Vol 20, No 4 (2018)

History of the Military medical academy is inextricably linked with the name of Peter I, who in 1715 laid the Vyborg district of St. Petersburg admiralty and land hospitals. In those hospitals, January 9, 1733 were formed hospital (surgeon’s) school for training local doctors, which were the prototype of the Academy. In 1786, the school joined to the surgeon’s main medical (medical and surgical) school, where seven professorships were established in 1795. December 18,1798 decree issued by Emperor Paul I «On the dispensation at the main hospital buildings for special medical schools and teaching theater». The construction of a special (separate) building made it possible to have the territorial and administrative independence of the educational institution. The main medical school received the status of Medical-Surgical Academy. In1809 the Academy became the Imperial, it was given the status and functions of the Russian academy of medical sciences. At the same period, there were formed three departments - medical, veterinary and pharmaceutical, allowing Academy initiated the medical, veterinary and pharmaceutical higher education in Russia. In 1858, at the Academy the Institute of doctors (the prototype of post-graduate) was created to prepare teachers for the medical faculties of Russian universities. Establishing in 1872 a «special education course for female scientists midwives», converted in 1876 in the women’s medical courses, the Academy has initiated the formation of women’s medical education, which in those days was not the only one in our country but also in Europe. Staff and graduates of the academy have covered themselves with unfading glory in all the wars in which Russia participated. The Academy in the XIX-XX centuries developed world renowned scientific medical schools which live today. Currently, the Military medical academy named after S.M. Kirov is the major higher military medical school, head research institution and a leading military medical establishment of the Ministry of Defense of the Russian Federation.

Results of treatment of 325 wounded are analyzed with penetrating wounds of the chest and identify risk factors for the development of infectious complications. Found that infectious complications of the chest organs developed in 49 (15,1%) cases. It has been established that the most frequent infectious complications of penetrating wounds of the chest are post-traumatic pneumonia (67,3% of cases) and acute empyema of the pleura (26,5% of cases). The most prognostic significant risk factors for the development of infectious complications were identified: the type of injury (odds ratio - 2,48;95% confidence interval - 1,34-3,76), the severity of injuries (odds ratio - 7,88; 95% confidence interval - 3,9-15,92), blood loss (odds ratio - 3,09; 95% confidence interval - 1,6-5,94), duration of stay in the intensive care unit (odds ratio - 9,25;95% confidence interval - 4,57-18, 74), the intersection of chest wall structures (odds ratio - 2,84; 95% confidence interval- 1,24-6,47). Measures aimed at the prevention of infectious complications should be started from the moment the woundedperson enters the hospital. The priority tasks are to maintain the patency of the tracheobronchial tree, expanding the lung,adequate drainage and debridement of the pleural cavity. A high risk of developing infectious complications in penetratingwounds of the chest is expected in the wounded in a severe and extremely serious condition (according to the scale of fieldsurgery - condition at admission more than 31 points). The duration of stay in the intensive care unit for more than 4 daysincreases the probability of infectious complications 9 times.

The results of percutaneous endoscopic and microsurgical discectomy have been compared. It was established that the operative intervention time, bed-day medians and disability period were significantly shorter (p<0,001) in the percutaneous endoscopy group. The average effective dose of radiation exposure for a patient during transforaminal endoscopy was 4,4 mSv, for interlaminar endoscopic techniques and microsurgery - 0,8 mSv. The proportions of complications and repeated operations in both groups were comparable. The risk of recurrence was 10% for the endoscopic group, 4,8% for the microsurgical group. Significant differences in terms of local and radicular pain, quality of life and the physical component of health have not been established. The mental component of health was the best in the endoscopic group. Good and excellent results on the MacNab treatment satisfaction scale in the endoscopy group were observed in 78,2% of cases, after microdiscectomy - in84,9%. Lower invasiveness of percutaneous endoscopy affected the reduction in the period of hospitalization and disability. The effectiveness of percutaneous endoscopic discectomy methods was comparable to standard microsurgical techniques. A statistically insignificant increase in the risk of hernia recurrence after percutaneous endoscopic discectomy was noted. Infectious complications were not typical for percutaneous endoscopic discectomy. Differences in the frequency of complications and reoperations between percutaneous endoscopic and microsurgical lumbar discectomy are also not confirmed.

