Sodium alginate is one of the most frequently used materials in biomedicine. However, alginate-based scaffolds have extremely low adhesive properties and have to be improved. The authors have proposed combined hydrogels of gelatin and sodium alginate which have been modified by peroxynitrite in heterophasic conditions using ethanol. It has been determined that thus modified sodium alginate contains an increased level of carbonyl, carboxyl and nitro groups. Authors have developed chemically and chemical-enzymatically cross-linked hydrogels with better adhesive properties and absence of cytotoxicity. Moreover, sodium alginate modification has a positive impact on cell morphology in comparison with control group of non-adhesive alginate-gelatin hydrogels. It allows the further improvement and application of the biomaterial which have been developed by the authors for bioengineering scaffold production and 3D culturing.

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by a decrease in platelet count, which often leads to bleeding. Evidence suggests that low platelet counts in ITP are the result of multiple factors, including impaired thrombocytopoiesis and changes in the immune response leading to platelet destruction. ITP is a heterogeneous disease with a course that is difficult to predict. In a significant number of cases, ITP becomes chronic, requiring long-term maintenance treatment, which leads to an increased risk of hemorrhagic complications and a decrease in quality of life. A deeper understanding ofthe etiology and pathogenesis ofthis disease makesit possible to identify potentialtherapeutic targets for the development of new effective treatments. This review summarizes recent advances in understanding the ITP pathophysiology, evaluating current therapeutic strategies and methods for predicting therapy response.

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by increased platelet destruction and decreased platelet production. The formation of antibodies to platelet and megakaryocyte glycoproteins plays a major role in the pathophysiology of ITP. All treatment strategies for ITP attempt to increase platelet count and reduce the risk of bleeding complications. Corticosteroids remain the most commonly used first-line therapy for ITP, but their long-term use is limited due to the development of severe complications. Today the new treatment methods including the use of thrombopoietin receptor agonists (TPO-RA) romiplostim, eltrombopag and avatrombopag with a number of advantages over standard therapy are of great interest. These drugs are recommended for use in the second-line therapy and show high efficacy in patients with ITP, particularly in real clinical practice. In most cases TPO-RA provide stable and long-term remission of the disease, allowing you to reduce or discontinue the use of glucocorticosteroids and avoid splenectomy. Many studies of the mechanism of action, efficacy and toxicity of TPO-RA have been performed. the research results significantly expand our knowledge about these agents. This review provides comparative data of the TPO-RA safety and the main aspects of their clinical use. The features of the new drug avatrombopag, recently approved for use in the Russian federation, are described. the overview presents the advantages and limitations of each drug, possible adverse events and methods for their control.

Background. The leading role in the control of the immune response and peripheral tolerance is played by T-regulatory cells, as well as costimulatory molecules C28 on T-lymphocytes, which are necessary for effective activation. While T-regulatory cells in immune thrombocytopenia (IT) are actively studied in order to find an effective influence on their functions, publications on the study of costimulation processes in this disease are quite rare. Given the pronounced immunosuppressive effect of glucocorticosteroids (GCS) used in the treatment of patients with IT, it seems particularly relevant to study the role of T-regulatory cells and the expression features of costimulatory C28 molecules on T-lymphocytes to expand our understanding of the disease pathogenesis and justify new approaches to treating patients in real clinical practice.Aim. To evaluate the clinical and prognostic significance of T-regulatory cells and C28 expression on peripheral blood T-lymphocytes in patients with newly diagnosed IT and resistant to GCS therapy.Materials and methods. The content of T-regulatory cells and C28 expression features on peripheral blood T-lymphocytes were studied by flow cytometry in 18 patients with newly diagnosed IT and 19 patients resistant to GCS therapy. Thirty healthy individuals were examined as a control group.Results. A significant (p ˂ 0.05) decrease in the content of classical T-regulatory cells (C4+C25+hiC127–) was revealed both in patients with newly diagnosed IT and in those resistant to GCS, while no significant differences were found in C8+C28– peripheral T-regulatory cells level in patients with IT of both groups compared to healthy individuals. In patients with IT of both groups, a significant increase in the proportion of T-helper (p < 05; p ˂ 01, respectively) and cytotoxic C8+ (p ˂ 0.05; p ˂ 0.01, respectively) T-lymphocytes expressing C28 was found compared to normal values. The level of T-helper lymphocytes (C4+C28–) was 2 times higher in the group of patients with resistance to GCS compared to newly diagnosed IT patients, and 3.5 times higher compared to healthy individuals.Conclusion. T-regulatory cells and expression of C28 costimulatory molecules play an important role in the immunopathogenesis of IT. A significant increase in the content of the C4+C28null lymphocyte population (C4+C28–) in the peripheral blood of IT patients can be a prognostic criterion for GCS resistance, which may require a revision of the treatment strategy.

