Facilitators and barriers to adolescent participation in a TB clinical trial.

The inclusion of adolescents in TB drug trials is essential for the development of safe, child-friendly regimens for the prevention and treatment of TB. TB Trials Consortium Study 31/AIDS Clinical Trials Group A5349 (S31/A5349) enrolled adolescents as young as 12 years old. We assessed investigator and coordinator described facilitators and barriers to adolescent recruitment, enrollment, and retention.Interviews were conducted with six investigators from sites that enrolled adolescent participants and six investigators from non-enrolling sites. Additionally, two focus groups were conducted with study coordinators from enrolling sites and two focus groups with non-enrolling sites. Discussions were transcribed, analyzed, summarized, and summaries were reviewed by Community Research Advisors Group members and research group representatives for content validity.Investigators and coordinators attributed the successful enrollment of adolescents to the establishment and cultivation of external partnerships, flexibility to accommodate adolescents' schedules, staff engagement, recruitment from multiple locations, dedicated recruitment staff working onsite to access potential participants, creation of youth-friendly environments, and effective communications. Non-enrolling sites were mainly hindered by regulations. Suggestions for improvement in future trials focused on study planning and site preparations.Proactive partnerships and collaboration with institutions serving adolescents helped identify and reduce barriers to their inclusion in this trial..

[Acute purulent otitis media in children]. / Ostryi gnoinyi srednii otit u detei.

OBJECTIVE: Improving the effectiveness of inpatient care for children with acute purulent otitis media. MATERIAL AND METHODS: 100 children at the age from 0 to 18 years were inspected from January to August 2021. The main diagnostic methods included otoscopy, pharyngoscopy, rhinoscopy. Bacteriological examination of the pus from the ear was done for all patients. RESULTS: Acute purulent otitis media is a common cause of hospitalization in children aged 0 to 3 years. The main causative agents of the disease in toddlers are Staphylococcus aureus and pneumococcus (38%), in preschoolers and primary school children - pyogenic streptococcus and pneumococcus (30%), in high school students - Staphylococcus aureus.

[Effectiveness of baloon dilation of Eustachian tube in children with otitis media with effusion]. / Effektivnost' ballonnoi dilatatsii slukhovoi truby u detei s khronicheskim ekssudativnym srednim otitom.

Otitis media with effusion is one of the most common ENT diseases in childhood. Absence of acute symptoms, prevalence of pathology among preschoolers, who often cannot complain on discomfort in the ears and hearing loss, lead to late diagnosis and treatment. Standard surgery is highly effective, but it is not able to help all patients. A new, minimally invasive technique of surgical treatment of otitis media with effusion - balloon dilation of the Eustachian tube provides additional opportunities in solving these problems. OBJECTIVE: To evaluate the effectiveness and possibilities of its increasing in balloon dilation of the auditory tube in children with chronic otitis media with effusion. 34 children with chronic otitis media with effusion were under observation, who underwent 54 operations using a balloon catheter for the auditory tubes. The mismatch between the pressure value and the baloon diameter has been experimentally shown, and therefore a technique for intraoperative control of the effectiveness of the procedure has been developed. The effectiveness of balloon dilation in the study was 30.8-64.3%, depending on the following factors: the stage of otitis media at which the treatment was carried out, the combination of balloon dilation with tympanostomy, the use of intraoperative efficiency control technique. The high safety of the operation and the possibility of its effective implementation in patients with an operated cleft-palate are shown.

[Proteases for obtaining of food protein hydrolysates from proteinaceous by-products].

Due to the increasing shortage of food protein in the world, the most effective and complete use of proteinaceous substrates is an urgent task. The most promising way to utilize secondary protein-containing raw materials is to increase its nutritional value through enzymatic hydrolysis. The use of protein hydrolysates obtained from protein-containing by-products has great potential in various areas of the food industry, as well as in the production of foods for medical and special dietary uses. The aim of the research was to propose optimal methods for processing protein substrates to obtain hydrolysates with desired properties, taking into account the characteristics of the main types of proteinaceous by-products and the specificity of proteases used. Material and methods. We used the data contained in PubMed, WoS, Scopus, and eLIBRARY.RU databases, which meet the requirements of scientific reliability and completeness. Results. Collagen-containing wastes from the meat, poultry and fish processing industries, whey, soy protein and gluten are the main types of protein-containing by-products successfully used to produce food and functional hydrolysates. The molecular structure, basic biological and physico-chemical properties of collagen, whey proteins, various protein fractions of wheat gluten and soy protein are described. The expediency of enzymatic treatment of protein-containing by-products using proteases is shown to reduce antigenicity and eliminate anti-nutritional properties, improve nutritional, functional, organoleptic and bioactive properties for subsequent use in food production, including those for medical and special dietary uses. Information is presented on the classification of proteolytic enzymes, their main properties, and the effectiveness of their use in the processing of various types of proteinaceous by-products. Conclusion. Based on the literature data analysis, the most promising methods for obtaining food protein hydrolysates from secondary protein-containing raw materials are proposed, including pretreatment of substrates and the selection of proteolytic enzymes with a certain specificity.

