Vol 19, No 2 (2017)

The results of the evaluation of the effectiveness of using inosine glycyl-cysteine-glutamate disodium (Molixan) in acute severe poisoning with ethanol are presented 57 cases of hospitalized patients (males) with I or II stage of alcoholic coma were investigated. Patients in the control group of 27 people received only the basic therapy of acute alcohol poisoning. 30 people from the main group in addition to basic therapy received moliksan drug at a dose of 3 mg/kg intravenously. Laboratory indicators of metabolic acidosis, which developed in patients of both groups, included by significant blood disorders of pH up to 7,24±0,02 and buffer capacity of blood to 6,2±0,15 mmol/l. The signs of hypoxia affiliated to metabolic acidosis: a decrease of partial pressure of oxygen (up to 64,3±5,18 mm Hg) and hemoglobin oxygen saturation (up to 74,4±5,6%), which were on average 1,6 times lower than normal values. The use of molixan promoted an earlier (3 hours instead of 10–12 h in the control) recovery of consciousness in patients poisoned with alcohol. Recovery of consciousness occurred on the background of a decrease in the severity of metabolic acidosis and hypoxia: blood pH in patients of the main group increased to 7,39±0,04; partial pressure of oxygen was 86,7±3,5 mm Hg. The oxygen saturation reached 96,2±3,3%. In general, moliksan is effective in rapid recovery of consciousness in patients in alcoholic coma. Additional inclusion of molixan in the treatment of acute severe intoxication with ethanol is accompanied by faster normalization of the parameters of the acid-base state and the blood gas composition compared to patients receiving only basic therapy.

Results of studying the effect of histological type of atherosclerotic plaques in the area of vascular anastomoses after reconstructive operations on the main arteries of the lower extremities on the risk of developing late thrombotic complications are presented. It was found that atherosclerotic plaques in patients with no evidence of a hemodynamically significant restenosis in the distal anastomosis identified thickening and overgrowth of fibrous connective tissue, the amount of lipids is minimal or absent, stored elastic fibers and the layers of smooth muscle cells. The extracellular lipids in extensive, but well-defined area in the intima. Macrophages are single and located mainly along the periphery of the lipid core, form clusters of 2–3 cells, there are no lipid inclusions in the cytoplasm. In atherosclerotic plaques of patients with late thrombosis in the distal anastomosis area, a significant uneven thickening and proliferation of fibrous connective tissue was revealed, lipid inclusions are represented by a large nucleus or a group of nuclei. Elastic fibers are replaced by collagen fibers and inclusion of lipids, several sites of calcification are noted. Macrophages form association of 4-5 cells at the periphery of the lipid core and in the coating, where their number is significantly higher; in their cytoplasm the inclusion of lipids are noted. Generally, it was revealed that the histological characteristic of atherosclerotic plaques of VI, VII type (AHA 5 classification [6]) correlated with the high risk of late thrombotic complications in patients operated with peripheral artery disease.

Medical, ethical and legal aspects of burns in pregnant women are considered. It is shown that not a significant number of clinical cases and a small number of scientific publications create certain difficulties for a comprehensive study of various issues of this topic. It is established that the professional training of doctors, especially the initial level of knowledge of young professionals, is the decisive factor in correctly assessing the severity of the condition of the burned woman both at the site of first aid and at her subsequent treatment in the hospital. The need for careful collection of anamnesis and a full-scale examination of all women of reproductive age who seek medical help or who are admitted to inpatient treatment with thermal trauma is emphasized. Significant is the joint work of a team of specialists, whose main role is assigned to combustiologists, obstetricians, and in the presence of extensive lesions of the skin and resuscitators. Possible negative variants of the course of a thermal trauma are given in the event that the victim begins to engage in self-treatment or turn to non-specialized specialists or physicians. Increases the likelihood of developing general and local complications that negatively affect the normal course of pregnancy. The importance of the topic under consideration for representatives of the military medical service is taken into account, taking into account the quartering of military units in remote garrisons or in cases of their involvement in peacekeeping operations or liquidation of the consequences of peacetime.

Experience and the increasing dynamics of application of endoscopic and endovideo surgical surgeries on surface ships of Navy is considered in the last decade. Introduction of endovideosurgical technologies began to happen also to the practician of ship surgeons to larger intensity in recent years. Modern low-invasive technologies considerably increase the level of rendering the surgical help in the sea, improve quality of treatment, promote bystreyshy recovery of seamen and their return to execution of the official duties. The case of performance of laparoscopic endovideosurgical appendectomy by team of surgeons on the Russian aircraft carrier «Admiral Kuznetsov» is described during a fighting campaign in January, 2017. It is shown that performance of endovideosurgeries is possible in the conditions of the large surface ship. At the same time not only completeness of health service of the ship the necessary endovideosurgical equipment, but also existence onboard the expert owning a technique of laparoscopic interventions remains important aspect. In the conditions of distant campaigns by the ships of Navy at urgent situations it is necessary to expand the volume of endovideosurgeries for improvement of result of treatment of the injured military personnel in the sea. Constant improvement of skills of regular doctors of the ship and the affiliated surgeons from military hospitals is necessary.

