Vol 21, No 2 (2019)

Investigate the effect of extracorporeal circulation on the erythrocyte morphology, the intensity of gas exchange in the body tissues of the patient was determined before the operation, during the operation and during the postoperative treatment using morphometric analysis of the form of erythrocytes. It was established that during the operation with artificial blood circulation, the ratio of the voltage of oxygen and carbon dioxide in arterial and venous blood changes, indicating a shift in the oxygen capacity of the blood. Since the oxygen concentration in the oxygenator is known and under constant control, a decrease in the oxygen capacity of the blood reflects the intensity of tissue respiration on the one hand, and the degree of mechanical damage to red blood cells on the other. The intensity of tissue respiration was judged on the basis of a previously unknown fact that the form of erythrocytes depends on the degree of their saturation with oxygen. It is noted that blood, saturated with oxygen (arterial) under normal conditions of gas exchange in the lungs, is 90–95% composed of small red blood cells (villous length 0,3–0,4 μm), venous blood is represented mainly by large vorous forms of red blood cells (villous length 0,4–1 μm). The form of red blood cells is reversible and changes both after passing through the lungs (oxygenator), and after gas exchange in the tissues. The inhibition of oxygen consumption by red blood during perfusion indicates a change in the metabolic processes, shape and resistance of red blood cells, which allows a more complete assessment of the pathophysiological changes that occur in the body in response to perfusion. The proposed methods of morphometric analysis of erythrocytes, as well as determining their osmotic resistance, can serve as express methods for analyzing red blood during heart operations using extracorporeal circulation, in order to correct it in time and replenish it.

A total of 60 patients (38 women and 22 men, 36,54±2,14 years old) with a Epstein – Barr infection were examined. The patients were divided into two groups depending on the treatment regimen: 1 group – 34 patients received ingaron therapy (10 intramuscular injections of 500000 units every other day); group 2–26 patients received valcyte (450 mg 2 times a day, by mouth, 2 months) + ingaron at the same dosage. One month after the end of antiviral therapy in the 1st group, negative results of half-chain reaction were obtained only in 29,41% of patients. The combination of valcyte and ingaron in patients of the 2nd group was different and differed in the duration of the injection of ingarone: 2a group: ingaron 10 injections of 500000 IU intramuscularly every other day; 2b group: ingaron 20 injections of 500000 IU intramuscularly every other day; 2c group: ingaron 10 injections of 500000 IU and 15 injections of 100000 IU intramuscularly every other day. The best result after the introduction of ingaron was obtained in 90% of patients who received the longest course of ingaron in the form of 20 injections of 500000 IU every other day in combination with valcyte. In the other groups, where the total dose of ingaron was lower, positive results were found in 60 and 66,7% of patients. A significant positive change in the number of copies of deoxyribonucleic acid Epstein – Barr virus was found in samples of saliva and the severity of clinical complaints in patients one month after the ingaron monotherapy or combination therapy (valcyte and ingaron) was completed. The best effect of treatment with ingaron is achieved in patients with chronic Epstein – Barr infection with the prolonged introduction of ingaron (at least 20 injections).

During the clinical examination, 620 military personnel (502 men and 118 women) aged 25 to 55 years serving in the land forces of the Armed Forces of the Russian Federation, determined the incidence and severity of the pathology of the temporomandibular joint and masticatory muscles. A clinical study was performed using a survey, clinical examination, auscultation of the temporomandibular joint, and the determination of the tone of the masticatory muscles. To identify the temporomandibular joint pathology, the degree of mouth opening, the presence of mandibular deviation during opening and closing of the mouth, the presence of sound phenomena in the temporomandibular joint during mandibular movements, as well as the presence of arthralgia in the state of physiological rest and during lower jaw movements were evaluated. Symptom analysis to assess the severity of the temporomandibular joint pathology was carried out in points. To identify and determine the severity of the clinical course of the pathology of the masticatory muscles, a technique was used in the work that allows such an assessment in points based on the severity of complaints of fatigue of the masticatory muscles, compression or gnashing of teeth, the presence of hypertrophy or hypertonus of the masticatory muscles, and the presence of generalized forms of periodontitis and or) increased tooth wear. It was found that diseases of the temporomandibular joint in male military personnel are less common (12,8%) than female military personnel (22,9%), while parafunctional masticatory muscles are more common in men (2,4 %) than women (1,7%). Pathology of the temporomandibular and masticatory muscles, regardless of gender and age, usually combines, aggravates each other, and in 25–66,7% of cases occur in moderate or severe. It has been shown that in the course of planned in-depth medical examinations of military personnel, it is necessary to identify persons with clinical signs of pathology of the temporomandibular joint and masticatory muscles, and send them to the military medical organizations to clarify the diagnosis and conduct specialized treatment. It is noted that it is advisable for dentists when conducting scheduled in-depth examinations or military-medical examination it is advisable to carry out auscultation of the temporomandibular joint with the use of an electronic stetofonendoskop and myotonometry of the chewing muscles proper. This, with minimal time, will significantly increase the efficiency of detecting temporomandibular joint and masticatory muscles in military personnel.