The main challenges leading to the decrease of bone mineral metabolism in the conditions of the North are covered. The presented results of a study of 29 soldiers serving in the extreme conditions of the North, to study the mineral density of bone tissue in the distal forearm. Revealed a significant decrease in bone mineral density, as well as a deficiency of essential elements in this cohort. So, when densitometric training of servicemen serving in the North, the average Z-test was 0±1,8 SD, the change in bone mass corresponded to the Z-test less than -2 SD, was determined at 31,03%. Vitamin D3 deficiency was detected in 96,5% of cases. Analysis of the bio-element state of the hair revealed a deviation of the reference interval in 100% of military personnel, a decrease in essential elements: cobalt, selenium, magnesium, vanadium and an increase in the level of barium, bromine, arsenic, as well as caesium. The interrelation of the elemental status and bone mineral density is revealed. 100% of the examined hair samples showed a significant decrease in the level of cobalt, selenium and iodine. (p<0,05) a decrease in boron, magnesium, calcium, vanadium (p<0,05) and a significant increase in chromium, manganese, and copper. A quantitative study of toxic elements revealed a significant (p<0,05) increase in mercury, rubidium, strontium, and caesium. A correlation was established between the Z-test and the level of vitamin D3, body mass index and dynamometer. The data obtained determine the required level of trace elements in order to prevent disturbances of mineral metabolism and bone loss.

Currently, endoscopic hemostasis is the «gold» standard in the treatment of patients suffering from ulcerative gastroduodenal bleeding. General mortality in ulcerative gastroduodenal bleeding according to the Department of ambulance organization of the research Institute of emergency care. I.I. Dzhanelidze in St. Petersburg in 2016 was 5%, and postoperative8,5%. Transcatheter arterial embolization, due to the development of endovascular hemostasis techniques, is an alternative to palliative surgery in the failure of conservative treatment of ulcerative gastroduodenal bleeding using endoscopic hemostasis techniques, especially in the group of patients with high risk of surgery and adverse outcome. It was found that the reduction in mortality in patients with gastric ulcer bleeding can be achieved by reducing the number of palliative interventions, wider use of angiographic embolization for the prevention and treatment of recurrent bleeding and expanding indications for urgent radical operations outside the recurrence of hemorrhage. The use of transcatheter arterial embolization in elderly patients with severe somatic pathology and recurrent gastric ulcer bleeding can prevent the recurrence of bleeding and perform hemostasis. The success of the transcatheter arterial embolization procedure depends on many factors. Primarily from the anatomical features of the patient. In one case, the patient had a 60% stenosis of the proximal segment of the gastrointestinal splenic trunk, which did not allow the procedure to be performed. Important is the choice of agents for embolization depending on the location and diameter of the source of bleeding. Success also depends on the technical equipment of the hospital and the experience of the surgeon. The absence of significant differences in mortality between the main and control groups, in our opinion, is due to the severity of the General somatic condition of patients included in the study. The obtained results determine the need for further studies to optimize the indications and methods of transcatheter arterial embolization in emergency surgery of gastroduodenal bleeding.

80 cases of lethal outcomes with a clinical diagnosis of sepsis were analyzed. In 31 of them, the pathologoanatomical diagnosis was confirmed - histologically, the internal organs showed metastatic purulent foci. This criterion for the morphological diagnosis of sepsis corresponded to the modern definition of sepsis as a pyogenic bacterial infection with hematogenous generalization and the absence of a specific pathogen. When re-examining archival micropreparations, special attention was paid to finding inconspicuous small metastatic septic foci in the myocardium, kidneys, and brain (mini foci). Their detection required careful searches with a high magnification of the microscope due to fading with adequate antibiotic therapy with therapeutic pathomorphosis. To confirm suppurative inflammation in metastatic septic foci, neutrophilic granulocytes were identified by immunohistochemistry with an expression of CD15. Most often, mini-foci were found in the myocardium, less often in the brain. The presence of morphological signs of microcirculation disorders in all 80 observations was also recorded: leukostasis, «sludge-phenomenon», diapedesis haemorrhages, convolutions in the lumen of the vessels. In the group where sepsis was confirmed, leukostasis, sludge-phenomenon and diapedesis haemorrhages were more common. Comparison of the number of signs of microcirculation disorders in sepsis, confirmed histologically, with violations in the clinical diagnosis of «sepsis», not confirmed pathologically, was made. The obtained ratio made it possible to consider the pronounced and widespread microcirculatory disorders as objective microscopic criteria that require the study of additional sections for the detection of metastatic pustules for reliable diagnosis of sepsis. At the same time, it is possible to detect single mini-foci, indicating the presence of sepsis.

The assessment of the skin microbiota state in elderly people with diabetes mellitus is given. For the research and development of quantitative and specific indicators of deep microbiota of the skin used the method of agar imprints. The revealed changes in the skin microbiota in patients with diabetes mellitus are of interest as adaptive characteristics of the organism, and also serve as a harbinger of deviations in the clinical and physiological status of patients and give reason to present the basic laws of skin biocenosis in elderly people suffering from diabetes mellitus. It was found that the species composition of the microbiota does not change in the control group in the deep layers of the forearm skin, and the number of colony-forming units increased, which corresponds to skin dysbiosis of the I degree. It was also found that representatives of Staphylococcus spp occupy a dominant position in the skin microbiota in persons with diabetes mellitus, both in frequency of occurrence and in quantitative measure. At the same time, in the observed patients, regardless of the type and stage of diabetes mellitus, an increase in the number of colony-forming units by 1 cm2 of the deep layers of the forearm skin was revealed, which corresponds to the dysbacteriosis of the skin of the III degree. This is 2,6 times greater than in healthy individuals. This increase is directly correlated with the severity of diabetes. It is shown that dysbiosis can manifest itself by clinical local symptoms, and then by General disorders, which 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 diabetes mellitus and to improve the effectiveness of treatment and preventive care.