Anthropometric examination, analysis of the component composition of the body and somatotyping according to the scheme of V.P. Chtetsov, was performed on 248 young men and men of the first mature age living in the conditions of the European North. It is shown that the majority of the examined have a normal body weight (youth – 75,3%, men – 63,8%). The body weight deficit in young men is more common, and overweight and obesity are more common in men of the first mature age. In both groups of men, the abdominal somatotype prevails. In the second place – muscular type, on the third – thoracic and on the fourth – indefinite. It has been established that young men and men of muscular somatotype have a greater content of muscle mass in the body. 38,1% of men with abdominal somatotype showed an increased body weight. It was established that youth and men of muscular somatotype have a greater content of muscle mass in the body. The absolute content of the muscular component in them is 35,8±0,9 and 36,7±1,6, respectively, and the relative content is 42,2±0,7 and 45,0±1,4 kg (p<0,05). For individuals with an indeterminate somatotype, average values of muscle mass are typical, and for the chest muscle – minimal. Moreover, in men of these somatotypes, the absolute values of muscle mass decreased markedly from adolescence to the first adult age. Thus, in the persons of the chest somatotype they were 28,9±0,6 and 26,9±2,4 kg respectively. It is shown that the environment stimulates the development of certain morpho-functional structures of the body, which provide the best level of adaptation to the conditions of the North. The revealed regional features probably provide the best level of adaptation of the organism to the conditions of the European North, which indicates the formation of a phenotype adapted to living conditions in the northern region.

It is substantiated that the duration of ventricular systole is a measure of myocardial contractility and heart failure. Heart failure is based on myocardial systole impairment, which can be detected by ventricular systole duration/ the deviation of the actual component from the constant K in Bazett formula is systolic function impairment indicator. Actual component indicator is close to constant K at healthy people. Percent of deviations is equal to 1,3±0,5. Constant K could be used as a control indicator for determining deviation percent from the actual K coefficient. The increase in coefficient K is in direct proportion from heart failure severity. It is not always possible to detect heart contractility abnormalities during the first stages of heart failure. In these cases stress tests are useful. The coefficient K increasing during exertion and detects the heart contractility abnormalities. All patients with arterial hypertension and ischemic heart disease have impaired heart muscle contractility and signs of congestive heart failure. Congestive heart failure is based on the heart muscle disorder.

To clarify the pathogenesis of neuropathy in 20 patients with newly diagnosed primary (thyrogenous) hypothyroidism in the background of autoimmune thyroiditis electroneuromyographic study of hand nerves before and after the start of hormone replacement therapy was conducted. At the beginning of the study, all patients were diagnosed with manifest hypothyroidism. The serum levels of thyroid stimulating hormone were elevated, and the concentration of free thyroxin was reduced. At the end of the study (after 6 months), the concentration of thyroid stimulating hormone and free thyroxine in the blood serum were within reference values, which indicated the effectiveness of treatment of hypothyroidism. During electroneuromyographic examination before treatment in 5 patients were recorded normal levels compared to normative data by age and sex. In 15 recorded the data for violation of the sensory fibers. Data for breach of conduct has not been received by the motor fibers. After 6 months of starting hormone replacement therapy data for violation of the sensory and motor fibers had been received from 14 of 20 patients. 6 noted the positive dynamics of electroneuromyography. The lateralization of the severity of the lesions of the nerve fibers depended on the leading arm. Thus, the decrease in the amplitude of the sensory potential of the median was more pronounced in the right, leading arm. For the ulnar nerve, this dependence of the lateralization of the lesion was not detected.

With this stimulus electroneuromyography been identified primary lesion of nerves and clarify the role of the effect of hormone replacement therapy on the development of neuropathies.

