Vol 20, No 3 (2018)

Currently, it is possible to improve the outcome of the treatment of gastroduodenal ulcer bleeding by reducing the mortality, primarily in patients with a persistent high risk of rebleeding against the background of the conservative treatment and high operational risk. Unacceptably high postoperative mortality in high-risk surgical patients reaching 60%, often forces the surgeons to use the conservative treatment for these patients, which often leads to rebleeding, open surgery despite the high risk and unsatisfactory outcome of the treatment. A minimally invasive technique such as transcatheter embolization of the gastric and duodenal arteries in gastrointestinal ulcer bleeding, allowing to affect the source of bleeding by endovascularization with a minimal surgical trauma, made it possible to achieve hemostasis in 60 of 61 patients (98%). Rebleeding after arterial embolization occurred in 3 patients (5%). In 51 patients (85%), endovascular hemostasis was permanent. Additionally, 6 patients (10%) underwent delayed surgery at different times after arterial embolization. Overall mortality in high-risk surgical patients was 9.2% and was not related to arterial embolization, which compares this data favorably with many literary sources. With its impact, arterial embolization with an adhesive composite based on N-butyl-2-cyanoacrylate is an alternative to the surgical treatment of gastroduodenal ulcer bleeding and an operation of choice for high-risk surgical patients.

38 patients with newly diagnosed tuberculosis, immediately after the end of the main course of treatment, when they were transferred to the third group of dispensary supervision (6-9 months) and when they were removed from the dispensary supervision (2-3 years later), a skin test with an allergen tuberculous recombinant was made. The positive skin test with tuberculosis recombinant allergen was defined at 20 patients - 13 mm. At the moment of removing to the III group only one skin test with tuberculosis allergen recombinant became negative, 19 (94,5%) patients had positive reactions - 13±2,3 mm. At the time of discharging from dispensary the positive reactions were determined at 16 (80%) cases - 10±2,3 mm, p<0,05. In this group, 13 (65%) patients had normergic skin tests with tuberculosis allergen recombinant and 7 (35%) - hyperergic tests. At the time of removing to the III group at five from seven patients with hyperergic tests the results remained the same, median and at the moment of discharging from tuberculosis service only one patient had the hyperergic skin test with tuberculosis allergen recombinant - 18mm. Among patients with normergic skin tests with tuberculosis allergen recombinant at the time of group III removing median was 11±2,1 mm. At the last dynamic control the normergic results were determined at 15 (75%) patients and the tests median remained almost unchanged - 10±1,8 mm, the differences are reliable compared to the initial data (p<0,05). In group which included 18 patients with negative skin tests with tuberculous allergen recombinant, the skin response stayed negative throughout all examination period except for one patient so patients of this group had not only clinical, radiological and bacteriological, but immunological signs of involution of the tuberculosis process. The study of the influence of clinical, epidemic and social factors to skin reaction showed that first group patients were significantly more likely to be unemployed (30% versus 5,5%; p<0,05) whereas in second group married patients were reliably registered (61,1% versus 25%; p<0,05). Other factors differed unreliably.

In accordance with the existing Federal sanitary standards, noise and infrasound are considered to be an harmful production factor and in terms of their prevalence they occupy a leading place in the national economy. To prevent the harmful effects of noise and infrasound on the health of members of the armed forces establishes the main lines. For prognostic assessment of harmful influence of production factors on production facilities and transport the special assessment of working conditions is carried out without fail. Hygienic research of workplaces has shown that noise and infra-sound levels correspond to harmful and dangerous classes, that is, risks of professional pathology of acoustic Genesis are created. The presence of acoustic sources in the Armed forces requires constant monitoring of them, the annual special assessment of working conditions development of preventive measures. The impact of noise and infra-sound leads to a decrease in military and professional performance and an increase in General and professional morbidity. The leading place in the structure of morbidity of noise etiology is a sensorineural hearing loss. This requires further improvement of the provision of specialized assistance to military personnel in the presence of noise hearing loss. In the current regulations of the military medical services noise and infrasound are not identified as a harmful factor, and therefore not fully developed the issues of professional selection, monitoring and medical examination of noise pathology. An important place in the system of prevention of harmful effects of noise is given to the means especially individual of protection against noise. Their absence and low efficiency pose a threat to the acoustic safety of military personnel. Provision of personnel with means of individual protection against noise and control of the correctness of their operation are the most relevant measures to reduce the noise pathology of the hearing organ. The existing system of measures to combat the harmful effects of noise in the Armed forces requires revision in accordance with the existing state legislative and legal framework.