The content of vitamins A, E, D, C, B1, B2, B9 and B12 in plasma and serum of 156 servicemen serving in the Arctic zone of the Russian Federation in the autumn and spring periods using high-performance liquid chromatography, immunochemoluminescence, fluorimetric and spectrophotometric techniques were established. The study included men aged 18 to 25 years old, somatically healthy, the service life of at least four months from the time of the call. The military personnel are comparable in terms of physical health indicators, have received the same nutrition for a long time under the conditions of the barracks, had equivalent conditions of service and physical activity for a long period of time. In the examined servicemen, the prevalence of hidden (subclinical) forms of vitamin A, E, D, C, B1, B2 B9 and B12 deficiencies were found in both the traditional spring-summer and the epidemically dangerous autumn-winter period. The idea of the seasonal “spring” nature of vitamin deficiency has been revised - at the autumn point of the study, its prevalence was no less than in the spring, although there was indeed a spring deterioration in vitamin C and B1. It was concluded that the need for constant vitamin support for military personnel in the Arctic zone, improving the diagnosis of subclinical vitamin deficiencies, mainly due to the introduction of modern methods of laboratory diagnostics. A scheme of vitamin support is proposed by alternating the intake of a multivitamin preparation and a product enriched in vitamin C for 1 month.

The influence of the structural polymorphism of the interleukin-10 genes (1082G/A; rs1800896) and tumor necrosis factor-α (308G/A; rs1800629) on the risk of adverse clinical forms of community-acquired pneumonia in young men has been evaluated. In patients with community-acquired pneumonia in young men, the GG genotype of the gene for interleukin-10 (1082G/A; rs1800896) and the AA and AG genotypes of the tumor necrosis factor-α gene (308G/A; rs1800629) have been found to be associated with a severe and prolonged course of this diseases. AA and AG genotypes of the tumor necrosis factor-α gene (308G/A; rs1800629) are associated with the complicated course of community-acquired pneumonia in young people. It was revealed that in young men, in the presence of the GG genotype of the interleukin-10 gene (1082G/A; rs1800896), the relative risk of developing severe disease increases by 3,2 times and the risk of developing long-term community- acquired pneumonia increases by 2,7 times. If young patients suffering from community-acquired pneumonia, AA or AG, have the genotype of the tumor necrosis factor-α gene (308G/A; rs1800629), the relative risk of developing severe course increases by 3,3 times, prolonged course - by 2,6 times, and complicated course - 1,9 times. The results of the study should be used in the diagnosis of community-acquired pneumonia in order to predict the development of adverse clinical forms. Interleukin-10 gene polymorphism (1082G/A; rs1800896) and tumor necrosis factor-α (308G/A; rs1800629) are individual typological features of a person, the verification of which is relevant for use in the diagnosis of community-acquired pneumonia in young people to predict development adverse clinical forms of the disease.

Traumatic shock is considered to be the most common clinical form of a severe patient’s condition (63%). Timely and adequate blood volume resuscitation is one of the most important procedures in providing medical care to critically injured casualties and patients at the forward medical evacuation stage. The key to this problem, especially when the infusion therapy is needed at the pre-hospital stage, is the development of alternative (extravascular) techniques of plasma volume expander administration. The article presents the results of testing of the first domestic medical devices for intraosseous infusion in critically injured casualties and patients. At present, on commission of the Russian Ministry of Defense and with the scientific support of Kirov Military Medical Academy, domestic enterprises developed test samples of medical devices to provide intraosseous infusions: a «Disposable device for intraosseous infusion of solutions if there is no intravenous access, which was designed on the basis of a spring drive» - the index «VKI-P», developed by limited liability company «Novoplast-М» and a set for intraosseous infusion using an electric drive - the index « VKI-E», developed by limited liability company «Research engineering company «Spetsproekt». Assessment of performance of test samples of the medical devices for intraosseous infusions «VKI-P» and «VKI-E» was carried out using pathophysiologic model of traumatic shock in 14 experimental animals (pigs) by creating artificial blood loss of medium severity, 25% of circulating blood volume (in average 440 ml), followed by its resuscitation with intraosseous infusion of 0,9% solution of NaCl. As a result of the performed tests it was found that the device «VKI-P» and the set «VKI-E» provide for NaCl infusion in major vessels (with an intraosseous infusion), 750 ml of volume during 45-50 min, and can be used as an alternative access to provide infusion as a part of anti-shock therapy, which solves the problem of volume resuscitation when giving care to severely injured casualties and patients at the forward medical evacuation stages. These samples may be recommended for inclusion into the medical service list of complete supplies and the Medical Corps supply support, the Armed Forces of the Russian Federation.

