Vol 21, No 3 (2019)

The possibility of optimizing the differential diagnosis and rational treatment of carpal tunnel syndrome is substantiated. It was established that clinical and neurological examination of patients with an assessment of the symptom of «shaking» is a specific (93,2%) and sensitive (95,9%) marker of carpal tunnel syndrome. The use of B vitamins and ipidacrine as part of a combination therapy allows reliably (p>0,05) to lower the severity of sensory and motor disorders, improve the functional activity of the affected hand, which correlates with positive changes in electroneuromyography parameters (restoration of sensory conductivity). A multidimensional analysis of the study results revealed clinical predictors of the effectiveness of conservative therapy in patients of this profile: the total duration of the disease is less than 3 weeks, the absence of pronounced hypotrophy of the tenar muscles, the amplitude of the motor response during stimulation n. medianus with a voltage of electric current >5,5 mV, motor conduction along the median nerve >51,6 m/s, elimination of sensory disturbances after the 1st session of local blockades with glucocorticosteroid agent, use of B vitamins and ipidacrine. With these clinical predictors of the effectiveness of conservative therapy, the probability of relieving pain and achieving results on the outcome questionnaire and the inability of the arm and hand ≤ 10 points using conservative therapy in patients diagnosed with carpal tunnel syndrome was about 90%. Thus, the identification of carpal tunnel syndrome should be carried out taking into account the diagnostic value of clinical symptoms (the symptom of «shaking», hypoesthesia in the area of innervation of the median nerve) and tests of Tinel and Falen. Treatment of patients with carpal tunnel syndrome should be regulated based on clinical predictors of the effectiveness of conservative therapy and indications for surgical intervention. When planning a conservative treatment of carpal tunnel syndrome, it is advisable to include vitamins of group B and ipidacrine in the basic therapy.

Such a disease as lymphocele can’t be called widespread in the population, and therefore the incidence of this topic, both in the domestic and in foreign literature is rather scarce. In addition, from several sources studied by us, not a single one speaks of the traumatic origin of the lymphocele. Thus, we can talk about the originality of the described clinical case. In addition to a brief overview of this problem, an example of successful endovideosurgical treatment of a patient with post-traumatic lymphocele of the small intestine mesentery root is given. The patient was admitted to the clinic of faculty surgery named after I.I. Grekov North-Western State Medical University named after I.I. Mechnikov with complaints of abdominal pain, arising mainly in the sitting position, not related to eating and defecation. According to the ultrasound of the abdominal cavity on the left in the mesogastrium, at the level of the navel, between the intestinal loops, an avascular hypoechoic rounded formation with a clear even contour, with a hyperechoic capsule, is measured, measuring 65×67×70 mm. According to the multislice computed tomography of the abdominal cavity in the left flank at the level of L2–L3 in the interhelium space, a rounded cyst-like formation of fat density with clear even contours, intimately adjacent to the wall of the small intestine, with a thick capsule from 4 mm to 7 mm thick, with overall dimensions is determined 66×64×68 mm, along the inner contour of the capsule, single flat calcined inclusions are detected. The diagnosis at admission – cyst of the mesentery of the small intestine. The patient underwent surgery in the volume of laparoscopic removal of a cyst of the mesentery root of the small intestine. The postoperative period was complicated by lymphorrhea. Thus, taking into account the data of anamnesis, clinical picture, laboratory and instrumental studies, intraoperative picture and histopathological conclusion, the final diagnosis is post-traumatic lymphocele of the mesentery root of the small intestine. The patient was discharged on the 21st day of the postoperative period in a satisfactory condition under the outpatient supervision of a surgeon of a polyclinic at the place of residence.

The possibility of using efferent therapy techniques in the complex treatment of patients with chronic Epstein – Barr virus infection is substantiated. It was established that prior to the therapy, the fluctuation in the number of copies of the deoxyribonucleic acid of Epstein – Barr virus per 1 ml of saliva sample in the group of patients suffering from chronic Epstein – Barr virus ranged from 1×103 to 9,68×105 copies. 10 days after the course of procedures (plasma exchange+plasma sorption), 55% of patients showed a significantly significant decrease in the number of copies of the deoxyribonucleic acid of Epstein – Barr virus from 327483,33±87070,83 to 13323±3789,96 (p=0,001) and 44,83% of patients received negative results of the polymerase chain reaction. Half of patients with initially high content of deoxyribonucleic acid copies (105–104 copies) had a negative polymerase chain reaction in saliva samples, half of another patients showed a significantly significant decrease in the number of deoxyribonucleic acid copies. In patients with a low number of copies, the opposite effect is observed, that is, after a course of efferent therapy, the number of copies of Epstein – Barr deoxyribonucleic acid tends to increase, as confirmed by the polymerase chain reaction in saliva samples. This is due to the release of free virus particles from the depot areas due to the diffusion of an increased volume of circulating blood during the procedures. However, in the general group of patients, the level of antibodies of the immunoglobulin G class to the nuclear antigen of the Epstein – Barr virus in the blood serum tends to decrease, and the level of antibodies of the immunoglobulin G class to the capsid protein of the Epstein – Barr virus significantly decreases after efferent therapy. After a course of plasma exchange+plasma adsorption, patients have no complaints of pain in the throat and joints, low-grade fever, chills, sweating and manifestations of stomatitis. The course application of plasma exchange+plasma adsorption increases the effectiveness of standard antiviral therapy and can be recommended for patients suffering from chronic Epstein-Barr virus infection as part of a comprehensive treatment.