Computer tomograms of the abdominal part of the aorta and its unpaired branches of adults belonging to three age groups are analyzed: the first, the second mature, and the elderly. It has been established that individual morphometric parameters of the abdominal part of the aorta and its unpaired branches in men and women significantly change with age. It is proved that the diameter of the aorta at different levels significantly increases with age from the first mature age to the elderly by an average of 5 mm. In addition, in men, the length of the abdominal aorta, celiac trunk and main trunk of the superior mesenteric artery do not change with age. In women, the length of the celiac trunk increases with age by 5,9 mm, the length of the main trunk of the superior mesenteric artery – by 17 mm. It can be assumed that this fact is due to the structural features of the connective tissue structures of the arterial wall in women, and, in particular, the elastic framework. The angle of discharge of the celiac trunk in men changes unevenly with age – in the second period of mature age, there is a statistically significant decrease on average of 12,3°, then in old age an increase of 15°. Moreover, in women, the values of this indicator vary more evenly. The angles of discharge of other vessels did not show a clear age dependence, since this parameter is largely due to the constitutional features. The aorto-mesenteric distance changes with age only in women. In old age, it is on average 4,4 mm larger than in the first period of mature age. In general, a number of morphometric parameters of the abdominal part of the aorta and its unpaired branches significantly changes with age. The findings are important for endovascular interventions.

The efficacy of treatment was evaluated by the fixed combination drug «Exforge-H» in 40 patients suffering from grade 3 arterial hypertension. All patients underwent general clinical and laboratory and instrumental examination (electrocardiography, echocardiography, 24-hour blood pressure monitoring) before and after 6 months of treatment. It was established that treatment with «Exforge-H» statistically reliably reduces the level of blood pressure, normalizes the variability and daily blood pressure profile. So, two weeks after the start of treatment, the systolic and diastolic pressure levels during clinical measurement decreased by 32,1±2,7 and 30,4±1,9 mm Hg. Art. respectively. After 3 months of treatment, 60% of patients showed achievement of the target level of blood pressure, and after 6 months – 96%. High hypotensive efficacy of treatment was also demonstrated during the daily monitoring of blood pressure in all its indicators. A significant decrease in systolic and diastolic pressure was observed during the day and night hours. The amplitudes of systolic and diastolic pressure variability have also been improved. At the same time, the variability of systolic pressure during the day was reduced by 46%, diastolic – by 49%, and at night by 59,3 and 52,8%, respectively, indicating a normalization of blood pressure during the day. All this was also accompanied by a decrease in the clinical manifestations of the disease. So, after 6 months of treatment, 84% of patients had positive clinical dynamics: a decrease in cardiac and cerebral symptoms, as well as emotional lability, which positively correlated with a decrease in the level of clinical blood pressure. The cardioprotective effect of the drug is expressed in the form of regression of left ventricular hypertrophy. In general, the use of the three-component fixed drug «Exforge-H» (valsartan – 80 mg, amlodipine – 5 mg and hydrochlorothiazide – 12,5 mg) is manifested by an increased antihypertensive effect due to the influence of its constituents side effects and the development of metabolic changes.

Despite the widespread and active introduction of new minimally invasive technologies in clinical phlebology, the Troyanov – Trendelenburg operation today is an important step in the extensive complex of various methods of surgical treatment of varicose veins of the lower extremities. This intervention can be performed under local anesthesia with minimal trauma and excellent cosmetic results. The leading position in the treatment of chronic venous diseases currently takes endovenous laser photocoagulation, the implementation of which is being offered now even to patients with complicated and advanced forms of the disease. The combination of Troyanov – Trendelenburg operation and laser thermocoagulation can significantly reduce the risk of downward recanalization of the great saphenous vein, as well as eliminate side effects and complications that occur during traction of the vein. To eliminate technical errors in the course of ligation of great saphenous vein in the area of sapheno-femoral anastomosis under local infiltration anesthesia and to simplify the detection of the target vessel, especially in obese patients with severe subcutaneous fat, we have developed a method for performing Troyanov – Trendelenburg, which decreases the time of the surgical treatment of the mouth section is up to 10–15 min; the risk of possible complications is reduced. In addition, this treatment does not increase the bed-day and recovery periods. It was concluded that the use of a laser beam at the end of the working part of the fiber, previously carried out under ultrasound control directly into the area where the great saphenous vein falls into the deep system, as a visual guide, greatly facilitates the search for the main saphenous vein, especially in obese patients. The operation of Troyanov –Trendelenburg allows you to process all branches of the Delbe beam and eliminate the continued progression of thermally induced thrombosis proximal to the anastomosis, and therefore possible pulmonary thromboembolism from the large subcutaneous vein subjected to laser coagulation.

