Vol 21, No 1 (2019)

The problems of early vascular aging are analyzed as one of the possible key parameters for the development of cardiovascular pathology. The integral indicator, which is «vascular age» can be higher than chronological in the presence of modifiable and non-modifiable risk factors. Vascular aging is a generalized process involving all layers of the arterial wall, which is based on structural and functional changes in large arteries. Early vascular aging is the accelerated development of relevant changes in patients with high cardiovascular risk. At the same time, the processes of arteriosclerosis, manifested in the degeneration of elastic fibers and the accumulation of collagen in the media, and atherosclerosis occur in parallel. Estimated true age of the heart and blood vessels (vascular age) reflects the degree of individual cardiovascular risk in a form understandable to the patient. Accessibility in the perception of this parameter for patients can significantly increase adherence to drug therapy and lifestyle changes. An indicator of early vascular aging can serve as a tool to reassess the cardiovascular risk category. It justifies the search for new models for theoretical understanding and influence on the increased risk of cardiovascular complications, as well as preventing the manifestation of cardiovascular diseases. In connection with this perspective, the most important cardiovascular risk factor is discussed - the age that determines the aging process, and especially vascular aging. The speed and severity of age-related changes depends on the many interactions between age, lifestyle, comorbidities, and genetics. The main data of the modern concept of early vascular aging are considered: the definition, the main mechanisms of vascular aging, methods for assessing early vascular aging, the clinical significance and the possibilities for its reduction.

The role of intrarenal expression of C1q on clinical and laboratory parameters and the development of morphological changes in the renal tissue in patients with type 2 diabetes complicated by diabetic nephropathy was studied. It was noted that the presence of C1q deposits was detected in all zones of the glomerulus and interstitium of the renal tissue. The frequency of detection of C1q expression depended on the morphological class of diabetic nephropathy. With the development of nodular formations of Kimmelstil-Wilson, the frequency of detecting the expression of C1q in the area of the mesangial matrix and along the glomerulus capsule decreases to 0%. In the epithelium of the urinary tubules, C1q expression remains, regardless of class, and in the interstitial region of expression, the fraction, on the contrary, tends to increase from 8,3% in class IIa to 20% in patients with class IV diabetic nephropathy. Along the tubular basement membrane, the complement fraction was absent, regardless of the morphological class of diabetic nephropathy. Glomerular expression of the C1q-component deposits was found to contribute to the progression of chronic kidney disease, as it affects the decrease in glomerular filtration rate (F=4,533; p=0,039; β= −0,303; CI: 0,37; 13,343; p=0,039). The expression of C1q deposits in the interstitium plays a role in the development and progression of focal interstitial sclerosis (F=4,462; p=0,045; β=0,295; CI: 0,005; 0,375; p=0,045), determining the severity of tissue interstitial tubulointerstitial changes in diabetic nephropathy and is one of factors contributing to the progression of renal tissue arteriolar hyalinosis (F=4,349; p=0,05; β= −0,535 CI: −1,095; 0,001; p=0,05).

Considers a case of successful endovideosurgical treatment of a patient with postoperative diaphragmatic hernia, admitted to the clinic of faculty surgery named after. I.I. Grekov North-Western State Medical University named after I.I. Mechnikov. The patient was hospitalized with a diagnosis of acute pancreatitis, however, as a result of the follow-up examination, taking into account the history and clinical picture, a diagnosis of left-sided postoperative diaphragmatic hernia was made. Diagnosis was carried out using spiral computed tomography of the chest and abdominal organs, as well as using radiation research techniques. According to the above studies, the contents of the hernia were the spleen and the bottom of the stomach. It was decided to perform surgery in the volume of laparoscopic removal of a diaphragmatic hernia on the left with a plastic reticular endoprosthesis. Intraoperative, early and late postoperative complications are not observed. Due to the choice in favor of a minimally invasive surgical treatment technique, the likelihood of complications was minimized. The favorable postoperative course was confirmed by x-ray data of the thoracic and abdominal cavities, performed on the 5th day of the postoperative period. The absence of clinically significant changes in clinical and biochemical blood tests also indicates a smooth postoperative course. The patient was discharged for outpatient treatment in a satisfactory condition after 12 days after surgery. The results of multispiral computed tomography of the thoracic and abdominal cavities, performed on an outpatient basis one month after the operation, confirm the successful outcome of surgical treatment.