The attitudes of adults suffering from various forms of diseases of the temporomandibular joint with pain syndrome to the internal picture of the disease have been studied. To determine the type of attitude of the patient to the disease, the «Type of attitude towards the disease» method was used. It was established that in patients suffering from temporomandibular joint pathology, the tolerance to chewing load was often reduced, and the morphometric index of 75,7% of the people surveyed was below 0,7 in u. e. Data on attitudes to the disease obtained prior to the treatment of persons suffering from temporomandibular joint diseases, did not show age and gender differences, as well as differences, taking into account the form of the pathology of the temporomandibular joint. It was noted that prior to the start of therapy, regardless of age and gender in persons suffering from temporomandibular joint diseases, types of attitudes toward the disease were observed, in which maladaptive behavior was observed with a predominantly intrapsychic response to the disease. Thus, among the types of attitudes towards the disease, patients suffering from temporomandibular joint diseases before treatment were more likely to have hypochondria (29,7%), melancholic (25,9%), neurasthenic (10,8%) and less often – alarming (8,1%) and apathetic (5,4%) types. At the same time, the presence in patients of mental maladjustment in connection with the pathology of the temporomandibular joint is marked primarily by an intrapsychic orientation of the response to the disease. This was manifested by characteristic reactions of the type of irritable weakness, anxious, depressed, and depressed. The treatment carried out within 30–40 days, allowed eliminating or significantly improving their condition in 94,6% of patients, but in 5,4% of patients, mild arthralgia remained in the temporomandibular joint. Patient treatment efficacy was 72,4%. Patients mostly had complaints about pain in the temporomandibular joint, including when eating and talking, and decreased sound phenomena in the temporomandibular joint when opening and closing the mouth. Comprehensive treatment with the use of behavior and nutrition, various dental treatment and preventive measures, exercise therapy exercises, as well as non-steroidal anti-inflammatory drug etoricoxib, made it possible to achieve effective treatment in 40,3% of cases. At the same time, patients suffering from the temporomandibular joint pathology were able to change inadequate reactions to the disease, eliminate the pronounced phenomena of mental maladjustment, as well as create realistic treatment settings for them, help restore broad social connections and actively participate in treatment.

The functional state of the pituitary-gonadal system in men is evaluated on the background of risk factors. It has been established that men who carry out their work at chemically hazardous objects (destruction zones, storage facilities for highly toxic chemicals) are subject to the combined effects of stress factors in the working environment. The pituitary-gonadal system, which is the basis of the reproductive function of the body and is based on complex hormonal regulation, is one of the most vulnerable systems. It’s normal functioning in men is mediated by the interaction of the main pituitary hormones and testosterone. The main factors of chemically hazardous objects due to the specifics of the work performed on them are: overheating, physical exertion, desynchronosis, and tension. It is assumed that the negative effects of the action of the factors of the working environment can be mediated both by their direct impact on the male gonad and by affecting the secretion of gonadotropins by the adenohypophysis. The effect of a complex of stress factors leads to the formation in men involved in the destruction and storage of highly toxic chemicals a relative androgen deficiency in combination with hyperprolactinemia and an increase in gonadotropin levels. At the same time, the greatest decrease in testosterone in the blood is observed in men working at the sites of destruction than in people working in the storage warehouses of highly toxic chemicals of the same age category. The relative androgen deficiency in personnel of chemically hazardous objects is transient in nature. Termination of work with highly toxic chemicals for a period of up to 14 days leads to a significant increase in the total testosterone in the blood of men.

Premature aging in young and middle-aged men suffering from polymorbid cardiovascular disease. It was established that it was 7,53±2,02 mg/l (in healthy people it was 0,65±0,24 mg/l), tumor necrosis factor-α 34,3±4,85 pg/ml (in healthy people – 7,69±4,6), interleukin-1β 5,14±2,08 pg/ml, interleukin-6 10,99±5,7 pg/ml (in healthy people – 2,23±1,27; 4,39±0,77), against the background of low anti-inflammatory activity – interleukin-4 10,99±5,7 pg/ml, interleukin-10 2,6±1,79 pg/ml (in healthy people – 7,42±1,19; 32,34±7,51). In patients with polymorbid cardiovascular system pathology there was an increase in anxiety and depression, a decrease in working capacity against the background of increasing the tone of the autonomic nervous system. When assessing the rate of aging in the group of patients, an increase in the biological age and functional class of aging was noted – 54,5±3,15 years and the V-worst class. Thus, we were able to establish that in young and middle-aged men with polymorbid cardiovascular system pathology, high C-reactive protein titer, along with altered immuno-inflammatory response, are the most important factor in maintaining chronic inflammation in the body, which determines the progression of endothelial dysfunction, systemic atherosclerosis and, as a result, an increased risk of cardiovascular events. The reactivity of the immune system in the absence of an active inflammatory focus in this category of persons is due to inflamming, which initiates premature aging of the body.

