Vol 22, No 2 (2020)

. We consider the possibility of optimizing the diagnosis of infection caused by SARS-CoV-2 using polymerase chain reaction in a multi-specialty hospital, repurposed for the treatment of COVID-19 patients, using the example Of the military medical Academy named after S.M. Kirov. The analysis of scientific publications selected in accordance with the purpose of the study, analyzed data from 218 samples of polymerase chain reaction in patients with COVID-19, who were in the clinics Of the military medical Academy named after Sm. Time intervals were established depending on the clinical forms and severity of the infectious process, in which the probability of a positive and negative result of a polymerase chain reaction to SARS-CoV-2 RNA was maximum and minimum. It was shown that during the examination and treatment, molecular biological diagnostics were performed excessively (4 times in more than 50% of patients) and in 97,3% of patients unreasonably early (8,5±0,4 days). At the same time, the highest frequency of negative results of polymerase chain reaction to SARS-CoV-2 RNA was observed in the period from 9 to 10 and from 12 to 14 days, while it depended on the clinical form and severity of the infectious process. In this regard, the volume diagnosis using polymerase chain reaction should be reduced and to conduct research when entering the hospital, on the 9th-10th day (in patients inapparently forms and acute respiratory diseases, lung flow) and 12–14 days before discharge in patients with moderate and severe course of the infectious process.

Аbstract. We consider the possibility of optimizing the diagnosis of infection caused by SARS-CoV-2 using polymerase chain reaction in a multi-specialty hospital, repurposed for the treatment of COVID-19 patients, using the example Of the military medical Academy named after S.M. Kirov. The analysis of scientific publications selected in accordance with the purpose of the study, analyzed data from 218 samples of polymerase chain reaction in patients with COVID-19, who were in the clinics Of the military medical Academy named after Sm. Time intervals were established depending on the clinical forms and severity of the infectious process, in which the probability of a positive and negative result of a polymerase chain reaction to SARS-CoV-2 RNA was maximum and minimum. It was shown that during the examination and treatment, molecular biological diagnostics were performed excessively (4 times in more than 50% of patients) and in 97,3% of patients unreasonably early (8,5±0,4 days). At the same time, the highest frequency of negative results of polymerase chain reaction to SARS-CoV-2 RNA was observed in the period from 9 to 10 and from 12 to 14 days, while it depended on the clinical form and severity of the infectious process. In this regard, the volume diagnosis using polymerase chain reaction should be reduced and to conduct research when entering the hospital, on the 9th-10th day (in patients inapparently forms and acute respiratory diseases, lung flow) and 12-14 days before discharge in patients with moderate and severe course of the infectious process.

The significance of the glomerular filtration rate calculated by the Cockcroft - Gault formula as one of the highly sensitive criteria for assessing renal allograft dysfunction is substantiated. The study demonstrated that in the group of patients with an increased level of daily proteinuria there is a significantly lower level of serum creatine in comparison with the group of patients with a normal level of daily proteinuria. Moreover, in patients with a normal level of daily proteinuria, there are significantly higher values of glomerular filtration rate calculated by the Cockcroft - Gault formula, compared with patients with an increased level of daily proteinuria. Thus, it is shown that the level of serum creatinine currently used in clinical practice, as a laboratory marker of renal allograft dysfunction, does not allow to detect impaired renal allograft function at the earliest possible date. It has been demonstrated that the glomerular filtration rate calculated by the Cockcroft - Gault formula is a highly sensitive and specific laboratory marker of renal transplant dysfunction. Determining the glomerular filtration rate calculated by the Cockcroft - Gault formula makes it possible to diagnose renal allograft dysfunction at the earliest stages, which will significantly improve the survival of the transplanted kidney due to timely changes in patient management tactics and correction of immunosuppressive therapy.

It was found that eye damage can be considered as a marker of neurosyphilis. Similar data regarding the diagnostic value of damage to the ears, nose and throat in patients with syphilis infected with human immunodeficiency virus are single. It was revealed that neurological symptoms in patients suffering from neurosyphilis are equally common in patients infected with human immunodeficiency virus and those not infected with this virus (42,2 and 44,7%, respectively). In other cases, the disease is asymptomatic. At the same time, specific damage to the eyes, ears, nose and throat is diagnosed in 57,8% of patients with neurosyphilis infected with the human immunodeficiency virus. The structure of the specific damage to the ears, nose and throat in patients suffering from neurosyphilis infected with the human immunodeficiency virus is presented in 30,7% of cases with specific angina, in 15,3% - decrease in bone conduction, in 7,6% - hearing loss and in 46, 10% - other unspecified symptoms. The structure of the damage to the organ of vision was papillitis - 38,4%, anterior uveitis and panuveitis - 23,1 and 15,3%, respectively. Neuroveitis, retinal angiopathy, and peripheral chorioretinal dystrophy were equally common in 7,6%. For patients suffering from neurosyphilis infected with the human immunodeficiency virus, a combination of damage to the eyes, ears, nose and throat is characteristic. In particular, in one patient a combination of specific tonsillitis with papillitis was noted, in the other with uveitis. Thus, specific damage to the eyes, ears, nose and throat is characteristic of patients suffering from neurosyphilis infected with the human immunodeficiency virus.