An ultrasound examination has shown that on average 22 (29,7±5,3) of 74 children, infected by Giardia, have a lesion of the gastrointestinal tract manifested as reactive alterations of the pancreas. Clinical symptoms of 20 children (about 27%) revealed in the form of complaints of abdominal pain, 9 (12%) – in form of decreasing appetite and 9 children have allergenic reaction revealed on skin in different intensively, 8 children (10,8±3,6%) – in form of sleep disorder, 5 (6,8±2,9%) – in form of loose stools, 4 (5,4±2,6%) children felt sick, 1 child – vomit and the last one (1,4±1,4%) – in form increase temperature until subfibril indicators. Besides alteration in the pancreas, 6 (8,1±3,2%) children revealed reactive changes of the liver. The signs of dyskinesia of biliary tract were shown on 12 (16,2±4,3%) children. Among the combined lesions of the gastrointestinal tract, 16 (21,6±4,8%) children had reactive changes simultaneously from the side of the liver and pancreas. Moreover, 10 (13,5±4%) children were shown several combined reactive alteration in the liver, the pancreas and the sings of dyskinesia of biliary tract at the same time. In 6 (8,1±3,2%) cases combined alterations in liver and dyskinesia of biliary. The research has established, that in 44 (almost 60%) cases children did not follow personal hygiene rules. Contact with pets took a place in 30 cases (40,5±5,7%). Geo- and oligophagy were observed in 16 (21,6±4,8%) and 15 (20,3±4,7%) cases, respectively. Thus, the most frequent manifestations of giardiasis were reactive changes in the pancreas. The main causes of the disease of children of different age groups were not compliance with personal hygiene, contact with animals, as well as geo- and onychophagy. The presence of clinical symptoms: abdominal pain, nausea, vomiting, loose stool, fever to subfebrile degrees indicate an acute course of giardiasis in children.

Clinical characteristics and risk factors of adjustment disorders among police officers after a detached duty to the North Caucasus region were studied. Patients were examined before and after detached duty with clinical psychopathological analysis and psychometric tests. Usage of psychometric tests and the measurement of the quality of life in the study of the adjustment disorders made it possible to objectify the evaluation of the severity of psychopathological symptoms. The research has revealed that prolonged detached duty to the North Caucasus is a psycho-traumatic situation and it could cause mental and behaviour disorders. Our research proposed the original classification of adjustment disorders: obsessive reaction, obsessive-depressive disorder and obsessive-depressive disorder with disturbance of conduct. Adjustment disorder among police officers is a complex psychopathological phenomenon and it`s clinical pattern included basic and additional components. The main manifestations of the adjustment disorder are obsessive and depressive symptoms, disturbance of conduct; additional manifestations include asthenia and vegetative disturbance. Obsessive thoughts of the psychotraumatic situation, symptoms of depression and disturbance of conduct represented the unfolded clinical form of the adjustment disorder. An absence of disturbance of conduct in the clinical pattern of disorder qualified as an abortive form of an adjustment disorder. An increased level of anxiety, psychological personality traits in the form of aggressiveness, liability, rigidity and sensitivity were revealed as predisposing factors for adjustment disorder.

The decrease in values of correlation coefficients with high (high anxiety) and average (low anxiety surveyed individuals) the degree of importance on the background of the empirical variant of antihypertensive therapy, to medium (high anxiety) and weak (low anxiety surveyed) the degree of importance on the background of a targeted treatment option indicated for the approximation of the reciprocal adaptive reactions of the organism of patients to those in healthy high- and low anxiety persons of a corresponding temperament. Thus, a decrease in the activity of the sympathetic division of the autonomic nervous system and the hypothalamic-pituitary-adrenal system in cortisol and an increase in the activity of the renin-angiotensin-aldosterone system in the aldosterone range in the temperamental range from choleric to melancholic (choleric → sanguine stemmatics;); oxygen in tissues and the content of potassium in erythrocytes, as well as an increase in sodium concentration in both healthy high and low anxiety individuals and patients with arterial hypertension It corresponds to the temperament in the background as an empirical and targeted antihypertensive therapy. In healthy and hypertensive patients with men, regardless of temperament and anxiety, as well as a variant of antihypertensive therapy, during the magnetic storms with an increase in the power of the γ-background of the medium (within the limits of the norm), the level of oxygen utilization by the tissues and the content of potassium in erythrocytes decreased. sodium increased. Depending on the temperament, a change in the content of the studied parameters in high- and low-anxiety cholerics was observed during the day, in sanguine on the first day, and in phlegmatic and melancholic on the second day from the onset of magnetic storms. In addition, in contrast to the empirical treatment option, against the background of the directional treatment of the values of the studied parameters, the terms of returning to the original values (before the magnetic storm).In contrast to the empirical, against the background of the treatment option aimed at relieving the features of temperament, the values of the parameters were significantly closer, and the terms of returning to the initial (before the magnetic storm) values and the degree of correlation between the γ-background, the oxygen utilization coefficient of tissues and the content of the studied electrolytes coincided with those in healthy high- and low-anxiety individuals of the corresponding temperament. Therefore, antihypertensive therapy aimed at relieving the peculiarities of the psychosomatic status of patients is a more effective treatment option for patients with hypertension.