Analyzed the clinical and epidemiological aspects of human toxocariasis in the Astrakhan region. It was established that from 2013 to 2017 in its territory 34 cases of human toxocariasis were recorded. In the structure of the total number of helminthoses for the analyzed period, the share of toxocariasis accounted for 0,2% of cases and 0,2% of the total number of all parasitosis recorded in the Astrakhan region. Both adults and children were affected by toxocariasis. Thus, the share of the adult population was 82,4%, incl. persons employed in production (working population) – 67,6%, pensioners – 11,8% and unemployed – 2,9%. The proportion of children in the overall incidence of toxocarcosis was 17,6%, of which 11,8% attended kindergartens and secondary school 2,9%. And in one case the child was unorganized – he was at home with his parents – 2.9%. The main complaints of people seeking medical care were: cough – 23,5%, general weakness – 17,6%, pain in the epigastric region and temperature rise to subfebrile numbers – 11,8%, allergic rhinitis and muscle pain and joints – by 5,9%, as well as decreased appetite, allergic rashes on the skin of varying degrees of intensity, feeling of suffocation and weight loss – by 2,9%. When ascertaining the epidemiological history, it was found that the probable cause of the development of the disease could be: not following personal hygiene rules – 94,1%, eating unwashed fruits and vegetables – 88,2%, close contact with domestic dogs – 52,9%, onigophagy – 20,6%, contact with domestic cats – 14,7%, geophagy and the habit of licking hands – 8,8% each, and contact with stray dogs – 5,9%. Personal hygiene rules were observed in 5,9% of patients. Generally, the current situation on human toxocariasis in the Astrakhan region remains highly relevant. The main causes of the disease were close contact with both domestic and stray animals, as well as non-compliance with the rules of personal hygiene. The presence of diseased antibody titers in the formulation of enzyme immunoassay 1:800 and above, as well as the presence of a clinical picture of the disease, indicates the direct presence of parasitic invasion in the examined.

The data of electroencephalography, evoked potentials of the brain and positron emission tomography are analyzed before and 3 weeks after the multipattern botulinum toxin therapy of spasticity in 25 patients with post-comatose long-term consciousness disorders, including one patient who died against the backdrop gradual improvement of consciousness from acute heart failure four months after the end of second course of multipattern botulinum toxin therapy. Found that improvements of the brain functional state against the backdrop of reduced spasticity were observed regardless of primary brain damage origin, level of consciousness and of multipattern botulinum toxin therapy course repeatability. The observed dynamics of neurophysiological indicators had a normalizing direction, some differences associated with the initial level of consciousness. Electrophysiological changes during the improvement of consciousness against the background of multipattern botulinum toxin therapy were not specific. Features of improving energy metabolism in the certain areas of the brain could be caused by just such treatment, and reflected the contribution of pathological sensorimotor integration in maintaining impaired consciousness. Postmortem neuromorphological study of the patient brain identified progenitor stem and proliferating cells and newly formed neurons in brain areas whose in-life functional state was continuously improving, newly formed neurons migrating flow through the corpus callosum and diffuse activation of axonogenesis. We assume that the central effect of multipattern botulinum toxin therapy associated with improvement of consciousness, may be a double. The first is immediate, due to a decrease in pathological afferentation from the muscles, the second – apparently deferred and prolonged, manifested in the activation of functional neurogenesis and axonogenesis in the brain. The continuation of complex multimodal research on the study of post-comatose long-term consciousness disorders seems promising.

The psychological characteristics of professionally maladapted cadets are considered. For signs of maladjustment were taken: performance – 3,5 points and below; physical fitness – 3 points and below; high incidence: the number of days of work loss from the beginning of the school year – 11 days or more; low discipline; poor relationship with the command and with colleagues, low psychological stability. Psychological personality traits can both contribute to the military-professional adaptation, and hinder it. Well-adapted cadets for training in a military college are characterized by a high level of stress tolerance, they are curious, have flexible thinking, they have hyperthymic characterological features. Professionally maladjusted cadets are characterized by stereotyped thinking, the prevalence of anxious and exalted character traits, the use of physical force against another person, readiness for the manifestation of negative feelings with the slightest excitement (hot temper), suspicion of relations with others, the expression of negative feelings as through form (cry , screeching), and through the content of verbal responses (curses, threats), the oppositional manner in behavior from passive resistance to active struggle From established customs and laws, they are more aggressive. Based on discriminant modeling, a highly informative forecast model of military professional maladjustment of cadets was developed as part of medical and psychological support measures (Wilks lambda: 0,29207 approx. F (4,58)=35,146; p<0,0001, predictive ability – 95,24 %). Predictors of military-professional maladjustment of cadets of a military university are a combination of indicators: stress tolerance, aggressiveness index, suspicion, guilt. It is advisable to use the mathematical model of the forecast of military-professional maladjustment of the cadets of the military higher educational institution in the framework of the activities of medical and psychological support for the cadets of the military higher educational institutions.

