The aim of the research: to identify the key attributes of corporate employee health promotion programs that are most important for employees using the Kano model.

   Materials and methods. Experts have identified the essential attributes of corporate employee health promotion programs. A survey of employees in the Tyumen region was conducted, the results were processed using the Kano model. The most significant, appealing and neutral attributes were identified. The indices of employee satisfaction and dissatisfaction for each attribute were calculated. The author's Python program was used to determine the correspondence between an attribute and a category according to the Kano model.

   Results. The priority attributes include: rehabilitation after occupational diseases, availability of a room for short-term rest, time off for visiting a doctor, fitness discounts. Appealing attributes: healthy eating, physical education. Attributes with dual perception: regular medical examinations, telemedicine consultations. Indifferent attributes: automated control of physical activity, stress management programs, corporate challenges.

   Conclusion. Employers should focus on mandatory attributes (rehabilitation, flexible schedule), and use healthy nutrition and fitness as competitive advantages.

   The aim of the study: to evaluate the association of metabolic syndrome (MetS) with postoperative complications and duration of treatment in elderly patients after robot-assisted radical prostatectomy.

   Material and methods of the study. A retrospective, controlled, single-center observational study was conducted. 100 patients were divided into a comparison group (n = 50) and a MetS group (n = 50).

   Results of the study and their discussion. The incidence of postoperative complications was statistically significantly higher in patients with MetS (p = 0,005). The duration of postoperative hospitalization was statistically significantly longer in patients with MetS.

   Conclusions. In elderly patients with metabolic syndrome, robot-assisted radical prostatectomy is significantly more often accompanied by the development of postoperative adverse events and a longer duration of treatment.

   The aim. To evaluate markers of systemic low-intensity inflammation (CRP-hs, TNF-α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18) in patients with prediabetes..

   Materials and methods. The analyzed group included 122 individuals with prediabetes, average age 46,2 ± 8,2 years. Average values of carbohydrate metabolism parameters in the group were: fasting glycemia - 6,31 [6,1; 6,6] mmol/l, glycemia after 2 hours during the oral glucose tolerance test – 8,2 [7,1; 9,1] mmol/l; glycated hemoglobin – 5,86 [5,6; 6,1] %. The levels of CRP-hs, TNF-α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18 were determined (ELISA Vector-BEST, Russia).

   Results. Depending on the clinical forms of prediabetes, the prevalence of marker levels in the group of patients with IGT was observed withregard to TNFα (p < 0,001) and IL-8 (p < 0,05). In the group of patients with HbA1c ≥ 5,7 % et < 6,5% – for TNFα (p < 0,003) and PAI-1 (p < 0,033). As BMI increased in patients with prediabetes, there was an increase in the levels of CRP-hs (p = 0,021), TNF-α (p = 0,021), IL-1ß (p = 0,04), IL-8 (p = 0,016). In patients with prediabetes and cardiovascular diseases, there was an increase in the level of markers of systemic low-intensity inflammation: 2,9 times CRP-hs (p < 0,01), 3.1 times TNFα (p < 0,001), 2 times IL-4 (p < 0,042), 1.8 times IL-8 (p < 0,001), 1.6 times IL-18 (p < 0,001).

   Conclusions. Markers of low-intensity systemic inflammation demonstrated an increase in levels in the group of patients with cardiovascular diseases. An association was found through independent predictors of high cardiovascular risk. This allows these parameters to be included in programs for comprehensive assessment of cardiovascular risk in patients with early carbohydrate disorders.

   Objective. To evaluate the effectiveness of early targeted infusion therapy in patients with ischemic stroke, in combination with high-protein nutritional support calculated based on the level of urea in daily urine, in terms of reducing the time of onset of physical rehabilitation.

   Materials and methods. In two comparable groups of patients with ischemic stroke, hypovolemia was corrected: in the main group, in addition to basic infusion therapy, bolus administration with orientation according to the FloTrac® system and high-protein nutrition calculated based on the level of urea in daily urine were used; the control group received basic infusion therapy according to generally accepted approaches and nutrition without priority of high protein intake. The timing of the onset of motor rehabilitation from the moment of admission and the degree of neurological deficit according to the NIHSS scale at discharge from the hospital were assessed.

   Results. In the main group, rehabilitation sessions began, on average, one day earlier than in the control group; also, the main group had a lower NIHSS score at discharge.

   Conclusions. Targeted correction of hypovolemia with a focus on the indicator of the increase in stroke volume during the passive leg raise test (FloTrac®) allows for earlier initiation of active physical rehabilitation and improves long-term prognosis.