Presents a clinical case of successful treatment of a patient with a giant non-parasitic liver cyst. The patient was examined on an outpatient basis: when performing an ultrasound study, and then using a spiral computed tomography of the abdominal organs, a cystic formation measuring 130×160×170 mm was revealed in the projection of the IV, V, and VIII segments of the liver. The analysis for the presence of antiparasitic IgG antibodies showed a negative result, which indicates the non-parasitic nature of the cyst. The patient was admitted to the clinic of faculty surgery named after I.I. Grekov for planned surgical treatment. After preoperative preparation, the patient underwent surgery in the amount of laparoscopic fenestration of a non-parasitic liver cyst with cholecystectomy (due to the presence of concomitant cholelithiasis). The technique of argon plasma coagulation was used for the treatment of the cyst bed. The patient was activated in the first day of the postoperative period. The postoperative period was uneventful. According to the histopathological examination of the surgical material, the fibrous wall of the cyst with property flattening. According to the results of a control ultrasound examination of the abdominal cavity after removal of the drainage the fluid in the abdominal cavity was not located. Clinically and biochemical blood tests showed no clinically significant abnormalities. The patient was discharged in satisfactory condition on the 12th day of the postoperative period. Thus, the presented clinical case shows that even the giant size of the cyst is not a contraindication for the use of endovideosurgical treatment methods.

Probable causes of lethal outcomes at various options of medical emergencies at immunokomprometirovanny patients of a gemoblastozama with the proved sepsis against the background of a neytropeniya after carr ying out polychemotherapyare presented. Some features of development of infectious complications after carrying out chemotherapy at patients of this category such as sepsis, septic shock, infectious and toxic shock, refractory sepsis are marked out. Moreover, among patients with various types of sepsis, patients with acute myeloid leukemia, complicated by sepsis, predominated – 15,19%, septic shock – 13,29%, and infectious-toxic shock – 11,39%; against patients suffering from lymphoproliferative diseases – 5,91, 8,37 and 4,43%, respectively. The urgent and combined states which authentically influence the current and an outcome of a disease are determined which allow to determine the volume and precedence of the carried-out anticipatory intensive therapy at patients from after the carried-out polychemotherapy in the period of a neytropeniya against the background of violation of an immune condition of patients are defined. Thus, the greatest number of deceased patients in the group with emergency conditions were patients with a diagnosis of cardiogenic shock – 19,57%, acute myocardial infarction of the 2nd type – 13,04%, and acute cardiovascular insufficiency – 13,04%. The most significant predictors of post-cytotoxic complications were identified, groups of patients who are most subject to post-cytotoxic infectious and medical emergencies are defined and studied.

The analysis of the results of the examination and treatment of 280 patients with various forms of peritonitis treated with the use of endovideosurgical techniques in the period from 2009 to 2016 was carried out. Of these, 50 patients required the implementation of sanation relaparoscopy, which constituted the main group. The comparison group included 15 surviving patients after performing one or more relaparotomies treated for the period 2015–2016. The most optimal techniques for the sanation of the abdominal cavity by endovideosurgical method are described. The main indications for the implementation of relaparoscopy «on demand» and «according to the program» were determined on the basis of the clinical picture, intraoperative data, leukocyte intoxication index, abdominal index and Mannheim peritonitis index. The main criteria for termination of relaparoscopy in programmable mode are established. The study revealed that it is necessary to strive to use endovideosurgical techniques (in the absence of absolute contraindications). The materials obtained in a number of cases allow to avoid laparotomy, which is especially important for patients who perform relaparoscopy «according to the program» has a diagnostic nature and is necessary to control the condition of the abdominal cavity, taking into account the running pathological process revealed during the primary operation. It was also found that the use of repeated endovideosurgical interventions both «on demand» and «according to the program» can reduce the number of postoperative complications and the length of hospital stay.