The dental examination of 3329 (1760 men and 1569 women) adults aged from 18 up to 102 years living in the cities and rural areas of the Southern Federal District of the Russian Federation was carried out. Taking into account age (young, average, elderly, senile, long-livers), a floor and the place of residence indicators of security and needs in the dentoprosthetic help are studied, and also the frequency of occurrence of functional pathology of the chewing apparatus is determined. It is established that with age needs in a denture it isn’t dependent on a floor and the place of residence it is enlarged. Among living in rural areas larger needs in the orthopedic dental help during all age periods became perceptible that it is bound to remoteness of the treatment and prevention facilities giving dentoprosthetic help from places accommodation of residents of the village. Security with dentures was higher at residents of the cities. Duration of use of dentures at residents and the village made from 6 months to 15 years. At the same time, at residents of the cities of full-fledged dentures whom they use, more, than at residents of the village. Inferiority of the replacing dental designs was bound to their functional and esthetic inferiority, and also the increased wear or their defects. Dentures on artificial legs were taped only residents in 2,1–6,5% of cases that demands organizational measures for approach of modern methods of after treatment of the chewing apparatus to inhabitants of rural areas. In all age groups, it isn’t dependent on the place of residence, there was a high frequency of functional pathology of the chewing device.

Chromosomal aberrations analysis was performed in peripheral blood lymphocytes of the two groups of Siberian Chemical plant employers – sublimation factory staff and the administration. Chromosomal aberrations frequency (7,24±0,048 per 100 cells) in the sublimation factory staff were significantly (р<0,001) increased relative to the administration group (1,29±0,66 per 100 cells) mainly because increasing of single fragments. This type of chromosomal aberrations in staff was 6,4±0,41 per 100 cells vs. 1±0,52 in the administration group (p<0,001). The rates of chromatid and chromosome types of chromosomal aberrations were comprised. The high level of chromosomal aberrations in the sublimation factory staff indicate to mutagenicity of occupational factors of the factory. Low level of chromosome type of chromosomal aberrations indicate an absence of important radiation exposure. Bias of the chromatid type of chromosomal aberrations allows proposing of the leading role of non-radiation factors in the formation of genotoxic effects in the sublimation factory staff. It draws attention to issues of chemical safety of the enterprise. These results suggest the need for regular cytogenetic monitoring at the Siberian Chemical Plant, even under favorable radiological situation.

It was considered the influence of severity of lung injury on the course of traumatic disease in combined trauma of the chest. It is established that the extensive damage to the lung parenchyma make the greatest contribution to the course and the outcome of traumatic disease in combined injuries of the chest with lung injury. Such damage prevent normal gas exchange, leading to disturbances in the system of transport of blood gases and, as a result, hypoxemia, acute respiratory failure of different degree, as well as to the development of systemic inflammatory response syndrome. These violations occur in patients with extensive lung injury as early as within acute period of traumatic disease, and in the second and third periods are the most pronounced. This group of patients is characterized by a high incidence of visceral and generalized bronchopulmonary infectious complications, higher mortality. The pulmonary complications and sepsis are the main cause of lethal outcomes in patients with extensive lung injury. At the same time, the course of traumatic disease in its clinical manifestations, the dynamics of the severity of the condition, complications and outcomes in patients with limited lung injury is the same as in patients with Multisystem injuries of the chest without injury of the lungs. Thus, one of the main factors that have influence on the course of traumatic disease, the incidence of visceral and generalized complications, and mortality in patients with closed injury of the chest, is the volume of damaged lung parenchyma (that is, its extent), or the severity of lung injury.

One of possible ways of overcoming a takhifilaksiya to antiangiogenic medicines at patients with a neovascular age makulyar degeneration is medicine change. The short-term assessment of efficiency of change of antiangiogenic medicine in actual practice was a research objective. Two groups of examinees with a neovascular age makulyarny degeneration and indications to the 6 th injection of inhibitor of angiogenesis are created. In the first group (7 patients, 9 eyes) carried out intravitrealny introduction of an aflibercept at an interval of a month, in the second group (8 patients, 8 eyes) – each 2 months. Estimated visual acuity according to tables of Early Treatment Diabetic Retinopathy Study, thickness of the central retina according to an optical coherent tomography. At patients of the first group in 1 month after the 2 nd intravitrealny introduction of an aflibercept visual acuity significantly hasn’t changed: increase according to tables of ETDRS has made 1±6 signs. Thickness of the central retina opposite has authentically decreased (p<0,05) by 137±223 microns. At patients of the second group in 1 month after the 2nd intravitrealny introduction of an aflibercept of significant changes of visual acuity according to tables of Early Treatment Diabetic Retinopathy Study hasn’t occurred (p>0,05). Unlike the first group of reliable reduction of thickness of the central retina it is noted, average decrease has made 24±82 microns (p>0,05). Thus change of medicine for antiangiogenic therapy doesn’t give increase in visual functions. At the same time, monthly introduction of an aflibercept leads to significant decrease in thickness of the central retina and provides significantly the best anatomic result, than introduction at an interval of two months that can affect visual acuity maintenance duration in the long term.

