Vol 21, No 4 (2024)

Reforming the rehabilitation system for children with cerebral palsy is currently a pressing problem in the social sphere of the Russian Federation. The aim of the work is to analyze the state of disability in children with the consequences of cerebral palsy. The study used data from the Federal State Statistics Service, the Federal Register of Disabled Persons, and information from the Unified Automated Information System of the Medical and Social Expertise (EAVIISM). Analysis of data on the level of primary childhood disability in the Russian Federation due to diseases of the nervous system showed fluctuations in 2018–2021. Comparing the rates of primary disability in children with cerebral palsy in Moscow and the Central Federal District, there was a decrease in the number of children in this category from 332 to 228 people in Moscow and from 1160 to 790 people in the Central Federal District. Violations were often noted in children aged 0 to 3 years. According to the gender structure, boys prevailed mainly, their proportion was 57–58 %. In terms of the degree of disability in children, 1st and 2nd degree prevailed, the disorders were associated with self-care and movement. In general, the level of disability of children with cerebral palsy recognized for the first time in the Russian Federation is higher than in Moscow and the Central Federal District, this was explained by the presence in the Central Federal District and Moscow of a high level of medical and rehabilitation care for children with cerebral palsy.

Goal. The study of approaches to improve the efficiency of building lean competencies among healthcare professionals through quality management components (Donabedian triad) with an assessment of the result of invested educational investments. Materials and methods. The article presents the author's methodology for deploying advanced training programs in lean technologies through quality management of the Donabedian triad. The formation of training programs through the blocks "structure", "process", "result" is aimed at increasing the effectiveness of improving the necessary skills in the field of process improvement. As an example, the structure of one of the professional development programs is given with an assessment of the investments made in the skills of employees and on the results of the activities of a medical organization. Results. During the period of comparative analysis of training and implementation of the inventory management system in a medical organization, using the skills acquired during training, an assessment of the profitability of the invested costs for the resulting effect for a medical organization (ROI indicator) is shown. Each ruble invested in investments under the same conditions brought 46 rubles to the hospital. Scientific contribution. The formation of a methodology for practice-oriented postgraduate training programs with an assessment of their effectiveness in the long term on the activities of the organization, which requires continued research in this direction. Conclusion. The effectiveness of postgraduate training of specialists can be achieved only through joint consolidated approaches aimed at obtaining and improving the necessary skills that increase the effectiveness of the organization. The scope of application. The described concept of practice-oriented learning can be applied in any field of activity. Limitations of future research. Not revealed.

The variability in the shape of the alveolar arches is due to numerous etiological factors, which predetermines the methods of diagnosis and the choice of methods for modeling artificial dental arches in full removable dentures. Purpose. To determine the features of the diagnosis of unilateral narrowing of the superior alveolar arch and modeling of complete removable prostheses. Material and methods. The materials of the study are presented by a clinical case of a patient with unilateral narrowing of the upper jaw with the optimal size of the inferior alveolar arch. For diagnostics, a method for constructing geometric figures on scaled photographs of models of edentulous jaws is proposed. In particular, the parameters of the diagnostic triangle and the semi-ellipse made it possible to assess the deviation of the actual dimensions from the calculated indicators, taking into account the individuality of the dimensions of the gnathic part of the face. Results and discussion. The features of the shape and size of the alveolar arches in unilateral narrowing of the upper jaw determined the placement of artificial teeth along the midline of the alveolar ridge. At the same time, the shape of the dental arch did not correspond to the ellipse. The chewing teeth on the side of the narrowing of the upper jaw closed with the reverse overlap and the torchial values of the molars of the right and left sides were different. Conclusion. The results of the study made it possible to evaluate the modeling of artificial cross-occlusion with a change in the torque values of the molars on the side of the narrowing as an optimal occlusal equilibrium that provides a functional optimum of the masticatory apparatus in the complete absence of teeth in combination with unilateral narrowing of the upper jaw.