   The aim study to the effectiveness of zinc and macronutrient deficiency correction in patients with new coronavirus infection.

   Materials and Methods. In 2021–2023, a comprehensive clinical and laboratory examination of 641 patients with a new coronavirus infection was carried out at the Perm Regional Clinical Infectious Diseases Hospital. Using the envelope method, 2 groups of 43 people with protein and zinc deficiency were formed. In group the first, the nutritional status was corrected with the sipping mixture "Supportan" 100,0 x 3 times a day per os, for a course of 14–21 days, as well as a zinc preparation of 25,0 mg per os for a course of 10–14 days. In the second group additional correction with micro- and macroelements was not carried out, the therapy was carried out in accordance with current clinical guidelines. The observation time for patients corresponded to their stay in the hospital, as well as in the period of early convalescence. The course of the disease, duration of intoxication syndrome, complications that arose during the disease, fatal outcomes in both groups, and the presence of asthenia during convalescence were assessed. The results of the study were processed using the statistical software package Statistica 10.0.

   Results. In group the first, by day 4 (3; 5) of therapy, 90,6 ± 4,5 % showed a decrease in intoxication symptoms, in group the second, by day 5 (4; 6), in 74,4 ± 6,7 % (p = 0,012) and p = 0,046, respectively. A decrease in the volume of previously visible consolidation zones in the lungs and "ground glass" zones on days 10–14 of therapy in group 1 was recorded in 40 people (93,0 ± 3,9 %), in group 2 – in 33 people (76,7 ± 6,4 %), p = 0,033. On the background of correction with a sipping mixture and a zinc preparation, the nutritional status deficiency was stopped in group 1 by days 14–21, and CRP, IL-6, and procalcitonin levels quickly regressed. During the early recovery period in group 1, asthenia was detected in 32,5 ± 7,1 % of patients, in group 2 – in 60,4 ± 7,5 % (p = 0,008).

   Conclusion. Correction of deficiency of the main representatives of the protein pool and zinc during therapy of patients with COVID-19 reduces the duration of intoxication syndrome, accelerates the process of tissue restoration after an infectious disease, and also improves the physical condition of the patient during the period of early convalescence.

   Aim of research: to evaluate the dynamics of ambulatory blood pressure monitoring parameters in patients with arterial hypertension by adding spironolactone to standard antihypertensive therapy of calcium antagonist and angiotensin-converting enzyme inhibitor antihypertensive therapy.

   Materials and methods. 70 patients were randomized into two groups: the first group received of amlodipine/lisinopril combination, the second group followed the same regimen of therapy with addition of 25 mg/day of spironolactone. The monitoring period was 6 months. In all patients we studied and compared the dynamics of office blood pressure, ambulatory blood pressure monitoring parameters including morning blood pressure surge and morning blood pressure surge rate initially, through/peak ratio.

   Results. After of 24 weeks of treatment the office and daily average blood pressure decreased in both groups. Diastolic blood pressure decreased to a greater extent in the spironolactone supplementation group. In the spironolactone group, in distinction from the two-component therapy group, the morning blood pressure surge decreased on average by of 5,0 (-15,4; +2,4) mm Hg. In the standard therapy group, an increase in the morning blood pressure surge rate on average by of 3,1 (1,3; +16,4) mm Hg/h was noted, which was not observed in the spironolactone group. The mean final effect/peak effect ratio for systolic blood pressure became equal 43,5 (7,5; 71,0) % during two-component therapy and 69,0 (46; 89) % in the spironolactone group (p < 0,05).

   Conclusions: The addition of spironolactone to the standard two-component combination in patients with arterial hypertension leads to an additional decrease in office and average daily diastolic blood pressure, reduction of morning blood pressure rise and increase of the antihypertensive effect uniformity in the form of an increase in the final effect/peak effect ratio.

   Research Objective. The aim of this study is to comprehensively assess D-dimer and platelet (PLT) levels in patients with severe and critical COVID-19, analyze their correlation with the intensity of the inflammatory response and disease severity, and identify the days of stay in the intensive care unit (ICU) associated with the highest risk of unfavorable outcomes.

   Materials and Methods. A total of 70 individuals were examined: the study group included 50 COVID-19 patients (age 45,5 [32–48] years), and the control group consisted of 20 healthy volunteers (age 42,5 [34–47.5] years). The study group was further divided into two subgroups: severe course (Subgroup I, survivors, n = 30) and critical course (Subgroup II, deceased, n = 20). Venous blood levels of D-dimer, PLT, leukocytes (WBC), and C-reactive protein (CRP) were measured in COVID-19 patients on days 3, 5, 7, 10, and 16 of the disease, while the control group was assessed once. The respiratory index (RI) and its correlation with D-dimer and PLT levels were evaluated in the study group. Additionally, correlations between WBC/CRP and D-dimer/PLT levels were analyzed. Statistical analysis was performed using Student’s t-test, ANOVA, Spearman’s correlation, and ROC analysis.

