Vol 19, No 3 (2017)

A significant number of patients on an outpatient dental appointment, insufficient knowledge of issues of oral pain syndromes, unusual polymorphism, difficulties in diagnosis and treatment cause interest in the problem. Muscle spasm is the basis for the development of muscle fascial pain syndrome of a face. Analysis of the data on anamnesis and examination of the oral cavity made it possible to draw up a general idea of patient’s dental status, put a presumptive diagnosis, and diagnose the risk factors for the development of the disease. Under observation, there were 57 patients who, after a complete examination including radiological examination, were diagnosed with muscle facial pain syndrome. Severity of pain intensity was assessed by means of a visual analogue scale. The complex etiological and pathogenetic treatment of patients was based on the elimination of possible causative factors and the impact on the pathogenic mechanisms of pain syndrome formation. The effectiveness of the complex etiological and pathogenetic treatment was confirmed by subjective data and the results of a visual analogue scale. It was established that patients suffering from myofascial pain syndrome of a face, believed that surgical operations and manipulations in the oral cavity were the cause of a pain in 47,37% of cases, 21,05% – the earlier endodontic treatment and 22,81% – the transferred stress. The majority of patients had a duration of the disease from one to several years, indicating a persistent nature and a long duration of the disease and a late appeal to a certified specialist. A statistically significant decrease in the pain index from the visual analogue scale confirmed the effectiveness of the complex etiological and pathogenetic treatment.

Cardiovascular diseases are still the main cause of death in older people. By foreign colleagues for a more adequate evaluation of the functional state of the senile organism the term «frailty» was proposed. The Edmonton Frailty Score was developed as a screening method for determining the degree of senile decrepitude. We evaluated the influence of the phenomenon of senile decrepitude on the outcomes of surgical treatment of patients with coronary and valvular pathology. The study included 127 patients over 65 years of age who underwent planned surgical treatment for coronary heart disease (88 patients), isolated valvular pathology (14 patients), a combination of ischemic heart disease and valvular disease (25 patients). As part of the preoperative examination, all patients were assessed the Edmonton frailty score, as a measure of qualitative assessment of the body’s functional reserves. It has been proven that the prognostic value of the frailty index, in addition to the generally accepted risk stratification scales, makes it possible to more accurately predict treatment outcomes for cardiac patients of the elderly and senile age (p<0,002). Perioperative risk factors for 30-day mortality were also analyzed. A significant contribution to the development of 30-day lethality was made both by the fact of using cardio-pulmonary bypass (p<0,001) and the time of its use (p<0,003). The overall 30-day mortality was 13,4% (17 patients): 30% (9/29 patients) in the group of «very frail» patients, 8% (6/69 patients) in the group of «moderately frail» patients and 6% (2/29 patients) in the group of «non frail» patients.

Two groups of men aged 18-44 years were studied. 73 men with normal body weight (body mass index from 18,9 to 24,9 kg/m2, X±δ=22±1,4) were selected for the group of patients with community-acquired pneumonia of a mild course. Control group – 105 practically healthy men with normal body weight (body mass index from 19 to 24,7 kg/m2, X±δ=22,5±1,4). The study of the body composition was performed using bioimpedance scales (fat analyzer «Tanita BC-545N» (Japan)). In the group of patients, bioimpedansometry was performed on admission to a medical institution, on the 3-rd, 7-th and 15-th days after the disease, in the control group also on the 1-st, 3-rd, 7-th, 15-th day of the examination. Analysis of the components of the body composition in men in patients with community-acquired pneumonia of a mild course at different stages of treatment suggests a statistically significant decrease in the total water content compared to the first day of treatment of the disease, which increased only by the 7-th day of the disease, but did not reach the 1 day. At certain stages of the disease, the parameters of total muscle mass with water, body mass index, total fat content changed. The index of total muscle mass with water had lower values compared with the 1st day of the disease, reaching the minimum values by the 3-th day of treatment of the disease. The body mass index of patients on the 7-th day of the disease was significantly lower than on the 1st day. In the dynamics of the total fat content at the treatment stages, the tendency to change its values was inversely proportional to the total water content. Bioimpedance measurement can adequately and timely detect changes in body composition in patients with pneumonia, thereby helping to optimize treatment.