With 60 lower limbs of adults studied angioarchitectonics of the dorsalis pedis artery and its main branches. We distinguished 3 variants of the dorsalis pedis artery angioarchitectonics – straight, with the medial and lateral bends. Moreover, for each of them can be characterized by specific topographo-anatomical relationships of their branches to the bones and joints of the foot. It was proved that the location of the dorsalis pedis artery trunk influence on the levels of it divergence and the amount of its branches. The morphometrical study shows a wide range of differences between the minimal and maximal values of the internal diameters of both the dorsalis pedis artery and its main branches. The average values of cured inner diameters of arteries were indicated. Grossly visible anastomoses between the branches of the dorsalis pedis artery are normally absent except for the well pronounced anastomosis revealed only between plantar branch of the dorsalis pedis artery and the lateral plantar artery.

Modern vascular prostheses are prone to thrombosis and infections. Effective anticoagulant antibacterial therapy approaches and the development of other prostheses materials are very relevant today. In this context, prostheses from the decellularized vessel and bioresorbable material, polylactide for example, are of great interest due to the high probability of endogenous endothelization induced by the extracellular protein matrix, followed by the formation of the autogenic matrix of the vessel. Such blood vessels are characterized by atrombogenicity, porosity of the structure, prone to integration with the vascular wall of the recipient, endothelization, matrix and vessel formation. We would like to emphasize that such prostheses are capable of growth and are suitable not only for adults, but also for children with cardiovascular defects. However, our study of these prostheses in the dynamics of the posttransplantation period did not match the expected results: the prosthesis from the decellularized aorta turned out to be unsuitable within the first month after transplantation. The prosthesis from the bioresorbable material didn’t cause complications but conceal the risk of spontaneous insolvency caused by predetermined bioresorption and postponement formation of extracellular matrix. We assumed that the hybrid biosynthetic prosthesis consisting of two layers: the inner one made of a bioresorbable thrombo-resistant material and the outer one – from a decellularized vessel may be the decision. The internal bioresorbable layer will remove the problems of thrombosis, the formation of an aneurysm, and the external layer from the vascular matrix will ensure the migration into the prosthesis of the cells of the precursors of endotheliocytes and myocytes.

Here we report the results of comparative analysis of the heart rate variability of cadets of the educational institution of the Ministry of the Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters of 1st and 5th courses which entered in 2011 and in 2016. It is established, that all cadets have the prevalence of parasympathetic part of the autonomic nervous system in modulation of the heart rate. There are no significant differences between main parameters of the heart rate variability in cadets entered in 2011 and in 2016. Thus, the total spectra power of the of heart rate variability was 6854±1708 and 6885±1712 ms2/Hz, the ratios of lowand high-frequency components were 0,6±0,2 and 0,67±0,22 сonventional units, parasympathetic reactivity indexes of the autonomic nervous system (coefficient 30/15) were 1,4±0,07 and 1,5±0,08 сonventional units, respectively. After 5 years of training the graduates of 2016 (entered in 2011) had significantly improved functional state, their functional reserves were increased, and ratios of heart rate variability for professional adaptation had been formed as more effective compared with graduates of 2011 (entered in 2006). The first group has total spectra power as 8115,77±942,44 ms2/Hz, the second group – 3582,37±383,14 ms2/Hz, the ratio of lowand high-frequency components was 0,97±0,14 and 0,80±0,12 сonventional units, respectively. All of this indicates that cadets had a moderate sympathicotonia, which persisted at the level of a stable trend in the performance of the low intensity functional test (active orthostatic test). The ratios of lowand high-frequency components after the active orthostatic test were 5,0±0,75 сonventional units in group of 2016 vs. 3,28±0,59 сonventional units in group of 2011 (р<0,01). The centralization index characterizing the involvement of ergotropic mechanisms of central nervous system in maintaining homeostasis for graduates of 2011 was 3,11±0,63, and for graduates of 2016 – 5,04±0,92 (р<0,1), which showed the formation of steady processes related to professional and hyperadaptational background. The reactivity index of the parasympathetic autonomic nervous system (coefficient 30/15) in graduates of 2011 and 2016 was almost the same and equaled 1,40±0,04 and 1,41±0,05 сonventional units, respectively, and therefore did not significantly affect the heart rate variability.

