The article presents the results of a review of literature on the possibility of visualization in the health care system of the Russian Federation as one of the main methods of implementation of lean production. The historical aspect of the use of various imaging techniques in medicine is reflected in detail, as well as the advantages of some visualization tools in the organization of medical care. The existing legal and methodological framework for the use of visualization in the activities of medical organizations of various profiles is analyzed. Search publications carried out on the bases e-library, Medline, Scopus, Pub Med, The Cochrane Library and RINC.

Objective: to evaluate the immediate and somewhat distant results of surgical revascularization using the left MKA in patients with diabetes, compared with the results of autovenous CABG, to identify possible complications when using the left MA in patients with diabetes. Materials and methods: 2 groups of patients who, from 2010 to 2012, were selected. performed artery bypass surgery. All patients had type II diabetes. In the first group, the mammaro-coronary artery bypass surgery (MBS) was always used, in the second group and was not performed for various reasons. Results: evaluated indicators aft er 1 year and 6 years. In the immediate postoperative period, we noted a decrease in the class of angina in both groups. We did not observe a significant difference in the violation of the healing of the sternum. In the long-term period, in the group where MBS was performed, we noted a lower mortality rate, a lower class of angina pectoris and a smaller percentage of complications in the cardiovascular system. Conclusions: In patients with multifocal lesions of the coronary bed and concomitant diabetes, the preferred method of coronary artery bypass surgery is MBS, which can be supplemented with CABG. This is confirmed by sixyear observation. MKA can be safely used in diabetes and especially in the stem lesion of the left lance. Problems with the healing of the sternum with careful allocation of LMA we have not noted.

Objective: to assess the diagnostic significance of atrial and brain natriuretic peptides for the detection of chronic heart failure in comorbid patients with atrial fibrillation and chronic obstructive pulmonary disease. Materials and methods: 120 patients depending on the presence of chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and atrial fibrillation (AF) were divided into the following groups: I group (n=28) — patients with COPD without cardiovascular disease (CVD), II group — patients with CHF and COPD without AF (n=30), III group — patients with CHF and AF without COPD (n=33), IV group — patients with CHF, AF and COPD (n=29). Th e concentration of precursors of brain and atrial natriuretic peptides (NUP) (NT-proBNP and MR-proANP) was evaluated. Results: The level of NT-proBNP exceeded the reference values in all patients with CHF (I, II, III groups). In patients with CHF, AF and COPD the highest values of NT-proBNP concentrations were obtained, which were 2.2 times higher in the group of patients with CHF and COPD without AF (p=0.000) and 1.9 times higher in patients with CHF and AF without COPD (p=0.01). Comparative analysis of the MR-proANP level allowed to judge a higher concentration of this indicator in patients with CHF and COPD without COPD in comparison with the level of the marker in the groups of patients with CHF, AF and COPD (p=0.001), CHF and COPD without AF (p=0.000) and COPD without CVD (p=0.000). Conclusions: in patients with AF and COPD, the study of brain NUP NT-proBNP in connection with structural and functional changes of the right ventricle, against the background of existing cardiac arrhythmias and pulmonary pathology is preferable to determine the presence and severity of CHF. The elevated level of MR-proANP is of diagnostic value in patients with AF and CHF without COPD, due to the increased volume load on the Atria due to the presence of AF.

Objective: to evaluate the eff ectiveness of the regional cervical cancer screening program by liquid-based cytology. Materials and Methods: the geography of screening includes 54 medical units of the Rostov region, where patients are taken swabs from the cervix. HPV positive patients with abnormal PAP smears are invited to the Regional cervical pathology center for diagnosis and treatment. Methods. liquid-based cytology, the HPV test RealTime PCR, colposcopy with video recording, biopsy of the cervix by the method of loop excision or electroradiographic conization. Results: From 2014 to 2017, 188 641 cytology tests were performed. Cervical cancer was revealed in 189 women – (0.1 %), H-SIL and ASCH in 566 (0.3 %), 377 ASCUS (0.2 %), L-SIL in 23014 (12.2 %), absence of intracellular lesions or malignancy in 164495 (87.2 %). 2162 HPV-positive women aged 18 to 69 years were invited to the Regional cervical pathology center gynecologist for examination. Treatment by conization (622) and excision (830) of the cervix was performed in 1452 patients, H-SIL and CIS were revealed in 1162 women (78 %). Conclusion: tests such as liquid-based cytology and HPV testing, their optimal multiplicity and sequence allow timely detection and treatment of precancerous cervical epithelium lesions.

