The effectiveness of the developed approaches to the conservative treatment of traumatic injuries of the rotatory-bicepital complex is assessed. The long-term results of conservative treatment of 29 patients for the period from 2004 to 2017 and treated in the Mogilyov regional hospital and the SCTC of the 6th Minsk city clinical hospital were studied. The conservative treatment indications were considered to be the cases with traumatic partial local or extensive injuries of the rotator-bicepital complex in the presence of clinical manifestations in the form of pain syndrome and limitation of limb movements and in the absence of a decrease in limb strength in the sectoral testing of elements. The proposed tactical approaches implied immobilization, physiotherapy, local injection therapy.The developed conservative approaches to treating patients with damage to the rotary element of RBC allowed one to achieve a favorable outcome in the absolute majority of cases with long periods of patient follow-up, which improved the performance evaluation indicators according to the Oxford questionnaire for Me shoulder from 56 [48–58] to 12 [12–32] (Me [Q25–Q75]). The applied conservative approaches to treating patients with damage to the rotary element of RBC are a promising way to improve the clinical treatment results of patients with partial injuries of the rotator-bicepital complex.

The article presents the results of viral infections monitoring in children at different times after renal transplantation and experience of their use in treatment of post-transplant complications. This study presents the results of virological investigation of relevant agents of viral infections (CMV, EBV, HSV 1, 2 tons, HHV 6, HHV 7, VZV, ADV, BKV and JCV). The frequency of identifying the viral infections in blood in the early postoperative period (the frst 3 months after transplantation) was 20.0 %, in the late postoperative period – 8.0 %, in the case of graft dysfunction – 21.4 %. According to the results of PCR tests of urine, BK and / or JC viruses were identifed in 40.0 % of recipients in the early postoperative period and in 47.1 % of recipients in the late postoperative period. The dominant pathogens were polyomaviruses, BKV (22.9 %) prevailed in the early postoperative period, and JCV (36.8 %) in the late postoperative period. There are the examples of treatment of acute transplant rejection combined with HHV 6 viremia and graft dysfunction combined with a long-term persistence of BKV infection. The use of vanganciclovir in the frst case and the replacement mycophenolate mofetil (MMF) by azathioprine in the second one allowed stabilizing the function of the transplanted organ.

Dynamics of a coronary artery calcium index as a factor of a cardiovascular risk in chronic terminal hepatopathy patients who need transplantation is determined. A prospective single-center cohort study was done and included 250 patients who need liver transplantation. The observation time was 5.4 ± 3.29 years from the moment of putting a patient on the waiting list. In addition to the assessment of occurrence and dynamics of traditional cardiovascular risk factors, calcium index indicators were determined by the method of multispiral computer tomography at the stage of including a patient into the study and after fve years of dynamic monitoring. The calcium index indicator in chronic terminal hepatopathy patients who need transplantation exceeded the limits of the recommended norm defned by a value of the 75th percentile, in 56.3 % (n = 152) of the examined patients at the stage of putting them on the waiting list. While comparing the coronary calcinosis indicators after fve years of dynamic monitoring the recipients of the liver transplants showed higher values of the calcium index in comparison with the patients with chronic terminal hepatopathy who did not receive the donor organ (CI, AJ-130 – 223 (38; 597) and 141 (4; 176) units respectively, p < 0.05; CI, Volume-130 – 314 (73; 748) and 203 (8; 284) mm2, respectively, p < 0.01), and the patients with metabolic syndrome (CI, AJ-130 – 186 (78; 463) and 74 (21; 192) units respectively, p < 0.01; CI, Volume-130 – 278 (74; 623) and 124 (74; 273) mm2 respectively, p < 0.01) and/or ischemic heart disease (CI, AJ-130 – 274 (102; 683) and 109 (34; 246) units respectively, p < 0.01; CI, Volume-130 – 382 (98; 834) and 382 (98; 834) mm2 respectively, p < 0.01) from the overall population. The obtained results make it possible to suppose that in addition to the radical solution to the liver defciency problem, the performance of orthotopic liver transplantations on patients with chronic terminal diseases accelerates the development of coronary atherosclerosis in the long-term postoperative period.