A brief description of the specifics of the military professional activities of submariners of the Navy is given. Destructive factors that negatively affect the mental and physical performance of submariners are indicated. The necessity of using the means of on-board dispensary for restoring the disturbed functions of the organism is substantiated. The possibilities of maintaining the physical and professional performance of seamen-submariners in a long campaign by means of water training, which include the use of functional components of the dispensary, based on the methodological principles of physical training. The following principles of hydrofitness are formulated: aerobic orientation, psychological toning simulation, naturalness of movements, breathing exercises, attention orientation, two-way action, water pressure, symmetrical counteraction, alignment. It was revealed that the use of power exercises in the conditions of the swimming pool of the dispensary helps maintain the physical performance of the officer-operators in long-term autonomous navigation at the proper level. The results of study characterizing the differences in the changes in the psychophysiological parameters of the experimental and control groups under test are presented. It is established that under the influence of hydrodynamic exercises, the subjects of experimental group experienced significant positive shifts in the studied psychophysiological parameters. The examined control group revealed regressive dynamics of mental and physical performance.

Pulmonary contusion presents the most common, but highly controversial chest injury when diagnosed; however, the data on pulmonary contusion rate found in Russian and foreign literature is rather scarce. Pulmonary contusion rate was stated to be 30,6% among casualties with associated mechanical traumas, and 50,6% for associated chest trauma. In its turn it was 4,3% for ballistic injuries, whereas the rate amounted up to 15,7% for injuries with the leading chest trauma. It should be stressed that chest ballistic injuries accompanied by pulmonary contusion when compared with mechanical traumas were characterized by more massive lung parenchyma damage, and the proportion of extensive pulmonary contusion reached 66,1%. Among ballistic injuries with pulmonary contusion blast trauma constituted 15,4%, fragment wounds – 32%, bullet wounds – 52,6%. The group of blast trauma casualties with pulmonary contusion appeared to demonstrate the most severe condition. This group was characterized by high complication rate (56,5%) and lethal outcomes (65,2%). The injury severity, however, was determined mainly by extrathoracic injuries, chest trauma being leading only in 17,4% of cases, and the proportion of extensive pulmonary contusion reached 44,6%. The group of pulmonary contusion casualties with associated fragment wounds when compared with blast wounds, were characterized by the decrease in total rate of injury severity and the increase in chest trauma severity, the chest being the leading damage area in 45,1% of cases. Chest injuries were penetrating in 90% of cases, being characterized by the significant increase in hemopneumothorax rate (by 5 times) and continuing intrapleural hemorrhage (by 4 times). The complication rate reached 66,6%, the proportion of pulmonary complications constituted 25,5%, the lethality rate was noted to decrease down to 25,5%. Pulmonary contusion associated with bullet wounds proved to be the most severe. It was significantly characterized by higher score according to the unbiased chest trauma diagnosis scale «Military field surgery – lung contusion» – 20,1±3,1, and by chest trauma severity score according to the scale «Military field surgery – injury gunshot wounds» – 5,8±0,6. The proportion of extensive pulmonary contusion in pleuropulmonary complications is 37,2%, the lethality rate increased up to 32,1%.

Relevance of the available threats of emergency situations of social character – acts of terrorism is defined. Scenario modeling of terrorist attack is carried out. The scientific base of a research of the medical and evacuation characteristic struck at mine and explosive and fire lesions is defined. The analysis of normative legal documents of the Russian Federation the defining place and a role of federal executive authorities in national security issues – counteraction to terrorism is submitted. The role of the Armed forces of the Russian Federation in counteraction to terrorism is defined and unique experience of activity of its health service is analyzed. It is shown that unique experience of health service is based not only as a result of medical support of troops (forces) and the population at elimination of medical and sanitary consequences of acts of terrorism and counter-terrorist operations, but also when carrying out peacekeeping operations and operations on fight against the international terrorism, and also at mitigation of consequences of emergency situations on explosive objects. It is defined that the most probable scenario of terrorist attack is, so-called, «The Parisian and (or) Izmir scenario». Studying of the medical and evacuation characteristic of sanitary losses as a result of scenario model of act of terrorism was based on standard results of influence of explosives with formation of gunshot and mine and explosive wounds. Scientific search is run and the task of determination of the most significant results on the movement struck to outcomes and duration of their treatment in medical military units (divisions) and the military-medical organizations with definition of characteristics of lesions was solved. As the instrument of definition of indicators of the medical and evacuation characteristic of wounded and patients, and also assessment of their influence the method of the medico-statistical analysis with use of the discriminant analysis and the analysis of survival with creation of linear discriminant functions and models of function of departure (extract) or Kaplan and Maier’s model served. The discriminant model with including of the factors which are significantly influencing the result of treatment with definition of the remote forecast struck at act of terrorism is developed and the model of duration of stay in medical military units (divisions) and the military-medical organizations is constructed. The received results of the medical and evacuation characteristic the struck and revealed factors which are significantly influencing an outcome and duration of their treatment are defined as basic of an object of the «model struck in emergency», basic for formation.

