INTRODUCTION. Frostbite is a common cold injury that is associated with high rates of disability and requires long and difficult treatment. A vascular endothelial growth factor (VEGF)-encoding pCMV-VEGF165 plasmid-based gene therapy product designed for therapeutic angiogenesis may be a promising tool to promote microcirculation recovery and accelerate lesion healing in local cold injury. This hypothesis needs to be tested in an experimental animal study. AIM. This study aimed to evaluate the efficacy of the pCMV-VEGF165 plasmid gene therapy product for the management of cold injury of a limb in rats. MATERIALS AND METHODS. The study included 42 mature female outbred white laboratory rats. A third to fourth-degree local cold injury was experimentally induced on the dorsal surface of the left hind paw by applying a neodymium magnet frozen in liquid nitrogen. The animals received periwound injections of the test product (super-coiled circular double-stranded plasmid deoxyribonucleic acid at a dose of 60 μg) and placebo (water for injections) on days 2 and 7 after frostbite modelling. The authors evaluated the general condition of the animals, the condition of the damaged paw, the wound area, the healing rate, the body mass, and, after planned euthanasia, the mass of the hind paws. RESULTS. Starting from day 7, the rats treated with the test product showed significantly faster tissue regeneration at the site of cold injury than the control animals. The mean wound surface area reduction in the test animals amounted to 47.36% [25.55; 55.45], whereas that in the control animals was 28.95±18.55% (p<0.05). On day 10, the test group still had a significantly higher tissue regeneration rate than the control group (58.70±15.35% vs 42.01±17.41%, respectively, p<0.05). Later, there was no statistically significant difference in the wound surface healing rates between the groups, which could probably be attributed to the nature of wound healing in the experimental model since rodent wounds heal predominantly by contraction. CONCLUSIONS. The pCMV-VEGF165 plasmid gene therapy product injected in the periwound area at a dose of 60 μg on days 2 and 7 after cold injury simulation in rats reduces damage, accelerates tissue regeneration under the scab, and expedites scarring.

В настоящем исследовании продемонстрированы фармакологические эффекты моксонидина – агониста имидазолиновых рецепторов центрального действия в условиях моделирования экспериментальной преэкламсии у мышей с мутацией в гене agouti. Моксонидин в дозировке 40 мкг/кг эффективно снижал уровень систолического и диастолического артериального давления до 117,9±1,64 мм рт. ст. (p<0,05) и 72,6±1,75 мм рт. ст. (p<0,05) соответственно. Также исследуемый препарат статистически достоверно снижал коэффициент эндотелиальной дисфункции в 2 раза, не позволяя, однако, достигнуть показателей интактных животных (p<0,05). Отмечалось также снижение концентрации С-реактивного белка в 1,4 раза, что, вероятно, подтверждает эндотелиопротективные свойства моксонидина и свидетельствует о возможной противовоспалительной активности. Основные биохимические показатели, характеризующие глубину нарушений обмена веществ у мышей линии Agouti viable yellow также претерпевали значимые изменения при фармакологической коррекции моксонидином: так, статистически достоверно снижался уровень гликемии до 9,0±0,13 ммоль/л, концентрация общего холестерина и триглицеридов до 3,1±0,1 ммоль/л и 1,6±0,06 ммоль/л соответственно. Также моксонидин статистически достоверно снижал количество самок, у которых развивались неблагоприятные исходы беременности.