The possibility of application of platelet-rich autoplasma in patients with an augmentation urethroplasty with buccal flap. It is found that patients treated with the closure of the bed of buccal mucosa with intraoperative administration of autologous platelet rich plasma in the area of the bed (group 4) had lower pain syndrome than patients treated without closure and without administration of autologous platelet rich plasma (group 1), patients only with sutured wounds of the cheek (group 2) and patients who underwent the administration of autologous platelet rich plasma without suturing of the buccal defect (group 3). The median pain intensity on the 2nd day was 3 points, on the 3rd day 2,6 points, on the 4th day of 1,9 points (p<0,001). Statistically significant differences among the 2nd, 3rd and 4th groups of up to the 4th day of observation are not revealed. On the 5th day in the 4th group, the median was 4,2 points, in the 1st group - 1,6 points, in the 2nd and 3rd groups - 3,3 points (p<0,001). Pairwise comparisons revealed statistically significant differences of pain in the 1st and 4th groups compared with the 3rd group (p<0,001 and p=0,007, respectively). In the figures between the 2nd and the 3rd groups the differences were insignificant (p=0,75). Difficulties in opening the mouth in the 1st day were observed in 21,9, and 11,7 to 21,2 and 14,7% for the 1st, 2nd, 3rd and 4th groups respectively (p=0,117). On the 5th day facial asymmetry was in 90,2, 51,4, of 90,9% and 47% patients of 1st, 2nd, 3rd and 4th groups respectively (p<0,001). By the end of the first week, the patients did not make any of the above-mentioned complaints. By the end of the first month, complaints on a decreased cheeks sensitivity remained with one person (3,2 per cent) from the 1st group and with one person (2,6 per cent) from the 2nd group (p=0,623). By the 6th month, the above-mentioned symptoms were absent. Thus, the use of autologous platelet rich plasma in combination with suturing of the defect of the inner surface of a cheek allowed to reduce postoperative pain by 2,5 times compared with patients without suturing the bed of a cheek and without the autologous platelet rich plasma administration.

Despite the progress and the ever-increasing prevalence of intraoperative monitoring, improvement of the methods of anesthesia, the success of clinical pharmacology, the importance of surgical, medicamentous aggression in the manifestation of mechanisms of surgical stress remains. In these conditions, the role of anesthesiologists in ensuring patient safety during surgical intervention and anesthesia becomes even more important, as well as in the early postoperative period. All of the above circumstances determine the urgency of searching for opportunities to improve the safety of anesthesia by means of objective forecasting of the development of critical incidents and complications. To this end, a prospective study was conducted with the participation of 96 patients who underwent planned surgery on the abdominal organs. In the preoperative period, the functional condition was assessed using a cardiorespiratory and a six-minute walk test. It is shown that the anaerobic threshold, determined with the help of a cardiorespiratory loading test, can be used as a predictor for predicting the development of critical incidents. A decrease in the anaerobic threshold value of less than 11.95 ml/kg/min indicates a high probability of developing critical incidents with a sensitivity of 92% and a specificity of 77%. At the same time, the available method of objective evaluation of the functional state - a six-minute step test, was not informative, which was proved by the input of statistical analysis.

A comparative analysis of the results of the use of a biodegradable hydrogel containing nanoparticles of silver, cream, including silver sulfadiazine 1%, in the treatment of victims with deep burns of face after running late necrectomy. The experiment was based on the results of examination and treatment of 27 patients (13 women and 14 men), aged 24–55 years with deep burns of face and other areas ranging from 0.5 to 5%, which were being treated in the clinic of thermal damages in S.M. Kirov Military Medical Academy in the period from 2015 to 2016. In the experimental group (13 patients) the wounds were applied with biodegradable hydrogel «Argakol». In the control group (14 patients) after necrectomy a bandage with the sulfadiazine silver 1% cream was applied. The treatment assessment of efficacy was performed by visual monitoring of the wound healing process, nature and amount of discharge, epithelization time from the start of application of the drugs studied. The estimated number of microorganisms per 1 cm2 surface and 1 g of wound biopsy was carried out according to the method of Loeble et al. [29]. Biopsy sampling was done immediately after late necrectomy, on 8th and 15th days of treatment. In the treatment process, the number and structure of microorganisms were studied. It is proved that the hydrogel is very effective, which manifests itself in a reduction of the wounds contamination by microorganisms, enhancement of the granulation formation and acceleration of boundary epithelialization. In patients with deep burns of a face the use of the drug containing nanoparticles of silver, reduces the time of preparation of the wounds to the autodermoplasty.

Currently, the trend of a disease caused by the human immunodeficiency virus is unfavorable, the epidemic situation in our countr y on this disease continues to worsen. Starting comorbidity «disease caused by the human immunodeficiency virus + drug addiction» was added by new epidemic contingents which forms a large group of patients with polymorbidity (disease caused by the human immunodeficiency virus + tuberculosis + viral hepatitis, and related secondary infections, against previously existing or firstly appeared and somatic and neuropsychiatric diseases). To date, there is a mass emergence of comorbid and severe forms of this pathology, which is accompanied by high mortality and low life expectancy of these patients, even despite the use of highly active antiretroviral therapy. The fatality rate in intensive care units is high (more than 60%), which is due to a number of unfavorable prognostic factors, the main of which are late diagnosis of the disease (due to late health encounters of patients), long periods of staying in intensive care units. The clinical case of the person named NN who was affected by a disease caused by the human immunodeficiency virus is discussed. This clinical case underscores the regular and thorough clinical follow-up of patients with a comorbid to the main disease pathology in accordance with existing regulatory documents and the importance of the timely appointment of an individually selected antiretroviral therapy regimen, without waiting for the development of a disease caused by the human immunodeficiency virus associated illnesses.