The relation between heliogeophysical factors and the osmotic pressure of blood plasma in patients with arterial hypertension with different temperaments is analyzed. It is found that with increasing solar activity (Wolf numbers and radio flux wavelength 10,7 cm), is closely related increase in atmospheric pressure, air temperature and γ-background (within normal limits) in the workplace examinees. It was revealed that in choleric and sanguine patients there is a reliable high inverse correlation relationship between heliogeophysical, meteorological factors and total peripheral vascular resistance, while the phlegmatic and melancholic - the average direct and direct high correlation relationship. Antihypertensive therapy with diuretics with increased solar activity, combined with an increase in the atmospheric pressure, γ-background and the air temperature in the workplace, due a decrease in total peripheral vascular resistance at the choleric and sanguine and increase in total peripheral vascular resistance in healthy individuals and phlegmatic patients and melancholic. The presence of significant and reverse correlation relationship between the total peripheral vascular resistance and osmotic pressure of blood plasma in choleric and sanguine and significant, but a direct correlation - the phlegmatic and melancholic indicates the inclusion of an adaptive process various physiological mechanisms, which determines the need to consider the temperament at solar biospheric relations bonds.

The results of the dynamics of speech and other cognitive functions restoration in all periods of ischemic stroke have been established. In the study of speech functions, the motor form of aphasia was more often diagnosed (in 59,1% of cases). In the acute period of ischemic stroke in 80% of cases, speech disorders of severe severity were detected. It was statistically proved that the motor component of speech recovered faster than the touch one. For example, all patients, suffering from sensory aphasia the earlier rehabilitation period ischemic stroke, a volume of understanding speeches sufficiently limited. Parognosia was diagnosed with 50% of patients, in 25% of cases, a violation of phonemic hearing was reviled. At follow-up study there is a positive dynamic in the form of restoration of the impressive component of speech, 75% of patients relatively freely understand human speech. At an in the acute period of ischemic stroke spontaneous speech is changed (lateral and verbal paraphasia is diagnosed in all patients). Polyphasia phenomena had been diagnosed with 50% of patients. Repetitive and dialogue form of speech highly limited. In a late period, polyphasia had been diagnosed with 25% examined. Improvement in the form of a decrease in the number of literal and verbal paraphases was reviled with 75% of patients. 80% of patients were able to dialogue form of speech. In general dynamics of indicators of the degree of speech recovery in women is slightly higher than in men, and does not depend on the age of patients. It was revealed that the most effective speech was restored in the first year after the acute cerebrovascular accident. The restoration of the impressive component of speech was faster in all forms of aphasia. A high level of quality of life was noted in patients with baseline less impaired mobility (an index of Riverbed, Rs=0,68; p=0,01) and less dependent on others (Barthel index, Rs=0,43; p=0,003). Prognostically unfavourable facts for speech restoration include the area of ischemic focus more than 0,8 cm. When assessing cognitive functions in the residual period, 85% of patients were diagnosed with moderate disorders, 15% of patients were diagnosed with mild cognitive impairment. The obtained data substantiate the need to optimize speech therapy assistance in all periods of ischemic stroke.

Рresents information on the level of dental care for the urban and rural population of the Southern FederalDistrict of the Russian Federation, which were obtained based on dental examination data of 3658 adults (1524 men and2134 women) of young and middle-aged (from 21 to 59 years) city and countryside. It was established that urban residentshad significantly lesser untreated carious lesions, including caries of the filled tooth, and removed teeth that were not restoredwith dentures. The main causes of tooth loss, regardless of sex and place of residence, were complicated caries (periodontitis)and periodontal pathology (periodontitis heavier). In men and women living in the city, the intensity of the carious processwas 11,54±0,82 and 9,14±0,67, respectively; while those living in rural areas, respectively, 12,26±0,64 and 11,44±0,68. Thelevel of dental care varied significantly depending on the place of residence and, regardless of gender, the urban populationwas characterized as satisfactory (the index of the level of dental care for men is 53,47%; for women is 60,5%), and ruralresidents as insufficient (the index of the level of dental care for men is 39,07%; for women is 40,12%). The need to improvethe material and technical base of state (municipal) medical and preventive institutions providing dental care to rural residents,as well as the resumption of the work of dental mobile teams or mobile dental offices, based at the regional, regional anddistrict hospitals. It was noted that industrial and agricultural enterprises can help the dental health of villagers greatly byorganizing dental offices with their medical-sanitary units and medical centers.