Recombinant Pneumolysin of Pneumococci Induces TLR4 Expression and Maturation of Dendritic Cells In Vitro.

Pneumolysin (Ply) is a target for the development of serotype-independent pneumococcal vaccines, an important condition for the efficacy of which is their ability to activate innate immunity with the subsequent formation of adaptive immunity. In this study, the ability of recombinant full-length Ply (rPly) of pneumococci to induce TLR expression and maturation of dendritic cells generated from mouse bone marrow was evaluated. It was shown that rPly in vitro increased the number of dendritic cells expressing Toll-like receptor 4 (TLR4) on the membrane. rPly caused maturation of dendritic cells generated from mouse bone marrow, which manifested in a decrease in the number of progenitor cells (CD34), an increase in the number of cells expressing the adhesion molecule CD38, costimulatory molecules CD80 and CD86, molecules of terminal differentiation of dendritic cells CD83, as well as molecules of antigenic presentation of the major histocompatibility complex class II.

[The cochlear implantation in patients with syndromic deafness. Clinical examples]. / Osobennosti provedeniya kokhlearnoi implantatsii u patsientov s sindromal'noi glukhotoi.

OBJECTIVE: To describe clinical observations of patients with syndromic deafness. RESULTS: Deaf patients with CHARGE, Crouzon, and Wildervanck syndromes were monitored at the Russian Research Clinical Center for Audiology and Hearing Rehabilitation (Moscow) in different years. All of them were diagnosed having bilateral congenital deafness. After collecting anamnesis, evaluating the results of computed tomography of the temporal bones, and audiological examination, it was decided to conduct the cochlear implantation. CONCLUSION: The only method that allows patients with bilateral congenital deafness to gain hearing is the cochlear implantation. The malformations of the tympanic cavity structures, an abnormal course of the facial nerve canal lead to technical difficulties during the surgical stage of cochlear implantation. The navigation equipment, monitoring of the facial nerve makes it easier to find anatomical structures, as well as to avoid injuries.

[Peculiarities of preparing a patient with a cochlear implant for a magnetic resonance imaging]. / Osobennosti podgotovki patsienta s kokhlearnym implantatom k provedeniyu magnitno-rezonansnoi tomografii.

OBJECTIVE: To develop an algorithm of actions aimed at preparing a patient with a cochlear implant for magnetic resonance imaging (MRI). MATERIAL AND METHODS: A deaf patient after bilateral cochlear implantation (CI) came to St. Vladimir Children's City Clinical Hospital (Moscow) with symptoms of the demyelinating disease for MRI of the brain and spinal cord. Magnet were removed for MRI, then new magnets were installed. CONCLUSION: The temporary removing magnet for MRI of the brain and spinal cord allows to significantly reduce artifacts of MRI images.

[The main steps in treatment of the children with otitis media with effusion]. / Osnovy okazaniya meditsinskoi pomoshchi pri ekssudativnom srednem otite.

MATERIAL AND METHODS: 361 children at age from 11 months to 18 years with otitis media with effusion (OME) were inspected after tympanostomy during 2013-2018 years. Treatment was carried out in accordance with the stages of OME: secretory, mucous, fibrous. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, computed tomography. Surgical treatment may be required already at the secretory stage of the disease, as well as in all cases with mucous and fibrous stages of OME. RESULTS: In children with recurrences of OME and in patients with congenital cleft lip and palate, it is preferable to use long-wearing ventilation tubes and balloning of the auditory tubes. The effectiveness of surgical treatment of OME was 97.6%. CONCLUSION: The authors recommend dispensary observation of patients with OME for 12-24 months.