Aspects of disturbance of the general and local metabolism in a case of a connective tissue dysplasia syndrome of a temporal and mandibular joint are considered. In patients with temporomandibular joint pain dysfunction syndrome presenting no signs of general somatic diseases, in 78,6% of cases no bone mineral density changes in standardized zones of the axial skeleton were revealed. In patients with temporomandibular joint pain dysfunction syndrome associated with connective tissue dysplasia, in 83,4% of cases bone mineral density changes in standardized zones of the axial skeleton were recorded. In addition, in 58,3% of cases osteopenia was registered in one of the standardized zones of skeleton and in 25,1% of cases osteopenia was revealed in two standardized zones of the axial skeleton. In patients with temporomandibular joint pain dysfunction syndrome presenting no signs of general somatic pathology, the level of radiopharmaceutical accumulation in temporomandibular joint area at both sides corresponds with that of the control group. In patients with temporomandibular joint connective tissue dysplasia, increased values of the radiopharmaceutical accumulation coefficient were registered at both sides of the temporomandibular joint, which corresponded to the second degree of accumulation (moderate). Correlation between the values of the skeleton bone mineral density and the marked radiopharmaceutical capture rate was revealed in patients with temporomandibular joint pain dysfunction syndrome presenting no signs of general somatic pathology, similar to that of individuals in the control group. The patients with temporomandibular joint connective tissue dysplasia showed moderate inverse correlation between the axial skeleton bone mineral density and the radiopharmaceutical accumulation coefficient in temporomandibular joint. Direct correlations were revealed between the value of radiopharmaceutical accumulation coefficient in temporomandibular joint of second degree and bone mineral density osteopenia in one zone; and the value of radiopharmaceutical accumulation coefficient in temporomandibular joint of second degree and bone mineral density osteopenia in two zones.

In modern urgent surgery the problem of diagnostics and treatment of heart injures and pericardium remains the most difficult and actual. Algorithms of intensive therapy for an injury of heart remain poorly studied, literature on this subject contains contradictory information. First of all a restriction of experience within one medical institution is the reason why there is no accurate algorithms, in such cases an available experience of large hospitals in emergency assistance is of great value. The main indication for a medical and diagnostic video-assisted thoracoscopy is an injury of a chest in the area of the «heart zone», for exception of wounds of heart or determination of the nature of a damage of chest on condition of stable hemodynamics at the victim. 10 manuals on anesthesia for patients with penetrating wounds of the chest in the «heart zone». To all patients the diagnostic video-assisted thoracoscopy was carried out, within 40 minutes after receiving a wound, after an examination of pleural cavity injuries of heart, for elimination of which the thoracotomy had been carried out, were revealed. After the objective assessment and carried out standard instrumental and laboratory researches in injured patients there were not observed any clinical displays of an acute heart attack. During the endoscopy research stage in all cases the collapse of collateral lung was carried out by the method of forcing of carbon dioxide in a pleural cavity, by means of an electronic insufflator, to ensure an adequate view of intrapleural operation space. Application of this technique do not exert negative impact on system of hemodynamics and indicators of gas exchange. Conversion of operation in a thoracotomy did not cause any changes in the data obtained, which did not significantly differ from the results that were received during the diagnostic video-assisted thoracoscopy.

The specific weight of genital herpes caused by the herpes simplex virus of the first and / or the second type is evaluated. The features of the risk factors for genital herpes are analyzed depending on the type of the virus. It is established that at present there is a tendency to form an interlayer of patients (18,5%), in whom genital herpes is caused by the herpes simplex virus of the first type. This virus is most often detected in patients under the age of 30, mostly women (80%) who are on the early stage of the disease (57%). Patients with genital herpes who have a herpes simplex virus of the first type are less likely to be married, are more likely to have casual sex, more often indicate a lack of a regular sexual partner, are less likely to be in a relationship with a partner for less than 2,5 years. More than half of patients with genital herpes do not attach importance to the presence of their disease. However, most of them are afraid to infect a sexual partner and are ready to receive long-term, including suppressive, therapy to prevent relapses. However, most patients are not aware of the genital herpes status of the sexual partner. The main risk factors for genital herpes caused by the herpes simplex virus of the first and second types are generally similar – female sex, young age, lack of a regular sexual partner and the presence of random sexual intercourse. However, the probability of infection with the herpes simplex virus of the first type among women of a young age is higher than that of the second type of herpes simplex virus.

