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The high probability of permanent loss of professional fitness and a significant risk of disability of the injured as a result of limb injuries with peripheral nerve damage contribute to both the continuous improvement of surgical techniques on the peripheral nerves, and the implementation of experimental and anatomical studies aimed at developing new ways to restore the lost innervation. Various types of peripheral nerve injuries are observed in peace and wartime victims in 2-6% and 9.8% of cases, respectively. The high degree of disability of patients with the consequences of peripheral nerve injuries requires improvement of diagnostic and reconstructive plastic approaches in this category of patients. A promising method of restoration of the distal part of the crossed nerve with extensive defects of the nerve trunk is its connection with the lateral surface of the intact donor nerve by the end-to-side neurorraphia. The lack of unambiguous views on the nature of reinnervation in this case, even in the presence of single publications on the positive outcomes of such interventions allow us to use this method only in the absence of the possibility of using autonerval transplants to replace extensive defects of peripheral nerves. The purpose of the study: in experiments on laboratory animals to determine the features of modeling trauma of nerve trunks in relation to the development of the main stages of recovery of lost innervation by connecting peripheral nerves by the end-to-side neurorraphia and to determine the range of simple and demonstrative methods of clinical and instrumental control of the functional state of the restored peripheral nerves in a long-term experiment on laboratory animals. Methods. A comprehensive experimental surgical and clinical-instrumental study was performed on 61 laboratory animals (Chinchilla rabbits of both sexes, phenotypically healthy individuals). In the experimental operating room under intravenous anesthesia, modeling of peripheral nerve defect was performed by resection of the total peroneal nerve with a length of 1 cm at the level of the middle third of the thigh. In animals of the studied group (n=39) to restore innervation, the "end-to-side" neurorraphia of the distal portion of the crossed common peroneal nerve with a specially formed defect of the perineural membrane on the lateral surface of the tibial nerve was performed. In the comparison group (n=22) no replacement of the defect of the common peroneal nerve was performed. The follow-up period after experimental interventions ranged from 1 to 290 days. Morphofunctional state of restored nerve trunks was determined by clinical, radiological and electrophysiological methods. Research results. Performing unilateral resections of the common peroneal nerve in laboratory animals (rabbits) with subsequent restoration of the distal portion of the crossed nerve by connecting it by the end-to-side neurorraphia with a nearby intact donor nerve allows to obtain reproducible in the experiment positive results of tissue reinnervation. Indirect assessment of the functional state of the restored nerves is possible using simple and accessible clinical tests, for example, the amplitude of the abduction of the toes of experimental animals in the study of the unconditional reflex of preparation for landing characterizes the conductivity of the common peroneal nerve. When performing experimental studies with multi-stage reconstructive plastic interventions on the peripheral nerves of laboratory animals, the inclusion of radiological methods in the complex of diagnostic measures allows performing in vivo visualization of the surgical intervention area, the restored nerve trunk, as well as the tissues innervated by its branches, which makes it possible to adjust the plan of subsequent morphological studies. Conclusions Performing resection of the common peroneal nerve of laboratory animals (rabbits) at the level of the middle third of the femur as a model of peripheral nerve injury allows to practice the technique of restoration of the distal section of the crossed nerve by connecting it with the adjacent intact donor nerve of the end-to-side neurorraphia. Performing a simple test with the initiation of an unconditional reflex of preparation for landing allows us to qualitatively assess the functional state of the common peroneal nerve in experimental animals. 3. The inclusion of radiological research methods in the program of comprehensive assessment of the peripheral nerves allows to perform their visualization in vivo with the definition of the main morphological characteristics of the restored in experimental reconstructive plastic interventions of nerve trunks.

The information presented in the literature on the use of minimally invasive interventions in the treatment of hyperparathyroidism is not fully justified by topographical and anatomical studies and does not take into account individual features of the location and syntopia of the parathyroid glands, which requires additional scientific research. Purpose of the study: based on the topographical and anatomical features of the structure of the anterior neck region, determine the most rational methods of minimally invasive interventions on the parathyroid glands, evaluate their clinical effectiveness and justify their use in the implementation of a treatment and diagnostic algorithm in patients with hyperparathyroidism. Material and methods: The design of the study consisted of two stages – anatomical and clinical. Anatomical stage is performed on 2 levels: 1) on anatomical material, which included 15 human cadavers; 2) on plastinated cross-cuts of the neck (n=3) of human cadavers. During the clinical stage, the results of examination and treatment of 53 patients with hyperparathyroidism, who underwent surgery using three methods: Сonventional (n=18/34%); Minimally Invasive Video Assisted Parathyroidectomy (n=32/60%) and Transoral Endoscopic Parathyroidectomy Vestibular Approach (n=3/6%). Results: at the anatomical stage, the validity and safety of minimally invasive video-assisted Parathyroidectomy was proved. The use of this access in clinical practice as an alternative to the traditional one has shown its effectiveness in reducing the frequency of specific postoperative complications from 16.7% to 6.3% with an acceptable increase in the duration of surgery from 42.8±15.7 to 64.4±23.5 minutes and maintaining the average duration of inpatient treatment after surgery at the level of 3.4±0.6 days. Conclusion: minimally invasive video-assisted parathyroidectomy can be considered the operation of choice in the treatment of patients with hyperparathyroidism. The use of this technique with the implementation of lateralization of the thyroid lobe, the preservation of the upper and lower thyroid vessels, as well as the use of intraoperative neuromonitoring and Identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid can improve the results of surgical treatment, reduce the number of postoperative complications, the frequency of persistence and relapse of the disease, and improve the quality of life of patients.

