Vol 22, No 3 (2020)

Abstract. Clinical and epidemiological and electrocardiographic features of Wolf – Parkinson – White syndrome in men of military age were studied. The study was a retrospective study with a solid sample of patients. Of the 1,9056 men residents of St. Petersburg between the ages of 18 and 27, Wolf-Parkinson-White syndrome was identified in 107 (0,56%) people. The disease was asymptomatic in 38 (35,5%) patients. All identified individuals with Wolf – Parkinson – White syndrome, in addition to asthenic Constitution type, which was observed in 68,2% of cases, were assessed for signs of systemic connective tissue involvement. It was found that flat feet, scoliosis or kyphosis, myopia, as well as mitral valve prolapse and abnormally located chords in the left ventricle of the heart are detected in almost every second man of military age. Due to the inability to assess the presence of all signs of systemic connective tissue involvement, the isolation of specific variants of dysplastic phenotypes in patients with Wolf – Parkinson – White syndrome was not performed. It was found that in the presence of increased dysplastic stigmatization, the clinical course of Wolf – Parkinson – White syndrome is characterized by a lower number of asymptomatic cases (6,3 and 16,7%, respectively; p<0,05), an increase in the frequency of paroxysmal tachyarrhythmias (81,5 and 63,1%, respectively; p<0,05) and a high incidence of vegetative-vascular disorders (82,8 and 15,4%, respectively; p<0,05).

Abstract. The frequency of occurrence of arterial hypertension genes in individuals at risk of sudden cardiac death was studied. The relationship between risk factors for sudden cardiac death and the presence of polymorphisms of arterial hypertension genes was revealed. There was a high incidence of homozygous risk variants AGTR2 AA and CYP11B2 TT-polymorphisms responsible for the development of left ventricular hypertrophy, including in young individuals. A correlation was found between deaths in close relatives under 50 years of age and the presence of polymorphisms in the CYP11B2 344 C>T gene in young people at risk of sudden cardiac death. We have obtained data indicating the feasibility of conducting a study of the polymorphism of the CYP11B2 gene in the presence of a risk of sudden cardiac death. A direct correlation was found between the presence of fatal outcomes in relatives under 50 years of age by the mechanism of sudden cardiac death and the number of homozygous variants of arterial hypertension genes. Mathematical models for predicting the presence of polymorphisms in genes responsible for the possibility of arterial hypertension are constructed. Among the constructed mathematical models, the most informative were models for detecting carriers of mutations in the genes ADD1 1378 G>T, CYP11B2 344 C>T and NOS3 894 G>T. The expediency of the analysis to search for mutations of arterial hypertension genes, especially in the CYP11B2 344 C>T gene, for the possibility of earlier and more intensive preventive measures in young people is shown. The data obtained indicate that there are relationships between the risk of sudden cardiac death, some known predictors of its occurrence, and the genes for arterial hypertension.

Abstract. The clinical efficacy and safety of the use of percutaneous techniques in the treatment of kidney stones in 72 servicemen were studied. All percutaneous operations were performed by one operating team. It was found that percutaneous urolithiasis surgery was effective in 88.9% of people. «Stone free rate» was achieved in 83,8% of military personnel undergoing standard percutaneous nephrolitholapaxy and in 94.3% of patients undergoing minipercutaneous nephrolitholapaxy. With stones larger than 2 cm, the effect was observed in 81.8% of cases with standard surgery and in 96% of patients with mini-percutaneous approach. Percutaneous interventions in military personnel with stones larger than 2 cm were effective in 84,6% of patients with standard surgery and in 90% with mini-percutaneous access. Complications according to the Clavien-Dindo classification were found in 29,1% of servicemen: in 20,8% of cases of standard nephrolitholapaxy and in 8,3% of minipercutaneous nephrolitholapaxy. The bulk of the complications were Grade I–II – 20,8%. Grade III – IV were determined less frequently – in 8,3% of cases. Urosepsis (Grade IV b) and death (Grade V) were not observed in our study. Duration of labor losses for conscripted servicemen were about 17 days, for contract servicemen when performing standard nephrolitholapaxy – 12,8 days, for military personnel with minipercutaneous nephrolitholapaxy – 11,2 days. The dismissal rate among conscripts was 18,2%. There were no contractual servicemen who were dismissed from the ranks of the Armed Forces of the Russian Federation, however, 14,7% of servicemen who underwent a standard operation and 11,1% of patients who underwent mini-percutaneous nephrolitholapaxy after surgery needed sick leave for a period of 15 days. In general, percutaneous techniques are common and effective methods of surgical treatment for military personnel suffering from urolithiasis. Mini-percutaneous approach for nephrolitholapaxy is safer than the standard approach, but it is less effective for coral calculi. Percutaneous methods for removing kidney stones are associated with a low rate of dismissal and short recovery times for military personnel.