   Results. Elevated D-dimer levels were observed, with peak values in the deceased subgroup on day 10 (2,36 ± 0,11 ng/mL; p < 0,001). At the same time point, Subgroup II exhibited the lowest PLT counts (107,05 ± 5.07 × 10⁹/L; p < 0,001). A significant correlation was found between high D-dimer levels and thrombocytopenia compared to elevated WBC and CRP levels, as well as between D-dimer/PLT and RI on days 7 and 10 in the deceased subgroup. ROC analysis identified optimal prognostic cut-off values for mortality: D-dimer >1,41 ng/mL and PLT <126,0 × 10⁹/L on day 7 of the disease.

   Conclusion. High D-dimer levels and thrombocytopenia in the setting of systemic inflammation indicate thromboinflammation and coagulopathy in critically ill COVID-19 patients, serving as unfavorable prognostic markers. A D-dimer level >1,41 ng/mL and PLT count <126,0 × 10⁹/L by day 7 of ICU admission may predict fatal outcomes in critical COVID-19 cases.

   The purpose of the study. To evaluate the prognostic significance of osteopontin (OPN) in determining the risk of adverse cardiovascular and osteoporotic events in women with chronic heart failure (CHF) comorbid with type 2 diabetes mellitus (DM2) and osteoporosis during 36 months of observation.

   Material and methods. The study involved 90 women aged 50-65 years with CHF, type 2 diabetes mellitus and osteoporosis, divided into two groups depending on the initial concentration of OPN in the blood: group 1 – with OPN level ≤23,5 ng/ml and group 2 – with OPN level > 23,5 ng/ml. The combined endpoint was death from common causes, an increase in the functional class (FC) of CHF, the development of non-fatal myocardial infarction (MI), pulmonary embolism, stroke, cases of hospitalization with decompensated CHF and osteoporotic bone fractures.

   Results. In women with a higher level of OPN (> 23,5 ng/ml), the risk of developing cumulative complications was significantly higher (OR = 4,98, p = 0,001). Analysis of individual events revealed a significant increase in the risk of progression of FC (OR = 4,13, p = 0,001) and decompensation of CHF (OR = 2,67, p = 0,021), development of MI (OR = 5,38, p= 0,019) and osteoporotic fractures (OR = 4,86, p = 0,003) with an initial concentration of OPN > 23,5 ng/ml during 36 months of observation. The level of OPN above 23,5 ng/ml with sensitivity = 82 % and specificity = 69 % (area under the curve = 0,86, p = 0,001) predicts the occurrence of adverse cardiovascular events for the combined endpoint, and with sensitivity = 75 % and specificity = 65 % (area under the curve = 0,74, p = 0,001) – the development of osteoporotic fractures during three years of observation.

   Conclusion. Osteopontin is a risk factor for the development of adverse cardiovascular events and bone fractures in women with CHF, type 2 diabetes and osteoporosis.

   Diabetic ketoalkalosis (DK) is a rare but potentially severe complication of diabetes mellitus, requiring emergency medical intervention. The main triggering factors for DK include infectious diseases, surgical procedures and trauma. The pathogenesis of DK involves processes related to reduced circulating blood volume due to persistent vomiting, leading to hydrogen ion loss and elevated blood bicarbonate levels, ultimately resulting in alkalemia. The clinical manifestations of DK resemble those of diabetic ketoacidosis (DKA), except for the presence of intractable vomiting, a symptom specific to DK patients. The diagnosis of DK is primarily confirmed through laboratory findings, including metabolic alkalosis (pH > 7,3 or blood bicarbonate > 18,0 mmol/L) and a delta ratio exceeding 2,0. Differential diagnosis should exclude classic DKA, euglycemic DKA, and hyperglycemic hyperosmolar state. The principles of intensive care for DK are similar to those for DKA and include: fluid resuscitation with isotonic crystalloid solutions to correct dehydration, electrolyte imbalance correction (primarily hypokalemia), intravenous short-acting insulin therapy. Despite its potential severity, DK can be successfully managed without serious complications or fatal outcomes if diagnosed and treated promptly and correctly.

   A review of the literature on the prevalence and genetic causes of lipid metabolism disorders is presented, the results of major studies and registries devoted to the study of the epidemiological features of dyslipidemia are analyzed.