Introduction: The relevance of the topic is due to a wide range of clinical manifestations of frostbite, including long-term complications such as neuropathy, chronic pain, and functional impairments. Tissue recovery after frostbite depends on the degree of microvascular damage, and VEGF (vascular endothelial growth factor) is considered a promising agent for stimulating angiogenesis and improving tissue trophism. The aim of the study was to study the effectiveness of the use of a genetic construct – pCMV-VEGF165 plasmid in the correction of delayed complications of cold injury in rats. Materials and Methods: Local frostbite of III-IV degree was modeled in 18 rats using a neodymium magnet cooled in liquid nitrogen. On days 2 and 7 after the injury, pCMV-VEGF165 (60 µg) was administered to the wound edges. The control group received a placebo. The state of the neuromuscular system was assessed using electromyography on days 28 and 60. Results and Discussion: In the control group, a significant decrease in the amplitude of the M-response (1.75 times, p=0.001) and an increase in the latency period by 10% (p=0.004) were observed, indicating axonal damage and myelinopathy. The decrement index of the M-response increased (2.2 times), suggesting impaired neuromuscular conduction. In the pCMV-VEGF165 group, the amplitude of the M-response, latency period, and decrement index did not differ significantly from those in the intact animal group. Conclusion: pCMV-VEGF165 promotes a reduction in the degree of tissue damage and accelerates their regeneration by restoring blood flow, confirming its effectiveness in preventing delayed complications of cold injury.

Introduction. The health of the population largely depends on the availability for a general practitioner (GP) with the knowledge and practical skills necessary to provide high-quality primary health care. Purpose: to study the educational needs, preferred forms, and methods in training Russian GP. Materials and methods. The study was conducted at the Departments of General Medical Practice of the Institute of Vocational Education of Sechenov University, Family Medicine of Belgorod State University, Polyclinic Therapy, Postgraduate Training and Nursing of Kemerovo State Medical University, General Medical Practice and Polyclinic Therapy of the Russian Medical Academy of Continuing Professional Education. The study used sociological, statistical and analytical research methods. The final analysis included four hundred two questionnaires for GP. Results. The disciplines (modules) of the specialty of the therapeutic profile have the greatest practical significance for Russian GP: internal medicine, laboratory and instrumental diagnostics, emergency medical care and oncology. In relation to all disciplines (modules), the need to improve the level of theoretical and practical training was identified. Its main directions are determined. Full-time and part-time forms of education are the most acceptable modes. Most prefer traditional teaching methods. The most convenient is training for 144 hours or short-term thematic educational programs. Research limitations. The limitations of the study are the urban working conditions of the GPs who took part in the survey, as well as subjective assessment, which was the subject of study and analysis. Conclusion. Improving the quality of training in GP will contribute to increasing the satisfaction and motivation of doctors, as well as improving the quality of primary health care and the health in the country’s population.

Introduction: Tau proteinopathy is a pathology associated with the activation of post-translational modifications and interactions of pathophysiological cascades of neuroinflammation with hyperphosphorylation of Tau aggregates. Therefore, preference is given to agents that have properties in reducing or slowing down the processes of neuroinflammation and post-translational modifications in the brain. Materials and Methods: The study was conducted on male and female homozygous individuals of a transgenic murine line with overexpression of mutant human Tau gene (P301S) and a background wild mouse line C57Bl/6J. To assess the progression of Tau proteinopathy, behavioral tests were used at two control time points, and the last one measured the level of neuroinflammation markers and tau-proteinopathy. Results and Discussion: In the group of P301S mice treated with ARA-290, an improvement in the phenotypic picture of Tau proteinopathy was demonstrated compared with intact animals. In the Barnes circular maze test, mice showed a decrease in the total distance traveled and the latent time spent on the platform, which indicates a rapid entry into the shelter. In the O-shaped maze test, the group maintained a fairly high level of spontaneous exploratory behavior. In the vertical rod test, the animals recorded the best time indicators that they needed to turn and maintain balance compared to the intact group. A statistically significant decrease in the level of GSK-3β and an increase in CDK5 and PP2A were revealed, which indicates a dephosphorylating effect on Tau protein, as well as markers of neuroinflammation. NF-KB and TNF-α were significantly reduced by 57% and 32%, respectively, compared to the intact group. Conclusion: In the model of transgenic P301S murine line with overexpression of the mutant human Tau gene, the peptide agonist of the EPOR/CD 131 heteroreceptor demonstrated neuroprotective properties, which were confirmed by indicators of behavioral tests and markers of neuroinflammation and tau-proteinopathy.

