Vol 23, No 3 (2021)

The results of examination and treatment of 647 patients with endogenous hypercortisolism were studied: pituitary corticotropinoma was detected in 494 (76.4%) patients, corticosteroma and pre — corticosteroma of the adrenal gland — in 142 (21.9%), bilateral macro-nodular hyperplasia of the adrenal glands of primary adrenal origin-in 11 (1.7%). Differential diagnosis of clinical forms of endogenous hypercortisolism was based on the assessment of the level of adrenocorticotropic hormone and cortisol, both in peripheral blood, and with selective bilateral blood sampling from the adrenal veins and lower stony sinuses, and the study of the nature of samples with 8 mg of dexamethasone. Topical diagnostics consisted in assessing the state of the adrenal glands and pituitary gland during computed tomography and magnetic resonance imaging with the use of contrast agents, and the use of special software 3D-Volume Rendering Technique allowed optimizing tactical and technical approaches to performing surgical interventions. Of the operated patients with adrenocorticotropic hormone dependent endogenous hypercortisolism, total removal according to the control magnetic resonance imaging was achieved in 92.3% of cases, subtotal — in 7.7%. However, hormonal remission was achieved only in 82.4% of cases. All patients with corticosteroma and pre-corticosteroma of the adrenal gland underwent adrenalectomy: in 6 patients by open method, in 136 patients by endovideosurgical method (in 11 patients by laparoscopic method, in 124 patients by retroperitoneoscopic method, and in 1 patient by thoracoscopic transdiaphragmatic adrenalectomy). In all patients, the operation led to recovery. Patients with benign macronodular hyperplasia of the adrenal glands needed conservative treatment with steroidogenesis blockers. Indications for surgical treatment in the volume of unilateral adrenalectomy occurred only in 2 patients.

The dynamics of the structure of aortic valve pathology over the thirty-year (1991–2020) period of operation of the cardiac surgery hospital of the first department and the clinic of surgery for advanced training of doctors of the Military Medical Academy named after S.M. Kirov is evaluated. 849 cases of aortic valve replacement were retrospectively studied (626 (74%) men, 223 (26%) women). The average age of the patients was 51.8 ± 9.7 years. It was established that the main causes of aortic valve damage were rheumocarditis, calcified aortic stenosis, infectious endocarditis and congenital heart disease in the form of a bicuspid aortic valve. A significant decrease in the incidence of rheumatism as a cause of aortic malformation was revealed from 36% in the period from 1991 to 2000 to 13% in the period from 2011 to 2020. The frequency of calcified aortic stenosis during this period, on the contrary, increased from 30% to 70%, respectively. At the same time, the relationship between the increase in life expectancy of the population of the Russian Federation and the frequency of occurrence of calcified aortic stenosis is traced. This is due to a long asymptomatic period that characterizes the natural course of this pathology, as a result of which the clinical manifestations of this pathology manifest, as a rule, only in old age. During the study period, an increase in the average age of patients who needed aortic valve replacement was also noted. If in the last decade of the twentieth century. it was 41.5 years, then in the period from 2011 to 2020, the average age of patients who needed aortic valve replacement increased to 61.5 years. Thus, over the past thirty years, there has been a significant change in the structure of the pathology of the aortic valve. Calcified aortic stenosis has become the most common cause of prosthetics of aortic malformation, against the background of a significant decrease in the frequency of rheumatic genesis of aortic valve damage.