The article presents the results of a study on the modeling of acute pancreatitis in an experiment on large laboratory animals. The authors have proposed an original experimental model for studying the characteristics of the course of acute pancreatitis caused by the introduction of liver bile into the pancreatic ducts of the pig. The morphogenesis of experimental acute pancreatitis in the initial phase of the disease at the ultrastructural level using light and electron microscopy was studied in detail. It has been shown that with the development of acute destructive pancreatitis, the left lobe and the body of the pancreas undergo more destructive changes. In the right lobe, destructive changes are less pronounced. When using light microscopy in the pancreatic tissue, phenomena of pronounced interstitial edema, granular dystrophy of pancreatocytes, dilation of venous and lymphatic vessels on the background of arteriospasmwas found. Expansion of the common pancreatic duct was accompanied by desquamation of the epithelium in its lumen and the formation of microerosias. Occasionally, free erythrocytes were encountered, which may indicate a violation of the hemato-tissue barrier. Results of electron microscopy data showed that the most characteristic ultrastructural changes for the early phase of the disease should be considered a violation of the structure of such important cellular organelles as the nucleus (apoptosis), endoplasmic reticulum, and mitochondria. In this case, the synthesis and maturation of zymogen granules is disturbed. Due to the disruption of the structure of the foamy (protective) cells of the pancreas, its structure was not protected from harmful pathogenic effects (in our experiment, liver bile). Not only the parenchyma (the cells that form the secret), but also the stroma of the gland (fibroblasts) is subject to pathological changes. Thus, the whole complex of morphological disturbances established at the ultrastructural level indicates significant pathophysiological disturbances in the work of the pancreas and confirms the validity propose of the experimental model of acute pancreatitis.

The possibility of using hair as one of the objects of research for the diagnosis not only the fact of use of psychoactive substances but also identification the statute of limitations and duration of using toxic substances is considered. These results are important not only in medical practice to provide doctors with a compфlete picture of remission in patients (F10–F19), but also in judicial practice to resolve social issues, for example, custody issues. A model of long-term use of substances (phenobarbital and diphenhydramine) was developed on laboratory animals – guinea pigs of white, black and red natural colour. Enzymatic hydrolysis techniques (chymotrypsin, hemopexin and papain) was developed to isolate psychoactive substances from the hair staff of laboratory animals. phenobarbital and diphenhydramine were detected in animal hair 28 days after the substance was discontinued. Phenobarbital was detected in an amount of from 18,91 to 19,85 ng/mg, diphenhydramine from 5,71 to 7,04 ng/mg. The developed methods of enzymatic hydrolysis were tested on expert material (hair) of the examined persons collected according to the recommendations of the Order of the Ministry of Health of the Russian Federation № 40 of January 27, 2006. In total, 118 hair samples were analyzed during the study, 14 samples showed a positive analysis for the presence of psychoactive and other substances: methamphetamine, methylecgonine, cocaine, amphetamine, formethorex, pirogerone, methadone, tetrahydrocannabinol, phenobarbital, tropicamide, diphenhydramine, salbutamol, nicotine. Developed methods of isolation allow screening search to detect psychoactive substances for the diagnosis of their use.

The flight structure of distant and military-transport aircraft is subject to the influence of the flight overloads accompanied by the development of gravitational deviations and difficult functional reorganisations, the occurring haemodynamic changes directed on indemnification in an organism of the pilot. The organisation of a high-grade food is necessary for indemnification of the adverse influence of factors обитаемости on a state of health of pilots during flights of the big duration directly onboard the plane. New, subject to preliminary tests, the pre-production model of an onboard food allowance represents a set of products for a food of pilots in long flight. It should possess high organoleptic characteristics, sufficient food and power value, meet requirements to storage and convenience of the use in food directly in flight. At modern scientific and technical level preliminary tests of a pre-production model of an onboard food allowance with the participation of staff of distant and military-transport aircraft in real conditions of military activity are conducted. During carrying out of preliminary tests of an onboard food allowance it is established, that its use in food military men throughout long flight was not accompanied by negative changes of a state of health of pilots. Products apart an onboard food allowance possess high organoleptic properties. To reduce the energy value, it is advisable to optimize the content of basic nutrients by reducing the fat content. Received by questioning and interrogation of consumers data testify about the necessity of expansion of assortment of a diet the following foodstuff: raw milted, dried fruits, chocolate, etc. Received during a performance of the yielded work results is a scientific basis for the perfection of a food of the given category of military men.

Military-professional work staff of research courts, especially in long sea campaigns, it is characterised by high emotional and psychological pressure, touch and motor deprivation. A food of seamen should not only correspond to balanced diet principles but also carry a treatment-and-prophylactic orientation. The analysis of operating food rations of crews of research courts, shows, that many of them an assortment of products, a chemical compound and power value not to the full meet requirements of an organism of military men for energy and nutrients. First of all, it concerns the maintenance and balance of essential nutrients: fibres, especially animal origin, polyunsaturated fatty acids, vitamins, macro-and microcells. Besides a food, one of the determinatives обитаемости the Navy fleet ships, directly defining the success of the performance of problems of experts, is water supply. Maintenance of staff of crews of the ships with good-quality fresh potable water has always been difficult to multistage a hygienic and technical problem. In the course of the given work the hygienic estimation of a food and water supply of experts is spent, problem aspects in a food and water delivery of crews of research courts are revealed, to define ways of their decision. The obtained data testify, that the complex approach to a food and the staff water delivery, directed on preventive maintenance of the alimentary-caused diseases among military men of research courts and maintenance high Trudo - and fighting capacity of the crews, including perfection of a food allowance of staff of the ships is necessary, for technology of water preparation. Potable water air-conditioning biologically significant macro-and microcells will be the important means of preventive maintenance of disease of military men.

