The presence of unique natural and recreational resources in the Baikal region is a basic condition for the development of rural tourism. Rural tourism is becoming an ecological and social alternative to the technogenic development of agricultural areas. The optimal ecological, social and economic effect of the development of rural tourism requires a multifactor consideration of the territories specifics. This is particularly topical in relation to rural settlements located on the lands of specially protected natural territories. In the Baikal region, Tunkinsky administrative district (the only one in Russia) is located within the borders of the national park. Based on the analysis of the ecological, social and economic situation in the Tunkinsky district in the last decade (2009-2019), the authors conducted a preliminary assessment of the potential for the development of rural tourism. The most promising type of rural tourism, providing synergy of the social and economic development of the Tunkinsky district and compliance with environmental requirements, can only be eco-tourism, which is focused on recreational activities. The article proposes the creation of a tourist cluster of equestrian culture for the development of mobile recreation in a civilized manner. In particular, the Buryat ethnocultural equestrian center and the Cossack equestrian culture center in close cooperation and coordination with the administration of the district and the administration of the national park can conduct year-round work on programs and projects for sports, cultural, educational, ethnographic, and health tourism involving all the settlements in the Tunkinsky district.
Objective: The article presents an analysis of the clinical efficacy and causes of unsatisfactory outcomes of surgical treatment in patients with degenerative diseases of the lumbosacral junction of the spine. Methods: Patients were allocated to one of three groups, depending on the method of surgical intervention on the lumbosacral junction: 1) (n=352) - operated by the method of microsurgical discectomy; 2) (n=83) - operated with the use of artificial IVD prostheses; 3) (n = 183) - operated with the use of interbody fusion and posterior rigid stabilization. To investigate the causes of unsatisfactory outcomes, a correlation analysis was conducted of long-term clinical outcomes with preoperative instrumental parameters in the operated segment, surgical tactics used, and the development of complications. Results: It is determined that long-term “good” clinical outcomes are associated with individual preoperative parameters of the lumbosacral junction of the spine - linear displacement, sagittal angulation, height of the interbody space, degree of IVD degeneration by ADC. Conclusion: In degenerative diseases of the lumbosacral junction of the spine, the detailed analysis of long-term clinical outcomes enable the identification of the causes that affect the development of unsatisfactory outcomes, which are individual morphostructural changes in the lower lumbar segment: the amplitude of the segmental angle, the angle of the lumbar lordosis, the degree of linear displacement of the vertebrae, the height of the interbody space, and ADC. Complex clinical and instrumental analysis enabled us to determine possible surgical tactics. Level of Evidence II; Prognostic Studies— Investigating the Effect of a Patient Characteristic on the Disease Outcome.
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