Vol 19, No 1 (2017)

Analysis of biological fluids steroid profiling, obtained by combination of high performance liquid chromatography with classical tests in 151 patients with adrenal incidentalomas, is presented in this article. Subclinical Cushing’s syndrome is diagnosed by the combination of following criteria: urinary excretion of free cortisol and free cortisone more than the lowest value of reference range after 2 mg dexamethasone suppression test with the blood cortisol level more than 90 nmol/l after

1 mg dexamethasone suppression test. Increased rаtio of corticosterone/11-dehydrocorticosteron and urinary free cortisol/ urinary free cortisone as well as decreased ratio of 6β-hydroxycortisol/ urinary free cortisol obtained in patients with subclinical Cushing’s syndrome , might be used as an additional diagnostic criteria of this disease. The investigation of steroid profiles in biological liquids by high performance liquid chromatography for patients suffer from the adrenal incidentaloma has a great significance when blood cortisol level after the dexamethasone suppression test lays in the range from 50 to 90 nmol/l, which can be called as «the grey zone». The combination of subclinical symptoms of Cushing’s syndrome, obtained by classical samples and high performance liquid chromatography improves sensitivity and improves the diagnosis of disease.

52 patients with headache (migraine – 21, tension headache – 31) and 47 healthy women were examined. All women underwent neurological, laboratory and ultrasound (transcranial doppler) examinations. Blood flow and laboratory parameters were significally different between controls and patients with headache and antiphoshpolipid syndrome. All patients with antiphoshpolipid syndrome had changes in thrombotic system and plasma. Almost all blood flow parameters in all examined arteries were significally hire in patients with antiphoshpolipid syndrome than in controls. Comparing blood flow in different cerebral arteries between two groups, we found statistical significance in medium cerebral artery. Blood flow velocity in the middle cerebral artery was increased with the increasing severity of headache on a visual analogue scale. The index of pulsation, in contrast, is lower in the main group, reflecting the decrease of vascular resistance and flexibility of blood vessels. Our study revealed a trend to more pronounced changes in coagulogram and more striking clinical manifestations in patients aged 31–41 years than among patients aged 20–29 years. Comparison of laboratory parameters in patients with antiphospholipid syndrome with various forms of headache revealed a statistically significant difference between the values of the level of D-dimer and induced platelet aggregation. Increased level of fibrinogen detected only among patients of the main group aged 30–41. It is revealed that high values of fibrinogen, factor V resistance, peak flow velocity in the middle cerebral artery have a direct impact on the severity of the headache.

Abstract. The frequency of occurrence of endodontic-parodontal lesion of jaws is established based on the carried-out clinicoradiological inspection of 1525 (843 (55,28%) men and 682 (44,72%) women) adults of different age groups. There were 456 people young age, 523 – an average age, 329 – elderly and 217 people of senile age among surveyed. Fyodorov – Volodkina index is used for the assessment of a hygienic condition of an oral cavity, assessment of intensity of a course of pathology of a parodont is carried out with using complex parodontal index. It is shown in work that the frequency of occurrence of endodontic-parodontal lesion at adults of various age groups – 24,13% and it is getting higher with age. The endodontic-parodontal lesion at persons of young and average age was, respectively, in 1,97% and 18,74% of cases, and at persons of advanced and senile age the frequency of occurrence of endodontic-parodontal lesion reached, respectively, 34,35% and 68,2% in the corresponding age groups. It is shown that endodontic-parodontal lesion despite of age, but the frequency of occurrence of endodontic-parodontal lesion higher at women. It becomes perceptible that endodontic-parodontal lesion at young and average age come with satisfactory individual care of an oral cavity at mild or moderate severity of parodont pathology. In the senior age groups, despite of sex, endodontic-parodontal lesion come with unsatisfactory individual care of an oral cavity at serious severity of parodont pathology. It is emphasized that the high frequency of occurrence of endodonticparodontal lesion at middle-aged persons, and also at people of the senior age groups causes need to principals and managers of units of a therapeutic and surgical odontology of stomatologic treatment and prevention facilities, to provide a possibility of performance of expanded dental treatment-and-prophylactic actions when carrying out sanation of an oral cavity, and also before a denture.

Healthy patients had all temporal characteristics of systole and diastole within Golden Proportion standards. Physical activity had changed the ratio of systolic/diastolic characteristics. At rest all proportions were restored. It was found that heart rate during the physical activity increases according to the principle of golden proportion. Heart rates that save heart activity within golden proportion are the limits of physiological functioning of the organ. Patients with congestive heart failure had systole enlargement and shortening of diastole compared to control patients as well as compared to the cardiac cycle. The direct dependence of cardiac cycle temporal characteristics changes and congestive heart failure severity were found. The higher the functional class of heart failure, the more violations of these indicators. Ventricular systole decreases less among patients with congestive heart failure than in healthy people. That is why systole cardiocycle ratio among patients with congestive heart failure increases. While diastole decreases during tachycardia sooner than cardiocycle this leads to reduction diastole and systole cardiocycle and systole ratio. Diastolic or systolic dysfunction doesn’t exists separately. Heart failure revealed itself with both cardiac cycle phases dysfunction.