Results of early restoration of the ability to independent movement after amputation of the lower extremities as possibilities of prevention of development of the complications connected with a hypodynamia for reduction of terms of medical rehabilitation and restoration of quality of life are presented. Preparation for prosthetics was carried out with the application of modern methods of medical physical culture according to four motor activity levels. For prevention of development of contractures of joints, decrease in the puffiness of tissues of a stump will be applied techniques of medical physical culture, orthopedic laying, elastic bandaging of a stump of a shin and hip, carrying compression elastic and polymeric (silicone) covers. For improvement of lympho-venous outflow, reduction of puffiness of soft fabrics and of a phantom pain syndrome elastic glue bandaging (a therapeutic adhesive tapes) of a stump is shown. Non-drug treatment of phantom pain syndrome is especially relevant at contraindications, intolerance the patient of medicines. Among non-drug techniques of simplification of a phantom pain, syndrome use various techniques of reflexotherapy (acupuncture, an akupressura, etc.), to an empatotekhnik, a mirror therapy, phantom-impulsive gymnastics. Holding sessions of a mirror-therapy was followed with phantom-impulsive gymnastics by the standard technique. For prevention of formation of a flexion contracture of a knee joint after below-knee amputation used universal adjustable elastic orthosis for the knee made of polyurethane foam in the form of the rolled design with the fixing tapes is offered. Besides of, the technique of training moving by artificial limb helps the truncated extremity with the regulated reception sleeve or the made reception sleeve which is put on a stump from the water hardened plastic bandage is improved. The value of the offered technique consists in the imitation of end-bearing on a stump in the adjustable socket with the put-on reception sleeve and to training in use before fitting and walking with an artificial limb. This medical technology of early restoration of moving ability after amputation of a shin or a hip with the application of new designs of adjustable reception sleeves from thermoplastic materials in the form of a adjustable socket row with modular connection for assembly of artificial limbs of the lower extremities by express methods provides essential positive social and economic effect. The technical documentation set on new designs of artificial limbs of a shin and hip is developed for early primary prosthetics. The offered medical technology of early primary prosthetics is introduced at 27 state and five non-state prosthetic and orthopedic enterprises of the Russian Federation and also the prosthetic and orthopedic enterprises of Dushanbe (Republic of Tajikistan), Tashkent (Republic of Uzbekistan).

The advantage of biotesting in comparison with the physicochemical analysis of the use of Paramecium caudatum for toxicological studies has been shown. Physical and chemical analysis often fails to detect unstable compounds. In addition, these tools are not possible to determine the ultra-low concentration of chemicals. In addition to the traditional use of laboratory animals, representatives of protozoa have recently been used. In connection with this, a test object of the Simplest type was chosen and justified. The advantages of using the simplest compared with the use of laboratory animals. The various models used to test toxic substances are described. Their advantages and disadvantages are noted. The main advantages of second-order models using alternative models (various hydrobionts, bacteria, cell cultures, etc.) are described. The relevance of using the culture of cells of the ciliate Paramecium caudatum for toxicological studies has been shown. The methodological aspects of the biotesting of organic solvents using the proposed test object are presented. A unidirectional change in the toxicometric parameters of organic solvents for two types of biological objects: a white mouse and a culture of infusoria Paramecium caudatum were revealed. The possibility of using Paramecium caudatum for toxicological studies has been shown. A correlation was noted between the indicators of the general toxicity of organic dyes and those of white mice.

This work presents the results of in a noninvasive topographic and anatomical study of the gallbladder and the anterior abdominal wall parameters in the right hypochondrium region (based on the results of spiral computed tomography and 3D modeling) in both sexes with different body types. It is established that there are some features of the gallbladder’s bottom and neck holotopia, depending on sex and body type of the patient. Extreme variants of the gallbladder’s position are revealed. The bottom of the gallbladder is located: a) the most lateral position in hyperstenic men; b) maximum medial in astenic women; c) maximum cranial in astenic men; d) the most caudal in astenic women. The gallbladder’s neck is located: a) the maximum lateral position in normostenic men; b) maximum medial in astenic women; c) maximum cranial in astenic men; c) the maximum caudal in astenic women. A mathematical algorithm is proposed and a software package is developed to determine the gollbladder’s bottom and neck probabilistic location in the three-dimensional coordinate system in patients depending on gender and body type. The developed technique allows to choose the type of operative access, to plan its individual localisation, and also to calculate criteria of operative access depending on patient’s anthropometric data during preparation for intervention. This allows to decide on the rationality of the use of a surgical access, choose its optimal location, the size of the skin incision, thereby reducing surgical trauma during the intervention and leads to improved quality of treatment of patients with gallstone disease.

