[FUNCTIONAL DIAGNOSTICS FOR THE NEEDS OF MEDICAL AND SOCIAL EXAMINATION OF THE RUSSIAN FEDERATION].

The problems of licensing and licensing control of medical activities in the Russian Federation are related to the fundamental responsibility of healthcare - to comply with federal standards of safety, quality and accessibility. The introduction of special diagnostic equipment into the activities of the institutions of medical and social expertise of the Russian Federation and the obligation to use it for expert needs from 2022 has become the time to answer the questions: what are the safety and quality requirements when carrying out work using special diagnostic equipment; whether the organizational and managerial schemes of the activities of institutions of medical and social expertise should change; whether this is a new level of development of medical and social expertise or an expansion of the competencies of functional diagnostics; Are we standing at the origins of a new type of medical activity, and is there much new in this? Answers to these questions should not be expected from the future, putting at risk, in a period of uncertainty and searching for solutions, the life and health of patients, but it is advisable to look in the history of domestic medicine and science, their best practices, adapting them to the strict compliance with the legal field of our country today today.

[MODERNIZATION OF SOCIAL PROTECTION IN THE RUSSIAN FEDERATION: PROBLEMS AND PROSPECTS OF TELEMEDICINE IN THE PRACTICE OF MEDICAL-SOCIAL EXPERTISE].

One of the main duties of the Russian Federation is to respect and protect the rights and freedoms of its citizens. In addition, the Russian Federation as a social state the activities of which are designed to provide a decent life and a high level of social protection for all categories of the citizens, without exception, by regulating social, economic and other spheres of society provides social support to all segments of the population, paying special attention to certain categories of citizens which, due to life circumstances or health conditions, need social assistance and special support from the state. The main massif in the category of socially unprotected layers of the population are people with physical disabilities. Comprehensive support for the above category of citizens is carried out, among other things, based on the decision of the medical and social examination. However, the current situation has greatly complicated the on-site examination of disabled people and predetermined the correspondence order as the only possible mechanism for medical and social examination during the coronavirus pandemic. Thus, in fact, conditions close to emergency sent medical and social expertise to the path of telemedicine.

[Surgical treatment of a patient with traumatic rupture of the aortic arch and late oesophageal perforation]. / Khirurgicheskoe lechenie bol'nogo s travmaticheskim razryvom dugi aorty i pozdnei perforatsiei pishchevoda.

Described herein is a clinical case report regarding a patient presenting with traumatic rupture of the aortic isthmus with the development of a pseudoaneurysm occupying virtually the entire posterior mediastinum and measuring 20?10 cm in size. He was immediately treated as an emergency to undergo prosthetic reconstruction of the portion of the aortic arch and descending thoracic aorta by means of temporary bypass grafting with a synthetic graft in order to protect the visceral organs. The postoperative period was complicated by oesophageal perforation with the formation of an oesophago-paraprosthetic fistula, infection of the vascular graft, accompanied by the development of pleural empyema and mediastinitis. A second operative procedure was performed, consisting of subclavian-iliac bypass grafting on the right with a polytetrafluoroethylene graft measuring 20 mm in diameter, exclusion of the intrathoracic portion of the oesophagus, creation of a gastro- and oesophagostoma, retrieval of the vascular graft followed by suturing of the aorta, pleurectomy, decortication of the lung, and removal of the empyemic sac on the left. There was no evidence of ischaemia of the spinal cord or visceral arteries. One month postoperatively, he underwent a traumatological stage and 4 months thereafter plasty of the oesophagus with an isoperistaltic gastric pedicle, extirpation of the thoracic portion of the oesophagus, to be later on followed by closure of the oesophagostoma. The patient experienced no difficulties either while walking or during other physical activities, with the ankle-brachial index amounting to 0.9. With time, he developed difficult-to-correct pulmonary hypertension. Unfortunately, the patient eventually died of acute cardiopulmonary insufficiency 9 years after right-sided extra-anatomical subclavian-iliac bypass grafting.