Based on the analysis of simulation results of Wagner-Unverricht form polymyositis on mice of DBA/2 line, theoretical and experimental models of oxidative stress in the biological system were compared. It is shown that oxidative stress develops when the balance between the intake of free radicals and the effectiveness of the antioxidant system of the body is impaired. The main role for maintaining radical balance in the biosystem belongs to reversible electron transport through the plasma membrane during the interaction of the free radical flow with the active centres of the cell membrane. The electromagnetic nature of this interaction is underlined. The possible electrical structure of the active centre of the plasma membrane, based on the physicochemical laws of adsorption of electrically charged particles on the surface of liquid crystals, is presented and discussed in detail. The possibility of ion transport through the active centre in its interaction with the free radical is shown. It is noted that the electron transfer through the cell membrane provides the energy necessary for the non- spontaneous reverse transfer of ions in the energy-dependent component of the thermodynamic process that can form the action potential. The presence of irreversible interactions of the free radical flux with the bilipid layer of the plasma membrane in the places of defects of the liquid crystal structure is shown, which leads to the development of destructive changes. It is noted that the hypothesis of the electromagnetic nature of neurohumoral regulation presented in the paper can serve as a basis for further studies of discrete energy effects on the reflex and automatic activity of neurons, including the understanding of the mechanisms of the trigger of automatic processes in glia neurons, up to large neurons of the cerebral cortex, affecting the activity of the Central nervous system and the whole biosystem.

The needs and possibilities of import substitution in the prosthetic and orthopedic industry for prosthetics and orthotics of lower limbs from local and imported component materials were determined. We analyzed the stock list of special equipment, materials, and modules used in the manufacture of prostheses and orthoses of the lower limbs, indicating local and foreign suppliers. The technical characteristics of equipment, materials, and modules of lower limb prostheses that are not manufactured in the Russian Federation were determined. We indicated the stock list, components, equipment, and materials, which production is more reasonable to be organized in Russia instead of using imported products of similar purpose. We carried out operational tests and clinical trials of prosthetic and orthopedic products that were made from new thermoplastic materials. These materials are developed by local manufacturers for the production of a bucket of the prosthesis for lower and upper limbs, orthoses and orthopedic devices, actively correcting braces, stop holders, etc. We indicated the ways of implementing the state policy to eliminate reliance of local prosthetic and orthopedic industry on import. Proposals for the optimization of reference documentation were developed. The role and position of research organizations that solve the problems of import substitution and that focus on the creation of new and improvement of existing technologies of physical medical rehabilitation of patients with muscle-skeleton disorders were defined. We determined the importance of institutions of advanced training for doctors and other specialists who work in prosthetic and orthopedic enterprises and rehabilitation centers.

The epidemiological situation for acute respiratory diseases, chickenpox, meningococcal infection in the garrisons, as well as in the whole regions of Russia, is unstable. Group and flash morbidity are registered, which determines the relevance of this pathology. Diseases of the X class occupy a leading position in the structure of the overall morbidity, both among conscripts and contract soldiers. The prevalence of infectious diseases in the structure of morbidity of servicemen of the armed forces of the Russian Federation is due to the combined effect of factors of communal and domestic arrangement and military labor. The article summarizes the experience of organizational, methodological and practical work of doctors- specialists of strengthening the staff of the Department of infectious diseases of the Military Medical Academy. S.M. Kirov in the organization of medical-evacuation support of patients with infectious diseases in military units (training centers) and military medical organizations of the military districts (Northern Fleet) in the context of daily activities of troops (forces) in the period of the seasonal rise of morbidity. The problematic issues of the organization of medical and evacuation support of infectious patients, the task of improving the level of work as a medical service (especially pre-hospital level) and doctors- specialists strengthening groups to prevent the spread of infectious diseases among the personnel. It is established that the level of General morbidity increased during the analyzed period, mainly due to respiratory diseases. In the structure of infectious diseases, the most relevant are adenovirus diseases, chickenpox, meningococcal infection. Currently, in the military units (training centers) of the armed forces of the Russian Federation, there is no single guide (position) for the organization of additional (non-standard) insulator. The order of actions of commanders (chiefs) on the organization of its deployment and functioning is not defined.