   Rituximab is a synthetic (genetically engineered) chimeric monoclonal antibody that has occupied its niche of application not only in relation to lymphoproliferative diseases (non-Hodgkin lymphomas and chronic lymphocytic leukemia), but also in relation to a number of other diseases. However, when using this drug, a number of complications occur, including immune ones. A certain pattern of development of immune complications has been revealed depending on the stage of therapy. During rituximab therapy, cases of transient decrease in B-lymphocytes or immunoglobulin levels are often reported, which are leveled 6-12 months after the end of treatment with this drug. It also describes the development of prolonged and persistent neutropenia, which develops delayed in relation to the end of therapy. There are risk factors associated with immunological complications: male gender, Caucasian race, age over 50 years, immunocompromised conditions (immunosuppressive therapy, primary and secondary immunodeficiency). The most effective methods of prevention include: detection of severe infectious complications in the last 6 months of patient follow-up, detection of a critical decrease in the level of class G immunoglobulins (less than 4 g /l) and its correction by immunosuppression therapy; determination of the content of mature B lymphocytes in peripheral blood and preventive sanitation of foci of chronic infection.

   Conservative treatment of forearm bone fractures in children is considered the gold standard. The article analyses the possibilities of remodeling fractures that have healed with displacement and determines the age limits for restoring an acceptable anatomical shape of the forearm bones. It is noted that fractures of the distal radius are the most unfavorable for conservative treatment. In the rewiew possible complications of conservative treatment of fractures of this localization are considered and factors leading to secondary displacement of bone fragments are classified. Determination of these prognostic factors allows to identify patients with the highest risk of re-displacement and to adjust treatment tactics.

   Disability after store is caused not only by motor, speech, and other focal neurological symptoms but also by neuropsychiatric disorders. Post-stroke depression (PSD) complicates the effectiveness of rehabilitation measures, reduces the efficacy of treatment for concomitant diseases, exacerbates and increases mortality. This article reviews contemporary perspectives on the prevalence, etiology, pathogenesis, and genetics of post-stroke depression based on scientific literature. The pathogenesis of depression is significantly influenced by the metabolism of biogenic amines, thus particular attention is paid to genetic factors of serotonin metabolism disorders and its role in the development of ADD. Pro-inflammatory cytokines are considered as potential markers of high risk for depression development. Literature on post-stroke anxiety (PSA) is scarce, especially regarding the combination of PSA and PSD. However, the presence of anxiety in patients with PSD prolongs its duration, increases its severity, and significantly reduces the effectiveness of rehabilitation measures.

   Acute myocardial infarction (AMI) is a potential life-threatening complication of coronary heart disease and occupies a leading place in the mortality structure of the population. In recent years, methods of early diagnosis of AMI and comorbid conditions have been improved, which can play an important role in a personalized approach to therapy and prediction of outcomes and complications. The problem of developing and introducing new sensitive and specific biochemical and molecular biomarkers of AMI into real clinical practice is of great interest to Russian and foreign researchers.

   The purpose of this thematic review is to search, summarize and systematize the results of fundamental and clinical studies of the role of microRNAs as sensitive and specific molecular biomarkers of AMI.

   The authors conducted a search for publications in the databases PubMed, Web of Science, Scopus, Cochrane Library, Springer, ClinicalKey, Oxford Press, e-Library using keywords and their combinations. Publications from 2009–2024, including original clinical studies of AMI, were analyzed. As a result of this review, it was shown that circulating miR-1, miR-133a, and miR-208a can be considered promising molecular biomarkers of AMI. The presented brief review indicates that the early diagnosis of AMI has prospects for development due to the development and introduction into real clinical practice of new laboratory tests, including the study of the level of circulating microRNAs in the blood from the first hours of the development of acute coronary syndrome.

   The paradigm of current anesthesiological provision includes multimodality of anesthesia, one of the main components of which is the interruption of the transmission of an afferent pain impulse at the transmission stage. Regional peripheral blocks successfully cope with this task. Blocks of peripheral nerves passing through the flat intermuscular and interfacial spaces have recently become increasingly used as a component of surgical and postoperative anesthesia. This is explained by the widespread introduction of ultrasound navigation during anesthesiological and resuscitation manipulations, which provides good visualization of anatomical structures, the ability to control the movement of the needle, positioning its distal end and control the spread of local anesthetic. The most frequently performed are such planar blocks as: transversely planar block in the anterior abdominal wall, block of the thoracic nerves, block in the plane of the muscles straightening the back, block of the vagina of the rectus abdominis muscle, paravertebral block. All these techniques are united by the superficial location of anatomical structures and their good ultrasound imaging, the absence of nearby large vessels and nerve trunks, which minimizes unintentional injury of vessels and nerves, the use of low doses of local anesthetics, which minimizes the risk of systemic toxicity, as well as minimal effects on hemodynamics, a good and predictable analgesic effect. This article discusses the anatomy, indications, and techniques of the six most frequently performed planar blocks, which are able to provide effective surgical and postoperative anesthesia, early activation, patient comfort, and shorter hospitalization times. The popularization of these types of planar blocks will be facilitated by informing anesthesiologists about the technical features of their implementation and the advantages they provide.