According to transactional analysis (as a psychological model that serves to describe and analyze human behavior, both individually and as part of groups), in each person there are three main ego states: «Parent», «Child» and «Adult». At each moment in time, each healthy and integral person is located in one of these states (and, being in some certain situation, it can function on the basis of one of the states that are clearly distinguishable from one another). The essence of the presence of personality activity and freedom of choice and the existence of script programming, as well as moral, value and ideal attitudes can be the basis of a variety of intrapersonal conflicts. At the same time, a person, confronted with real events that do not correspond to ideal scenario ideas, may experience stress and perceive the current situation as difficult, which is determined by their own cognitive assessment of the situation. The nature of the distribution of ego states in the structure of personality was studied by us according to the method of D. Jongeward in 146 young people of different genders. Differences in ego states in the personality structure of young people (men and women) are due to the gender nature of the groups. People in conflict-free ego states should comply with the norms of politeness to prevent conflict, thereby satisfying the needs of both a positive and negative interlocutor, which is one of the important psychological factors for ensuring the reliability, efficiency and success of joint activities. The possible presence of a conflict can lead to nervous breakdowns, a decrease in the level of professional health (professional fitness).

The properties of synthetic polyester matrices made of polylactide-glycolide, polylactide-caprolactone and poly-ɛ- caprolactone are investigated. It was established that the matrix of polylactide-glycolide and polylactide-caprolactone have high levels of transparency, strength, but fewer indicators of elasticity and elasticity compared with poly-ɛ-caprolactone matrices and amniotic membrane. It was revealed that the transparency of the poly-ɛ-caprolactone matrices depends on the material thickness and tends to decrease with increasing material thickness, while the transparency of the polylactide-glycolide and polylactide- caprolactone matrices does not change with increasing material thickness. The terms of biodegradation of polylactide-glycolide and polylactide-caprolactone matrices with a thickness of 5 μm are about 30 days, which is comparable to the degradation time of the amniotic membrane on the surface of the cornea. It has been shown that human and rabbit limbal stem cells, as well as the cells of a human corneal epithelial cell line, adhere to the surface of all types of matrices under study, retain the typical structure of the actin cytoskeleton, the ability to proliferate and migrate during cultivation. Differences in the interaction of different cell cultures with different types of carriers were revealed. The studied mechanical properties, transparency, biocompatibility of cultured limbal stem cells with matrices and the timing of biodegradation of a 5 micron-thick polylactide-caprolactone matrix are close to the amniotic membrane. Taking into account the optimal combination of the investigated properties, the most acceptable for use as a carrier of cultured limbal stem cells is a polylactide-caprolactone matrix with a thickness of 5 μm.

There has been carried out a comparative analysis of adaptation to battle conditions in soldiers and sergeants passing through their military service by contract and by call-up, who have participated in military operations during the counter-terroristic operation in the Northern Caucases. It has been established that the combatants passing their military service by contract appear to demonstrate a more positive character of professional, medical and psychic-psychological components of adaptation to battle conditions, as compared to those passing their military service by call-up. The differences concern: significance for the servicemen of a number of war factors to which they have had to be adjusted; motivation for fulfilling their military duty; the level and dynamics of military-professional preparedness; distribution of the combatants by taking decisions to wage military operations, the manner of planning (programming, over-thinking) their actions in the forthcoming battle; the effect of staying in the armed conflict zone on their health status; the level and dynamics of their physical preparedness; markedness of manifestations of their psychic-emotional and psychic-somatic condition before the battle, during the battle and in case of getting an injury; the time necessary for their adjustment to living conditions in the zone of military operations. There have been substantiated certain directions for elevation of adaptation effectiveness, the basic ones of which are: raising the level of military-professional preparedness and motivation for fulfilling the military duty; improvement of the organism’s functional condition; creation of favorable psychological climate in the subunits. The obtained data may be used in conducting professional training of the servicemen for military operations, as well as in organization of their medical provision.