Intradermal injections of platelet-rich plasma is proposed to be an effective treatment for androgenetic alopecia. The mechanisms by which platelet-rich plasma affects the hair follicle are still not well understood. The aim of the study was to evaluate the effect of platelet-rich plasma on the microcirculation and proliferative activity of hair follicle cells. The study included 25 men, all patients received intradermal injections of platelet-rich plasma. To obtain platelet-rich plasma, blood samples were collected from each patient into 2 tubes with an anticoagulant. Centrifugation was carried out twice. An official calcium chloride solution was used as an activator. The course of treatment consisted of 4 procedures with an interval of 4 weeks between each procedure. The clinical efficacy of the therapy was evaluated by the dynamics of morphometric indicators of hair growth. Immunohistochemical examination was performed on vertical paraffin sections. All studies were performed before and after 4 months after treatment. Against the background of treatment with platelet-rich plasma hair density and average hair diameter increased by 12% (p=0,000067 and p=0,001947 respectively), the share of vellus hair decreased by 17% (p=0,002225), and the proportion of telogen hair by 16% (p=0,02836). Significant positive changes were absolute and relative values of CD34 expression area (∆287%, p=0,0001, and 325%, p=0,0003 respectively), and the absolute and relative values of the expression area of β-catenin (∆165%, p=0,0306 and ∆96%, p=0,0018, respectively). Thus, one of the mechanisms by platelet-rich plasma in patients with androgenetic alopecia is the improvement of microcirculation and cell proliferation of the hair follicle.

A comprehensive study was conducted to optimize the photodynamic effects of radachlorine in patients suffering from neoplastic and precancerous cervical pathology. The study included 37 patients with a diagnosis of a virus-associated malignant neoplasm of the cervix in situ. During photodynamic therapy, a second-generation “Radachlorin” group of chlorins of 0.35% 10 ml / fl was used, which was administered intravenously at a dose of 1 ml / kg body weight 2–3 hours before irradiation. It is shown that radachlorin is well accumulated in the foci of a malignant tumor and severe intraepithelial neoplasia. The maximum accumulation of the drug is noted after 30 minutes and lasts about 15 minutes, and then gradually decreases. To determine the optimal light dose during irradiation, a cytological study of smears of imprints from the biopsy material after light exposure in various light doses was carried out. The minimum light dose needed to activate a cascade of photochemical reactions is 150 J/cm2, the optimum is 300 J/cm2. The most effective mode of photodynamic therapy with the use of radachlorine for the treatment of dysplasia and pre- invasive cervical cancer is the dose of laser irradiation of 250 J/cm2 with a duration of the total irradiation time of 30–45 min (9–10 min per light spot). It has been established that photodynamic therapy is the method of choice in the treatment of preinvasive cervical cancer associated with the human papillomavirus, providing a pronounced antitumor and antiviral effect.

The aim of the study was to identify and analyze the relationship between the state of the autonomic nervous system and some indicators of hemostasis, as well as the level of complications in the groups of men suffering from hypertension and differing in temperament, anxiety and depression. It was found that in the years of active Sun, compared with other years, despite the therapy, there was a reduction in the time of blood clotting and an increase in the proportion of persons with complications of hypertension. In terms of treatment-choleric on the background of sympathicotonia, high- (low) anxiety pic of enhancing the speed of blood clotting (and the proportion of persons with complications of hypertension) coincided with the peak of Solar activity, the sanguine – shifted by 1 year, and phlegmatic and melancholic on the background of parasympathicotonia and depression has shifted to 3 and 4 years, respectively. In high-anxiety patients, the activity of the blood coagulation system (according to the studied parameters) and the proportion of persons who underwent complications in all years of the study were higher than in low-anxiety persons of the corresponding temperament. Compared with treatment administered empirically, treatment aimed at blockade of anxiety, sympathicotony and mild depression in high-anxiety choleric and sanguine, as well as the activity of the renin-angiotensin – aldosterone system (aldosterone) - in high-anxiety phlegmatics and melancholics, was combined with a more pronounced approximation of the rate of blood clotting and the proportion of persons with complications of hypertension to the values of such in healthy men, especially in years characterized by high solar activity.

