swelling Nafion in deuterated water is provided. Mainly, the polymer swelling is very sensitive to small changes (on the order of several tens of parts per million) in the content of deuterium, which, for instance, can help in understanding the isotopic effects in living tissues.

[Association of sleep disorders with headache]. / Sviaz' rasstroistv sna s golovnoi bol'iu.

AIM: The aim of the present study was to investigate the connection of sleep disorders (SD) with a headache (HA) among the representative sample of population. MATERIAL AND METHODS: 1115 inhabitants of Chuvashia (491 men and 624 women) aged from 18 to 70 years old have been interviewed (middle age 38.7±13.9 years old); respondents under 18 and over 70 years old were not included into the research. There were 690 city residents, and 425 residents of the rural areas. The questionnaire approved earlier in the research of HA, and also the questions directed to identification of SD were used. One-way ANOVA, Chi-square test were used to compare variables of the groups. RESULTS: There were 718 (64.4%) respondents with SD and HA (the main group), 366 (23.8%) with HA without SD (comparative group), 16 (1.4%) with SD without HA, and 15 (1.3%) without SD and HA. The main group of the respondents authentically differed from other groups in older age, a larger number of women and villagers, presence of concomitant diseases in them. In the respondents with SD arose more often, pain had the combined (polymorphic) character, HA were more severe, localized in several areas of the head, but were of smaller duration. Among them there were more people with short sleep duration (<5 hours of night dream) and accepting sedative-hypnotic medications. HA without SD had a pricking character more often; the respondents more often slept in the afternoon, differed in higher level of education, and a rarer occurrence of cases of the increased arterial pressure. CONCLUSION: SD are often connected with HA, with their frequency, expressiveness and localization. Development of SD from HA are influenced by existence of concomitant diseases, age, gender and the place a residence. SD make the current of HA more severe.

[Complex treatment results in a congenital glaucoma patient (case report)]. / Rezul'taty kompleksnogo lecheniia patsienta s vrozhdennoĭ glaukomoĭ (klinicheskiĭ sluchaĭ).

Early diagnosis of congenital glaucoma allows surgery to be performed at the stage of reversible glaucomatous alterations of the optic disc and retina. In primary congenital glaucoma, the main reason for visual acuity reduction following surgical stabilization of the intraocular pressure are corneal changes. These include an increased corneal diameter, Haab's striae, areas of thickening and a greater posterior elevation. The resultant irregular astigmatism leads to amblyopia and a marked decrease in visual acuity. Active pleoptic treatment started from a very early age in children operated on for compensated congenital glaucoma provides them an opportunity to achieve high visual acuity and full rehabilitation.

Systemic Amyloidosis Model on Young Mice.

Subcutaneous daily injection (with neglect of aseptics) of 0.5 ml solution of soybean cream substitute (10% volume in distilled water) during 30 days caused systemic amyloidosis in 30-day-old mice. All the known methods for induction of systemic amyloidosis are based on the use of old animals, as senile tissue bradytrophy allows effective simulation of amyloidosis.

Development of software and modification of Q-FISH protocol for estimation of individual telomere length in immunopathology.

Telomere length is an important indicator of proliferative cell history and potential. Decreasing telomere length in the cells of an immune system can indicate immune aging in immune-mediated and chronic inflammatory diseases. Quantitative fluorescent in situ hybridization (Q-FISH) of a labeled (C3TA[Formula: see text] peptide nucleic acid probe onto fixed metaphase cells followed by digital image microscopy allows the evaluation of telomere length in the arms of individual chromosomes. Computer-assisted analysis of microscopic images can provide quantitative information on the number of telomeric repeats in individual telomeres. We developed new software to estimate telomere length. The MeTeLen software contains new options that can be used to solve some Q-FISH and microscopy problems, including correction of irregular light effects and elimination of background fluorescence. The identification and description of chromosomes and chromosome regions are essential to the Q-FISH technique. To improve the quality of cytogenetic analysis after Q-FISH, we optimized the temperature and time of DNA-denaturation to get better DAPI-banding of metaphase chromosomes. MeTeLen was tested by comparing telomere length estimations for sister chromatids, background fluorescence estimations, and correction of nonuniform light effects. The application of the developed software for analysis of telomere length in patients with rheumatoid arthritis was demonstrated.

Telomere Length of Individual Chromosomes in Patients with Rheumatoid Arthritis.

We analyzed telomere length of individual chromosomes in peripheral blood lymphocytes of healthy individuals and patients with rheumatoid arthritis. Quantitative fluorescent in situ hybridization and subsequent computer analysis of metaphase chromosomes showed that distribution of telomere length on individual chromosomes is different under normal and pathological conditions. Patients with rheumatoid arthritis had significantly shorter chromosome 4p telomeres, which can be essential for pathogenesis of this multifactorial disease. Additionally, disease activity inversely correlated with telomere length on chromosome 10p carrying genes involved in T cell differentiation and proliferation.

[The role and place of high-dose immunosuppressive therapy and autologous transplantation of hematopoietic stem cells for autoimmune diseases].

