[EVALUATION OF THE MEDICAL AND ECONOMIC EFFICIENCY OF NON-INVASIVE PRENATAL TESTING IN MOSCOW].

AIM: to evaluate the medical and economic efficiency of prenatal diagnostics of fetal chromosomal abnormalities (CA) in pregnant women in Moscow using a non-invasive prenatal test (NIPT) as a second-line model. A comparative analysis of the medical and economic efficiency of standard prenatal screening and prenatal screening with NIPT in groups of pregnant women, registered in Moscow, with high and medium fetal CA risk was carried out. Analysis was based on the number of children born with CA and the costs of medical care (direct costs) and social payments (indirect costs), calculated for both scenarios. Following standard prenatal screening 111 children with CA would be born, following prenatal screening with NIPT - only 26. Including NIPT in prenatal diagnostics increases direct costs by 299.97 million rubles and reduces annual indirect costs from 61.19 to 28.95 million rubles. Starting from the 13th year of using NIPT the estimated effect of reducing indirect costs would exceed direct costs. NIPT in prenatal diagnostics can increase the detection of fetal CA and reduce indirect costs. Assessing the indirect costs in economic efficiency enhances the accuracy of the estimate.

[Clinical and anatomical features of SARS-COV-2 with acute hemorrhagic necrotizing encephalopathy]. / Kliniko-anatomicheskie osobennosti SARS-COV-2 s ostroi gemorragicheskoi nekrotiziruyushchei entsefalopatiei.

Autopsy material and medical history were studied and analyzed in a 20-year-old male patient who had died from COVID-19 infection with the development of acute SARS-CoV-2-associated hemorrhagic necrotizing encephalopathy in adults with obvious endothelial dysfunction confirmed by virological examination of the autopsy material. In this case, the brain structures displayed the main found histopathologic signs: widespread vasculitis (endotheliitis) with varying degrees of segmental and total endothelial destruction; thrombosis mainly of the vessels of the microcirculatory bed; parenchymal hemorrhagic necrosis and inflammation (encephalitis); severe necrobiotic damage to neurons. Cerebrovascular immune damages and hypercoagulable states, which were observed in some acute viral neuroinfections, are the basis for the neurological complications of COVID-19. In this case of bicausal diagnosis (the presence of a comorbidity), the primary disease contributed to the acute progression of the background disease (secondary infiltrative tuberculosis with the development of specific pleuritis and pneumothorax with the addition of acute bilateral focal confluent bronchopneumonia with a history of undifferentiated immunodeficiency syndrome. Emphasis is laid on the possibility and importance of involving the brain structures in the process in COVID-19 for the timely diagnosis of emerging neurological disorders. A brief literature review is given.

[Features of the morphological manifestations of COVID-19-associated with acute hemorrhagic necrotizing encephalopathy in adults]. / Osobennosti morfologicheskikh proyavlenii assotsiirovannoi s COVID-19 ostroi gemorragicheskoi nekrotiziruyushchei entsefalopatii vzroslykh.

A case of COVID-19-associated acute hemorrhagic necrotizing encephalopathy in adults in combination with comorbid pathology was analyzed. The key data of the medical history, the results of laboratory and instrumental studies are presented. The results of postmortem forensic medical diagnostics with demonstration and description of macro- and microscopic changes in the examined organs are presented.

[The improvement of medical care of patients with oncologic diseases within the framework of the Priority National Project "Health"].

The article presents analysis of development of oncologic medical care with purpose to improve survival of oncologic patients and to decrease population mortality of malignant neoplasms within the framework of implementation of measures of the Priority National Project "Health" and the State Program "Health Care Development". The analysis is presented concerning crude and age-standardized incidence and mortality rates and provision of oncologic medical services with hi-tech medical equipment. The comparative analysis of project and process management methods demonstrated that project management is an efficient instrument for increasing accessibility and quality od medical care at a given period of time and to form points of increase for future development.

[Provision of personalized acoustic protection of aviation specialists (practical aspects)].

In the article observed the issues of individual protection of aviation technical personnel from the noise generated by military aircrafts. It is shown that modern innovative materials and technologies allow carrying out scientifically based selection of perspective acoustic protection means for aviation personnel. Conducted analysis has shown that specially designed aviation PPE are comparable by acoustic effectiveness with foreign analogs. The necessity of taking into account of personal psycho-physiological features in the process of designing, building and testing of PPE has been proved. Stress-protective function of acoustic protective equipment has been proved in experiments with aviation specialists. Discussing prospective investigation directions in the field of noise protection. One of them is the establishment of persons register (flight and technician personnel) working in acoustically adverse conditions as the basis for occupational risks management.