Abstract. Prevalence and clinical significance of electrocardiography findings was studied in 1189 older pilots in aged 55 years and older, who were consistently admitted to the Central Civil Aviation Hospital (Moscow) and examined on the regular bases. Resting 12-lead electrocardiogram was recorded in all subjects according to generally accepted methods. Normal electrocardiogram was found in 78,5% of older pilots. None of the examined showed signs of myocardial infarction. Minor electrocardiogram abnormalities was registered in 21,5% of pilots. Cardiac conduction disorders were predominated – 16,1% of cases, most of them were intraventricular conduction disorders – 13,7% of cases. Another electrocardiogram abnormalities were less common – 4% of cases. Mixed electrocardiogram abnormalities were noted in a small number of observations – in 1,4% of individuals. Thus, older civil aviation pilots are characterized a lower frequency of majority electrocardiogram deviations compared to a population of the same age. The evaluation of fitness to flight in some electrocardiogram deviations is depend of the presence or absence of cardiovascular disease, functional condition of the cardiovascular system and the data of additional examination methods. On the whole, the electrocardiogram use as a screening in asymptomatic individuals has some significant limitations - a number of detected abnormalities may be normal variants, as well as a normal electrocardiogram may be in significant narrowing of the coronary artery. Nevertheless, the need for electrocardiogram recording is recognized by aeromedical specialists of different countries, since this method is exclude a number of pathological changes, which are significant for flight safety.

Abstract. Presents a clinical case of the treatment of a patient suffering from Wilkie’s syndrome. Wilkie’s syndrome (aorto-mesenteric compression of the duodenum) is a compression of the duodenum (its horizontal section) between the abdominal aorta and the superior mesenteric artery. The causes of this disease are asthenic constitutional type, sharp weight loss, etc. A natural complication of Wilkie’s syndrome is the occurrence of a chronic violation of duodenal patency. The method of choosing treatment for aorto-mesenteric compression is surgery. The most optimal volume of surgery is the formation of duodenojejunoanastomosis according to Albrecht – Staveley, however, after this intervention, there is a high risk of a vicious circle syndrome. Patient M., 28 years old, who was scheduled for treatment, noted constant pain in the upper abdomen for 18 years, aggravated after eating, nausea, periodic vomiting, weakness. As a result of the examination, the patient revealed aorto-mesenteric compression of the duodenum. According to multispiral computed tomography of the abdominal organs with contrast at a distance of 40 mm from the mouth of the superior mesenteric artery, a horizontal branch of the duodenum is located between it and the aorta, its diameter at this level is no more than 4 mm, the angle of departure of the superior mesenteric artery from the aorta is 17 degrees. Violation of the passage through the duodenum was confirmed by fluoroscopy of the upper gastrointestinal tract with contrast. The patient underwent surgery. As a method of surgical treatment, an original modification of Albrecht – Staveley operation was used, which, in addition to achieving the main goal, is aimed at preventing the development of the «vicious circle» syndrome. The patient was discharged from the clinic on the 10th postoperative day in satisfactory condition.

Abstract. The risk factors for the formation of polymorbidity in military personnel of different age groups were studied during a medical examination to determine the category of fitness for military service. It was established that the most effective indicators in the form of linear dependences were: the level of trans-systemic polymorbidity and body mass index, waist-to-hip ratio, the cardio-anklevascular index, the thickness of the intima-media complex of the common carotid artery, the level of total cholesterol, and alcohol consumption.In the group of military personnel under the age of 35, positive correlation was found between trans-systemic polymorbidity and body fat, body fat percentage, body mass index, total cholesterol and low density lipoproteins.In the group of military personnel aged 36 to 45 years, positive correlation was found between trans-systemic polymorbidity and body mass index, percentage of body fat, and fat tissue in the body. Given the positive correlation between trans-systemic polymorbidity and indicators characterizing overweight, obesity is one of the leading factors in the formation of polymorbidity under the age of 45 years. It is shown that measures aimed at the prevention of polymorbidityshould basicallyinclude generally accepted measures for cardiovascular prophylaxis and obesity.

Abstract. The epidemiological situation of malaria incidence in the Astrakhan region from 1996 to 2019 is analyzed. During this period, 163 cases of human malaria were registered in the Astrakhan region. The largest number (134 (82,2 %)) cases of malaria were reported between 1996 and 2002. Since 2002, there has been a downward trend in the incidence of malaria from 11 (6,7%) in 2002 to 1 (0,6%) in 2019. Cases of malaria were registered between the ages of 5 months and 70 years, including 41 (25,2%) children aged 5 months to 17 years and 122 (74,8%) cases in adults. At the same time, 91 (74,6%) adults employed in various industries were in the group of people of working age. Three-day malaria was registered in 153 (93,3%) people, 8 (4,9%) people – tropical malaria and 1 (0,6%) – four-day and ovale-malaria, respectively. In the Astrakhan region, 141 (86,5%) people registered imported malaria from both the Commonwealth of Independent States and the African continent. In addition to imported malaria, 11 (6,7%) cases reported secondary malaria from imported malaria. The percentage of repeat cases was 11 people. All cases of malaria were diagnosed on the basis of epidemiological history, clinical picture and laboratory studies. Thus, in recent years, isolated cases of imported malaria have been registered in the Astrakhan region. Both children and adults are susceptible to the disease. Malaria was imported to the Astrakhan region mainly from Azerbaijan, Tajikistan and countries of the African continent.

