Aim. To compare morphological properties, mineral, and organic pattern of magnesium phosphate bions (MPB) and calcium phosphate bions (CPB) for the assessment of MPB as a control group for the evaluation of СРВ-specific endothelial toxicity.

Materials and Methods. Both MPB and CPB were artificially synthesized employing blood-mimetic medium supersaturated of magnesium and phosphorus salts, respectively. Morphology of MPB and CPB was investigated by electron and atomic force microscopy, elemental analysis was performed utilizing energy-dispersive X-ray spectroscopy, atomic emission spectroscopy, and CHN-SO analysis, functional groups were examined using Fourier-transform infrared spectroscopy and Raman spectroscopy, while chemical formula was identified by X-ray powder diffraction analysis. Protein profile of MPB and СРВ was screened employing polyacrylamide gel electrophoresis with the following silver staining.

Results. Both MPB and CPB represented spherical spongeous particles of 80-200 nm diameter and mean diameter of around 120 nm, tending to form clusters of several particles. Both MPB and CPB contained carbon, oxygen, nitrogen, hydrogen, and phosphorus. However, MPB also contained magnesium but had minimum calcium content while СРВ had a significant amount of calcium but were devoid of magnesium. Both MPB and CPB contained phosphate, carbonate, and hydroxyl functional groups but MPB consisted of magnesium phosphate hydrate and huntite while CPB were comprised of hydroxyapatite and carbonate-hydroxyapatite. Protein composition of MPB and СРВ was similar.

Conclusion. MPB are similar to CPB excepting the chemical formula; hence, MPB can be considered as an appropriate control group to evaluate specificity of СРВ-related endothelial toxicity.

Aim. To identify the possibilities of echocardiography in the evaluation of myocardial fibrosis inт patients with ST segment elevation myocardial infarction (STEMI).

Materials and Methods. We recruited 70 consecutive patients who have undergone percutaneous coronary intervention due to STEMI. Echocardiography was performed at the time of admission, on 8th-10th day post-admission and one year after STEMI to evaluate left ventricular ejection fraction. Assessment of cardiac fibrosis was carried out at the latter time point using magnetic resonance imaging.

Results. All patients had the signs of cardiac fibrosis, yet they were more pronounced in those with decreased LVEF (40-49%). A positive correlation was observed between the extent of cardiac fibrosis and LV dimensions at the admission (p = 0.01) while the correlation of cardiac fibrosis with LVEF was negative (r = -0.30, p=0.01) at all the time points. Cardiac fibrosis was associated both with systolic and diastolic dysfunction.

Conclusion. Echocardiographic evaluation of LVEF can be useful in making diagnosis and evaluating severity of cardiac fibrosis in patients with STEMI.

Aim. To assess the role of matrix metalloproteinases (MMPs) in pathological remodeling of the left ventricular myocardium in patients with ST-segment elevation myocardial infarction (STEMI).

Materials and Methods. We recruited 175 consecutive patients with STEMI (average age 61.3 (range 47-89) years, 116 (66.3%) males and 59 (33.7%) females). Control group was represented by 87 healthy volunteers (average age 59 (range 43-68) years). Serum levels of MMP-1, MMP-3, MMP-9, N-terminal pro В-type natriuretic peptide (NT-proBNP), and pro-atrial natriuretic peptide (proANP) were measured at the time of admission and on the 12^th day from the onset using enzyme-linked immunosorbent assay. Echocardiography was performed in all patients at the same time points to assess cardiac fibrosis. Groups were stratified according to the extent of left ventricular dysfunction.