The aim of this study was to determine the possibility of studying the nature of the influence of cardiocytoprotectors on energy metabolism in cardiomyocytes using a model of human peripheral blood leukocytes.Materials and methods. Sixty Wistar rats were divided into groups: 1) intact rats; 2) rats with experimental myocardial ischemia; 3) rats with myocardial ischemia, which were injected with cardiocytoprotector – trimetazidine, 4) meldonium, 5) cytoflavin and 6) ethoxydol. Animals were taken out of the experiment 10 days after the administration of drugs by decapitation. The activities of pyruvate dehydrogenase and citrate synthase were determined in mitochondria of myocardial homogenates and in mitochondria of leukocytes by spectrophotometric methods.Results. The decrease in pyruvate dehydrogenase and citrate synthase activity in cardiomyocytes and in leukocytes were revealed in case of myocardial ischemia modeling. The introduction of cardiocytoprotectors led to the activation of these enzymes both in heart cells and in blood leukocytes. Direct positive correlations were obtained between the activity of pyruvate dehydrogenase in the mitochondria of cardiomyocytes and in the mitochondria of leukocytes (r = 0.811; p < 0.0001); between citrate synthase activity in the mitochondria of cardiomyocytes and in the mitochondria of leukocytes (r = 0.909; p < 0.0001).Conclusion. Changes in energy metabolism in blood leukocytes under the influence of cytoprotectors reflect similar changes occurring in heart cells.

Introduction: The aim of this study was to evaluate the processes of bone remodeling and osteoreparation in modeling femoral fracture in mice with zero expression of 11β-HSD2 (11β-HSD2-/-) or both 11β-HSD2 and apolipoprotein e (11β-HSD2-/-/ApoE-/-). Materials and Methods: The experimental study was conducted on 60 male mice weighing 24-30 g. The study used male mice that lacked the expression of 11β-HSD2 (knockout mice with the Hsd2-/- genotype) and male mice that lacked the expression of 11β-HSD2 and apolipoprotein E (double knockout mice with the Hsd2-/-/ApoE-/- genotype). The control group includes wild type C57bl/6 animals. Modeling of a fracture of the proximal metaphysis of the femur was performed in animals at the age of 6 months using a closed technique. Fracture fusion and bone remodeling and osteoreparation processes were evaluated 6 weeks after fracture modeling. Results and Discussion: It has been shown that a violation of the regulation of steroid hormone metabolism in groups of animals with the Hsd2-/- and Hsd2-/-/ApoE-/- genotypes leads to an increase in the number of ungrown fractures by 3 and 3.5 times, respectively, in comparison with wild-type animals. It was found that the microcirculation level of the proximal metaphysis of the left femur in the area of the formed bone callus in the group of animals with the genotype 11β-HSD2-/- significantly decreased from 92.075±4.33 perfusion units (PE) in the group of wild-type animals to 82.67±3.54 PE (p=0.0002) in the group of animals with the genotype HSD2-/- and up to 75.85±5.64 (p<0.0001) in the group of mice with the Hsd2-/-/ApoE-/- genotype. When calculating the coefficient of endothelial dysfunction, an increase in the coefficient of endothelial dysfunction was found from 1.297±0.19 in intact animals to 2.115±0.45 (p<0.00001) in the group of mice with the Hsd2-/- genotype and to 2.41±0.04 (p<0.00001) in the group of mice with the Hsd2-/-/ApoE-/- genotype. In animals with impaired cortisol metabolism, there was a slowdown in the formation of bone tissue in the fracture area, bone trabeculae had a smaller width, large amounts of fibrous and connective tissue were observed in the lumen between bone fragments, and an increase in intertrabecular spaces was noted Conclusion: The close relationship between the metabolism of 11β-HSD2 and NO, confirmed in this study, can be considered as a promising pharmacotherapeutic target. It is obvious that approaches to changing the activity of 11β-HSD have significant therapeutic potential in the treatment of osteoporosis, bone remodeling disorders and osteoreparation in fractures against the background of formed osteoporotic changes in the violation of steroid hormone metabolism.