Abstract. The issues of reconstruction of the anterior abdominal wall in patients with median postoperative ventral hernias remain relevant for many years. The paradigm of their treatment is gradually shifting towards functional minimally invasive reconstructions of the anterior abdominal wall. The indications and technical aspects of endoscopic posterior separation surgery are considered. The analysis of 70 transversus abdominis release was carried out. The average age of patients with postoperative ventral hernias was 61,2±10 years. The median follow-up was 14,2±8,2 months and the anaesthesia risk was 2,8±0,5. The mean hernia width was 151,7±73,7 cm² and the implant size was 832,9±243,3 cm². In the early postoperative period complications were observed in 7 (10%) patients, including the one with retromuscular hematoma, four with retromuscular space infection and two with superficial vein thrombophlebitis. Late complications were observed in 6 (8,7%) patients, there were persistent seroma (3) and chronic pain (3). No hernia recurrence was detected during this period. Thus, the use of endoscopic abdominal wall separation reduces the risk of local complications compared to similar open surgery. At the same time, there is a low level of hernia recurrence and a satisfactory quality of life. In total there were 70 (100%) transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal transversus abdominis release operations performed, among them 14 (77,8%) were bilateral transversus abdominis release and 32 (61,5%) were unilateral transversus abdominis release – 4 (22,2%) and 20 (38,4%) respectively were transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal – 10 (14,3%) operations with combined access were performed: 3 (16,7%) and 7 (1,5%) respectively transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal transversus abdominis release. In 13 (18,6%) cases simultaneous operations occurred, including 7 (10%) laparoscopic cholecystectomy and 6 (8,6%) endoscopic inguinal hernioplasty.

Abstract. A review of the literature on remission of immune thrombocytopenic purpura in children and a retrospective analysis of its course in a young patient who was successively applied, first to no avail, standard drug therapy, and then, due to the lack of effect, a physiotherapy technique based on the principles of activation therapy. It is known that immune thrombocytopenic purpura is a rare acquired autoimmune disease characterized by isolated thrombocytopenia with the occurrence of hemorrhagic syndrome of varying severity, which can lead to fatal bleeding. At the same time, antiplatelet antibodies are detected only in half of patients suffering from immune thrombocytopenic purpura, and therefore are not a necessary criterion for diagnosis, which in turn makes it difficult to diagnose the disease and does not allow them to be used as a criterion for the effectiveness of treatment. Despite the fact that in childhood, most cases of immune thrombocytopenic purpura occur in acute form, often with the development of spontaneous remission, but in a significant part of patients, relapses of the disease are accompanied by significant thrombocytopenia, hemorrhagic syndrome, and a decrease in the quality of life, which requires specific therapy up to splenectomy. When using the Reverse wave technique in the treatment of immune thrombocytopenic purpura, a stable, long-term remission was achieved in a young patient. The prospects of studying the application of this physiotherapy technique in clinical practice are discussed.

Abstract. The models for the prognosis of infectious complications and the outcome of acute pancreatitis are developed based on a mathematical analysis of the totality of clinical and laboratory data on the course of the disease, which have the form of a decision tree. It was revealed that laboratory indicators show statistically significant intergroup differences and allow to form a prognosis of the course of the disease. The threshold values of laboratory parameters calculated as a result of applying the classification and regression algorithm by constructing a decision tree are the nodal points for the distribution of patients according to the likelihood of further development of the disease. Thus, the presence of an international normalized ratio of more than 1,31 or an international normalized ratio of more than 1,31 and a hematocrit of less than 40% with a predictive probability of 80% is associated with the development of infectious complications in any period of the disease in the first 3 days of the development of the disease. If in the first 3 days of the disease the glucose level exceeds 11,55 mmol / L and the concentration of Ca²⁺ ions is less than 0,66 mmol/L, the probability of death is more than 70%. If the glucose level is more than 11,5 mmol/L and the level of Ca²⁺ ions is less than or equal to 0,66 mmol / L, or the glucose level is less than or equal to 11,5 mmol/L and the prothrombin index is less than or 83% and the hematocrit is less than or equal to 39,8% the probability of developing a fatal outcome at any period of the disease is 3 times higher compared to other patients. Prediction models of infectious complications and disease outcome have an accuracy of 78 and 87%, respectively. The use of these models allows stratification of patients upon admission to the hospital, highlighting the most disadvantaged patients in the prognostic plan. The models are quite simple and easy to use, do not require complex expensive studies. Thanks to the algorithm used in building models, they have the properties of self-learning, which in the future will increase their accuracy.