Human parvovirus infection is characterized by a variety of clinical manifestations. Based on the genetic analysis, genotypes 1a, 1b, 2, 3a, 3b of parvovirus B19 are distinguished, which have different geographical distribution. In the period 2005–2016, in Belarus 210 strains of parvovirus B19 isolated from the patients with various forms of parvovirus infection, mainly erythema infectiosum, were genotyped. All strains, except one, belonged to genotype 1a. One strain belonged to genotype 3b and was isolated from a child with aplastic crisis who arrived in Belarus from Kazakhstan for medical care. On the phylogenetic tree, the strains of genotype 1a formed two groups related to the subtypes 1a1 and 1a2. During the 12-year observation, both subtypes circulated in Belarus, but with varying intensity. In the highest incidence years, as well as one or two years before and after this (2005–2008 and 2013–2016), strains of subtype 1a2 predominated in circulation. During the period of low incidence (2009–2012), the dominant position belonged to subtype 1a1. The average genetic distance inside each subtype was 0.51 % for 1a1 and 0.56 % for 1a2. Between subtypes it was also small – 1.32 %. It can be assumed that subtype 1a2 is more new for Belarus and therefore might be connected with the increase of morbidity.

Treatment of peritoneal adhesions are still of great importance today. One of the prophylactic measures is biodegradable gels and membranes. The objective of the investigation was to develop and to experimentally assess new materials based on pectin and alginate. Alginate hydrogel was prepared with 4.0, 7.0 and 10.0 weight per cent. The pectin sols were synthesized by the “green chemistry” method. To make flms and porous membranes the solution casting method and the freeze-drying technique were used accordingly. The materials were studied in vitro and in vivo. Their physical properties, biocompatibility, biodegradability, adhesion, the prevention effect, the possibility of using as a matrix for mesenchymal stem cell transplantation were assessed. Alginate hydrogel of 7.0 weight per cent didn’t cause postoperative complications and led to low adhesions incidence – in 10 % of cases (in the comparison group – 85.7 %). Pectin flms obtained by the solution casting method became deformed already in the physiological solution. Biodegradation of the flms was absent in the experiment, abscesses and infltrates in the abdominal cavity were noted. Mesenchymal stem cells didn’t attach to such flms. Porous pectin matrices synthetized by the freeze-drying technique became partially decomposed already in the physiological solution. In the experiment, these membranes were biodegraded in half animals with the formation of mild adhesions only in 25 %. Mesenchymal stem cells showed a good attachment to their surface. The developed materials based on alginate gel and porous pectin membranes showed a high biodegradation, good biocompatibility, adhesion the prevention effect and the possibility of using as a matrix for stem cells transplantation.

The hepatoprotective effect of the self-emulsifying composition with berberine was studied in the model of toxic liver damage in rats with acetaminophen and its hepatoprotective properties were analyzed in comparison with the use of berberine in free form. The course introduction of self-emulsifying composition with berberine before intoxication of rats with acetaminophen to a greater extent inhibits the development of cytolysis of hepatocytes, and also promotes the enhancement of the glutathione unit of the antioxidant system, increasing the content of total and free sulfhydryl groups, compared with the introduction of free berberine in animals.

The results on the in-stent restenosis in the mid-term period after successful coronary arteries chronic total occlusion (CTO) recanalization by the antegrade approach are assessed. The study included 117 patients who underwent coronary artery CTO recanalization for the period from 2009 to 2012. After 6.1 ± 0.9 months (stage К1) and 12.7 ± 1.6 months (stage К2), all patients were examined by coronary angiography, intravascular ultrasound and optical coherence tomography. During the frst half of the year after the CTO recanalization, there was a more frequent in-stent restenosis rate in the right coronary artery (in 25.6 %) as well as a predominance of focal types of restenosis (59.1 % of the total). The incidence of restenosis depending on the DES type varied over a wide range of values (from 0 to 52.4 % in the frst half of the year and from 0 to 41.2 % in the second half of the year). A signifcant increase in the incidence of restenosis was observed after the trapidil eluting stents implantation (52.4 % in the frst half of the year, 26.3 % in the second half of the year) and sirolimus eluting stents (38.9 % in the frst half, 41.2 % in the second half of the year). Our data show that different types of DES differently determine the changes in the vascular lumen during the medium term period after the successful CTO recanalization.