The features of the vegetative status with different types of aging in patients with erectile dysfunction in late ontogenesis are considered. It is established that patients with erectile dysfunction in late ontogenesis, enduring their aging process according to the ontogenetic model, in contrast to patients with somatic diseases have more pronounced metabolic disturbances associated with the activity of the sympathetic nervous system. Also, patients with erectile dysfunction and age- associated diseases are more likely to complain about sleep disorders, which may be related to aging on the developmental type. Patients with age-associated diseases have significantly lower overall testosterone levels, compared with the group of patients with somatic diseases. In patients with age-associated diseases, the overall hearth rhythm energy was significantly lower compared to patients with general-somatic diseases, which indicates a decrease in the adaptive capacity of the cardiovascular system and low stress-resistance in this group of patients. In general, in patients with erectile dysfunction aging according to the ontogenetic model of aging, activation of sympathetic influences and a decrease in parasympathetic tone are noted in the vegetative status.

An important task of modern medical radiobiology and toxicology is the search for effective medical means of anti-radiation and anti-chemical protection. Important is the development of drugs that would be effective not only for acute radiation exposure, but the lesions of toxic and highly toxic substances. These substances include a large group of compounds represented by hormones, growth factors and cytokines. Experimental evaluation of drugs from the groups of antioxidants, steroids and cytokines in the survival rate and life expectancy of animals irradiated with x-rays irradiation revealed their comparative radioprotective efficacy. Application of interleukin-1β as a prophylactic and early therapeutic purpose with different variants of radiation exposure increases survival of irradiated animals, reduces the severity of post- irradiation hematopoietic depression; has a positive impact on the dynamics of the number and the functional-metabolic status of peripheral blood leukocytes of irradiated animals. Shown the therapeutic efficacy of interleukin-1β in cases of poisoning by cytotoxicants with different mechanisms of cytotoxic action by criteria of survival rate, the severity of depression of hematopoiesis, the dynamics and the functional-metabolic status of peripheral blood leukocytes of animals. The results of the studies allow us to recommend further studies on the effectiveness of the integrated use of gemostimulating drugs with different mechanisms of action for various variants of radiation and chemical injuries that cause hematopoietic suppression. In particular, the evaluation of the effectiveness of the complex application of interleukin-1β and colony-stimulating factors (G-CSF, GM-CSF, etc.) in experiments on large laboratory animals is promising.

The chronic pain syndrome is almost connected with a various degree of asthenic and affective disorders. It is accompanied by asthenia in 76,5% of patients, anxiety – in 72,9% of patients, depressive disorders – in 31,4% of patients. Pain parameters on visual analogue scale are connected with a neuropathic component of pain, severity of anxiety disorders and degree of asthenia. The parameters of neuropathic component of pain is closely associated with a data on state and trait anxiety. It was found, that in patients with a long history of chronic pain syndrome, anxiety impairment reliably decreases, depression impairment reliably increases during the time. It is necessary to include psychopharmacological and not pharmacological methods in complex therapy at the earliest stages of chronic pain syndrome to treat or prevent psychological disorders and to raise efficiency of treatment.

The tolerance of military personnel of motor-volitional type of activity to altitude hypoxia was assessed. With this aim, the research results concerning influence of physical activity on a range of physiological and psychophysiological factors of 40 volunteers in the course of pressure chamber research, modelling 5000 m ascent, were analyzed. It was determined that the change in levels of hemoglobin saturation in blood should be taken as the main criterion for division of the volunteers according to the tolerance to artificial hypobaria and hypoxia. Significant decrease of oxyhemoglobin in blood was registered from the first minute of being at the altitude of 5000 m. On the basis of developed technology four types of organism reactions on physical activity under the influence of artificial hypobaric hypoxia were defined. At high level of resistance to altitude hypoxia blood saturation in the majority of time periods under analysis is preserved at the level higher than 75%, mean stability is achieved when oxyhemoglobin concertation is in the range of 65–75%, while low stability is characterized by decrease of this factor up to 65%. Also, according to our opinion, the fourth type of reaction should be defined – unstable one that is characterized by rapid decrease of arterial blood ventilation during the first 10 min of ascent lower than 60% and development of clinical signs which are typical for an acute oxygen deficit. The application of suggested method of assessment of human tolerance to hypobaric hypoxia in pressure chamber conditions on the background of physical activity allows to prognosticate the development of similar reactions in military personnel when they perform physical activities in analogous hypoxia conditions, including highlands.