The given clinical observation and monitoring of successful treatment of celiac axis compression syndrome with prevailing neurovegatative symptoms. Determined that celiac axis compression syndrome is characterized by polymorphism. In the absence of timely and adequate treatment, neurovegetative disorders may become leading in the clinical picture of the disease. In this regard, these patients are often suspected of hypochondria, which in turn greatly complicates the timely diagnosis of this pathology. The most reliable objective symptom of the celiac axis compression syndrome, allowing to suspect the disease, is systolic murmur, heard in the projection of the celiac trunk. The use of modern non-invasive medical imaging methods (computed tomographic angiography and color duplex scanning) and radiopaque aortography allowed us to establish the etiology of the vascular pathology of the celiac trunk and verify the somatic genesis of neurovegetative symptoms, eliminating hypochondriacal disorder. Surgical treatment, in our case surgical decompression of the celiac trunk, showed high efficiency and reliability. A complete regression of symptoms was noted 4 months after surgery. Positive immediate and long-term results of surgical treatment are confirmed by non-invasive instrumental methods.

As an alternative to fixing tissues with sutures in world surgery, the method of their adhesion using fibrin-based adhesive compositions is finding increasing use. However, they are so far inaccessible to surgeons, due to the lack of certification in our country. The cyanoacrylate glue used previously by domestic ophthalmologists had insufficiently pronounced adhesive properties and some histotoxicity and is practically not used at present. Experimentally substantiates the possibility of applying in ophthalmology a modified method of manufacturing a two-component fibrin glue. Two series of experiments were carried out to test the original method of preparing the components of fibrin glue. A preliminary study of its adhesive properties was carried out on the eyes of three rabbits (6 eyes) of the Chinchilla breed by gluing the amniotic membrane on the corneal stroma after partial surface keratectomy. Another six rabbits of the Chinchilla breed (12 eyes) carried out transplantation of the amniotic membrane on the corneal stroma: for the right eyes, interrupted sutures (group A), and for the left eyes – fibrin glue (group B). Postoperatively, the healing process was monitored dynamically using biomicroscopy and photo fixation on the 1st, 3rd, 5th, 7th, 10th, 15th, 30th, 45th and 90th day. Additionally, on the 30th day optical coherent tomography of the corneas of experimental animals was performed. The qualitative and quantitative composition of the components has been determined, which ensures the manufacture of fibrin glue, as well as its application in vivo by fixing the biomembrane (amnion) to the de-epithelialized cornea. The proposed method of preparation of fibrin glue provides reliable adhesion of the amniotic membrane to the stroma of the cornea and reduces the time of the operation. The method creates conditions for an earlier onset of epithelialization and contributes to the preservation of the transparency of the cornea compared with suture fixation.

The prospects for the development and objectives of the Military Innovation Technopolis «ERA» for the search, development and implementation of advanced ideas and developments, breakthrough technologies in strengthening the defense capability of the Russian Federation are discussed. According to the scientific direction «Biotechnical Systems and Technologies», a testing laboratory of biomedical and additive technologies was created in the Military Innovation Technopolis «ERA» to study 3D printing technologies of models of organs, tissues and medical devices for use in military medicine. Highlights the issues of testing and implementation of medical products manufactured using 3D printing (models of preoperative (pathological) organs, tires and langets, anatomical models of complex bones and elements of the human skeleton) with the participation of Military innovation technopolis «ERA» and the S.M. Kirov Military Medical Academy to medical institutions of the Ministry of Defense of the Russian Federation, for use in preoperative planning, training, training of doctors, rehabilitation. In November 2018, the country’s supreme leaders visited Military Innovation Technopolis «ERA», to which the first results of the technopolis were presented, including the testing laboratory of biomedical and additive technologies. In the laboratory, more than 150 models of complex bones and skeleton elements were made, which are used to train cadets and students of the S.M. Kirov Military Medical Academy at the Department of Normal Anatomy. More than a dozen organ layouts with various pathologies were created and sent to military hospitals and clinics fractures of the bones of the hand and forearm. Unique medical devices are created, for example, a holder for an ultrasound device sensor. A clinical example of the use of a preoperative model for planning an operation to remove an aortic aneurysm in the Military Innovation Technopolis is given. In the main and central military clinical hospitals of the Ministry of Defense of the Russian Federation, working groups have been created for the introduction of additive technologies, at whose meetings the use of 3D printing technologies in personalized military medicine is discussed. The use of three-dimensional printing in military medicine will significantly improve the traditional methods of visualization and, accordingly, diagnostic and treatment of pathology.

The influence of some factors of military service on quality of life of the military personnel in the Arctic zone of the Russian Federation was investigated. It was revealed that statistically significant correlation with the overall assessment of quality of life had: the degree of satisfaction with the quality and convenience of military uniforms, provision of personal protective equipment, as well as the number of square meters of living area per one family member. A direct statistically significant relationship between the frequency of a positive response to the question about the feeling of cold in the military uniform, corresponding to the season and the frequency of alcohol consumption by servicemen was found. Data were obtained on the difference in the provision of personal protective equipment among various categories of servicemen. A retrospective comparative analysis of the results of similar studies of other authors was carried out. The assessment of the effectiveness of the activities carried out in the Armed Forces of the Russian Federation to improve the quality of life of servicemen is given. The possibility of using the short version of the questionnaire, the World Health Organization for an assessment of quality of life of the military personnel is shown. Additional questions to the questionnaire allow us to assess the dynamic impact of measures to improve the quality of life of servicemen and their families, as well as to search for and eliminate the influence of negative factors of military service, to develop measures to improve the efficiency of military labor, preserve health and stimulate high interest of military personnel in service under the contract in the Arctic zone.

