Th is article provides an analysis of literature sources on diagnostic methods, features of surgical treatment and rehabilitation aft er large joint total arthroplasty in patients with sarcopenia. Descriptive and analytical methods were applied. Publications were sought on e - library, Medline, Scopus, Pub Med, Th e Cochrane Library and RINC. Th ere is currently no single criteria for identifying individuals with sarcopenia and there are no unifi ed protocols to follow such patients in the postoperative period aft er total arthroplasty of large joints, which requires new randomized experiments.

Objective: Comparative analysis of the results of surgical treatment of patients with tumors of the thymus gland via sternotomy and thoracotomy (ST), videothoracoscopic (VTS) and the robotic-assisted (RA) interventions. Materials and methods: Th e results of surgical treatment of 138 patients with tumors of the thymus gland (TG) were analyzed TS was performed in 78 patients, VTS – 47, RA – 13. Th ere were 65 men, 73 women. Th e average age of patients was 50,5±12,7 years (from 19 to 81 years). Results: Intervention time of thymomthymectomy (TTE) by ST amounted to 91.2±33,4 min, VTS of 93.6±25,5 min, RA – 142,7±26,9 min. Aft er ST 6 (7.7%) patients had complications in the postoperative period, 2 (2.6%) fatal outcome. Aft er VTS in one patient complicated post-operative course. Th e duration of stay of the patient in hospital aft er ST TTE was 10.1±3.6 days, VTS – 6.6±1.9 days, RA – 6.3±1.4 days. Loco-regional recurrence and progression of the disease in the remote period were not revealed. Good eff ects (A and b) aft er the VTS TTE achieved at 20.0% of cases in RA at 27.3%, while ST TTE 8.4% of cases. Conclusion: Demonstrated safety and effi  cacy of minimally invasive techniques (MIT) in the surgical treatment of patients with thymoma. As were the advantages of the VTS and RA when performing TTE in comparison with ST.

Objective: to compare long-term results of total hip replacement according to approach and type of fi xation (cemented, uncemented). Materials and methods: the outcomes of 39 total hip replacement were estimated for the fi rst time aft er 5-6 years and for the second time aft er 11-15 years aft er the treatment. they have been compared by Bartel, Harris and WOMAC scores. Results: Kaplan-Meyer and descriptive statistics applied to get validated results. Conclusions: received data demonstrated durable positive functional results while Keggy’s approach has been used. Cemented fi xation and hybrid prostheses have longer survival rate than cementless devices.

Objective: to assess the possibility of using mammary coronary bypass without bypass in high-risk patients and multifocal coronary artery disease, to analyze the immediate and long-term postoperative periods, to study clinical features in patient groups. Materials and methods: Th e study included 60 patients. All patients had a high risk of surgical intervention and a complicated pre-operative history. In the fi rst group, despite the multifocal lesion of the coronary arteries, for various reasons, we performed mammary coronary bypass on a working heart. In the second group, all patients underwent aorto-coronary bypass + mammary coronary bypass with bypass in a standard scheme using cold cardioplegia. Later, the results were evaluated aft er 30 days, 1 year, 5 years aft er the intervention. Results: It was showed that the immediate postoperative results and indices during the year had a positive dynamics - the class of angina pectoris decreased, the hemodynamic parameters changed. In addition, the rejection of bypass in patients with a complicated anamnesis made it possible to exclude complications from the excretory and nervous systems that we observed in the second group. In the future, we observed an increase in the class of angina in the fi rst group. Th e recurrence of angina pectoris is associated, in our opinion, with the progression of coronary atherosclerosis, an increase in existing stenoses and the appearance of new stenoses. Conclusions: mammary coronary bypass without bypass can be successfully used in high-risk patients and multifocal lesion of the coronary bed. Th is can be regarded as an outcome with extremely dangerous use of bypass for complete myocardial revascularization. Th e immediate results are positive and minimize postoperative risk from adjacent organs and systems. Anatomical and functional state of mammary coronary bypass is satisfactory, both in the near and the delayed period. Long-term observations indicate an increase in the class of angina and complications of IHD in this group of patients. Th e way out in this situation we see in the combined work of the surgical and endovascular team. 

