Home – Home – Jornals – Siberian Scientific Medical Journal 2019 number 2

In addition to the respiratory tract damage, an acute viral infection caused by the influenza A virus in the human body can cause central nervous system damage. Based on previous studies suggesting that the highly pathogenic influenza virus A/H5N1 A/Goose/Krasnoozerskoye/627/05 is neurotropic and induces inflammation in the central nervous system, the neurotropic and proinflammatory potential of seasonal influenza virus A/H1N1 A/Tomsk/13/2010 was studied on the mouse model. Material and methods. Work was carried out on the 2 month male mice BALB/c line divided into two groups - intact (5 animals) and intranasal infected with influenza A/H1N1 A/Tomsk/13/2010 dose of 1 MLD₅₀ (20 animals for virological and 35 animals for histological studies). Viral titration obtained from the homogenates of lungs and brain was performed on MDCK cells, calculated by the method of Kerber in the modification of Ashmarin and expressed in lgTCID₅₀ /ml. Histological studies included an immunohistochemical analysis of the lungs and the brain to detect influenza virus, markers of inflammation and tissue repair, as well as a morphological analysis of destructive changes in the tissues of the brain frontal cortex. Results and discussion. It was shown for the first time that the seasonal influenza A/H1N1 virus A/Tomsk/13/2010 does not have neurotropic potential. Simulation of influenza infection using the selected strain causes damage to the brain frontal cortex, which is expressed by perivascular and pericellular edema, small foci of hemorrhages and gliocytosis. Infection of BALB/c mice with a selected strain of influenza A virus causes activation of microglial cells of the frontal cerebral cortex. At the same time, the classical change of the phenotype from M1 to M2 does not occur, in the late days of the experiment (21-30) the proinflammatory classical phenotype prevails.

Endogenous mechanisms of reactive oxygen (ROS) and nitrogen species production and of antioxidant defense systems in tumor cells are analyzed. Increased ROS production is an important regulator of metabolic changes in these cells: enhanced proliferation, apoptosis inhibition, resistance to hypoxia and to cytostatics (doxorubicin, carboplatin, cisplatin, etc.). The most active ROS sources in tumor cells are mitochondria, NAD(P)H oxidases and peroxisomes, which synthesize O₂^{·- and H₂O₂. In mitochondria, the superoxide anion radical is generated mainly by complexes I and III; membrane NAD(P)H oxidases Nox1, Nox2, Nox3, and Nox5 produce O₂·-, Nox4, and dual oxidases DUOX-1, DUOX-2 - mainly H₂O₂. Increasing ROS stationary concentration activates endogenous antioxidant defense mechanisms, such as redox-dependent antioxidant respons(iv)e element system Keap1/Nrf2/ARE and autophagy, which allows tumor cells to survive under oxidative stress and may underlie resistance to radio- and chemotherapy. The possibilities of tumor cell redox balance regulation by antioxidants with targeted action and by specific inhibitors of ROS enzymatic production are discussed.}

Osteoarthritis is chronic degenerative-inflammatory disease of the joints accompanied by destruction of the articular cartilage and leads to disruption of joint function and at later stages - to the appearance of contractures, muscular atrophy and skeletal deformities. The main clinical manifestation of osteoarthritis is chronic pain of varying intensity and limitation of joint mobility, which significantly worsens the quality of life of patients. Modern research points to the multifactorial nature of the osteoarthritis development. With the development of the disease, significant changes occur at all levels of the organization, including changes in molecular processes in the cartilage, accompanied by disturbances in its structure and functional properties, as well as violations of the regulation of the synthesis of cartilage matrix components by chondrocytes. The study of the pathogenesis of osteoarthritis was the basis for the development of new drugs. A precondition is a pre-clinical trial involving in vitro and in vivo studies on model animals and / or cell cultures. Therefore adequate experimental models are needed. Currently, there is no consensus in the world on the most appropriate universal model of osteoarthritis, since each model has its own mechanisms for inducing a common degenerative process and limits of its applicability. The problem of reliability of alternative modeling, efficacy, bioequivalence or toxicity of substances for humans requires their full validation and qualitative verification, using animal models. Toughening ethical norms and banning preclinical studies in animals stimulates the development of in vitro models. There are international documents describing experiments with animals. It is called «International recommendations on biomedical research with animals» and is developed by international medical scientific societies (CIOMS). One thesis reduced the use of experimental animals and substitution to mathematic models and in vitro biological systems. The purpose of this review is a comparative description of experimental models, in vivo and in vitro , used to study pathological processes in osteoarthritis and the limits of their applicability.

