Health risks from asbestos have been evaluated on the basis of professional histories from remote past, when exposures at workplaces were greater than today. The linear no-threshold model has been applied, although its relevance has not been demonstrated. Fibers are often found in the lungs and pleura at post mortem examinations. The fnding of fbers does not prove that a disease was caused by asbestos. It can be reasonably assumed that targeted search for mesothelioma and other asbestos-related diseases in exposed people resulted in increased detection rate. Histological and immunochemical characteristics of malignant mesothelioma partly overlap with other cancers, which may contribute to overdiagnosis in exposed populations. Amphibole asbestos is more toxic than chrysotile but there are discrepancies between experimental and epidemiological data. The promising way to obtain reliable information is lifelong animal experiments. Asbestos bans applied in some countries are excessive and should be reconsidered on the basis of independent research. It can be reasonably assumed that non-use of asbestos-containing brakes, freproofng, and insulation increases the harm from fres, armed conflicts and trafc accidents.

The paper analyzes the literature data on the role of cytokines in the pathogenesis of malignant neoplasms (MN). Cytokines are biologically active, hormone-like proteins that regulate a wide range of processes occurring in the body. Cytokines determine the type and duration of the immune response, stimulation or suppression of cell growth, their differentiation, and functional activity. The complex of cytokines produced in the tumor microenvironment plays an important role in the pathogenesis of MN. The spectra of biological activities of cytokines overlap in most cases. The same process in a cell can be stimulated by more than one cytokine, creating a favorable environment for the initiation and progression of MN. The immune system can recognize transformed cells. Various cytokines correspond to specifc pathways activated by receptors on the cell surface, which in turn cause intracellular signaling cascades that affect target cellular functions. Cytokine genes are mutually related to oncogenes. Cytokines, which are released in response to infection, inflammation, or during an immune response to an antigen, can inhibit tumor development. In turn, cytokines, which weaken apoptosis and promote invasion and metastasis, promote tumor growth. Cytokines are involved in the initiation, development and metastasis of malignant neoplasms through various mechanisms.

Erythropoietin (EPO) exerts its effect on erythroid lineage cells through interaction with the EPO receptor (EPOR), the so-called canonical pathway, and through a complex consisting of EPOR and a common cytokine receptor beta subunit (CD131) – a non-canonical pathway for non-hematopoietic cells of the human and animal body. EPO realizes its effects through the launch of a signaling cascade, which begins with the phosphorylation of Janus kinase 2 (JAK2) and then with the involvement of phosphatidylinositol-3 kinase B (PI3K) or Ras-mitogen-activated protein kinase (MAPK) or signal transducers and transcription activators (STAT). EPO exhibits a direct cytoprotective effect through increased CD131 expression and subsequent development of anti-apoptotic and anti-inflammatory effects in target cells. In addition to its use in the treatment of anemia, EPO is increasingly being used in correction of inflammatory and degenerative processes, both in experimental and clinical studies. EPO promotes the engraftment of stem cells, differentiation of mesenchymal stem cells in the connective tissue direction, suppresses the inflammatory response and apoptosis of cells in the lesion. The article includes literature data concerning EPO and its clinical use in inflammatory and degenerative processes, based on data from eLibrary and the National Center for Biotechnological Information (NCBI) for the period 1998–2022.

Mesenchymal stem cells (MSCs) are multipotent stromal cells that can differentiate into various cell types, including adipocytes, osteocytes, chondrocytes, etc. MSCs can be isolated from various human and animal tissues. MSCs are characterized by high proliferative capacity, differentiation in the connective-tissue direction, paracrine and trophic activity (they produce a wide range of biologically active molecules), are capable of migrating to the zone of organ and tissue damage, and exhibit immunosuppression. There are similarities and differences between human and mammalian MSCs in phenotype and functional activity. The therapeutic potential of MSCs has been shown on experimental models and in clinical trials, which allows us to consider the MSC-oriented cell technologies as an alternative to traditional methods of treatment. The article presents a review and analysis of the literature devoted to the study of MSCs properties, signaling pathways involved in the regulation of cell activity, the prospects for the use of MSCs in the treatment of inflammatory and degenerative diseases. During preparation of the review full-text, free access articles for the period from 2006 to 2022 were taken from eLibrary and National Center for Biotechnology Information (NCBI) databases.