AIM: To determine the possible boundaries of high-dose immunosuppressive therapy and autologous hematopoietic stem cell transplantation (HDIT-autoHSCT) for autoimmune diseases (AUDs), such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and multiple sclerosis (MS). SUBJECTS AND METHODS: A long-term trial was conducted at one center to evaluate the efficiency and safety of HDIT-autoHSCT in patients with AUDs. The previous standard therapy was noted to be resistant or lowly effective. The age of 10 patients with systemic connective tissue diseases was 27.6±2.8 years; the pre-HDIT-autoHSCT disease duration was 5.9±1.3 years; the median posttransplantation follow-up was 39.3 months. The age of 49 patients with MS reached 34.9±1.33 years; the pretransplantation disease duration was 8.4±0.69 years; the median post-HDIT-autoHSCT follow-up was 42 months. The efficiency of transplantation was evaluated on the basis of clinical findings, by using scales, laboratory tests, and magnetic resonance imaging. Pretransplantation conditioning was carried out according to the protocols: a) BEAM + antilymphocyte globulin (ALG); b) fludarabine + melphalan + ALG. No fatal outcomes due to a transplant procedure were observed. RESULTS: Overall 5-year survival after transplantation was 80% for systemic connective tissue diseases and 95% for MS; 5-year progression-free survival rates were 30% in the RA and SLE groups and 45% in the MS group. HDIT-autoHSCT turned out safe and reduced the activity of the process and further disease progression for a long period of time, as confirmed by regression of clinical symptoms and/or status stabilization in 9 patients with SLE or RA and in all patients with MS. CONCLUSION: The favorable factors associated with the results of transplantation are age younger than 35 years in collagenoses with their short-term duration and moderate signs; age younger than 40 years in MS with a disease duration of less than 10 years and expanded disability status scale scores of not more than 6.5. Of importance are functional system scores, duration of first remission, and an index of disease progression in different types of MS.

Efficiency of Cell Therapy in Liver Cirrhosis.

We studied safety and clinical efficacy of transplantation of autologous bone marrow cell in complex therapy of 158 patients with chronic hepatitis and cirrhosis of the liver. The efficiency of cell therapy was assessed in 12 months after single injection of the cells. The positive response (alleviation of liver cirrhosis or stabilization of the pathological process) was observed in 70% cases. The efficacy of therapy correlated with the severity and etiology of the disease and was maximum in patients with Child-Pugh class A (in 82.5% cases) and class B liver cirrhosis (in 79% cases); in patients with class C liver cirrhosis, the positive response was achieved in 42.5% cases. In 39 patients, ultrasonic examination performed in 3 years after transplantation revealed no focal lesions or ectopic ossification foci.

Suppressor cells - the basis of the immunopathogenesis of cancer.

There are numerous data in experimental and clinical medicine that convincing evidence on the leading role of the immune system in the pathogenesis of tumor diseases. Exactly immune cells such as cytotoxic T lymphocytes, NK cells, macrophages and dendritic cells have the ability to kill tumor cells. Under normal conditions the activity of these cells is a factor of inhibition proliferation and differentiation of tumor cells. An appearance of tumor itself, as uncontrolled cell growth and clinical manifestation, says that it was changed the cytotoxic activity of the cells causing tumor immunity. The main factor, if not the only reason for the decline of anti-tumor activity of the cells, is the formation of powerful extra- and inside-tumor suppressor mechanisms suppressing cytotoxic activity of anti-tumor immune-competent cells and allowing tumor cells to avoid surveillance by the immune system. It is showed that T and B cells, macrophages, and cells of myeloid origin suppressors possess these immunosuppressive properties. Therefore, in the future, methods to suppress functional activity of cells suppressors of various geneses can be the basis for immunotherapy of tumor growth.

[The alcohol effect on natural chronobiological rhythms of suicidal activity in patients supervised by addiction treatment specialists and psychiatrists]. / Vliyanie priema alkogolya na khronobiologicheskie ritmy suitsidal'noi aktivnosti u patsientov, nakhodivshikhsya pod nablyudeniem narkologa i psikhiatra.

AIM: To study the alcohol effect on chronological rhythms of suicidal activity in patients supervised by addiction treatment specialists and psychiatrists. MATERIAL AND METHODS: We have analyzed 1094 cases of suicides committed by men who lived in Cheboksary and Novocheboksarsk. The suicide committers were divided into two groups by presence or absence of blood and/or urine alcohol; each group was subdivided into three subgroups: a) mentally healthy suicide committers (MHSC), b) those who were under the supervision of the psychiatrist (PS), c) those who were supervised by addiction treatment specialists (ATS). Chronobiological rhythms were assessed using z-scores, frequency biological rhythms were evaluated with Kolmogorov-Smirnov's test with the Lilliefors correction and rank correlation. The trends of each chronobiological number were computed, the differences of obliquing angle of the trend were evaluated using 2×2 contingency tables (c2 with Mac-Namara's amendment). RESULTS: All suicide committers of the 1st group showed daily rising suicide trend, which had highs in the active wakefulness period. In the 2nd group, the trend did not change in MHSC and ATS, but in PS it significantly changed to descending with two peaks at 6-8:59 and 18-20:59. Upward weekly trend in PS in both groups was almost the same (in the 1st group the obliquing angle of the trend was 19° and in the 2nd group - 21°), the maximum was observed on Saturday and Sunday. In MHSC of the 1st group, the trend was moving downward, and in the 2nd group it was low. Both MHSC and ATS had the maximum on Monday. Annual trend in the 1st group in all samples was low. In the 2nd group, the trend remained low at MHSC and ATS and changed up in PS (16°) with the maximum in November-December. CONCLUSION: Chronobiological characteristics of deaths confirmed by peaks exceeding the average proportion of suicides from 1.5 to 2.5 times were noted in all groups of suicide committers. Alcohol intake significantly changed the suicidal chronobiological rhythm in PS.

LOW-INVASIVE TECHNOLOGIES OF INITIAL SURGICAL D-BRIDEMENT IN POLYTRAUMA AT THE FIRST STAGE OF PROGRAMMED MULTISTAGED SURGICAL TREATMENT

The authors described the variants of initial surgical d-bridement on the basis of experience of treatment of 183 patients of multistaged treatment program.