Аbstract. Factors predisposing to the development of osteoarthritis in military personnel are analyzed. The physical stress inherent in military labor, for example, in the airborne troops, creates a high load on the joints and can cause the early dismissal of military personnel from the ranks of the Armed Forces of the Russian Federation. Based on the pharmacodynamics of chondroprotectors (stimulation of chondrocyte function, cartilage tissue regeneration processes, inhibition of the synthesis of inflammatory mediators, etc.), it can be argued that they have a significant effect on the pathogenetic mechanisms of the development of osteoarthritis, i.e. the mechanism of action of chondrocytes is reduced to the suppression of catabolic and stimulation of anabolic processes in the joints. The main principles of therapeutic nutrition for osteoarthritis are, a decrease in calorie intake, limiting the amount of carbohydrates, animal fats and salt consumed. A balanced diet, including sufficient macro- and micronutrients, has a therapeutic effect in patients with complaints of joint pain, helping to restore the damaged structure of the elements of the musculoskeletal system. The inclusion of dietary supplements in the diets of patients with complaints of joint diseases ensures the intake of nutrients necessary for the synthesis of glycosaminoglycans. These factors accelerate the rehabilitation of patients after extreme physical exertion and injuries of the musculoskeletal system inherent in military labor. An analysis of the materials of a clinical study – a comparative study of the effectiveness of the treatment of osteoarthritis of the knee joint at the initial stage of the disease with the help of a representative of the group of chondroprotectors – Аrthra containing chondroitin sulfate, glucosamine and non-steroidal anti-inflammatory drugs, is carried out. The introduction of chondroprotectors as a means of preventing osteoarthritis in the diets of military personnel experiencing extreme joint loads will strengthen the ligamentous-articular apparatus by normalizing cartilage moisture saturation, inhibiting the action of proteolytic enzymes and stimulating the synthesis of glucuronic acid, which improves the elasticity of connective tissue.

Abstract. The method of determining the accumulation of condensate by registering the noise level in the respiratory circuit of ventilators is substantiated. According to the proposed method, the condition and performance of the apparatus is monitored during artificial lung ventilation and oxygen therapy. With hardware ventilation, an increasing turbulent flow of a water or gas stream is formed in the respiratory circuit, accompanied by an increase in the noise effect and vibration. An increase in the level of acoustic noise from fluctuations in the accumulation of condensate in gaseous media was recorded by an instrument for objective measurement of sound level — a sound level meter. Indicators of noise effects reached a higher level on the wet circuit (the presence of condensation droplets or accumulations of mucus) of the liquid compared with the indicators obtained on the “dry” breathing circuit. The difference in recorded noise levels reached 10 dB, and increased from 37,73 to 47,36 dB. Areas of the respiratory circuit with the greatest degree of narrowing of the lumen and critical accumulations of water condensate and mucus are a source of turbulence in the air flow and increased noise. In conditions of prolonged artificial ventilation of the lungs, the rate of humidified air-gas flow is constantly changing, especially with hardware modeling of the phases of inspiration and expiration, and an increase in temperature in the humidifier chamber. The proposed technique is designed to identify critical levels of water condensate in the apparatus breathing circuits by recording the intensity of the increase in noise level and choosing the rational mode of operation of medical equipment. Data on the emerging critical situation are displayed on the sound level meter screen and inform medical personnel about the need to rehabilitate the circuit of the artificial lung ventilation apparatus. The primary field of application is resuscitation and intensive care units, medical transport teams during in-hospital or inter-hospital transportation, and surgical operating rooms during inhalation anesthesia.

Abstract. In the work, a review of scientific articles on the behavior of tissues and organs of the human body under local mechanical effects on it, as well as a description of the physico-mechanical properties of biological materials. The selection of mechanical behavior for each biological material as part of a mathematical model of the human torso was carried out, its finite element model was created, validation experiments were modeled using data presented in the literature. An original calculation model of a human torso with a tuned interaction of organs with each other was developed. Contact interaction parameters are determined. The developed computational model of a human torso was verified based on data from open sources for an experiment with mechanical action by a cylindrical impactor. An algorithm for processing pressure and acceleration graphs has been implemented in order to obtain tolerance curves. A specialized modular program has been created for the automated processing of calculation results and the output of the main results. 42 numerical tests were carried out simulating the entry of a steel ball into each of 21 zones for power engineers of 40 and 80 J. According to the results of the tests for each organ, pressure and acceleration tolerance curves were obtained, animations of the behavior of organs under shock were created, visualization of the pressure field propagation in organs was obtained torso.

