Digital medicines are innovative drugs with targeted effects on the basis of aptamers that have a unique digital code. Digital drugs are easily synthesized and chemically modified, stable, non-immunogenic and non-toxic. The aim of the review is to present the scientific achievements of KrasSMU devoted to the development of digital medicines based on aptamers and to search for biomarkers in comparison with the world level. It was shown that for the first time in the world, aptamers to postoperative materials of lung cancer were obtained in KrasSMU, that are able to find circulating tumor cells in the blood of oncological patients; for the first time in the world, there were obtained aptamers suppressing the growth of pathogens of salmonellosis; there were developed aptaconstructions, capable in vivo to carry out the destruction of malignant tumors.

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The literature does not describe the work of an ambulance in the forming urban agglomerations that causes the urgency of its study.
The aim of the research. To study the age structure of the population and analyze the ambulance calls in the Krasnoyarsk urban agglomeration.
Material and methods. The age structure and the ambulance call in the Krasnoyarsk urban agglomeration for 2016 were analyzed. The age structure of the population and the work of the ambulance was analyzed according to the data of forms No. 30 of the state medical statistics. The analysis of the received information was carried out with the use of absolute and relative indicators, as well as intensive indicators.
Results. The analysis showed that the proportion of the able-bodied population in the agglomeration is 62.2 %, and non able-bodied is 37.8 %, 54.3% of them are over working age. In 2016, there were 476939 departures of the ambulance brigades and 477341 people were provided with medical care, 42.6 % of them were of working age, 31.0 % were over working age and 26.4 % were younger than the able-bodied age. An analysis of ambulance arrivals for reasons showed that 83.3 % of visits were associated with sudden illnesses and conditions, 9.2 % - accidents, 7.5 % - transportation of patients, parturient women and puerperas. The largest number of people who got first aid belonged to the senior non able-bodied age group (585.6 per 1000 population of the corresponding age group), and the smallest to the able-bodied population (262.0 per 1000 population of the corresponding age group). The share of hospitalized patients was 39.2% of the total number of people have got the medical care, while their share in the territories was varied from 17.3 % in Divnogorsk to 39.2 % in Krasnoyarsk.
Conclusion. Our analysis of the age structure of the population and the ambulance calls in Krasnoyarsk urban agglomeration made it possible to determine the scope and structure of the ambulance calls in the administrative territories included in the agglomeration and agglomeration as a whole, which will allow us to develop a program for its improvement.

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The aim of the research. Comparative evaluation of the use effectiveness of vacuum-assisted laparostomy and vacuum-instillation laparostomy in patients with advanced purulent peritonitis.
Material and methods. The work was carried out by employees of the Department of Surgical Diseases named after prof. A. M. Dykhno, Krasnoyarsk State Medical University named after prof. V.F. Voino-Yasenetsky on the basis of the Krasnoyarsk Regional Purulent-Septic Center. The study included 23 patients who were treated with vacuum assisted laparostomy and 24 patients who had vacuum-instillation laparostomy using an original instillation-drainage device. To assess the effectiveness of using classical and instillation treatment regimen with local negative pressure, the SOFA (Sepsis-related Organ Failure) scale and the abdominal cavity score were used. The dynamics of changes in microbial contamination of the abdominal cavity, the time of muscular-fascial closure of laparostoma, the dynamics of changes in intra-abdominal pressure, the frequency of complications, lethality, the durability of stay of patients in the intensive care unit and the total length of the hospital treatment period were studied.
Results. An analysis of the results showed that vacuum-instillation laparostomy is more effective in the sanitation of the abdominal cavity in the perioperative period. It allows to reduce bacterial contamination and perform earlier primary muscular-fascial closure of the abdominal cavity. The use of vacuum- instillation laparostomy reduces the incidence of intestinal fistula and abdominal abscesses. The mortality rate in patients with widespread purulent peritonitis with the use of vacuum-assisted laparostomy and vacuum-instillation laparostomy is comparable.
Conclusion. The method of vacuum-instillation laparostomy allows to increase the efficiency of perioperative sanation of the abdominal cavity.