Morphological substantiation of the clinical efficacy of platelets rich plasma was carried out in the treatment of 22 men with androgenetic alopecia from the 1st to the 4th stage according to the Norwood-Hamilton scale were included. All patients received intradermal injections of platelets rich plasma 0,15 ml per injection. The course of treatment consisted of 4 procedures with an interval of 4 weeks. Clinical efficacy was assessed by the dynamics of morphometric indices of hair growth. Histological examination was carried out on horizontal sections, stained with hematoxylin and eosin, the morphology of the hair was counted at four levels. Evaluation of morphometric growth parameters conducted before treatment and 4 months after the onset of it. It was established that the therapy of platelet-rich plasma has a pronounced clinical efficacy, consisting in a significant (p=0,00025) increase in hair density by 11% and average hair diameter by 10% (p=0,00766), a 14% decrease in the share of hair follicles (p=0,00959). Histologically, the increase in hair density was significant at the level of the bulb of the hair follicles by 148% (p=0,0034) and at the level of the sweat glands by 65% (p=0,0326), and also by the tendency to increase their number at the level of the sebaceous glands. This was combined with a significant decrease in the proportion of telogen hair at 47% (p=0,0153). Thus, the positive clinical effect of plasma-rich plasma therapy in men suffering from androgenetic alopecia is based on reliable morphofunctional changes in the hair follicles.

Data on optimization of tactics of treatment of victims with deep facial burns in 314 patients (194 men and120 women) aged 18-60 years are presented. All patients were treated in the clinic of thermal lesions of the Military medicalAcademy S.M. Kirov in the period from 1991 to 2016 the expediency of using early necrectomy for removal of the studiedcontingent of patients with mild and moderate severity. The result is a reduction in the time of hospitalization and a reductionin the number of scarring. Statistically, the duration of treatment in victims with isolated deep burns was reduced 3 times, inpatients with mild and moderate severity, with extensive thermal lesions, 1.8 times. At the same time, the obtained data indicatethat the terms of removal of the dead skin and restoration of the skin do not affect the mortality of victims with isolated deepburns of the face. In the group of severe and extremely severely burned tactics of treatment of deep burns on the face whenperforming early necrectomy in other areas of the body also has no effect on mortality. It is significant that the shortage ofdonor resources is one of the determining factors in the choice of conservative treatment tactics for this category of patientsin a significant number of observations both at the Academy and in other specialized departments of the Russian Federation.

A comparative analysis of hemogram parameters, iron metabolism, C-reactive protein, hepcidin, soluble transferrin receptor in patients with malignant neoplasms, accompanied by anaemia and without it. Patients with anaemia compared with non-anaemic patients had lower haemoglobin, erythrocyte, hematocrit, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration, iron, iron transferrin saturation, total iron-binding capacity, and higher levels C-reactive protein, hepcidin, soluble transferrin receptor (p<0,05). Negative correlations of moderate strength between hepcidin and erythrocyte levels (r=-0,41), hemoglobin (r=-0,3), hematocrit (r=-0,35), and total iron-binding capacity (r=-0,51) and transferrin (r=-0,54). In addition, negative correlations of moderate strength were revealed between the soluble transferrin receptor and hemoglobin level (r=-0,57), hematocrit (r -0,49), iron transferrin saturation (r=-0,47), mean corpuscular hemoglobin (r=-0,44), mean corpuscular volume (r=-0,39). A direct correlation of moderate strength was found between the soluble transferrin receptor and transferrin (r=0,41) and total iron-binding capacity (r=0,38), as well as between hepcidin and ferritin (r=0,61), C-reactive protein (r=0,48). In general, the development of functional iron deficiency in patients with anaemia and malignant neoplasms has been established, and the value of hepcidin and soluble transferrin receptor in the genesis of this anaemia has been confirmed.

Experimental data about the physiogeny at 603 military men and penal system officers are given in various climatic conditions of Russia, Transcaucasia (Abkhazia, Azerbaijan, Armenia, Georgia) and Afghanistan and at 604 young men entering the military university. Homeostatic ranges of physiogeny adjustment at physiogenic losses in the meridian functional systems of the military personnel, penal system officers in extreme conditions are determined by the electropuncture method. Protective adaptive reactions of eight degrees are revealed by the standardized method of personality research and by the «adaptability»” scale. Discriminant decisive rules on the reference of physiogenic losses to the 1-8th degrees of protective adaptive reactions in boundary mental conditions are applied. Decisive rules establish threshold levels of normal mental state without the loss (the 1st degree), of liminal with latent one (the2nd and 3 degrees) and borderline mental state with obvious (the 4-8th disadaptation degrees) losses. Patients with symptoms are sorted by simple calculation with the use of computer equipment at the reduction of time up to 5 min. for one patient according to eight degrees of protective adaptive reactions for acupuncture performing. Methods of the discriminant analysis are perspective for the solution of diagnostics and medical sorting problems. Reliability of establishment of the correct diagnosis of physiogeny considering physiogenic losses without resorting to other diagnostic methods makes 70-95%. Acupuncture correction of physiogenic losses activates reactions of homeostasis restoration. This physiological correction leads to the transition of physiogeny in limits of the normal mental state of the 1st degree and liminal condition of the 2nd and 3rd degrees of reactions of homeostasis restoration.

