卷 340, 编号 10 (2019)

The development of hospital-replacing forms of medical care is determined by the need of the population in this type of medical services, as well as the need for rational and efficient use of financial resources and material and technical resources. It is shown that hospital-substituting technologies provide a more efficient use of bed capacity, a reduction in cases of unjustified hospitalization, and can improve the efficiency of work while maintaining the quality of medical care provided. The results of a comparative analysis of various hospital-replacing forms of medical care according to the criteria of medical, social and economic efficiency are given, and a list of key indicators for evaluating the work of a day hospital has been determined.

Modern technologies allow not only to virtually plan a reconstructive surgery, but also to obtain patterns for resection and osteotomy, individual titanium reconstructive plates based on the results of planning. In the period from 2007 to 2017 in the center of maxillofacial surgery and dentistry of the N.N.Burdenko Main Military Clinical Hospital was performed 144 operations to eliminate bone defects of various localization with the use of additive technologies. In 136 (93%) cases, these were defects of the bones of the facial skeleton and the cranial vault, in two cases - the clavicle, in one - the scaphoid bone, in one - the radius, in two - the humerus, in two cases - the femur defect. To eliminate defects in 125 (87%) cases, revascularized autografts were used, in 19 (13%) - alloplastic materials. The clinical observations of the successful use of additive technologies are given as examples. The use of surgical models and templates during reconstructive operations reduces the time of the operation itself and reduces the number of postoperative complications.

Information is given on the stages of development and the current state of state sanitary and epidemiological surveillance in the Armed Forces of the Russian Federation. Actual aspects of the control and surveillance activities of the centers of the state sanitary and epidemiological surveillance of the Ministry of Defense are highlighted, the need for a transition to its risk-based model is shown. A list of activities whose implementation is necessary for such a transition is presented. The proposed model requires testing in one or two military districts to obtain evidence of improving the quality of surveillance activities and reducing the incidence of infectious and mass noncommunicable diseases (poisonings) among the personnel of the RF Armed Forces. It is assumed that the introduction of a risk-based model will provide optimal efficiency in the use of labor, material and financial resources involved in the implementation of state sanitary and epidemiological surveillance, reduce costs and increase the effectiveness of the centers of state sanitary and epidemiological surveillance of the Ministry of Defense.

A comparative analysis of the incidence of specialists of assembly teams and personnel of other units. The incidence of military personnel was estimated considering the number of initial complaints about diseases of the nervous system, digestive systems and blood circulation. To assess the influence of factors of military labor on the health status of specialists, a study was made of its dependence on the intensity of maintenance of special equipment. It was revealed that the specialists of assembly crews are 1.5 times more likely than the military personnel of other units to have circulatory system diseases and there is a connection between the intensity of work and the incidence of specialists. It is concluded that it is necessary to improve the system of medical support for personnel, to develop optimal working and resting conditions, to ensure the possibility of a full restoration of the functional state of the body of military personnel after performing maintenance work on special equipment.

Skeleton damage is the main clinical and radiological syndrome and is observed in all patients with multiple myeloma. After courses of standard chemotherapy and subsequent high-dose chemotherapy with autotransplantation of hematopoietic stem cells, some positive dynamics is observed in the form of an increase in bone density of vertebral bodies, which is confirmed by the results of dual-energy X-ray absorptiometric densitometry and computed tomography.

Activation of neutrophils is a mandatory stage and a sensitive marker of systemic inflammatory conditions that can lead to the development of multiple organ failure. The purpose of the study was to study the anti-inflammatory effect of lithium chloride on human neutrophils in vitro. The study was carried out on 5 healthy donors isolated from blood neutrophils, some of which were activated using 100 mkMfMLP and 100 ng/ml lipopolysaccharide, then their activity was evaluated using fluorescent antibodies to CD11b and CD66b degranulation markers. Intact and activated neutrophils were treated with a solution of lithium chloride at a concentration of 9 mmol. Lithium chloride reduces the level of neutrophil activation, having an anti-inflammatory effect on neutrophils preactivated by bacterial components, and tends to decrease the expression level of CD11b and CD66b molecules on the surface of intact neutrophils, inhibiting their activation and degranulation.

Data on the use of the method of distant ischemic preconditioning as a non-drug method for increasing the physical performance of a healthy person has been published in the literature. The report provides an overview of studies in which it was shown that distant ischemic preconditioning is potentially able to increase such indicators of physical performance as the maximum oxygen consumption, time to load to failure, power of the load performed, etc. The effect was especially significant when applying the method during several consecutive days.

The results of a comprehensive examination of 46 patients with ulcerative colitis are presented. In 25 patients, a histomorphologic and microbiological study of biopsy specimens of the colon wall was performed. Morphological signs of ulcerative colitis were present in 24 patients, in one case Crohn’s disease was diagnosed. The full range of diagnostic signs characteristic of ulcerative colitis was determined in 19 patients. In 50% of cases, a pronounced activity of the inflammatory process was observed, in 30% - moderate, in 20% - its minimum degree. In patients with moderate and severe inflammation in biopsy specimens, in 70.9% of cases, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Aeromonas hydrophyes and mixed infection were detected. In patients with moderate and severe disease, the course of treatment, considering the results of tests on the microflora, was supplemented with antibacterial therapy. The above complex characteristic of ulcerative colitis shows the need for a microbiological study of biopsy specimens of the intestinal wall of patients, which makes it possible to choose antibacterial chemotherapeutic agents with proven efficacy against the identified microorganism.

The article is dedicated to academician Nikolai Molchanov - a professional military man, a doctor, a participant in three wars and a lieutenant general of the medical service. N.S.Molchanov is a major scientist who made a significant contribution to the development of problems of pulmonology, cardiology, post-traumatic visceral pathology. The author of 250 publications, 4 monographs, 5 textbooks. Under his leadership, 31 doctoral and 58 master’s theses were completed.

The results of the work of the scientific-practical conference with international participation «Hip joint endoprostheses with a shortened femoral component are presented. Development prospects. Features of postoperative rehabilitation treatment», held March 22, 2019 in the medical and rehabilitation clinical center of the Ministry of Defense of the Russian Federation. During the conference, topical directions for improving trauma and orthopedic care were identified, such as the importance of promoting hip joint arthroplasty using shortened femoral components and coordinating actions between ambulatory trauma specialists, day hospitals, trauma departments and rehabilitation centers on the basis of a single methodological base, and developing and implementing uniform methods of conservative and operative treatment and rehabilitation based on criteria for evidence-based medicine, improving standards of care in young patients.