Results. Levels of MMP-1 were 1.7-fold and 2.7-fold higher on the 1^st and 12^th day after STEMI onset, respectively, as compared to healthy individuals. Similar trend was found for NT-proBNP and proANP (2.3-fold and 1.5-fold increase in serum NT-proBNP and 3.5/1.8-fold increase in proANP in patients with STEMI in comparison with healthy blood donors on the 1^st and 12^th day after STEMI onset). Concentrations of all MMPs onthe 12^th day 1.1-1.6-fold exceeded those at the admission; however, the reverse was the case for NT-proBNP and proANP. Patients with systolic dysfunction (< 55% left ventricular ejection fraction, n = 128) and diastolic dysfunction (E/A < 1, n = 112) had higher concentrations of all indicated markers, yet statistically significant differences were determined only for MMP-3, NT-proBNP, and proANP in patients with systolic dysfunction and for MMP-9 in those with diastolic dysfunction both on the 1^st and 12^th day after STEMI onset.

Conclusion. Patients with systolic dysfunction have significantly higher levels of serum MMP-3, NT-proBNP, and proANP on the 1^st and 12^th day after STEMI as compared to those without while patients with diastolic dysfunction are characterized by higher MMP-9 level at the same time points.

Aim. To assess the incidence and course of labor and delivery in women with post-term pregnancy.

Materials and Methods. We studied 6,506 medical records of women admitted to the Birthing Center of the Podgorbunsky Regional Clinical Emergency Hospital during 2015-2017. Out of them, 130 women with post-term pregnancy were assigned to the study group, and 130 women with full-term pregnancy (37-41 weeks) were enrolled in the control group to evaluate the frequency of maternal and neonatal complications.

Results. The incidence of post-term pregnancy was 2%. These patients commonly suffered from obesity. Chronic hypoxia, gestational anemia, gestational diabetes were among the most frequent complications of pregnancy. Women with post-term pregnancies had higher prevalence of premature rupture of membranes, abnormal labor, and cesarean sections while their newborns had higher birth weight and lower Apgar scores.

Conclusion. Post-term pregnancy is associated with a high risk of both maternal and neonatal complications. Labor induction after 41 weeks of pregnancy is an efficient preventive measure.

Aim. To identify spatiotemporal features of rabies spread in island forest-steppe areas of East Siberia, a geographic region where this infection was not previously recorded among foxes.

Materials and Methods. We analyzed 871 cases of rabies in animals registered during 20022018 in Republic of Khakassia and Krasnoyarsk Region. Mapping was carried out using geographic information system technologies (QGIS 3.6.3 program). The cartograms were prepared annually.

Results. About 50% of rabies cases were registered among foxes (Vulpes vulpes), and the cases were mainly confined to the steppe and forest-steppe landscapes. The spread of rabies beyond the forest-steppe hollows occurred along the valleys of large rivers with an average speed of 142.9 kmper year (б = 63.7).

Conclusion. After the introduction of the virus in 2002, rabies spread over 3 years to all the steppe and forest-steppe hollows of the Yenisey Siberia. Subsequently, a natural focus with pulsating boundaries was formed. The core of the outbreak is located in the Minusinsk and Chulym-Yenisei hollows. The results of the mapping can be used to combat rabies, for instance, in performing oral vaccination of foxes.

Aim. To determine the prevalence of resistant and dormant forms of Klebsiella pneumoniae in pediatric patients.

Materials and Methods. The study was conducted in the Regional Pediatric Clinical Hospital from 2013 to 2018. Antibiotic resistance of Klebsiella pneumoniae strains (n = 485) was studied by the disk diffusion test and using serial dilutions to identify minimum inhibitory concentration (Vitek 2 Compact). RAPD-typing of 34 Klebsiella pneumoniae was performed using the Total Lab program. In addition, we studied susceptibility of 42 and 76 Klebsiella pneumoniae strains to antiseptics and disinfectants, respectively. Sensitivity of 24 Klebsiella pneumoniae strains to 4 series of bacteriophages was measured using the Appelman method. Persistence of 39 of Klebsiella pneumoniae clinical isolates was carried out by Kaldalu method.