The increase in the number of patients with persistent viral infection, as well as the use of antibacterial drugs, caused the increase in the population of patients with a high risk of developing fungal diseases. In the content of paranasal sinuses, a more than half of the patients with chronic sinusitis showed fungi or fungal-microbial associations. Despite the fact that the epidemiological data in the publications of modern national and foreign researchers on fungal rhinosinusitis are rather discrepant, it is quite decisive that the prevalence of fungal sinusitis has a significant tendency to grow, especially in the last decade. The informativeness of the microscopic, microbiological, and pathomorphological studies of the surgical material with the aim of fungal balls detection. The results contents of paranasal sinuses in 148 patients who had undergone endonasal endoscopic surgical intervention. Computer tomography the maxillary sinus in 113 patients, in the sphenoidal sinus in 25 patients, in the ethmoidal sinus in 7 patients, and in the frontal sinus in 3 patients. With microscopy of native material and preparations stained with white flour white, the presence of fungi is revealed 114 and 136 patients (77 and 91,9%) correspondingly. When sowing the contents of the sinuses onto elective media its cultivation under two temperature conditions (28 and 37оС) revealed growth of filamentous fungi in 26 (17,6%) patients. Histopathological examination confirmed the clinical diagnosis of a fungal ball in 128 (86,5%) patients. The most informative method for detecting the fungal body is the microscopy of preparations stained with white flour white.

Infringements of colonial resistance of a microbiota of a skin at the elderly, suffering diseases of an ear, a throat and a nose (an otitis, a tonsilitis, a sinusitis, etc.) are considered on a background of a diabetes. To study changes in quantitative and specific indicators of deep microbiota of the skin, the method of agar prints was used. It is established that the indicators of quantitative changes are associated with a metabolic disorder and may be factors predisposing to the development of other diseases against the background of diabetes mellitus. The revealed changes in the indices of colonial resistance in patients with diabetes mellitus are of interest as adaptive characteristics of the organism in diseases of the ear, throat and nose of various etiologies, and serve as a harbinger of deviations in the clinical and physiological status of patients with diabetes mellitus. Thus, in patients with diabetes mellitus, the composition of the microbiota of the skin corresponds to that of healthy individuals of the same age. Regardless of the type and stage of diabetes mellitus, they showed an increase in the number of colony-forming units of the deep layers of the skin of the forearm, which corresponds to the dysbacteriosis of the third-degree skin. In the structure of biocenoses, in patients of the otolaryngological profile, against the background of diabetes mellitus, changes that correspond to the dysbacteriosis of the skin of the IV degree are revealed. In this category of patients, there is a pronounced secondary immunodeficiency, which is manifested by inhibition of the investigated nonspecific immunity indices, which is a predisposing factor for the onset and development of a purulent infection. It is shown that dysbiosis can manifest itself with clinical local symptoms, and then with general disorders that aggravate the course of the underlying disease and complicate treatment. An integrated approach to this problem can be used for a more differentiated assessment of the prognosis of complications in patients with an otorhinolaryngological profile against diabetes mellitus and increasing the effectiveness of therapeutic and preventive care.

Based on the analysis of the changes in the bioelectrical activity of the brain, the dynamics of cerebral blood flow and the vegetative balance of the body, the efficacy of a single 15-minute session of audiovisual stimulation for the correction of the functional state of the organism was evaluated. It was found that after the audiovisual stimulation session, the mean value of the alpha-rhythm power in the frontal, anterior-parietal and occipital leads of the right and left hemispheres of the brain was statistically significant more than in the background study. Such a change in the power of the alpha-rhythm reflects the level of ascending activation necessary for the organization of adaptive behavior, and can also characterize the intensity of the neuro-emotional stress. Increasing the power of the α-rhythm indicates a decrease in the level of nonspecific cerebral activation and is one of the main characteristics of the state of functional comfort. Statistically significant ifferences in the indices of powers of the β - and β -rhythms inherent in the state of active wakefulness were determined. The decrease1 2in the power index of the electoencephalography delta rhythm was revealed. The revealed dynamics of cerebral blood flow parameters was subject to pronounced individual differences, which made it impossible to determine the direction of the trend. It was established a gradual decrease in the power of the low-frequency component of the cardiorhythm with simultaneous increase in the contribution power of the high-frequency component, reaching a statistically significant difference at the last stage of registration, which leads to a significant decrease in the coefficient of vagosympathetic balance after the audiovisual stimulation session. The revealed changes indicate a decrease in the tone of the sympathetic part of the autonomic nervous system. Thus, it is established that after a single 15-minute audiovisual stimulation session, the value of the α-rhythm power in the frontal, anterior parietal and occipital leads of the right and left hemispheres of the brain increases, the power indices of the beta and delta rhythms of the electoencephalography decrease, the stress index and the vegetative index decrease balance, and also the coefficient of the vagosympathetic balance of the rhythmocardiogram. These changes characterize the optimization of the functional state of the organism and contribute to an accelerated restoration of working capacity.