The importance and relevance of antibiotic drugs are characterized. Data on the number of currently registered antibiotic drugs in the Russian Federation is given. It is noted, that poor quality antibiotics is one of the possible reasons for the development of antibiotic-resistant microorganisms. The standardization and quality evaluation of this group of drugs is an important task of the national health care. Conceptual system is presented, classification of antibiotics is proposed according to the chemical structure, mechanism of action, spectrum and type of action. Pharmacopoeia methods of quantitative determination of antibiotics in drugs and methods proposed by the group of researchers are described briefly. A special attention is drawn to the aminoglycoside antibiotics, as one of the first introduced into medical practice (neomycin, kanamycin, tobramycin, streptomycin, amikacin, etc.). It is noted, that side reactions in case of overdose with aminoglycoside antibiotics cause auto- and nephrotoxicity, neuromuscular blockade and a number of other serious consequences, therefore developing of a quantitative method that meets modern requirements for this group is a topical issue. The perspective of using the turbidimetric method for the quantitative determination of aminoglycoside antibiotics in the national standardization and quality control system for this group of drugs is noticed.

Due to the scientific progress in biomedical technologies, methods of tissue and organ regeneration in humans based on cell technologies are being developed. At the same time the legislative framework is being improved in the area of biomedical cell products circulation. Skin equivalents for restoration of superficial skin lesions (burns, wounds, ulcers, etc.) are the most demanded in traumatology, combustiology, military medicine. The analysis of legal regulations of biomedical cell products circulation in our country has been performed to solve the problem of biomedical cell products development in the interests of medical service of the Russian Federation Armed Forces and health care using them in military medical organizations. Basic modern requirements of the Federal Laws, government decrees, orders of the Ministry of Health, regulating the relations connected with biomedical cell products circulation in the Russian Federation are presented. It is established that the Federal Law No.180 dated 23 June, 2016 «On the Biomedical Cell Products» and the sub-legal acts adopted in accordance with it were developed taking into account the international experience and foreign law enforcement practice. They were aimed at regulating relations in connection with biomedical cell products circulation, as well as the relations associated with the donation of biological material for the purposes of production and medical care with the use of biomedical cell products. Most of the norms of the above mentioned Federal Law are borrowed from other sources of law regulating similar areas of legal relations – preclinical and clinical trials, state registration of medicinal products for human use, donor organ and tissue recovery, cord and donor blood sampling, expression of will for post-mortem sampling of biological materials for educational and scientific purposes, use of medical products. Adoption of the Federal Law «On Biomedical Cell Products» and the introduction of sub-legal acts will help to protect human rights in the sphere of biomedicine and will promote the development of biomedical technologies in our country.

Several problems were raised in military medical service as a result of marked changes caused by the Armed Forces reforming. In correlation with the current tendency of qualitative changes in the military conflicts nature and weaponry, revision of basic theoretical propositions relative to the art of war, ongoing reforming of the Armed Forces of the Russian Federation there was put forward a number of tasks before the military-scientific personnel that require the operative and effective solution. One of these tasks is the development of well-composed scientific ideology and practical recommendations concerning the building of the Armed Forces of the Russian Federation medical service management system. In this paper we determine some problems in the field of medical service management system of the Armed Forces of the Russian Federation and propose possible ways of their solutions. It is stated that in order to increase the validity of the main methodological principles for the formation of the management system of the medical service of the Armed Forces of the Russian Federation, it is necessary to identify the factors that affect it. It is revealed that these factors are: the current level of development of forms and methods of conducting of an armed struggle; the alleged manner of actions of the potential enemy; the military doctrine of the Russian Federation; the concept of the Russian Federation Armed Forces formation; the purpose of designing the administrative structures of medical service; principles of utilization and application of forces and facilities of medical service in military conflicts; mobilization and economic opportunities of the state; natural and geographical features of a region on the territory of which there could be a military conflict of one or another scale, etc.

Intensive application of Ionizing Radiation Sources in civil and defense industry, medicine, nuclear power engineering and an increase in the number of staff working in the context of exposure to radiation requires constant improvement of radiation safety measures at such facilities. Hence, the radiation hygiene specialists must not only have adequate professional competence, but also understand the whole spectrum of recurring problems in this field of expertise. Certain areas of concern about the radiation and hygiene measures in the Armed Forces were actively discussed in periodical publications: (Petreev I.V., Solovey E.P., 2011; Tsvetkov S.V., 2011; Omelchuk V.V., 2013; Azarov I.I. and others, 2014; Kotov S.S. and others, 2015; Petreev I.V., Tsvetkov S.V., 2016), at numerous research and practice conferences, including those with international participation, as well as on pages of the annually published Radiation and Hygiene Passport of the Russian Federation. We have made an attempt to bring these data up to date in order to comprehensively present the primary areas for further improvement of radiation safety control measures in the Armed Forces of the Russian Federation. In our opinion, among the urgent problems we should mention: the lack of full-time posts of specialists in radiation hygiene in the management bodies of the medical service, military sanitary and epidemiological institutions and other medical organizations, a significant lag in the laboratories in equipping radiation monitoring equipment and their lack of accreditation; the absence of a specialized organization designed to implement methodological guidance and information and analytical support for the entire range of radiation and hygiene measures in the RF Armed Forces; as well as the abolition of an specialized department of naval and radiation hygiene of the SM Kirov Military Medical Academy, which led to the destruction of the military doctors training system on radiation hygiene issues.