Results. Klebsiella pneumoniae was most frequently found in the intestines (826.41 per 1000 patients, 95% Cl = 80.24-84.80) and the throat (33.96 per 1000, 95% Cl = 2.38-4.56). Colonization of multiple loci was identified in 18.22 per 1000 patients (95% Cl = 4.42-7.22). The dominant circulation of clonal line A was established. The vast majority of Klebsiella pneumoniae strains (92.76%) were ampicillin-resistant. The minimal proportion of resistant strains was found for carbapenems, being 3.41% for imipenem and 4.25% for meropenem. One third of the strains (31.22%) were resistant to amoxicillin combined with clavulanic acid, and 34.90% of the strains produced extended-spectrum P-lactamase. The share of resistant strains to third-generation cephalosporins (cefotaxime and ceftazidime) was 29.11% and 28.32%, respectively. For cefoperazone-sulbactam, resistant strains were found in 9.43%. Proportion of the strains resistant to aminoglycosides was 14.35% to netilmicin, 15.06% to amikacin, and 20.71% to gentamicin. The proportion of Klebsiella pneumoniae with high sensitivity to polyvalent bacteriophage was only 6.81%. Studied alcohol-based hand antiseptics were not effective at a 1:16 dilution in half of the experiments. Certain strains of Klebsiella pneumoniae were absolutely resistant to disinfectant, and persistent microorganisms forming dormant forms were also revealed.

Conclusion. The hospital population of Klebsiella pneumoniae was characterized by the predominant circulation of clonal line A which exhibited production of a wide ^-lactamase spectrum, demonstrated ampicillin and bacteriophage resistance, and frequently evolved into dormant forms.

Aim. To assess the trends in the incidence of gastric cancer in the Omsk region during 2006-2017.

Materials and Methods. We carried out a descriptive study based on statistical reports (Form No. 7) of the Omsk Region healthcare institutions during 2006-2017. General and standardized indicators of gastric cancer incidence (per 100,000 population) were calculated.

Results. Gastric cancer was responsible for 6.4% of all cancer cases in Omsk Region during the study period; this proportion was above the Russian average (6.0%). From 2006 to 2017, gastric cancer incidence in Omsk Region decreased 1.2-fold (from 27.6 to 22.4 °/₀₀₀₀; p < 0.001). In Omsk, the incidence of gastric cancer did not change significantly from 2010 to 2017 (T_decrease = -0.46%) with a moderately pronounced steady trend to decrease in rural areas (T_decrease = -1.24%). The assessment of standardized indicators revealed an emerging increase in gastric cancer incidence in the region from 2010 to 2017 (T_increase = 0.98%).

Conclusion. The rate of decrease in gastric cancer incidence was 2.7-fold higher in rural areas as compared to Omsk. Current situation requires studying the trends related to risk factors of gastric cancer in Omsk Region in order to improve primary prevention.

Aim. To explore the prevalence of alleles and genotypes in rsl544410 polymorphism within the VDR gene in the population of Kemerovo Region.

Materials and Methods. Genotyping was performed in 232 residents of Kemerovo region (125 men and 107 women, average 58,3 ± 1,86 (range 45-74) years of age). DNA was extracted from the peripheral blood utilizing a thermocoagulation method while genotyping was carried out by allele-specific polymerase chain reaction.

Results. Heterozygous (G/A)    rsl544410 genotype prevailed in the studied sample (46.1%). Homozygous genotype A/A associated with the reduced bone mineral density and osteopenia/osteoporosis was defined in 13.8% of individuals. The ratio of rsl544410 genotypes was comparable with that of ethnically close populations.

Conclusion. High population frequency of the A/A genotype of the rsl544410 polymorphism within the VDR gene may be one of the factors determining the high prevalence of osteoporosis in the population of Kemerovo Region.

In Russia, liver diseases largely contribute to the mortality. Here we review the literature on current management of alcoholic liver disease, which remains the leading cause of cirrhosis worldwide. The main risk factors for alcoholic liver disease are intake > 40 g and > 30 g of ethanol per day respectively for men and women, genetic predisposition, and obesity. Diagnosis is conventionally made on establishing of alcohol use disorder (AUDIT questionnaire). The main clinical forms of alcoholic liver disease are steatosis, hepatitis, and cirrhosis which can be discriminated by a panel of instrumental and laboratory investigations. The severity of alcoholic hepatitis is reflected by Maddrey discriminant function > 32 and MELD (Model for End-Stage Renal Disease) index > 20. Treatment of alcoholic liver disease considerably depends on abstinence and proper nutrition. In the absence of contraindications and insufficient efficiency of standard treatment, corticosteroids may be applied. Hepatoprotective drugs might also be efficient at various disease stages.