Presented modern advances in personalized medicine, discussed the perspective directions of development of genetics. Prospects of development of translational medicine in the Ministry of defence of the Russian Federation, implementation of technologies of molecular diagnostics and screening of noninfectious pathology at the military personnel, including pathology of system of blood circulation, molecular genetic and cellular mechanisms of development of cardiovascular diseases, regularities of expression (on/off) of genes in a cell are considered. The works of specialists of the Military medical Academy are described. S. M. Kirov in the field of research of molecular genetic polymorphisms in servicemen of the Armed forces of the Russian Federation. The individualization of approaches to the prevention, diagnosis and treatment of noncommunicable diseases in the Armed forces of the Russian Federation is reflected, in particular, the effect on the morpho-functional state of the circulatory system depending on the polymorphism of the genes of the renin-angiotensin-aldosterone system encoding the production of enzymes and proteins involved in the metabolism of lipids, collagen and hemostasis system in servicemen with and without cardiovascular diseases. In addition, the Association with structural polymorphism of angiotensin-converting enzyme genes and features of the structural and functional state of the circulatory system and metabolic status were studied. The stable influence of the genotype of some genes (F7 (R353Q, Exxon 8), LPL (N291S), PON1 (–107C/T) and 5’F7 promoter) on the development of cardiovascular diseases and on the age dynamics of the morpho-functional state of the circulatory system was revealed. Investigated the structural polymorphism of paraoxonase as a risk factor of myocardial infarction in men under 45 years, as well as issues of the effect of Smoking as a risk factor of atherosclerosis to the level of methylation of deoxyribonucleic acid. The issues of development of personalized medicine, improving the quality and availability of medical care for military personnel, as well as the development of high-tech health care, the formation of air medical evacuation, telemedicine and medical decision support system based on artificial intelligence. The perspective directions of development of health-saving technologies in military medicine are planned.

In accordance with the existing guidelines, the implementation of epidemiological surveillance of the outcomes of surgical interventions is a complex and time-consuming process, requiring large human and time resources. One of the tools for obtaining operational information on the state of the epidemic process of nosocomial infections in military medical organizations is the introduction into practice of an electronic medical record of an inpatient patient, which is a collection of electronic personal microbiological medical data relating to a patient that is collected and used in a medical organization. An approach to the development of medical and technical requirements for the creation of an automated information system for processing the results of microbiological research in the military medical organizations of the Ministry of Defense of the Russian Federation in modern conditions is considered. The development and implementation of an automated microbiological monitoring system will allow for continuous monitoring of the microbial landscape and the sensitivity of the selected microflora both in а hospital as a whole and in each department separately. With its help, we can get information about the leading microflora, depending on the type of pathology and even on specific diagnoses. Knowledge of the leading microflora and of an antibiotic sensitivity’ level directs doctors to conduct adequate antibiotic prophylaxis and rational therapy of severe patients before receiving an antibiogram, and this is the basis for developing algorithms for rational antibiotic therapy of specific nosological groups of diseases for each hospital. Multicomponent database program will allow predicting the possible outbreak of nosocomial incidence in a particular compartment in respect of a particular pathogen. In addition, this information can be used in planning the procurement of the most effective antibacterial drugs for specific hospitals and regions.

The expediency of introducing of personalized approach to the organization of medical rehabilitation for military personnel of the Armed Forces of the Russian Federation in medical resort organizations of the Ministry of Defense of the Russian Federation was scientifically justified. It has been established that among all security agencies the Ministry of Defense of the Russian Federation has the most developed network of sanatorium-resort organizations. The latter includes 40 sanatoriums, 11 houses and recreation centers, sanatorium-resort treatment in which annually passes over 200 thousand military personnel, pensioners of the Ministry of Defense of the Russian Federation and members of their families, as well as persons of civilian personnel of the Ministry of Defense of the Russian Federation. It was established that in the structure of patients who underwent medical rehabilitation in military sanatoriums in 2018, contract servicemen and members of their families accounted for 51%, conscription soldiers – 34%, pensioners and members of their families – 15%. In the group of patients whose organization and conduct of medical rehabilitation was carried out using personalized approaches, medical rehabilitation was highly effective in 46,2%, moderately effective in 50,9% and low effective in 2,9% of cases. The indicated distribution was significantly (p<0,05) different from the comparison group (37,5; 57,3 and 5,2%, respectively). In general, it is necessary to further improve organizational approaches to the medical rehabilitation of servicemen, pensioners of the Ministry of Defense of the Russian Federation and their family members after inpatient treatment. The introduction of common methodological approaches with the use of personalized technologies for organizing and implementation of medical rehabilitation will significantly improve the efficiency and quality of rehabilitation measures, make rational use of hardware and personnel of military medical resort organizations in accordance with the patient’s disease profile, and the availability of this type of medical care for all categories patients.