[The main steps in treatment of the children with otitis media with effusion]. / Osnovy okazaniya meditsinskoi pomoshchi pri ekssudativnom srednem otite.

THE AIM: Of the investigation was to establish the standard and improve the treatment of otitis media with effusion (OME) in children. 361 children at age from 11 months to 18 years were inspected after tympanostomy during 2013-2018 years. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, CT. MATERIAL AND METHODS: Treatment takes into consideration the reveal of OME: surgical initially. The tympanostomy preferable place is anterior-inferior quadrant. RESULTS: In cases with cleft palate or reccurence OME long-term tubes and balloonisation of ET are preferable. CONCLUSION: Authors received normalization of the hearing thresholds in 97.6% cases, but after surgery the patients have to be followed-up during 12-24 months.

Synthetic Analogs of Streptococcus pneumoniae Capsular Polysaccharides and Immunogenic Activities of Glycoconjugates.

Streptococcus pneumoniae is a Gram-positive bacterium (pneumococcus) that causes severe diseases in adults and children. It was established that some capsular polysaccharides of the clinically significant serotypes of S. pneumoniae in the composition of commercial pneumococcal polysaccharide or conjugate vaccines exhibit low immunogenicity. The review considers production methods and structural features of the synthetic oligosaccharides from the problematic pneumococcal serotypes that are characterized with low immunogenicity due to destruction or detrimental modification occurring in the process of their preparation and purification. Bacterial serotypes that cause severe pneumococcal diseases as well as serotypes not included in the composition of the pneumococcal conjugate vaccines are also discussed. It is demonstrated that the synthetic oligosaccharides corresponding to protective glycotopes of the capsular polysaccharides of various pneumococcal serotypes are capable of inducing formation of the protective opsonizing antibodies and immunological memory. Optimal constructs of oligosaccharides from the epidemiologically significant pneumococcal serotypes are presented that can be used for designing synthetic pneumococcal vaccines, as well as test systems for diagnosis of S. pneumoniae infections and monitoring of vaccination efficiency .

[Promising races of baker's yeast for the production of food ingredients enriched with selenium and chromium].

It is known, that Saccharomycetes can accumulate mineral substances with targeted enrichment of the growth medium. However, the influence of the genetic affiliation of the culture and the technological factors of yeast strains, the composition of growth media on the efficiency of essential trace elements incorporation into the biomass and on the change of theirs intracellular components content have hardly been investigated. In this regard, the aims of this work was to select promising races of yeast Saccharomyces cerevisiae, develop a biotechnological method for obtaining food ingredients enriched with selenium and chromium on their basis, and study their trace element composition. Material and methods. Industrial strains of baker's yeast (Saccharomyces cerevisiae) were used: RCAM 01137, Y-3439 and Y-581. Yeast were grown on malt wort (pH 4.6) with a dry matter content of 12% with the addition of mineral salts in stationary conditions at a temperature of 30 °C for 18 h, after which the yeast biomass was separated by centrifugation. A method for enriching yeast with trace elements has been selected, which consists in the process of culturing cells on malt growth media containing chromium chloride or selenium dioxide in various concentrations. The total protein content was determined by the Kjeldahl method, polysaccharides and ergosterol - by spectrofluorometric method, selenium - by fluorimetric method. The content of trace elements in yeast biomass enriched with chromium was studied by mass spectrometric method with inductively coupled plasma. Results. It was shown that the highest specific growth rate was demonstrated by the yeast strains RCAM 01137 and Y-3439, and the highest level of maltase activity was in the Y-581 strain. It was found that the amount of biomass after cultivation of the yeast S. cerevisiae RCAM 01137 and Y-3439 was 6.00 и 5.42 g/100 cm3, respectively. It was noted, that the yeast S. cerevisiae Y-581 had capability of high synthesis of ergosterol (1.08±0.04%), the level of which was 2 fold higher than other strains. S. cerevisiae RCAM 01137 yeast showed the greatest ability to selenium enrichment, its content in biomass increased 137 fold and amounted to 2740 µg% when cultivated on a medium containing 800 µg/dm3. S. cerevisiae Y-581 yeast strain showed the highest capability to chromium sorption. The chromium concentration in its biomass was 8340 µg% in case of cultivating on a medium containing 750 µg/dm3. The usage of about 2.7 g of selenium enriched yeast biomass, or 1.0 g chromium enriched one, satisfies the daily requirement for these trace elements. Conclusion. Cultivation of S. cerevisiae cells on growth media containing trace elements makes it possible to obtain yeast biomass samples that can be used to obtain food ingredients for creating food products that contribute to the maintaining human health and improve the quality and duration of life.