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Морфологическая характеристика изменений периферических нервов и тканей таргетных зон при соединении периферических нервов по типу «конец-в-бок» в эксперименте А.Ю. Ништ, В.С. Чирский, Н.Ф. Фомин ФГБВОУ ВО Военно-медицинская академия имени С.М. Кирова МО РФ, Санкт-Петербург, РоссияВведение. Перспективным способом восстановления иннервации, утраченной при травмах периферических нервов, является соединение дистального сегмента поврежденного нерва с интактным нервом-донором по типу «конец в бок». Немногочисленные публикации о случаях выполнения данных вмешательств наряду с отсутствием фундаментальных представлений об источнике и механизме восстановления волокон нерва-реципиента, состоянии нерва-донора, а также о полноте реиннервации тканей после подобных вмешательств сдерживают внедрение данного способа в широкую хирургическую практику. Цель исследования -дать морфологическую характеристику изменений нерва-донора и нерва-реципиента, а также оценить морфофункциональные результаты реиннервации мышечной ткани в условиях соединения пересеченного периферического нерва с интактным нервным стволом по типу «конец в бок» в эксперименте на лабораторных животных. Материалы и методы. Исследование выполнено на 79 лабораторных животных (кроликах). У животных экспериментальной группы после моделирования травмы общего малоберцового нерва на уровне середины бедра дистальный сегмент пересеченного нерва соединяли с интактным большеберцовым нервом по типу «конец в бок». В группе контроля после моделирования аналогичной травмы общего малоберцового нерва реконструктивные вмешательства на поврежденном нерве не проводили. Результаты. При исследовании микрохирургической анатомии этапов реконструктивно-пластических вмешательств на периферических нервах, связанных с хирургическими манипуляциями на периневральных футлярах нервных стволов, подтверждена высокая вероятность частичного повреждения нервных волокон, непосредственно прилежащих к периневрию. Результаты морфофункционального исследования периферических нервов и иннервируемых ими мышц свидетельствуют о частичном восстановлении утраченной иннервации за счет соединения дистального сегмента поврежденного нерва-реципиента с интактным нервом-донором по типу «конец в бок» в эксперименте на лабораторных животных. Морфологической основой реиннервации нерва-реципиента в данном случае являются регенерирующие аксоны из состава нерва-донора, неизбежно повреждаемые на этапах микрохирургического вмешательства. Репаративная регенерация волокон нерва-донора обеспечивает как реиннервацию дистального сегмента нерва-реципиента, так и частичное восполнение собственных потерь нерва-донора. Ключевые слова: периферический нерв, травма периферического нерва, мышечная атрофия, восстановление нервов, соединение периферических нервов по типу «конец в бок», регенерация периферических нервов, восстановление иннервации Для корреспонденции: Алексей Юрьевич Ништ. E-mail: nachmed82@mail.ru Для цитирования: Ништ А.Ю., Чирский В.С., Фомин Н.Ф. Морфологическая характеристика изменений периферических нервов и тканей таргетн...

The author's technology of interdisciplinary openended engineering is considered in the article. This technology provides a comprehensive formation of design and projectorganizational competencies. It creates a basis for the development of managerial abilities of a design engineer and increases the practical orientation of the educational process. The author's understanding and definition of the developed technology of education are formulated in the article. The stages, methodological tools and procedures that form the basis of the developed technology in the educational process of engineering bachelor's degree are shown. An organizational model of technology of open-ended engineering is presented, from which its integrating functions in the construction and implementation of the entire educational program are visible. The analysis of the characteristics of students' learning activities is carried out, as well as the intermediate results of its application in the educational process. Keywords -open-ended engineering; technology of interdisciplinary open-ended engineering; engineer-designer; head of engineering project; full life cycle of the product; project management.

In recent years, significant progress has been made in the treatment of severe injuries and traumas. In critical situations, for the heaviest category of wounded, the outcome is largely determined in the next few minutes after admission to the hospital. The only possible tactic that gives a chance to save the lives of such victims is the tactics of multi-stage surgical treatment (damage control). The low effectiveness of traditional methods of training surgeons in the basics and techniques of this tactic makes it necessary to develop new forms of training. One of the most progressive and sought-after is training on biological material (large animals or cadaver material), but the methodology for conducting such studies has not been worked out before. For the first time in Russia in November 2018, a unique training and practical course «SMART» (Modern Methods and Algorithms for the Treatment of Wounds and Traumas) was conducted, combining training in both living tissues and cadavers. Participants were given the opportunity to see and independently work out the basic combinations of typical surgical techniques and maneuvers aimed at eliminating the life-threatening consequences of injuries and traumas.

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