We evaluated the prevalence of cardiovascular risk and signs of initial atherosclerosis in young and middle aged men, undergoing military service in the Arctic region. It have been found, that military service in the North and the Arctic zone is fraught with negative influence of climatic factors conducive to the development and progression of cardiac disease. The prevalence of classical cardiovascular risk factors had a multidirectional character. The frequency and severity of arterial hypertension was higher in men performing military service in temperate climates. Military contingent of the Arctic region was characterized by overweight, inadequate consumption of fresh fruits and vegetables combined with physical inactivity. The Systemic Coronary Risk Evaluation algorithm and Framingham risk scale have been used for estimation of the probability of cardiovascular events. There was high frequency deployed stages of fatty liver disease in the troops of the Arctic region. Identified a high occurrence of dyslipidemia and 1-hour postprandial hyperglycemia, as well as reducing the elasticity of arteries. Has been noted the hidden character of the violations of lipid and carbohydrate metabolism, which makes them difficult to diagnose through routine survey techniques. For early detection of initial atherosclerotic changes have been recommended the inclusion in the diagnostic algorithm such test as detailed lipid profile, glucose tolerance test, ultrasound examination of the carotid arteries and dynamic sphygmomanometry.

Histological and immunohistochemical analysis of morphofunctional features of leiomyomatous proliferation associated with adenomyosis (desmin, type IV collagen, basic fibroblast growth factor expression) was performed. Two types of leiomyomatous proliferation have been established: diffuse perifocal leiomiomatous hyperplasia without micromyoma development (97,8%) and perifocal leiomyomatous hyperplasia with development of microand macroscopically visible myomas (62,6%). Immunohistochemical study revealed differences in morphological and functional characteristics of perifocal leiomyomatous proliferation in deep and superficial endometrioid heterotopias. It was confirmed that the loss of desmin expression and positive expression of type IV collagen reflect a significant remodeling of the myometrium in this pathology. Topographical relationship between the smooth muscle proliferates in cytogenic adenomyosis stroma and microvessels as well as high frequency of microand macroscopically visible myomas formation in adenomyosis suggests potential for leiomyomas to appear in the setting of adenomyosis. The severity of the main clinical manifestations of adenomyosis – dysmenorrhea and menstrual disorder depends on the depth of endometrioid heterotopias in the myometrium and the degree of perifocal leiomyomatous hyperplasia. Significantly more patients with deep adenomyosis and moderate or severe perifocal leiomyomatous hiperplasia had complains of severe dysmenorrhea, and heavy menstrual bleeding. New conservative methods of treatment of this pathology need to be finding because of consistency of perifocal leyomiomatous hyperplasia associated with adenomyosis. These methods should be directed not only to suppress the progression of epithelial and stromal components in heterotopias, but also to prevent the proliferation of smooth muscle.

The case of successful minimally invasive surgical treatment of a patient with a giant hydatid cyst of the liver is presented. Outpatient ultrasound examination revealed the formation of the right lobe of the liver with a size of about 10 cm. During hospitalization in the naval surgery clinic of S. M. Kirov Military Medical Academy, the comprehensive clinical and radiological examination was performed. Diagnosis: hydatid cyst of the liver. Data for the prevalence of the process was not received. Diagnostic laparoscopy to assess the degree of liver damage and determine the possibility of minimal invasive removal of the cyst was performed. Mobilization of the liver by incising the falciform ligament was produced. The possibility of performing laparoscopic pericystectomy was established. Dissection of cysts, removing of scoleces without opening their capsules and atypical resection of 4, 7 and 8 liver segments with treatment of resection zone by argon-plasma coagulation was produced. Drainage in the resection area was set. Debit of excretion by drainage per day was about 100 ml of serous-lymph excretions. Control fistulography was performed. Relations of cavity with ductal system of the liver were not revealed. The postoperative period was uneventful. After 10 days after surgical intervention multislice computed tomography was performed. Information about presence of structures in the abdominal cavity is not obtained. The patient was discharged after 12 days in a satisfactory condition.

The changes of psychological women’s state in the earliest rehabilitation period are considered after the fulfilment of hysterectomy in connection with myoma of uteri. The psycho-physiological status (one hundred and four) 104 of gynecological sickly women was examined from ten till fourteen days after the fulfilment of hysterectomy. The psychological state of examined patients was determined by the creation of meanings hypochondriatic, trouble-depressed, hysterics, negative and troubled nervous displays and autization. The high level of realization their problems are peculiared (the following peculiarities) through the dissatisfaction and pessimism in the valuation their perspectives, inertness, strongly expressed emotions, skepticism, uncertainty diffidence, affiliative need in understanding, love and friendly attitude. This type shows the depressive reaction in the limits of adaptational syndrome and is connected with the illness, which disturbed the usual way of life and perspective plans. There are three types of personalities: asthenic-neurosis, epilepticoidny-excited and hyperthymic. The part of other personal types (sensitive, labile, hysteroid and unstable) turned up very few and put together from four till seven present. Emotional-will sphere of patients was characterized by deeply development of reactional trouble and personal trouble, showing the lower emotional stability, development of neuropathic state and desadaptational disorders. The growth levels of troubles for the patients who felt hysterectomy was deeply shown of situational character: the situation is endured by them as psychotraumatic, their state is characterized the distinctness feeling of physiological discomfort, inside trouble, tensity, nervous, unsatisfied of actual life situation, troubled mark of perspective. Under the influence of negative facts of operative interference and losing reproductive function begins the changing of functional state of nervous system, appearing the growth of trouble, low activity and growth number of patients with the symptoms of social physiological disadaptation. The women who endured hysterectomy need in the course medical and physiological rehabilitation in order to correct the physiological desadaptation.