The aim of the research was to study plasmids 2.3 MDa (3609 bp) and their distribution in Salmonella Enteritidis strains isolated from various environmental sources at different times on the territory of the Russian Federation. Material and methods. A PCR typing of 33 S. Enteritidis strains, isolated for the period from 1995 to 2017, containing plasmid 2.3 MDa described earlier in microbe strains has been carried out. Results and discussion. The plasmid was firstly sequenced by us. Its relatedness to plasmid in GenBank from the strain of S . Typhimurium CFSAN001921 described in the United States has been revealed. It has been established that plasmid p2.3 presents within 23 years in S . Enteritidis strains isolated from patients and food at administrative territories of majority of the Russian Federation subjects. In addition, it has been shown that plasmid p2.3 can be heterogeneous in nucleotide composition. Conclusion. Considering the fact that plasmid p2.3 was isolated from patients in the USA, and strains we investigated were from patients and food in Russia, it can be assumed that the distribution area of the plasmid has a transcontinental nature.

Effects of glyproline-containing peptide Selank on oxidative stress parameters in the brain and thin intestine were studied. Material and methods. Traumatic brain injury (TBI) was induced in rats by a shock model (weight drop method). Three groups were formed: «Intact control» (injection of sodium chloride isotonic solution), «control with TBI» (TBI model + injection of sodium chloride isotonic solution), «“Selank” with TBI» (TBI model + injection of peptide solution at a dose of 0.1 mg/kg body weight). All solutions were administered intraperitoneally in a volume of 0.5 ml for 5 days, in groups 2 and 3 the first injection was introduced in 3 hours after TBI. The evaluation of free radical oxidation processes in animal tissues was performed by chemiluminescence method. Analysis was performed in homogenates of fresh biomaterial, the results, obtained in millivolts, were calculated per 1 gram of wet tissue and were presented in relative units. Results. Post-traumatic effects in brain tissue have led to the intensification of free radical oxidation processes. Hyperproduction of free radicals, lipid hydroperoxides was observed, the rate of peroxide radical formation increased. In homogenates of white rat small intestine the stress effect did not cause a change in chemiluminescence parameters. Peptide «Selank» administration at a dose of 0.1 mg/kg after traumatic stress led to a significant decrease in all chemiluminescence indices in the tissues.

The objective of the study was to conduct a comparative assessment of the morphometric parameters of the dental and basal maxillary arches depth on preparations of male skulls, depending on the craniotype. Material and methods. The study was performed on 106 preparations of male skulls of the first and second periods of adulthood with physiological occlusion of the teeth. The cephalic index was defined as the ratio of the lateral size of the cerebral cranial region to its longitudinal size. The depth of the dental arch was measured from the point located at the center of the cutting edge of the medial incisor to the point of intersection with the line connecting the distal surfaces of the crowns of the teeth at the level of the canines, first premolars, second premolars, first molars, second molars. The depth of the basal arches was measured from the most prominent points between the medial incisors from the vestibular and lingual sides of the jaws to the point of intersection with the line connecting the distal surfaces of crowns of canines, premolars and molars. The results of the study. The minimum and maximum limits and the average indicators of the dental and basal arches depth at the level of canines, premolars and molars were determined. A comparative analysis of indicators of the dental and basal arches revealed that on the mescephalic and dolichocephalic skulls the basal arches depth at the level of the canines was larger than the dental arches depth ( p < 0.01). The dental arches depth was larger than the basal arches at the level of premolars, and did not depend on the criniotype ( p < 0.001). At the level of the first molars, the basal arch depth at the palatal side was larger than the index of the dental arch ( p < 0.05). At the level of the second molars, the dental arch depth was larger than the basal arches depth of both surfaces ( p < 0.05 and p < 0.001). Conclusion. It was concluded that the dental arches depth of brachycephalic and dolichocephalic was significantly larger than the basal arch depth. The similarity of the basal arches depths at each measurement level in all craniotypes was revealed.