The basic biological effects of viruses which allow them to leave from immune supervision, and also feature of development antiviral the immune answer are resulted. The role of natural killers, cytotoxic T-lymphocyte, T-killers, macrophages is characterized. It was established that the concrete virus co-operates only with certain receptors; on a cage there can be receptors for various types of viruses; receptors for a certain virus can be on cages of various types. On this background the characteristic of the cores chemokines, intimate mechanisms providing development antiviral the answer is given. It is revealed that biological activity chemokines is regulated by receptors which contact several fibers which belong either to group CC-chemokines, or to group CXC-chemokines. Chemokines homologous among themselves can contact the same receptors. It is shown that chemokines receptor CXCR 4 provides human immunodeficiency virus penetration, sensuous to T-cages, CCR 2 – to macrophages, CCR 3 – to eosinophil cells, CCR 5 – to T-helper 1 type. Eotaxin interrupts communication of a virus with receptor CCR 3 that specifies in more important role of the last in pathogenesis infection a human immunodeficiency virus. Natural ligand macrophage-like the squirrel of an inflammation 1 and RANTES block macrophage-like infection a human immunodeficiency virus, but not an infection caused by other viruses, sensuous to T-cages. It is established that increase of the maintenance of matrix ribonucleic acid CCL 4/MIP-1 β and CCL 5/RANTES in plasma of blood at persons with a virus infection both CXCL 8/IL-8 and CCL 4/MIP-1β reflects development of an immune inflammation. Definition of an expression of matrix ribonucleic acid chemokines and chemokines receptors can be the important diagnostic sign of progressing of a virus infection. Chemokines and them transmitter are responsible for effects of cages in sites of an inflammation and directly cause activation of cages. Chemokines and their receptors are extremely important for the control of a virus infection and replication.

Currently, one of the most effective agents for a treatment of myelodepressions of various etiologies are colony-stimulating factors related to a class of cytokines that reduce the extent and duration of post-radial myelo- and immunodepression. Their effects are in a significant shortening of a period of agranulocytosis, a decrease in its severity, an increase in the functional activity of neutrophils, a reduction in the severity of infectious complications, leading to an increase in the survival of experimental animals, especially if these drugs are used in the early periods after irradiation. Judging by the data available in the literature, the granulocyte colony-stimulating factor is the main hematopoietic growth factor, which is involved in the regulation of proliferation, differentiation and maturation of myeloid precursors of granulocytes. Based on the experience of oncologists, hematologists, the results of therapy for victims of radiation accidents, and experimental research data, cytokines, including granulocyte colony-stimulating factors, are regarded as the main means of early care for radiation- induced neutropenia and allow us to consider their use as means of early pathogenetic therapy of acute radiation sickness in humans. Therapy with colony-stimulating factors is recommended to begin for all victims with an acute radiation sickness as soon as possible from the moment of irradiation and continue until the absolute number of neutrophils in the peripheral blood reaches a level of more than 1×109/l after recovery from the moment of maximum neutropenia.

The modern concepts of pathological reconstruction of long tubular bones are analyzed. One of the reasons for the development of pathological fractures in athletes and military personnel is the development of osteopathy in consequence of nutrition disorders: elimination of certain groups of food from a diet, and among women these are fasting, skipping meals, eating restrictions. Also, overtraining among men reduces the level of testosterone, which leads to osteopenia and the development of stressful bone damage. The value of the vascular factor for the appearance of pathological restructuring is noted. The vascular system of bone tissue is prone to disruption of the local circulation, since the vessels of the bone in the closed bone spaces are unable to expand sufficiently, which can lead to local tissue disorders: hypoxia, ischemia, dystrophic processes in the tissue. It is noted that with a stress fracture the intraosseous blood flow slows down and stops, the capillaries of the compact or spongy bone turn off, and the ischemia of the periosteum occurs. The circulatory arrest leads to the release of plasma from the microcirculatory bed due to increased permeability of the vascular wall. This causes swelling of the muscles, fascial spaces, and further exacerbates bone damage. Also, factors of stressful bone restructuring are excessive strains. The initial cause of the injury may be a biochemical abnormality in the cells of the bone. The bone adapts to many levels of intermittent, repeated deformations of compression and stretching by increasing the density. However, in the presence of abnormally high and repetitive forces, the ability to recover is not adequate and the damage begins to exceed regeneration. As a result, excessive tension or repeated stress leads to the fact that the bone does not have time to adapt to stress. Understanding the mechanisms of the pathological trauma of long tubular bones reveals the cause-and-effect relationship of these injuries, which will make it possible to use the resources of the healthcare system more effectively in the field of diagnostics, treatment and rehabilitation.