The analysis of the general morbidity in the military educational organization for the period from 2013 to 2018 has been carried out. The level, structure and dynamics of the general morbidity of conscripts and under the contract of the military educational organization have been evaluated. It has been established that the most relevant for the military educational organization are diseases of the chapter X «Diseases of the respiratory system» according to the International Statistical Classification of Diseases and Related Health Problems 10th revision. It was revealed that acute sinusitis, acute tonsillitis and other diseases belonging to block «Acute upper respiratory infections (J00–J06)» (acute pharyngitis, acute nasopharyngitis, acute laryngitis and tracheitis, etc.) prevail in the structure of respiratory diseases. At the same time, the dynamics of the incidence of diseases of the respiratory organs of conscript servicemen tends to increase, and contracted servicemen tend to decrease. We believe that the high prevalence of these diseases in organized military squad is associated with the impact of a complex of various factors, such as living conditions, the specific nature of military professional activities, etc. To improve the health of military personnel in a military educational organization, it is necessary to pay equal attention to measures aimed at eliminating severe risk factors that under certain conditions (stress, weakened immunity, excessive physical and mental stress) can cause, aggravate, and recurrence of the disease, and to prevent the occurrence and risk factors influence the development of disease (vaccinal, rationalization of labor conditions, leisure, nutrition and physical activity). The conducted studies create prerequisites for further targeted optimization of the system of epidemiological surveillance of respiratory diseases and the improvement of preventive measures.

The system of medical support for the flight of state aviation, which has developed over 110 years of aviation medicine, ensures, above all, the preservation of the professional performance of flight personnel. Currently, the system includes three mandatory phases: annual medical examination, dynamic medical monitoring during the intercommission period and pre-flight medical examination. Strict observance of all medical rules allows to exclude cases of violation of professional performance, as well as the development of pathological conditions in pilots during flight operations. At the same time, airplanes and helicopters of state aviation are increasingly used not only for transporting personnel, but also for evacuating people from natural disasters, in the event of a terrorist threat, and in other urgent situations. In this case, the decision to evacuate patients suffering from pathology of the circulatory and respiratory systems is taken by the physician who provides medical flight support. However, there are situations in which aviation medical evacuation of patients is carried out unaccompanied by medical personnel. Existing diseases of the circulatory and respiratory systems are quite diverse and are found in a large number of passengers of air transport, especially in the elderly. The growing popularity of diving under water, as one of the types of leisure, also requires careful attention to the issues of safe travel of such persons in the near period after diving. The world experience of air travel for people suffering from various pathologies consists in the availability of recommendations for such patients from various medical communities, but there is no single view on these issues. On this basis, it is necessary to develop certain standards for medical support of aeromedical evacuation.

Nonalcoholic fatty liver disease is currently considered as the most common disease of the liver and internal organs. Its close connection with diabetes mellitus, obesity, atherosclerosis, arterial hypertension, chronic kidney disease, rectal cancer, polycystic ovaries, psoriasis, etc. Nonalcoholic fatty liver disease includes various chronic clinical and morphological changes of liver parenchyma: steatosis, steatohepatitis, fibrosis, liver cirrhosis and hepatocellular carcinoma. According to the large-scale epidemiological studies, the prevalence of the nonalcoholic fatty liver disease in Russia currently stands at 37,1%. In the strategy of diagnosis of this disease, it is necessary to exclude alcoholic liver disease, chronic viral hepatitis, metabolic diseases, autoimmune liver diseases, taking medications, the effect of alimentary factor, etc. the methods used to exclude alcoholic liver damage with the help of international validated questionnaires are given in Detail. The most characteristic shifts in laboratory parameters of biochemical blood analysis, as well as the calculated diagnostic indices, such as the index of fatty liver, the index of nonalcoholic fatty liver disease, the index of liver steatosis, steatotest, the index of fibrosis of nonalcoholic fatty liver disease, FibroMax and others are shown. The instrumental methods of diagnosis of nonalcoholic fatty liver disease are described in detail: ultrasound, computed tomography, morphological examination of liver biopsies, determination of the parameter of controlled attenuation of the ultrasonic wave in the liver tissue using fibroscan. For the purpose of non- invasive determination of fibrosis degree different variants of elastography are used: transient, acoustic pulse wave, magnetic resonance. The most sensitive and specific methods of diagnosis of non-alcoholic fatty liver disease are selective magnetic resonance imaging with quantitative determination of fat and proton magnetic resonance spectroscopy. These techniques are practically not used in normal clinical practice due to the complexity and high cost of the equipment.

