[The higher education at the post-Soviet territories: the long echo of the Bologna process]. / Vysshee obrazovanie na postsovetskom prostranstve: dolgoe ékho Bolonskogo protsessa.

The objective of the present work was to analyze the possibilities envisaged by the Bologna system for the improvement of the quality of higher medical education at the post-Soviet territories. Any academic innovations including, in the first place, the accession to the Bologna process should be assessed in terms of their influence on the quality of education. This article describes the main factors responsible for the impaired quality of specialist training and the unjustified growth in the number of students in the combination with the loss of motivation to study. The arguments are provided in support of the opinion that the principles of the Bologna Declaration work fairly well only In the framework of the western educational model, but even there their widespread implementation not infrequently gives rise to contradictory and conflicting attitudes. At the same time, the two-level training systems deserve attention, firstly as a mechanism facilitating transition of a student to another speciality after he (she) completes the first-level course and, secondly as a means to shorten the total length of training. It is demonstrated that the competency-based model regarded as an exclusively European innovation has actually been borrowed from the Soviet higher education system. The devastating consequences of the total transition to the modular education are discussed.

[The experience with the reconstruction of the superoposterior wall of the external auditory meatus during stapedoplasty].

The objective of the present study was to improve the effectiveness of stapedoplasty by developing the method for the prevention of the formation of retraction pockets in the tympanic membrane and cicatrical fixation of auditory ossicles. A total of 60 patients presenting with grade I-II otosclerosis and conductive or mixed-type hearing impairment were surgically treated during the period from 2008 to 2014. Twenty four of these patients had undergone stapedoplasty in the preceding period in different clinics that either failed to improve their conditions or resulted in their deterioration. A new method was proposed for the reconstruction of the superoposterior wall of the auditory canal during stapedoplasty that consists of the replacement of the removed fragment by the last 150-200 mcm ultrathin allocartilaginous plate. This plate prevented the subsequent retraction of the superoposterior portions of the tympanic membrane and its fusion with either the long process of the anvil bone or the prosthetic ring. The method of this operation is described. The analysis of long-term results of the treatment confirmed the high effectiveness of the proposed approach.

[The role of the perinatal transmission and persistence of human papilloma virus in the development of juvenile respiratory papillomatosis]. / Rol' perinatal'noi peredachi i persistentsii virusa papillomy cheloveka v razvitii iuvenil'nogo respiratornogo papillomatoza.

This review paper presents the results of the recent studies designed to elucidate the etiopathogenetic role ofhuman papilloma virus infection in the development of respiratory papillomatosis in the children. Special attention is given to the possible pathways and mechanisms of the mother-to-child transmission of papilloma virus, its frequency and risk factors during pregnancy and in the postnatal period. The results of investigations into the frequency of papilloma virus infection in the children are presented along withrisk factors contributing to its persistence and the development ofjuvenile respiratory papillomatosis. The possible approaches to the management of this condition are proposed.

[The possibilities for the application of the fluoroplast-based prostheses with a diamond-like carbon nanocoating in ear surgery (an experimental study)].

The objective of the present study was to elucidate general and local characteristics of the tissue reactions to the implantation of radiation-modified polytetrafluoroethylene (PTFE)-based fluoroplast F-4PM20 with a diamond-like carbon (DLC) nanocoating or with the diamond-like carbon coating containing the dispersed nano-sized silver particles to the experimental animals (rats). A total of 150 inbred white rats were included into the experiment; they were divided into 3 groups comprised of 50 animals each. The rats in group 1 were implanted with the 5 nm thick strips of fluoroplast F-4PM20 having the diamond-like carbon nanocoating. The animals of group 2 were implanted with the same material containing nanoparticles of chemically pure silver dispersed in the coating, those in group 3 (controls) were implanted with the fluoroplast F-4PM20 without a coating. The animals were sacrificed on days 7, 21, 30, and 60 days after the onset of the experiment. The tissues surrounding the implant as well as heart, lung, spleen, liver, and kidney tissues were taken for the histological study. The local reactions of different tissues were found to be uniform even though there was an apparent tendency toward the less pronounced granulation and scarification processes in the animals implanted with the diamond-like carbon coating containing the dispersed nano-sized silver particles. In none of the groups, the animals exhibited statistically significant lymphoid tissue hyperplasia in the spleen which suggested the activation of the immune system in response to implantation. It is concluded that the PTFE-based fluoroplast F-4PM20 implants with the 5 nm thick DLC coating and a similar coating containing the dispersed nano-sized silver particles can be applied for middle ear reconstructive surgery, being a histologically compatible material that does not cause an inflammatory degenerative response of the tissues.