Abstract. The features of the introduction of an information system for monitoring the movement of medicines in civil and military health care are considered. It has been shown that in order to counteract the inflow of substandard, falsified and counterfeit medicines to medical and pharmacy organizations, from July 1, 2020, all subjects of their circulation in the Russian Federation are required to enter the necessary information into the automated information system for monitoring the movement of medicines. The preliminary results of the experiment on labeling with control (identification) marks of medicines and monitoring of their circulation are evaluated. It is noted that the introduction of an automated information monitoring system in practice is associated with a number of problems that contribute, in particular, to an increase in the cost of medicines. It was established that in the formation of regulatory mechanisms for monitoring the movement of medicines,the specifics of drug provision in military health care were practically not taken into account, which in turn led to the emergence of a number of legal conflicts. It was revealed that, on the one hand, the obligations to participate in the medicine movement monitoring system have been lifted for the Ministry of Defense, the Federal Security Service, the Foreign Intelligence Service, and, on the other hand, other power ministries and departments must provide the required information to the system. It was emphasized that, given all the problematic issues, the introduction of an information monitoring system has a positive effect on the activities of drug circulation entities, as well as enhancing the effectiveness of drug provision for citizens. It is advisable to provide for separate participation in the information system for monitoring the movement of medicines of the Ministry of Defense and some other power ministries and departments, providing the opportunity, on equal terms with other participants, to confirm the quality of the medicines in circulation.

Abstract. Data analysis contained in the official forms of medical statistics allows us to state that in St. Petersburg in 2011–2012 yr. 8% breast cancer incidence increase and 6% mortality rates decrease in women were noted. Years of potential life lost due to breast cancer in 2012 yr. among St. Petersburg female residents in aged 30 to 64 years decreased 8% compared with 2011 yr. data (2632 and 2435 in 2011–2012, respectively). Years of potential life lost due to breast cancer in 2011–2012 yr. decreased 16% (1101 and 948 in 2011–2012 yr. respectively) in St. Petersburg women aged 50 to 59 years (group of maximum incidence rate among patients with malignant neoplasms of the mammary glands). The results of medical care assessment providing to breast cancer patients in St. Petersburg over the past 9 years has allowed to state the positive dynamics in the anticancer fight effectiveness. In 2011–2018 yr. the incidence of breast cancer in women in St. Petersburg increased by 28,2% (from 45,67⁰/₀₀₀₀ in 2011 yr. to 58,58⁰/₀₀₀₀ in 2018 yr.), and the 5-year survival rate of patients with breast cancer in St. Petersburg increased by 4,9% (from 60,4% to 63,4% in 2011 and 2018 yr. respectively). Considering these data the number of years of potential life lost due to breast cancer in the analyzed period decreased. This circumstance can be regarded as one of the indicators of the medical care quality in breast cancer patients and as an indicator of the proper organization of oncological service functioning in the administrative and industrial center of Russia.

Abstract. Despite great advances in the biology of stem cells, there are still many dark spots. Genetic modification techniques, which can be used to track the lines of different cells, primarily stem cells, help to solve this problem. Various methods of biotechnology research are considered, allowing to evaluate the options of introducing new genes into cells and even whole organisms, as well as methods of controlling their expression in time and space, their activation, differentiation and decrease in functional activity, expression of several target genes. Options with multi-cystron vectors encoding several proteins are described. Options for introducing genes using plasmids, electroportation of their disadvantages and advantages are characterized. The most promising and the safest is a retroviral vector using lentivirus vectors capable of generating additional copies of itself, which is very important in the field of biotechnology security. A line of packing cells, usually 293T cells, is used to produce a viral vector. Prospects for the use of adenovirus and adenoassociated vectors are characterized. The achievement of modern biotechnology methods is the system of short palindrome repetitions located in groups, which is a unique tool for genome editing. At the heart of this system is the process of cutting out sequences of deoxyribonucleic acid, which are permanent and which are supported by cells regardless of subsequent divisions or changes in condition. The system allows geneticists and medical researchers to edit parts of the genome by removing, adding or modifying successive sites of deoxyribonucleic acid. An important problem with biotechnology methods is how to control the expression of transgenes. Today, it is quite effective to control expression with a factor present in the gene delivery vector itself and which is only active in a certain type of cell. Endonuclease bacteriophage P1 is used to regulate transgene expression, which cuts deoxyribonucleic acid only at specific sites. This system is introduced in both eukaryotic and prokaryotic systems.