Аbstract. In the process of special training of military servicemen, various elements of the musculoskeletal system of a person are constantly exposed to mechanical loads of various frequencies, intensities and strengths. With such prolonged and shock loads characteristic of military personnel and athletes, permanent minor damage to the bones occurs, which over time can lead to impaired formation of bones and joints, up to the development of the disease. Violation of the motor reactions of the limb ultimately leads to the suppression of the mechanisms of social adaptation, physiological functions and aggravates the course of most diseases, decompensating processes that affect not only the quality of life, but also its duration. A very important point is that labor losses in military personnel during stress fractures can reach 6 months, which negatively affects the service, with a total duration of 12 months of military service. In this regard, questions arise about the advisability of such military servicemen in the army and further spending of budget funds for their maintenance. The stress fractures of long bones are analyzed on the example of fractures of the tibia. It has been established that the greatest number of injuries associated with stress fractures occur during combat training conducted in a special military uniform. A feature of the course of stress fractures is increasing pain in the limb. Among injured with tension fractures, 83,5% of the military did not do the sports before drafting, and physical activity that arose during the service was difficult or not tolerated.

The effectiveness of cytoreductive operations in geriatric patients with stage IV colon cancer was assessed. A comparative analysis of the results of surgical treatment of metastatic colon cancer in patients of various age groups was carried out. The molecular biological properties of colon adenocarcinoma in patients with metastatic colorectal cancer were studied. The clinical significance of immunohistochemical markers as the proliferative index of stem cancer cells (ALDH+Ki-67+) and the chemokine receptor CXCR4 was determined for predicting the long-term results of surgical treatment of patients with stage IV colon cancer has been determined. It was found that the survival rates of elderly and senile patients are not inferior to those in patients under 60 years of age. A comparative analysis of the immediate and long-term results of treatment indicates the effectiveness of cytoreductive interventions in elderly and senile patients suffering from stage IV colon cancer. It was found that the expression level of the receptor for CXCR4 chemokines and the proliferative activity of stem cancer cells correlate with the life expectancy of patients after cytoreductive interventions and can be used to clarify the indications for their implementation.

The results of a prospective study of 66 patients aged 32,6±3,8 years infected with the human immunodeficiency virus who were treated in an anti-tuberculosis medical organization for tuberculosis meningoencephalitis are presented. Of these, 49 (74,2%) were newly diagnosed with tuberculosis, and 17 (25,8%) had relapses and chronic forms of tuberculosis. According to social characteristics, patients were distributed as follows: working - 9 (13,6%), non-working - 57 (86,4%), disabled people with tuberculosis - 4 (6,1%), persons who previously served their sentences in prison - 48 (72,7%). All the surveyed patients had bad habits: they continued to actively use psychoactive substances - 52 (78,8%) people, abused alcohol - 43 (65,2%), smoked - 60 (90,1%). In 97% of cases, tuberculosis of the meninges and Central nervous system was a complication of respiratory tuberculosis: tuberculosis of the intra-thoracic lymph nodes - 42,4%, disseminated pulmonary tuberculosis - 27,3%, infiltrative pulmonary tuberculosis - 22,7%, and caseous pneumonia- 7,6%. The most effective method for diagnosing the tuberculosis etiology of meningoencephalitis in patients infected with the human immunodeficiency virus is the study of cerebrospinal fluid using a polymerase chain reaction. Deoxyribonucleic acid of Mycobacterium tuberculosis was detected in 31 (47%) patients. The characteristics of the cerebrospinal fluid in the examined patients are presented as follows: a decrease in glucose in 45 (68,2%) patients, an increase in protein in 59 (89,4%), and cytosis at the upper limit of normal values in 10 (15,6%). High mortality rates (47,7%) in patients infected with the human immunodeficiency virus in combination with tuberculosis meningoencephalitis are associated with a high degree of immunosuppression.