Objective: to improve the results of treatment of patients with obliterating atherosclerosis with critical ischemia of the lower extremities by individual selection of anticoagulant therapy for the prevention of thrombosis aft er reconstructive surgery on the arteries of the lower extremities. Materials and methods: 82 patients were divided into 2 groups: 1 group (48 patients) - reconstructive surgery on the arteries of the lower extremities and anticoagulant therapy under the control of the coagulogram. 2 group (34 patients) - reconstructive operations with the selection of anticoagulant therapy with the help of hemostasiogram indicators and the T-2 thrombodynamics test. Results: Out of 48 patients in the 1 study group, a good eff ect was observed in 36 patients (75.00%), in 9 (18.75%) - satisfactory, and in 3 cases (6.25%) - unsatisfactory. In the 2nd group: good results - 33 (97.06%) patients, and in 1 (2.94%) patients - satisfactory. Unsatisfactory results were not. Th e number of repeated operations within 1 year, performed in the 1st group, was statistically signifi cantly 2 times greater than in the second group. All the second operations are associated with the development of thrombotic complications. With a combination of the majority of hemostasiogram and «Trombodynamics T-2» tests, the dose of heparin therapy was adjusted, increasing by 2500 units, i.е. the patient received 7500ED 4 p / day. If during the «T-2 thrombodynamics» and coagulogram on the 6th day aft er surgery, hypercoagulation was determined, then the dose of heparin increased again by 2500 units. Conclusions: Comparative analysis of hemostasiogram indices in the fi rst hours aft er the performed operative treatment is not very useful for predicting the frequency of thrombotic complications, while 6 days aft er operative treatment it indicates the presence of statistically signifi cant diff erences between the two study groups. Th at indicates a more adequate selection of a dose of heparin in the second group.

Objective: determination of levels of the kallikrein-kinin system (KKS) indicators in cutaneous melanoma and in the skin not associated with tumor in female mice with chronic neurogenic pain in the dynamics of В16/F10 melanoma growth. Materials and methods: the study included 8 weeks old female С57ВL/6 mice weighing 24-26 g (n=132). Th e animals were divided into 4 groups: 64 – В16/F10 melanoma with chronic neurogenic pain (main group), 22 – chronic neurogenic pain without melanoma, 27 – В16/F10 melanoma only (comparison group), 19 – intact mice. KKS parameters were determined by ELISA. Statistical processing of results was performing using the Statistica 10 program and the Wilcoxon test. Results: chronic pain infl uenced the development of transplantable В16/F10 melanoma: tumors in animals of the main group appeared 1 week aft er the transplantation and were bifocal; 100% metastasis to the liver, lungs and to non-typical sites (the heart and uterus). Tumors in mice of the comparison group appeared in 2 weeks, and metastases in 4 weeks. Th e mean survival was 19.17±1.35 days in the main group and 30.25±1.67 days in the comparison group. In the skin of mice of the main group, we observed progressive kininogen consumption, KLK-1 depletion from the second week of the tumor growth, and its accumulation in the tumor with its maximum by the end of week 3. KLK-14 signifi cantly increased in the skin; in the tumor it stabilized aft er an increase in week 1. KKS parameters diff ered signifi cantly in the skin and tumor tissues of mice in compared groups. Conclusions: Chronic neurogenic pain causes a radical reorganization of KKS metabolism in the skin of intact mice: an increase in kininogen and prekallikrein and a decrease in KLK-1. B16/F10 melanoma transplantation with chronic neurogenic pain preserves the increase of prekallikrein in the skin, but increases as well its consumption in tumor tissue simultaneously with the activation of KLK-1 (in the skin until its exhaustion) and KLK-14.

Objective: to study the variants of the structure of the coronary sinus valves and the left  inferior phrenic vein in the aspect of interventional arythmology. Materials and methods: We studied 30 preparations of hearts and 120 preparations of the veins of the diaphragm of people who died between the ages of 22 and 75 and the left  inferior phrenic vein in 30 patients of both sexes of the same age. Sectional, dissection, injection, morphometric, angiographic and statistical methods of investigation were used. Results: Analysis of the results obtained with the help of various sectional and clinical methods of investigation revealed that in 13% of cases an alternative way of conducting the left  ventricular electrode through the left  inferior phrenic vein with cardiac resynchronization therapy is possible. Conclusions: Venous sinus as the main pathway for implantation of the left  ventricular electrode may be suitable for catheterization in 86% of patients, and for 13% of patients an alternative route for conducting the left  ventricular electrode is needed. Th e left  inferior phrenic vein, which fl ows into the inferior vena cava in 60% of cases, is freely or conditionally catheterized and can serve as an alternative route for conducting the left  ventricular electrode.