Введение. Идиопатическая тромбоцитопеническая пурпура (ИТП) – иммунное заболевание, в патогенезе которого происходит антитело-опосредованное нарушение мегакариоцитопоэза и тромбоцитопоэза. Заболевание проявляется гемор­рагическим синдромом различной степени тяжести на фоне изолированной тромбоцитопении. Несмотря на современные методы терапии и доступность препаратов, ИТП неизлечима, но возможно достижение ремиссии различной длительности. Цель исследования: оценка роли аватромбопага – нового агониста тромбопоэтиновых рецепторов в терапии пациентов с иммунной тромбоцитопенией в Московской области (МО). Материалы и методы. Ретроспективно (за период с 2009 по 2023 гг.) проанализированы данные 3000 амбулаторных карт пациентов с диагнозом тромбоцитопении. Из них в регистр ИТП МО вошли 420 подтвержденных клинических случаев различных форм заболевания – 125 (29,76%) мужчин и 295 (70,24%) женщин, стаж заболевания – от 1 мес до 14 лет, возраст включения в исследование – от 18 до 82 лет; медиана возраста составила 50,5 лет. У всех пациентов оценивали эффективность проводимой терапии, включая полный ответ (количество тромбоцитов ≥ 100×109/л при отсутствии кровоточивости), ответ (количество тромбоцитов ≥ 30×109/л или двукратное их повышение от начального уровня при отсутствии кровоточивости); отсутствие ответа (количество тромбоцитов < 30×109/л, или менее чем двукратное их повышение от начального уровня, или наличие кровоточивости). Результаты. В первую линию терапии 420 пациентов получали лечение глюкокортикостероидами (ГКС), на терапию не ответили 340 (81,9%) больных, которые во второй линии терапии получали агонисты тромбопоэтиновых рецепторов (ромиплостим, элтромбопаг). Полный ответ достигнут у 237 (69,7%) больных, ответ – у 49 (14,4%), отсутствие ответа установлено в 54 (15,9%) случаях. В рамках обсуждения результатов исследования рассматриваются возможности применения аватромбопага в лечении пациентов с иммунной тромбоцитопенией. Заключение. При анализе данных регистра наибольшая эффективность терапии больных с ИТП определена у агонистов тромбопоэтиновых рецепторов. Introduction. Idiopathic thrombocytopenic purpura (ITP) is an immune disorder characterized by antibody-mediated disturbance of megakaryocytopoiesis and thrombocytopoiesis, which manifests by isolated thrombocytopenia, risk of spontaneous hemorrhage and bleeding of varying severity. Despite modern methods of therapy and availability of drugs, ITP is incurable, but it is possible to achieve remission of various durations. Aim: to assess the role of avatrombopag, a new thrombopoietin receptor agonist, in the treatment of patients with immune thrombocytopenia in the Moscow Region (MR). Materials and Methods. Data from 3,000 outpatient medical records of patients diagnosed with thrombocytopenia were retrospectively analyzed (from 2009 to 2023). Of these, ITP register in the MR included 420 confirmed clinical cases of various disease forms – 125 (29.76%) men and 295 (70.24%) women, disease duration – from 1 month to 14 years, age of inclusion in the study – from 18 up to 82 years; median age was 50.5 years. All patients were evaluated for the treatment effectiveness, including complete response (platelet count ≥ 100×109/L in the absence of bleeding), response (platelet count ≥ 30×109/L or a 2-fold increase from the initial level in the absence of bleeding); no response (platelet count < 30×109/L or less than 2-fold increase from baseline, or presence of bleeding). Results. In the first line of therapy, 420 patients received glucocorticosteroids (GCS); 340 (81.9%) patients did not respond to therapy and further received thrombopoietin receptor agonists (romiplostim, eltrombopag) in the second line of therapy. A complete response was achieved in 237 (69.7%) patients, response – in 49 (14.4%), no response was found in 54 (15.9%) cases. As part of the discussion of study results, the possibilities of avatrombopag use in the treatment of patients with immune thrombocytopenia are considered. Conclusion. Analyzing the registry data, the highest therapy effectiveness in ITP patients was determined with thrombopoietin receptor agonists.