Currently, explosive trauma is rare in peacetime injury surgery, but is of great importance in the work of surgeons. This is due to damage of a large number of anatomical areas, various damaging factors of the explosion and the simultaneous entering of several victims. The results of forensic medical examinations of 24 corpses of people who died as a result of terrorist acts in the subway of Minsk on 11/04/2011 and St. Petersburg on 03/04/2017 were analyzed. Incompatible with life injuries as the immediate cause of death were found only in 33,3% of cases. Profuse blood loss was the immediate cause of death in 66,7% of those killed. The most common (in 87,5% cases) cause of profuse blood loss was internal bleeding: in 7 (50%) cases - due to damage to organs and large vessels of the chest, in 6 (42,9%) cases - due to combined damage to the anatomical structures of the chest and abdomen, in 1 (7,1%) case - due to damage to the parenchymal organs of the abdominal cavity and retroperitoneal space. The leading role in thanatogenesis during the considered explosive peacetime injuries was occupied by blood loss, its specific gravity was 66,7%. Profuse blood loss in 87,5% of cases was due to damage to the organs of the chest and abdomen. Potentially salvable were 7 (29,2%) dead who received damage to the main vessels of the limbs, damage to internal organs without injuring the heart and large blood vessels. Thus, the development of new ways to stop intracavitary bleeding at the advanced stages of medical care for victims with explosive injuries and injuries is a priority aim.

A clinical case of a relatively rare variant of pneumoconiosis, late silicosis, which developed 25 years after the termination of contact with fibrogenic dust, is described. The patient was examined at the consultative and outpatient department of the North-West Scientific Center for Hygiene and Public Health (the clinical base of the Department of Military Field Therapy of S.M. Kirov Military Medical Academy). It was established that the patient worked for 15 years as a crusher at a mining and processing plant, where the work was accompanied by exposure to dust of fibrogenic action (granite gneiss) containing free crystals of silicon dioxide, noise, vibration and an unfavorable microclimate, and also worked as a repairman for 12 years where it was exposed to abrasive dust, noise and adverse climate. In the general assessment of working conditions, taking into account the combined and combined effects of harmful factors, they are considered harmful to the crusher (class3.3) and acceptable to the crusher / repairman (class 2.0). For the entire period of work of this employee, occupational diseases were not established and he was not referred to a professional pathologist. Based on the study of a professional history, data on the sanitary and hygienic characteristics of working conditions, the results of a clinical examination, including physical and laboratory methods, spirography, fibrobronchoscopy, radiography and computed tomography of the lungs, a diagnosis of late silicosis was established.

The bilateral defect of the pars interarticularis (spondylolysis) is often the cause of low back pain syndrome and can lead to development of spondylolistesis. In some cases inefficiency of conservative treatment of this condition forces orthopedists to use surgical technologies. At the same time, in young patients with intact intervertebral discs, the rigid segmental fixation of the spine should be avoided. Where no neural decompression is needed, selective osteosynthesis of the pars defect is an optimal technique. The authors present the results of surgical treatment of 15 patients with single and two-level lumbar spondylolysis, 4 of which revealed minimal I degree lytic spondylolystesis of the L5 vertebrae. Localization of the pathological process in all patients was noted on both sides. In two patients spondylolysis defects of two vertebrae were detected (in one- adjacent L4 and L5, in the other - L2 and L4 vertebrae with sacralization of L5). The average period from the onset of symptoms ranged from 6 months to 2 years (an average of 14 months). All patients undergone bone autoplasty with iliac crest bone graft, and osteosynthesis of vertebral arches by a combined laminar-transpedicular system of the «screw - rod - hook» type. All patients had excellent and good anatomic and functional results. The used method of surgical treatment of patients of this category should be considered pathogenetically justified, as it is aimed at repair of spondylolytic defects as the main cause of segmental instability and forward displacement of vertebrae. The possibility to avoid fixation of intact segments of spine allows to categorize this operation as organ-preserving.