199 military servicemen involved in work with chemical weapons storage and destruction were examined on the inpatient basis at the Department of combat medicine of the Military medical academy after S.M. Kirov in 2010–2012. It was established that in the personnel employed at the chemical weapons destruction plants and was in constant contact with organophosphorus compounds the frequency of isolated nosological forms, such as hypertension, atherosclerosis, gastrointestinal erosive/ulcerous lesions, discirculatory encephalopathy, and vegetative sensory polyneuropathy, was decreased and possibility of combined forms was increased. Thus in the persons with more then 10 years length of work the combined nosological forms were found in 81,8% of cases. The combination of hypertension, atherosclerosis, discirculatory encephalopathy, gastrointestinal erosive/ulcerous lesions, and vegetative sensory polyneuropathy took place in 6% of cases. Besides, with the increased length of work with chemical weapons total cholesterol, triglycerides, β-globulins, uric acid, β-glutamyl transpeptidase, and alanine aminotransferase the levels of the mentioned indices were above norm. It was also revealed that results of the veloergometry test in the military servicemen with the length of work less that 5 years were negative in 100% of cases, in the persons with the length of work from 5 to 10 years 3,1% did not finish the test, in the persons with the length of work more than 10 years the negative test was only in 71,9% of cases, uncompleted β– in 16,2%, and the positive test – in 11,9% of military servicemen. Echocardiography military servicemen involved in work with chemical weapons storage and destruction revealed the signs of atherosclerosis of the aorta were found significantly more frequent than in the others (50,6 vs 42,9% respectively). The persons with the length of work with chemical weapons more than 10 years the signs of atherosclerosis of the aorta were found significantly more frequently (78,8 vs 42,9%, p<0,01) indicating correlation between the length of work and the development of atherosclerosis. In addition, in this group 32,69% of military servicemen demonstrated an abnormal interventricular septum widening (p<0,05) and in 29,92% – decrease of transmitral to transaortic blood flow ratio below 1.

The article analyses the peculiarities of psychological status in girls of the Republic of Dagestan mothers, which before pregnancy the period experienced a high risk of a terrorist threat during the occupation by militants in September 1999, Revealed that mild depression and masked depression in girls mother, which before pregnancy the period experienced trauma associated with the threat of life is determined much more often than in the group of girls whose mothers have not experienced the vital stress. In both groups of cases of severe depression was not observed. Girls whose mothers are in before pregnancy the period experienced mental trauma associated with life-threatening demonstrated a high level of neuroticism, which combined with introversion and falsity, they showed a tendency to an underestimation of their self-esteem, which is comparable to highly aggressive, and creates preconditions for violation of interpersonal contacts and social adaptation. They are also characterized by coldness, formality in contacts, high physical aggression, negativism, suspicion, verbal aggression, fears, unreasonable resentment, poor emotional control, low level of responsibility, moodiness, increased impulsivity, anxiety, distractibility and insufficient concentration of attention. They are usually have little interest in the life of the school community and take a destructive position in conflicts. In general, the most important personal characteristics of these girls are: low level of emotional stability, frustration and a high level of anxiety.

The dynamics of immune parameters changes and the apoptosis in animals with carcinosarcoma Walker 256 after exposure to whole body hyperthermia (43,5°C) is analyzed. It was found that the features of immunomodulatory and apoptosis modulatory effects of hyperthermia (43,5°C) in animals with tumors are as follows: the effect of hyperthermia is manifested by increasing number of of lymphocytes (CD3+, CD4+, CD8+ and CD20+) on day 7 and decreasing to 14 th day of the experiment. Against the backdrop of a temporary increase of lymphocytes Th 1-type notes a persistent increase of interferon-γ, which is a reflection of the activity of the cellular immune reactions of the body in response to hyperthermia. Furthermore, it was found the increasing of expression levels of pro-apoptotic protein Bad, Bax and decreasing of level of expression of the protein Bcl-2 anti-apoptotic in posthyperthermal period. For example, protein expression indicators in Bad carcinosarcoma Walker 256 cells at the 7th and 14th day posthyperthermal period were significantly (p<0,05) higher, respectively, 2,05 and 2,15 times as compared with the initial state. The expression of Bax protein level was also higher than the corresponding figure before the session of hyperthermia (43,5°C), on the 7th and 14th day in 3,52 and 1,69 times, respectively (p<0,05). We assume that hyperthermia as the method that is not related to the direct thermal damage to the tumor tissue is capable to provide immunomodulatory and apoptosis modulatory effects.