Multiple primary malignant neoplasms (MPMNs) is a complex process in which the development of 2 or more neoplasms simultaneously or after a certain interval is observed. MPMNs develop independently from each other within one or more organs. Many etiopathogenetic factors can cause MPMNs. Numerous studies have been conducted to study the effect of T-cell immunity on the development of this pathology. Today, there is a steady upward trend in the prevalence of mpmns, which, on the one hand, is due to more effective methods of early diagnosis, an increase in patient overall survival, and early antitumor therapy (chemotherapy, radiation therapy), on the other hand, this trend may be associated with pathology of T-regulatory cellular immunity. T-regulatory cells play a strategic role in the development of immune homeostasis, and their function is closely related to the occurrence of a wide range of pathologies, including autoimmune diseases and malignant neoplasms. The article presents a clinical case of a patient with a confirmed diagnosis: mpmn, immune thrombocytopenia (idiopathic thrombocytopenic purpura). On prednisolone therapy, remission was achieved for 2 metachronous tumors and a complete hematological response for immune thrombocytopenia was obtained. there were no signs of hemorrhagic syndrome and complications during prednisone therapy. It is planned to continue monitoring the patient for metachronous tumors by a hematologist, an oncologist at the place of residence, as well as at the center for orphan diseases of the Moscow Regional Research Clinical Institute named after M. F. Vladimirsky with control of platelets and general condition.

УДК 517.95 MSC: 14B07, 34E05, 34E10, 34K26, 35K15 DOI: 10.21538/0134-4889-2023-29-1-77-90 Для параболического уравнения типа Гамильтона — Якоби $S_t + 2^{-1} (S_x)^2 + V(x,\varepsilon) = S_{xx}$ строится специальное асимптотическое решение с заданной асимптотикой функции потенциала.

Background. Immune thrombocytopenia (ITP), or idiopathic thrombocytopenic purpura, is a hematological autoimmune disease characterized by bleeding and an isolated decrease in platelet count <100 × 10 9 / l. The decision to start treatment for ITP depends on several factors. The ITP treatment strategy is based on the clinical symptoms, with a focus on reducing the risk of severe bleeding and increasing platelet counts. Aim. To evaluate the efficacy of 2 nd line therapy with the thrombopoietin receptor agonist eltrombopag in patients with ITP. Materials and methods. 490 patients with ITP are under observation at the center for orphan diseases of M. F. Vladimirskiy Moscow Regional Research Clinical Institute. The present study included 186 patients with primary ITP after 1 st line glucocorticosteroid therapy. eltrombopag, a thrombopoietin receptor agonist, was prescribed as the 2 nd line of therapy. Results. The median platelet count prior to eltrombopag therapy in all patients was 27.5 × 10 9 / l. after eltrombopag therapy, a significant (by 490 %) increase in platelet levels (median 135 × 10 9 / l) and a complete response according to clinical recommendations were noted. Conclusion. Glucocorticosteroids (prednisolone, dexamethasone) remain the drugs of choice for the 1 st line of therapy. Treatment with drugs of this group in most cases allows achieving an optimal platelet level and preventing bleeding. In case of inefficiency, intolerance, occurrence of side effects, the appointment of thrombopoietin receptor agonists eltrombopag or romiplostim is recommended. therapy with eltrombopag at a dose of 50 mg daily for several weeks has been able to achieve an increase in platelet levels, correct hemorrhagic syndrome, reduce the number of side effects during first-line glucocorticosteroid therapy, and improve the patient’s quality of life.