The great complexity of complex geriatric assessment makes it relevant to search for methods that facilitate the selection of patients who really need it. The article presents the results of studying the possibility of using a routine clinical examination to select elderly cardiological patients with an increased risk of senile asthenia. The study involved 52 elderly patients with heart and vascular pathology. All of them underwent a generally accepted clinical and laboratory-instrumental examination, the results of which were compared with the data of the questionnaire «Age is not a hindrance». To identify the relationships between the parameters of clinical and geriatric status, analysis of variance and correlation analysis were used; summary frequency tables were built and analyzed. The significance threshold (p-value) was less than 5% (p<0,05). As a result of the study, it was found that the general condition of patients differing from satisfactory, complaints of shortness of breath, headaches, the presence of peripheral edema, lack of pulse on the dorsalis pedis arteries and posterior tibial arteries indicate an increased likelihood of senile asthenia in the subjects (p<0.05).

Aim. To evaluate 24-hour blood pressure (BP) profile and systemic inflammation in patients with coronary artery disease (CAD) depending on the presence of obstructive sleep apnea (OSA). Material and methods. This cross-sectional cohort study included 132 patients with CAD aged 62,3±6,9 years. Depending on OSA, all patients were divided into 2 groups: group 1 (n=60) — without OSA, group 2 (n=72) — with OSA. Systemic inflammation was assessed using neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), Systemic immune-inflammation index (SII) — platelets´neutrophils/lymphocytes. Blood pressure was monitored with assessment of average daily values, circadian rhythm, and variability. Results . Patients with OSA had higher nighttime blood pressure values (p<0,05) and 24-hour variability (p<0,05). In group 2 patients, a pathological blood pressure profile was detected in 66,7% of cases, while in group 1 — in 36,7%. The systemic inflammation indices were significantly higher in patients with OSA than in the group without OSA — NLR by 18,8% (p<0,01), PLR by 22,5% (p<0,01), MLR by 19,0% (p<0,01), SII by 41,0% (p<0,001). Conclusion. We established that patients with coronary artery disease and OSA have more pronounced systemic inflammation, more often have a pathological 24-hour BP profile ("non-dipper", "night-peaker"), BP variability, higher values of average 24-hour, daytime and nighttime BP compared with patients without OSA.

РезюмеАктуальность: Распространенность фибрилляции предсердий в современном мире постоянно растет.В большинстве случаев, эта патология встречается у людей пожилого и старческого возраста, что делает ее важной гериатрической проблемой.Несмотря на большое количество исследований, остается много нерешенных вопросов, касающихся патогенеза и терапии фибрилляции предсердий.Цель исследования: Анализ современных данных литературы об этиологии, патогенезе, диагностике и лечению фибрилляции предсердий.Материалы и методы: Анализировались научные работы, находящиеся в открытом доступе в базах данных PubMed, Embase, Web of Science, Elibrary и Google Scholar.Для последующего анализа преимущественно отбирались публикации, вышедшие на английском языке и размещенные, начиная с 1 января 2017 года.Учитывались имеющиеся в публикациях ссылки на ранее опубликованные работы.Поиск литературных источников производился по следующим ключевым словам: фибрилляция предсердий, прямые оральные антикоагулянты, катетерная абляция, генетика.При анализе литературных данных особое внимание уделялось систематическим обзорам и метаанализам результатов научных исследований.Результаты: В обзоре представлены современные данные о влиянии воспаления и состояния вегетативной нервной системы на развитие фибрилляции предсердий, большое внимание уделено роли генетических факторов в ее развитии.Уделено внимание особенностям медикаментозной терапии у пожилых.Сопоставлены эффективность различных подходов к лечению фибрилляции предсердий, обращено внимание на возможные перспективы дальнейших