This article analyzes the sanitary–parasitological and sanitary–bacteriological state of the soil of the Astrakhan region for 2015 to 2019. In total, 7587 soil samples taken from various environmental objects were studied, and 18.197 studies have been performed. Of the samples, 333 (4.4%) samples did not meet the hygiene standards. For parasitic purity, 4566 (60.2%) soil samples were examined, and 9132 (50.2%) studies have been performed. The largest number of soil samples were collected and examined in 2015 and 2016, which amounted to 943 (20.7%) in 2015 and 1046 (22.9%) in 2016. The number of samples that do not meet hygienic standards was 62 (6.6%) in 2015 and 91 (8.7%) in 2016. In 2015, the positive findings were helminthiasis caused by unfertilized eggs of Ascaris lumbricoides (4 [0.5%]), eggs of Toxocara canis (37 [3.9%]), and larvae of Strongyloides stercoralis (21 [2.2%]). For microbiological indicators, the largest number of soil samples were collected and examined in 2019 and amounted to 694 (23.0%), of which positive findings in the form of common coliform bacteria of Escherichia coli amounted to six (0.9%). Studies for bacteriological indicators in 2016 have used 662 (21.9%) samples, which is 0.9 times less than the samples taken in 2019. The sanitary condition of the soil of the Astrakhan region remains stably tense, as evidenced by positive findings in the form of eggs and larvae of helminths, as well as pathogenic bacteria of Escherichia coli. The presence of ascarid eggs, toxocars, and strongylid larvae in the soil indicates contamination of these objects with the feces of infected people and animals. The presence of coliform bacteria of Escherichia coli in the soil also indicates contamination with the feces of sick people.

This study presents the results of the examination of potential donors of blood and its components for immunoglobulins M and G to patients with coronavirus disease 2019 (COVID-19) living in St. Petersburg. A total of 6782 people aged 18−24 years were evaluated, which accounted for 2.07% of the region’s population (326 760 people) of this age group. The study was carried out in the spring and autumn of 2020. A negative result (absence of antibodies) was obtained in 93.5% of the participants. The rates of immunoglobulins M and M + G were 0.58% and 4.18%, respectively, in the spring and autumn. Moreover, the number of participants who had immunoglobulins M and G + M in the autumn period was four times higher than the indicators of the spring period, which indicated greater infection activities in the population during this period. This is most likely due to the active movement of the population in the summer. When comparing the rates of COVID-19 infection and the frequency of occurrence in donors of the same age, markers of human immunodeficiency virus 1 and 2 and hepatitis B and C in 2020 (0.024, 0.012 and 0.13%, respectively) indicate the urgency of the problem of donor selection during blood services, especially during a difficult epidemiological situation because of COVID-19. Along with organizational measures for the selection of donors (e.g., attracting individuals from organized groups in which there are no signs of an unfavorable epidemiological situation to donation), mandatory testing of potential donors for immunoglobulins M and G should be considered.

Through an immunohistochemical study, the molecular biological properties of adenocarcinoma in patients with stage IV colorectal cancer with synchronous unresectable liver metastases, who underwent cytoreductive interventions for volume removal of the primary tumor, were examined. This study clarified the criteria for selecting patients with stage IV colon cancer with unresectable synchronous metastases in the liver for cytoreductive surgery from the standpoint of the molecular biological properties of the tumor. The prognostic significance of immunohistochemical markers such as the index of proliferative activity of stem cancer cells (ALDH + Ki-67 +) and the receptor for chemokines CXCR4 was established. The level of their expression correlates with the life expectancy of patients who underwent cytoreductive surgery. Thus, the high proliferative activity of cancer stem cells (ALDH + Ki67 + > 50%) and the high expression of chemokine receptor (CXCR4 > 70%) correlate with the rapid disease progression after surgical treatment. A significant inverse relationship was traced between the expression level of the receptor for chemokine CXCR4 as well as the proliferative activity of cancer stem cells and life expectancy of patients with stage IV colon cancer after cytoreductive surgery. The expediency of immunohistochemical studies in patients with metastatic colon cancer has been substantiated. Its implementation provides important information about the potential for tumor aggressiveness, which makes it possible to clarify the indications for performing cytoreductive surgery and improve the results of surgical treatment of this category of patients.