Background . Nasopharyngeal cancer is a rare head and neck cancer with a relatively high risk of locoregional recurrence and distant metastases. The most common sites of metastases are bones (70–80 %) followed by liver (30 %), lung (18 %), and lymph node (axillary, mediastinal, pelvic, and inguinal). Thyroid gland is an uncommon site of metastasis with an incidence ranging from 0.5% to 24 %. Thyroid metastasis from nasopharyngeal cancer has been reported in only 9 cases in the world literature and no one in Russia. Case report . We report a case of thyroid metastasis from nasopharyngeal cancer found incidentally in a 53-year-old female patient. Conclusion . Metastases to the thyroid gland are rare, and patients with metastatic thyroid disease rarely present with organ-specifc symptoms, thus raising diagnostic diffculties for both clinicians and the pathologists. This clinical report demonstrates the diffculties of differential diagnosis,as well as the importance of a thorough collection of complaints, anamnesis, and clinical examination.

Glucocorticosteroids (GCS) are the first-line treatment for idiopathic thrombocytopenic purpura (ITP). Despite their high efficacy in patients with newly diagnosed ITP, an adequate level of platelets remains after GCS withdrawal in only less than 20 % of patients. Additionally, GCS use is associated with an increased risk of different adverse reactions, including serious and life-threatening ones. Thrombopoietin receptor agonists represent a relatively new class of drugs for treating ITP as a second-line therapy. This paper reviews the risks of GCS pharmacotherapy, as well as the evidence supporting the use of thrombopoietin receptor agonists as both first-line and second-line treatment for patients with ITP.

Иммунная тромбоцитопения – это заболевание крови иммунного генеза, характеризующееся изолированным снижением уровня тромбоцитов ниже 100×109/л и проявляющееся геморрагическим синдромом разной степени выраженности. Этиология заболевания неизвестна. Патогенез связан с изменениями в Т-клеточном звене иммунитета и выработке антител к тромбоцитам с последующим их разрушением в селезенке. Цель. Оценить эффективность второй линии терапии агониста тромбопоэтиновых рецепторов ромиплостима у пациентов с иммунной тромбоцитопенией. Материалы и методы. В ГБУЗ МО МОНИКИ им. М.Ф. Владимирского, в Центре орфанных заболеваний Московской области (ЦОЗМО) под наблюдением находится 67 пациентов, принимающих препарат ромиплостим. В настоящее исследование включались мужчины и женщины с первичной иммунной тромбоцитопенической пурпурой после первой линии терапии глюкокортикостероидами. Статистическая обработка данных проводилась с помощью Graphpad Prism 9. Результаты. Медиана повышения уровня тромбоцитов у 67 пациентов после терапии ромиплостимом [Q25–Q75] составила 128×109/л [97–190×109/л]. Терапию ромиплостимом в Московской области получают 67 пациентов с иммунной тромбоцитопенией. По полученным данным, полный ответ отмечается у 49 пациентов – 73,12%, частота ответа у 15 пациентов – 22,39%, не ответивших 3 пациента – 4,48%. Выводы. Применение ромиплостима показало хороший результат у пациентов с иммунной тромбоцитопенией, не вызывая токсичности и улучшая качество жизни у пациентов с иммунной тромбоцитопенией. Immune thrombocytopenia is a blood disease of immune origin, characterized by an isolated decrease in the level of platelets below 100×109/L and manifested by hemorrhagic syndrome of varying severity. The etiology of the disease is unknown. The pathogenesis is associated with changes in the T-cell link of immunity and the production of antibodies to platelets, followed by their destruction in the spleen. Purpose. To evaluate the effectiveness of the second-line therapy of the thrombopoietin receptor agonist romiplostim in patients with immune thrombocytopenia. Materials and methods. In GBUZ MO MONIKI them M.F. Vladimirsky, 67 patients taking Romiplostim are under observation at the Center for Orphan Diseases of the Moscow Region (TsOZMO). The present study included men and women with primary immune thrombocytopenic purpura after first-line corticosteroid therapy. Statistical processing: data was carried out using Graphpad Prism 9. Results. The median increase in platelet levels in 67 patients after treatment with romiplostim [Q25–Q75] was 128×109/L [97–190×109/L]. Discussion. 67 patients with immune thrombocytopenia receive romiplostim therapy in the Moscow region. According to the data obtained, a complete response was noted in 49 patients – 73.12%, the response rate in 15 patients was 22.39%, 3 patients did not respond – 4.48%. Conclusions. The use of romiplostim showed a good result in patients with immune thrombocytopenia, without causing toxicity and improving the quality of life in patients with immune thrombocytopenia.