Biomarkers are often used as a surrogate measure in the assessment of risk, severity, and prognosis of the disease. For the optimal use of biomarkers in predicting cardiovascular risk, they should demonstrate reproducibility in sequential quantitative measurements and show high sensitivity and specificity. In recent years, classic biomarkers of myocardial necrosis such as troponins were complemented by inflammatory markers (C-reactive protein, cytokines, matrix metalloproteinases) and markers of myocardial dysfunction (atrial and cerebral natriuretic peptides). Currently, conventional biomarkers are widely used for the timely diagnosis of myocardial infarction while an increasing number of novel markers are utilized to evaluate the risk of adverse outcomes in patients with acute coronary syndrome.

On-pump CABG is commonly accompanied by the development of postoperative cognitive dysfunction considerably affecting the prognosis in this group of patients. However, there are no accepted guidelines on diagnostics and prevention of postoperative cognitive dysfunction. Here we review the incidence, mechanisms, and outcomes of postoperative cognitive dysfunction after coronary artery bypass graft surgery and highlight the benefits of statins for its prevention. We further provide evidence from national and international studies assessing the role of statins in the prevention of postoperative cognitive dysfunction.

Aim. To perform a systematic review of hepatitis В risk factors in patients receiving hemodialysis.

Materials and Methods. We screened English-and Russian-language databases for relevant obser- vational cohort studies. Screening of publications and extraction of primary data were carried out in accordance with the Cochrane recommendations. The significance of hepatitis В risk factors was given in odds ratios with 95% confidence intervals.

Results. All included primary studies demonstrated that patients on hemodialysis are at high risk of acquiring blood-borne diseases due to the combination of various risk factors. For example, duration of hemodialysis > 2 years significantly increased hepatitis В risk (OR = 2.24, 1QR 1.052.08).

Conclusion. A critical attitude to modifiable and non-modifiable risk factors increases the effectiveness of epidemiological surveillance and infection control and ensures quality and safety of medical care for the patients receiving hemodialysis.

Here we analyze the data on the actual nutrition of schoolchildren in different geographical regions. In many areas, they consume insufficient amounts of meat and meat products, milk and dairy products, fish, eggs, vegetable oil, potatoes, fruits and vegetables, yet having excessive consumption of bread, pasta and confectionery. Currently, it is established that many children have already formed irrational stereotypes of food choices at the time of admission to the primary school, and their further nutrition remains unbalanced. The lack of vitamin intake is year-round, and therefore the overall situation can be considered as a polyhypovitaminosis. This may be associated with low socioeconomic status or inappropriate food consumption pattern, additionally affected by regional features. Efficient preventive measures require the development of a unified system of social and hygienic monitoring of the organization of schoolchildren nutrition at the regional level, accompanied by annual in-depth data analysis.

Inherited metabolic disorders represent a heterogeneous group of diseases which are difficult to be diagnosed in pediatric and therapeutic practice. Theirclinical symptoms are non-specific and common. Here we discuss epidemiology, pathophysiology, signs and symptoms, and diagnostics of lysosomal storage diseases. We also describe a clinical case of Wolman disease underlining the importance of clinical alertness on inherited metabolic disorders. As a replacement therapy for these diseases is rapidly developing, a proper diagnosis is of crucial importance to improve prognosis and quality of life.

Ovarian tumors in pregnancy occur in 0.1-3.4% of women. Here we describe a case of a patient with 8 x 10 cm dermoid ovarian cyst which was unexpectedly detected during cesarean section. Subsequent histological examination confirmed the diagnosis.