The technique of the systemic-morphological analysis allowing to create alternative decisions is provided. Options of medical support of troops (forces) and the population in case of elimination of medical and sanitary consequences of emergency situations of natural, technogenic and social character are developed: «Departmental», «Interdepartmental»,«International». Concerning each option, nine indices (criteria) are offered: legal regulation; controllability system; complexity of the organization of system; resource (material) cost intensity; personnel security; adequacy of medical care; efficiency; experience and innovations; self-sufficiency of actions. For the production of computation and a choice of the most rational option of planning of system the original dialogue program system of «MPRIORITY 1.0» (MY PRIORITY) realizing a method of the analysis of hierarchies by repetitions (iterations) is used. The results characterizing each of the considered alternative options with the replying weight priority are received and their preference is defined. During the first iteration priorities for the system of indices and criteria, characteristic of achievement of result with emphasis on normative legal regulation of activities with the organization structure and management system were defined. In the second - priorities for the system of indices and criteria with emphasis on the organization of delivery of healthcare with the existing system of material support, medical supply and also an adequate level of training of medical frames were changed. Results were subjected system to the analysis and sentences are developed for health service of the Armed Forces of the Russian Federation, in particular for Service of medicine of catastrophes the Russian Defense Ministry, on the organization of system of medical support of troops (forces) and the population in case of elimination of medical and sanitary consequences of emergency situations of natural, technogenic and social character.

Odontogenic maxillary sinusitis is a problem that is at the junction of two specialities: otorhinolaryngology and dentistry. According to domestic and foreign authors in the structure of dental diseases, odontogenic maxillary sinusitis is6-24%. According to doctors-otorhinolaryngologists among all types of sinusitis about 40% is odontogenic maxillary sinusitis. Currently, there is a gradual increase in the number of odontogenic maxillary sinusitis. This is due to the improved diagnosis of this pathology. The use of dental computed tomography usually allows establishing reliably the cause of odontogenic maxillary sinusitis. Unsatisfactory results of treatment of some dental diseases, the increase in the number of odontogenic maxillary sinusitis determines the relevance of the study. The problem of odontogenic maxillary sinusitis is considered, modern views on the aetiology, pathogenesis, clinic, diagnosis and treatment according to domestic and foreign authors, as well as some issues of the relationship of pathology of intraosseous structures and the course of odontogenic maxillary sinusitis, the principles of an interdisciplinary approach in the treatment of odontogenic maxillary sinusitis are presented. The search for new methods of treatment of odontogenic maxillary sinusitis is dictated by some differences in clinical manifestations of odontogenic sinusitis from rhinogenic. The approach based on the joint primary examination and treatment of patients with suspected odontogenic maxillary sinusitis by an otorhinolaryngologist and maxillofacial surgeon, as well as the development of further tactics for the management of this category of patients, is, in our opinion, promising. The use of modern methods of functional endoscopic surgery is an effective means of prevention and treatment of odontogenic maxillary sinusitis, as it is a minimally invasive technique that allows you to create conditions for further rational prosthetics of the oral cavity.

Анализ причин происшествий на транспорте и объектах энергетики показывает, что основным их источником является человек. Так, оператор является источником от 70 до 80% нештатных ситуаций на атомных станциях и до 90% на воздушном и морском транспорте. Профессиональная деятельность человека сопровождается ответной реакцией его психических и физиологических функций, которая отражает процессы адаптации к реальному или ожидаемому воздействию рабочей нагрузки, факторов окружающей среды, эмоциональных переживаний, а также характеризует остаточные процессы после этих взаимодействий. Всё это свидетельствует о необходимости обеспечения требуемой функциональной надежности человека в системе«человек - машина - среда», под которой в физиологии труда принято понимать динамическую компоненту, отражающую устойчивость и резервные возможности функциональных систем человека по обеспечению его высокой работоспособности как в обычных, так и в экстремальных условиях.В последние годы при оценке функциональной надёжности значительное внимание уделяется использованию в медико-физиологических исследованиях интегральных показателей. Одними из них являются суммарный обобщённый интегральный показатель и обобщенный логарифмический показатель. Предлагается вариант адаптации нормирования данных интегральных показателей с учетом дисперсий, создаваемых учитываемыми параметрами группы исследуемых лиц, находящихся в тех же условиях, что и сам обследуемый, и формирующих те же приспособительные реакции. Адаптированная таким образом методика расчёта интегральных показателей может быть применена для мониторинга работоспособности и процессов адаптации операторов морской техники в ходе моделирования профессиональной деятельности на тренажерах при условии, что оцениваемые параметры должны иметь количественное исчисление, нормальное или близкое к нему распределение.