Objective: study of components of an insulin-like signaling pathway in kidney tissues in local and advanced clear cell renal cell carcinoma depending on the gender of patients. Materials and methods: the object of the study was conditionally intact kidney tissue and tumor and perifocal tissues obtained during the surgical treatment of 100 patients with histologically confirmed clear cell kidney cancer (local cancer (Т1-2N0М0) n=50, advanced cancer (Т3-4N0М1) n=50). Levels of the IGF-1, IGF-2, IGFBP-1 and IGFBP-2 growth factors (Mediagnost, Germany) and STH-releasing (Peninsula Laboratories International, USA) were determined by ELISA using standard test systems. The results were analyzed using Statistica 6.0 (Stat-Soft, 2001). Results: levels of IGFВР-2 and STH-releasing in conditionally intact tissues in women were 44% and 40% lower than in men, respectively. The IGFВР-2 level in perifocal tissues of women was 38% higher than in men, while STH-releasing was lower by 1.9 times. Tumor tissues of local kidney cancer in women showed significant decrease in IGF-1 by 25%, IGFВР-1 by 29% and IGFВР-2 by 2 times. Levels of IGFBP-1 and IGFBP-2 in conditionally intact tissues of women with advanced cancer were 2 and 2.7 times lower, respectively, compared to men. IGFBP-2 and STH-releasing in perifocal tissues of women were increased by 43.8% and 44.6%, respectively. In tumor tissues of women with advanced kidney cancer, levels of IGF-1 were 1.7 times higher, IGF-2 – 31% lower, IGFBP-2 – 2.8 times lower and STH-releasing – 36% lower, compared to men. Conclusions: IGFBP-2 in all studied kidney tissues in local and advanced cancer was an identically variable index characterizing gender differences in the body’s reaction to the tumor process.

Objective: valuation of diff erent duodenal perforation surgical management following endoscopic retrograde transpapillary manipulations. Materials and methods: thirty-one patients with duodenal perforation following transpapillary manipulations (17 own observations, 14 — admission from other hospitals). Th e 14 (45.2 %) cases had a diagnosis less than 24 hours, 17 (54.8 %) — more than 24 hours aft er injury. Twenty patients had the primary reconstruction of duodenum with various drainage options of zone of injury. Sixteen patients had a two-stage surgery procedure: 5 cases aft er of primary reconstruction of duodenum and 11 — like a primary surgery (more than a day aft er injury). Results: aft er primary of duodenum reconstruction 11 patients (55.0 %) had no complications, 5 (25.0 %) — were re-operated, 4 (20.0 %) — were died. Aft er two-stage surgery procedure 9 patients (56.3 %) had no complications, fi ve (31.2 %) had surgical complications, 2 (12.5 %) were died. Conclusion: the primary of duodenum reconstruction can be performing, when the duodenal perforation there is less than a day. When there is a clinic of septic complication of retroperitoneum and abdominal cavity, two-stage surgery procedure is justifi ed.