The patient satisfaction is one of the key criteria of quality of medical care and indicator of patient-oriented approach and factor determining competitiveness of medical organization. The purpose of the study - the comparative analysis of patient satisfaction with primary health care provided by general practitioner and district physician, taking into account their gender, age characteristics, frequency and goals of visiting polyclinic. Sociological study was carried out on the basis of out-patient medical organizations in Moscow, Kemerovo and Belgorod. The final analysis included 415 questionnaires of respondents aged 18 years and older. The patients with different rate and purposes of visiting medical institution are equally satisfied with medical care provided by general practitioner and district physician. The satisfaction with general practitioner may have gender characteristics. The satisfaction with district physician may have age characteristics. The satisfaction with both specialists may depend on health status of patient. The model of providing primary health care according to principle of general practitioner may be more universal, while according to principle of district physician more acceptable for elder patients. In order to increase satisfaction with primary health care for all categories of patients, it is necessary to consolidate best organizational approaches of both models.

In conditions of active development of medical and pharmaceutical sciences and dynamically changing work environment the education of physician is to be both continuous and personalized. Purpose of the study. To investigate effect of gender, age and work experience on educational needs and on preferences of forms and methods of training in the system of continuing medical education of Russian general practitioners. The research bases were Chairs occupied with issues of personnel training for general medical practice in Moscow, Belgorod and Kemerovo. The sociological, statistical and analytical research methodologies were applied. The overall analysis covered 402 questionnaires for general practitioners. The sampling of respondents included 19.1% of men, 80.9% of women; 52.4% were aged 36-55 (60) years, 29.3% - 24-35 years and 18.3% - 56 (61) years and older; 45.0% had experience in general medical practice up to 2 years, 16.3% - 3-4 years, 27.0% - 5-6 years, 11.7% - 7 or more years. The results of comparative analysis of opinions of physicians of both genders and various age with different time of experience concerning level of significance for practice of various areas of competence within the framework of specialty and their preferences regarding organizational forms, training methods and its duration are presented. It is established that gender, age and length of service had no significant effect on the studied parameters. However, certain characteristics associated with these factors are identified. The further study of possible influence of other internal and external factors can contribute in the future into formulation of scientifically grounded approach to choosing personalized trajectory of education of general practitioner.

The development of COVID-19 is accompanied by involvement of various cytokines in pathological process. Their change depends on age, concomitant pathology and some other factors that have not been sufficiently studied in elderly patients with coronary heart disease (CHD). The content of cytokines in blood plasma of patients aged 60-74 in the early period of recovery from COVID-19 also remains unknown. The aim of our study was to determine the content of systemic cytokines in elderly patients with coronary heart disease at the early stages of recovery after COVID-19. The patients aged 60-74 with CHD who had COVID-19 of moderate severity grade (n = 40) made up the main group. in which the study of The cytokine levels were studied in blood plasma 3 to 4 weeks after recovery. The control group consisted of 38 elderly patients with coronary heart disease and negative tests for COVID-19. of cytokines in both groups were determined by means of flow cytometry with “Becton Dickinson FACS Canto 2 (USA)” machine using appropriate reagent sets. We have found that, in elderly patients with CHD at 3-4 weeks after recovery from COVID-19, if compared with elderly patients with CHD without COVID-19, the content of IL-6 in blood plasma was increased to higher degree and at statistically significant difference, up to 32.9±2.3 pg/mL versus 6.5±0.7 pg/mL in the control group (p < 0.001). Excessive content in the main group was also detected for IL-17 in blood plasma which was 25.4±1.9 pg/mL at the early post-COVID-19 period, whereas it was 7.8±0.7 pg/mL (p < 0.001) in the age-matched patients with CHD only. TNFα and IFNγ levels were elevated among 60-74-year-old patients with CHD and COVID-19 at 3-4 weeks after recovery, being 128.6±2.7 pg/mL and 57.6±2.8 pg/mL, respectively. In control group, the concentration of these cytokines was significantly lower, i.e., 56.3±2.2 pg/mL and 25.9±1.7 pg/mL, respectively (p < 0.001). The changes in contents of other cytokines studied seemed less pronounced, and the level of IL-4 was not significantly different between the both groups. Hence, in elderly patients with CHD and COVID-19 at 3-4 weeks after recovery, IL-6, IL-17, TNFα and IFNγ are the most elevated cytokines at the systemic level.

