Extimia (empegfilgrastim) is the first original Russian drug from the group of granulocyte colony-stimulating factors for the prevention and treatment of febrile neutropenia, a dangerous infectious complication associated with the hematological toxicity of cancer chemotherapy. Being a pegylated form of filgrastim, empegfilgrastim has a more pronounced therapeutic effect, and also has an increased half-life. Over the past few years, the drug has confidently entered the clinical practice of Russian oncologists, however, there are no publications on the experience of its use in the field of oncohematology. This article presents the results of a retrospective comparison of two groups of patients who received chemotherapy for blood system tumors. Patients from the first group received empegfilgrastim as prevention and treatment of neutropenia, patients from the second group received filgrastim. The results showed that, on average, the use of empegfilgrastim th reduced the recovery period of the absolute number of neutrophils by 3 days, and the period of 4 grade neutropenia (agranulocytosis) by 3,8 days during intensive and high-dose chemotherapy courses. Also, the use of empegfilgrastim allowed patients with high and extremely high risks of developing febrile neutropenia to receive 10,3% more planned chemotherapy courses on time without reducing the dose rate of chemotherapy.

The study is devoted to the development of a reliable, reproducible and effective way to create chronic corneal erosion (CCE) in experimental animals, as well as the assessment of the clinical and morphological features of corneal regeneration in response to the use of platelet-rich plasma (PRP) under experimental chronic corneal erosion (ECCE). It relates to experimental medicine, namely to ophthalmology, and military ophthalmology in particular. Studies were performed on 12 chinchilla rabbits (24 eyes). At the first stage, all animals were reproduced a model of experimental chronic erosion of the cornea: local ultraviolet (UV) irradiation with an exposure of 45 min on the previously deepithelized surface of the cornea. At the second stage, all the studied animals were divided into three groups (4 rabbits in each). In the 1st main group (MG), instillation of PRP was carried out in 1 drop every 1 minute for 10 minutes (10 drops) once, in the 2nd group they were treated according to the above method daily for 5 days. In the control group (CG), treatment for PRP was not used. As a result of the study, it was shown that local exposure to ultraviolet radiation prevents the corneal epithelization in the irradiation zone up to the 30th day of the experiment. In this case, the relief of inflammation and the completion of epithelization of the irradiated area becomes possible only after the growth of superficial vessels to it. The therapeutic effect of the use of platelet-rich plasma in experimental chronic erosion of the cornea due to growth factors, adhesive molecules and dissolved fibrin contained in it is based on the formation of a normal adhesion complex between the epithelium and the Bowman membrane and stimulation of reparative regeneration, as a result of which the corneal epithelium is restored.

The article presents a retrospective study of 64 patients with pancreatic pathology who underwent gastropancreatoduodenal resection. As a result of the study, it was noted that 33 patients developed postoperative complications, most of which were classified as grade III Clavien-Dindo. The analysis of the effectiveness of the new preoperative diagnostic score for pancreatic resections is performed. When calculating points on the PREPARE score, it was found that the expected (prognostic) low risk of developing postoperative complications corresponded to 48 patients, the intermediate - 10, and the high - 6. In fact, only 22 patients from the "low-risk" group had complications (6 - "mild" I-II degree in Cl.- D., 16- "heavy" III-V degree in Cl.- D.), 6 from the " intermediate " group (2 and 4, respectively) and 5 from the "high" group (all "heavy" III-V degree in Cl.- D.), which totaled 33 cases. Using ROC analysis, it was found that there were significant differences in PREPARE points (AUC=0.645, pAUC=0.047 [0.510-0.779]) and no differences in risk groups (AUC=0.601, pAUC=0.167 [0.461-0.740]). The results of the study indicate that the diagnostic score of preoperative diagnostics for pancreatic resections PREPARE may have a prognostic ability, when evaluated before surgery by points. Patients from the "high" risk prognostic group are of particular interest for the study. The use of the PREPARE score in patients who have undergone gastropancreatoduodenal resection can be an effective prognostic indicator of the development of postoperative complications, the need for and delay of the patient in the hospital, which will help reduce postoperative mortality. However, further research is needed on the predictive capabilities of the PREPARE score to include more patients.