Objective: the development of non-medicated and preventive, as well as architectural and planning measures to reduce respiratory diseases. Materials and methods: the study group consisted of 60 patients aged 23 to 64 years with a diagnosis of allergic rhinitis based on the medical and diagnostic institution of Novosibirsk, in 2017, in a questionnaire format with subsequent analysis and synthesis from the results of the study. Twenty public areas (pre-school, school and multifunctional institutions) located in various functional areas of the city, the presence of the number and species diversity of tree plants-allergens are also considered, in 2018. Results: existing preventive and non-drug measures of allergic rhinitis require optimization. Architectural and planning complex of tasks to reduce respiratory diseases is completely absent. Conclusions: the technique for reducing respiratory diseases, based on the developed scientifi c and practical non-drug and preventive, as well as architectural and planning recommendations

Purpose: to evaluate changes in muscle strength in elderly patients with signs of premature aging. Materials and methods: the study included 1080 people: 540 aged 44 to 54 years (mean age 49.1±2.2) and 540 at the age of 55 to 64 years (mean age 57.2±2.4). All patients, depending on the proposed variant of nutritional support and physical activity, were divided into three groups: the 1st (standard recommendations), the 2nd (standard recommendations, Scandinavian walking and daily walks for at least 30 minutes), the 3rd (standard recommendations, Scandinavian walking, daily walks for at least 30 minutes and nutritional support). Results: it was found that in the group of men and women aged 55-64 years, where nutritional support and physical activity were applied, the dosage indicators for the total carpal dynamometry were lower, but lower than in the same group aged 45-54, which is due to decrease in the index of car dynamometry with age. Conclusion: for the prevention of sarcopenic agerelated changes, it is possible to recommend a credibly eff ective system of nutritional support and motor training, for both men and women.

Objective: development of new quality criteria for fresh frozen plasma. Matherials and methods: at diff erent times of storage of fresh frozen plasma harvested standardly and from the donors aft er Biolan exposure, the parameters of the kallikrein-kinin system were determined: the activity of kallikrein, the inhibitory activity of the α1 -proteinase inhibitor, α2 -macroglobulin, the total arginine-esterase activity and the level of prekallikrein. Results: during the quarantine process of fresh frozen plasma, prepared in a standard way, the processes of proteolysis activation is noticed already by 10th day from the beginning of FFP storage, and the preparation of donors for the blood donation with help of the biolan adaptogen provides better preservation of the components of the kallikrein-kinin system. Conclusions: analysis of the main components of the kallikrein-kinin system can be used as an additional criterion of the quality of fresh frozen plasma before the transfusion procedure.

Objective: to study the clinical efficacy of re-PUVA therapy in patients with torpid forms of chronic true hand eczema. Materials and methods: the study involved 78 patients (47 women, 31 men) with severe and moderate forms of chronic true hand eczema. Clinical indices were used before and after treatment: HECSI, DLQI. The patients were randomly divided into 3 groups: 1 group (25 people) received standard therapy (antihistamines, external glucocorticosteroid drugs, emollients); 2 group (27 people) received the indicated standard therapy against the background of PUVA; Group 3 (26 people) -standard therapy on the background of re-PUVA (combination of PUVA with retinoids (isotretinoin)). The duration of therapy was about 3 months. Results: in group I, before treatment, the average value of the HECSI index was 76.0 ± 37.9, and after the treatment, 63.6 ± 30.2; in group II, before treatment, the average value of the HECSI index was 78.3 ± 34.2, and after treatment it decreased to 51.5 ± 24.0, in group III, respectively, before treatment, the average HECSI was 77.2 ± 35.3, and after course of therapy 28.7 ± 14.0. The duration of remission in the first group after a course of standard therapy was 2.52 ± 1.1 weeks, in the second group 15.7 ± 7.5 weeks, in the third group 61.7 ± 32.4 weeks. Conclusions: The re-PUVA method is most effective in the treatment of chronic eczema of the hands in comparison with the PUVA and standard therapy.

Clinical observation of the patient with parasagittal meningioma at the level of the middle third of the superior sagittal sinus and falx is presented. When such tumors are removed, the main task is to prevent damage to the parasagittal veins, the injury of which can cause a persistent neurological defi cit in the postoperative period. A feature of this case is the complex use of advanced minimally invasive methods of angiographic diagnosis when planning surgical treatment, which signifi cantly increases the chances of a successful outcome of the operation.

Moskalenko Ekaterina Petrovna: teacher, scientist, organizer and public figure. to the 90th birthday.