[CLINICAL ASPECTS OF SEPTIC ENCEPHALOPATHY].

Septic encephalopathy is a form of general cerebral dysfunction caused by a systemic inflammatory reaction. Its investigation encounters enormous difficulties for the lack of reliable biological markers of neuronal lesions and methods for the evaluation of consciousness in severely ill patients. Hence, the importance of correct clinical interpretation of the character and magnitude of CNS activity. Examples are presented demonstrating the difficulty of interpreting disorders in CNS activity associated with evere community-acquired pneumonia.

Professional reliability of military pilots: medical and social-psychological aspects.

Presented based on previously performed by the authors the following analysis of the medical, social and psychological aspects of the pilot professional reliability. The scheme of interaction of its structural and functional components is developed, set their coefficients of importance. It is shown that to conform with the requirements of the profession of flight cooperation, social and psychological components of professional reliability of pilots need a set of measures on formation of their professionally important qualities.

[Development of a methodology of for medical-flight examination of flight personnel under condition of hospital].

Development of a methodology of for medical-flight examination of flight personnel under condition of hospital. When performing an experimental study of ways of improvement of hyperbaric ascent involving 95 servicemen,of special contingent determined lack of ascent security of flight crews to altitudes up to 6500 meters due to the large percentage (10%) of revealed reduced hypoxia tolerance of mild and moderate level in military personnel and potentially high risk of high-altitude decompression disease without a preparatory desaturation. The experimental testing of 5 minutes ascent technique for 5000 m and 6000 m is performed, justified criteria of hypobaric hypoxia tolerance of mild and moderate level during the examination of health state of 589 aircrew personnel (including personnel with approved diagnoses) in hyperbaric chamber in relation to hospital conditions. It is experimentally shown that the method of the survey in the chamber on hypoxia tolerance of mild and moderate level in the ascent to the height of 5000 m and 6000 m is an effective mean of determining the functional state and reserve capacity of the organism to identify hidden forms of human diseases and can be used for medical-flight examination of flight personnel in a hospital.

[Hypobaric chamber as a test of the aircrew of Russain Air Forces].

Authors research clinical medical importance of hypobaric ascends to an attitude of 5000 meters for 20 minutes for detection of latent forms of diseases and assessment of professional health and ascends to an attitude of 5000 and 6000 meters for 5 minutes when performing psychophysiological training for high altitude flying. According to test of 1326 pilots of Russian Air Forces, including pilots with different diseases, hypobaric ascends showed high diagnostic effectiveness for the professional health assessment. By using of both methods it was revealed that frequency of detection of decreased tolerance to hypoxia is the same (in average in 2,7 and 3,1% of total number of patients). By ascends in 38 patients (2,9%) was revealed decreased tolerance to hypoxia of medium level. It indicated about low functional state and space capacity of pilots. It was proved that hypobaric ascends of 5000 and 6000 meters for 5 minutes could be considered as an effective method of checkup of aircrew for the aviation physical examination.

Ion detector of time-of-flight mass spectrometer with registration of leading and trailing edges.

The accuracy of the ion flight time measurement in the time-of-flight mass spectrometer is critical to achieving high resolution. The pulse amplitude variation of the detector pulses leads to the registration time spread at a given pulse detection threshold. This time spread can be eliminated by determining the position of the pulse apex. To determine the position of the pulse apex, the output of the ion detector is fed simultaneously to the two channels of the time-to-digital converter. In this case, the first channel is set to register the leading edge, and the second channel is set to register the trailing edge of the pulse. Using a simple processing of the received data, the position of the pulse tip is determined. Thus, the dependence of the temporal position of the peak on the pulse amplitude is largely eliminated. Examples are given, and the efficiency of using this algorithm to increase the resolution of time-of-flight mass spectral peak registration is demonstrated.

Note: Isolated high-voltage thermo-compensated DC power supply for mass spectrometry.

The design of a highly stable isolated high voltage power supply is proposed and developed. The power supply is characterized by good temperature stability (<15 ppm/°C) and very low ripple level (<7 ppm) which were reduced by using a sinusoidal voltage in the transformer conversion. We anticipate that the power supplies of this type can find their utility in modern high-resolution mass spectrometers, particularly in time-of-flight and Orbitrap-type instruments providing a high resolution of ∼100 000 FWHM and high accuracy of m/z determination.

[A dose-effect curve in the range of biological and therapeutic action of the radon treatment].