We studied the possibility of pharmacological correction of neurological disorders in guinea pigs and rabbits with the lithium salt of disulphide of glutathione and inosine medication in experimental allergic encephalomyelitis caused by inoculation of the main myelin protein in Freund’s complete adjuvant. The intradermal test with the main protein of myelin was accomplished in all animals to confirm the autoimmune process at 21st day after sensibilization. The lithium salt of disulphide of glutathione and inosine medication was administered intramuscularly every other day at a single dose of 10 mg/kg for 5 weeks. The symptoms of experimental allergic encephalomyelitis were more pronounced in rabbits and to a lesser extent in guinea pigs. The high therapeutic efficacy of lithium salt of disulphide of glutathione and inosine was established according to the severity and incidence of neurological disorders (dysfunction of the pelvic organs, ataxia, tremor, paralysis and paresis of the limbs) and lethality rate. Early (at 5 days after sensibilization) and subsequent therapeutic use of lithium salt of disulphide of glutathione and inosine prevented the development of experimental allergic encephalomyelitis in 75% of laboratory animals, in the rest 25% of the animals the course of experimental allergic encephalomyelitis was comparatively mild. There were no lethal outcomes in study group compared with lethal outcomes in 70% of animals in control group. Experimental evidence of neuroprotective effects of lithium in brain ischemia and in neurodegenerative diseases highlights new opportunities for the use of lithium-containing drugs in clinical neurology. It has been confirmed that the lithium salt of glutathione and inosine disulfide has a moderate immunosuppressive effect, inhibiting the biosynthesis of antibodies and the delayed-type hypersensitivity reaction.

Possibilities of quality control of experimental series of a set of reagents for bacteriological studies «Selective differential diagnostic environment for the isolation of the causative agent of anthrax and closely related bacilli of the Bacillus cereus group» is justified. Findings of the investigation of growth properties of the selective medium showed typical colonial morphology of virulent strains of Bacillus anthracis (B. anthracis 81/1, B. anthracis 1(CО), B. anthracis 1193, B. anthracis И-363, B. anthracis 1283) and its vaccine strains B. anthracis CTI-1, B. anthracis Ihtiman, B. anthracis Sterne 34 F2, B. anthracis 55, B. anthracis 71/12 - II Tsenkovsky’s vaccine). The colour of the batches of selective medium and Hottinger’s agar around the Bacillus anthracis colonies was unchanged. Whereas, the colour of selective medium around colonies of closely related saprophytes of genus Bacillus discoloured to bright-yellow, allowing to differentiate colonies of anthracic micro germs and closely related microorganisms. Presence of inhibiting properties of the selective medium was confirmed using heterologous germ cultures (Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Proteus vulgaris HX-19) which showed no growth in all series of the tested medium. Meanwhile, the typical colonial morphology of strains of these microorganisms was observed on Hottinger’s agar.

Features of adaptation after psychical traumatic stress in healthy military men who performed special tasks more than half a year ago were studied. It is shown that 40% of combatants have signs of partial posttraumatic stress disorder, which evidences about negative adaptation after psychical traumatic stress. Signs of partial posttraumatic stress disorder in all manifest as neurotic disorders, and in 7,5% of combatants are associated with signs of psychotic disorders. Among the signs of neurotic disorders, the manifestations of somato-vegetative disorder were encountered in 62,5%, affective tension - in 50%, sleep disorder - in 43,8% and anxiety-phobic disorder - in 43,8%. Among the signs of psychotic disorders, there were mildly pronounced manifestations of social phobia, panic disorder and depression. Soldiers with partial posttraumatic stress disorder have a statistically significant decrease in the self-assessment quality of life in such indicators as «general health», «mental health» and «social functioning». The negative correlation between scores of life quality and signs of partial posttraumatic stress disorder pieces of evidence that namely this disorder impacts on the quality of life in combatants. Comparison of servicemen groups with and without signs of partial posttraumatic stress disorder according to the expert evaluation indicators, exhibited by the unit commanders, and according to the indicators of the operator working, did not reveal a significant difference between them. Thus signs of partial posttraumatic stress disorder in combatants decrease self-assessment life quality but do not have an effect on the professional aspect of social functioning under favourable conditions. This military personnel are needed in medical and psychological correction and rehabilitation to prevent the development of maladaptation in stressful conditions.