Abstrаct. The features of the course of chronic obstructive pulmonary disease are considered. It was established that this pathology is widespread in patients with tuberculosis and is determined in one third of patients. Moreover, the combination of respiratory tuberculosis and chronic obstructive pulmonary disease have a mutual aggravating effect, and the patient’s serious condition can be caused by both exacerbation of chronic obstructive pulmonary disease and progression of the tuberculosis process. The severity of the comorbid state is associated with a decrease in adaptive-adaptive mechanisms and a violation of the state of the homeostasis of the body. Patients with a combination of pulmonary tuberculosis and chronic obstructive pulmonary disease are characterized by intense types of adaptive reactions, with their extreme manifestations, a deep and pronounced disturbance in homeostatic balance and a decrease in the reactivity of the body. Such changes are combined with functional disorders of the respiratory system (changes in spirometric indicators, impaired airway, impaired ventilation function and diffusion capacity of lung tissue). The combined course of pulmonary tuberculosis and chronic obstructive pulmonary disease affects the effectiveness of the treatment and its outcome. In patients with comorbid pathology, there is a decrease in the frequency of abacillation and closure of decay cavities, the formation of pronounced residual tuberculous changes in the lungs. At the same time, in patients with pulmonary tuberculosis, chronic obstructive disease has a more severe course, with a pronounced symptom complex and a high probability of frequent exacerbations. In more than half of cases, chronic obstructive pulmonary disease is characterized by an unfavorable course with a high risk of exacerbations, more than twice a year, which is an extremely unfavorable factor for predicting the course of chronic obstructive pulmonary disease and the development of complications. Identified violations impair the quality of life of patients suffering from comorbidity. Therefore, it is diagnostically important to assess the initial state of chronic obstructive pulmonary disease in patients with tuberculosis, to predict its course and the risks of exacerbations.

Based on the analysis of literary sources and the data of our own experimental studies, we examined the features of gunshot wounds of military personnel protected by body armor. The classification of body armor by design is given. In addition, the gradation of body armor according to the protection class according to GOST 34286-2017 is given. It is shown that the widespread use of body armor in modern armed conflicts has led to a noticeable decrease in the frequency of gunshot wounds to the chest. According to the mechanism of the formation of a gunshot injury through a bulletproof vest, three main types of injuries were identified: closed local contusion injury when the bulletproof vest was not broken; a gunshot wound when piercing a bulletproof vest; gunshot wounds due to ricocheting of striking elements from the surface of the body armor (external or internal ricochet). It has been established that closed trauma in case of bulletproof vest penetration can occur both in the form of damage to the skin and subcutaneous tissue with the formation of hemorrhages, and in the form of bruises of internal organs, accompanied in severe cases by ruptures of internal organs (liver, spleen, lungs, etc.), with development life- threatening complications - intense pneumothorax, intra-abdominal bleeding, etc. It is shown that when piercing a bulletproof vest through the wound, in addition to a deformed bullet and clothing elements, fragments of armor can be introduced lei with additional damage. When bullets approach a bulletproof vest at angles of 20 degrees or more, rebound elements of dismantled bullets can occur, which can cause severe damage to both the owner of the bulletproof vest and others.

It is shown that one of the priority areas of the social policy of the Russian Federation is the consideration of improving the drug supply, the rationale for the national drug policy, as well as the introduction of the drug reimbursement (insurance) system, as one of the key mechanisms to increase the affordability of drugs by partially or fully reimbursing their cost citizens when providing medical care on an outpatient basis. It was revealed that in the context of reforming the healthcare system, the specifics of the work of power ministries and departments are not sufficiently taken into account. In this regard, the features have been studied and an assessment has been given of the prospects for introducing drug insurance into military health care as part of project activities, as one of the mechanisms for implementing interagency cooperation in modern socio- economic conditions when reforming drug supply. It is reflected that the introduction of drug insurance mechanisms can increase the availability of drugs, have a positive effect on the health of the assigned contingents, and reduce the frequency and duration of hospitalizations. At the same time, the following were identified as the main prospects and systemic prerequisites for implementation: the need to create a reliable legal basis for the formation and subsequent development of a unified state system of drug supply, taking into account the specifics of military health; transition to a rational system of financing drug supply for the provision of medical care on an outpatient and inpatient basis as part of a project to develop a new model for the provision of primary health care and specialized medical care based on a unified medical and technological hospital base; prospective reduction of expenses for the supply of medical care in stationary conditions; optimal distribution of rights and responsibilities, ensuring coherence between health authorities; prevention of duplication, ensuring equal and guaranteed drug supply for citizens as part of the project to ensure the quality and accessibility of medical care to privileged contingents of the Ministry of Defense of the Russian Federation. A possible model of drug supply for contingents attached to military medical organizations is substantiated when providing medical care on an outpatient basis when introducing a drug insurance system at the state level. The following key elements of a grounded model are described: adjustment of drug supply management; clarification of the categories of assigned contingents; optimization of the order of dispensing of drugs; the formation of restrictive lists of drugs; optimization of financing.