The aim of the study was to develop and apply a perioperative complex of preventive measures aimed at reducing the incidence of respiratory complications in patients with operable forms of lung cancer. Materials and methods. The study has been conducted between September 2016 and January 2018. 103 patients with operable forms of lung cancer were treated, with anatomic resection of the lungs or pneumonectomy in the conditions of the oncology department of the Tomsk Regional Oncology Center. All patients in the perioperative period used a developed set of measures aimed at preventing the development of respiratory complications. A retrospective analysis was made of the case histories of 66 patients underwent treatment in cancer department of Tomsk Regional Oncology Center between 2014 and 2016, all patients underwent surgical treatment for lung cancer using standard prevention methods. We compared the incidence and structure of respiratory complications in a group of patients using the developed complex and in the retrospective control group. Results. The analysis of groups of patients revealed statistically significant differences in the number and structure of complications. In patients who developed the prophylactic complex at the stages of treatment, respiratory complications were registered in 4 (3.9 %) cases, while in the retrospective control group, respiratory complications developed in 8 (12.1 %) patients. According to the complications structure, the results also vary, in the group with the developed complex, none of the patients registered postoperative pneumonia while in the control group pneumonia developed in 5 cases and was the cause of death in 3 patients. Conclusion. The use of the developed complex in patients with oncopulmonological profile significantly reduces the incidence of respiratory complications in the postoperative period.

The cognitive decline in cardiac patients may be associated with insufficiency of the cerebral blood supply and inhibition of the brain functional state that manifested as a slowing of spontaneous EEG activity. On the other hand, the attention networks functioning is closely related to the theta oscillatory activity. We have studied the relationship between background theta activity (4-6 Hz) and attentiveness networks functioning in patients with severe coronary artery disease (CAD). Material and methods. We evaluated the parameters of alerting, orienting and executive control using the attention network test (ANT) in 41 CAD patients. Resting-state EEG with closed and open eyes also was recorded from 62 channels positioned according to the International 10-20 system. Spectral EEG power was calculated for frequencies from 0.1 to 50 Hz. Statistical analysis was done using Statistica 10 software package. Results and discussion. The regression analysis revealed positive associations of alerting and the theta rhythm (4-6 Hz) power with eyes closed in the right central and temporal brain regions. Negative relationships between the alerting system and the theta rhythm power in the right frontal and left occipital sites were obtained. Orienting system was positively related to the theta reactivity in the left temporo-parietal and right central brain areas; a negative relationship was established for the right occipital site. The executive control correlated negatively with the reactivity of the theta power in the right frontal and left parietal areas of the cortex, positively - right central region. It was demonstrated that attention disorders in CAD patients are associated with theta activity changes, predominantly in the right hemisphere. The study of EEG resting-state parameters can be useful for predicting impaired attention in patients with cardiovascular diseases.

The purpose is to assess the structural state of the cornea and pre-corneal lacrimal film in patients with myopia before refractive surgery, to identify the relationship with changes in cytokine concentration in the tear. Material and methods. 62 patients (124 eyes) with myopia were examined. The first group included 26 patients, only glasses were used for the correction of myopia, and in the 2nd group, 36 patients who used soft contact lenses during 5 to 15 years. Methods of examination: determination of the thickness of the corneal epithelium, height and width of the lacrimal meniscus, assessment of the biomechanical properties of the cornea, the Norn and Schirmer tests. Content of cytokines in the tear - interleukin 10 and tumor necrosis factor α - was measured using the test set «BEST» by enzyme immunoassay. Results. The decrease in the thickness of the epithelium of the cornea, the height and width of the lacrimal meniscus, the stability of the tear film, and the ratio of interleukin-10 to the tumor-α necrosis factor in patients who use contact lenses for a long time are revealed. The conclusion. Prolonged wearing of contact lenses for correction of myopia is accompanied by signs of symptomatic dry eye syndrome against a background of moderate oppression of the anti-inflammatory activity of tears.

The purpose of the study was to provide of diagnostic profiles of harmful effects caused by long inhalation of 1,1,2,2-tetrabromoethane (TBE). Material and methods. The object of research was white rats exposed to the round-the-clock inhalation of TBE within three months. The TBE concentration in air samples from exposure chambers was determined by means of the Agilent 7890 B chromatograph (France). Urine analysis and biochemical blood test were conducted by means of the standard and unified laboratory methods. Results and discussion. TBE inhalation (concentration 0.2 ± 0.01, 0.6 ± 0.03 and 1.8 ± 0.07 mg/m³) leads to structural and functional changes in target organs. The expressiveness and the changes range grew with the toxic effect level increase. We have defined group of deviations of biochemical indicators connected with the mechanism of toxic action and pathological changes in target organs. When planning clinical trials with high probability it is necessary to expect the diagnoses relating to critical organs and systems - nervous system, liver and kidneys.