The state of regulatory mechanisms using mathematical analysis of cardiac rhythm is studied. To estimate the functional state is used passive orthostatic test (tilt-test). The initial tone of the autonomic nervous system is determined by calculating the parameters of spectral analysis of heart rate variability (power spectrum of high frequency, low frequency and very low frequency components. The balance of the autonomic nervous system is evaluated identifying the ratio of low and high frequency from which the very low frequency component was excluded. All subjects were divided to two groups: «sympathotonics», in which this ratio ≥1, and «vagotonics»with this ratio <1. Central hemodynamic parameters (heart rate, minute volume of blood flow, stroke volume, total peripheral resistance) were recorded by impedance rheography. Orthostatic stability was evaluated by the changes of these parameters during the orthostatic test. The differences in hemodynamic responses to orthostatic effect in groups «sympathotonics» and «vagotonics» are identified. Total peripheral vascular resistance in the group «sympathotonics» in response to orthostatic load increases significantly, the stroke and minute volume of blood flow is reduced more than in group «vagotonics». High initial heart rate is observed in the group «sympathotonics» compared with group «vagotonics». There are identified the dependence of the degree of changes of hemodynamic parameters in the process of urgent adaptation of an organism to changes of position in space in individuals with different initial tonus of the autonomic nervous system.

In the experiment on the wound model in rats it was studied the clinical efficacy of the drug composition with dimethyl selenium. Experimental studies were carried out on white outbred male rats, which under ether anesthesia on the surface of the back after depilation and alcohol lubrication excised skin up to 4 cm in diameter to underlying fascia. Animals in the first group as a means to stimulate the reparative processes of the skin wounds were treated with the drug composition with dimethyl selenium, animals of the second group (comparative group) were treated with dimethyl sulfoxide, animals of the third group (control) did not receive local treatment and its wounds healed under aseptic bandage. Evaluation of the efficacy of dimethyl selenite and dimethyl sulfoxide was performed on the 1st and 3rd day of treatment with light microscopy of wound tissue biopsies painted with hematoxylin and eosin, and pikrophuksine by Van Gieson method. It was found that wounds in animals of the control group were characterized by necrosis edge, hemorrhage, expressed soft tissue edema and inflammatory infiltration with more disintegrating polymorphonuclear leukocytes. Local use of the drug composition with dimethyl selenium led to a significant reduction in severity of pathological manifestations of inflammation and accelerating repair. Dimethyl sulfoxide also has anti-inflammatory effect, but less pronounced than dimethyl selenite. It is shown that the use of selenium in the local treatment of wounds to reduce necrosis in the wound edges, accelerate proliferative processes in the granulation tissue and thereby contribute to faster and more complete healing of wounds.

The results of experimental studies to assess virucidal action of the disinfectant on the basis of polyhexamethyleneguanidine hydrochloride and alkyldimethylbenzylammonium chloride are discussed. To assess the virucidal properties of the test substance was used the concentrate of norovirus obtained from a pool of human faeces, of the hospitalized with acute gastroenteritis. Concentrate of norovirus has received by multi-stage purification using centrifugation and membrane filtration on filters of nitrocellulose, in a tangential flow. Initially, the presence of particles of norovirus in the preparation and the absence of a concomitant viral infection was confirmed using transmission electron microscopy using standard techniques of identification by characteristic morphological features and molecular biological confirmation. High virucidal activity of the drug was revealed. We can assume that a charged polycation (polyhexamethyleneguanidine hydrochloride and alkyldimethylbenzylammonium chloride) electrostatically interacts with the particles of norovirus. The interaction starts with the outer negatively charged P-domains, then S covers the hydrophobic domains, which leads to dissociation of the capsid and thus to the destruction of viral particles. RNA of norovirus in the absence of the receptor protein is not capable to infect more than that, it also breaks down and inactivates components of the disinfectant. Furthermore, the authors investigated the spectrum of the dominant circulating strains of microorganisms in a medical hospital. For the rotation of disinfectants in hospitals associated with medical care for the prevention of infections the polyhexamethyleneguanidine hydrochloride and alkyldimethylbenzylammonium chloride has been used. In a multidisciplinary hospital the above-mentioned disinfectant was applied, and positive results were obtained, testifying to the effectiveness of the disinfectant of polyhexamethyleneguanidine hydrochloride and alkyldimethylbenzylammonium chloride

Using modern analytical equipment and justified and developed methodological approaches and calculations amino-acid composition of the domestic peptide drugs cortexin, retinalamin, pineamin has been studied. For the first time the exact amounts of each amino-acid out of 17 have been discovered in the specified drug products as well as the fact that cortexin has additional non-proteinogenic ornithine amino acid, retinalamin has taurine, pineamin has ornithine and taurine while cerebrolysin does not contain free amino acid cystine. It has been determined that among the cortexin amino acids 65% of them constitute L-glutamic and L-aspartic acids that together with ornithine specify bioenergetic characteristics of the drug. Absolute amount of every amino acid in cortexin in comparison with cerebrolysin (in an amount of 1 mg of the organic drug) is reasonably larger, in particular amount of aspartic, glutamic acids and tyrosine is 6,5–7 times larger, amount of serine is 9 times larger and amount of arginine is 12 times larger. Stability of amino acid spectrum of every domestic peptide drug has been achieved that is stable notwithstanding lot and time of manufacturing. For reasonable results interpretation and cortexin pharmacokinetics evaluation cerebrolysin was chosen as a reference product. Choosing of Cerebrolysin as a comparator with cortexin is explained by the fact that another medication close by indications and the structure does not exist, although in degree of preparedness the cerebrolysin is hydrolyzate, that is the final product of the process, which is an important stage of its production. At the same time, peptide medications of domestic production – cortexin, retinalamin and pineamin which having a two-component – the original peptide substance and a stabilizer (amino acid glycine), are really transferred hydrolysis process on the patient’s metabolism. Years of experience in applying cortexin was revealed no changes in metabolism when intramuscular administration, due to the minimal amount of medication (10 mg), constant availability and accessibility of aminopeptidases, short duration of the preparation.