The effectiveness and quality of liver biopsy in rats are applicable to the aspiration and automatic liver biopsy system. Histological examination of 240 biopsy specimens in 100% of cases identified portal tracts. The number of portal tracts to determine the stage of liver fibrosis in rats of the 1st group who underwent liver biopsy was performed using an 18 G aspirating needle from the puncture liver set (Menghini type), which is 4–5, you have the 2nd group, which one-time guillotine soft tissue biopsy with a semi-automatic action of 16G×20 cm, Italy) – 7–8 portal tracts. The average size of the biopsy in the 1st group is 0,5 cm, in the 2nd group – 1 cm. Thus, the automatic biopsy system allows you to get liver tissue in 100% of cases. At the same time, the automatic system eliminates the additional traumatization of experimental animals, as well as minimizes efforts to separate the biopsy material from the organ. In addition, the automated system for liver biopsy allows to evaluate 7–8 portal tracts with a biopsy size of 1 cm, this provides a reliable histological assessment of pathological changes in liver tissue to assess the stage of fibrosis and the activity of the inflammatory process over time.

The involvement of countries possessing nuclear weapons in local and regional armed conflicts poses a threat of use of nuclear weapon. In the case of this combined radiation injuries can make up to 70% of sanitary losses. The existing ideas about the methods of surgical treatment of combined radiation-thermal injures are contradictory and do not clearly provide procedure depending on the severity of injury or in non-classical forms of injury. The idea of the study was to estimate the effectiveness of performing an early necrectomy of a burn eschar after a two-factor injury, which includes modeling mild acute radiation syndrome in addition to a thermal burn on rats. A deep skin burn was simulated with hot water over an area of 10% of the body surface after total γ-irradiation at a dose of 3 Gy. Then after 3 h the burn eschar necrectomy was performed. It was established that the chosen method of surgical treatment of a deep burn significantly aggravates the severity of irradiated animals, which is manifested by the death of more than 50% of rats in the first 4 days after necrectomy. The operative trauma became the leading component of the combined injury formed and determined the severity of its course. Thus, the burn eschar necrectomy modifies a light two-factor radiation-thermal injury to a classic combined radiation injury. Despite the severe postoperative period, necrectomy significantly accelerates the healing of burn wounds in irradiated animals. This indicates the promise of finding methods for compensating abnormalities developing in the postoperative period in order to accelerate wound healing before the onset of radiation sickness and prevent infectious complications.

The study of topographic and anatomical features of the common peroneal nerve and its main branches was performed on 72 lower extremities of adult corpses. Morphoscopic and morphometric established that the higher the level of development of the common peroneal nerve, the greater the diameter, it has held more distance to the branch of the lateral cutaneous nerve of the calf. The average value of the diameter of the common peroneal nerve at the place of formation is 10,1±2,8 mm. Differences in the level of development of the common peroneal nerve play an important role in the evaluation of the clinical picture of his injuries. In the «high» version of the formation, the probability of isolated damage to the common peroneal nerve is higher with trauma to the upper and middle third of the thigh. In this embodiment, the formation between the tibial and the common peroneal nerve revealed «anastomoses». Their presence helps to explain the possible dissonance between the clinical picture and the anatomical substrate of the lesion. It is shown that the lower the level of nerve formation, the greater the angle at which the nerve departs. The loose type of branching of the common peroneal nerve at the level of the head of the fibula does not allow adequate mobilization of the nerve in this area. This, in turn, does not allow intraoperatively overcome diastasis with nerve injury at the level of the fibula head. The surface location of the nerve, as well as its immobility in this place cause a high risk of compression-ischemic neuropathy. These features of the formation and variant anatomy of the common peroneal nerve explain a small percentage of favorable outcomes of surgical treatment of lesions of the common peroneal nerve and its main branches. The obtained morphometric data should be used as an indicator of the range of anatomical norms in the conduct of neuroimaging examination techniques (ultrasound, magnetic resonance) in the diagnosis of damage to the common peroneal nerve.

Investigation of physiological mechanisms of cognitive functions and efficiency of cognitive activity is the major problem of military service psychophysiology. We have studied the effect of military-training experience on cognitive functions, heart rate variability and bioelectrical activity of sensorimotor cortex of cadets. Cadets with military-training experience from Suvorov Military (quantity of errors in Shulte’s test (0,16±0,57) in comparison with the cadets without military-training experience (0,54±1,08) (F=4,7; p=0,03). Cadets from Suvorov Military School had a higher quantity of false start (46,36±17,68) and lower quantity of retardation (86,39±17,44) on visual stimulus of test «Reaction on moving object». Cadets without military-training experience had quantity of false start – 38,04±18,95 (F=5,8; p=0,02) and quantity of retardation – 100,48±20,37 (F=15,1; p=0,001). Cadets with military-training experience solved a lower quantity of tasks in the test «Hours with rotation» (26,18±6,71) in comparison with the cadets without military-training experience (29,10±7,89; F=4,3; p=0,04). The maximum time of solving one task at cadets with military-training experience is more (38,07±10,66 sec) than at cadets without military-training experience (34,07±10,57 sec; F=4,0; p=0,05). Cadets with military-training experience had lower heart rate, the higher standard deviation of R–R-intervals and variation range, high level of relative power in the high-frequency spectral bound. They had high activity of sensorimotor cortex of right cerebral hemisphere in the tests with the switching of attention and had low activity of sensorimotor cortex of left cerebral hemisphere in the test with arithmetic tasks.