The purpose of the study was to study the levels of placental growth factor (P l GF) and soluble receptor-1 vascular endothelial growth factor (sVEGF-R1) in the mother’s serum during normal pregnancy and pre-eclampsia developed before 34 weeks of pregnancy in the period 11-13 weeks. Material and methods. In a prospective study, 95 patients were selected on the basis of risk factors for the development of pre-eclampsia in the first prenatal screen and further examined blood for PlGF and sVEGF-R1. According to the results of the course of pregnancy, the patients were divided into 4 groups: the first group - preeclampsia developed before the 34th week of pregnancy, the 2nd group - uncomplicated pregnancy, the 3rd group - pregnancy proceeding with fetoplacental insufficiency, the 4th group - pregnancy ending in preterm labor. Results and discussion. In women with preeclampsia that developed before the 34th week of gestation, the medians of sVEGF and PlGF were 2275 and 64.5 pg/ml, respectively, in pregnancy with placental insufficiency - 648.9 and 31.5 pg/ml, in pregnancy ending in preterm labor - 102.5 and 20 pg/ml, in uncomplicated pregnancy - 1170.0 and 34,5 pg/ml. The results can be used in the screening of the first trimester of pregnancy to predict various pathological conditions of pregnancy.

Aim of the study - to investigate the features of the course of atrial fibrillation in patients with arterial hypertension and extracardiac pathology, affecting the progression of atrial fibrillation and the development of chronic heart failure (CHF). Material and methods. In the observational cohort study, 308 patients of 45-65 years old with atrial fibrillation and arterial hypertension in combination with extracardiac pathology (diabetes mellitus, n = 40; diffuse toxic goiter, n = 42; hypothyroidism, n = 59; abdominal obesity, n = 64 and chronic obstructive pulmonary disease, n = 47) were observed. The control group consisted of 56 patients with arterial hypertension with atrial fibrillation, without concomitant extracardiac diseases that were matched by sex and age. To assess the progression of atrial fibrillation, patients were monitored for 12 months. CHF analysis was performed initially and after 12 months, using Strazhesko - Vasilenko classification to determine the stage and using the NYHA classification to assess the functional class. Results. In all presented clinical groups, there were no differences in the frequency of the permanent form of atrial fibrillation, the paroxysmal form was more often revealed in cases of thyroid disease and abdominal obesity, and the persistent form - in chronic obstructive pulmonary disease, diffuse toxic goiter and diabetes. In patients with atrial fibrillation and arterial hypertension with concomitant extracardiac diseases such as diffuse toxic goiter ( p < 0.038) and diabetes mellitus ( p < 0.003), the progression of atrial fibrillation begins reliably earlier than in the control group. CHF developed in all clinical groups, but more often than in the comparison group, it occurred in patients with diffuse toxic goiter ( p < 0.004), diabetes mellitus ( p < 0.008), abdominal obesity ( p < 0.001) and chronic obstructive pulmonary disease ( p = 0.05).

Work purpose - assessment of the physical development and a functional status of 8-years-old children of Gorno-Altaysk, taking into account the nationality, gender, group of health and social conditions. Material and methods. The object of research was the schoolchildren of 8 years, in total 115 children (57 boys and 58 girls), including 30 girls and 31 boys of Russian nationality and 28 girls and 28 boys the Altaian nationality. The following parameters were determined: 1) anthropometric (body length and weight, thorax circumference, Ketle index, Pinye index). 2) functional parameters: assessment of external breath parameters (Vital lung capacity, Vital index); cardiovascular system parameters in the conditions of relative rest; dynamometric (strength of the muscles of the hand, hand index). The analysis of medical records and assessment of social conditions with questionary were also carried out. Results. Morphofunctional parameters of the most part of the examined children corresponded to average values. Comparison by national sign has shown that there were practically no differences between groups of boys of these nationalities whereas at girls the distinction on the main genotype was revealed: the Russian girls had the higher body length, than the Altain’s. The boys’ functional indicators depended on the level of morphological development to larger extent in comparison with girls. The obesity was revealed at 22 % of boys. It was suggested that boys have higher organism sensitivity to the influence of adverse environmental factors. Conclusion. It was noted, that children with constitution mesomorphic type, weak development of the hands muscular strength, and low indices of the lungs vital capacity prevailed in families with inadequate material income. The frequency of girls’ catarrhal diseases to some extent depended on the level of material income of parents, whereas in boys it depended on the level of their physical development. On the basis of nationality, there were no differences among boys, while Russian girls were higher than Altaian’s.