The characteristics of the umbilical cord extracellular matrix are discussed relatively of their potential use for tissue engineering. The purpose of this review is to assess the current knowledge about using of homologous biomaterials with regenerative properties to create bioengineered structures. One of the most important components of tissue engineering - matrix (scaffold), resident cells can migrate, attach to it and function. Due to their structure, matrices should be easily integrated into the patient’s tissue and provide conditions for cell growth and differentiation. The cells that populate the matrix in the bioreactor before the transplantation of this construction, or resident cells recruited into the transplanted extracellular matrix), and cell- matrix interactions are absolutely necessary components of tissue engineering. Available commercial bioengineering products made from mammalian tissues have certain advantages and significant disadvantages due to the risks of immunological reactions and transmission of infectious agents. The transplantation of products from xenogenic materials is prohibited by law in the Russian Federation. The donor material is limited, receipt of human cadaver material requires a long period of legal registration, which has a detrimental effect on the biomaterial. Therefore, finding a suitable homologous biomaterial is ongoing. Due to the peculiarities of the embryonic phenotype, extraembryonic tissues have special biological properties, one of which is the scarless healing of wounds. Low immunogenicity, optimal mechanical properties of extracellular matrix, presence of cell adhesion molecules and growth factors promoting regeneration provide anti-inflammatory, anti-fibrotic, anti- scarring properties for tissue engineering structures from umbilical cord and amniotic membrane. Umbilical cord and amnion due to the availability and non-invasiveness of obtaining from healthy young donors are an excellent source of homologous biomaterial for extracting matrices, cells and hydrogels for tissue engineering and regenerative medicine.

There is information about the business of professorial and teachers’ faculty of the Department of naval and radiation hygiene and the Department of General and Military hygiene S.M. Kirov’s Military-medical academy into a limitation of consequences the most enormous radiation emergency, which happened on 26 of April 1986, on Chernobyl nuclear power plant. A significant part of the participants in the liquidation of the accident were servicemen, the cause of that military-medical service took the direct part in the implementation of preventive measures. A set of activities for the health protection liquidators and residents of settlements, placed on the contaminated areas allowed to significantly reduce the radiation exposure from external and internal radiation. The basis for the prevention of both acute lesions and long-term consequences was the maximum permissible level of the planned emergency radiation of 25 Rem. The entire faculty of the Department of Naval and Radiation Hygiene and a number of employees of the Department of General and Military Hygiene, who on a rotational basis were continuously in the zone of work to eliminate the consequences of the accident, went through the mill of Chernobyl. Their personal contribution to the solution of urgent scientific and applied problems of minimization of radiation impact and preservation of the health of servicemen-liquidators of the accident were noted.

A modern approach to the complex diagnosis of liquorrhea, both transcranial and nasal, is considered. The terminology and the most common and used variants of classification of liquorrhea are given. An epidemiology and causes of liquorrhea according to the modern literature are described. The history of the study of cerebrospinal fluid and various methods of its study are briefly presented. Special attention is paid to the review of modern methods of diagnosis of liquorrhea which were described in the literature. Both simple samples of «halo-test» and «handkerchief» and high-tech endoscopic methods of visual diagnostics are considered. The data of various authors on the effectiveness of intrathecal administration of fluorescein, indigocarmin and other dyes is presented, their shortcomings are noted. The methods of laboratory diagnosis of liquorrhea by determining the level of glucose, protein and specific for cerebrospinal fluid biomarkers β -transferrin and β-TP are described. The role of neuroimaging methods of examination, such as multispiral computer tomography, cisternography, magnetic resonance imaging and radionuclide studies, in the diagnosis of liquorrhea was determined. Based on the analysis of the literature data and their own experience, the authors present an improved algorithm of complex diagnosis of liquorrhea, including the collection of complaints and anamnesis of the disease, general laboratory diagnostic complex, objective examination (including rhinoscopy), consultations by other specialists, bedside methods of diagnosis of liquorrhea, laboratory methods of verification of cerebrospinal fluid and radiation diagnostic techniques.

The article analyzes the world experience in methods of applying of stomach nutritional fistula. Different methods of gastrostomy are described, their classification is given. The advantages and disadvantages of common surgeries are outlined. The most often used traditional surgeries are: gastrostomy by Stamm, Topver and tubular gastrostomy. Complication rate of these operations led to a further search for minimally invasive techniques: percutaneous puncture, laparoscopic gastrostomy, and laparoscopically- assisted percutaneous endoscopic gastrostomy. A significant disadvantage of minimally invasive puncture techniques is the need to purchase relatively expensive disposable sets for primary installation and replaceable low profile tubes. The cost of these supplies in Russia is much higher than the money allocated in the obligate medical insurance system, which makes the method economically unprofitable for medical institutions and patients. Partially, the costs could be reduced by the use, as a gastrostomy tube, a Foley urinary catheter. There are several studies that have confirmed economic advantages and absence of a reliable difference in the number of complications and duration of use such tubes. However, some complications are reported: migration of catheter into the duodenum with the development of obstruction, decreased comfort and quality of life. The conducted study showed absence of classification of gastrostomy types and their complications. The final consensus in clinical use of different types of gastrostomy in different situations is absent. There is a tendency to decrease rate of traditional laparotomical operations in favor of less invasive interventions making it difficult for adequate analyzing. In cases with need for revision, biopsy and fundoplication, laparoscopic or laparoscopically-assisted percutaneous endoscopic gastrostomies are preferred which has proven itself in children. For a group of palliative patients of elderly age with high risk and doubtful prognosis, minimally invasive puncture gastrostomes are more appropriate.