Background. Idiopathic thrombocytopenic purpura (ITp) is an autoimmune disease characterized by antibody-mediated platelets destruction and impairment of their production, which manifests itself as: isolated thrombocytopenia, risk of spontaneous hemorrhage and bleeding of varying severity. ITp is a hematological, orphan disease with an incidence of 1–4 cases per 100,000 population. In modern literature, primary and secondary immune thrombocytopenias are distinguished. primary immune thrombocytopenia is a diagnosis of exclusion. To verify it, a certain diagnostic search is required.Aim. To evaluate clinical characteristics and treatment efficacy in patients with a confirmed primary immune thrombocytopenia in the Moscow region.Materials and methods. This article presents the results of an analysis of more than 2,400 outpatient records of patients diagnosed with thrombocytopenia (for the period from 2010 to 2022). Of these, about 400 confirmed clinical cases of various ITp forms were included in the ITp registry of the Moscow Region. All patients live in the Moscow region, receive treatment and are observed at the Center for Orphan diseases of the M.f. vladimirskiy Moscow Regional Research Clinical Institute.Results. There are 415 patients with a verified diagnosis of ITp in the register of the Moscow Region Center for Orphan diseases of the M.f. vladimirskiy Moscow Regional Research Clinical Institute (71 % (n = 294) are female). In 69.8 % (n = 290) of patients at the time of disease manifestation, hemorrhagic syndrome was recorded. As a first-line therapy, 92.8 % (n = 385) of patients received corticosteroids (prednisolone, methylprednisolone, dexamethasone), in the second-line therapy, 82 % (n = 340) of patients were recommended therapy with thrombopoietin receptor agonists (romiplostim, eltrombopag). The options for third-line therapy in patients with ITp are rituximab monotherapy, splenectomy, and intravenous immunoglobulin. Splenectomy was performed in 3.37 % (n = 14) of patients.Conclusion. when evaluating this register, the highest efficiency of thrombopoietin receptor agonists (romiplostim, eltrombopag) is observed – 84.1 % of the objective response.

Актуальной проблемой является оценка взаимосвязи морфологических показателей и скоростно-силовых качеств школьниц и волейболисток 11-12 лет, обучающихся в ДЮСШ, что дает возможность тренерам-преподавателям обеспечить качественный отбор для занятий в ДЮСШ, а также индивидуализировать подход к физическому воспитанию девочек на занятиях по избранному виду спорта. Оценены соматические показатели по первому (габаритному) уровню варьирования и особенности развития скоростно-силовых качеств у представителей различных соматических типов в контрольной и экспериментальной группах. Результаты комплексных исследований существенно расширяют теоретические знания в обосновании использования морфологических критериев при построении тренировочного процесса на занятиях по волейболу.