The current regulatory and legal framework for the Ministry of Health and the Ministry of Defense of the Russian Federation for regulating the provision of medical care to servicemen suffering from chronic infectious diseases (chronic viral hepatitis and infection caused by the human immunodeficiency virus) are considered. The problems of information support of rendering medical aid to servicemen of this category is estimated. The developed methodology and draft normative document of the collection of medical information’ organizing in the register of infectious pathology and servicemen infected with the infection caused by the human immunodeficiency virus are presented, and a provision on this register is developed. The content, volume and algorithm of creation of the information-analytical system of the register of infectious pathology and of the servicemen infected with the human immunodeficiency virus have been substantiated, as well as the need to introduce new technologies of medical document circulation into the medical service of the Armed Forces of Russia on the basis of personified accounting of servicemen and medical and psychological assistance rendered to them. It is shown that for the well-functioning of the register within the framework of an informed list of tasks, the high-speed secure communication channels between the participating military units, institutions and management bodies of the medical service will be required. Consequently, the improvement of the information support system for the management of the medical supply of troops in peacetime and wartime is an important component of improving the management of medical care for military personnel.

The statistical data on the account of the cases of injuries of the inhabitants of St. Petersburg during the attack of animals in 2010–2012 (before the implementation of measures to modernize Russian health) and 2012–2014 (after their implementation). For the study, cases of human trauma caused by aggressive behavior of animals registered in the departments of Federal Service for Supervision of Consumer Rights Protection and Human Welfare (indicators of monitoring and information bulletins, as well as information on the effectiveness of the measures taken to prevent infections) in St. Petersburg were used for the study. Observations were included both with a safe clinical outcome of this type of trauma, and in cases of verification of infectious complications. It is established that bites of animals of the city’s residents are observed often. Among cases of bitten a high proportion of wounds is noted in children. Despite the fact of bites (mostly by unknown dogs), in every fifth case, victims (even when warning of the danger of these injuries) refuse from rabies vaccination, and half of the victims who seek medical help refuse vaccination against rabies. The latter represents a particular threat inherent in this type of damage, since at present no treatment for this disease has been developed. Information on the frequency and characteristics of the provision of medical care to people affected by the attack of animals, it is advisable to consider systematically, using interdisciplinary approaches. A purposeful study of medical support for people who have been attacked by animals, development and implementation of algorithms for carrying out the affected medical and diagnostic activities in the format of a unified system of medical care is a task whose solution is relevant for medical science and practice.

The general characteristic chemokines as is given the fibers participating in various immunophysiological and immunopathological processes. Features of their secretion, interaction with profile receptors, expression immunologic competence cages are reflected. The priority principle of interaction chemokines with corresponding receptors, and also prevalence concrete cytokines for development of the immune answer either on Thl, or on a Th2-way is shown. Chemokines besides maintenance of migration of leukocytes regulate angiogenesis, stimulate an exit of haemopoetic predecessors in ischemia sites, and also regulate development and prolipheration B-lymphocytes. The metabolism of chemokines is closely connected with matrix metalloproteinase which carry out proteolysis chemokines, change transit of leukocytes. They are capable as to inactivate chemokines, and to split them, promoting occurrence of the antagonists connecting a receptor without carrying out of a signal.

Along with general characteristics of chemokines, features of participation chemokines in development antibacterial and antiviral immune answers are described. It is established that a number chemokines, operating through concrete receptors, provide angiogenesis tumours, promote progressing of tumoral process both direct, and the mediated mechanisms. Some chemokines, are necessary for metastasizing for a tumour, providing distribution of tumoral cages to bodies, where expression for them corresponding receptors. And others chemokines, produced, in particular fibroblastes, stimulate a survival and growth of neoplastic cages paracrine with a way. The special role lipoprotein is shown low density in an induction lisso and endotheliocyte by cages macrophage chemotaksis a protein, interleukin-8, fractalkine in processes aterogenesis.

The results of the analysis of domestic and foreign literature devoted to the problems of diagnosis and treatment of breast cancer among female personnel are presented. It has been established that female servicemen have a tendency to increase the incidence of breast cancer. Possible differences in risk factors for breast cancer between military personnel and civilian women and the possibility of preventing breast cancer among female personnel are discussed. Despite the progress made in the diagnosis of breast cancer, the percentage of tumors released during initial treatment remains high. A high percentage of neglected forms of breast cancer among newly diagnosed tumors testifies not only to the formal nature of the on-site medical examination, but also to the insufficient oncological alertness of doctors and the low sanitary culture of servicemen. The need for screening breast cancer among female soldiers is grounded. The need to improve the system of providing assistance to female personnel suffering from breast cancer, providing early diagnosis, timely comprehensive treatment and dynamic observation. The creation of a single cancer registry of the Ministry of Defense of the Russian Federation is proposed. The necessity of introduction of uniform standards of diagnostics, treatment and prophylaxis of breast cancer for military health organizations is substantiated.