In our country and abroad in recent years as one of the main indicators of the status of nutrition, in addition to the body mass index, is the percentage of body fat, which can be determined by a fairly wide range of techniques. In the daily practice of a military doctor, there are often no complex and expensive devices to determine the fat component of the body, such as a widespread bioimpedance analysis of body composition. The article provides many options for determining the fat component of the body. It coliperometric facts technique (the technique of Durnin - Womersley, J. Matiegka in the modification of M. M. Dyakonov, Jackson - Pollock, Gallagher, and others) and circumferential techniques (methods, used in the naval and land forces of the United States of America, the methodology developed in the Y. M. C. A. and its modification). The results were compared with the results of bioimpedance analysis of body composition. To compare the accuracy of the coincidence of the results obtained by the methods used, the method of the mean square error of the model was used. Then the correlation analysis was carried out and regression models were built.The comparative analysis revealed the most informative methods of determining the fat component of the body, which are recommended to use in the practice of a military doctor at different levels of medical care for soldiers. Fat mass can be estimated by the percentage of fat in the body, determined using the caliper-Pollock method, in the presence of calliper- compass, or circumferential technique used in the naval forces of the United States of America.

The results of morphological studies of auxiliary elements (patella, meniscus, cruciate ligament, synovial bags) of 60 knee joints of adult corpses, 30 of which were intact (without signs of deforming arthrosis) and 30 with signs of deforming arthrosis of stages III-IV are presented. It is established that the auxiliary apparatus undergoes significant changes in the progression of deforming arthrosis. In a greater degree degenerative changes prone articular cartilage of the patella and medial condyles of the knee joint. The affected areas were characterized by thinning of the articular cartilage or its complete absence, as well as the presence of osteophytes along the edges of the articular surfaces. The measurements of the relative length, width, and thickness of the meniscus also confirmed the fact of their substantial deformation and degeneration, mainly of the medial meniscus. The posterior part of the body and the horn of the medial meniscus were most susceptible to the destruction of the cartilaginous tissue and were accompanied by the erasure and disintegration of the inner margin. Synovial membranes with deforming arthrosis were thickened, compacted and locally hyperemic, had papillary growths, which indicates the presence of synovitis and fluid accumulation not only in the joint cavity but also in synovial bags, the sizes of which were significantly increased. Intra-articular ligaments are hyperemic, and fragments are noted. Pterygoid folds are enlarged, locally hyperemic, with a vascular pattern, elongated processes are visualized along the edges. Identified morphological changes in the progression of deforming arthrosis lead to trophic and metabolic disturbances of all structures of the knee joint. The results of the study of the auxiliary elements of the knee joint can be used as a control in the diagnosis of deforming arthrosis.

Despite the positive changes in the regulation of the accordance of benefits at the federal and regional levels, this problem has not been sufficiently studied so far in the area of organizational and legal interaction between civil and military healthcare. The current order of drug supply to certain categories of citizens attached to military medical organizations results in an unjustified expenditure of resources and an increase in the burden on healthcare, which indicates the irrationality of the existing mechanisms of drug supply. In this regard, it is necessary to develop rational economic and pharmaceutical mechanisms, as a set of methods for managing and interacting the entities that determine the order of drug supply for certain categories of citizens, while optimizing the financial, information and material resources of military and civilian healthcare. Theoretical approaches to the formation of rational economic and pharmaceutical mechanisms of drug supply are presented. Rational economic and pharmaceutical mechanisms of drug supply of certain categories of citizens attached to military medical organizations have been substantiated and developed. The characteristic of integration and coordination mechanisms of interaction of military and civil health on drug supply of certain categories of citizens in a single legal space is given. As the basic mechanisms of coordination of interaction are given: information exchange; standardization; direct supervision. The results of an assessment of sound and developed rational economic and pharmaceutical mechanisms of drug supply in the areas of organizational, social and economic efficiency are presented. It is noted that the implementation of the mechanisms of drug supply in the system of preferential drug supply can contribute to the formation of a system of drug supply balanced with the available resources of the country’s population; the formation of economic and social responsibility at each level of decision-making; the optimization of transparency and controllability of financial flows; the optimization of the financial burden on the federal, regional and departmental budgets; the equal access to medicines for all categories of citizens; guaranteed drug supply to socially vulnerable groups of the population.