Dysferlin is a transmembrane calcium-binding protein of the ferlin-1-like protein family, which includes myoferlin Fer1L3, otoferlin Fer1L2 and other ferlins Fer1L4, Fer1L5, and Fer1L6 along with dysferlin itself. Dysferlin is synthesized in all cells of the body, but most actively – in the symplasts of striated muscle tissue. The full range of functions performed by this protein is not fully clarified, but the following have been clearly shown: participation in the post-injury repair of sarcolemma and intracellular vesicular systems, generation and maintenance of the correct functioning of the sarcolemmal T-tubule system, regulation of endo- and exocytosis and inflammation, participation in phagocytosis. Mutations in the dysferlin gene lead to the development of a number of neuromuscular diseases of the autosomal recessive type of inheritance called dysferlinopathies: Miyoshi myopathy, limb-girdle muscular dystrophy type 2B, and distal anterior compartment myopathy. These diseases are characterized by the impaired expression of mRNA and/or the function of the protein dysferlin in skeletal muscles, which is caused by mutations in the DYSF (dystrophy-associated fer-1-like) gene. Although rare, dysferlinopathy is characterized by continuous progression causing severe disability, which explains the importance of research and development of appropriate treatments, including gene therapy. The article presents information on the structure of dysferlin, the mechanisms of its normal functions, as well as the biochemical basis of the pathogenesis of dysferlinopathies.

Цель настоящей работы заключалась в оценке экологической опасности отходов литейного производства, представляющих собой отработанную формовочную массу, содержащую в качестве связующего материала один из популярных в литейном производстве пластификатор МФ на основе меламиноформальдегидной смолы, в состав которой входят меламин (C3H6N6), формальдегид (CH2O), бутанол (C4H9OH), а также остатки аммиака (NH3), который используется при её синтезе.Исследования были выполнены методом нарушенного полного внутреннего отражения (НПВО) на ИК Фурье-спектрометре Vertex 70 фирмы Bruker и отражательной приставке МНПВО фирмы Pike Technologie.В качестве элементов МНПВО использовали кристаллы KRS-5 с углом падения излучения на объект θ = 45.Результаты исследований представлены на рис. 1. Рис. 1. Результаты ИК-спектроскопии в режиме МНПВО для образца без термообработки Характеристические полосы поглощения 4 и 5 указывают на наличие азометиновых групп, содержащихся в основаниях Шиффа -N-замещенных алифатических иминах, или на присутствие в образце изоцианатов -N=C=O.Алифатические имины хорошо гидролизуются с образованием карбонильных соединений и аминов.Амины относятся ко II классу опасности, изоцианаты -к I классу опасности [1], что необходимо учитывать при захоронении и утилизации отходов литейного производства, содержащих пластификатор на основе меламиноформальдегидной смолы.Список литературы 1. ГОСТ 12.1.007-76Система стандартов безопасности труда (ССБТ).Вредные вещества.Классификация и общие требования безопасности (с Изменениями № 1, 2).

Introduction. There is no treatment for recurrence of head and neck squamous cell carcinoma, which significantly increases the overall survival (OS) of patients.The study objective is to analyze the results of treatment of patients with recurrences of squamous cell carcinoma of the head and neck and to assess the impact of risk factors for relapse, as well as different treatment options for relapse on OS. Materials and methods. In the period from 2012 to 2016, 182 patients with relapses of squamous cell carcinoma of the larynx, oral cavity and tongue received treatment in the Chelyabinsk regional clinical center of Oncology and nuclear medicine. The group 1 included 66 patients with resectable relapse who were operated. The group 2 consisted of 25 patients who received a course of radiation therapy. The group 3 consisted of 46 patients who underwent chemotherapeutic treatment of relapse. The group 4 was represented by combined treatment (surgery + radiation therapy), this group included 9 people. The group 5 consisted of those of patients who were not specifically treated for relapse because of the low Karnofsky index in patients (<70 %). Results. OS among patients who received special treatment was significantly higher compared with the group of symptomatic therapy. The median OS in the special treatment group was 40 months, and without it – 18 months. Comparing all types for treating relapse, the highest rates of OS were in the surgical treatment group. OS rates in combined therapy group and radiotherapy group were comparable rate in the radiotherapy. The lowest OS rate was after chemotherapy (only 21 months).Conclusion. Surgery is the optimal method for treating recurrent squamous cell carcinoma of head and neck, if it is resectable. If surgical treatment is not possible, no other method significantly increases the OS. If the overall status of the patient is normal, re-radiation or polychemotherapy may be performed. A limited category of patients can be subjected to combined treatment for relapse.