The article substantiates the need for the use of telemedicine technologies in the Armed forces of the Russian Federation. On the basis of the analysis of the literature presents the main directions of their use: remote consultation of doctors with each other, the transfer of data about the patient in a single center, remote monitoring of physiological parameters. The directions for the use of telemedicine technologies in the interests of the Ministry of defense and the need to develop a portable individual device for monitoring the basic physiological parameters of soldiers. Information on the creation of the military innovative technopolis «Era» is presented, the main goals and objectives that will be implemented on its basis are given. The urgency of the creation of «Research laboratory for monitoring vital functions of the body of soldiers and prevention of pathological conditions» on the basis of military innovative technopolis «Era» is emphasized. The main directions of the work of this laboratory and the expected results to be obtained at this site are given. In November 2018 the work of the laboratory, its main goals, objectives and prospects were presented to the President of the Russian Federation. Currently in the laboratory by the specialists of the Military medical Academy n.a. S.M. Kirov and the scientific company of the military innovative technopolis «Era» testing of various domestic wearable devices is carried out comparing them with reference diagnostic systems and software revision.

The results of the telemedicine advisory center, organized on the basis of the Bekhterev Psychoneurological Research Institute, for the semi-annual period (from October 2018 to March 2019). The center provides scheduled consultations on the profiles of «psychiatry» and «psychiatry – narcology». Consultations are organized through the circulation of documents in the system developed by the Ministry of Health of Russia and the All-Russian Center for Disaster Medicine «Protection». For half a year of work of the telemedicine center from the subordinate regions (Southern, North-Western, North-Caucasian and Volga federal districts) 76 requests for consultations were received. More than half (57,9%) of patients requiring telemedicine consultation were women. The largest number of requests for telemedicine consultations came in February 2019. It has been established that the Southern Federal District showed the greatest interest in consultations with the use of telemedicine technologies, the number of their requests was 35,5%, and the smallest number of requests came from the North-West Federal District. 88,2% of all complaints were in the «psychiatry» profile, 11,8% – «psychiatry – narcology». 90,9% of women and 84.4% of men received counseling on the «psychiatry» profile. 30,2% of requests were returned to doctors for revision, due to the lack of completeness of the documents provided. At the end of the consultation, a medical report is sent to the attending physician, which indicates recommendations for the further management of the patient. Recommendations on the need for additional examinations and the appointment of drug therapy received 52,8% of patients, respectively.

The characteristic of population Т-lymphocytes is presented. The variety of effects of these cells is connected with presence of many subpopulations which name small subpopulations helper T-lymphocytes: Тh1, Тh2, Тh3, Тh9, Тh17, Тh22. Mechanisms of activation of these cells and their role in development of mechanisms of the adaptive immune answer, and also possible variants of development of immune dysfunctions and an immune pathology are described. However, the leading part is allocated to the characteristic regulatory T-lymphocytes. From all subpopulations regulatory lymphocytes subpopulation CD4+CD25+high-Т-lymphocytes. Regulatory function autoimmunity а from these cells is most well investigated is shown already at early age. Given subpopulЫation Т-lymphocytes is capable to render suppressor influence on various types immunocompetent the cells providing functioning both congenital, and got immunity. Very important role in functioning CD4+CD25+high-Т-lymphocytes belongs transcriptional to factor FoxP3. It is established, that FoxP3 renders negative effect on activation of T-cells, possibly, owing to oppression efferent functions interleukin 2. Suppressor the effect of these cells is not limited to the T-cells specific to self-antigens. Their influence extends on all microenvironment lymphocytes. Regulatory function CD4+CD25+high-Т-lymphocytes is carried out by means of rendering cytotoxic effect on a cell-target by means of perforins, granzyme A and CD18 without participation of a Fas-receptor. CD4+CD25+high-Т-lymphocytes can render suppressor effect through production transforming growth the factor and expression him on a membrane of a cell. Except for these cells are described Тh3-lymphocytes and inducible regulatory cells. Effects which they cause, are connected with production transforming growth the factor, interleukins 4 and 10. The given biological functions lead to oppression of production of antibodies plasmacytes and modulate presenter activity of macrophages and dendritic cells.