Arterial hypertension is a multifactorial disease, a significant role in the pathogenesis of which is played by a genetic factor. In recent years, many studies have been carried out to identify genes in various diseases, including arterial hypertension, and candidate gene databases have appeared, to which the results of these studies have been added. There are known polymorphisms of genes associated with the development of arterial hypertension, as well as with a change in the pharmacodynamics of antihypertensive drugs. The following genes and the peculiarities of metabolism and activity of pressor systems associated with their polymorphisms are most studied: genes of the cytochrome system (CYP2D6, CYP2C9, CYP11B2); genes of the renin-angiotensin-aldosterone system: ACE (angiotensin-converting enzyme gene), AGT (angiotensinogen gene), AGTR1 and AGTR2 (angiotensin 1 and angiotensin 2 receptor genes). The objective of the study was to study the frequency of detection of gene polymorphisms associated with the development of arterial hypertension in patients with hypertensive neurocirculatory asthenia and stage I hypertension. A total of 77 conscripts and contract employees between the ages of 18 and 40 were examined. Using the amplifier, the following genes were studied by polymerase chain reaction and detection: the p-450 cytochrome gene (CYP11B2) and the AGT renin-angiotensin-aldosterone system gene: 704 T> C. Polymorphisms of candidate genes for arterial hypertension were found in 100% of the examined. AGT polymorphisms: 704 T> C and CYP11B2 were more often detected in stage I hypertension than in hypertensive neurocirculatory asthenia. Conducting genetic research at a young age in patients with hypertensive neurocirculatory asthenia will reveal a risk group for the development of hypertension.

Pulmonary hypertension is a polyetiological condition that can complicate myocardial infarction and weigh down its course [7, 8, 19]. The aim of the study is to assess the risk factors for the development and progression of pulmonary hypertension against the background of myocardial infarction. The study included men aged 18 to 60 years with myocardial infarction who had a standard diagnostic algorithm performed in the first 48 hours (1) and at the end of the third week of the disease (2). The patients were divided into three groups: I - the study group, with pulmonary hypertension arising on the background of myocardial infarction (average pressure in the pulmonary artery is 25 mm Hg. and more) - 84 patients; II - with a normal level of average pressure in the pulmonary artery (less than 25 mm Hg.) in the subacute period of myocardial infarction-183 patients; group III - 184 patients with elevated levels of average pressure in the pulmonary artery at both points of the study. As a result, it was found that the main risk factors for the development of pulmonary hypertension in the subacute period of myocardial infarction are bradycardia on ECG in history, the presence of chronic cerebral circulation disorders, the tendency to bradycardia during physical examination, lower than in the control groups, indicators of cardiac output, heart index, left ventricular mass index, left ventricular mass index in the first 48 hours of the disease; higher levels of sodium concentration in blood plasma in the first 48 hours of the disease, the atherogenicity coefficient at the end of the third week of the disease, than in patients of control groups.

Endoscopic operations performed by a herniological patient are becoming increasingly common in specialized hospitals. At the same time, despite the large flow of patients in this category, the optimal option for minimally invasive surgery is not yet specified. Thus, the problem remains unresolved: which of the endoscopic plasty methods is preferable - TAPP (transabdominal preperitoneal plasty) or TEP (total extraperitoneal plasty)? The aim of the study was to evaluate the results of surgical treatment of patients with inguinal hernias with a minimally invasive method according to the TAPP and TEP methods, followed by justification of the appropriateness of using one or another endoscopic technique. The results of treatment of 1015 patients with inguinal hernias operated on from 2014 to 2019 were studied. (331 patients were operated laparoscopically - TAPP and 684 patients - according to the TEP technique). The learning curve with TAPP averaged 30 interventions performed, with TEP 45-50. The duration of surgery using the TAPP technique was longer compared to TEP. In all cases, the early postoperative period was uneventful, pain according to the VAS scale was greater in the group of patients operated on laparoscopically. Later postoperative complications developed with the same frequency - in the TAPP group in 0.9% of patients, after TEP in 1.2% of patients. Relapse of the disease was diagnosed in 3 cases (0.9%) after laparoscopic hernioplasty, and after surgery according to the TEP technique, in 3 cases (0.4%). At the same time, TEP hernioplasty favorably differed from laparoscopic intervention by the absence of the need to use endogeniostepler, less pain and a shorter postoperative bed-day.