The review is devoted to analysis of Russian and foreign literature related to the assessment of neurotoxic disorders after convulsive substances poisoning. It is noted that currently there are more and more observations, showing that the manifestations of toxic encephalopathy, including convulsive status, are the result of growing imbalances between the major excitatory and inhibitory mediator systems of the brain. Wherein excessive and prolonged stimulation of glutamate receptors (excitotoxicity) leads to neurodegenerative damage that is the basis for the effects of convulsive substances poisoning. We present clinical observations of the complications and consequences of acute poisoning, accompanied by convulsions. Convulsant intoxication with generalized convulsive syndrome, as a rule, corresponds to severe poisoning or extremely severe degree, leading to prolonged and severe intellectual disabilities. It is shown that modeling the toxic effect of certain convulsive agents using experimental animals helps evaluate the severity and duration of observed irregularities, match them with the corresponding benchmarks and implement neuromorphological analysis of brain structures that play a key role in the development of convulsions. Integration of clinical and experimental data revealed that a greater focus should be placed on the assessment of the mental and neurological status, cognitive and neurovegetative functions and brainwave patterns. We believe that the development of diagnosis of neurotoxic disorders methodology – the effects of convulsive substances poisoning - will allow identifying therapeutic and preventive measures during medical rehabilitation (rehabilitation treatment) of surgical patients.

Despite the obvious improvement in the examination and treatment results in patients with malignant tumors, the problems of providing medical care to this contingent of patients are still preserved. Until now, surgeries (radical mastectomy, lumpectomy) remain the main method of breast cancer treatment. Such operations, as a rule, lead to mammary glands deformities and life quality worsening of these patients. Currently, reconstructive surgery is an integral stage of the psychological rehabilitation of women after breast cancer surgical treatment. The data of researchers, who have experience in mammary glands deformities correction after surgical treatment of breast cancer, was specifically studied. In the article the information about intercellular interaction, which occurs when adipose derived stem cells are implanted into the area of malignant tumor surgical removal, was analyzed. Possible options of autologous adipose tissue (containing stem cells) transplantation application in cases of correction of breast deformities after cancer removal are discussed. Based on the results of practice of breast surgery specialists, authors concluded, that autologous adipose tissue (containing stem cells) transplantation in cases of correction of breast deformities after the surgical treatment of malignant tumors is nowadays possible by indications. Based on the information presented in publications of scientists from different countries, promising areas of research have been defined for studying the aspects of oncological safety of transplantation of autologous fat tissue (containing stem cells) for correction of breast deformities after malignant tumor removal.

Noted, that a significant part of the neuroendocrine pancreatic tumors are nonfunctioning, id est. not secreting into blood a variety of gastrointestinal hormones and polypeptides and as a result, not accompanied by typical clinical manifestations. In some cases, with nonfunctioning tumors it occurs randomly and is in fact appears to be incidentaloma. Unfortunately, the scan search often starts in the detection of distant metastases of neuroendocrine tumors and development of cancer cachexia. It is shown that in recent years some authors have noted a positive shift – in the first year from the onset of the disease, the cause of the disease cannot be defined in 45–55% of cases. Diagnostics of neuroendocrine tumors of the pancreas is a highly complex task, the solution of which depends on the choice of treatment and its remote results. Currently, the only radical method of treatment of hormonally functioning tumors of the pancreas is a surgical method. It is shown that symptomatic therapy can be only considered as a stage of preoperative preparation of a patient. The indication for surgical treatment in this situation, along with the ineffectiveness of conservative treatment is the size of detectable formations of 2 cm or more, which is a risk factor of distant metastases. According to modern views, patients with nonfunctioning neuroendocrine tumors of the pancreas are subjects for surgical treatment. Given that in 70–92% of cases they are malignant, most often distal or extensive pancreatoduodenal resection used. Currently, it is noted that the large size of the tumors are not a contraindication to surgery and if the tumor dormant and up to 1 cm size, then a short-term observation is possible. Any tumors found in the pancreas, need to be enucleated or, – if possible – widely excised. There are analyzed the rational and integrated use of modern arsenal of surgical and therapeutic methods, which significantly prolong life, improvement of its quality in patients with metastatic forms of neuroendocrine tumors of the pancreas.

At the present time, the whole system of education is rapidly developing, and the higher military school is involved in this process too. One of the main tasks of the Russian educational policy is to improve quality of education by preserving its solid fundamentality and making it correspond to the current and future needs of a person, society and the nation. This requirement can also be entirely applied to post-graduate education of doctors of medical and preventive care profile. Methodological support of the educational process provides its effectiveness, and serves as means for improving quality of teaching. Having analyzed current traditional forms of teaching and modern educational technology, we developed an individual methodology for conducting lectures on general hygiene using an innovative technology called «mind-maps». The method is targeted at students of the advanced professional education department. At the same time, using mind-maps is applicable to all categories of students and is not limited to conducting lectures only. Recommendations on how to evaluate results of the educational process and develop methodical support for a lecture with the help of mind-maps are given. Their theoretical and practical core and stage-by-stage designing process are demonstrated by example of a lecture, during which students consider measures aimed at improving work conditions and enhancing safety of medical employees. Mind maps are a graphical tool, which helps students find answers to issues raised by the lecturer.