Questions of modern condition in using of membrane technologies in the sanitary control of water quality, assessment of the main advantages of membranes for microfiltration and ultrafiltration, as well as the prospects for the use of new membranes based on innovative materials were considered. Special attention in research was given to the improvement of the method of membrane filtration of water samples for the concentration of enteric bacterial and viral pathogens from water bodies of the environment (surface waters, waste water, etc.), and evaluated the capabilities of modern laboratory techniques, including rapid, for detection of their markers. The widespread introduction of membrane technology in sample preparation and detection of bacterial and viral pathogens leads to increased information content and reduced research time, which has important epidemiological significance. These innovative approaches will definitely expand our testing capabilities in the control of water quality in field conditions, flood, natural disasters, disaster at addressing the challenges faced by troops, and other situations. The results of the conducted experimental studies give reason to recommend the practice of sanitary-microbiological control of water quality filtration membranes of certain materials with specific pore diameter. For counting Escherichia coli, bacteriological sowing on a dense nutrient medium with the membrane filtration method, it is recommended to use filtration membranes of cellulose acetate and cellulose nitrate with an average pore diameter of 0,45 µm. Application of innovative filter media for sample preparation and detection of rotaviruses in water, allowed to obtain the optimum for the detection of more simple and rapid methods the concentration of rotaviruses whose markers were determined in the reaction of agglutination of latex and by immunochromatographic analysis. This allowed us to consider the use of the entire laboratory complex of quality control of water in the extreme and field conditions.

The analysis of infectious morbidity in the Armed Forces of the Russian Federation in 2015 was carried out, the level and structure of primary morbidity of conscripts and contract servicemen are estimated. It was found that for the most relevant for troops are respiratory diseases (acute respiratory infectionsand pneumonia), group «childhood infections», acute intestinal infections, tuberculosis and diseases of the skin and subcutaneous tissue. At the same time immunoprophylaxis in the Armed Forces of the Russian Federation is one of the important methods of prevention of infectious diseases. To increase the effectiveness of immunoprophylaxis it is expedient to amend the regulations. The results of control (supervisional) measures are provided in the framework of realization of the state sanitary-epidemiologic inspection at servicemen lifesupport objects, and main causes of Russian sanitary legislation offence are indicated. Some problems which provide stable sanitary-epidemiologic situation in the Rusian Armed Forces are pointed out as well. It is recognized that in the majority of cases the conditions concerning the location, food-, water supplyand bath-laundry services correspond to the federal and departmental sanitary legislation. Military work conditions allow for preventing traumatic and occupational diseases. The authors emphasize that radiation hygiene occupies a highly important place in the occupational hygiene. In general, the sanitary-epidemiological situation in the Armed Forces of the Russian Federation assessed as prosperous. The level and structure of primary morbidity of conscripts and contract servicemen during the last five years have remained stable. However, in some military units (institutions) of military districts the sanitary-epidemiological situation for some nosological forms in 2015 was defined as unstable.

Russia’s health care prevention orientation was the top priority in the Soviet period, and still is nowadays. Social-economic and political changes in the society as well as health care transformations have negatively influenced the prevention system, destroyed organizational inter connections, changed the mental mood for medication work. The introduction of compulsory medical insurance has not led to the improvement of prevention programs financing and has not let medical staff get interested in the final results of their professional activities. Alongside that, the analysis of sanitary statistical data has pointed to the continuing growth of cardiovascular diseases numbers. Thus, the pathology prevention improvement issue needs intent attention. To put an and to the status-quo in conditions of the prevention work underfunding a major emphasis has to be made on the increase of gnostic preparedness level of medical preventive services deliverers and consumers, that is medical staff knowledge level and patients awareness level increase. The necessity of simultaneous impact on the above mentioned objects is determined by the systemic approach principles when in the process of medical service delivery a medical service consumer-deliverer system is being formed, preventive in particular, and its functioning resultativeness will be seen through, among others, the degree of its components preparedness for coordination.

The level of accessibility and quality of care, efficiency of health system performance depends on the state and development of primary health care. Reforming the health care system due to the introduction of new principles of providing medical aid to the population and development of the institution of general practice. One of the objectives of the system of general practice, implemented in order to improve the quality of primary health care, outpatient care is to increase the volume, reducing the number of visits to specialists. Moreover, medical care is possible with different forms of organization of general practice, both in the offices and departments of general practice clinics in the structure. In recent years the Russian Federation achieved significant economic growth, resulting in financing the health sector has been increased, as well as set up the prospects for its further development. In the framework of primary health care routine inspections of certain categories of citizens, immunoprophylaxis, the introduction and development of hospital technology have been conducted with medicinal maintenance of patients within the guaranteed volume of free medical care. Russian Federation Ministry of Health carried out systematically work significantly increased the level of security of health care of the population, has increased the volume of preventive and sanitary measures, increased efficiency and quality of clinical examination of patients and the level of temporary and permanent disability decreased due to expansion of the guaranteed volume of free medical care. Among other things, provided for ensuring access to health care and improving the efficiency of medical services to the population, including the rural population.