Rationale : Most people infected with SARS-CoV-2 have asymptomatic or minor clinical manifestations and recover without any aggressive therapy. However, there are patient categories in need of specific treatment and those at high risk of severe disease. Control of viremia with antiviral therapy may not be the best therapeutic strategy, since, in addition to substantial toxicity, antiviral agents can suppress the production of antiviral antibodies and disintegrate adoptive immunity against SARS-CoV-2. Due to a high correlation between the symptoms severity in patients with COVID-19 and inflammation, anti-inflammatory corticosteroids have been proposed to treat the disease. However, clinical data do not support the systemic administration of corticosteroids for the treatment of patients with severe COVID-19. Such treatment may have a negative effect due to suppression of the adoptive immune system. In this regard, the development or use of already available of agents that modulate inflammation without compromising the adoptive immune response could be the most effective therapeutic strategy. Aim: To evaluate clinical efficacy and safety of the cell biotherapy technique, the extracorporeal photopheresis (ECP), in the treatment of patients with moderately severe new coronavirus disease COVID-19. Materials and methods : The study included four patients (three women and one man, age 42 to 60 years), with SARS-CoV-2 infection confirmed by gene amplification. All patients had CT-confirmed bilateral multisegmental viral pneumonia (grades > 2, i.e. with 25 to 60% involvement of the lungs). Prior to admission, all patients received antibiotics (azithromycin 500 mg daily and levo-floxacin / amoxicillin clavulanate 500 mg BID) and antipyretics for torpid fever of up to 38.5-39 °C. The outpatient treatment lasted for 8 to 14 days, with signs of progressive respiratory failure. In addition to the moderately severe and torpid course of viral pneumonia, three patients showed hematology test abnormalities, such as hypochromic anemia, leukopenia, leukopenia/lymphopenia, and moderate thrombocytopenia. Three patients had high C-reactive protein (CRP) levels. Inpatient treatment consisted of azithromycin 500 mg daily, levofloxacin 500 mg BID, hydroxychloroquine 200 mg BID, and low molecular weight heparin (enoxaparin 0.4 ml, 4000 anti-Xa IU, s.c. BID). Despite the treatment, the patients showed signs of progressive respiratory failure, with increasing dyspnea and gradual decrease in saturation from 96% to 92%. Isolation of peripheral blood mononuclear cells was done in an intermittent blood separator "Haemonetics MCS+" (USA), with subsequent cell irradiation with an extracorporeal blood irradiator (OKUFKE 320/400-600/650-01 "Yulia", ZAO NPKF "METOM", Russia). Ammifurin (ZAO "Pharmcenter VILAR", Russia) was used as a photosensitizer. Three patients had two ECP sessions with an interval of 24 hours, and one patient had one ECP session. Results: In three patients who had received two ECP sessions, there was a regression of radiographic signs of viral pneumonia from CT2 to CT1 (less than 25% of lung tissue involvement) during the next four days (96 hours). In one patient, the follow-up CT showed resolving pneumonia with less than 5% involvement of the lungs. The patients (n = 3) with baseline high CRP levels showed their normalization at 4 days after two ECP sessions. At 24 hours after a single ECP session, leukocyte count and differential, as well as platelets were restored. In three patients, viral RNA tests within 2 to 4 days after ECP were negative. These results were associated with normalization of body temperature, no further progression of respiratory failure, and a reduction in hospital stay. Conclusion: The use of ECP in 4 patients with moderately severe SARS-CoV-2 infection has contributed to the rapid relief of clinical symptoms, resolution of the inflammation and restoration of respiratory abnormalities in all of them. These observations allow us to consider ECP as an effective and safe method of treatment for moderately severe COVID-19 and a promising adjuvant method in the high-risk patients in order to prevent an unfavorable disease outcome.