P.A. Kupriyanov is an outstanding Russian scientist, talented organizer, world-famous surgeon, one of the pioneers of Russian cardiac surgery and anesthesiology, Honored Scientist of the Russian Soviet Federative Socialist Republic (1942), Academician of the Union of Soviet Socialist Republics Academy of Medical Sciences (1944), Lieutenant General of medical service (1945), Lenin prize Winner (1960), the Knight of the four Orders of the Red Banner (1943, 1944 – 2, 1948) and the three Orders of Lenin (1940, 1945, 1963), Hero of the Socialist Labour (1963). He took part in the First World War (from April 1915 to December 1917), rendered aid to the sick and wounded during the Civil War in Russia (1918–1920). He was the Chief Surgeon of the Leningrad Front during the Soviet-Finnish War (1939–1940), during the Great Patriotic War (1941–1945) at first he was the Chief Surgeon of the Northern Front and after its division into the Karelian and Leningrad fronts he was the Chief Surgeon of the latter one. Having passed a difficult and thorny path P.A. Kupriyanov made a large contribution to the development of such spheres of medical science as operative surgery and topographic anatomy, military field surgery, abdominal and thoracic surgery, cardiovascular surgery, anesthesiology, etc. The very beginning of his professional and artistic career, formation as a military field surgeon and those difficulties a young surgeon had to overcome as well as the first meeting of P.A. Kupriyanov with Vladimir Andreevich Oppel are described in detail.

The analysis of the A.K. Iordanishvili’s manual «Gerontostomatology» is presented. It is noted that aging of the population of the Russian Federation is changing the field of professional activity of dentists, making tasks of improving the quality of dental care and improving the quality of life of older and senile persons, to be of highest the priority. A study of the factors determining the rehabilitation potential of older and senile dental patients with multimorbid conditions shows that medico-social and general characteristics of patients in conjunction with the dental status indicators are prognostically significant in the planning of rehabilitation activities. It is emphasized that the state of oral cavity reflects the age-related changes and health of a person, his economic status. This predetermines the need for an integrated approach to the older person, since apart from dental problems, it is necessary to take into account the overall somatic status and the socioeconomic factors affecting the health of the elderly, especially when in the older age groups there is not only the high rate of incidence, but also the number of diseases of the internal organs in each patient. It is noted that pathological and adaptive processes in the oral cavity in patients with somatic pathology have their own characteristics adversely affecting the results of dental rehabilitation, and the multifactor effect of the internal and external environment dictates the need for a generalized vision and a holistic approach to man, using multidimensional diagnostic and therapeutic measures in gerontostomatology. This means the integrity of the approach not only to the sick organ, but also to the sick person in a complex of his ecological, socio- psychological and moral problems. The existence of close correlation relationships between medico-social, general and dental indicators predetermines the need to consider systemic homeostasis in patients with comorbid pathology when treating people of older age group suffering from dental diseases. It is concluded that the training of students of dental faculties of medical schools under the section «Gerontostomatology» using the reviewed manual, familiarization of dentists with this manual will help them to work with older persons and will improve the possibility of assessing the presence and phase of involutive changes in the organs and tissues of the masticatory apparatus. Moreover, it will allow choosing the optimal complex of dental rehabilitation measures and contribute to the improvement and development of a modern, relevant and essential for Russian medicine area of dentistry.

For almost 80 years since the discovery of Y. pseudotuberculosis, the causative agent of pseudotuberculosis, the disease was considered a zoonosis. Cases of human infection were very rare and usually lethal. In the middle of XX century, cases of human pseudotuberculosis with involvement of mesenteric lymph nodes and symptoms of acute appendicitis were described in Europe. Since 1959, annual epidemic outbreaks of a new infectious disease have been reported in the Far East of the Union of Soviet Socialist Republics among individuals in organized groups, who consumed the same type of food. The disease was called «Far Eastern scarlet-fever-like fever», but its causative agent was not known. In 1966, a naval microbiologist V. Znamensky for the first time in the world isolated Y. pseudotuberculosis from feces of such a patient. However, scientific leaders of that time were not convinced by this finding of a provincial microbiologist. To provide a direct evidence that the microbe is a cause of the scarlet-like fever, in January 1967, V. Znamensky self-inoculated Yersinia culture isolated from a patient. Six days later, he developed a severe septic form of scarlet-like fever and was hospitalized to the Military Medical Academy, where he was examined and successfully treated.