An algorithm for matrix convolution of the energy spectrum of multiple docking of ligands into relevant target proteins is presented. Using anxiolytic activity as an example, a matrix convolution of the energy spectrum of multi-target multiple docking into 22 convolutional variables was performed. Using the methods of ANOVA, discriminant analysis and neural network analysis, high statistical significance of using the obtained convolutional variables for assessing the integral multi-target affinity of ligands to a set of relevant biotargets was shown. As a result, a new method for constructing convolutional neural networks for in silico search for pharmacologically active substances based on matrix convolution of the energy spectra of multi-target multiple docking was developed.

In the structure of comorbidity in patients with HIV infection, neoplasms of various forms occupy a significant place. According to the classification of the Centers for Disease Control and Prevention, 1993 (CDC), all MN in HIV infection are classified into malignant neoplasms that determine the stage of AIDS, the so-called AIDS-associated tumors (AAT) and AIDS-non-associated tumors (NAAT). To characterize the epidemiological and clinical morphological structure of comorbidity in HIV infection in combination with oncological diseases in the Volgograd region. We studied extracts from outpatient records, patient medical histories, histological examination protocols. The largest proportion of oncological pathology in HIV-infected persons in the Volgograd region is malignant neoplasms, which were detected in 73.7 % of patients (109 cases). The average median age in HIV-infected patients with neoplasms was 41.1 years, with a predominance of 57 % women. The most common malignant tumor is cervical cancer 17.4 %, which belongs to AIDS-associated tumors. Breast cancer 13.2 %, colorectal cancer 9.2 %, lung cancer 9.2 % are the most common among AIDS-unassociated tumors. It is necessary to continue the epidemiological, clinical and morphological analysis of malignant neoplasms in HIV-infected patients, taking into account the stages of diseases, the results of treatment, and therapeutic pathomorphosis, which will allow for the implementation of a multidisciplinary approach in the treatment and diagnostics of comorbid pathology.

Determining the types of dental arches is a relevant topic of scientific and practical research. Purpose. Development of research methods and determination of the features of trusal types of dental arches of physiological occlusion. Material and methods. A retrospective cahort study of 62 pairs of plaster models of jaws, the occlusal status of which corresponds to the physiological norm, was carried out. To distribute the material according to the types of trusal arches, the recommendations of specialists were used with the measurement of the distal transversal and odontometry of 14 teeth of the upper and lower jaw. In the photographs of the models, central and distal points were established, which were connected by diagonal lines that formed a diagnostic triangle. When determining the angular parameters, the sine of the angles was mathematically calculated and measured using a protractor. Outcomes. The value of the index for the mesotrusive type was (0.68 ± 0.04) units, the value of the index less than 0.63 units is characteristic of the dental arches of the retrusive type, and more than 0.72 units is characteristic of incisor protrusion. The value of the incisal angle, for the mesotrusive type, ranged from 70 to 78°. An increase in the central angle of more than 79° determined the belonging of the dental arch to the retrusive types, and a value of less than 69° is characteristic of the protrusive arches. Conclusion. Thus, the resulting determination of the size of the trusal type and the incisal angle of the dental triangles of both jaws can be used to assess the features of the dental arches and their distribution according to the trusive type.

A retrospective analysis of linear and angular parameters of dental and alveolar arches was carried out on 62 pairs of models of the upper and lower jaw with signs of physiological age norm. The construction of diagnostic triangles of dental and alveolar arches was carried out on photographs of jaw models obtained from plaster. The trusal index was determined through the ratio of the arc depth to its width. The central angle of the arcs was determined between the diagonals. It was found that for the mesotrusal type of the upper dental arches, the trusal index ranged from 0.64 to 0.72, and for the alveolar arches, the index ranged from 0.72 to 0.78 units. The value of the central angle of the upper dental triangle in the mesotrusive type of arches ranged from 70 to 74°, and the angle of the upper alveolar triangle in the same type of arch was 62–69°. A decrease or increase in the indicators determined the belonging of the arcs to the protrusive and retrusive variants.