Surgical treatment of patients with chronic slow-transit constipation leads to unsatisfactory results in almost a third of cases. It appears relevant to the search for the causes of unsatisfactory results of surgical interventions in such patients and the need to develop a rational diagnostic algorithm; its implementation will allow us to determine the indications for surgical treatment and justify the volume of colon resection. For this purpose, the results of the examination and treatment of 53 patients with constipation were analyzed. The median disease duration was 15 years, and the median duration of constipation was 6.2 ± 1.6 days. Patients were divided into a group with a positive effect of conservative treatment and a group without the expected effect. The symptoms, results of laboratory tests of blood and feces, and instrumental studies of the colon were analyzed. A balloon expulsion test was used to exclude proctogenic constipation. The evacuation function of the colon was studied by X-ray examination, while the transit time of barium sulfate or X-ray contrast markers through the gastrointestinal tract was estimated. Twenty-four patients underwent surgery for chronic slow-transit constipation, while the sigmoid colon was removed in one patient, including 7-left-sided hemicolectomy and 16-subtotal resection of the colon. Long-term results were examined in the period from 3 to 6 months after surgery. In the total examination of the semiotics of chronic slow-transit constipation, the results did not show significant differences between the groups of patients and did not allow us to justify the stratification into severe and non-severe disease course by its specific symptoms. The use of X-ray contrast markers for the assessment of the state of the evacuation function of the colon makes it possible to quantify the severity of various motor disorders and justify the choice of the volume of its resection. The analysis of the long-term results of the treatment of patients with chronic slow-transit constipation allows us to conclude that segmental resections of the colon (left-sided hemicolectomy, resection of the sigmoid colon) have a good therapeutic effect if the preoperative examination revealed a “segmental” type of failure of the evacuation function of the colon, and subtotal resection of the colon is appropriate for the “common” type. The absence of negative results of surgical treatment of patients with chronic slow-transit constipation, in which the formation of a colonic anastomosis was performed with a short stump of the sigmoid colon, indicates the possibility of using this option to complete the surgical intervention.

This study analyzed the results of treatment of patients with inguinal hernias, with an assessment of the advantages and disadvantages of endovideosurgical hernioplasty techniques. The clinical study used the data of 1317 patients with inguinal hernias. The results revealed that the totally extraperitoneal inguinal hernia repair had some advantages over laparoscopic hernioplasty, such as a shorter duration of surgery (43 ± 15 min), mild pain on a visual analog scale, and an average bed-day after surgery. Complications were diagnosed in 16 (1.2%) patients, and most had Clavien–Dindo grade II complications. Relapses were detected in 7 (0.5%) cases. Thus, endoscopic hernioplasty (laparoscopic and totally extraperitoneal inguinal hernioplasty) was the preferred surgery for patients with bilateral inguinal hernia, recurrent hernia after traditional hernioplasty, and metabolic syndrome and young people of working age. The use of a modified technique of totally extraperitoneal inguinal hernioplasty with a clear understanding of the multifascial structure of the anterior abdominal wall may reduce the risks of both intraoperative and postoperative complications and increase the cost-effectiveness of treatment of patients with inguinal hernias, allowing us to obtain good results.

Studies have examined various approaches in the diagnosis and surgical treatment of patients with cholelithiasis complicated by choledocholithiasis, evaluated the possibilities of using modern methods of treating the disease, and proposed a strategy to prevent the abandonment of bile duct concretions. The relevance of this problem is related to the variety of diagnostic and surgical treatment methods of choledocholithiasis, high disease frequency, and nonexistence of a unified approach to the examination and choice of surgical treatment in patients with cholelithiasis complicated by choledocholithiasis. These issues indicate the need to study this problem and identify optimal approaches to examination and treatment, including modern minimally invasive methods of treatment. The analysis of the diagnostic value of various examination methods and surgical outcomes was based on the experience of treating 154 patients with cholelithiasis complicated by choledocholithiasis in the clinic of the S.P. Fedorov Faculty of Surgery of the S.M. Kirov Military Medical Academy. An algorithm for examining patients with cholelithiasis was formed based on the diagnostic value of various research methods, which allows timely detection of choledocholithiasis. The results of various approaches to the surgical treatment of patients with cholelithiasis complicated by choledocholithiasis were analyzed. In the absence of general somatic contraindications and the availability of technical capabilities, a one-stage approach to surgical treatment was suggested. Moreover, an individual approach is necessary for the treatment of patients with cholelithiasis complicated by choledocholithiasis, taking into account the nature of the disease course and its complications, comorbid status of the patient, and technical capabilities of a particular hospital. The sequence and timing of operations with a two-stage approach should be determined, taking into account the acute conditions and comorbidities of the patient. The use of modern minimally invasive technologies, such as transpapillary and trans-bubble choledochoscopy, dosed papillotomy, and “rendezvous” technique for the cannulation of the large papilla of the duodenum, allows us to improve the results of surgical treatment and reduce the risk of complications. Transpapillary and trans-bubble nanoelectroimpulse lithotripsy are alternative methods of resolving major choledocholithiasis in both one-stage and two-stage treatment.