Significance. Patient satisfaction with medical care is one of the key performance indicators of the health care system. The purpose of the study: to conduct a comparative analysis of patient satisfaction with primary care provided by general practitioners (GP) and district physicians (DPh) in Russia and identify indicators that can be used to manage accessibility and quality of primary care, using the principles of value-based healthcare. Material and methods. The study used analytical, sociological and statistical methods. The survey was conducted by the method of sampling. The minimum sample size equaled to 400 observation units. The survey bases included medical organizations providing medical care on an outpatient basis in the cities of Moscow, Kemerovo and Belgorod, the places that have undergone reforming and introduced GP practices. Results. The final analysis included 415 questionnaires. Patient satisfaction with medical care, provided by GP equaled to 87.6%, satisfaction with care provided by DPh added up to 73.3% (p<0.001). Patient satisfaction with individual parameters of medical care related to the medical organization, doctor and doctor-patient relationship also turned out to be statistically significantly higher if provided by GP. The average score ranged within 3.8-4.2 and 2.2-2.4, respectively. For both the GP and DPh models of care delivery, the lowest satisfaction was reported for the parameters characterizing its organization. Based on the results of our own research and results of earlier papers, the indicators of primary care accessibility and quality that are of greatest value to the patient were identified. Conclusion. Based on generalization of the study results and data published in scientific literature, a set of indicators has been proposed to ensure continuous monitoring over quality and accessibility of primary care and make organizational and managerial decisions using the principles of value-based healthcare.

Atomic force microscopy has established the changes of mechanical properties of lymphocytes' membranes from patients with acute and chronic lymphoblastic leukaemia. The stiffness of cell membrane was increased under influence chemotherapy along with the ultrastructural organisation of the lymphocyte's surface was different between patients with acute and chronic leukaemia. In the blood of patients with acute leukaemia were circulated two types of lymphocytes with small and large spherical globules on the surface, respectively. The lymphocytes from patients with chronic lymphoblastic leukaemia carried on their surface the large structures of irregular shape. Significant differences in the structural properties of lymphocyte's surface in patients with acute and chronic lymphoblastic leukaemia point at differences cell response to the action of chemotherapy drugs.

The choice of specialty by graduate of medical university can be promoted by particular social, demographic and personal characteristics. Purpose of the study is to investigate demographic, social and personal characteristics of students in residency on specialty "General Medical Practice" in the Russian Federation. The sociological, statistical and analytical methods are applied. The sampling for survey consisted of 81 respondents. The specialty "General Medical Practice" is chosen mainly by women residing in city, non-married and without children. They are not characterized by participation in public life and they are characterized by the presence of hobbies (hobbies). The choice is conditioned by multidisciplinary nature of medical care and scope of professional horizons. They are attracted by treatment work and are less interested in pedagogy and science. In perspective, 80% of female respondents are going to get another specialty. More than 70% of respondents plan to work in out-patient conditions and predominantly in state sector of health care. For women, main goals of further professional training are improvement in main and adjoining specialties and career promotion. And in educational program, internal diseases are of greatest interest. The preferred forms of training are internships and e-learning. The main direction of improving educational process is increasing of scope of practical training. The comparative analysis of study results with data of previous publications was implemented. The factors influencing commitment to specialty are revealed. The proposals increasing attractiveness of general medical practice for graduates of medical universities and keeping in specialty after residency are formulated.