Based on the analysis of Russian and foreign literary sources, the definition of the concept of polymorbidity is given, its classification, information on prevalence, measurement methods and practical significance are given. It is emphasized that at present in the literature the concepts of polymorbidity, comorbidity, multimorbidity coexist, while there is no universally accepted definition of them. This uncertainty is historically conditioned and is associated with the use of these concepts by various scientific schools. In most modern literary sources, polymorbidity (multimorbidity) refers to a combination of two or more chronic diseases in one patient. At present, a considerable number of different methods of measuring polymorbidity are used, which have their own advantages and disadvantages, and a universal method has not been developed. The most convenient for assessing polymorbidity is currently recognized polymorbidity index Charlson. Due to the lack of unified approaches to the measurement of polymorbidity, as well as taking into account the fact that studies are conducted in different population samples, the published figures for the prevalence of polymorbidity vary considerably. Emphasis is placed on the fact that polymorbidity is a multifaceted problem that has not only clinical but also economic and social importance, which requires a further in-depth study.

The main historical aspects of the research work of the Department of Aviation and Space Medicine of the S.M. Kirov Military Medical Academy are presented for a 60-year period of its activity with a characteristic of the contribution of the department’s staff at different periods. One of the priority tasks of the department was not only training medical specialists for the Air Force but also carrying out scientific research aimed at solving both applied and fundamental problems of aviation and space medicine. The directions of these studies were laid by the founder of aeronautical physiology academician Leon A. Orbeli and are related both to the development and improvement of science and technology, and to the development of aviation and cosmonautics. Today, the main scientific areas of the Department of Aviation and Space Medicine are: improving the medical support system for flights on modern and promising aviation and space technology; development of methods and techniques for increasing the stability of the body of pilots and cosmonauts to flight factors; assessment and forecasting of the functional state and professional reliability of the flight crew, astronauts and operators for the management of space vehicles, as well as the development of tools and methods for correcting adverse changes in the functional state and improving the professional performance of pilots and astronauts. The Department continues research on one of the most important problems of flight safety - the loss of spatial orientation, new types of illusions are being studied. To ensure the work of the department at the present stage, the educational and material base is represented by the most modern medical and special equipment grouped into adjacent and complementary areas.

Some aspects of the state of the Imperial Military Medical Academy before the beginning of the First World War, the activities of the Academy to train military doctors for the army during the war before the events of October 1917 are presented. The imperialist development path introduced Russia at the beginning of the 20th century in a complex knot both external and internal political and economic contradictions, that influenced the activities of the academy. The sad experience of the Russian-Japanese war of 1904-1905 demanded an introduction to the educational process of military and military-medical disciplines. Since 1907, the Main Military Medical Directorate has proposed the introduction of compulsory study by students of the Academy of military regulations, military administration, military field surgery with radiology and field surgery, military hygiene, the theory of searchable diseases and epidemics, «military medical service» according to the programs approved by the military minister. Despite the fact that such «militarization» during the period of ongoing military reforms was acutely perceived by both students and the Conference, referring to the overload of curricula, the requirements of the time created prerequisites for further development in the second half of the 19th and early 20th centuries scientific schools. Outstanding global discoveries in the field of medicine by the beginning of the First World War allowed the Academy to preserve the status of the main scientific center of medicine, and not only the military, Russian Empire. On the eve of the First World War, Russian military medicine accumulated a wealth of experience both in organizing medical care at the front and in evacuating the wounded and sick and in matters relating to the theoretical justification and practice of treating wounds and diseases. The frontline experience of introducing the latest methods and advanced technologies for treating the wounded, contributing to the further development of military medicine, was noted.