Wavelet compression of off-axis digital holograms using real/imaginary and amplitude/phase parts.

Compression of digital holograms allows one to store, transmit, and reconstruct large sets of holographic data. There are many digital image compression methods, and usually wavelets are used for this task. However, many significant specialties exist for compression of digital holograms. As a result, it is preferential to use a set of methods that includes filtering, scalar and vector quantization, wavelet processing, etc. These methods in conjunction allow one to achieve an acceptable quality of reconstructed images and significant compression ratios. In this paper, wavelet compression of amplitude/phase and real/imaginary parts of the Fourier spectrum of filtered off-axis digital holograms is compared. The combination of frequency filtering, compression of the obtained spectral components, and extra compression of the wavelet decomposition coefficients by threshold processing and quantization is analyzed. Computer-generated and experimentally recorded digital holograms are compressed. The quality of the obtained reconstructed images is estimated. The results demonstrate the possibility of compression ratios of 380 using real/imaginary parts. Amplitude/phase compression allows ratios that are a factor of 2-4 lower for obtaining similar quality of reconstructed objects.

Multidrug-resistant tuberculosis patients' views of interventions to reduce treatment loss to follow-up.

SETTING: Patients who initiated treatment for multidrug-resistant tuberculosis (MDR-TB) at 15 Programmatic Management of Drug-resistant Tuberculosis (PMDT) health facilities in the Philippines between July and December 2012. OBJECTIVES: To describe patients' views of current interventions, and suggest changes likely to reduce MDR-TB loss to follow-up. METHODS: In-depth interviews were conducted between April and July 2014 with MDR-TB patients who were undergoing treatment, had finished treatment at the time of the interview (controls), or had been lost to follow-up (LTFU). Responses were thematically analyzed. RESULTS: Interviews were conducted with 182 patients who were undergoing or had completed treatment and 91 LTFU patients. Views and suggestions could be thematically categorized as approaches to facilitate adherence or address barriers to adherence. The top themes were the need for transportation assistance or improvements to the current transportation assistance program, food assistance, and difficulties patients encountered related to their medications. These themes were addressed by respectively 63%, 60%, and 32% of the participants. CONCLUSIONS: A more patient-centered approach is needed to improve MDR-TB treatment adherence. Programs should strive to provide assistance that considers patient preferences, is adequate to cover actual costs or needs, and is delivered in a timely, uninterrupted manner.

[The study of the process of enzymatic hydrolysis of yeast biomass to generate food ingredients with the specified fractional composition of protein substances].

With the use of enzyme systems (ES) the directed biocatalytic destruction of subcellular structures of the yeast biomass Saccharomyces cerevisiaе has been conducted for obtaining products of the specified structural-fractional composition. The composition of ES-1 included the enzymes catalyzing the hydrolysis of cell wall polysaccharides of yeast. Enzymes were dosed out at the rate of ß-glucanase - 300 units of ß-GcS/g of yeast, mannanase - 28.9 units of MS/g of yeast. ES-2, along with the enzymatic composition of ES-1, also contained a proteolytic complex, which included enzymes of bacterial origin, which were neutral, serine and metal-depended proteases (in a dosage of 2 units of PS/g of yeast). ES-3 consisted of the enzymes with ß-glucanase, mannanase, proteolytic activities and was further reinforced by high dose of proteases of fungal origin (10 units PS/g of yeast) for the implementation of deep hydrolysis of protein substances of yeast cell protoplasm to low molecular weight peptides and free amino acids. The action of enzymatic systems with different substrate specificity on the degree of destruction of subcellular structures of yeast was illustrated by electron microscopy. The resulting degradation products had different fractional composition and structural features. The results showed that ЕS-1 treatment of yeast led to deformation of the cell walls, but did not affect the composition of the protein fractions, represented by peptides with different molecular weight (20-60 kDa) that were characteristic for the starting material. The use of ES-2 has provided a deeper degradation of the protein-polysaccharide matrix of the cell walls and partial hydrolysis of proteins with the formation of soluble protein components with molecular weight less than 14 kDa. ES-3 treatment of yeast cells allowed to obtain composition with predominant content (89%) of free amino acids and short peptides with molecular weight up to 300 Da. The efficacy of targeted destruction of subcellular structures of Saccharomyces cerevisiae with getting of fermentation biomass with the specified fractional composition of protein substances for the production of food ingredients with special functional effects has been shown.