Diagnostic and tactical errors in the management of patients with traumatic neuropathies of the limbs are considered. Attention is drawn to the problem of treatment of traumatic lesions of the peripheral nerves and the organization of medical care in modern conditions for patients with this pathology. The paper describes the difficulties encountered in the differential diagnosis and interpretation of the clinical picture of peripheral nervous system damage, as well as the possibilities of neurophysiological and neuroimaging methods of diagnosis, describes the most common variants of innervation. The most common traumatic neuropathies after medical interventions are presented. It is established that a high degree of mechanization of production, an increase in the number of road accidents, growing household injuries and the mass introduction into everyday life of extreme sports lead to an increase in injuries of the peripheral nervous system. The article pays special attention to the organization of medical care for patients in hospital conditions, as well as the main subjective and objective causes of errors in practitioners during topical diagnosis and treatment of nerve injuries. Attention is drawn to the fact that in order to provide modern high-tech medical care for damage to the nerves of the upper and lower extremities, specialists of surgical and neurological profile need to know the architectonics of the peripheral nervous system and the basic laws of degenerative-regenerative processes in damage to the nerves and plexuses. Rational therapy of victims of this profile should be planned and implemented in the early period of traumatic disease.

The present review is concerned with the modern state of the problem connected with the severity degree estimation of the lower extremity blast injury. The specific character of modern combat activity is considered to be the prevalence of the blast trauma in the structure of casualties, this trauma amounting up to 69% of all the combat injuries. The problem of the adequate unbiased estimation of the severity degree for this kind of trauma appears to be critical, because it is important for the appraisal of the necessary volume of medical care provided for the casualties and optimal assignment of the casualties to the medical evacuation stages beginning from the combat zone up to the specialized trauma center. The combat blast trauma is distinguished from the civilian trauma, it also differs from blast injuries occurring during technological disasters. In this regard, the use of traditional estimation parameters for the lower extremity trauma severity, based on clinical findings of civilian injuries, seems not possible. The development of appropriate severity estimation technique for the lower extremity blast trauma is essential not only for the medical care, but also for the adequate experimental modeling processes using human cadavers and biomorphic models, and the development of virtual “mathematical” simulators. Currently, investigators are involved in developing specific severity degree estimation scales for the lower extremity blast injury, based on the case histories analysis and casualties’ follow-up. Foreign experts have proposed a number of assessment classifications of mine-explosive injury, allowing to formulate a diagnosis and determine the severity of the injured explosive limb injuries. In our country, there is currently no generally accepted classification developed in relation to the explosive injury of the lower extremities, but the methods proposed by domestic military field surgeons and traumatologists allow us to effectively assess the severity of this injury and make a certain sorting decision.

The evaluation sheet was tested and practical skills for conducting puncture and catheterization of the internal jugular vein in clinical residents at the station «Catheterization of the internal jugular vein under ultrasound control» were evaluated. The manipulation was performed by 28 second-year clinical interns on the phantom, which allows the puncture of the vessel under the control of ultrasound. The evaluation of manual skills, independently of each other, was carried out by two teachers. Successfully station passed 100% of the examinees. The total time spent on the passage of one resident station was 6,3 (5,1; 7,3) minutes. In 100% of cases, the residents demonstrated their knowledge of the technique of puncture and catheterization of the internal jugular vein. In 8 (28,5%) cases, the most frequent errors encountered during the passage of the station were associated with the absence of time fixation after the manipulation, in 10 (35,7%) residents the state of health was not monitored. The differences in the completed evaluation sheets of teachers amounted to 3%. It is shown that the developed evaluation sheet allows you to objectively assess the practical skills of graduates of residency. This evaluation sheet will be further used in the assessment of practical skills at the stage of primarily specialized accreditation for graduates of residency in the speciality «Anesthesiology and reanimatology».

Described the stages of the formation of one of the first in Russia departments of skin and venereal diseases of the Military medical academy. S.M. Kirov. The contribution of eminent dermatovenerologists of the department leaders is noted: A.G. Polotebnova, V.M. Tarnovsky, T.P. Pavlova, P.A. Velikanova, M.G. Mgebrova, S.T. Pavlova, О.K. Shaposhnikova, A.N. Rodionov. So, A.G. Polotebnov is considered to be the founder of Russian dermatology and venereology. V.M. Tarnovsky was the initiator of the creation of the first in Europe Russian Syphilidological and Dermatological Society. T.P. Pavlov is known for his works on the histopathology of dermatoses, and also raised a large school of dermatology. S.T. Pavlov described for the first time in the world acantholytic cells in pemphigus, and Academician OK Shaposhnikov was the country’s leading specialist in immunology and histopathology of skin vasculitis. Currently, the department’s priorities are: the study of the molecular genetic basis of psoriasis, lymphoproliferative, bullous skin diseases, the study of foci of chronic infections in various dermatoses, the creation of teledermatology and teledermatohistopathology systems in medical institutions of the Ministry of Defense of the Russian Federation, pathohistology, trichology, psychodermatology, development of new external agents for the prevention and treatment of infectious skin diseases using liposomal yy technologies. It is shown that as a result of the work done, the Department of Skin and Venereal Diseases of the Military medical academy. S.M. Kirov reliably secured the status of Russia’s leading scientific and methodological center for the study and treatment of skin diseases.