The main events related to the assignment of the «Imperial» Medical and Surgical Academy status are considered. In the days of the celebration of the Academy’s 100th anniversary, publications dedicated to this event asserted that grateful offspring would always honor the memory of the Academy high Founders and Patrons. Our great predecessors, who celebrated the jubilee ideologically and organizationally, had recognized and honored Emperor Paul I as its founder. But the name and status the «Imperia Academy» was received from the hands» of Emperor Alexander I. On August 27, 1808, the Medical Surgical Academy, which had received Permission to be called Imperial, that was, a new quality (education) and other rights, the advantages granted to it, opened its first solemn meeting. That day, in our opinion, can claim to be considered the Birthday of the Imperial Medical and Surgical Academy. We emphasize that it is only about of the «Imperial» status. At that meeting the president of the academy James Wylie announced that the emperor «deigned to take on the title of Honorary Member of the Academy». On September 18, 1809, another great celebration took place in the Assembly Hall of the Academy devoted Alexander I and other High Men receiving the title of Honorary Members of the Academy. At the same time, the Emperor «showed his special favor to the Academy and bestowed upon it the Highest Charter, which «protects the rights and advantages of the Academy for all time». The most important provision of the Highest Charter was that, as a pledge of special imperial favor, the Medical and Surgical Academy was given the title of the Imperial Medical and Surgical Academy. That great celebration, its ritual procedure were reflected in the academic records: a thanksgiving service in the name of the Smolensk Mother of God in the academic church; the arrival of guests to a large academic audience (Assembly Hall, Conference Hall), members of the State Council, members of the Holy Synod, government ministers, foreign ministers; the arrival of Emperor Alexander I in «the Academy house»; the announcement of the Highest Diploma; the presentation of the diploma by the Minister of Internal Affairs Prince A. Kurakin to Emperor Alexander I; the highest order to present the diploma of the Academy; the receipt of the diploma by the President of the academy James Wylie and his thank-you speech; receiving diplomas Honorary Members of the Academy; election of new Honorary Members of the Academy; final speech of the President of the Academy; a visit to the Emperor of the academic church; breakfast of the Emperor in the dining room and his departure from the academy; further celebrations in the academy.

The article is devoted to the history of the Department of physical training of the military medical Academy named after S. M. Kirov. The article briefly highlights the key periods of education and formation of the Department of physical training, since 1900, when the initiative of a number of progressive professors of the Academy was formed by the Commission on physical exercises of students, which included the great Russian scientists, professors I.P. Pavlov and G.I. Turner. For students, optional classes in gymnastics, fencing, skating, game in small towns, riding began to be carried out. It was 1900 consider the beginning of the introduction to the educational process of the Academy of physical education classes, which became the basis for the formation of Throughout the period, the faculty of the Department of physical training worked outstanding athletes, the merits of which the Department of physical training and the Academy will always be proud. This is the honored master of sports of the Soviet Union and Russia, Champions and winners of Olympic, World, Europe, Soviet Union, and Russia: a fencer B.B. Melnikov, biathlete N.W. Puzanov, volleyball A.N. Einhorn and P.I. Voronin, gunner M.B. Umarov, a fighter, A.B. Novikov, honored coach of Russia and honored worker of physical culture of the Russian Federation A.S. Rakhlin, and others. For the glorious, eventful history of the Department of physical training, repeatedly changed its name, but one thing has always remained unchanged: at the Department of physical training worked and work highly qualified specialists, and a historical essay about the Department of physical training allows us to come close to all generations from the date of its formation to the present time.

The main scientific and practical milestones of the founder of the Russian prosthetics in orthopedics of Professor Herman Aleksandrovich Albrecht are covered. November 20, 1907 after the public defense of the thesis on the topic: «Pathology and therapy of lateral knee bends» GA. Albrecht was awarded the Conference of the Academy of Doctor of Medicine degree. After public defence of a thesis on the theme: «pathology and treatment of lateral curvature of the knee». One after another began to appear in print: «the question of fluoroscopy and radiography gunshot injury», «traumatic separation of the lower epiphysis of the radius», «Appetizers as a method for the treatment of genu valgum», «Pathology and treatment of hallux valgus», «the technique of treatment of coxitis tuberculosis», «Isolated fracture of the trochleae humeri with a bloody reduction method, the technique of treatment of pseudoarthrosis autoplastic way». German Alexandrovich considered the prosthesis as a special area of medicine and technology that have important national economic significance. The primary means of training was surgery. In addition, in medical institutions was to be made, fitting, final fitting of prosthetic devices and training in their use patients. Also provides a broad familiarization of surgeons with the essential requirements of the prosthesis. In 1916 G.A. Albrecht put forward a plan to create a state system for the reorganization of prosthetic aid for war invalids, which provided for free prosthetics and preparation for it in medical institutions, the creation of a network of prosthetic workshops, the scientific development of new prosthetic devices and the training of special personnel. These progressive ideas were implemented only in 1919. At his request the Mariinsky shelter was renamed the Institute of Prosthetics, and since 1922 the institute opened its own prosthetic-assembly workshop. In 1928, the opening of a 30-bed medical-prosthetic hospital was opened in the Institute in addition to a 50-bed dormitory intended for waiting prostheses. In this way organized a uniform system of preparation for prosthetics, supply of prostheses and learning to use them in a special institution, which has for this purpose the necessary medical and technical personnel and equipment. German Alexandrovich was a highly qualified physician, research worker and teacher is not unusual for the time, however, harmonically the current profile. After 10 years in the clinic of Professor G.I. Turner, he acquired a comprehensive knowledge of orthopedics, which formed the basis for his later activities. Having a brilliant operative technique, Albrecht has developed its own methods of arthrodesis of the ankle and knee joints, modification kinaesthesia operations on stumps of the upper arm and forearm, as well as highly desirable variation of talangsari the first metacarpal and the splitting of the stump of the forearm by Krukenberg.