The purpose of research is to estimate disease incidence for chronic myeloid leukemia in the Altay Region. Material and methods. The absolute morbidity rate of chronic myeloid leukemia in the Altai Region (primary disease incidence), as well as the intensive morbidity rate (per 100000 adults of population) have been investigated since 2014 to 2016. The Federal State Statistics Service data on population base was used as a basis for the intensive rate estimation. Epidemiological retrospective study was conducted by means of analyzing medical files of patients with primary case definition of chronic myeloid leukemia in the Altai Region. Results and discussion. Primary disease incidence for chronic myeloid leukemia in the Altai Region from 2014 to 2016 made up 20-24 patients per year. The number of primarily detected cases of CML varied from 1.02 to 1.24 per 100 000 adult population annually. The frequency of CML disease detection in urban population figured up to 60 % of the total number of the patients, however the statistically significant differences in intensive rate were not revealed. Male:female ratio corresponded to 49.3 : 50.7 % respectively. The peak of CML disease incidence in the Altai Region accounted for the age of 50-59 years. Median age of patients with primarily defined CML without considering gender was 52 years, whereas median age in women ranged rather higher than in men: 54.3 years old and 49.6 years, respectively. Conclusion. Primary disease incidence for chronic myeloid leukemia in the Altai Region amounts to 1.14 : 100 000 of adult population per year. The disease equally affects men and women. No difference in case incidence has been observed in the urban and rural population, in spite of the territorial peculiarity of the Altai Region (third place in the Russian Federation for rural population numbers; a great number of small population villages, relying mainly on general medical services).

A number of studies have shown that social support has a direct positive effect on health, since it plays the role of a buffer that alleviates psychosocial and physical stresses. The aim of the study was to establish associations of the prevalence of coronary heart disease and levels of social support in men of an open population of a mid-urbanized Siberian city. Material and methods. In order to conduct a one-stage epidemiological study on an open urban population using the «random number» method, a representative sample was drawn from the electoral lists among males aged 25-64 years of the Central Administrative District of Tyumen. The sample included 1000 people, four age categories by decades of life (25-34, 35-44, 45-54, 55-64 years). The response to cardiac screening was 85.0 %. Social support was assessed by the Berkman - Syme test in two positions: the close contact index (ICC) and the social link index (SNI). The conclusion about the presence of coronary artery disease was conducted according to strict and extended epidemiological criteria. The «defined» coronary heart disease, «possible» coronary heart disease and coronary heart disease have been allocated according to expanded epidemiological criteria. Results and discussion. In the open population of the mid-urbanized Siberian city (on the model of Tyumen), men of working age with the presence of coronary heart disease were found mostly low level of social support mainly due to the low social link index. The results obtained in the open population of Tyumen in relation to social support and its association with the prevalence of coronary heart disease can serve as the scientific basis for conducting targeted socially-oriented preventive measures among working-age men in other urban-medium-sized Siberian cities.

Purpose of research - to assess the feasibility and effectiveness of informatization of practical health care medical organization. Material and methods: timing, statistical analysis, systematization, sociological (questionnaire) survey, the object of the study is a medical information system. Results and discussion. The main characteristics and principles of the medical information system, as well as the technology of its implementation in the institution of practical health care are described. The results of the use of the system for 5 years, important changes in the organization of the diagnostic and treatment process and management of the medical organization are presented. The introduction of the electronic medical card helped to reduce the time for its filling and delivery from the registry to the specialist’s office. The rational schemes of routing of citizens at carrying out of preventive examinations within the framework of the examination have been developed. At the same time, the main set of measures envisaged by it is currently carried out during 2-3 hours within one day (previously, citizens spent up to 4 hours for examination, sometimes two days). The medical disability electronic certificate used in the center, reduced the time of its registration, has ruled out re-visits of patients to clinics because of the wrong filling out, allowed us to realize the remote control over filling correctness. The module «Pharmacy» and the creation of a single nursing post contributed to a more rational accounting and use of medicines in the hospital Center, to reduce the cost of this article by 15 %. The use of the system in the transition to an effective contract allows quickly and objectively assessing the activities of employees and taking into account the cost of one point to calculate the amount of incentive payments, which employees can see in person. Conclusion. The results show that the informatization of medical organizations is the most important factor in the successful development of the institution, improves the quality and availability of medical care to the population.