The leading criteria for choosing minimally invasive surgical treatment of mechanical jaundice of tumor origin in the hepatopancreatobiliary zone are substantiated, which increase the effectiveness of surgical intervention and reduce the number of complications and mortality. The examination and surgical treatment results of 325 patients with mechanical jaundice of tumor origin, who underwent minimally invasive decompression of the biliary tract after clinical and laboratory diagnostics following national clinical recommendations, were analyzed. Based on the treatment results, the leading criteria that affect the selection of the method of minimally invasive drainage surgery are identified. The main criteria influencing the choice of minimally invasive intervention to decompress the bile ducts were as follows: level of bile duct block, severity of mechanical jaundice (according to the classification of E.I. Galperin), and the operability of the patient. Endoscopic stenting was the method of choice in inoperable cases at the level of block I with mechanical jaundice of classes A and B. Moreover, endoscopic stenting was the most successful intervention with a minimum number of complications in people with block II level. The indication for percutaneous transhepatic biliary drainage was a level III biliary tract block, as well as the ineffectiveness of endoscopic stenting. Cholecystostomy is the safest and most effective in patients with block level I with class C mechanical jaundice and in operable cases with the same block level. In general, results of surgical interventions aimed at eliminating mechanical jaundice of tumor origin, conducted using modern examination methods of patients and taking into account the assessment of criteria such as the block level of the bile ducts, severity of mechanical jaundice, and general condition allow us to justify the choice of the most successful and safe option for its elimination.

This study analyzed the treatment results of 345 patients who underwent planned and emergency transpapillary surgical interventions for various diseases of the biliopancreatoduodenal region. Among these patients, 68.9% were women and 31.1% were men aged 18–92 (mean age, 63.7 ± 4.5) years. The study included patients who used various types of transpapillary endoscopic interventions as a treatment method, such as endoscopic papillo-sphincterotomy (71.9%, including choledocholite extraction in 68.7% of the patients), endoprosthetics of the common bile duct and main pancreatic duct (17.8%), balloon dilatation and bougienage of bile duct strictures (6.2%), mechanical lithotripsy (2%), nasobiliary drainage (1%), endoscopic wirsungotomy (0.8%), and endoscopic papillectomy (0.3%). Variants of the inflow of hepaticoholedochus and Wirsung duct were assessed using magnetic resonance cholangiopancreatography. The active implementation of preventive measures regulated by the global community made it possible to reduce the overall incidence of complications of transpapillary interventions to 13.1% and the rates of postoperative mortality to 1.3% (p < 0.05). The use of these measures led to a significant decrease in the incidence of acute post-manipulation pancreatitis from 10.3% to 4.8%, postoperative bleeding from 8.9% to 5.5%, cholangitis from 2.8% to 0.7%, and a low incidence of retroduodenal perforation in 1.1%. Personalized consideration of the modern recommendations of the global endoscopic communities (Europeans, Americans, and Japanese) when performing endoscopic retrograde cholangiopancreatography, as well as original approaches associated with the determination of the anatomical features of the structure of the Vater papilla with variants of fusion of hepaticocholedochus and Wirsung duct, helped to significantly reduce the overall incidence of complications following transpapillary endoscopic procedures from 22.2% to 13.1%.

An algorithm for the diagnosis and treatment of infectious and inflammatory complications after endovideosurgical hernioplasty in patients with postoperative ventral hernias using traditional and minimally invasive methods of therapy was proposed. The study was based on the treatment results of 177 patients who underwent endovideosurgery for postoperative ventral hernias. Despite the perioperative antibiotic prophylaxis according to the accepted at the S.M. Kirov Military Medical Academy, according to the protocol scheme (first-generation cephalosporin at a dose of 1 g once parenterally 30 min before the operation, followed by repeated administration in case of operation duration of > 3 h), course of the early postoperative period on days 3–5 in 8 (4,5%) patients after endovideosurgical hernioplasty was complicated by suppuration in the intervention area. When analyzing the causes of infectious and inflammatory complications, in both the main and control groups of observations, all suppuration in the area of surgical interventions was diagnosed in patients with metabolic syndrome (stages II–III obesity and type 2 diabetes mellitus). The use of the “negative pressure wound therapy” resulted in wound cleansing for 4.1 ± 2.5 days (p < 0.05) and was comparable with the traditional method of treatment, but more active growth of granulation tissue prevailed in the wound, which contributed to its accelerated healing. The “negative pressure wound therapy” is effective in the systemic infectious and inflammatory process, especially after prosthetic hernioplasty of large W3-postoperative hernias. Drainage of abscesses under ultrasound navigation is possible with small (S ≤ 10 cm²) delimited purulent processes in the area of the polypropylene implant with the preservation of the latter.