A model of the process of metrological control of measuring instruments is presented. The model includes 6 or9 stages, depending on the results of metrological control. Based on the list of measuring instruments, a contract is concludedfor metrological control. After the conclusion of the contract, the collection of documents necessary for verification iscollected. Further, the measuring instruments are transferred to an accredited organization. An accredited organization carriesout verification. If, according to the results of verification, the tool is deemed suitable for use, then the stage of obtainingconfirmation of the verification is carried out. The output at this stage will be a verification certificate. If, according to theresults of verification, the measuring instrument is not suitable for operation, then the stage of canceling the verificationcertificate is carried out. The next steps in this case are to receive notice of unsuitability for use and write-off of the measuringinstrument. At this process is considered complete. The target indicators (indicators) of the process are: the measurementerror of specific measuring instruments within the established limits. Monitoring (control) of the process is carried out bya metrology engineer of a medical organization. Control methods are: control of the calibration intervals of measuringinstruments. The model is recommended as a model for use in medical organizations. The use of this model in the presenceof a target indicator (indicator) of the process of metrological control will ensure the necessary quality of metrological workin a medical organization within the framework of the internal quality control system.

Currently, much attention is paid to the preservation of vision in the Russian Federation. Of particular importance are corneal diseases requiring surgical treatment (keratoplasty). In this regard, the identification of problems in the organization of specialized ophthalmic care for patients in need of keratoplasty is extremely relevant, and their solution will ensure the proper level of quality and accessibility of medical care provided to them. A survey of 840 ophthalmologists from different regions of the Russian Federation was conducted. Problems with obtaining donor material (53,6 per 100 respondents), inaccessibility of keratoplasty in the region (28,6 per 100 respondents), imperfection of the legal framework for corneal transplantation (26,2 per 100 respondents), long waiting times for the operation were identified patients (22,6 per 100 respondents), the lack of equipping a medical organization with modern medical equipment (20,2 per 100 respondents) and an insufficient number of quotas for operations (20,2 per 100 respondents). The absence of a donor tissue bank significantly affects the availability and quality of specialized ophthalmic medical care and requires the adoption of appropriate organizational measures. Experts note the need to provide medical organizations with an adequate amount of donor material. In this case, the improvement of the regulatory framework governing the issues of donation and corneal transplantation is of great importance. The creation of tissue banks in various constituent entities of the Russian Federation will shorten the waiting time for keratoplasty by patients and increase the degree of satisfaction rendered to them by medical care.

Professionally important qualities of aviation doctors that have a direct impact on flight safety have been investigated. It was established that in the practice of an aviation doctor out of 200 professionally used bathrooms, only 99 turned out to be professionally important and noted as desirable. Of these, 26 competencies are necessary. It was found that out of 99 desirable professionally important qualities, organizational qualities are one of the main (30,3%) and become the main and determining (53,8%) of the 26 necessary professionally important qualities. The latter included: a high level of responsibility for the work performed, a small impossibility, the ability not to succumb to someone else’s influence, especially on the part of reputable persons, discipline, demanding, the ability to defend his point of view before the command, integrity, readiness and ability to accurately perform the prescribed actions and instructions, the ability not to prevent himself from working even to immediate superiors. Also, among the 26 necessary professionally important qualities, the second most important for flight safety are the qualities characterizing cognitive processes (15,4%), and the qualities characterizing knowledge (11,5%) become the third. The absence of negative moral attitudes such as the admissibility of material remuneration for professional services in addition to wages and a tendency to dependent behavior (gambling, psychostimulants, alcohol intake, tobacco smoking, Internet addiction, sexual or food dependence) plays an important role in the practical work of the aviation doctor. At the same time, the presence of such personality features as risk propensity and acceptance in relation to people are undesirable in medical safety assurance of flights.

The dynamics and structure of the dismissal of officers and military personnel of the Russian Armed Forces for health reasons in 2003-2018 are analyzed. It was established that the average annual dismissal rate for officers was7,98±1,10‰, contract servicemen 3,92±0,32‰, conscripted military personnel 17,57±1,19‰, female military personnel9,14±1,37‰. The polynomial trend of dismissal of all categories of military personnel showed decreasing trends. The level ofdismissal of military personnel by the leading classes of diseases and nosologies (groups in chapters) is presented. The indicatorsof the causes of dismissal were correlated with the chapters and nosologies of the International Statistical Classification ofDiseases and Health Problems, 10th revision. The 1st rank of dismissals for health reasons for officers was taken by indicatorsof diseases characterized by high blood pressure (I10-I15), the 2nd - coronary heart disease (I20-I25), the 3rd - diseases ofthe esophagus, stomach, and duodenum (K20-K31); contracted military personnel have diseases of the esophagus, stomachand duodenum (K20-K31), diseases characterized by high blood pressure (I10-I15), neurotic, stress-related, and somatoformdisorders (F40-F48); in conscripted servicemen - neurotic, connected stress, and somatoform disorders (F40-F48), diseasesof the esophagus, stomach, and duodenum (K20-K31), behavioral disorders in adulthood (F60-F69); among female militarypersonnel obesity and other types of excess nutrition (E65-E68), diseases characterized by high blood pressure (I10-I15),inflammatory diseases of the female pelvic organs (N70-N77). Prevention, timely treatment and rehabilitation of leadingnosologies will contribute to improving the health and professional longevity of the Russian Armed Forces.