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The aim of the research. Assessment of patients condition with widespread purulent peritonitis and predicting the outcome of the disease.
Material and methods. The study included 50 patients with widespread purulent peritonitis. who were evacuated from primary care facilities after performing a surgical sanation of the focus of intra-abdominal infection. Assessment of the condition severity was carried out using modern scales SAPS-II и SOFA. From the laboratory indicators, the leukocyte intoxication index, C-reactive protein, procalcitonin and lactate were included in the study panel. Additionally, the microbial number in peritoneal exudate and the value of intra-abdominal pressure were evaluated.
Results. Studying the dynamics of these indicators using modern methods of statistical processing allowed us to determine the threshold values of these parameters and the critical periods when, based on a comprehensive assessment of diagnostic data, a decision is required to change the surgical tactics and the protocol of intensive therapy.
Conclusion. It can be assumed that when performing the 2nd sanitizing operation, increasing the predictive criteria above the threshold values allows not only to predict the outcome of the disease, but also to plan the need for changing the therapeutic tactics in terms of activating surgical and intensive care measures.

The aim of the research. To study the frequency of genetic polymorphism of IL-1β (C3953T, T511C, T31C), IL-10 (G1082A, C592A, C819T) and its association with concentration IL-1β, IL-10 in the blood serum and lymphocytic-platelet adhesion in patients with various forms of chronic purulent otitis media.
Material and methods. 299 patients with chronic purulent otitis media (146 patients with mesotympanitis, 153 with epitimpanitis) and 183 patients without
pathology (control group) were examined. All patients had standard clinical, x-ray, audiometric examinations to verify the diagnosis, molecular genetic
analysis of DNA by PCR and immunological examination by ELISA were carried out. Statistical processing of the obtained data was carried out using a
software package STATISTICA 6,0 (StatSoftInc., USA). The critical level of significance in testing of statistical hypotheses was taken to be less than 0.05.
Results. A statistically significant prevalence of the homozygous genotype C / C and the heterozygous genotype -T / C over the high-producing allele C *
IL-1β gene, respectively, in polymorphic loci 31 and 511 and homozygous genotypes A / A and C / C for the low-producing alleles of the A * and C * IL-10 gene respectively in the polymorphic loci -1082 and -819 in the group of patients with a cariose-destructive course of chronic purulent otitis media. High
values of IL-1β (p <0.05) were registered against a background of low IL-10 values (p <0.05) in the serum of patients with epitimpanitis in the carriage of highproducing variants of the genes of pro-inflammatory cytokines and low-producing alleles of anti-inflammatory cytokines. Lymphocytic-platelet depression was found in all patients with chronic purulent otitis media.
Conclusion. The data obtained suggest that the common immunopathogenetic link of chronic purulent otitis media is the axis: genes IL-1β, IL-10 - the
corresponding cytokines - lymphocytic-platelet adhesion. The carrier of genotypes-31CC and -511TS promoter of the IL-1β gene increases the possibility of developing a destructive form of the disease.

The aim of the research. To study the healing process of the experimental wound with the use of our combination with miramistin and metronidazole in
comparative aspect with the “Levomekol” ointment.
Material and methods. The following composition served as the material for the study: Miramistin solution 0.01 % - 100.0 g, Metronidazole 1.0 g, Sodium salt
of carboxymethyl cellulose - 4.0 g. The experiment was performed on 120 male Wistar rats, which were divided into 2 statistically homogeneous groups of 60
animals in each, a purulent wound was modeled to all the experimental subjects using the method of P.I. Tolstykh. In the control group the local treatment of
the wound was performed with the help of “Levomekol” ointment, in the experimental group the treatment was performed by composition 1. Assessment of the course of the wound process was carried out using planimetric, microbiological and histological methods of research. The data were registered and the animals were removed from the experiment on the 1st, 3rd, 5th, 8th, 10th and 15th days.
Results. The data of the microbiological study confirmed the high efficiency of the combination developed by us in relation to standard test strains of
microorganisms-pathogens of wound infection. As a result of the planimetric study, a significant reduction in the area of wounds in the experimental group
was revealed compared with the control one on the 10th and 15th day of the observation, which indicates a more favorable course of the healing process in
the experimental group. The use of the combination developed by us in the treatment of the purulent-inflammatory process of the soft tissues promotes an early decrease in the microbial contamination of wounds, in comparison with the “Levomekol” ointment, that was noted on the 8th and 10th days. After
the histological examination, it was noted that the processes of regeneration and epithelization proceeded better in the experimental group in relation to the
control.
Conclusion. Thus, our combination with miramistin and metronidazole, has an effective antimicrobial effect against gram-positive and gram-negative
microorganisms, shortens the course of the first and second phases of the wound process compared to the use of a standard agent.