[The microbiological structure of chronic suppurative otitis media in the Gomel region].

The objective of the present work was to study the spectrum of microbiota maintaining the inflammatory process in the cavities of the middle ear of the patients presenting with chronic suppurative otitis media (CSOM) and to estimate its susceptibility to antibiotic agents. The discharge from the ears was subjected to microbiological analysis in 138 patients with CSOM. Some of the microorganisms proved highly sensitive to antibiotic agents. The following etiologically important pathogens involved in the maintenance of the chronic pyoinflamatory process in the cavities of the middle ear were identified: bacteria, fungi, and bacterial-fungal associations that accounted for 66.3%, 6.7%, and 26.9% of all CSOM cases respectively. The former group was dominated by S.aureus (34.6%) whereas the group of non-fermentative Gram-negative species and enterobacteria comprised 16.3% and 15.4% of their total number respectively. The microbiota was shown to be highly susceptible to cephalosporins of the 1st and 2nd generations and fluoroquinolones of the 2nd generation. C. albicans proved highly sensitive to fluconazole while mycelial micromycetes responded fairly well to itracnazole and voriconazole.

[Reconstructive mastoidoplasty following sanitation surgery on the ear].

The objective of the present study was to enhance the effectiveness of surgical rehabilitation of the patients presenting with "operated ear disease". Sixty four patients underwent sanitation surgery on the ear by means of plastic correction with the use of a muscular-periosteal flap on a feeding pedicle with the simultaneous restoration of the posterior wall of the external auditory canal by the implantation of septal autocartilage. The surgical technique is described. The analysis of long-term results of the treatment of such patients has demonstrated its high efficacy.

[Auditory brain stem implantation: reality and prospects].

This review describes the history of development and application of the auditory brain stem implantation techniques and current clinical progress in this field. Indications for the use of this methods adopted in different countries are considered in conjunction with peculiar features of the design of the most common types of the implants. The basic surgical approaches and the most frequently observed postoperative complications are described. The data obtained by different researchers on the functional efficacy of surgical intervention and opportunities for the improvement of its audiological outcome with the help of modern technical means and surgical modalities are discussed.

[Use of autotransplants and implants in ossiculoplasty].

The paper presents a comparative analysis of efficacy of ossiculoplasty (OP) using different transplants. A total of 202 operations were performed. Prostheses made of the fragments of the auditory ossicles, or a cortical layer of the temporal bone (n=81), of nail plate (n=56), titanium implants (n=65) were applied. A satisfactory result was achieved in 72-87% ossiculoplasties. Functional outcomes of OP did not vary significantly with type and material of the prosthesis. Main causes of poor OP results were fixation or displacement of the prosthesis with fibrous tissue; in case of titanium prostheses -- perforation of the tympanic membrane with prosthesis extrusion.

[Reconstruction of the chain of the auditory ossicles after radical operation on the middle ear]. / Rekonstruktsii tsepi slukhovykh kostochek posle radikal'noi operatsii na srednem ukhe.

As restoration of hearing in patients after radical surgery on the middle ear for otitis media purulenta chronica remains topical, we tried to increase the efficacy of ossiculoplasty in such patients by staged reconstruction of the middle ear. A total of 102 patients were examined and operated on. A modified classification of osseous chain defects was used to evaluate the degree of damage to the osseous system. The following policy was employed for reconstruction of the middle ear: in patients with large trepanation cavities (more than 5 ml) mastoidoplasty was carried out as the first stage using a musculo-periosteal flap with an anterior or inferior pedicle; at the second stage, myringoplasty was performed using a two-layer graft followed by ossiculoplasty with autotransplants (fingernail plate, auricular or tragal cartilage, cortical layer bone). Long-term follow-up of the patients showed that good and satisfactory hearing levels were obtained in 79.4% of the patients. The air-bone gap was closed by 10 dB or more in the speech frequency range in 80.4% of the patients. Staged reconstruction of the middle ear using autotransplant materials significantly decreased the number of postoperative complications (perforation of the plastic flap, cicatrical displacement of the prosthesis and graft rejection).

[The dynamics of two-layer graft acoustic properties at different times after myringoplasty]. / Dinamika akusticheskikh svoistv dvukhsloinogo transplantata v razlichnye sroki posle miringoplastiki.

A two-year follow-up tympanometric results have been analysed for 40 patients subjected to myringoplasty. Ultrathin allocartilage was used as one of the transplant components. The static compliance of the neotympanic membrane seemed to change in a wide range, but the changes did not affect hearing. The formation of an adequate neotympanic membrane takes place by the end of the second year after the operation.

