The COVID-19 pandemic determined the necessity for prompt diagnostics and optimal routing of patients, followed by rehabilitation and secondary prevention, as domestic tourism intensifies. The epidemic increased the importance of digital systems for the tourism service market. Digitalization took leading positions in the tourism industry and made market participants adapt to these changes for optimizing their activities and increasing revenues. Further development of tourism in Russia, giving the ongoing pandemic, would require digital technologies such as multilanguage informational services overcoming language barriers, digital tourist cards, mobile apps introducing cultural and national landmarks online, web services for preparing tourist routes. Judging from scientific and practical experience, we can expect that medical, social, physical and psychological rehabilitation supervised by medical personnel will improve body functioning including heart, lungs, central nervous system as well as restore patients’ quality of life in general.

In recent years, a particular approach to the treatment of elderly patients with combined cardiac pathology has been gaining importance. It is aimed at adequate antihypertensive therapy and correction of chronologically occurring circadian biorhythms to study the curative effect of ramipril on the daily blood pressure (BP) profile and somnological characteristics of elderly patients with arterial hypertension (AH) and coronary artery disease (CAD). In an outpatient setting, 57 patients with the 1 st and 2 nd degree of stage III essential AH in combination with angina pectoris (AP) 1 and 2 functional class (FC) were examined. Patients underwent general clinical, laboratory examination, daily monitoring of blood pressure, somnological questionnaire survey. The study results allowed us to conclude that ramipril has a significant corrective effect on the regular BP profile and somnological characteristics in patients with combined cardiac pathology.

Background. Disorders in the production of neuroendocrine peptides in the digestive tract can cause changes in, intestinal motility and the formation of visceral hypersensitivity, characteristic of patients with irritable bowel syndrome (IBS). From this standpoint, of particular interest is the study of the role of a number of major endocrine cells (EC) of the colon, secreting motilin, vasoactive intestinal polypeptide, and somatostatin, in IBS. Aims to evaluate the density of ECs with different hormonal activities that secrete motilin, vasoactive intestinal polypeptide and somatostatin in the mucosa of the sigmoid colon in patients with IBS that occurs with constipation and diarrhea. Materials and methods. 85 patients with IBS were examined. The first group included 44 patients with diarrhea (IBSd), the second group included 41 patients with constipation (IBSc). The comparison group consisted of 36 practically healthy people. The diagnosis of IBS was based on the Rome IV criteria. Patients and healthy people were examined according to a single program, including clinical, instrumental (colonoscopy, ultrasound examination of the abdominal organs), laboratory (clinical blood test, feces for calprotectin and antibodies to gliadin in the presence of diarrhea), morphological and immunohistochemical methods. Results. The clinical picture of IBS corresponded to the classical manifestations of this pathology. Among patients with IBSc, there was a more frequent feeling of incomplete emptying of the intestine after defecation, compared with patients with IBSd (p 0.05). Among patients with IBSd, there was a statistically significant increase in the number of ECs producing motilin and vasoactive intestinal polypeptide, as well as a lower density of ECs secreting somatostatin, compared with the control group (p 0.05). In the IBSc group, there was a decrease in the number of ECs producing motilin, vasoactive intestinal polypeptide and an increase in the number of ECs producing somatostatin, compared with the control group (p 0.05). Conclusions. An increase in the number of cells producing motilin, vasoactive intestinal polypeptide and a decrease in the number of cells observed for the production of somatostatin in the mucosa of the sigmoid colon is characteristic of the manifestation of IBSd. At the same time, an increase in ECs secreting motilin, vasoactive intestinal polypeptide and an increase in cellular elements producing somatostatin reveals manifestations of IBSс.

Cancers of the gastrointestinal tract are widespread among the population and cause significant damage to the health care system. In order to improve the strategy of preventive measures and the detection of oncological diseases at the early stages, it is necessary to provide timely impact on possible risk factors contributing to the onset and progression of malignant neoplasms. This review demonstrates the association between the pathology of the biliary tract and oncological diseases of the digestive system, discusses the possible mechanisms of the influence of cholelithiasis and cholecystectomy on the development of malignant neoplasms of various parts of the gastrointestinal tract.

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изучена роль клинико-инструментальных данных, экспрессии Ki-67 и α-гладкомышечного актина (α-SMA) в слизистой оболочке толстого кишечника у больных с дивертикулярной болезнью толстого кишечника (ДБтК) и при ее сочетании с аденоматозными полипами кишечника (аПК) и колоректальным раком (Крр). В исследование были включены 190 больных с ДБтК (120 человек; 1-я группа), при ее сочетании с аПК (55 пациентов; 2-я группа) и с Крр (15 больных; 3-я группа). Контрольная группа была представлена 28 пациентами с синдромом раздраженного кишечника (СрК; 4-я группа). ДБтК была верифицирована при наличии от трех и более дивертикулов в слизистой оболочке толстой кишки (СОтК). Выявлено, что эспрессия Ki-67 в группе ДБтК и при ее сочетании с аПК и Крр выше средних значений в группе пациентов с СрК. Экспрессия α-SMA в СОтК увеличивалась у больных с ДБтК и достигала максимума при Крр.

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