The inclusion of an indicator of pathological prevalence is considered as an element of improvement of social and hygienic monitoring. This criterion allows considering donosological state of the human body and complexity of the development of pathological processes. Material and methods. It is offered to use information data bases of the regional diagnostic centers and bureau of forensic medical expert examination for determination of pathology prevalence among the population. The prevalence of pathological lesions is established on the materials of the researches conducted earlier, including the analysis of appeal ability of patients to the diagnostic center (for 3 years - 496.5 thousand), realization of diagnostic technologies, the results of the necropsy of 35.8 thousand of the deceased at the bureau of forensic medical expert examination and their comparison with the indices of incidence and mortality. Results. Analytical models with the use of the methods of modeling and plotting are elaborated. The models include all necessary technological stages in the use of information data bases of medical institutions where the mass diagnosis of pathology with the sufficient level of its revealing is possible. Application of these models has allowed defining the importance of separate methods of diagnostics for the assessment of the disease incidence rate, functional and morphological deviations and also the presence of the pathological processes leading to a lethal outcome and the prevalence of pathological organ lesions. It forms a basis for determination of prospects of realization not only diagnostic and medical technologies, but also preventive ones. Conclusion. It is expedient to include the analytical models presented in the paper in the general system of estimates of social and hygienic monitoring for identifying cause-effect relations with the factors of the habitat, assessment of population importance of separate risk factors and calculation of potential demand for medical technologies. The analytical model is developed for definition of strategic positions in public health protection taking into account these information blocks.

Purpose - to analyze the effectiveness of the algorithm used to monitor and treat premature infants. Material and methods. 903 premature babies were under the supervision of ophthalmologists from our clinic over the past 4 years (2014-2017). Retinopathy of prematurity was revealed in 302 patients. The laser photocoagulation was required in 78 cases. Repeated interventions were performed in 13 patients. Induced regression of the disease occurred in 72 children. The development of the 4-5 stage of the active phase of retinopathy of prematurity occurred in 6 patients. In 4 cases, the development of the 4-5 stage of the active phase of retinopathy of prematurity occurred in the case of posterior aggressive retinopathy. Results and discussion. The teamwork of ophthalmologists and neonatologists, timely and complete examination, reveals early signs of retinopathy of prematurity. Timely laser photocoagulation reduces the risk of disability, development of blindness and low vision. Reducing the number of laser photocoagulation carried out with an unchanged number of examinations, a low number of patients with terminal stages of the disease testify to the high effectiveness of monitoring and treatment of children with retinopathy of prematurity.

Research objective - assessment of the state, organization, issues and development outlook of psychotherapeutic aid at the regional level. Material and methods. The expert card permitting to carry out expert assessment of psychotherapeutic aid at the regional level was developed. The standard method was used for expert assessment. The method of concordance with the Kendall coefficient ( W ) was used to determine the consistency of experts’ opinions. Experts were the health professionals, psychotherapists, psychiatrists. 156 experts took part in the assessment. Results: According to the opinion of 61.1 ± 4.8 % of the experts, psychotherapeutic aid is in high demand at the stage of primary health care, but at the same time 70.5 ± 4.5 % of the experts believe that it is less available at this stage ( W = 0.4; p < 0.001). 68.5 ± 4.6 % of the experts feel that the amount of psychotherapeutic aid, administered to adult population in the territory of Novosibirsk region, is insufficient ( W = 0.3; p < 0.001). According to 85.9 ± 3.4 % of the experts, the development of availability of such aid is necessary. Conclusion: Increase in awareness concerning psychotherapeutic aid among doctors and patients, as well as opening of psychotherapeutic offices as part of standard polyclinics, rise in the number of psychotherapeutists and introduction of psychotherapy into the compulsory health insurance system will facilitate the improvement of the management of psychotherapeutic aid at the regional level.