As a result of long-term (1987–2017) clinical follow-up of the health status of 3,190 military servicemen who liquidated the consequences of the Chernobyl nuclear power plant accident, it was established that during the analyzed period, malignant neoplasm’s were registered in 396 (1,8%) of the examined contingent,199 people among them died. The average annual incidence rate was 10.3 ‰. A contribution of malignant oncopathology to the overall morbidity structure did not exceed 3% (IX ranked according to the ICD-10 classification), while the share of diseases resulting in mortal outcome was 28% (II ranked place). In the structure of nosological forms of tumours, newborns of the organs of the genitourinary system (predominantly the prostate gland) – more than 40%, among the dead – tumours of the digestive and respiratory organs – 50% prevailed among those who survived by the end of 2016. 90% were solid tumours, 10% – oncopathology of the hemopoietic system. There was no correlation between the amount of absorbed dose and the lifespan of cancer patients. The most significant risk factors for this indicator were the age of the liquidators at the time of arrival in the accident zone (less than 40 years) and the duration of the emergency rescue operation (more than 70 days). It is shown that the average multi-year level of cancer incidence, its structure, the probability of death from malignant neoplasm’s and the life expectancy of liquidators with tumour pathology does not significantly differ from similar indicators of similar age groups of the male population of the Russian Federation. The data obtained indicate that low-power radiation in doses of 20 cSv and below does not adversely affect the dynamics of cancer incidence of liquidators compared to the non-irradiated population of Russia.

It justifies the introduction of measures to improve the organization of medical care in the «traumatology and orthopedics» profile for servicemen, citizens dismissed from military service, members of their families and civilian personnel of the Armed Forces of the Russian Federation in military districts and the Northern Fleet. The structure of the main classes of diseases of the musculoskeletal system, about which the indicated contingent was admitted to the military medical organizations for the period 2012–2017, is analyzed. The total number of treated patients of all privileged contingents for 6 years increased by 7%, and the military personnel – by 5,4%. The proportion of injuries of trauma and orthopedic patients treated permanently decreased. In the structure of injuries of the musculoskeletal system, injuries of the lower leg and knee joint are most common. In the structure of surgical interventions, the share of trauma and orthopedic operations in the Armed Forces of the Russian Federation is about 55–58% annually. The procedure for providing specialized trauma and orthopedic care to this category of patients in military districts and the Northern Fleet has been studied. In the Western and Central military districts, conditions have arisen under which in the first specialized medical care in the «traumatology and orthopedics» profile is provided to military personnel mainly in the clinic of military traumatology and orthopedics of the Military medical academy named after S.M. Kirov, while in the Central Military District similar assistance is provided to specialized victims mainly in the trauma wards of military medical organizations of district subordination. A set of organizational and treatment-diagnostic measures has been developed, aimed at optimizing the organization of medical care in the «traumatology and orthopedics» profile for citizens enjoying the right to receive it in the military medical organizations of the Ministry of Defense of the Russian Federation.

The following review of domestic and foreign literature shows a subtle but close relation between autoimmune neuroimmunological reactions and tumour-associated processes. A detailed description of paraneoplastic antibodies, their interactions with profile receptors and possible development of neoplastic processes are given. It is suggested that, because of the proximity of tumour and tissue antigens, the autoantibody-induced diseases may occur at the early stages of carcinogenesis and therefore serve as its early precursors. These onconeural antibodies have been found in diseases associated with the paraneoplastic syndrome (such as paraneoplastic encephalomyelitis, paraneoplastic cerebellar degeneration, paraneoplastic retinopathy, opsoclonus-myoclonus syndrome, stiff person syndrome, paraneoplastic subacute sensory neuropathy, Lambert– Eaton myasthenic syndrome, paraneoplastic myositis), as well as in certain other types of sociopathology. It is of particular importance that onconeural antibodies may also be found among healthy individuals, often close relatives, which could suggest a possible oncological prognosis regarding tumour localization and the onset of its clinical manifestation. Considering the autoimmune pathogenesis of the paraneoplastic neurological syndrome, these interactions of onconeural antibodies with the receptors and the appearance of oncoantigens may suggest a possibility of developing an effective immuno-modulating antitumor therapy which could significantly improve the quality of life for oncopathology patients.