Objective: to study pro- and anti-infl ammatory cytokines serum levels at postmenopausal osteoporosis and their changes depending on separate polymorphic options of VDR, COL1A1 and LRP5 genes. Materials and methods: 180 postmenopausal women (60,0±0,77 years) were examined. Th e osteodensitometry was carried out by dual-energy x-ray absorptiometry method. Detection of 283 A>G (BsmI, rs1544410) polymorphisms of VDR gene, -1997 C>A (rs1107946) and 1546 (6252) G>T (Sp1 S>s, rs1800012) of COL1A1 gene, 3989 C>T (Ala1330Val, rs3736228) and 1999 G>A (Val667Met, rs4988321) of LRP5 gene was carried out by real-time PCR method. Enzyme-linked immunosorbent assay was used for defi nition of serum levels of interleukin (IL) -1β, -4, -6, -8, -10, -17A, tumor necrosis factor alpha (TNF-α), interferon gamma (INF-γ), osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B ligand (RANKL). Results: it was established that women with postmenopausal osteoporosis had (P<0,05) increased serum IL-1-β, IL-8, IL-17A, TNF-α, RANKL concentration and decreased IL-4, IL-10 levels. Patients with GG genotype of rs1544410 polymorphism had also increased (P<0,05) IL-1-β, RANKL levels, OPG/RANKL index and decreased IL-10 values. Women with GT or TT genotypes of rs1800012 polymorphism of COL1A1 gene had (P<0,05) decreased IL-10, OPG values, OPG/RANKL index, but persons with CA or AA genotypes of rs1107946 polymorphism of COL1A1 gene had increased IL-4, IL-6, IL-8, IL-10, RANKL levels. IL-10 concentration decrease (P<0,05) was established for patients with GA genotype of rs4988321 polymorphism and CT or TT genotypes of rs3736228 polymorphism of LRP5 gene. Conclusion: the obtained data refl ect important pathogenetic aspects of postmenopausal osteoporosis and can be used for development of individualized treatment-and-prophylactic actions for women.

Objective: Evaluation of the eff ectiveness and identifi cation of the benefi ts of a video-assisted fi stula treatment method using
fi stuloscopy, in comparison with traditional methods of surgical treatment of complex forms of chronic paraproctitis, trans- and extrasphincteric, relapsing rectal fi stulas. Materials and methods: A complex analysis of the results of surgical treatment was carried out in 228 patients with chronic paraproctitis, transphincteric, ectrasphincteric, including recurrent rectal fi stulas, divided into three groups (main and two control), depending on the surgical methods of chronic paraproctitis used. Results: the result of surgical treatment of pararectal fi stulas in the three study groups was compared. Th e eff ectiveness of treatment was assessed by the results of immediate and long-term postoperative period. It has been established that the use of a video-assisted fi stula treatment method using fi stuloscopy excludes the presence of an extensive postoperative wound in the perianal region, which signifi cantly reduces the likelihood of its secondary infection, and the sphincter trauma, and in fact virtually eliminates its insuffi ciency. Th e use of video-assisted method of treatment of fi stulas made it possible to reduce the number of postoperative complications. Conclusions. Th e fi nal results (92.7% of favorable outcomes) allow us to recommend a video-assisted treatment for fi stulas for wide practical implementation.