The aim of the research. To conduct a comparative analysis of risk factors for embolic stroke development based on material from the case histories and protocols of pathoanatomical autopsy of the deceased with ischemic stroke in the hospitals of Tomsk in the period from 01.01.2008 to 31.12.2015.
Material and methods. A retrospective cohort study of risk factors for embolic stroke development based on material from case histories and protocols of
pathoanatomical research of 8967 deaths in hospitals in Tomsk for the period from 01.01.2008 to 31.12.2015. Risk factors for embolic ischemic stroke in
groups with atrial fibrillation and sinus rhythm were analyzed, according to the scale CHA2DS2-VASc.
Results. According to protocols of pathoanatomical autopsy, the embolic ischemic cerebral infarction was detected in 206 deceased (2.3 %). All of them have arterial hypertension. In the group of patients with atrial fibrillation, acute myocardial infarction was in 22 % of patients, post-infarction cardiosclerosis
in 53 %, chronic heart failure in 86 %. Diabetes mellitus was diagnosed in 53 (41 %) patients, with a severe degree in 63 %, in 47 % of patients the target
values of the level of glycemia were not achieved. In the group of patients with sinus rhythm, acute myocardial infarction was detected in 24 % of patients,
postinfarction cardiosclerosis in 30 %, chronic heart failure in 62 %. Diabetes mellitus was diagnosed in 25 % of patients, with a severe degree in 74 %, in 63 % of patients the target values of the level of glycemia were not achieved.
Conclusion. It is of interest that, according to autopsy data, cardioembolic stroke was 1.6 times more often diagnosed in the group with sinus rhythm compared to persons with atrial fibrillation. In this case, the target values of INR before the onset of stroke were reached in 10 % of patients. Persons with arterio-arterial atherothromboembolic type of stroke prevailed both in the group with sinus rhythm and in the group with atrial fibrillation.

The aim of the research. To assess the effectiveness of passive verticalization on the background of ongoing ventilation in patients with acute impairment of cerebral circulation.
Material and methods. The analysis of 55 cases of patients diseases with a diagnosis - acute disorder of cerebral circulation by ischemic type, that are on AVL. Patients are divided into two groups: group 1 - with passive verticalization, group 2 - without passive verticalization.
Results. Respiratory support for patients in both groups began almost on an equal time frame from the moment of hospitalization, tht is explained by the identical initial severity of the patients. In patients of both groups, a ventilator-associated pneumonia was diagnosed. The beginning of hemodynamic disorders requiring inotropic support and its duration, also had comparable indicators in both groups, not having a statistically significant difference. The duration of inpatient treatment, stay in intensive care unit and duration of AVL in group 1 significantly exceed those indicators in group 2, that, in our opinion, is associated with lower mortality among patients who had verticalization (these indicators have a high statistical reliability). An analysis of the neurologic deficit in surviving patients for SHIG did not show any significant differences.
Conclusion. The use of early verticalization in patients with ischemic stroke on the background of AVL does not lead to a deterioration in the neurological and somatic statuses. In patients with ischemic stroke on the background of ventilation - increases the timing of ventilation, available in the intensive care unit and in the hospital for reliable in comparison with patients who had no verticalization.