The factors of the formation of primary disability in the former military personnel in the Republic of Dagestan were studied according to the appeal to the bureau of medical and social expertise over 5 years (from 2014 to 2018). The article analyzes gender and age indicators, social affiliation, causes of disability, nosological diseases of military personnel that led to disability, severity by disability group and others. An analysis of the disability indicators of former military personnel in the Republic of Dagestan as a large subject of the North Caucasus Federal District of the Russian Federation is important for organizing measures to continue previous professional activities for persons with limited ability to work. The revealed complex of socio-hygienic and medical-social indicators made it possible to determine the directions of labor and social integration of persons with disabilities from among former military personnel in society. The social indicator established in more than half of disabled people, the place of residence in rural areas, made it possible to recommend self-employment in the agricultural areas of activity (animal husbandry, vegetable growing, fruit and berry processing), in the service sector, and small business, including those related to revival and development of national Dagestan crafts. The state program «Accessible Environment» (2011-2020-2025) emphasizes the need to take into account the regional characteristics of primary and general disability, the national specifics of the development of territories. In this regard, the results of medical and social analysis allow us to more accurately determine the direction of the organization of labor and social integration of persons with disabilities from among former military personnel in the Republic of Dagestan.

The concept of «norm» is the key to biology and medicine. Recently, the norm has been associated with harmony. That which leads «opposites» to unity is harmony. It is closely related to the proportion of the golden ratio. The golden ratio is the basis of human health. Deviations from it can be used in medicine to diagnose pathological conditions. This fully applies to the work of the heart. The mathematical expression of harmony, symmetry is a method of assessing the norm of the heart. The golden proportion is manifested in the relationship of the temporal parameters of the cardiocycle, volumes of the left ventricle, types of blood pressure: pulse, diastolic, systolic. It was found that the golden proportions of systole, diastole and cardiocycle close to 0,382,0,618 are observed in men with a heart rate of 65 beats/min, in women - 55 beats/min. This mode of work of the heart corresponds to the rest of the body and is the norm. During physical activity, changes in the parameters of the cardiocycle occur (symmetry transformation). Violations of the golden relationship of the phases and the cardiocycle indicate damage to the heart. The magnitude of these deviations from the golden ratio depends on the severity of heart failure. Golden harmony in healthy people can be traced in the relations between the volumes of the left ventricle. These relationships are the ideal norm. Deviations in the relationship of volumes from golden ratio are a manifestation of pathology. Based on the principle of golden symmetry in healthy people, the normal EF is 62±3%, and not 50-80% as is accepted in practice. It is not an indicator of the norm. The mechanical activity of the heart is also determined by the laws of harmony. Pulse, diastolic and systolic blood pressure in healthy individuals are among themselves in the golden ratio (0,618). Violations of golden ratio are found in unstable forms of hypertension and damage to the heart muscle. Golden symmetry is the basis of the reference of the norm and the identification of pathologies of the human heart.

There are considered the factors affecting the choice of an antibacterial drug for antibacterial therapy, based on the analysis of the material. The analysis of these factors was provided. The most problematic pathogens of pleural empyema are non-fermenting gram-negative bacteria: P. aeruginosa, Acinetobacter spp.; Еnterobacteriales: K. pneumoniae, Escherichia coli, Enterobacter spp., Proteus spp.; gram-positive cocci: Staphylococcus spp., Streptococcus spp., Enterococcus spp.; anaerobic bacteria: Bacteroides spp., Clostridium spp., Fusobacterium spp., Peptococcus spp., Peptostreptococcus spp. Most authors note an increase of antibiotic resistance in pathogens of pleural empyema, which significantly complicate the choice of antibacterial therapy. It was revealed that the choice of drug for antimicrobial therapy should be justified on the basis of a systemic, integrated approach taking into account the etiology of the pleural empyema, the severity of the patient and concomitant pathology. The main factors influencing the choice of antibacterial drug are the origin of pleural empyema (in-hospital or out-of-hospital), the presence of previous admissions, the previously provided antibacterial therapy and the results of stratification of patients by the risk of polyresistant microflora. With the appearance of clinical signs of the in-hospital pleural empyema the choice of antibacterial drug for antimicrobial therapy should be made taking into account clinical and epidemiological data and the results of microbiological monitoring in the hospital.