Carbon monoxide poisoning due to gas monoxide gas inhalation takes the leading place in the list of inhalation poisonings, the fourth most frequent poisoning by psychotropic substances. On the basis of clinical observations of cases of poisoning with toxic products of exhaust gases, the range of problematic issues in the provision of specialized medical care in a multidisciplinary hospital is outlined and the possible ways of their solution are scientifically substantiated. This article describes the diagnostic approach to determining the severity of poisoning with highly toxic combustion products and components of the exhaust gas of internal combustion engines on the basis of indirect determination of pathological forms of hemoglobin in the blood of victims, as well as the characteristic of the possibility of using integrated score systems of risk stratification for patients. It was found, that the main problem in the provision of specialized medical care to victims with acute poisoning by toxic components of exhaust gases is the difficulty of assessing the severity of poisoning without the possibility of quantitative determination of pathological forms of hemoglobin in the blood, making it difficult to define indications for hyperbaric oxygen therapy and monitoring its effectiveness. It is shown, that the lack of gas-transport function of blood can be indirectly estimated from the results of measurement of the oxygen partial pressure, and comparing its results with the proper value taking into account the victim’s age. It is shown, that at a certain time of the evacuation, and the conditions of its carrying out can also calculate the initial concentration of carboxyhemoglobin in the blood of victims. It was found, that the presence of the victims of decompensated metabolic acidosis allows indirectly conclude about presence of severe poisoning largest degree of lactate in the blood of victims. According to echocardiographic studies in the dynamics, revealed that the decrease in left ventricular of heart ejection fraction may be a marker of a dynamic disorder and restore tissue oxygenation.

The structure of trained groups at Territorial center of disaster medicine of Arkhangelsk regional clinical hospital was analyzed retrospectively by the period 2011–2015 years. Among the trainees who have undergone courses of providing first aid to victims in various emergency and abnormal situations, the significant quantitative growth of the total number of listeners, as well as increase in their number inside the studied groups, were observed. We noted the significant increase in the number of employees of Ministry of Emergency Situations and the Ministry of Interior, trained in the center from 2013 to 2015, with the maximum determined in 2011. During the study period a 5-fold rise in the number of trained university students in Arkhangelsk was shown, with a significant predominance of students of the Northern State Medical University; a similar increase was observed in a group of drivers. The total number of trained employees of commercial and public organizations of Arkhangelsk region remains high, with a tendency to increase and with a significant predominance of the latter. It was found that further development of the educational activities of the Territorial center of disaster medicine requires strengthening of its material and technical base and increasing the number of trained techniques and methods of first aid among employees of private security companies, commercial enterprises, teachers of pre-school and school education, the crews of sea and river ships and a special contingent of industrial enterprises intended to provide first aid in the workplace.

Modern medical world can hardly be imagined without such an important and necessary examination as the Holter monitoring electrocardiogram which is now wordwidely used in each cardiology hospital department. Due to his invention Dr. N. Holter has become known to many physicians and patients. His method has been actively adopted to different areas of medicine and has stimulated the development of a new branch in cardiology which is also growing intensively now. Despite of the fact that Holter`s method has passed the age limit, it does not only lose its relevance and popularity in every day doctor`s routine but also finds new ways of a use, widening regularly the list of indications for treatment and becoming more and more complicated and multy-faceted. This method in combination with the impetuous development of medical equipment and technology has made it possible to test the patients with rare medical symptoms using ranged monitoring electrocardiogram, if a day-study monitoring doesn`t give enough information. It also helps to enlarge essentially the diagnostic resources. Now there is a chance for making a 7-day or more electrocardiogram monitoring: devices to make a request or view in real time recording as well as implantable devices to record the electrocardiogram for years, especially for patients with rare episodes of arrhythmias, angina pain, syncope of unclear etiology risk of a sudden death syndrome have been worked out. Therefore, the development and introduction systems of long-term monitoring electrocardiogram into clinical practice, expands absolutely the spectrum of indications for its putting into practice not only in cardiology but also in related areas of medicine.

This article reviews the latest developments in understanding the etiology, pathogenesis, risk factors, treatment and prevention of gastroand enteropathy caused by nonsteroidal anti-inflammatory drugs. Risk factors, modern therapeutic tactics of patients receiving non-steroidal anti-inflammatory drugs, as well as prevention of this disease have been considered. Nonsteroidal antiinflammatory drugs are widely used in the world due to their anti-inflammatory, analgesic and antipyretic activity. One of the major factors limiting the use of these drugs is their side effects on the gastrointestinal tract. Currently, the incidence of complications of the upper gastrointestinal tract reduces, and the rate of complications from the lower divisions increases. The clinical significance of enteropathy induced by nonsteroidal anti-inflammatory drugs remains undervalued, despite the danger and threat to the life of patients. Effects of the use of non-steroidal anti-inflammatory drugs in the intestine are poorly understood and are not always familiar to clinicians, and diagnosis of this disease is quite difficult. The pathogenesis of enteropathy is different from the pathogenesis of ulcer and erosion of the upper gastrointestinal tract, caused by nonsteroidal anti-inflammatory drugs. Treatment, and prevention are significantly different too. Demonstrated promising protection areas of the gastrointestinal tract by using and creating new products, in particular contain hydrogen sulphide, and nitrogen oxide. Particular attention is given to consideration of the data supporting the new ideas about how to glucocorticoid hormones important natural gastroprotective factors whose role becomes especially important in the conditions of oppression of prostaglandin production, occurring when taking non-steroidal anti-inflammatory drugs.