Abstract. An attempt to summarize the data of available information materials on epidemiological aspects, the state and prospects of prevention and treatment of hemorrhagic fevers was. Hemorrhagic fevers of viral nature-zoonotic diseases caused by viruses containing ribonucleic acid are classified into 4 families: Arenaviridae, Bunyaviridae, Filoviridae and Flaviviridae. They are spread all over the world, and their pathogens are easily transmitted from person to person, thereby spreading quickly enough beyond the main focus of biological infection. That is why the causative agents of hemorrhagic fevers are regarded as highly contagious biological agents, and agents bioterrorism. Unfortunately, there are currently no effective means of specific prevention and treatment of these infections, and therapeutic measures are limited to the use of symptomatic means. In this regard, the search for substances with pronounced antiviral activity against pathogens of hemorrhagic fevers that can effectively protect against these infections, as well as prevent their occurrence and spread is one of the priority areas of research in modern Infectology, and with the involvement of modern achievements in the field of molecular Virology and genetic engineering. The data obtained in this regard allow a more in-depth understanding of the pathogenesis of hemorrhagic fevers, the mechanisms of interaction of the pathogen with the host at the cellular level, the mechanisms of intracellular replication of viruses, the formation of the host’s response to «viral invasion» and clinical manifestations of diseases.

Abstract. Analysis of available literature and our own experience, the main causes of the lysis / rejection of autoderm grafts are systematized. It is shown that there is no consensus among combustiologists about the causes of these complications. It is believed that the leading cause of such complications is the general condition of the body, the unpreparedness of wounds for surgical treatment and the development of disseminated intravascular coagulation syndrome in seriously ill people. The frequency of unsatisfactory treatment results also correlates with the level of contamination of the burn wound. An increase in microbial seeding to 107 or 108 colony forming units per gram is a relative contraindication to surgery, while the optimal level for skin grafting is considered to be 104 colony forming units per gram. In addition, locally plastic interventions are possible with a microbial load of 105 colony forming units per gram, subject to compensation for violations of the general condition of the victim. Of great importance are the timing of autodermotransplantation. Conducting skin plastics later than 14 days after the injury increases the risk of postoperative complications. This is due to the peculiarities of the pathophysiological processes characteristic of burn wounds. During the first two weeks from the moment of the injury, the processes of reparative regeneration prevail in them, however, their intensity progressively decreases over time. It has been demonstrated that immune system disorders also have a significant effect on the rate of graft lysis. Domestic experts have developed an original method for predicting the likelihood of an unsatisfactory result of skin grafting, based on an assessment of a number of parameters of the immune system. The results of our observations indicate that the main causes of lysis / rejection of autodermotransplantants in the postoperative period are insufficient preparation of wounds for surgical treatment, changes in the general condition of the body, impaired immune system (autoaggression), and a high level of microbial contamination. The development of common criteria for assessing a patient’s readiness for skin grafting to prevent rejection of transplanted autoderm grafts remains an urgent task of combustiology.

Abstract. The first mention of pancreatic cancer dates back to 1761, when the six-volume work of the famous Italian anatomist G. Morgagni «On the location and causes of diseases discovered through dissection» was published. However, the history of surgical treatment of malignant tumors of the pancreas dates back to the end of the 19th century. The accumulated experience of operational techniques and the introduction of aseptic rules created objective prerequisites for performing operations in complex anatomical zones during that period of time. On July 16, 1882, the famous German surgeon F. Trendelenburg, firstly, performed a successful resection of the tail of the pancreas for sarcoma, founding the development of surgery in this field. However, the success in this sphere could not be shifted to a tumor of the head of the gland due to the subsequent separation of the duct system from the duodenum. Over the following years, many outstanding surgeons tried to solve this problem, such as: A. Codivilla, W. Halsted, W. Kaush, until in the early 40s A. Whipple proposed a new method of pancreatoduodenal resection, that became the gold standard for head cancer treatment pancreas. Although it was not possible to achieve significant success in the treatment of cancer in the original method of operation, as a result at various stages of time this procedure wasn’t used a lot and was almost forgotten. Today, surgery remains the leading method in the complex treatment of patients with pancreatic cancer. Minimally invasive technologies have been actively introduced into pancreatic surgery in the past two decades. The indications for surgery have been expanded, lymphadenectomy standards have been introduced, thereby increasing the chances of a successful cure.

Abstract. Considers an example of organizing and conducting practice-oriented classes on providing emergency medical care for injuries with medical personnel of the military level, garrison and base military hospitals in the Western military district. In large garrisons of the military district in 2019, we conducted four rounds of field training on the organization of emergency medical care for major life-threatening conditions. The format of classes included master classes and blitz lectures on various topics: cardiopulmonary resuscitation, stopping ongoing external bleeding, eliminating asphyxia and pneumothorax, transport immobilization, and features of the use of modern means of emergency medical care. An important practical part of the training was training with surgeons of military and hospital units on living biological objects. At the beginning and end of the course, primary and control tests of the level of knowledge were conducted. During the initial testing, the percentage of correct answers in the groups averaged: surgeons (n=20) – 53,9%, doctors of other specialties (n=25) – 56,5%, average medical staff (n=34) – 52,8%, health instructors (n=52) – 52,6%. During the control testing, the following results were obtained: 71,5; 83,5; 84,3 and 83,9% respectively. The format of classes reliably (p˂0,05) showed their high efficiency in all groups. Thus, the need to actively introduce a practice-oriented form of training in the form of demonstration classes, including the use of biological models and simulators, into the combat and special training of military medical personnel is obvious and beyond doubt.