The application of nanoparticles and nanocarriers in the area of cardiology has gathered much attention due to the properties such as passive and active targeting to the cardiac tissues, improved target specificity, and sensitivity. It has reported that more than 50% of CHDs can be treated effectively through the use of nanotechnology. The personalized approach to the choice of drugs in the treatment of patients with coronary heart disease (CHD) is designated as "diamond". How this relates to the antioxidant drug ethoxidol is to be sanctified in this article. To develop a personalized approach to the use of ethoxidol in patients with CHD based on the definition of criteria for predicting the cytoprotective properties of this drug when tested in vitro. With the introduction of ethoxidol into a sample with a leukocyte suspension, a significant increase in VIcells by 21% (from 41% to 62%, p <0.001) was observed, which indicates the presence of a cytoprotective property in this drug. A more detailed analysis of the dynamics of the VIcells index showed two variants of changes in cell viability: in 80% of patients VIcells was increased, on average, by 28% (from 36% to 64%, p <0.001) and in 20% of patients VI cells was decreased, on average, by 10% (from 68% to 58%, p <0.05). A number of conditions for the initial state of a patient with CHD were identified for the manifestation of cytoprotective properties in ethoxidol: a proatherogenic cholesterol profile (with a serum cholesterol level above 6.6 mmol/l and a high-density lipoprotein level below 1.6 mmol /l), impaired antioxidant status ( low level of serum catalase activity -less than 5 ??catal/l), signs of mitochondrial dysfunction (increased serum urea levels above 8.3 mmol/l, decreased total blood protein levels below 76 g/l), depletion of the adaptation system function (a decrease in the level of lymphocytes in the blood less than 35% and an increase in the level of neutrophils more than 52%), the normal state of thrombopoiesis (the number of immature platelets is not more than 7%). The antioxidant drug ethoxidol had cytoprotective properties in patients with CHD. At the same time, there were a number of conditions for the initial somatic status of patients, which determined the advisability of a personalized approach to the use of ethoxidol as a cytoprotector.

Aim. To assess the association of vitamin D deficiency with hormonal and metabolic disorders, including with insulin resistance and leptin levels, in patients with metabolic syndrome (MS) and chronic kidney disease (CKD).Material and methods. The study included 81 patients with MS and CKD aged 45-59 years (mean age, 51±4 years). Depending on vitamin D level, the patients were divided into two groups: group 1 (n=49) — patients with reduced level (23,2±5,1 ng/ml); group 2 (n=32) — patients with an adequate level (54,8±12,1 ng/ml). Statistical processing was carried out using STATISTICA 10.0 software.Results. In patients of the first group, the following parameters were higher than in the second one: waist circumference by 9,0% (p<0,05), waist-to-hip ratio by 8,2% (p<0,05), body mass index by 15,1% (p<0,05). The groups did not differ significantly in systolic and diastolic blood pressure levels. In the first group, the level of total cholesterol by 18,6% (p<0,01), low density lipoprotein cholesterol by 11,9% (p<0,05), triglycerides by 20,8% (p<0,01), Homeostasis Model Assessment Insulin Resistance (HOMA-IR) by 42,5% (p<0,001), leptin by 30,5% (p<0,01) were higher than in the second group. More severe left ventricular diastolic dysfunction in the first group than in the second one was determined as follows: lower left ventricular early to late filling (E/A) by 13,2% (p<0,05) and deceleration time of the early transmitral flow velocity by 13,1% (p<0,05).Conclusion. The results obtained indicate that patients with MS, CKD and vitamin D deficiency are more likely to have general obesity, more pronounced carbohydrate (HOMA-IR index) and fat (levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides) metabolism disorders, as well as high serum levels of leptin compared with patients with adequate levels of this vitamin.

In order to study attitude of graduates of medical specialties to employment in primary health care system and to postgraduate medical education, anonymous survey was carried out on sampling of 188 graduates of medical institute of the Belgorod State National Research University in 2020-2021. The analysis established that married students more often than single ones seek permanent job with guaranteed salary and social protection. The advanced graduates easier get their future specialty than weak and satisfactory ones. The graduates-foreign citizens and stateless ones consider themselves under-prepared for medical practice as compared with graduates-residents of city and oblast. The youths more often than girls meet future employers. the weak graduates meet the employers less often than advanced graduates. The satisfactory graduates, as compared with weak and advanced graduates, more often have close relatives among medical workers. By the time they graduate, youths more often than girls get experience of practical medical activity. The advanced graduates also more frequently get practical medical experience than weak and satisfactory graduates.