The aim of the research. To compare the effectiveness of the complex use of Dr. Arabin obstetrician pessary in combination with progesterone and only progesterone in pregnant women at high-risk group for the development of preterm birth.
Material and methods. There were 137 pregnant women of high-risk group for the development of preterm birth. The main group (I, n = 87) included pregnant women with Dr. Arabin’s pessary; in the control group (II, n = 50) included pregnant women without correction of the cervix. Patients of the two groups also took progesterone preparations.
Results. Dynamic observation of the location of the placenta during pregnancy allowed to register a different frequency of its migration in the study groups: 63.2 % (55/87) of the case in the first group (main group), only 16.0 % in the II (control group) 8/50), (χ2 = 10.743, p = 0.001). Premature births were registered in 11.7 % (10/85) in group I, in group II this indicator was 26.5 % (13/49) (χ2 = 2.469, p = 0.115). Operative births were 2 times more common in women who received only progesterone compared with the group with obstetric pessary Dr. Arabin (χ2 = 4,179, p = 0,040), the frequency of bleeding in birth in group II (control) was 7 times higher than this complication in the main group (I) (χ2 = 8.805, p = 0.003).
The conclusion. The use of obstetric pessary Dr. Arabin in combination with progesterone, effectively reduces the risk of developing premature birth and bleeding.

The aim of the research. The aim of this study was to compare the frequency of development, the severity of the clinical course of early neurosyphilis (RNS), and the efficacy of its specific therapy in HIV-infected patients (main group) and in persons without HIV infection (comparison group).
Material and methods. The results of a comparative analysis of the frequency of development, the severity of the clinical course of the RNS, and the effectiveness of its specific therapy in HIV-infected patients (the main group) and in people without HIV infection (comparison group) in the Irkutsk region are presented. The main group consisted of 85 patients with a combination of syphilis and HIV infection, in the comparison group - 1006 patients with syphilis without HIV who were hospitalized at the Irkutsk Regional Dermatovenerologic Dispensary in period from 2000 to 2016.
Results. It was revealed that RNS was developed 1.5 times more often (in 87.0 % in the main group and in 56.6 % in the comparison group), proceeded in the clinical forms with a more pronounced neurologic deficit and was worse succumbed for specific therapy in the main group than in group of comparison.
Conclusion. RNS in HIV-positive patients occurred earlier and more often, was in the severe clinical forms, and specific antibiotic therapy was marked with lower efficacy compared with syphilis patients without HIV infection. The obtained results indicate the need to change the tactics of diagnosis and optimize the therapeutic approaches to the treatment of neurosyphilis in HIV-infected patients.

The aim of the research. To assess the effect of additional short-term prescribing of doxycycline on the development of unfavorable left ventricular (LV) remodeling in patients with acute primary anterior myocardial infarction with ST segment elevation (IMspST).
Material and methods. Twenty-one patients with acute primary anterior Q-IMspST, admitted to the department and undergoing coronary ventriculography during the first 24 hours from the onset of the disease, were included. Echocardiography and the definition of degradation markers of the intercellular matrix were carried out at the 1st (T1), 3d (T2), 7th (T3), 14th (T4) days and 6 months after acute MI (T5). Immediately after inclusion in the study, the «envelope method» was used to determine patients who were prescribed doxycycline for the first 7 days.
Results. A significant decrease in matrix metalloproteinase (MMP) -9 and an increase in MMP-3 to T3, continuing to T5 (p <0.05) was revealed. Dynamics of MMP-2, as well as TIMP1 is not revealed. The ratio of MMP9 / TIMP1 was decreased from T2 to T3 (p <0.05). The concentration of the C-terminal telopeptide was decreased already to T4 (p <0.05). The relationship between the end systolic volume (ESV) of the LV and the diastolic (EDV) LV with MMP-9 at T5 (r = 0.81, r = 0.77, p <0.05, respectively) was found. In the group with additional doxycycline, there was an increase in the level of MMP-3 to T3, continuing to T5, and a decrease in the C-terminal telopeptide from T1 to T5 (p <0.05). In the group with standard therapy of IM, an increase in the level of MMP-2 from T3 to T5, a significant decrease in MMP-9 from T1 to T5, the ratio of MMP9 / TIMP1, in contrast was much lower at T2 and T3 (p <0.05). The parameters of EDV at point T5 and ESV of LV at T3-5 were significantly higher in the group with additional doxycycline. In the other group, a large amount of FV LV and apical rotation was detected, a smaller value of INLS, 2D global longitudinal deformation, and basal rotation at early and late times after IM.
Conclusion. The additional prescribing of doxycycline to patients with acute primary anterior IMspST suppresses the activity of MMP-2 and increases the activity of MMP-3 from the 7th day to the 6-month observation period. Significantly reduces the intensity of disintegration in the collagen I type to the 14th day. The absence of the effect of doxycycline therapy on the level of MMP-9 and the development of an unfavorable LVD was revealed.