The modern paradigm of combustology is experiencing a systemic crisis – a state in which existing means of solving problems and achieving goals have already become inadequate. Problematic issues in the theory and practice of burns arose in the course of scientific search and discovery of new facts that do not fit into the framework of previous concepts. The presence of a large number of significant anomalies, unpredictable situations and paradoxes testifies to the exhaustion of the heuristic, explanatory and predictive qualities of the paradigm, that is, its transition to the stage of «degeneration». The essence of the crisis is the existence of two mutually exclusive ways of science – mechanical determinism (empiricism), which excludes elements of random and probabilistic determinism, which presupposes the variability of events. The coordination between them is impossible. Comparative analysis of the test results by the methods of the current paradigm reveals their significant differences, which indicates the non-reproducibility and non-verifiability of the received facts. The cause of the crisis in combustiology is a violation in the process of cognition of the methodology of scientific tests, including the philosophical foundations of science, laws, categories and principles of dialectics, formal logic, probability theory, synergetics, the fundamental foundations of pathology, pathophysiology, statistics, etc., which constitute the foundations of science. The unavoidable sources of methodological defects of the paradigm are: identification of the concepts cause and causative factor, incorrect stratification of patients into groups of studies using the «severity of injury» as a system-firming factor, the lack of idealization, the use of inappropriate scales, statistical «scientometry», the lack of reliable prognosis of the outcome of injury, violation of principles the construction of the thesaurus of combustiology and the use of methods of metaphysical thinking.

The data of domestic and foreign literature on the study and study of combined radiation-chemical lesions are analyzed. The probability of the occurrence of victims with combined radiation injuries under various scenarios of nuclear and radiation incidents is noted. The data on the degree of elaboration of the problem, modern approaches to the clinic and diagnosis of this type of pathology are given. It is noted that the main attention of researchers was directed to the study of radiation-mechanical and radiation-thermal lesions. In the study of combined radiation-chemical lesions, most studies consider them as the interaction of ionizing radiation and chemical warfare agents. At the same time, many industrial toxicants are characterized by a synergistic interaction with ionizing radiation and mutual weighting of a lesion. The possibility of the occurrence of combined radiation-chemical lesions as a result of the joint action of ionizing radiation and carbon monoxide is substantiated. The nature of the mutual influence of ionizing radiation, radioprotectors and antidotes of carbon monoxide in the modern literature is almost not covered. It is likely that the use of radioprotectors can aggravate carbon monoxide intoxication. The necessity of further study and study of lesions caused by a combination of radiation and chemical (including carbon monoxide, as a quantitatively predominant toxicant during fires) factors have been substantiated. It is important to study the effectiveness of radioprotectors for the course and outcome of combined radiation injuries when used together with carbon monoxide antidotes and to assess their impact on the outcome of this pathology in order to improve the anti-radiation protection system.

Orthodontic treatment is an integral part of the complex treatment of patients with periodontal diseases and includes the solution of various interdependent tasks: stabilization of pathological processes in periodontal disease, conducting biomechanical analysis, providing periodontal support for affected teeth, stimulating the reconstruction of alveolar bone, improving bone tissue architecture, levelling occlusion disorders, creating conditions for rational prosthetics, reducing the volume of surgical interventions, improving aesthetics and dental prosthetics. However, today there is no consensus on the indications, time and methods of orthodontic treatment for periodontal diseases. The severity of damage to periodontal support tissues in patients with dental anomalies is more pronounced than in people of similar age without similar disorders. Most often, periodontal pathology is noted in patients with deep bite, the anomaly of the position of the teeth, narrowing of the dentition and the crowded position of the teeth in the frontal areas of the dental arches, various types of tort-anomalies. Complex treatment of patients with periodontal diseases in combination with dentoalveolar anomalies and secondary deformations of dentition and occlusion involves specific orthodontic measures that contribute to the restoration of aesthetic and aesthetics. Rational orthodontic treatment and rehabilitation tactics in such categories of patients can contribute to the onset of a state of long-term remission of pathological processes in the parodon-teeth, and also ensure its morphological integrity and functional preservation. Good hygienic control with the use of controlled dosage orthodontic treatment in patients with periodontal pathology does not impair their periodontal status.

New educations system of medical personal in the Russian Federation is analysed. The concept of continuous medical education is submitted. Accreditation of medical (military-medical) personal is described. The new system of training of specialists connects continuous medical education and accreditation of medical personnel. It is necessary to undergo accreditation at each level of professional education of medical personnel. Accreditation allows legal medical activity to medical personnel. Reakcreditation is carried out each 5 years. Accreditation examination includes testing, check of practical skills and the solution of situational tasks. Examination is held in the accreditation centers having the special equipment. Examination committees include practical doctors, members of the professional medical organizations, teachers of the medical universities and scientists. The accreditation centers are checked and examination committees are formed by the Ministry of Health. Each medical worker has to be registered on the website of the Ministry of Health and there make the private office. After that he can realize the individual plan of continuous medical education. It allows to take accreditation examination. Each medical worker has to study annually 30–36 hours at the medical university and also participate in scientific conferences. It gives him the educational credits necessary for an akcredittion. The new system of accreditation and continuous medical education has some problems. Still there is not effective system of data mining for database of training and accreditation of medical personnel.