On an experimental model of eventration in small and large animals (94 rats and 12 pigs), the safety and effectiveness of samples of aseptic protective dressings made of nanomaterials with impregnations used to prevent the development of complications from abdominal organs and tissues in comparison with control ones — gauze medical sterile ones were evaluated. After 3 hours, 3 and 7 days after surgery, the viability of the intestinal wall and the presence of complications were assessed on the basis of laboratory, experimental, instrumental and morphological techniques. The assessment of microcirculation (perfusion) of the intestine was carried out using the apparatus “LAKK-02”. It was found that according to the complex of clinical and laboratory, microbiological, morphological, microcirculatory data and expert assessment, the safest and most effective for the protection of abdominal organs was an aseptic bandage made of non-woven material spunbond impregnated with vinylin + silicone. The initial values of microcirculation parameters in the pig groups were: 18.4 [17.1; 19] perfusion units in the experimental group and 15.6 [6.8; 17.7] perfusion units in the control group. After applying the bandage in the experimental group, the level of microcirculation did not significantly change. In the control group, after 3-hour exposure to the bandage, a decrease in the level of microcirculation was observed to 6.5 [5.1; 8] perfusion units (p < 0.05 compared to the initial and similar stage in the experimental group). Thus, an aseptic bandage made of spunbond nanomaterial impregnated with vinylin + silicone retains the necessary moisture and protects the eventrated abdominal organs, demonstrates safe adhesive properties and prevents the development of local and general complications in the early postoperative period.

This study presents the results of the analysis of the funding mechanisms for drug supply of assigned contingents in the provision of outpatient medical care in military medical organizations. Existing approaches to determining methods for optimizing the need for drugs are considered. In addition, this paper presented approaches to the formation of a formulary list of medicinal products of a military medical organization. This study also showed the possibility of using pharmacoeconomic assessment in justifying targeted subsidies for drug supply. The relevance of the analysis of the assortment structure for entry into the approved list of vital and essential medicines is emphasized. A possible algorithm for substantiating a targeted subsidy for drug supply in the provision of outpatient medical care within the framework of military health care involved eight stages. First, the incidence of attached contingents entitled to drug supply at the expense of the Russian Ministry of Defense for outpatient treatment was analyzed. Second, the nomenclature of medicines was determined by comparing the incidence pattern of attached contingents with the list of medicines presented in the standards of medical care and clinical recommendations. Third, groups of drugs (with specific and wide spectrum of action) normally used are distinguished, considering the uniqueness of consumption when predicting (planning) demand. Fourth, the need for medicines were formulated using the normative method, modeling method, and logicoeconomic and other methods for determining the need, taking into account the peculiarities of their application in medical, social, and economic conditions of the military medical organization. Fifth, the created drug list was optimized based on the combined ABC-VEN analysis. Sixth, the formal list of the military medical organization was optimized by taking into account the results of pharmacoeconomic research on the treatment of specific diseases. Seventh, an analysis of the assortment structure in relation to the list of vital and essential drugs was performed to further substantiate their economic, clinical, and pharmacoeconomic effectiveness. Eighth, a targeted subsidy for drug supply was calculated, and application was filed, which contained calculations of planned costs with the appendix of the list of planned drugs for purchase, as well as commercial proposals justifying its cost.