Hospitalized patients are at higher risk of ischemic stroke than in the general population in the population. Inhospital ischemic stroke is one of the most serious complications developing in the hospital, and it is associated with a greater number of adverse outcomes compared with community-acquired stroke. According to the literature, there are several reasons for this fact. The most common pathogenic subtype of in-hospital ischemic stroke is cardioembolic subtype, characterized by extensive ischemic damage to brain tissue. Approximately 50% of hospitalized patients have proven the fact of cardiac embolic source. Also in-patients are characterized by the greater comorbidity and a higher risk of somatic diseases, which also have an adverse effect on the course of a stroke. And finally, in-hospital stroke is characterized by delays at all stages of urgent medical care compared to patients admitted to hospital with a diagnosis of stroke urgently through the emergency department. The most common reasons for these delays include the obvious difficulties of clinical diagnostics, the complexity of in-hospital logistics, lack of early recognition of stroke symptoms skills and lack of understanding of the paradigm of «time-to-brain» in choosing of the treatment strategy by physicians with other medical specialties. Lost time, in addition to the existing contraindications for thrombolytic therapy system, is the main reason for the low number of procedures thrombolysis in patients with in-hospital stroke. As a consequence, the treatment of patients with in-hospital stroke requires more economic cost. These patients have longer periods of hospitalization, and after discharge they often require the continuation of treatment in rehabilitation centers and social support measures. Researchers agree that improvement of the quality of care for patients with in-hospital stroke requires designing of special protocols on the similarity of those that are designed to assist patients urgently admitted with a diagnosis of stroke, as well as holding regular sessions with staff on the practicing of hospitals stroke diagnostic skills and the course of action of medical personnel in case of stroke.

The literature overview of the incidence rate on urolithiasis in the Russian Federation and, in particular, in population of some regions over the past 15 years is provided. We analyzed treatment methods for patients with calculi of kidneys, ureters and bladder, due to the current clinical possibilities. The article involves the discussion about the problems of implementation of modern minimally invasive methods as specialized medical care for patients with urolithiasis. We have compared the results of foreign investigations upon the clinical and economical effectiveness of medical technologies for that disease. While studying a database of domestic and foreign authors we have discovered the shortage of publications with the analysis of medico-economic arguments for minimally invasive technologies in urology. Given the high rate of development of urology as a clinical discipline, we find it expedient to properly estimate expenses and profitableness while using modern technologies in routine practice of medical institutions in Russian Federation. Heads of medical institutions in Russia note an insufficient amount of knowledge in the field of medical and economic analysis of the use of endoscopic techniques for kidney stones and ureters. When choosing the optimal method of intervention, specialists, mainly, turn to the questions of clinical effectiveness, rather than to the calculation of costs. Comparative analysis of the medical and economic substantiation of the methods of treatment of patients with urolithiasis in Russia has not yet been conducted. It is worthwhile to estimate not only the direct costs of performing surgical intervention and hospitalization of the patient, but also indirect costs: the costs of his outpatient treatment during rehabilitation, the lost profit of the enterprise where the patient is employed, etc. Generally, we have concluded that it is necessary to develop a system of economic evaluation of new medical technologies in treatment of urolithiasis which would help to efficiently use the foreign experience.

This review aims at basic etiological factors of occupational rhinitis and various reactions on them. The basic occupational allergens are characterized. Occupational allergic rhinitis is a widespread disease triggered by negative impacts of the work environment. According to the experts’ estimates, it affects no less than 15% of active population. However, it is supposed that the disease rate is higher for most patients prefer not to seek medical care, fearing to lose their jobs. The article provides a contemporary classification of rhinitis caused by occupational environment. Potential pathogenic mechanisms of the development of occupational rhinitis are reflected. The research defines IgE-dependent and non-IgE dependent occupational rhinitis. Nonallergic, irritant induced, occupational rhinitis is widely investigated, specifically, it’s most characteristic form – reactive upper airways dysfunction syndrome – caused by a single exposure to a highly concentrated irritant matter, such as gas, vapor, or smoke. The methods of diagnosing occupational rhinitis are observed according to their diagnostic value. Nasal provocative test is thoroughly described as a gold standard of occupational rhinitis diagnosis. The article introduces algorithms for diagnosis of rhinitis caused by occupational impacts. In addition, it discusses the issues of primary and secondary preventive measures against occupational rhinitis. The article provides an evaluation of working efficiency and social behavior of a diseased one according to the character, external evidence, speed of the pathologic process development, extent of the functional compensation, regress probability of pathologic changes after the removal of the contact with harmful occupational factor. Different ways to solve the issues of working efficiency are suggested.