Vaginal delivery after a Caesarean section remains a controversial topic: there is a lack of reliable data to help doctors and women in labour to determine the best option for delivery during subsequent pregnancy. The review analyzed and summarized the results of the studies devoted to childbirth of pregnant women with scars on the uterus, considered the advantages and disadvantages of vaginal childbirth and repeat Caesarean section, the frequency of complications in the attempt of vaginal childbirth in women with scars on the uterus has been assessed. The modern medical literature available in open sources has been studied: Russian-language scientifc electronic libraries eLibrary and CyberLeninka, Englishlanguage database of medical and biological publications PubMed. It is necessary to consider the data of anamnesis and clinical-instrumental data when choosing the best management tactics of pregnancy and delivery for women with scars on the uterus. Attempting to deliver vaginally helps to reduce maternal and neonatal morbidity, and a large number of studies on this issue should help to reduce the number of unwarranted repeat Caesarean sections. Vaginal delivery after a Caesarean section is an opportunity to avoid severe abdominal surgery and negative consequences associated with repeated Caesarean sections.

Osteoarthritis is caused by a complex interplay of genetic, metabolic, immunological, inflammatory, biochemical, and biomechanical factors. In recent years, a fairly large number of studies have been devoted to the role of cellular factors of the immune system in the development of osteoarthritis. The aim of the study was to analyze scientifc publications devoted to the study of cellular factors in the pathogenesis of osteoarthritis and to assess their signifcance in the development of joint pathology. Material and methods. The search for publications by keywords was carried out in the PubMed, Google Scholar, eLibrary databases and specialized journals related to therapy, rheumatology, traumatology and immunology from 2000 to 2022. Results and discussion. Summarizing modern ideas about the role of cellular factors of the immune system in the pathogenesis of osteoarthritis, it is necessary to note the presence of synovial inflammation, a key role in the development of which is assigned to macrophages. At the same time, patients with osteoarthritis are characterized by the predominance of classically activated macrophages with a pronounced pro-inflammatory effect. In addition, T lymphocytes also play an important role in the pathogenesis of joint damage. Among them, a special role is given to T helper cells, cytotoxic T lymphocytes and memory T cells. An imbalance of cytokines and chemokines produced by subpopulations of T lymphocytes is the reason for triggering a number of mechanisms for the onset and progression of osteoarthritis. A signifcant role in the development and progression of osteoarthritis is also assigned to neutrophils, which contribute to the development of inflammation. Neutrophil-produced elastase enhances cartilage degradation, chondrocyte apoptosis, unbalanced subchondral bone remodeling, and osteophyte formation. Conclusions. Knowledge of the role of cellular immune factors in the pathogenesis of osteoarthritis and ways to implement their effects determines the prospects for the use of immunotropic agents. Also, it should be taken into account that the occurrence and progression of osteoarthritis is due to the simultaneous combination of the influence of a wide range of various components, including risk factors, traumatic joint injury, etc.

The essence of the preconditioning effect is the activation of urgent defense mechanisms of adaptation as a result of a short episode of weak, non-damaging hypoxic or ischemic exposure, which contributes to an increase in the tolerance of the subsequent delayed, more severe exposure to hypoxia or ischemia. Aim of the study was to assess the literature data on the possibility of using the method of remote ischemic preconditioning (RIP) as a non-pharmacological method for correcting physical performance. Material and methods. In the Scopus, PubMed and eLibrary databases, a selection and analysis of modern literature sources devoted to the issues of increasing human performance, especially by nonpharmacological methods, as well as the use of distant preconditioning to increase physical performance and the mechanisms for implementing this effect, were carried out. Results. Since the discovery of the phenomenon until now, researchers have considered RIP, mainly as a way to protect organs and cells from ischemic damage in clinical practice. The article presents the literature data on the use of RIP as a non-drug method for improving physical performance with single and course use cases. In addition, the article focuses on the mobilization of the body’s own resources through the mechanisms of adaptation to hypoxia developing during RIP. Conclusions. Among the non-pharmacological methods of increasing physical performance, one of the most promising, in our opinion, is RIP that mobilizes the body’s own resources through the mechanisms of adaptation to hypoxia. The advantage of the method based on short-term cessation of blood circulation in the lower extremities and subsequent reperfusion does not apply to the ways prohibited in sports, does not require the use of drugs and the availability of special equipment, signifcant costs of economic and organizational resources.