[BALANCE OF Thl/Th2/Th9/Thl7/Th22 CYTOKINES IN POST-OPERATION PERIOD IN PATIENTS WITH MALIGNANT TUMOR OF LIVER].

AIM: Evaluate cytokine status in patients with malignant liver cells after surgery. MATERIALS AND METHODS: 33 patients aged 35 to 76 years were included into the study. Blood was obtained before the operation and in the post-operation period: after 6 and 24 hours and at day 7 Cytokine profile (IL-Ib, IL-2, TNF-α, IFN-γ, IL-12p70, IL-4, IL-5,IL-6, IL-10, IL-13, IL-9, I-17a, IL-22) was evaluated using Multiplex- 13 system (Bender MedSystems, Austria). RESULTS: In patients levels of all the studied cytokines (Thl/Th2/Th9/Thl7/Th22) were already increased before the operations, that gives evidence of the presence of an inflammatory proc- ess connected with activation of immune system effectors. CONCLUSION: Disbalance of cytokine system helper cells resulting in functional and organic alterations through induction of the "cytokine storm" may aggravate the state of these patients. Further studies on the correction of cytokine system in these patients are thus needed.

Multidrug-resistant tuberculosis patients lost to follow-up: self-reported readiness to restart treatment.

SETTING: Multidrug-resistant tuberculosis (MDR-TB) patients lost to follow-up (LTFU) from Programmatic Management of Drug-resistant Tuberculosis facilities in the Philippines. OBJECTIVES: To gain insight into patients' readiness to return to treatment. METHODS: MDR-TB patients who initiated treatment and were categorized as LTFU were identified using TB registers, contacted, and asked to consent to an interview and medical record review. At the conclusion of the interview, patients' readiness to restart treatment was assessed and examined in relation to demographic, clinical, and interview data. Odds ratios were calculated. RESULTS: When asked if they would consider restarting MDR-TB treatment, 3% of the 89 participating patients reported that they had already restarted, 34% indicated that they wanted to restart, 33% had not considered restarting, 28% were undecided, and 2% had decided against restarting. Patients who wanted to restart treatment were more likely to report having borrowed money for TB-related expenses (OR 5.97, 95%CI 1.27-28.18), and were less likely to report being self-employed (OR 0.08, 95%CI 0.01-0.67), or perceive themselves at low or no risk for TB relapse (OR 0.30, 95%CI 0.08-0.96) than patients who did not indicate an interest in restarting treatment. CONCLUSIONS: Efforts to re-engage LTFU patients in care should consider financial barriers, knowledge gaps, and personal adherence challenges in patients.

[The role of computer and magnetic resonance imaging in patients with deafness]. / Rol' komp'yuternoi i magnitno-rezonansnoi tomografii u patsientov s glukhotoi.

The objective of the present study was to evaluate the potential of CT and MRI for diagnostics of congenital and acquired pathology of the inner ear in the deaf patients. Two groups of the patients were examined. The first group consisted of 75 patients with congenital or acquired deafness etiology. The second group was comprised of 75 patients with deafness associated with acute bacterial meningitis suffered in the preceding period. All the patients were examined by CT and MRI of temporal bones. The results of the study provided a basis for the development of indications for the application of CT and MRI to examine the patients presenting with hearing loss and deafness. CONCLUSION: CT and MRI make it possible to identify individual features of the temporal bone structure significant for the surgical treatment. MRI appears to have an advantage over CT for diagnostics of early obliteration of the cochlea. Both CT and MRI are the optional methods for the examination of the patients with deafness developing after meningitis.

[SYNTHETIC CONJUGATED ANALOGUES OF CAPSULE POLYSACCHARIDES OF PNEUMOCOCCUS - AN INSTRUMENT FOR DETECTION OF POST-VACCINATION ANTIBODIES].