Surgery that involves complete removal of the tumor remains the only method which gives hope for cure of the patient, despite the significant number of combined and complex treatment methods of this disease. However, many provisions of this concept have changed drastically. It is shown that most authors today recommend after resection of the stomach to restore, if possible, the natural anatomical relationship, which provides the best functional results. At the same time noted that some researchers prefer the second method Billroth, some of them are staunch opponents of resection of the stomach according to the method Billroth-I in cancer. This opinion is based on the assumption that resection of the stomach according to the second embodiment Billroth better allows radicalism in the treatment of malignant neoplasms of this localization. The main constraint to the use of the most physiological surgery is the conventional wisdom about supposedly her cancer nerdycellist. The author substantiates the position that the intervention in the modification operations according to the method Billroth-I does not increase the number of postoperative complications, no differences in long-term results of surgical treatment of gastric cancer for two methods of reconstruction of digestive tract continuity after Subtotal distal resection. At the same time, the quality of life of patients better after the reconstruction of the digestive tract with gastroduodenal anastomosis. Exploring the indications for distal Subtotal gastrectomy according to the method Billroth-I, the majority of authors deem this method of restoring continuity of the gastro-intestinal tract only when early cancer, exophytic forms (I – II stage), located in the angle of the stomach or lower third of his body, and the absence of metastases in regional lymph nodes.

The historical Parallels between the events that took place at the Military medical аcademy in the period of change of social system in the country. The role and achievements were at that time leaders in the preservation and development of the institution. Their example clearly shown the role of personality in critical national periods. Despite the difficult political developments in the last century, Military medical аcademy not only retained its vitality, but also rapidly increased the pace of its development in all directions. Historical parallels convincingly showed that in the last century, when the socio-economic formations in our country changed, the Military medical аcademy not only maintained its vitality, but rapidly recovered from the upheavals, increased its development rates in all directions. This was an invaluable merit of those who led it. It was distinguished scholars, theorists, and clinicians, with the highest moral qualities, humanists, has a tremendous organizational skills. V.A. Yurevich, V.A. Oppel, M.D. Il’in, V.N. Tonkov, Yu. L. Shevchenko occupy a particularly important place in the history of the Academy. Their management of аcademy took place at crucial periods of the existence of our country. They managed not only to preserve this unique military medical facility, but to bring it to a new, higher level of development. Pafos, with whom the anniversary of the Academy was celebrated, became a recognition of its unprecedented contribution to the formation and development of medical science and education in our country. On December 17, 1998, the President of the Russian Federation issued a decree «On the Inclusion of the Military Medical Academy in the State Register of Highly Valuable Objects of the Cultural Heritage of the Peoples of the Russian Federation». The Decree was signed by the President of the Russian Federation B. Yeltsin.

Monograph by A.A. Mikhailenko, M.M. Odinaka, N.N. Yakhno “History of Russian neurology. Moscow Neurological School" (St. Petersburg: SpetsLit, 2015. - 511 p.) consists of a preface, eight chapters and an afterword. Already in the preface, the authors indicate that the monograph is presented not in the form of a detailed description of all types of activities of departmental groups, but in the form of essays, that is, the most important, remarkable and significant information and facts.

The main milestones of life and creative path of one of the heads of scientific school of aviation and space medicine Vasily Ilyich Kopanev – doctor of medical sciences, professor, Honored Scientist of Russian Soviet Federative Socialist Republic, Major-General of Medical Service are presented. Professor Kopanev V.I. is widely known with his investigations of psychophysiological specifics of flight specialists work, searchings of the ways to correct organism functional. Explored the dynamics of the parameters of the vestibular analyzer under the action of Coriolis acceleration. Priority developments of issues of vestibular stability, hidden forms of motion sickness of pilots and cosmonauts belong to V.I. Kopanev. V.I. Kopanev was the highly qualified pedagogue and organisator. He owns the important role in forming of structure-logical teaching scheme the academy’s aviation doctors, preparation of the list of practical skills and abilities, that are subject to obligatory working off in teaching lessons. Under his leadership the department of aviation and cosmic medicine became profile for the faculty of training doctors for the air force. In the education work he was paying a lot of attention to practical orientation of teaching and to the the improvement of the department laboratory base in accordance with the requirements of the everyday professional activities of aviation doctors. Under his leadership was made training base reconstruction of with the following creation of the thematic classrooms.

May 20, 2017 marked the 60th anniversary of the birth of colonel of the medical service in reserve, senior researcher in the research department (medical and psychological support) of the research center, doctor of psychological sciences and candidate of medical sciences, Professor Vladimir Aleksandrovich Korzunin.