The article analyzes the phenomenon of autonomy in the doctor – patient communication. Various theories and the concept of autonomy. The activity of the patient is considered as a priority for current concepts of interaction on the axis of a doctor – patient. The interaction doctor – patient relationship in the current conditions is difficult because of the lack of effective communication strategies and lack of experience determining the correct amount of the reported scientific information. Thus, updated conceptual study of the principle of respect for patient autonomy in the Russian medicine and the creation of conditions for its regulatory effectiveness. In this communication the doctor and the patient is initially mediated by a variety of factors: the activity of professional context (professional standard, professiogram); organizational level of influence on the communication (type of institution, socio-psychological and organizational environment in a team); institutional level (basic principles and legal foundations of the health system); Socio-cultural section of the communicative environment (set of informal rules of interaction between doctor and patient in the context of the mentality of a particular company); interpersonal level at which the realized and actual communication itself. It is important to understand what level of interpersonal communication plays a crucial role here range is great – from the master, the physician with personal values, to neutral, at which realized the situation and depersonalization technologizing communication. It is considered that autonomy is generated in the process of maturation of a subject position of the patient in a situation of real interaction with the doctor and the patient’s achievement of autonomy does not occur simultaneously, it is a long process, unfolding in specific socio-historical conditions. The degree of autonomy can be smaller or greater, but in general it can not affect the principle of respect for patient autonomy, which regulates the interaction warning notorious individual arbitrariness, as the admissibility of a virtuous and paternalistic deception evasion recognizing subjectivity of the patient.

Results of modern researches show, that quantitative level lipoprotein (a) and especially its low-molecular phenotypes аpо(a) are independent risk factors of a coronary atherosclerosis and correlate with presence, a current and degree of expressiveness of ischemic illness of heart. It was considered the presence, severity of atherosclerosis, the main arteries of the head with the risk of stroke and cerebrovascular complications of atherosclerosis by comparing the quantitative level of lipoprotein (a) and low molecular weight isoforms of apo (a) in patients with stroke or transient ischemic attack. It is noticed, that these indicators are less informative for diagnostics, the forecast, severity of the given diseases, than at a coronary atherosclerosis and ischemic illness of heart. Despite adequate lipid-lowering therapy in patients with atherogenic dyslipidemia, there is a high risk of cardiovascular complications. One of the main factors influencing the residual risk along with elevated triglycerides and reduced cholesterol of high density lipoproteins is lipoprotein (a). We study current understanding of the role of lipoprotein (a) in the development and progression of atherosclerosis, as well as the main directions of therapy, including lipid-apheresis. It is also important the organization of lipid-apheresis, its financing, the establishment of a national registry of patients with high levels of lipoprotein (a).

On materials of basic morphological researches the structure of an internal vertebral plexus is considered. It is shown that it consists of two departments – forward and back, each of which through system of avalvulvar intervertebral veins is reported with an external vertebral venous plexus. The main distribution collector of blood in an internal vertebral plexus are veins of its forward department. The data on interrelations of the spine veins with sine of a firm brain cover, the veins of internals and veins of the lower extremities are given. The internal vertebral venous plexus should be considered as the environments of a spinal cord (a venous case) providing humoral communication in a system: a spinal cord – covers – a spine column, and causing its integrity and communications with other extravertebral veins. Further applied the clinical value of data about functional characteristics of an internal vertebral plexus on the example of such heavy complications as bleedings, a varicosity, metastasis of malignant tumors, distribution of purulent processes, aseptic cicatricial and commissural epiduritis, a catheterization of epidural space. The reasons of each of complications are analyzed, and the list of the basic researches of their studying is given. Much attention is paid to the analysis of modern foreign literature. The reasons of bleedings are: the intraoperative injuries of veins of the vertebral canal and spontaneous hematomas in case of congenital angioma, new growths, thrombolytic therapy or venous hypertensia. Varicosity of veins of the vertebral canal arises in case of chronic thromboses, sharp narrowings or an underdevelopment of the inferior vena cava. Veins of a spinal column can be the ways of metastasis of tumors from different organs to a spinal column, and from it to the venous system of a skull and vice versa. Availability of numerous anastomosis with veins of other systems causes development and distribution of purulent processes in epidural space. Along with a purulent epidurit quite often arises also aseptic cicatricial and commissural epiduritis. And, at last, taking into account the features of a structure of an internal vertebral venous plexus reasons for the equipment of a cateterization of epidural space are given.