This study described the perspective and significance of using “complex vaccine systems” in improving immunoprophylaxis of major infectious diseases of various etiologies and genesis. Immunobiological drugs traditionally used for this purpose, along with the advantages, have disadvantages, such as increased reactogenicity and development of post-vaccine reactions and complications in some cases. Such adverse effects are serious obstacles to immunoprophylaxis on a mass scale. This circumstance was the reason for the improvement of immunoprophylaxis, and the main focus was the creation of chemical, recombinant, and subunit vaccines. However, compared with traditional drugs, these vaccines have inferior effectiveness, even if they are practically reactogenic and do not lead to the development of post-vaccine reactions and complications. The main approaches to the development of effective and safe methods of immunoprophylaxis are considered based on the development of “complex vaccine systems”, and the components can be protective antigens, biologically active substances of the corresponding microorganisms, adjuvants applied or embedded in the corresponding biologically active, and safe biotechnological platforms. Among the latter, nanoparticles and microparticles of polylactoglycolic acid, liposomes, lipids, and copolymers are recognized as the most suitable for the construction of “complex vaccine systems”. This paper highlighted new trends in the development of these methods of immunoprophylaxis and their advantages in comparison with traditionally used immunobiological drugs. Moreover, prospects are characterized and examples of developed vaccine preparations are presented. The mechanisms of action of postvaccination immunity and factors that influence its formation are described.

The phases of embryo development, starting with the formation of gametes and germlines, are considered. This study described the differences in the selection of germ and somatic cells. The formation of true germ cells is associated with the induction of bone morphogenetic protein. The zinc-finger transcription factor is the marker of the formation of true germ cells in primates. True germ cells have two types: germ cells that form endoderm and those that form an epiblast. Their differentiation is provided by the growth factor of fibroblasts due to the signaling protein FGF4, which interacts with the FGFR2 receptor in the primary endoderm. The migration of germ cells is controlled by the factors of stromal cells. The implantation of a fertilized egg is associated with the peculiarities of the differentiation of the trophectoderm and the influence of transcription factors. Since stem cell lines are isolated from non-brain tissues, their origin and development remain not fully established. In mice, the chorion is formed from a small area of trophectoderm covered with an out-of-the-mouth mesoderm on the proximal end of the egg lumen. In humans, the chorion, together with its basis—“non-embryonic mesoderm”—is the earliest appearance of tissue emanating from the primary endoderm. Modern research has confirmed the possibility of obtaining clones from the nuclei of early blastomere embryos. However, the use of cell nuclei at later stages yielded unsatisfactory results. The use of embryonic stem nuclei has produced much better results than the use of cells in the later stages of development. Therefore, whatever the source of the cores, they should be in the G0 or G1 phase, but not in G2.

This study presents the main historical aspects of the formation and subsequent development of the department and clinic of the faculty surgery of S.P. Fedorov, which is one of the leading surgical institutions in Russia. The main achievements of the multifaceted activities of the department and clinical teams over a 180-year period of fruitful work are analyzed. The paper also highlighted the role of N.I. Pirogov as a brilliant surgeon and the first head of the department in the formation of the basic principles of the development of surgery as a clinical and scientific discipline, which formed the basis for the subsequent work of the department team. The implementation of his innovative idea at that time of combining the department and clinic made it possible to implement the concept of surgery at the patient’s bedside; as a result, its theoretical and practical foundations were harmoniously combined in the educational process. This contributed to the formation of clinical thinking and significantly increased the level of professional training of doctors. Students of N.I. Pirogov have rich scientific, clinical, and pedagogical potential, which was accompanied by loyalty to traditions. Professor S.P. Fedorov made a huge contribution to the development of the scientific department school. For more than 30 years of his brilliant leadership, the department has become a real cradle of several scientific and practical areas, including urology, oncology, transfusiology, neurosurgery, hepatobiliary, and endocrine surgery. Compliance with the continuity between subsequent generations of surgeons, together with the talent and outstanding abilities of the department heads, such as V.N. Shamov, V.M. Sitenko, and N.A. Maistrenko, made it possible not only to implement the ideas of N.I. Pirogov but also to create a unique scientific school, whose representatives have made a great contribution to the development of several surgical disciplines.