Abstract. On June 12, 2020, Alexander Borisovich Zorin would have turned 90. Most of his life A.B. Zorin worked at the Military Medical Academy named after S.M. Kirov in 1^st clinic of surgery (of the perfection of doctors) named after P.A. Kupriyanov. He made a great contribution to the development of cardiovascular surgery in the Russian Federation, performed a number of fundamental research on the diagnosis and surgical treatment of heart defects, on May 31, 1988 he successfully transplanted a heart for the first time in Leningrad, was one of the initiators of the creation of the international program «Heart-to-heart», thanks to which the cardiac surgeons of Leningrad got the opportunity to learn from their foreign colleagues. After demobilization in 1991 he headed the cardiac surgery departments in the city hospitals of St. Petersburg, and headed the department at the Medical Academy of Postgraduate Education. In 2003 A.B. Zorin was awarded the medal «For the Contribution to the Development of Health Care in Russia», in 2004 he was awarded an insignia «St. Petersburg Appreciation» by the Governor of St. Petersburg Va.I. Matvienko and was elected an honorary member of the Public Council of Governors. In 2007 For the high achievements in the development of cardiac surgery, A.B. Zorin was awarded: The International Award named after Academician B.V. Petrovsky «Outstanding cardiac surgeon of the world», the a prize named after A.N. Bakulev «For a longstanding selfless and impeccable work and great personal contribution», the gold medal «For outstanding achievements and unprecedented personal contribution to the development of the world surgery».

Abstract. Fyodor Ivanovich Komarov (08/26/1920 – 01/25/2020) was a participant in the Great Patriotic War, a prominent domestic therapist, an outstanding figure in military medicine, a Hero of Socialist Labor, an academician of the Russian Academy of Sciences, a laureate of the State Prize of the Union of Soviet Socialist Republics, an honorary doctor of the S.M. Kirov Military Medical Academy, a professor and a retired colonel-general of the medical military service. F.I. Komarov’s scientific heritage is huge. Over 600 scientific works, including 33 monographs, were published by him personally and in co-authorship. Due to his comprehensive clinical background and deep knowledge of physiology and biochemistry, urgent problems of gastroenterology, cardiology, pulmonology, chronobiorhythmology and military professional pathology could be successfully solved. He made a great contribution to improve and reform the military medical service. Twenty six doctors and sixty candidates of medical sciences were educated under his leadership. Being a military doctor and holding high leadership positions, he was constantly engaged in the improvement of military medicine and military field therapy. He was also the head of medical support for the troops during the hostilities in Afghanistan, during the accident at the Chernobyl nuclear power plant and following the consequences of the earthquake in Armenia. He was elected chairman of the All-Union Society of Physicians several times. He was also a member of the Lenin and State Prize Awarding Committee under the Council of Ministers of the Soviet Union, chairman of the expert council of the Supreme Attestation Commission of the Union of Soviet Socialist Republics and editor-in-chief of the journal «Clinical Medicine» and an honorary member of a number of foreign academies. In 1999, he was awarded the title «Man of the XX century», became a laureate of four personal prizes: M.P. Konchalovsky (1979), S.P. Botkin (1985), N.I. Leporsky (1992), V. Kh. Vasilenko (2001). For his merits to the Fatherland, F.I. Komarov was awarded the title «Hero of Socialist Labor» (1980) in addition to forty five orders and medals.

Abstract. Brief biographical information about Maxim SemenovichSubbotin, the founder of aseptic and antiseptic in Russia, is provided. In 1884, M.S. Subbotin heads the Department of Surgical Pathology at Kharkov University. In addition to scientific and pedagogical activities, he will devote a lot of time to the organizational issues of the clinic. He uses the surgical department of a military hospital as a clinical base for training students at Kharkov University. In addition to the course of surgical pathology with desmurgy, he also conducts a course of surgical surgery, and since 1887, a parallel course of the faculty surgical clinic. However, teaching and scientific work in a small clinic (25 beds) could not satisfy Maxim Semenovich, since by this time he had formed into a major surgeon and scientist, ready for wide surgical and scientific activities. Becoming the head of the Department of Surgical Pathology of the Imperial Medical and Surgical Academy (1890) M.S. Subbotin began its reorganization according to the requirements of asepsis. He organized a new dressing room, the walls and ceilings of which were painted with light oil paint, the floor is covered with ceramic tiles.An operating unit began to function, consisting of two operating rooms, a sterilization room, a bathroom and a material room. A laboratory was established to conduct research and control operations. The clinic strictly and sequentially carried out sterilization of instruments, dressings, processing of the surgical field. M.S. Subbotin studied the effect of carbolic acid on the body, used it to treat wounds. He created his own tent for operations, invented a sterilizer oven, a catgut sterilizer with dry steam, an autoclave, and hemorrhoidal forceps. M.S. Subbotin invented a drainage pump for the treatment of purulent cavities, first made thoracoplasty with pleural empyema. He introduced aseptic and antiseptic into surgical practice. Created a scientific surgical school: P.I. Bukhman, S.S. Girgolav, L.V. Orlov, N.N. Petrov, N.A. Schegolev and others