Persistence length of dendronized polymers: the self-consistent field theory.

We present numerical results for the thermodynamic rigidity and induced persistence length of dendronized polymers with systematically varied topology of their grafts obtained by the Scheutjens-Fleer self-consistent field method. The results were compared to predictions of an analytical mean-field theory. The two approaches have marked different predictions. In particular, the analytical theory predicts that the induced persistence length and the effective segment aspect ratio of dendronized polymers are increasing functions of the degree of branching of their side chains, whereas numerical calculations provide evidence of the opposite dependences. This discrepancy is argued to be due to the ability of side chains to repartition from the compressed to the dilated regions of a curved bottle brush, which is accounted for by the numerical, but not by the analytical method. The difference is most crucial in the light of the expected ability of dendronized polymers to have a liquid crystalline ordering in semi-dilute solutions.

[WAYS OF IMPROVEMENT OF LOOP ENDARTERECTOMY RESULTS FROM ILIAC-FEMORAL SEGMENT].

The article presents an analysis of treatment results of 91 patients with iliac-femoral segment artery occlusion at the period from 2008 to 2014. Patients were divided into 2 groups: main group (n=30) consisted of patients who undergoing a half-closed loop endarterectomy with following implantation of stent-grafts in this area and control group (n=61) had patients whom were performed routine half-closed loop endarterectomy. The II degree of ischemia of lower extremities was in 88 (96,7%) patients and III degree had 3 (3,3%) patients. The areas of abnormalities of intravascular pattern were detected in 100% of cases in intraoperative angiography. They were modified using stent-grafts. A primary vascular patency was 100% in the first group and it numbered 65% in the second group during 5 years. The intraoperative angiography control with stent-graft implantation to the area of endarterectomy allowed reliable improvement of treatment results.

[EFFICACY OF CLASSICAL CAROTID ENDARTERECTOMY USING TEMPORARY SHUNT].

The study generalized the 15-year experience of classical carotid endarterectomy performance with application of a temporary carotid shunt and an autovenous path in 325 patients. There were analyzed the more frequent complications in standard groups. Advantages of given method were determined and it was specified the ways, which facilitated to reduction of intraoperative risks and increase of technical quality realization of different stages of surgery.

[Results of classic carotid endarterectomy using temporary carotid shunt].

The main method of elimination of stenosis of carotid arteries in atherosclerosis is the surgical operation. Meanwhile, there is no general opinion concerning the most efficient way of the performance of the operation. This research generalized an experience of performing the classic carotid endarterectomy with usage the temporary shunt and an autovenous patch in 167 patients. The most frequent complications were analyzed in standard groups. The advantages of the given method were determined, facilitating to the reduction of intraoperative risks and the increase of technical quality of performance of different stages of the operation. The work quotes 8 works.

[Treatment of abdominal aortic aneurysms in patients older than 70 years of age].

The investigation has shown that patients with the diagnosed abdominal aortic aneurysms must be operated, the age being not considered a contraindication to surgical treatment. Five years survival of the patients after resection of the abdominal aortic aneurysm and its prosthesis does not depend on the age and is higher than 70%, while the expectant management leads to rupture of the aneurysm and death of 70% of the patients. A medical algorithm has been developed allowing reduction of lethality of elderly patients with abdominal aortic aneurysms and less frequency of complications.

[Anaerobic parasitocenoses of the urinary tracts as a risk factor of acute pyelonephritis].

We examined 86 patients with acute gestational pyelonephritis, 72 patients with acute pyelonephritis admitted to hospital, 63 control women with favourable obstetric anamnesis and physiological pregnancy which finished in birth of a healthy child and 57 women with favourable obstetric anamnesis undergoing pregravidal examination. Microbiological factors of acute pyelonephritis risk and acute gestation pyelonephritis were determined. These factors were the presence of anaerobic parasitocenosis in the urinary tracts represented with trichomonades, mycoplasms, ureaplasms, herpes viruses and cytomegaly in various combinations.