The aim of the study was to carry out a comparative analysis of the linear size of the uterus in women during the frst period of adulthood and old age according to ultrasound examination data. Material and methods. The study was based on the results of ultrasound examination of 53 women with normal pelvic dimensions who were examined at the gynecology department of the Perm Krai Clinical Hospital during the period from 2021 to 2022. All the women consented to the examination, which was performed according to the indications in order to exclude probable pathology of the reproductive system. The ultrasound examination consisted of measuring the longitudinal (length), transverse (width) and anteroposterior (thickness) dimensions of the uterus using transvaginal access. Women were divided into two groups: the frst group consisted of 27 subjects of the frst period of mature age (22 to 35 years), the second group included 26 subjects of advanced age (75 to 88 years). Results. When comparing the indicators of uterine size, their statistically signifcant decrease from the frst period of adulthood to old age: uterine length decreased by 54.5 % (p < 0.001), width – by 57.8 % (p < 0.001), thickness – by 67.8 % (p < 0.001). We believe that this pattern can be substantiated by the onset of postmenopause and a decrease in estrogenic hormone content from reproductive age to senile age. Conclusions. The obtained results of the intravital comparative analysis of the uterus linear dimensions in women of the frst period of adulthood and old age expand the scientifc ideas about age-related features of this organ of the reproductive system, are the basis for further research and can be used by physicians of clinical specialties such as gynecology, gerontology, ultrasound diagnostics.

Violation of the extracellular matrix components synthesis regulation contributes to the formation and growth of uterine fbroids (MM). Changes of collagen metabolism in connective tissue may be associated with polymorphism of matrix metalloproteinase (MMP) genes. Aim of the study was to analyze of the association of regulatory regions of matrix metalloproteinase genes MMP2 (rs243865), MMP3 (rs3025058), MMP9 (rs3918242) with the development of uterine myoma, its histological form, several concomitant gynecological diseases. Material and methods. The clinical study of 69 patients (23–54 years old) with uterine myoma was conducted. According to the anamnesis, 57.9 % of patients had childbirth, 46.4 % of women had an artifcial termination of pregnancy, and 15.9 % of women had endometriosis. In histological examination, in 48.14 % the nodes corresponded to the phenotype of simple fbroids with a large proportion of fbrous tissue, 51.6 % with the phenotype of proliferating fbroids. The comparison group is represented by a random population sample of women from Western Siberia. 183 women without pronounced gynecological pathologies were examined. MMP2-1306 C/T polymorphism was analyzed by TaqMan, MMP3-1171 5A/6A, MMP9-1562 C/T by restriction fragment length polymorphism method. Results. The genotype frequencies of the analyzed genes did not signifcantly differ between the groups. The complex genotype MMP2-1306CC:MMP3-11715A6A:MMP9-1562CT was decreased in women with uterine myoma relative to the persons of the comparison group. In endometriosis patients MMP9-1562CC genotype was reduced and heterozygosity was increased relative to patients without endometriosis. The frequency of MMP2-1306CC:MMP9-1562CT complex genotype is signifcantly higher in women who gave birth than in women who did not give birth. Complex genotypes differences between histological variants of uterine myoma were revealed. Conclusions. The results of the study show the signifcance of polymorphism effect of the regulatory regions of the MMP genes in the development and nature of the course of uterine myoma.