Abstract. In 1940, having baggage of three fatal two-stage pancreatoduodenal resections, during the demonstration surgery, the famous American surgeon Allen Whipple performs the first successful one-stage pancreatoduodenal resection for pancreatic head cancer. It is immeasurable surprise and respect that such a volume of intervention was not planned, since the patient was diagnosed with a tumor of the antral part of the stomach before the operation. The complexity of the situation didn`t stop Allen Whipple’s plans, and the subsequent success, which gave not only 9 years of life of the operated patient, but also to the whole world the original method of operation, became the starting point of a new era of pancreatic surgery Whipple’s contribution to surgery is not limited to performing one-stage pancreatoduodenal resection. He pioneered the reform of postgraduate medical education in the United States of America, founded the world’s first plastic surgery training program, developed new methods of intra- and perioperative management of patients with colon cancer, criteria for diagnosing insulinoma, which are today called the «Whipple’s triad». The study of the structure of the spleen, as well as its role in the spread of tumor cells, made it possible to determine the indications and contraindications for splenectomy. He also developed and applied porto-caval and splenorenal shunting operations, which reduce pressure in the portal vein system in patients with liver cirrhosis.

Abstract. In November 2019, an important historical event was held. A small collection of F. Ruysch, which is stored in the fundamental Museum of the Department of normal anatomy of the Military medical Academy named after S. M. Kirov, has received a second life, thanks to friendly scientific relations between Military medical Academy and the University of Leiden. The unique collection of anatomical preparations, which Peter I called «The Eighth wonder of the world», was created by the great Dutch anatomist, doctor of medicine, Professor of anatomy and botany at the University of Amsterdam F. Ruysch. A large collection was acquired by Peter I in 1717 specifically to the future of the Kunstkammer (now the Museum of Peter the Great) and taken to Russia under the supervision of the first President of the Petersburg Academy of Sciences L.L. Blumentrost. Small collection of F. Ruysch was presented to Peter I in the late seventeenth century (1697). It has withstood more than 300-year storage period. Numerous movements and different storage conditions, of course, left its mark on the appearance of these precious unique anatomical specimens. The last event of violations were associated with the early repair of the anatomical building of the Military medical Academy.We must pay tribute to the enthusiasm and unselfishness of the staff of Leiden University headed by a great friend of Russia I.F. Hendriks, who was able to organize a team of professionals in the Museum business. This team included the head of Leiden University, Professor P.C.W. Hodendoorn and specialist in restoration and percussively anatomical preparations – A.J. Van Dam. Hard work was multi-stage. First conducted a thorough verification of anatomical specimens of F. Ruysch with the existing directories of the Department’s records. Identification of the preparations to the F. Ruysch collection was carried out by the appearance of containers, labels, appearance of preparations, the study of embalming fluid. Photo documentation of each study drug was accompanied by reports signed bilateral commission. After pre-treatment the special chemicals and equipment were delivered, and conducted direct work on restoration and percussively. It lasted 10 days. Members of the Department received a unique master class on the restoration of wet embalmed museum anatomical specimens, and received recommendations for their storage.

Abstract. The paper provides a brief description of the life, academic and teaching activities of Anatoly Mikhailovich Shelepov. His developmental landmarks as the head of one of the leading theoretical departments of the Kirov Military Medical Academy and the scientist are considered in the writing. Having graduated from the Suvorov Military School, he had to live his life with the name of Grand General Alexander Vasilyevich Suvorov and follow his mission «Never Give Up!». When managing the department he displayed his talent of the scientist, teacher, and leader of the academic teaching team. Anatoly Mikhailovich Shelepov created the scientific school of military healthcare administrators. His like-minded colleagues elaborate theories and concepts for development of the Russian Forces Medical Service, as well as practical aspects of medical support of the Armed Forces in military conflicts and peace-time emergency situations; solve the issues related to standardization of the medical support measures; study the history of military medicine. This happened in 1998. In 2003 the status of the leading scientific school was acknowledged at the federal level. Anatoly Mikhailovich Shelepov has been a member of the Russian Geographical Society (section of the military geography) since 1993. The territorial system of Army medical support was offered and developed, the scope of medical support to be provided to servicemen in local wars and military conflicts, as well as peacekeeping operations was justified and the image of the Russian Forces Medical Service until 2030 was offered under his direction.