[Results of using the domestic vascular prosthesis "Ekoflon"]. / Rezul'taty ispol'zovaniia otechestvennykh sosudistykh protezov "Ekoflon".

The aim of the work was to study long-term results of application of a vascular transplant from modified polytetrafluoroethylene "Ekoflon". The investigation included 121 reconstructions performed during the last 6 year, 53 prostheses being implanted in the aorto-femoral position, 68--in the femoro-popliteal-tibial position. The long-term results have shown that the transplant "Ekoflon" in the position of the aorto-femoral shunt is not inferior to textile analogues and even has a number of advantages. When it is used below the inguinal fold the results of patency were worse than those with the autovenous one. But when there is no adequate autovein, under conditions of critical ischemia, prosthesis "Ekoflon" might be the material of choice for saving the lower extremity. The dynamic ultrasound duplex scanning and histological investigation of the prosthesis samples have shown an original morphogenesis of its "implantation".

[Transthoracic defibrillation of cardiac ventricles: effects of novocainamide on effectiveness of an electric impulse of bipolar sinusoidal shape]. / Transtorakal'naia defibrilliatsiia zheludochkov serdtsa: vliianie novokainamida na éffectivnost' élektricheskogo impul'sa bipoliarnoi sinusoidal'noi formy.

Experiments on nembutal-narcotized dogs were made to study dose effects of novocainamide (10-65 mg/kg) on threshold values of transthoracic defibrillation current of bipolar sinusoidal shape. Reversible dose-dependent increase of the threshold of ventricular defibrillation by 21%, on the average, was achieved only after novocainamide lowering of arterial pressure by 15-35 mm Hg. Coefficient of correlation between the drug dose and intensity of the efficient current made up 0.72.

[Experimental and clinical research on the Russian Vitaflon blood vessel prosthesis]. / Eksperimental'no-klinicheskoe issledovanie otechestvennogo proteza krovenosnykh sosudov "Vitaflon".

The authors have performed an experimental and clinical assessment of a new graft. In 37 mongrel dogs 49 experiments were carried out with the implantation of grafts "Vitaflon" into different parts of the arterial and venous bed. It was shown that the domestic graft from modified polytetraftoroethylene had high biological inertia, good plastic properties, zero surgical porosity, strength and reliable "taking" by the recipient's organism. Following the experimental work the prosthesis "Vitaflon" (30-50 cm long and 8 mm diameter) was implanted in the femoro-popliteal-tibial position to 15 patients suffering from obliterating atherosclerosis of the lower extremity arteries. The period of follow-up observations was about 12 months. Thrombosis took place in two grafts in the early postoperative period. Other shunts were functioning well which was confirmed by the clinical picture and dopplerography.

[Cardiomyoplasty--a surgical method of treatment in heart failure]. / Kardiomioplastika--khirurgicheskii sposob lecheniia serdechnoi nedostatochnosti.

Until recently heart transplantation has been the only method of surgical treatment of severe myocardial heart failure. In the recent years operations of cardiomyoplasty have been performed more and more often for treatment of patients with this disease. The article presents the literature and personal data on the operation technique, indications and contraindications for it. First clinical results of the operative interventions fulfilled since 1994 are discussed.

[Effect of acute hypoxia on the phospholipid composition of the cell, microsomal and mitochondrial membranes of rat brain and liver]. / Vliianie ostroi gipoksii na fosfolipidnyi sostav plazmaticheskikh, mikrosomal'nykh i mitokhondrial'nykh membran mozga i pecheni krys.

Tissue-dependent alterations in composition of phospholipids, studied by means of thin-layer chromatography, were detected in plasma, microsomal and mitochondrial membranes of rat brain and liver tissues after influence of acute hypoxia in the altitude chamber at a "height" of 12,000 m 3-9 min. These alterations were maintained within 2 weeks after the acute hypoxia effect in all the membranes studied, while they were most distinct in plasma and mitochondrial membranes. In the group of hypoxia-stable rats the alterations in phospholipids were more pronounced as compared with the group of less stable animals.