The basic physiological functions of stem cells are given: the ability to reproduce and generate offspring, which are manifested at the level of the population, and not of a single cell. The manifestation of these functions depends on the quantitative and qualitative composition of the microenvironment. Stem cells consist of two fundamentally different types: pluripotent, which exist only in vitro (in vitro) and tissue, existing in the postpartum body (in vivo). Stem cells can be replaced without limitation in vitro and lead to the appearance of a wide range of cell types. Tissue stem cells under normal conditions do not generate cells characteristic of other types of tissue. Stem cells include cells capable of expressing the gene products characteristic of them. However, there is no universal marker to differentiate stem cells from non-stem cells. A key marker of pluripotency is the transcription factor - a pituitary-specific transcription factor is positive. A component that can be found in almost all types of stem cells is the telomerase complex. Another stem cell marker is called CD34 glycoprotein. The functional activity of stem cells is associated with a molecular marker referred to as leucine-rich repeat containing G-protein bound to receptor 5. However, other types of cells do not express this marker. The physiological capabilities of stem cells depend both on the cells themselves and on their environment. The most reliable way to identify stem cells is to determine their phenotype in vivo. This suggests that stem cells do not carry a universal molecular marker. Most likely, they have significant differences from transplanted cells, and these differences cannot always be detected in individual cells, but only at the population level.

The modern views and approaches to the management of patients with precancerous conditions and changes in the gastric mucosa are analyzed. There are no national or international recommendations for the management of this category of patients. Several draft recommendations have been published over the past 10 years, but the most noteworthy are the so-called recommendations for the management of precancerous conditions and stomach lesions (2012 and 2019). Representatives of the European society of gastrointestinal endoscopy, the European group for the study of Helicobacter pylori and the microbiota of the European society of pathologists participated in the development of these recommendations. The recommendations are supported by a number of major studies in accordance with the principles of evidence-based medicine. The problem of oncological diseases of the gastrointestinal tract always remains one of the most significant unsolved problems of world health. Today, the issue of timely diagnosis of precancerous conditions is acute. They include harmless, at first glance, conditions that do not have pronounced symptoms, but bring significant inconvenience to the patient’s life. This is what allows precancerous conditions to progress, to transform from benign to malignant neoplasms. There is only one way to prevent the process of cancer formation: timely detection and treatment of precancerous diseases. This is one of the most important tasks of a General practitioner. The constant search for ways to solve the problem of cancer determines the choice of successful, timely tactics of patient management and its favorable outcome. The presented data can be used in practice by internists and gastroenterologists.

Burn injury is a serious problem with high morbidity and mortality. Burn injury outcomes are the most important indicators of research results and an important criterion for decision making in clinical practice. The presence of dozens of prognostic techniques indicates the absence of an «ideal» model for predicting the outcome of burns, as evidenced by the need to validate them in each burn center. The use of prognosis models for clinical purposes allows you to determine the risk of mortality of an individual patient, that is, the severity of his condition. However, point scales do not allow to determine the severity of the condition of groups of patients. Moreover, the achievement of most of the stated goals of the forecast becomes impossible. A methodological error lies in the violation of the sequence of actions during the experiment. First of all, it is necessary to stratify research groups according to the severity of the condition, and only then study their characteristics. However, none of the known forecast models makes it possible to determine the severity of the condition of a group of patients, and, therefore, to stratify them for research purposes. Given the structure and methods of creating models of hope for multicenter randomized prospective studies, which are expected to improve their quality, are not justified. The criterion for creating the best model is its optimality, which allows forecasting to determine the severity of the condition in order to achieve maximum practical benefit. With its help, it becomes possible to plan experiments and solve real problems of combustiology. This model will allow you to create practical recommendations and standards for the treatment of burns.