The military hygiene as a subject in the Workers’ and Peasants’ Red army began to revive after the civil war. However, the textbooks, teaching guides and guidebooks appeared before 1917 were not accepted for training of the Red Army men and command staff. There was no unified departmental schedule on teaching of military hygiene in educational divisions and institutions provided by the authorities. Separate teaching guides on military hygiene were created initiatively and were intended for training of the Red army men in elementary rules of personal and public hygiene and prevention of infectious diseases, injuries, poisonings, and other health deteriorations. For example, in the Military Electrotechnical Academy of the Workers ‘and Peasants’ Red Army named after Budjonny developed a manual on military hygiene, which for many years was widely used for teaching military hygiene. The majority of educational and methodical materials of this period was created for military doctors. One of the active scientists and teachers of that period was a professor Fyodor GrigorievichKrotkov (1896–1983) who afterwards became the social leader, the Hero of Socialist Labor. F.G. Krotkov formed creative group with which he created the Reference book (1931) and the Guide to military hygiene (1933) which became a basis for the subsequent educational and scientific works on military hygiene. However, before the start of the Great Patriotic War, military hygiene was never introduced as a compulsory educational discipline in the educational process of military schools. In our opinion, the fundamentals of military hygiene must be known to every soldier, and especially to the officer corps, which requires their inclusion in promising medical training programs of all military training organizations.

The article presents information from the life of a maxillofacial surgeon and dentist in our country, one of the patriarchs of Russian military dentistry – Guard Colonel of Medical Service Valery Zabelin, who celebrated his 100th birthday in 2018. The data on the formation of V.P. Zabelin as a dentist, his combat path during the Great Patriotic War. The main directions of his scientific activity were noted, which touched upon the development and improvement of techniques for plastic closure of oroantral fistulas using soft local tissues, osteosynthesis of jaws at their fractures, the use of ultrasound in dental practice and maxillofacial surgery, as well as testing of new drugs: hemostatic, anesthetics, optimizers of reparative osteogenesis, as well as for orthopedic dentistry and dental production. Revealed his role in the development of issues of medical examination for maxillofacial injuries and major dental diseases. V.P. Zabelin was one of the pioneers in the study of the dental aspects of aviation medicine. He published more than 30 scientific works, introduced more than 50 rationalization proposals into the work of a number of military medical organizations. In the textbook «Military Dentistry» he wrote the section «Military Medical Examination of the Effects of Maxillofacial Injury and Certain Dental Diseases», which many experts today refer to. V.P. Zabelin, being one of the founders of national military dentistry, as well as the school of military dentists and maxillofacial surgeons, is rightfully recognized as one of the patriarchs of military health care.

The main milestones of the scientific and practical activities of an outstanding pathologist, pathologist, experimenter, academician Ippolit Vasilyevich Davydovsky are covered. I.V. Davydovsky in monographs «Bullet Wound of the Person» (1952, 1954) and «Pathology of gunshot wounds and damages» (the 34th volume of the work «Experience of the Soviet Medicine in the Great Patriotic War of 1941–1945») (1952) developed the doctrine about wound process and showed that in the bullet raw wound with the participation of microorganisms inevitably there is purulent melting of dead fabrics with the subsequent their diffusion and that this process is a process of biological cleaning of a wound (secondary cleaning of a wound). These works are unique in all world medical literature. The actual material of the military prosecutor covering in total over 1000 dead from wounds in different departments of a body, the material comprehended from medico-biological positions was their basis. However at extensive damages with adverse local and general premises for healing local complications (purulent flow, abscesses, phlegmons, secondary bleedings, etc.), which can be followed by the general reaction of an organism (temperature, blood changes, etc.), adequate to changes in the area of a wound are possible. I.V. Davydovsky called similar states is purulent-resorptive the fever having the different duration and weight. At long it is purulent-rezorbtivnoy to fever traumatic exhaustion can develop. These theoretical ideas of the course of wound process and pathogenesis of the general reactions of an organism emphasized the need of timely surgical processing of bullet wounds for achievement, according to I.V. Davydovsky, «anatomic purity of a wound» and fight against the general phenomena is purulent-resorptive fevers. In 1944 I was published relevant not only for wartime, but also today the book by I.V. Davydovsky «Traumatic exhaustion in the light of the doctrine about sepsis and is purulent-resorptive to fever» which practical value it is difficult to evaluate as basic provisions of this work substantially promoted change of medical tactics of treatment of seriously wounded. Also, the scientific contribution of the scientist in the development of gerontology, doctrines about infectious diseases and atherosclerosis is analyzed. The pedagogical activity of I.V. Davydovsky is noted.