AIM: Evaluation ofthe ability of capsule polysaccharides (CP) of Streptococcus pneumoniae serotype 3 and 14 and their synthetic structure analogues, conjugated with bovine serum albumin (BSA), to detect antibodies in post-vaccination sera of mice. Materials andmethods. Oligosaccharides correspond- ing to one, one and a half and two repeating links of serotype 3 and 14 S. pneumoniae CP were synthe- sized, their conjugates with BSA were produced by squarate method as well. Ligand content-per BSA molecule was controlled by MALDI-TOF spectrometry. Immune sera were obtained after 2 intraperi- toneal administrations to mice of glucoconjugates adsorbed on aluminum hydroxide or 13-valent pneumococcal conjugated vaccine. Determination of levels of post-vaccination class G antibodies and their sub-isotypes was carried out in EIA. RESULTS: Immunization of mice with neoglucoconjugates resulted in formation of predominantly IgGl recognizing serotype 3 and 14 S. pneumoniae C. IgG1 in mice immunized with a 13-valent conjugated vaccine recognized serotype 3 S. pneumoniae CP, but detected serotype 14 S. pneumoniae CP weakly. All the conjugated synthetic oligosaccharides were characterized by a high ability to bind antibodies in blood of mice immunized with the polysaccharide conjugated vaccine. BSA-tetrasaccharide of serotype 3 S. pneumoniae and BSA-tetrasaccharide of serotype 14 S.pneumoniae were characterized by the highest ability to detect IgG1 against C. CONCLUSION: Synthetic oligosaccharides, conjugated with BSA protein-carrier, may be used to develop diagnostic test-systems for determination of antibodies in post-vaccination sera.

[EPITOPIC SPECIFICITY OF A SYNTHETIC DISACCHARIDE, RECURRING LINK OF CAPSULE POLYSACCHARIDE CHAIN OF SEROTYPE 3 STREPTOCCUS PNEUMONIAE].

AIM: Study epitopic specificity of synthetic disaccharide, recurring link of serotype 3 S. pneumoniae, conjugated with bovine serum albumin (BSA). MATERIALS AND METHODS: Conjugate of the synthetic disaccharide with BSA was obtained by squarate method. Antigenic activity of the conjugate was studied in competitive EIA. Titers of IgG against capsule polysaccharide of serotype 3 S. pneumoniae were determined in EIA by using sera of mice immunized twice with disaccharide conjugate sorbed onto aluminum hydroxide. RESULTS: Disaccharide conjugate used as a well-covering antigen (4 µg/well) in EIA was characterized by a high degree of specificity and interacted only with IgG against serotype 3 S. pneumoniae in antimicrobial sera of animals without reacting with antibodies (ABs) against other pneumococcus serotypes (6B, 10A, 19A, 19F, 23F). Disaccharide conjugated with BSA was determined in competitive EIA to inhibit bonding of ABs to disaccharide by 78.8%, bacterial capsule polysaccharide by 56.9%, BSA did not inhibit the sera activity. The study of sera of mice immunized by serotype 3 S. pneumoniae disaccharide conjugate in EIA, where capsule polysaccharide was used as a plate-sorbed antigen, has established the presence of IgG against capsule polysaccharide at a titer of 1:1600. CONCLUSION: The disaccharide that is a single recurring link of serotype 3 S. pneumoniae contains a key epitope of capsule polysaccharide. The synthetic disaccharide could be used as a component of multivalent conjugated pneumococcal vaccines and for development of diagnostic test-systems.

[Cholesteatoma of the external and middle ear in the childhood].

The objective of the present work was to enhance the effectiveness of diagnostics of cholesteatoma of the external and middle ear in the children. The study included 66 patients presenting with chronic suppurative otitis media and one child having cholesteatoma of the external auditory meatus. All the patients were examined with the use of otoendoscopy and CT of the temporal bones. It was shown that the frequent occurrence of acute suppurative otitis media, exudative suppurative otitis media, and adhesive otitis media is the risk factor of the development of cholesteatoma of the external and middle ear in the children. The following CT features of cholesteatoma of the external ear were revealed: the sclerotic or mixed type of the mastoid process, the presence of pathological contents in the epitympanic space, homogeneous character of pathological contents in the antrum, widened aditus, caries of antrum walls, the presence of soft tissues around the auditory ossicles, destruction of the long process of the anval bone, and a soft-tissue structure in the external auditory meatus.