   Aim. To summarize and present up-to-date information on the most frequently performed and most effective regional peripheral planar blocks.

   Materials and methods. When writing the article, the literature on regional peripheral planar blocks was analyzed from the open electronic scientific databases PubMed, the national electronic medical library of the USA and the databases of the Russian scientific electronic library Elibrary and Cyberleninka.

   Conclusion. Sonoscopically well-visualized anatomical landmarks, the absence of closely located large vascular and nerve formations, a good prolonged analgesic effect even with a single injection of a local anesthetic, the possibility of prolonged anesthesia using catheter technologies during regional planar blocks creates conditions for safe, opioid-free and technically easy to perform postoperative anesthesia, which together contributes to an increasingly widespread use these types of blocks.

   Chronic kidney disease (CKD) in children occupies a special position within the system of chronic non-communicable diseases, as it inevitably impacts quality of life and, in advanced stages, necessitates the use of burdensome and costly treatment methods: renal replacement therapy (RRT) – dialysis and organ transplantation, both associated with a high risk of mortality. The concept of CKD, originally intended for adult patients, has since been adapted for the pediatric category, however despite the provision of clear diagnostic criteria and treatment recommendations, several unresolved issues, discrepancies, and challenges remain at various stages of diagnosis and treatment in children. The main difficulties include the vague clinical symptoms in the early, prognostically favorable stages of the disease, the relative reliability of diagnostic indicators used, age restrictions on nephroprotective medications, and a lack of interest from pediatricians and nephrologists in this issue, among others. We present a clinical case of a child with end-stage CKD, diagnosed for the first time at the age of 13.

   A scientific review is presented covering mucopolysaccharidosis type I (Hurler syndrome) caused by a deficiency of α-L-iduronidase, which leads to excessive accumulation of glucosaminoglycans in cell lysosomes with impairment of their function. The review is illustrated by a clinical example. A boy had a heart rhythm disorder of the arrhythmia type, extrasystole, since the 24th week of gestation, neurological symptoms, respiratory distress syndrome were registered after birth, and dilated cardiomyopathy developed. At the age of 6 months, a mutation of the IDUA gene (chr4:987858C > T was detected, the activity of α-L-iduronidase was 0,03 μmol/liter/hour (the norm is greater than 1,96 μmol/liter/hour). From the age of 8 months, enzyme replacement therapy (ERT) was started with laronidase at a dosage of 100 μg/kg/day. During the second infusion, anxiety and hyperthermia were recorded, there were no further adverse effects. Within 10 weeks of ERT, the progression of the disease is stopped, and the child's neuropsychic development improved. Previously, before the use of ERT, all cases of this disease ended in death in infancy. A special feature of this case is the detection of a rare mutation in the IDUA gene, which is not typical for most Slavic and Turkic peoples.

   The article presents a modern literature review highlighting the causes, clinical criteria, and management tactics of patients with a rare pathology – atypical lichen planus associated with candidiasis. The review is illustrated by a clinical example of a 50-year-old woman with the described pathology, which manifested itself in October 2024.

   Currently, in oncological practice, the installation of fully implantable intravenous port systems has become most often used to provide central vascular access. The advantage of port systems over other types of vascular access is associated with minimizing very early and early complications, but late complications are still relevant. The article presents clinical cases of late port-associated complications, patient management tactics in case of their occurrence and possible outcomes. The frequency of late complications of intravenous port systems was assessed. The most common complications are infections, thrombosis and mechanical damage (pinching and fragmentation of the catheter - pinch-off syndrome, damage to the portal chamber, dislocation of the chamber and catheter of the port system, etc.), which can cause interruption of specialized treatment, ineffectiveness of antitumor therapy, affect the outcome of the disease and cause death. Rare complications include such as eruption of the chamber (bedsore of soft tissues in the area of the port chamber) and extravasation of cytostatic drugs. A key aspect of the prevention of late port-associated complications is compliance, both by medical personnel and by the patient himself, with the recommendations for the care of long-term venous access systems set out in current clinical protocols.