This article shows that despite the high evidence of the effectiveness of cardiac rehabilitation, only a part of patients aimed at coronary artery bypass grafting (CABG) understand that adherence to the doctor’s recommendations is the key to success, and they need physical rehabilitation programs. Even fewer patients (72%) are ready to participate in such programs. These facts indicate the need for efforts aimed not only at introducing of interdisciplinary rehabilitation programs for patients with cardiovascular diseases, but also for activities that increase the motivation of patients to participate in such programs.

The aim of the research. To increase the availability of preventive materials for parents of early age children.
Material and methods. The opinion of parents of early age children, pediatricians and heads of medical organizations providing medical care to the children at an outpatient level was studied to develop a structural and organizational model of a healthy child electronic cabinet. To assess the effectiveness of the introduction of the electronic cabinet of a healthy child, the opinion of parents who visited the electronic office of a healthy child, district pediatricians, actively using the electronic office of a healthy child in preventive work with the population, and experts was studied.
Results. The technique of improving the organization of primary medical prevention with early age children, including the use of information technology, in the process of improving the medical literacy of parents by creating an electronic cabinet of a healthy child. The purpose of organizing an electronic cabinet for a healthy child is to provide informational materials electronically to parents of early age children in order to obtain the necessary knowledge and skills on care, nutrition and upbringing, which is a factor in the formation and increase of the responsibility the parents for the health of children, as well as enhancing the role of preventive measures for protecting the health of the child population.
Conclusion. Improving the organization of preventive work with early age children on the basis of the introduction of the electronic cabinet of a healthy child makes it possible to increase the availability of medical care for the child population in medical organizations that provide medical care to the children at an outpatient level.

The article deals with the clinical case of transcatheter correction of the secondary interatrial septum defect (ASD) in a 62-year-old patient, complicated by the occluder migration. Secondary ASD was diagnosed 10 years ago, indications for transcatheter correction were determined. An occluder with the diameter of 12 mm was implanted in the transseptal position. After 48 hours, the occluder was not detected in the septal position. The occluder was discovered, captured and relegated to the right femoral artery. An additional measurement of the defect size with the use of a “sizing” -balloon was carried out. Implantation of the occluder into a septal position with the diameter of 22 mm.

To date, the implantation of electronic devices, such as a pacemaker or implantable cardioverter-defibrillator, has been widely used in clinical practice to treat various types of heart rhythm disturbances. The number of implanted devices is growing steadily every year. Possible complications of the installation procedure for such devices are well known. In particular, electrode-associated complications are not uncommon for the implantation of a pacemaker or a cardioverter-defibrillator. A number of rare complications are described in the literature: surgery can be complicated by bleeding or effusion into the pleural cavity, pericardial cavity. We are describing the case of postpericardiotomy syndrome in a 71-year-old patient after an operation of atrial electrode reposition, diagnostic and therapeutic tactics. This case is indicative for specialists, since even a minor injury of the heart can cause this symptomatology.

This article presents a literature review on the problem of pigmentary papillary dystrophy of the skin (black acanthosis). The authors describe the clinical case of a malignant variant of black acanthosis in a patient with gastric adenocarcinoma. The defeat of the skin preceded the diagnosis of malignant formation during the year, in this connection, the authors emphasize the need for increased alertness in interpreting the clinical symptoms of this skin pathology.