The key stages of the medical care organization for the ambusted people after the gas explosion in Bashkiria in 1989 were investigated. The medical and geographical factors that determined the features of rescue operations were indicated. The chronological arrival of the first groups of volunteers, rescuers and medical workers to the place of emergency was presented. The information on the victims’ evacuation in local, regional and national standing hospitals was also presented. The decisions made by the leadership and command of the Union of Soviet Socialist Republics Ministries of Health and Defense to create the necessary group of medical forces and vehicles to help the victims of the accident were highlighted. The contribution of medical service specialists from both the Union of Soviet Socialist Republics Armed Forces and civil health in carrying out of medical and evacuation measures was emphasized. Their mobility and high professional training made it possible to provide timely and quality assistance to the burned. The obtained scientific and practical experience contributed to the further improvement of doctors’ professional skills who have not previously faced with such a massive admission of victims with thermal trauma after emergencies. The effective use of helicopters as vehicles for transportation of injured people from the accident site to the medical institutions, especially from difficult access areas was emphasized. The data of various authors on the victims’ statistics and their subsequent distribution to specialized ambustial in-patient facilities of the country was presented.

Parkinson’s disease is the second most important neurodegenerative disease and the main cause of disability and reduced quality of life, steadily progressing with a wide range of motor and non-motor disorders. Currently, the diagnosis of Parkinson’s disease is based on clinical criteria and can be confirmed only after the death of the patient on the basis of a pathological study of the brain, allowing to identify incorrectly folded α-synuclein protein as Levi cells associated with the loss of nerve cells in the substance of the nigra. In vivo, diagnostic biomarkers of Parkinson’s disease are currently virtually absent, which to some extent makes it difficult to identify patients at the preclinical stage prior to the loss of nerve cells in the nigra substance. Biomarkers of Parkinson’s disease are necessary to identify risk groups for this disease, monitor the progression of the disease and evaluate the effectiveness of therapeutic measures. The accumulation of α-synuclein is not limited to the Central nervous system. Aggregates of α-synuclein are detected in the peripheral nervous system. Experimental and pathomorphological data show that the accumulation of α-synuclein aggregates plays a key role in the development and progression of neurodegenerative diseases, including Parkinson’s disease. It is shown that α-synuclein pathology can begin and initially be detected not in the brain, but only in other organs and systems of the body, for example, in the gastrointestinal tract, in the prodromal phase of Parkinson’s disease long before it reaches the brain. According to one of the modern hypotheses, α-synuclein aggregates are initially registered in the peripheral nervous system as a result of certain external or genetic influences, and subsequently spread to the Central nervous system by means of pre-ganglion branches of ntrvus vagus. This hypothesis is confirmed by certain evidence in vivo, indicating that the progression of pathology from the periphery to the Central nervous system is due to intramuscular and intragastric injections of α-synucleic fibrils, or vagotomy, which significantly reduces the risk of Parkinson’s disease. Currently, α-synuclein is a potential biomarker of Parkinson’s disease. However, there is no clear information on the extent to which itsdetection in the biological fluids of the macroorganism in the absence of clinical manifestations of the disease can have diagnostic value and contribute to the earliest possible diagnosis of Parkinson’s disease.

Cardiovascular diseases caused by atherosclerosis and thrombosis continue to be the main causes of hospitalizations, disability and mortality rates throughout the world. Their development depends on many factors, among which the leading role belongs to dyslipidemia. It is well known that dyslipidemia is extremely heterogeneous and includes a wide range of disorders that are of great importance in the development and progression of cardiovascular diseases. Therefore, the correction of dyslipidemia is an essential element in reducing the risk of cardiovascular complications. Of all the classes of hypolipidemic agents, statins have the greatest evidence base for improving outcomes of cardiovascular diseases. A huge number of controlled clinical trials performed with these drugs, as well as a long experience of their real use in the clinic, made it possible to rather strictly formulate the basic principles of their use and control over their effectiveness and safety. Thus, assessment of the quality of therapy with statins and its compliance with the recommendations is an urgent task. In clinical practice, many patients with indications do not receive statins at all or rarely achieve «target values» of lipids, including due to low adherence to prescribed therapy. In addition, some doctors in practice do not always adhere to the requirements of clinical recommendations. Numerous studies conducted in various countries have shown that the measures taken to correct the risk factors for cardiovascular diseases are not sufficiently adequate and effective. This problem in one degree or another exists in all countries, but in Russia it is particularly relevant.

The organization of training of military medical specialists in the simulation center of the Military Medical Academy named after S. M. Kirov. The characteristic of specialized modules of simulation training, as well as the main stages of training students on simulation equipment. It is established that an important direction of improving the educational process in the training of military medical personnel is the need to significantly enhance the practical experience while maintaining the proper level of their theoretical knowledge. Thus, between the theoretical and practical training of medical specialists in the clinic, reasonably take their place mandatory modules of simulation training. Unlike the training of medical specialists for civil health, training on simulation equipment of military medical specialists has its own characteristics. Thus, simulation training for medical specialists of the Armed forces of the Russian Federation is carried out consistently and includes: development of basic skills: dressing wounds, the basics of nursing care, development of catheters, the production of enemas, intravenous and intramuscular injections, Heimlich maneuver, etc.; development of cardiopulmonary resuscitation skills of suturing, the tourniquet, the elimination of pneumothorax, mastering the skill of konikotomia and thoracocentesis, etc.; development of therapeutic and surgical skills (auscultation on the patient simulator, «Physics», basic surgical skills in a simulated «Traumaman» and «Lapsim»), skills for birthing, etc.; individual development of specialized medical skills (depending on the specialty): laparoscopic surgery, traumatology, ophthalmology, etc.; development of team work methods (hybrid operating room, etc.). In addition, the features of training medical specialists of the Armed forces of the Russian Federation on the simulation equipment is the need for practical training in the field (i.e. in conditions really close to combat), in accordance with the official purpose of graduates. To practice the skills of medical care in the military field is used Autonomous robot simulator class 6 realism «Caesar», which has a high margin of safety and is designed for use in difficult conditions.