Prenatal diagnosis of spinal muscular atrophy in Russia.

Ninety-two families with spinal muscular atrophy (SMA) applied for genetic counselling and further prenatal diagnosis. To minimize expenses, only one tightly linked informative marker was determined in the course of preliminary examination, and non-radioactive allele detection was preferably used. Four prenatal diagnoses of SMA type I, four of SMA type II, and one of SMA type III were made. This trial programme shows the considerable requirements, importance, and potential effectiveness of prenatal prediction of SMA in Russia.

[A method of myringoplasty used in patients with extensive defects of the tympanic membrane]. / Sposob miringoplastiki u lits s obshirnymi defektami barabannoi pereponki.

Multilayer transplants made up of an ultrathin allocartilaginous plate (an internal layer), autofascia of musculus temporalis (an intermediate layer) and stored amnion (an external layer) were used to eliminate extensive perforations of the tympanic membrane. The transplantation resulted in high proportion of the graft takes with a considerable improvement of hearing.

[The screening diagnosis of bronchitis and its premorbid states in the workers of the nonferrous metallurgy enterprises of the Arctic]. / Skrining-diagnostika khronicheskogo bronkhita i ego premorbidnykh sostoianii u rabochikh predpriiatii tsvetnoi metallurgii Zapoliar'ia.

Mass screening diagnosis of the workers and employees engaged in nickel industry of the Noril'sk industrial region (n = 3049) according to the clinico-epidemiological program of the All-Union Research Institute of Pulmonology demonstrated a high incidence of chronic bronchitis (CB) and its preclinical conditions. The persons at risk for CB accounted for 41.5%, for prebronchitis for 23%, and those with CB for 19%. Among men, CB and its preclinical forms were demonstrable at a greater rate (63.7%). The disease prevalence depends on the time of residence in the Extreme North. Irregularity of the disease prevalence among different occupational groups is determined not only by the industrial and hygienic working conditions but also by the whole complex of ecological factors of the extreme region.

[Characteristics of otorhinolaryngologic diseases in the indigenous rural population of the North]. / Osobennosti LOR-zabolevaemosti korennogo sel'skogo naseleniia Severa.

This paper presents the data describing specific features of ENT diseases in the aboriginal population of the North (Yakutians) obtained through mass-scale detailed examinations of the villagers. ENT pathologies were identified in 52.7% of those taken under examination. Among the pathologies ear diseases were in the first place (43.8%), pharyngeal diseases were in the second place (38.2%), nasal and paranasal diseases in the third place (14.2%). It is concluded that the prevalence and structure of ENT diseases among the population of the Far North should be taken into consideration when organizing ENT medical assistance in this area.

[The Northern variant of the norm in the thermal picture of the face]. / "Severnyi" variant "normy" teplovoi kartiny litsa.

One hundred and ten healthy residents of the cities of Krasnoyarsk and Norilsk were examined using the method of thermal visualization. As a result, a symptomcomplex of the thermal face picture typical of the Northern version of the norm was detected and described. When compared to the controls from Krasnoyarsk, delta T of the target group from Norilsk was on the average 0.07 degrees C lower. The knowledge of the thermal normogram in the Far North can help adequately interpret face thermograms of patients with nasal and paranasal pathologies in different geographical regions.

[Use of helium-neon lasers in the treatment of postoperative wounds of the pharynx]. / Ispol'zovanie gelii-neonovykh lazerov v lechenii posleoperatsionnykh ran glotki.

This paper presents the results of treatment of post-operative pharyngeal wounds in 54 tonsillectomized patients (residents of the Far North) using a helium-neon laser. The treatment had a significant analgetic and anti-inflammatory effect which was demonstrated by the so-called swallow test, bar-algisimetry, thermometry of the mucosa of the anterior palatine arches and mandibular area, and cytological examination of the exudate from the tonsillar niches. Application of a low energy helium-neon laser in tonsillectomized patients shortens the therapeutic period by 2 days.

[Thermographic and rhinorheographic parallels in clinical diagnosis of inflammatory diseases of paranasal sinuses]. / Termograficheskie i rinoreograficheskie paralleli v klinicheskoi diagnostike vospalitel'nykh zabolevanii okolonosovykh pazukh.

One hundred and thirty patients with inflammatory diseases of paranasal sinuses were examined using highly sensitive methods--thermography and rhinorheography. It is concluded that the combined application of these methods is highly efficient for early detection of inflammatory diseases of paranasal sinuses.