The most important trends in the development of pneumonia teachings were analyzed. Historical aspects of the study and evolution of pneumonia treatments from ancient times to the present day is considered in the context of the classification of the disease and the prospects for further improving diagnostic techniques, strategies and tactics of the treatment of pneumonia. Significant scientific advances in the diagnosis and treatment of this disease over the past century were demonstrated. Attention was drawn to the necessity of system clarity of generally accepted views, which set in the modern domestic pulmonology against pneumonia. It was stressed that the clinician is often in a difficult situation, not only in the practical use of recommendations for the diagnosis and treatment of pneumonia, but when he formulates a diagnosis. The question of imperfection of existing terminology in relation to the classification of pneumonia, proposed by the European Respiratory Society and currently used in Russia was raised. It was shown the necessity to create a domestic classification of pneumonia. Especially because we already had the experience of using the N.S. Molchanov’s classification, which remained for many years because of its simplicity and versatility unique and essentially completely acceptable and relevant today. It is shown that predicting the future course of evolution in the diagnosis and treatment of pneumonia, the most important and long overdue would be a shift from an empirical antibiotic therapy to targeted therapy with effective eradication of the causative agent.

It was discussed the methodical possibilities of improving the educational process in the clinical departments of the Academy. It was shown that the introduction of various technical devices helps develop students’ sustainable theoretical knowledge and practical skills. It was revealed that in the clinic, experience and authority of the teacher, a clear lesson planning time are crucial factors in determining the motivation of students to study a particular discipline. In this work, the role of the teaching staff, especially its ability to respond promptly to requests of students. Furthermore, one of the ways to identify students’ interests and difficulties encountered during the training cycle is a feedback system. In this respect it is enhances the role of the teaching staff, especially its ability to respond quickly to requests for students. Given that, for several years, on the last day of staying the group at the department, a voluntary anonymous survey of students and students on improvement methodological possibilities of the educational process at the Department of thermal injuries was carried out. The study of both positive and negative answers given faculty chair of objective data to analyze the effectiveness of teaching methods «thermal injury» in the conditions of daily operation of the surgical clinic. It was found that the educational process is not possible without the combination of analysis of theoretical issues with the presence of students in the clinical analyzes of their independent work with patients in the wards, in the dressing rooms, operating while performing surgery. According to students, these factors are the most significant in terms of the training of future medical practice. It emphasizes the importance of training teachers of the department, medical clinics and nursing staff, their human qualities, related to cadets and students. It is shown that the prompt elimination of certain defects helps to strengthen military discipline and labor collective of the department and clinic serves as a guarantor of professional skill of the team for further growth in the continuous improvement of the educational and therapeutic processes.

The article presents the main milestones of organizational and medical activities of N.A. Velyaminov at the time of the World War I, which are reflected in the unique manuscript – «Essays on the military-sanitary service in the patriotic war of 1914–1917 and memories of the academician Velyaminov», which is stored in the Military Medical Museum (SaintPetersburg). It belongs to the pen of the outstanding Russian doctor, surgeon, academician of the Imperial Military-Medical Academy – Nikolay Aleksandrovich Velyaminov (1855–1920). The representative of aristocratic family, he talked with the leaders of senior military leadership and the government, moved in high society circles, knew all the imperial family. During the war, N.A. Velyaminov at first was the Inspector of the organization of surgical care in the army at the Headquarters of the Supreme Commander, then in 1916 he was the chief of the sanitary department and the special plenipotentiary of the Russian Red Cross Society in the Guards, in 1917 he was the chief field sanitary inspector of the Russian Army. He had a high prestige among the makers of the domestic medicine. Author of manuscript reflected the state of the medical care in Russian army during the war, the work of the Main Military-Sanitary Administration, the activities of charitable organizations, and many other issues. The manuscript was begun in the end of the World War I. Currently it is planned scientific publication of this document. It would be a significant event for the Russian Historical Society, will make open up a number of unknown pages of organization of the medical-evacuation support in the Russian Army in 1914–1917, it possible to correctly assess the results of the medical service activity, much of which still remains unknown to historians.

The analysis of features of the dental help at chronic illness of kidneys is submitted in A.N. Belsky monograph, O.A. Belsky, A. K. Iordanishvili «Chronic illness of kidneys: features of dental pathology». It becomes perceptible that when people getting dental treatment-and-prophylactic actions at the patients suffering from chronic illness of kidneys it is not important only providing efficiency of the carried-out therapy in connection with existence of somatic pathology, but also prophylaxis of the complications caused by the chronic focus of a odontogenous infection. The frequency of occurrence and intensity of a course of caries and noncarious lesions of firm tissues of teeth at the persons suffering from chronic illness of kidneys is considered based on the clinical, laboratory and pilot research by authors in an available form, data on their needs in treatment and denture treatment are submitted. Special attention is paid to features of the parodontal status and pathology of a mucosa of an oral cavity at the patients suffering from chronic illness of kidneys. Data on a morphological structure and chemical composition of firm tissues of teeth, the clinic-functional characteristic of tissues of a parodont and a mucosa of an oral cavity at the persons suffering from chronic illness of kidneys are also provided. It is emphasized that character of a mineralization of firm tissues of teeth at chronic illness of kidneys differs from those at healthy people that demands providing the actions referred on rising of their resistance, and the sanation of an oral cavity which is carried out by the technique developed by authors promotes rising of dental health level at patients with chronic illness of kidneys and favorably influences a condition of mucosal immunity.

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