This study highlighted the main stages of the formation and development of surgery of bile ducts by the scientific school of Doctor of Medical Sciences, Honored Scientist of the Russian Soviet Federative Socialist Republic, Professor Sergey Petrovich Fedorov. The current state of this area of surgery and its prospects are also considered. The works of S.P. Fedorov and his students opened a new page in surgery of that time: surgical treatment of patients with liver and biliary tract diseases. The results of research of the last three decades are the subject of particular pride in the successful continuation of the work of the founder of hepatobiliary surgery in our country. The scientific search and relay of the achievements of the scientific school of Professor S.P. Fedorov were performed in numerous publications, such as in periodicals, monographs, manuals, and speeches in our country and abroad, in a cumulated form, and this is presented in dissertations. In the study of the peculiarities of housing and communal services, both fundamental and applied aspects of solving this social problem of modern society are being developed. After the death of Sergey Petrovich, 17 candidate and 5 doctoral dissertations on the problems of biliary tract surgery were defended in the clinic of S.P. Fedorov Faculty of Surgery of S.M. Kirov Military Medical Academy. After over the past years, more than 200 articles, four monographs and manuals were published, and many messages were made at scientific forums in our country and abroad.

Alexander Sergeevich Mozzhukhin was born on August 27, 1921, in Krasnsodar in a family of an employee. After graduating with honors from high school, A.S. Mozzhukhin became a student at the Kuibyshev Military Medical Academy and completed his medical education with honors at the military faculty of the 2nd Moscow Medical Institute. In 1943, A.S. Mozzhukhin came to the Department of Normal Physiology of S.M. Kirov Military Medical Academy, with whom he connected more than 30 years of his life and in which he went from adjunct to head of the department, and scientific secretary of the academic council of the academy. The scientific activity of A.S. Mozzhukhin began in the life-giving atmosphere, which was formed at the department during the leadership of Academician L.A. Orbeli and his closest assistant A.V. Lebedinsky. All scientific activity of A.S. Mozzhukhin is an organic and natural combination of fundamental problems, physiology, psychophysiology, human biology, and practical medicine. The main scientific direction of the Department of Normal Physiology under the leadership of A.S. Mozzhukhin was on the study of the interaction of afferent systems under exposure to extreme stimuli as well as on the study of human functional reserves. In addition, a team examined the physiological cost of pedagogical activity depending on the age, seniority, psychophysical characteristics of teachers, and type of training sessions. A.S. Mozzhukhin investigated the biological effects of ionizing radiation. Together with chemist F.Yu. Rachinsky, he created a radio defense drug RS-1 and became a leading Soviet radiobiologist. A.S. Mozzhukhin created a unique scientific physiological school of the S.M. Kirov Military Medical Academy, which scientifically proved that the adaptation process was accompanied by the formation and improvement of a specific system of functional reserves for body adaptation, and the systemic factor was the result of the activity (adaptation). A.S. Mozzhukhin, while working at P.F. Lesgaft Institute of Physical Culture, proved that functional reserves have potentials in changing the functional activity of structural elements of the body and their interaction among themselves to achieve the target result, adapt to physical and psychoemotional loads, as well as the effect of various factors of the external environment on the body. The bright memory of Alexander Sergeyevich Mozzhukhin will forever remain in the hearts of his students and followers.

October 12, 2021, marks the 100th anniversary of the birth of the Head of the Department of Medical Protection, Head of the Department of Armed Defeat and Protection of the Medical Academy, the Great Patriotic War, Doctor of Medical Sciences, Professor, and Colonel of the Medical Service, Ravil Garifovich Imangulov. For many years, R.G. Imangulov fruitfully worked in the field of military medical science and gone through all formational stages of a scientist and a teacher from an adjunct to the head of the department and professor-consultant of the Academic Council of the Military Medical Academy. During his service at the Military Medical Academy, Professor R.G. Imangulov took an active part in testing weapons of mass destruction and special field experimental studies in various regions of the country, aimed at the practical implementation of the latest achievements in the field of medical and technical means of anti-chemical and anti-radiation protection. For a long time, under his leadership and with his direct participation, fundamental research was carried out on the fundamentals of medical protection of troops and population from mass destruction weapons. His achievements in the field of medical protection against mass destruction weapons, both educational and scientific and practical disciplines, are of great importance for Russian military medicine. His fruitful years of activity did not only result in monographs, textbooks, teaching aids, scientific reports, and articles, but also the adaptation of official normative documents for the military personnel protection from mass destruction weapons, technical and medical means of individual, and collective protection.