Natural and medical sciences

Social innovations are important for solving the problems of rural devel­opment, since due to the intensification of polarization processes, the backlog of living conditions in rural areas from cities increases. Based on the statisti­cal reporting and agricultural censuses, the article assesses the changes and spatial distribution of production, social and demographic processes in rural areas of the Kaliningrad region over the past three decades. The differences in the situation in the west (in the rapidly developing Kaliningrad agglomera­tion) and in the lagging behind eastern municipalities are shown. Social inno­vations are seen as a way to solve the problems of peripheral territories.

The role of tourism in the development of rural areas could be confirmed, on the one hand, by the income received from this activity by the owners of ru­ral estates and guest houses. On the other hand, tourism, and above all its na­ture-oriented forms, contribute to the sustainable development of the territory. The aim of the research is to identify the resource potential of the rural areas in the coastal municipalities of the Kaliningrad region for organizing recrea­tional routes as one of the promising forms of rural tourism. As part of the re­search, a number of expeditions were organized to the Slavsk and Polessk mu­nicipalities, where an inventory of the existing infrastructure was carried out. Based on the results, a map of the tourism objects and infrastructure was drawn up. The work has both theoretical and practical value.

In the Kaliningrad region, as well as in other regions of Russia, the cen­ter-peripheral model of economic development directly affects the transfor­mation of the regional settlement system. Over the past 10 years, the dynam­ics of the population in rural settlements of the region has been determined by agglomeration and transport-geographical factors. The analysis of changes in the population of 1,068 settlements in the region (excluding cities and urban-type settlements) and their transport and geographical position resulte in con­clusions on the state of the settlement system both in the region as a whole and in the context of individual municipalities. The main conclusion is that the relatively small size of the region and high transport connectivity (along with a high level of economic development) generally smooth out negative so­cio-demographic processes, making the gap between agglomeration and pe­ripheral municipalities not as significant as initially thought.

The coastal area of Russia is a dynamically developing region of the coun­try, the geopolitical and geostrategic importance of which has grown significant­ly in recent decades due to changes in the external conditions of development. The differences in the socio-economic development of the coastal area of Russia are reflected in the numerous gradients of the migration situation, the study of which determines the purpose of this article. The study relies on typology, statis­tical and general scientific methods as well as on the Rosstat data on interre­gional and international migration of the population in the coastal regions of Russia at the regional and local levels in 1993—2018. Analysis of the transfor­mation of the migration situation in each of the coastal regions of Russia over the entire post-Soviet history has shown the presence of fairly stable core regions of attraction of migrants in the basins of the Baltic and Black Seas. Durng the study period they increased their migration attractiveness. Areas of outflow of migrants, formed mainly within the Pacific, Arctic and Caspian Seas basins, for the most part demonstrate a decrease in the intensity of migration loss, mainly due to international immigration. Here, the role of the emerging and most dy­namically developing local centers of attraction of the migrants is extremely im­portant for improving the migration situation. They can trigger the process of coastalization and extend it to the neirbouring areas.

The study examines the spatial and temporal distribution of global scien­tific knowledge on social innovation in rural areas. It is possible to assess the scientific productivity of a particular thematic area using the methods of sci­entometrics, which make it possible to compare the achievements of countries, regions and individual researchers, as well as to organize data on the infor­mation flow of scientific publications. The Scopus abstract database was taken as the data source, and the VOSviewer program was used for visualization. The study identified knowledge generation centers and the dynamics of their scientific productivity, as well as thematic clusters that include the seven most frequent aspects of social innovation in rural areas, in particular, rural development, digitalization, social entrepreneurship, ecosystem sustainability, rural community, helping the elderly, poverty.