The possibility of application of endovascular and two-stage combined revascularization of the penis in the arteriogenic ED treatment is shown. Twenty male patients with multifocal atherosclerotic lesions of the aorto-iliac-femoral segments underwent the analysis of the branching patterns of the IPA according to the classifcation by Adachi and Yamaki followed by the interventional endovascular intervention (angioplasty, stenting) of the iliac arteries. Seventeen patients underwent the unilateral and three patients – bilateral stenting of the common and external iliac arteries. Three patients out of the total number of the operated ones additionally underwent an open revascularization of the penis by epigastric-penic anastomosis. A complex preoperative examination of patients – candidates for revascularization of the penis for arteriogenic erectile dysfunction was performed and included ultrasound, МCT-angiography of the pelvic arteries, and electroneuromyographic examination of atherosclerotic lesions of the pool vessels of the inner pudental artery. Subsequently, endovascular and combined open revascularization operations were performed on the iliac and penis vessels. The erectile function improvement according to the IIEF-5 scale (8–12 scores before the operation vs 16–19 points after the operation) was noted in 1, 3, 6, 12 months (p < 0.05). Combined revascularization operations on the iliac and penis arteries (endovascular and open “bypass”) allow an adequate arterial blood perfusion to the penis in the steno-occlusive lesions of the pool vessels of the IPA affected by atherosclerosis.

A correlation analysis was made of the relationships between the structural changes in the brain and the content of idiotypic, anti-idiotypic antibodies to the soluble calcium-binding protein of the nervous tissue S100 in the serum of 318 children of the frst year of life with consequences of pre- and perinatal brain damage. We established the conjugation between the structural pathology of the brain, represented by cystic-atrophic changes, calcifcations, glia in the brain substance, periventricular leukomalacia, periventricular cysts, expansion of the ventricular system, congenital malformations of the brain, and the content of idiotypic, anti-idiotypic antibodies to the S100 protein in the serum blood of children 3, 6, 9, 12 months old. The concentration of idiotypic and anti-idiotypic antibodies to the protein of the nervous tissue S100 in the serum reflects the severity of destructive processes in the brain substance. Autoimmune processes are one of the mechanisms that lead to the structural damage to the brain in children with adverse pre- and perinatal factors.

The data on 248 victims with severe mechanical injuries admitted to the health care facility “Emergency Hospital” in Minsk for 2014 were examined. In the course of the study, positive and problematic issues were identifed that required a further development in the organization of care and treatment of victims with severe mechanical trauma at an early hospital stage.

The new information, that has become available at present, makes it possible to outline a mechanism of brain water metabolism in the realization of which an important role belongs to AQP4, the main aquaporin of the brain. This aquaporin controls water transfer across the blood-brain barrier and water exchange between brain parenchyma and the cerebrospinal fluid. In the world literature, AQP4 is viewed as a molecular target for the drug action directed at correction of the brain water metabolism disorders in pathologies. The new knowledge made it possible to outline principal approaches to pharmacological correction of cerebral water metabolism disorders and edema.

The review analyzes the current data on the main mechanisms of toxic effects of alcohol and its metabolites on pancreatic acinar cells in acute pancreatitis. It is shown that the mechanisms of cellular damage are multicomponent and closely linked by the regulatory factors of the molecular level. At the early stage of the disease, they lead to the following structural and functional changes in acinar cells that promote the premature intracellular trypsinogen activation and autoaggression: sustained rise of cytosolic Ca2+ and excess of mitochondrial matrix Ca2+; destabilization due to lysosomes and zymogen granules; debective autophagy; mitochondrial depolarization; decreased ATP production and necrosis.

Spondyloarthritis is a group of diseases characterized by a primarily chronic, progressive inflammatory process with the affection of the axial skeleton (spine and sacroiliac joints) and peripheral joints having some common etiopathogenetic and clinical signs. The modern concept of spondyloarthritis involves the isolation of predominantly axial and predominantly peripheral variants of the disease. The problem of spondyloarthritis is in the center of attention of the medical community. Studies of the leading rheumatological centers are devoted to the aspects of the onset and development of the disease, therapy and prevention of disease progression. Signifcant progress has been made in the treatment of spondyloarthritis. The article contains the current recommendations on the management of patients with axial spondylitis.