Hero of the Soviet Union Efim Anatolyevich Dyskin - a prominent domestic scientist and teacher of higher education, head of the department of normal anatomy (1968-1988), Honorary Doctor of the Military Medical Academynamed after S.M. Kirov, major general of the medical service. Professor E.A. Dyskin is the founder of the new scientific direction «Anatomy and Military Medicine». At the age of eighteen E.A. Dyskin volunteered for the front, participated in battles to defend Moscow. On November 16, 1941, he accomplished a heroic feat, for which he was posthumously awarded the title of Hero of the Soviet Union. However, after a serious wound, the Red Army soldier Dyskin survived, was treated in hospitals for about a year, at the same time he graduated from the feldsher school, from 1942 to 1947 studied at the Military Medical Academy. After graduating from the Academy from 1948 to 1968 E.A. Dyskin worked under the direction of Professor A.N. Maksimenkov a at the Department of Operative Surgery and Topographic Anatomy, where he went from an adjunct to a professor. In 1968 he was appointed as a head of the Department of Normal Anatomy, which he directed for 20 years.He created a scientific anatomical school that developed pecularities on the morphology of various types of gunshot wounds and the effects of extreme factors of military labor on the human body. Under his leadership, research was also conducted to study the state of collateral circulation, the functional anatomy of the digestive system, craniology, and the history of military medicine. Scientific ideas of Professor E.A. Dyskin continues to develop in the writings of students and followers at the Department of Normal Anatomy, and neuromorphology - at the Department of Nervous Diseases of Military Medical Academy.

Was established that the prototype of anatomical theaters in Russia was the anatomical theater of Leiden University (Holland), built in 1575. This theater is shown in color engraving of Cornelius Woodan, created in 1610. In St. Petersburg, at the Department of Anatomy and Physiology of the Imperial Medical and Surgical Academy, this engraving was received in 1805 as part of the collection of the anatomist V. Kruikshenk, acquired for the academy with the direct assistance of Emperor Alexander I. In Russia, the first anatomical theater appeared only in 1708. It was created at the Moscow Medical and Surgical Academy. Historians connect his appearance with a visit in 1697 by Emperor Peter the I of Leiden University. In St. Petersburg, the history of anatomical theaters dates back to the PetrovskayaKunstkamera, built in 1722. It demonstrated rarities - «freaks», and also heard scientific reports. Russian anatomical theaters as an arena for the production of public spectacular autopsy did not receive their development but became an integral part of the anatomy department at higher educational institutions. Such an anatomical training theater was built at the foundation of the Imperial Medical and Surgical Academy on the right bank of the Neva in a stone two- story building. The first head of the Department of Anatomy and hysiology, P.A. Zagorsky took part in its design and equipment. Zagorsky. There was a table in the center of the amphitheater, the dimensions of which made it possible to demonstrate a whole corpse at a lecture, to conduct physiological experiments. In this amphitheater, lectures were given by Professor P.A. Zagorsky, I.V. Buyalsky, P.A. Naranovich. It lasted until 1871. The creation of a new anatomical theater in Imperial Medical and Surgical Academy is associated with the name of Professor V.L. Gruber, who after N.I. Pirogov headed the Anatomical Institute. In 1857, V.L. Gruber visited 13 anatomical institutes in Germany and in his trip report substantiated the idea of building a new anatomical building - a specialized Anatomical Institute. V.L. Gruber report was approved by the Academy Conference, headed by its head - P.A. Dubovitsky. In 1864, the building was laid, the construction of which was completed only in 1871. The construction was carried out under the guidance of an engineer - captain of the academician of architecture K.Ya. Sokolova. In this three-story building, the current Anatomical building, two classrooms were built in each wing - № 1 and № 2. They look like an amphitheater and are a prototype of the best European anatomical theaters. Currently, overhaul has been carried out in this building; the design of the anatomical theater has been preserved in classrooms 1 and 2. These auditoriums, which are a historical monument of the Imperial Medical and Surgical Academy, are equipped with modern technical training aids. It is in these classrooms that cadets and students of the S.M. Kirov Military Medical Academy are currently starting their journey into medicine.

The main milestones of scientific and pedagogical activity, as well as the life path of one of the leading representatives of aviation medicine, Doctor of Medical Sciences, professor, outstanding researcher and wonderful teacher, author of works on the problem of influence of overload and hypervesomity on the body and central nervous system of man- Boris MikhailvichSavin are considered. Separate moments of his participation in the Great Patriotic War before daily work as the head of research department of the Military Medical Academy named after S.M. Kirov are presented. The contribution of Boris Savin to the study of issues related to aviation and space medicine, in particular: the study of the action on the body of overload and the clarification of physiological mechanisms underlying changes in higher nervous activity at accelerations, was analyzed; Studying the state of the central nervous system when exposed to various factors; Development of neuroreflective theory of adverse effect of accelerations on human body. Boris Mikhailvich has made a huge contribution to the development of aviation and space medicine and has entered the history of aviation and space medicine through his research and scientific publications, which include monographs «The influence of overload on the functional state of the central nervous system and the mechanism of disruption of its activities» and «Hypervesomeness and functions of the central nervous system».

The journal "Bulletin of the Russian Military Medical Academy" accepts articles and messages on the most significant issues of educational and methodological, scientific and scientific-practical, treatment-and-prophylactic and clinical work.