The results of the implementation of a three-tier system of internal quality control of medical care for children in need of rehabilitation after neuroinfections are presented. In 2015, a three-tier internal control system was developed at the clinic of the Children’s Research and Clinical Center for Infectious Diseases. The importance of introducing a new approach was determined by the severity of the patients at this clinic. The severity of the condition of children is due to the effects of neuroinfections. In addition, the quality of medical care is an essential element of improving the health care system in modern conditions. After the introduction of this system, the number of examinations carried out at the first level (heads of clinical departments) increased, at the second level (deputy chief physician for medical work and quality of medical care) decreased. The number of detected defects increased, but the quality factor of medical care turned out to be quite high and fell into the group of «insignificant deviations». The main defects are defects in filling in medical documentation and redundancy in laboratory and instrumental research. The leading position in the structure of defects is occupied by defects in filling in medical documentation with a specific weight of 32,4%. With the introduction of a new quality control system, the average length of stay of a patient in the rehabilitation department came close to the one prescribed in medical and economic standards. Revealed quite a large percentage of diagnostic studies that are not included in the medical and economic standards, that is, additional. This fact indicates the need to revise the medical and economic standards in the direction of expansion, taking into account the need. The third level of the internal control system is designed to assess the corrective actions taken as a result of audits at the first two levels of the internal control system. In general, the three-tier system has certainly improved the quality of care.

This review article examines the possibilities of surgical treatment of one of the socially significant diseases of modern society - arterial hypertension. The reasons for the development of parenchymal arterial hypertension have been disassembled. The reasons for the development of renovascular hypertension are discussed. Illuminates the pathogenesis of nephrogenic hypertension, statistical data on its prevalence. The issue of embolization of renal arteries in the treatment of nephrogenic arterial hypertension is considered. The forms of nephrogenic arterial hypertension in which the use of embolization is indicated. The etiology and pathogenesis of arterio-venous fistulas of the kidneys are described. Details of the world literature concerning the treatment of arterio-venous fistula and malformations of the kidneys are considered in detail. A review of literature data on materials used in embolisation of renal arteries in patients with arteriovenous fistula and malformations of the kidney is given. The etiology and pathogenesis of arterio-venous malformations of the kidneys are highlighted. The goal of embolization of the renal arteries in the preparation of patients with terminal renal failure and resistant arterial hypertension to kidney transplantation is described. The issue of preoperative preparation of patients before embolization of the renal arteries, the choice of operative access is considered. Methods of embolization of the renal arteries, possible complications and methods of their prevention are described. The data of the world literature concerning application of selective and superselective embolization of renal arteries in patients with parenchymal arterial hypertension are covered. The issue of potential use of renal artery embolization in other forms of nephrogenic arterial hypertension is also highlighted.

The theoretical bases of the social responsibility of business, the search for perspective directions of its development, as well as the historical aspects of the formation of the social responsibility of entrepreneurs abroad and in Russia are considered. The full characterization of external and internal directions of social responsibility is given, its multi- level character, conceptual definitions are shown. Thus, American scientists in their work on management in the United States define social responsibility as the actions of an organization that are undertaken for the benefit of society voluntarily, and not on demand. In modern Russian science, the social responsibility of business is defined as a broad concept that includes the complex responsibility of a business partner, employer, citizen and participant in social relations; as well as social responsibility implies the entrepreneur’s refusal to carry out activities that could harm society, in other words, the business should follow the principle of do no harm, and help. It is noted that in recent years in the Russian Federation the issues of social responsibility of business are considered in relation not only to large, but also to small business. It has been established that the interests of pharmacy workers today are not only in obtaining decent wages, but also in realizing goals such as job satisfaction, respect for the individual, support for education and career, etc. Long-term directions for the development of social responsibility of pharmacy organizations are formulated. A list of socially responsible labor practices is defined, the main ones being: the provision of comfortable and safe jobs; development of labor potential of employees (competence, skills, training, career growth, etc.); building of confidential relations of the employer with employees (truthful informing about the state of affairs in the organization, avoidance of deception and discrimination of employees), etc. Socially responsible labor practices can become the basis of their own social programs of employers, which will not only avoid the turnover of staff, but also attract the best specialists in the market, ensure the growth of the reputation of the organization and improve its image, which in the long run will be a promising advantage in the competition between pharmacy organizations.