Optimal dose regimen for radon treatment in different diseases should be estimated with dose-effect curve in the range of a stimulating action of moderate doses. The range of therapeutic doses is situated on the ascending part of the resultant curve between minimal and maximal levels of the factor effect.

[The actual problems of organization of medical care for rural population].

Population health status and medical care in rural areas is discussed. Trends in dynamics of such health indicators as mortality, morbidity and prevalence of socially perilous diseases are worse among rural population as compared with urban population. Economical, environmental, industrial and other factors impacting on health of rural population are revealed. Sociological research data demonstrating attitude of rural population to health and to medical care are quoted. Problems of financing, manpower strength and material and technical equipping in rural health institutions are discussed. Importance of priority national project "Health" for enhancement of rural medical care is shown including necessary measures for its realization.

[Controlled radon emanatorium].

Functioning of emanatorium for conduction of artificially prepared air radon procedures with utilization of both pure radon and its short-living daughter products is described as well as principal setting of the emanatorium and radiological parameters of the radon procedures. The conditions of possible clinical studies in the above emanatorium are outlined.

[Photomatrix LED therapy in patients with post-stroke arthropathy of the shoulder joint]. / Primenenie svetodiodnoi fotomatrichnoi terapii pri postinsul'tnykh artropatiyakh plechevogo sustava.

AIM: To assess the impact of quasi-monochromatic partially coherent infra-red radiation on the dynamics of recovery of the affected joint and the hemostatic system in patients with post-stroke arthropathy of the shoulder joint. MATERIAL AND METHODS: Fifty-five patients in the early, late and residual period of ischemic stroke were studied. Group I consisted of 27 patients who underwent 10 sessions of photomatrix therapy (wavelength 600 nm) on the affected joint, lasting for 10 minutes. In patients of group II (n=28), the duration of photomatrix therapy was 20 minutes. Patients of the comparison group (n=20) did not receive photomatrix therapy. RESULTS AND CONCLUSION: The results pointed to a significant reduction in the severity of pain, increase in the range of motion in the shoulder joint. All this was combined with a decrease in the severity of anxiety and depression, followed by a mild hypocoagulation effect and improvement of blood circulation in the paretic limb. The authors point out to the prospect of using this method for the prevention and treatment of post-stroke arthropathy.

[Study of changes in the enzyme-salt composition affecting the permeability of ocular tissues under infrasound phonophoresis].

This paper deals with the study of infrasound phonophoresis-induced changes in biochemical factors, which affect the permeability of eyeball tissues. During 10 days, the rabbit right eye was exposed to an infrasound in the changing pressure mode at 4 Hz and 173 dB for 10 minutes every day. The left eye remained control. After finishing a series of studies, the animals were slaughtered, the eyes were enucleated and prepared into individual tissues. Changes in sodium-potassium composition were investigated in the first series. By causing a reduction in the cellular content of K+, infrasound exposure was found to cause a decrease in membranous potential and activation Na-channel, as confirmed by the elevated intracellular levels of Na+. This in turn enhances ocular tissue permeability for drugs without damaging the structure of a cell membrane. Changes in the activity of the following enzymes: beta-glucosidase, cathepsin D, and hy- aluronidase. Infrasound was ascertained to enhance the activity of beta-glucosidase, which accounts for the lower levels of glucose in ocular tissues and points to the activation and acceleration of biochemical processes in the tissues. At the same time the increased concentrations of cathepsin D and hyaluronidase found in ocular tissues were responsible for a temporary reduction in the viscosity of hyaluronic acid, which promotes resolution of opacities, adhesions or scars and increased tissue permeability.

Modulation of corneal wound healing after excimer laser keratomileusis using topical mitomycin C and steroids.

A 193-nm excimer laser system was used to create deep stromal ablations in seven New Zealand white rabbits and shallow ablations in three. Eyes were randomized for treatment with topical mitomycin C, steroids, and erythromycin; topical steroids and erythromycin; or topical erythromycin only. All treatment regimens were instituted twice daily for 14 days. All eyes reepithelialized normally within 3 to 5 days. During 10 weeks of follow-up, all eyes developed moderate reticular subepithelial haze without significant differences among treatment groups. Results of light, fluorescence, and electron microscopic examination showed anterior stromal scarring and markedly reduced new subepithelial collagen formation in the group treated with mitomycin C, corticosteroids, and erythromycin. Focal abnormalities of Descemet's membrane and endothelial abnormalities were present in all treatment groups. Combination therapy with topical steroids, mitomycin C, and erythromycin to control the corneal wound healing response after refractive laser surgery appears promising and warrants further study.