North Caucasian State Academy

The article examines the theoretical and methodological foundations of system-dynamic modeling of digital processes in regional development in the context of the accelerating digital transformation of the economy and the increasing complexity of intersectoral interactions. The expediency of using the system dynamics methodology developed by Jay Wright Forrester to analyze the structural relationships between investments in digital infrastructure, human capital development, institutional changes and the dynamics of socio-economic indicators of the region is substantiated. The mechanisms of formation of positive and negative feedbacks affecting the stability of the digital ecosystem are revealed, as well as the time lags between technological investments and obtaining an economic effect are analyzed.

The article examines the impact of wars and international conflicts on global and national economies, as well as analyzes their role in the development of international law. Special attention is paid to how armed conflicts stimulate changes in the economic structure of states, transform international trade relations, increase sanctions pressure and at the same time create the need for the development of legal regulatory mechanisms. It is concluded that wars act not only as a factor of destruction, but also as a historical impulse to institutionalize international norms aimed at preventing humanitarian disasters, limiting violence and restoring the post-war order.

This literature review systematizes current approaches to lower limb revascularization, including surgical techniques used in the treatment of critical limb ischemia in patients with multifocal atherosclerotic arterial disease. The study analyzes the criteria for selecting surgical interventions and compares the advantages and disadvantages of interventional treatment methods in patients at high risk of atherosclerotic complications.

Chronic heart failure (CHF) remains one of the leading causes of morbidity, disability, and mortality worldwide. The primary clinical manifestations of CHF—dyspnea, fatigue, and exercise intolerance—significantly impair patients’ quality of life. Cardiac rehabilitation (CR) effectively improves physical performance, functional status, and compliance in patients with CHF. Conventional CR programs include moderate-intensity aerobic exercise, resistance training, respiratory muscle training, risk factor modification, and patient education. However, engagement in CR remains extremely low. Major barriers include insufficient referrals from healthcare providers, financial constraints, transportation difficulties, and limitations related to social, cognitive, and digital accessibility. This article discusses new strategies for expanding cardiac rehabilitation coverage, including the development of hybrid and home-based programs, the use of digital technology for remote monitoring, and the potential integration of artificial intelligence to personalize treatment approaches. Special attention is given to addressing digital inequality and ensuring broader access to CR programs for vulnerable populations. Innovative cardiac rehabilitation models have the potential to transform the care paradigm for patients with heart failure by increasing access to rehabilitation services and improving clinical outcomes.

BACKGROUND: The comprehensive use of therapeutic physical factors in rehabilitation programs contributes to improving the effectiveness of therapeutic measures by favorably influencing sanogenesis processes. AIM: To evaluate the effectiveness of an outpatient medical rehabilitation program for patients after colorectal cancer surgery using therapeutic physical factors. MATERIALS AND METHODS: An open-label, randomized, controlled prospective study included 126 patients who underwent colorectal cancer surgery. Using simple randomization, the patients were divided into three groups. In Comparison group 1 (n=40), rehabilitation followed the Russian guidelines (individual therapeutic exercise and pinaverium bromide). In Comparison group 2 (n=43), in addition to the rehabilitation measures of Group 1, patients received low-mineralized mineral water “Psyz.” In the Main group (n=43), patients received transcutaneous electrical nerve stimulation in the area of the cervical sympathetic ganglia in addition to Group 2 rehabilitation program. The effectiveness of rehabilitation measures was assessed using clinical symptom evaluation based on the Edmonton Symptom Assessment System (ESAS) and quality of life assessment with the European Quality of Life Questionnaire (EQ-5D). RESULTS: Statistical analysis demonstrated that incorporating therapeutic physical factors into outpatient medical rehabilitation programs for patients after colorectal cancer surgery significantly reduced clinical symptoms according to the ESAS scale (p 0.01) and improved quality of life indicators according to the EQ-5D scale, particularly in the Daily Activities (p 0.01), Pain and Discomfort (p 0.01), and Anxiety and Depression (p 0.01) domains. Meanwhile, the positive changes in the studied parameters were, on average, 12–15% lower (p 0.05) in Comparison group 1 and 8–10% lower in Comparison group 2 compared with the Main group. CONCLUSION: The inclusion of therapeutic physical factors in outpatient medical rehabilitation programs for patients after colorectal cancer surgery leads to a significant improvement in quality of life.

The article deals with the problems of personality-centred learning, shows its demand for digital realities, traces its features as an educational technology. A comparative analysis of views on the nature and specificity of developmental learning is given, its distinctive characteristics are shown. The influence of digital economic and market transformations on the processes associated with the need to “reformat” the goals and technologies of education is shown. The significance of person-centred learning as an educational practice and as a factor contributing to the formation of social norms and ethical values is investigated. The role of developmental learning in the development of humanistic aspects of education, democratic and axiological values is revealed. Attention is drawn to the way digital technologies give personally oriented learning a demanded character, increase its significance as a tool that helps to overcome negative manifestations associated with digital addiction. Its role in the formation of competences, practical skills andabilities required in educational and professional activities is traced. Personality-oriented learning is studied as the most important factor contributing to the development of individual potential of all participants of the educational process, to the discovery of students’ abilities, to the strengthening of trends related to self-realisation and self-identification. The advantages of developmental learning are identified, and the nature of possible risks caused by growing digitalisation is revealed. It is shown how the formation of a new type of person, called digital, transforms the system of didactic and methodological methods of learning, the ratio of traditional and innovative educational practices. It emphasises the need to find new ways of learning, adequate to the functional requirements of the educational sphere transforming in the conditions of digitalisation, of which personally oriented learning is a part.