Objective: justifi cation of the use of normobaric hypoxic therapy (NHT) for recovery of mental working capacity of the hazardous occupations specialists. Materials and methods. Th e studies included 26 hazardous occupations specialists (men aged 25-37 years old), with signs of non-pathological neurotic manifestations and decrease in mental capacity. 14 people (the basic group - BG) received medical and psychological rehabilitation (MPR) with the use of NHT: 12 procedures 2 hours stay in a room with O2 content 17-15%. For the remaining 12 people (comparison group - CG) similar activities of the MPR were carried out, and NHT was imitated. To assess the psycho-emotional status and mental working capacity were used: “State of health, activity, mood” (SAM); “Reactive anxiety” (RA); “Arithmetic account” (AA). Results. As a result of the MPR, the increase of the SAMintegral index in BG was 23% compared to the initial level, the decrease of RA about -14%; in the CG, similar changes amounted to an average of 15% and -8%, respectively (р<0,05). Th e increase of the AA-integral indicator in BG was averaged 38% of the reference level, in CG - about 20% (p=0.015). Conclusions: Th e NHT is the method of choice in correction of non-pathological neurotic manifestations, restoring of mental working capacity of the hazardous occupations specialists.

Objective: To evaluate the effi cacy and safety of a combination of direct antiviral drugs - paritrapeprivir, ritonavir, ombitasvir and dasabuvir in patients with compensated cirrhosis of HCV-etiology. Materials and methods: A prospective cohort study involved 30 patients with compensated cirrhosis of the liver with HCV etiology (class A in Child-Pugh) caused by the 1b genotype of the virus. All patients received a formal combination of direct antiviral drugs - paritrapeprivir, ritonavir, ombitasvir and dasabuvir (PROD) for 12 weeks. Effi cacy evaluation was conducted to achieve a sustained virologic response 24 weeks aft er the end of antiviral treatment (VDU 24). Results: Two weeks aft er the start of treatment the virus stopped being detected in 21 people (70%), aft er 4 weeks - in all patients. VDU 24 was also achieved in 100% of cases. One patient, operated prior to the initiation of antiviral treatment for hepatocellular carcinoma (HCC), relapsed both HCC and HCV infection 36 weeks aft er the end of the antiviral treatment. Adverse events in the form of mild headache and nausea were noted only in two patients (6.7%) and had an unexpressed and short duration. Conclusions: in real clinical practice, high effi cacy of direct antiviral drugs - PROD in patients with compensated cirrhosis of HCV-etiology (in 96.7% of patients) was demonstrated at a relatively low incidence (6.7%) of side eff ects. 

It was performed statistical analysis of the vascular rigidity parameters of the 224 students aged from 19 to 29 years at the stage angiological screening in the framework of prevention project «Th e University of healthy lifestyle». Used the device VaSera VS-1500 («Fukuda Denshi», Japan), which allows to estimate such stiff ness indicator, as Cardio-Ankle Vascular Index (CAVI), independent of the level of tensile blood ressure, acting on the arterial wall at the time of registration of the pulse wave. Th e apparatus also evaluates the vascular age of the subjects, which allows to detect early vascular aging or syndrome EVA. Presented data of descriptive statistics, percentile and quartile analyses. It was found that among medical students the signs of the syndrome EVA occurs at 12.7% of boys and 7.8% of girls. Maximum excess chronological age, that is, the passport age for boys can reach 20 years, and for girls 22 years respectively. Th ese data are useful to consider in the formation of cardiovascular risk groups among youth in the process of medical examination for the purpose of further development of more individualized programs of preventive intervention, aimed at restoration of the reduced elastic capacity of the vascular wall.

Objective: To develop a method for phased diagnostics, treatment and implementation of measures to prevent appropriate forms of allergic rhinitis based on scientifi c and practical research organized by the authors of the article. Materials and methods: Th e study group comprised 60 patients aged 23 to 64 years with a diagnosis of allergic rhinitis based on the diagnostic and treatment facility in Novosibirsk in 2017, in the form of a questionnaire with further analysis and synthesis of the results of the study. Results: existing options for diagnosis, treatment, preventive measures of allergic rhinitis require optimization. Summary: the author’s method of phased diagnostics, treatment and implementation of measures for the prevention of the corresponding forms of allergic rhinitis has been developed.

Th e article is devoted to rare syndrome of uncertain course of succession. Describes the etiology, phenotypic characteristics, symptoms, based on which a pediatrician and geneticist may suspect the Amsterdam dwarfi sm. Principles of treatment summarize the general. Clinical observation of the child R. 16 years old with multiple organ failure was conducted.