The main problem of simultaneous operations is their duration, which, as a rule, is more than 4 hours, which exceeds the allowable time and often causes complications in the postoperative period. Aim of the study was to evaluate the effectiveness of simultaneous operations performed by two surgical teams simultaneously. Material and methods. The object of the study was 24 patients aged 25 to 55 years, who simultaneously underwent classical abdominoplasty with navel transposition and anchor breast lift on implants by one and two surgical teams. The evaluation and comparison of the duration of surgical interventions according to the data of anesthesia charts have been carried out. Further, the assessment of the condition of patients before surgery and for 1 day in the postoperative period was carried out using the questionnaire for assessing the quality of recovery after anesthesia (QOR-40, quality of recovery 40-item questionnaire).Results and discussion. Performing abdominoplasty simultaneously with the correction of the shape and volume of the mammary glands by two surgical teams simultaneously reduces the duration of the intervention by 27 % on average, and therefore the quality of recovery of patients in the postoperative period is signifcantly higher. Prolonged exposure to general anesthesia and other potentially dangerous intraoperative conditions (for example, blood loss, hypotension, hypothermia, infections) interfere with the maintenance of physiological homeostasis by the body. And, therefore, reducing the time of surgery is important to reduce the frequency of complications. In order to minimize the operation time in combined cases of abdominoplasty and breast plastic surgery, it is logical to involve two operating teams at the same time, which reduces the total operating time to 3 hours. Conclusions. Today one of the main methods of solving problems associated with the duration of complex simultaneous operations is the simultaneous coordinated work of two surgical teams to minimize the duration of intervention and reduce postoperative complications.

Aim of the study was to analyze the course of coronavirus pneumonia in patients with pneumomediastinum. Material and methods. The study included 139 patients, 71 of whom developed spontaneous pneumomediastinum against the background of coronavirus pneumonia. Laboratory, clinical and radiological data were analyzed and compared. Results. The relationship between the severity of viral pneumonia (3rd–4th degree of severity according to MSCT) and pneumomediastinum was revealed. It was found that spontaneous mediastinal emphysema in patients with COVID-19 signifcantly more often leads to the development of acute respiratory distress syndrome, multiple organ failure and can be a predictor of negative prognosis of the disease outcome. Conclusions. Pneumomediastinum in patients with viral pneumonia caused by a new coronavirus infection is a predictor of severe disease and poor prognosis. With an increase in spontaneous mediastinal emphysema without pneumothorax, it is recommended to perform mediastinotomy according to Razumovsky’s indications, and in case of clinically signifcant concomitant pneumothorax – drainage and revision of the mediastinum.

Violations in the provision of medical care are detected by controlling the volume, timing, quality and conditions of medical care. The objective of the work is assessment of the activities of the round-the-clock hospital from the standpoint of the quality of medical care during the COVID-19 pandemic. Material and methods. A database of indicators reflecting the activity of round-the-clock hospital for four years, from 2017 to 2020 (Omsk) was formed. Analytical, statistical methods and the method of expert assessments were used to analyze the required indicators. Results. Evaluation of inpatient hospital activities during the COVID-19 pandemic compared to the “pre-pandemic” years showed a 1.9-fold and 2.9-fold decrease in the total number of quality examinations performed and the number of defects detected, respectively. The number of defects that were grounds for denial or reduction of payment for medical care found in the “before-COVID-19” years was 2.1 times higher than in 2020. In 2020, the weight of the share of those defects that directly reflect the quality of medical care increased signifcantly. The quantitative composition of the inpatient hospital staff changed insignifcantly during the analyzed period – the number of physicians increased  by only 5 % over four years, with no dynamics in the qualitative characteristics of the staff. The number of medical equipment increased by 27.6 %. Due to re-profling in 2020, there was a decrease in the number of hospitalized patients, with an increase in the proportion of patients admitted by emergency care (up to 91 %) and an increase in mortality by 2.7 times. Conclusions. One of the conditions for maintaining high quality of medical care is a balance between the main components of quality: accessibility, timeliness, sufciency, efciency and safety and the speed of its achievement, which in turn depends on the amount of resources and reserves.