New markers are needed to improve the effectiveness of serological screening for atrophic gastritis. To develop a cost-effective method for serological screening of atrophic gastritis with a high level of sensitivity. Of the 169 patients with atrophic gastritis, selected by the visual endoscopic Kimura-Takemoto method, 165 showed histological mucosal atrophy using the updated Kimura-Takemoto method. All 169 patients were examined for postprandial levels of gastrin-17 (G17) and pepsinogen-1 (PG1) using GastroPanel® (Biohit Plc, Helsinki, Finland). We used the histological standard of five biopsies of the gastric mucosa, in accordance with the Kimura-Takemoto classification system to assess the sensitivity of G17 in detecting gastric mucosal atrophy. We also compared the morpho-functional relationships between the detected histological degree of gastric mucosal atrophy and the serological levels of G17 and PG1, as the markers of atrophic gastritis. The sensitivity of postprandial G17 was 62.2% for serological levels of G17 (range: 0-4 pmol/L) and 100% for serological G17 (range: 0-10 pmol/L) for the detection of monofocal severe atrophic gastritis. No strong correlation was found between the levels of PG1 and degree of histological atrophy determined by the Kimura-Takemoto classification system to identify the severity of mucosal atrophy of the gastric corpus. In the presented clinical case of a 63-year-old man with multifocal atrophic gastritis, there is a pronounced positive long-term dynamics of the serological marker of atrophy - postprandial G17, after five months of rennet replacement therapy. Serological screening of multifocal atrophic gastritis by assessment of postprandial G17 is a cost-effective method with high sensitivity. Postprandial G17 is an earlier marker of regression of atrophic gastritis than a morphological examination of a gastric biopsy in accordance with the Sydney system. Therefore, postprandial G17 is recommended for dynamic monitoring of atrophic gastritis after treatment.

Introduction. Pilonidal disease (pilonidal sinus, epithelial pilonidal sinus) is a common pathology detected by surgeons and coloproctologists. The disease is observed in 3-5% of the population. The vast majority of patients with pilonidal sinus are operated on under 30 years. Postoperative complications occur in 13-24% of patients, and 6-30% have relapses of the disease.The aim of the study was to improve the treatment results of patients with pilonidal disease complicated by multiple fistulas of the coccygeal-sacral-gluteal region by developing new surgical treatment options, prediction and prevention of pathological scarring.Materials and methods. The study involved 141 patients with pilonidal disease complicated by multiple fistulas of the coccygeal-sacral gluteal region. Depending on the treatment options used, all patients were divided into 2 groups: 45 (31.9%) patients were treated with conventional techniques; a comprehensive personalized approach was used in 96 (68.1%) patients. A developed personalized approach to the treatment of pilonidal disease included: predicting pathological scar formation (studying the acetylator properties of the body, the concentration of acute phase inflammatory proteins in the peripheral blood); performing original surgical procedures considering prevalence of the inflammatory process, the shape of the gluteal structure, the wound size after excision of the pilonidal sinus, pathologically altered tissues in the gluteal region. Therapeutic measures were aimed at preventing pathological scar formationResults. A comparison of the immediate and long-term treatment results of patients with pilonidal disease complicated by the sacrococcygeal-gluteal region fistulas, who were exposed to the comprehensive treatment, demonstrated that their parameters were markedly better than those received conventional treatment: the number of early postoperative complications reduced from 17.8 to 6.3% (P0.05); relapses - from 11.1 to 3.1% (P0.05), development of excessive scar formation - from 35.6 to 4.1% (P0.05); complaints of discomfort – from 17.8 to 6.3% (P0.05). The duration of hospital treatment decreased by 4.1 days (P0.05), and the period of complete healing reduced by 11 days (P0.05).Conclusions. To obtain adequate short-term and long-term results in the treatment of patients with pilonidal disease complicated by multiple fistulas, the following steps are required: thorough preoperative preparation; an individual approach to choose a surgical option considering the prevalence of the inflammatory process, the topographic and anatomical structure of the coccygeal-sacral gluteal region; a postoperative wound size; rational management of patients in the postoperative period. Study of the dynamics of proteins in the acute phase of inflammation and the acetylator activity of the body helped reveal a group of patients with a predisposition to pathological scar formation, who then were performed timely anti-scar therapy.

The article proposes to consider the structure of the mechanism for accumulating and using the resources of a budgetary institution aimed at ensuring the effectiveness of its functioning. Moreover, special attention is paid to such functional blocks as planning and accounting, resource attraction, risk management, control and audit of resource efficiency. The directions of further development of this mechanism are substantiated, including those related to the use of key performance indicators by budgetary institutions (their main managers), as well as to improving the skills and expanding the competencies of internal controllers (through the use of modern data analytics tools) in order to improve the quality of the control function.