An analysis of the experience of medical support of troops in the wars and military conflicts shows that their characteristic feature was and remains the constant improvement of the organizational forms of medical support for the troops aimed at optimizing the medical rehabilitation of the wounded and sick. The results of the analysis of medical support of troops during the Great Patriotic War showed that the composition and content of the sanitary minimum level for servicemen should be in constant accordance with the requirements for the level of professional training of servicemen. Organization of medical care for participants of the Great Patriotic War of 1941-1945 and the Afghan conflict of 1979-1989 in the postwar period shows that the basis of all measures to monitor the health of war participants must be a system of active personal dynamic observation. Active dynamic monitoring of the state of health using automated information systems allows to solve the problem of restoring health among participants in wars and military conflicts at the optimal level, provides medical information necessary for assessing the health status of participants in wars, determining the scope and composition of medical and recreational activities. Active invitation of the patient, who is on dispensary supervision, makes it possible to conduct a comprehensive assessment of his health status. However, the effectiveness of the system of medical control over the health of war participants largely depends on the high degree of automation of information processes in the system of dynamic control over the health of a workable and efficient resource on a national scale. The implementation of the principles of dynamic monitoring of the health of participants in wars can be carried out through the practical implementation of Decision 36 of the Plenum of the Academic Medical Council with the Chief of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation (1996). Special attention was paid to the necessity and urgency of the development and operation of an automated information system on the wounded and sick on the basis of the Military Medical Museum. At the same time, it is necessary that its electronic information module is located in the institution where the wounded and sick war veterans are kept in the hospital. At present, such an institution in the Armed Forces of the Russian Federation is an archive of military medical documents of the Russian Military Medical Museum.

Laboratory animals have been widely used in biomedical research for centuries, and there is as much debate about the validity and acceptability of it. Since ancient times there are rules and moral practices, the law fixes the responsibility for the cruel treatment of animals. Currently, developed countries have accepted laws to protect animals, which are implemented through sophisticated mechanisms. Worldwide there is a growing recognition that attention to the observance of animal rights is one of the indicators of the civilization of society. Unfortunately, in Russia, the question of legislative regulation of moral concepts of animal treatment is highly relevant. Currently, in our country, there is no an effective system of control and punishment for violations of the rules of treatment of animals, so that the government cannot effectively influence the institutions in which do not apply ethical and legal norms of work with experimental animals. In addition, in the schools of biomedical and veterinary science, not enough attention is paid to the teaching of bioethics and the ethics of experiment on animals, which makes the level of training of graduates not corresponding to the modern requirements of the civilized countries of the world. It is necessary to develop a new modern documentary base in accordance with the spiritual, scientific and legal guidelines adopted throughout the world, which will determine not only the world recognition of domestic scientific research but also will be a clear indicator of the level of development of morality and civilization of Russia.

The work organization of evacuation hospitals in Saratov during the Stalingrad battle is analyzed. A brief description of the medical issues of the Stalingrad strategic defensive operation is given. The factors that determined the evacuation of a significant number of wounded and sick Red Army soldiers to the medical facilities of the Local evacuation point-45 are indicated. Statistical data are provided on the number of people taken to treatment and sent to other rear hospitals who suffered from the site of the crucial battle of the Great Patriotic and World War II. The importance of using railway, water and motor vehicles for the evacuation of the wounded and sick was noted. The issues of the organization of sanitary and hygienic and antiepidemic work in Saratov and the region in the period of approaching the front, high crowding of the local population and arriving refugees, as well as the constant arrival of ambulance transports are considered. The enormous role of the Saratov Medical Institute staff in medical and consulting work in evacuation hospitals was emphasized. Their high professional training, constant search of non-standard ways of solving complex problems arising in the course of daily clinical activity, allowed to achieve high results in the work of medical institutions, to save the lives of a large number of wounded soldiers and commanders of the Red Army. The contribution and main directions of medical and scientific activity of leading specialists of the medical institute in the considered historical period of time are highlighted.

The main life stages of scientific and practical activities of Henry Ivanovich Turner are presented. It is noted that initially G.I. Turner was interested in problems far from orthopedics: acute purulent processes in the right ileal fossa, the cecum and the appendix. In 1892 G.I. Turner defended his doctoral thesis on «the anatomy of the cecum and the vermiform Appendix in relation to the pathology of perityphlitis». In 1894, Turner was admitted to the degree of assistant Professor of clinical surgery, reading two lectures, he was confirmed in this rank. In 1895, held the appointment of Turner Professor of desmurgy and machineryi Military Medical Academy. He revived the teaching of the subject and translated it into «practical ground». Thanks to the energetic work of Turner as an organizer was revived by the Department of desmurgy and machineryi Military Medical Academy and Surgical Museum of the Academy. Under Henry I. the Museum has been enriched with new type of instruments, dressings, and splints, collection of damaged bones, who helped in the study of desmurgy. This collection has survived to the present day and has more than 800 drugs and has no analogues in the country. A lot of effort and energy gave G.I. Turner to help sick children, handicapped, vocational rehabilitation of crippled children. For many years he supervised the work of an orphanage in St. Petersburg (St. Lachtinskaia, 12), which in 1932 was transformed into the research Institute of child disability in the name of G.I. Turner. This Institute became the organizational and methodical centre of childhood disability in the Soviet Union.