Мета роботи – аналіз застосування об’єктивного структурованого клінічного іспиту як етапу проведення атестації випуск­ників державного закладу «Дніпропетровська медична академія міністерства охорони здоров’я України». Основна частина. ОСКІ має певні переваги перед традиційними методами оцінки – усними співбесідою, письмовими роботами, тестуванням і прийомом практичних навичок біля ліжка хворого. ОСКІ де-факто залишається практично єдиним методом, що дозволяє ефективно оцінити навички значної кількості студентів за мінімальний час на рівні «показати» піраміди клінічної компетентності G. Miller. На відміну від письмових, усних іспитів і тестування, ОСКІ не просто оцінює рівень теоретичних знань студентів, але перевіряє їх компетентність у застосуванні наявних знань на практиці. Висновок. Порівняно з прийомом практичних навичок біля ліжка хворого ОСКІ дозволяє забезпечити більшу різноманітність клінічних ситуацій, відтворити рідкісні клінічні випадки, перевірити навички студентів в «делікатних» ситуаціях, допускає можливість лікарської помилки.

Objective - to study the concentration of pro- and anti-inflammatory cytokines in patients with early latent syphilis before and after treatment. The study was conducted in 112 patients with early latent syphilis (52 men and 60 women) and 15 healthy persons of the control group - all aged 18-43. Serological tests were used: the classical complex of serological reactions (CSR), ELISA, the reaction of passive hemagglutination (RPGA), immunofluorescence reaction with absorption (RIF-abs) and RIF-200. Using ELISA, the levels of cytokines IL-2, IL-6, IL-10, TNF alpha, and INF gamma were determined in serum (in patients with latent syphilis, before and after treatment). The analysis of the received data was carried out with application of the program package Statistics 6.0. To identify the relationships between the indices, Friedman's nonparametric variance analysis with the definition of chi(2) was used. The concentration of IL-10 before treatment in patients with early latent syphilis was significantly increased by 3.7 (14.9 +/- 0.9 pg/ml compared to the control group 4.11 +/- 0.5 pg/ml). The dependence of the content of this cytokine on the period of infection was established. It was found that one year after treatment concentration of IL-10 remained 1.8 times higher. The concentration of IL-6 was increased by 6.5 times in patients with latent early syphilis and was also dependent on the period of the infection, and also even 1.5-2 years after treatment the IL-6 content remained elevated. It was also found that in patients with latent early syphilis the concentration of IL-2 was increased by 2.3 times and it did not normalize in 24.5% of patients even two years after treatment. In patients with latent early syphilis, the concentration of TNF alpha was increased by 3.6 times. After treatment, the concentration of TNF alpha decreased, but exceeded the control values by 1.55 times. Further analysis of the concentration of TNF alpha revealed that, with a disease period of up to one year, the concentration of this cytokine was normal during ten months after treatment, and in patients with the disease period of more than one year, after treatment normalization of the TNF alpha level was absent in 64.5% even after 18 months. It was found that the concentration of INF gamma in patients with early latent syphilis before treatment was increased by 3.8 times in comparison with the control group. After treatment, almost 25 % of patients with the duration of the infection more than one year revealed no normalization of INF gamma and it was increased by 1.5 times. In patients with latent early syphilis there was a significant increase in the concentration of cytokines TNF alpha and INF gamma, an imbalance of IL-2, IL-6, IL-10 as well as. The dependence of the cytokine concentration on the period of infection is noted. Based on the study of the cytokine status in patients with early latent syphilis with periods of infection of more than one year, the use of immunomodulatory therapy may be recommended. Increasing the concentration of such cytokines as TNF alpha, IL-6, IL-10 after treatment can be used as prognostic tests of serological resistance.