A linear algorithm for calculating the vertical geological structure at a given point in the region has been developed as an additional tool for the de­sign procedure to access groundwater resources of the Moscow-Valdai aquifer. The descriptions of the test set of boreholes were digitized in the Kaliningrad region. The study proposes an algorithm for constructing a "virtual well”, which describes the desired vertical geological structure at the user's point, considering the values of the filtration coefficients, levels of water occurrence and its establishment, flow rate and other parameters of real boreholes. The calculation is based on the use of data on the boreholes closest to a given user request point. The proposed algorithm can facilitate the design of water supply for small enterprises and personal users of small towns and villages in the re­gion at the expense of groundwater resources.

The article analyses the results of the examination and treatment of 18 patients with acute biliary pancreatitis (ABP). They underwent endoscopic retrograde endobiliary interventions (EREBV), which were performed in the X-ray surgery under endotracheal anesthesia using X-ray vision and included the following: endoscopic retrograde cholangiopancreaticography (ERCP), en­doscopic papillosphincterotomy (EPST), lithotripsy, lithoextraction, duct stenting. The following types of EPST, subtotal, limited, papillotomy, were performed.

After performing a papillotomy, 1 (5.6 %) a bleeding was stopped by con­servative measures. The fatal outcome was accounted for 1 (5.6 %). The pa­tient was admitted with symptoms of severe intoxication, pancreatogenic shock, and was diagnosed with total pancreatic necrosis. Despite the intensive therapy, there was a progression of the disease, an increase in multiple organ failure. In the remaining cases, the treatment was successful.

In the nearest period, 16 patients underwent laparoscopic cholecystecto­my within 1 to 6 months. In the long-term period, at the terms of 13 and 18 months, 2 patients had a recurrence of pancreatitis. They were cured by a course of conservative therapy. At the initial admission, these patients were diagnosed with severe pancreatitis and a long history.

Frequency and variability of heart rate served as instruments to assess the stress resistance of two groups of students with different average academic performance in different periods of the educational process: at the beginning and at the end of the autumn semester. Mental stress always statistically sig­nificantly increased the heart rate in both groups of students, but significantly decreased heart rate variability only in the group of students with better aca­demic performance at the end of the academic semester.

The variety of options for the course of gouty arthritis necessitates the search for informative and accessible methods for diagnosing this disease. The detection of the sodium monourate crystals deposits in synovial fluid is asso­ciated with certain technical difficulties. In this regard, ultrasound diagnos­tics of gout is of particular value. The article raises questions of the im­portance of ultrasound assessment of joints in the diagnosis of gouty arthritis. Especially interesting is the possibility of evaluating the first metatarsoph­alangeal joints as a screening area for research. In our work, we found a high frequency of detection of echographic signs of gout in this area, even in the ab­sence of clinical manifestations. The use of ultrasound examination of the first metatarsophalangeal joints can be recommended at the stage of differential di­agnosis of gouty arthritis in clinical practice of primary specialized care.

Catatonia is an important syndrome found in both psychiatry and gen­eral medicine. However, identification and treatment of this phenomenon is difficult without modern diagnostic scales for catatonia.

Purpose — to describe the cases of inhibited and excitable catatonia in adolescents with affective disorders.

Methods — clinical observation in accordance with the ICD-10 diagnos­tic criteria for affective disorders in depression and mania, the use of Beck de­pression scale, Beck anxiety scale, Young scale of mania, Bush-Francis catato­nia rating scale. Differential diagnosis with the participation of a team of spe­cialists: neurologist, psychiatrist, clinical psychologist, cardiologist, infectious disease specialist, pediatrician.

Results and discussion. Catatonia in children occurs in various condi­tions that are not always associated with schizophrenia: with general deve­lopmental disorders, epilepsy, affective disorders, sports injuries of the cervical spine. Difficulties in recognizing and appropriately treating catatonia can lead to poor patient outcomes due to inappropriate treatment that aggravates the course of catatonia. The most effective treatment for catatonia is benzodi­azepine tranquilizers and / or electroconvulsive therapy; the latter is the method of last choice if the early administration of benzodiazepine derivatives has been missed, or they are ineffective even at high doses. The use of a stand­ardized, highly valid Bush-Francis catatonia rating scale will facilitate the di­agnosis of this disorder and taking a fast decision-making.