The article describes the most important events in the history of blood transfusions tied with the Military Medical Academy. Among them is the first successful direct blood transfusion from person to person in Russia on April 8 (20) 1832 by the obstetrician of the Department of Midwifery, medicine and medical police of the Imperial Medical-Surgical Academy A.M. von Wolf and the difficult path of public recognition of this event with the complete scientific destruction of the author on the pages of the Military Medical Journal. Various facts, in contrast to earlier publications, were reconstructed from original sources, earlier if cited, then from later descriptions, which is why they are often incorrect. The background of the most important event in domestic surgery and transfusiology on June 23, 1919 in the hospital surgical clinic of the Military Medical Academy, Professor S.P. Fedorov – the country’s first blood transfusion with regard to group compatibility, made by V.N. Shamov and his assistants, N.N. Elansky, I.R. Petrov, P.Ya. Stradin and S.V. Geynac. Compared with the United States, the obtained sera showed full compliance with the United States, which was of tremendous importance not only for medicine but also for the economy of the young Soviet State. All participants in this study subsequently made a significant contribution to the development of not only domestic transfusiology but also surgery in general.

A historical analysis of the teaching of botany in the Military Medical (Medico-Surgical) Academy was conducted. The key periods of the formation and development of teaching botany in the Medico-Surgical Academy, then in the Military Medical Academy are highlighted. The teaching of botany in the Medico-Surgical Academy has been conducted since the foundation of the Academy (1798). The training of specialists in the field of pharmacy began in 1808, when a pharmaceutical department was opened at the Imperial Medical-Surgical Academy. The role of botany as a propaedeutic discipline for teaching pharmacognosy (the science of medicinal plants) is shown. The history of the creation and design of the Pharmaceutical Garden (the first botanical garden in the Russian Empire) and the Botanical Garden at the Medical-Surgical Academy (1843) is described. In 1860, an independent department of botany, phytomy and phytophysiology was opened. Analyzed the contribution of many famous scientists of the time in the formation and improvement of the teaching of botany in the Medical-Surgical Academy. The technique of teaching botany by specialists in the field of botany and pharmacy is described. The historical connection of botanist scientists of several generations, the relationship of teaching botany to teaching related disciplines in this historical period is shown. In 1930, the Department of Botany ceased to exist independently; The course of botany was taught in different departments. Since 1952, a separate course of botany has been abolished, and the botanical section was included, as a component, in the course of general biology. From 2013 to the present, the Academy has been training cadets and students in the specialty «Pharmacy». The curriculum for students in this specialty provides for the study of botany in the form of a separate course.

The information about the life of a prominent maxillofacial surgeon and dentist, one of the patriarchs of domestic dentistry, World War II veteran, doctor of medical sciences, assistant professor, colonel of medical service Yakov Emmanuilovich Bronstein, who stood at the origins of domestic dentistry and was among the first who created domestic military dentistry. The data on the formation of Ya.E. Bronstein as a military doctor, dentist and maxillofacial surgeon, his combat career during the Soviet-Finnish armed conflict and the Great Patriotic War. Turning to the life and professional and social activities of Yakov Emmanuilovich, one can find not only interesting scientific facts from the history of dentistry and maxillofacial surgery, but also analogies with modernity, answers to many clinical problems of the specialty and medicine of today. The main directions of his scientific activity, which touched the questions of practically all sections of oral and maxillofacial surgery, are noted. His research is devoted to the study of the pathogenesis of the main pathology of the teeth – caries and periodontal pathology, as well as topical issues of maxillofacial, reconstructive and plastic surgery of the face and jaws. A great contribution was made by Ya.E. Bronstein in the study of the dental aspects of aviation medicine – identifying the role of hypoxemia and the emotional factor in the origin of endogenous hypo-and avitaminosis C, as well as the significance of massive doses of ascorbic acid in raising the «ceiling» in pilots and in preventing and treating periodontal diseases. Trudy Ya.E. Bronstein was one of the most important in the creation of Professor D.A. Entin first national theory of dental caries, as well as the development of the pathogenesis of periodontal disease. It is noted that Ya.E. Bronstein was a refined expert in the history of Russian military dentistry, maxillofacial surgery and a true professional in these medical specialties. Associate Professor Ya.E. Bronstein did not create his own scientific school, but being one of the founders of domestic dentistry and military dentistry of our country, as well as the school of military dentists and maxillofacial surgeons, should rightfully be recognized as one of the patriarchs of domestic dentistry.