Presents information from the life of a maxillofacial surgeon and dentist, one of the patriarchs of domestic dentistry, a veteran of the Great Patriotic War, academician of the Academy of Medical Sciences of the Union of Soviet Socialist Republics, doctor of medical sciences, professor, colonel of medical service Anatoly Ivanovich Rybakov, known in our country and abroad, who was the first director of the Central Research Institute of Dentistry. The data on the formation of A.I. Rybakov as a military doctor and dentist, his combat path during the Great Patriotic War. Turning to the life and professional and social activities of Anatoly Ivanovich, one can find not only interesting scientific facts from the history of dentistry and maxillofacial surgery, but also analogies with modernity, answers to many clinical problems of the specialty and medicine of today. The main directions of his scientific activity, which touched questions of almost all sections of dentistry and maxillofacial surgery, are noted. A.I. Rybakov was one of the creators of the working concept of the pathogenesis of dental caries and periodontal diseases, the author of the first recorded discovery in dentistry on the phenomenon of the production of intestinal antigen by the oral mucosa of mammals, the founder of the study of the epidemiology of dental diseases in Russia and the Republics of the Soviet Socialist Republics. It is noted that he was a refined connoisseur of the history of national ballet, a true professional and an authority in this field of art. Anatoly Ivanovich, being one of the founders of domestic dentistry, as well as the school of dentists and maxillofacial surgeons, is rightfully recognized as one of the patriarchs of domestic dentistry.

June 23, 2019 marks the 100th anniversary of the birth of prominent Russian transfusiologist, professor, student of academic V.N. Shamov, participant of the Stalingrad Battle Semyon Vavilovich Ryzhkov (1919–2004). He was the one who established the Russian Ministry of Defense Blood Service. In 1961, he founded the Research Laboratory of Fibrinolysis Blood and Tissue Preservation, which since 1964 bears the name of the Blood and Tissue Center. He had been the head of the Center for 20 years. His academic interests covered such issues as the use of hemodialysis in acute renal failure, the cryopreservation of red blood cells and bone marrow, which brought him the Union of Soviet Socialist Republics State Prize in 1978, the substantiation of the safety of a 400 ml blood donation, and the use of donor hardware plasmacytopheresis. The article presents data on the contribution of the scientists of the Military Medical Academy to the development of the national blood transfusion service from the 2nd half of the XIX century till the establishment of the Ministry of Defense Blood Service in 1965. June 21, 1919 V.N. Shamov, N.N. Elansky, and I.R. Petrov carried out the first donor and recipient matching blood transfusion in Russia. They contributed a lot to teaching medical practitioners to do blood type tests. In 1926, N.N.Yelansky was the first in Russia to publish the study Blood Transfusion. In 1944, V.N.Shamov was the first in Russia to publish The Blood Transfusion Manual for Military Doctors. On the battlefields of Lake Hassan, the Khalkhin Gol River, and in Spain, the surgeons of the Military Medical Academy proved the universal type 0 blood transfusion to be a successful technique. The opinions of scientists on blood donation and preservation, indications and contraindications to blood transfusion in peacetime and wartime are presented.

The main years of the life and scientific creativity of I.P. Pavlova. Illuminated little-known facts from the life of a scientist. It is noted that IP Pavlov is one of the most prominent representatives of modern natural science, the creator of the materialistic theory of higher nervous activity of humans and animals, the founder of the largest physiological school of modernity and new approaches and methods of research in physiology. Pavlov I.P, studied many topical problems of physiology and medicine, but his most systematic and thorough research relates to the physiology of the circulatory and digestive systems, as well as the higher parts of the central nervous system: they are rightfully considered classic, which opened new pages in the relevant sections of physiology and medicine. New and valuable were the results of his research also on individual issues of the physiology of the endocrine system, comparative physiology, physiology of labor and pharmacology. Being deeply convinced that “for a natural scientist, everything is in a method,” IP Pavlov elaborated and introduced the practice of physiological research into the method of a chronic experiment, based on the need for a multilateral and detailed study of the body’s functions in natural conditions, in inseparable communication and interaction with the environment. This method brought the physiology out of the impasse created by a one-sided, analytical method of acute vivisection experiment that prevailed for a long time. Used in the early works of Pavlov on the physiology of blood circulation, the method of chronic experiment was elevated to the rank of a new scientific experimental principle in basic research on the physiology of digestion and then perfected when studying the functions of the higher parts of the central nervous system. Pavlov I.P comprehensively researched and studied the dynamics of the secretory process of the gastric and salivary glands, pancreatic glands, the work of the liver in the use of food of different quality, proved their ability to adapt to the nature of the causative agents of secretion. Created by Pavlov’s theory of higher nervous activity is one of the greatest achievements of natural science in the 20th century. It is a system of the most reliable, complete, accurate and deep knowledge of brain functions and is of great practical importance for medicine, psychology, pedagogy, and scientific organization of complex labor processes.