This study focuses on such an important topic as gunshot open globe injury received in the course of combat operations [6], at home [7] and at work [3]. This topic is relevant because gunshot open globe injury is the most common injury for military ophthalmologists [2, 5]. An experimental reproducible standardized model of a type B gunshot open globe injury (without a foreign body) was developed to study the features of this injury in S.M. Kirov Military medical academy [1]. Due to the wide variety of gunshot injuries to the eye in appearance and internal structure [4, 8], it became necessary to record changes during the experiment. Therefore, it was decided to use high-speed photo and video shooting. Thus, it is possible to conclude that there is currently a need to develop a technique for photo and video recording of an image of a gunshot open globe injury. The study is divided into several stages, including specific tasks. The study includes literature analysis, modeling of various types of gunshot open eye injury, and visualization of changes using high-speed photo and video fixation. The result of this study is the developed method of high-speed photo and video fixation and description of macroscopic changes in various types of gunshot open globe injury. The study was carried out on the basis of two institutions. The first part of the work was carried out in Institute of military medicine, the other part was conducted at the Department of ophthalmology named after Professor V.V. Volkov, S.M. Kirov Military medical academy in 2018-2020 years.

At Department of Hospital Therapy Military Medical Academy has been performed prospective study with the participation of 122 st servicemen. Patients after primary carrying out oral glucose tolerance test have been divided into 2 groups: 1 - 60 men with the level of nd glycemia ≥ 8,6 mmol/l after 1 hour of the test; 2 - 62 with a normal 1-hour glycemia. All of the examined patients initially and over time have been evaluated lipid, carbohydrate metabolism, an ultrasound scaning of the heart and of the common carotid arteries. The patients st curation have been realized for 3.8 to 1.5 years. In the initial examination, the two samples were compared in AH (78% vs 74% for the 1 and nd 2 groups, respectively, p>0.05) at average blood pressure values of 156/98 and 153/97 mm Hg. accordingly (p>0.05); AO (42% vs 40%, p>0.05), BMI 29.3 vs 27.4 ± 4.2 kg/m (p=0.015); hypodynamia (42% vs 38%, p>05). Smoking prevailed in men in the 1st group (53 vs 31%, χ =5.0; p=0.02). Against the background of drug therapy, there was an achievement of normotensia in 35 and 46% of patients in the 1 and 2 2 2 st nd groups, respectively (p>0.05); smoking cessation - in 30 and 15% of the subjects (p>05). Alimentary obesity after curation was determined in 67 2 and 50% of men in these subgroups (χ =3,6; p=0.05), which indicated a negative dynamics compared to the initial anthropometric data (p>0.05). Has been identified a number of characteristics for patients with early postprandial hyperglycemia: more atherogenic changes in lipid spectrum, high incidence of prediabetes and diabetes mellitus type 2 in the dynamics. Has been observed more active progression of atherosclerosis as a thickening of the intima-media complex for men with 1-hour hyperglycemia. The presence of 1-hour hyperglycemia is an early marker of development prediabetes and diabetes mellitus type 2, with the result that this indicator should be assessed in everyday clinical practice, along with levels of fasting plasma glucose and 2-hour plasma glucose after postload test.

The idiopathic normal pressure hydrocephalus (Hakim-Adams syndrome) is characterized by the expansion of liquor-containing cavities, which is clinically manifested by a triad of symptoms: impaired gait, cognitive impairment, and impaired urination. One of the most common diseases associated with iNPH is Alzheimer's disease. Both diseases are found in the same age group with similar complaints of memory impairment. In clinical practice, their differential diagnosis is based on the identification of the Hakim-Adams triad. However, the determination of the combination of these two states, which is observed with a frequency of up to 75%, is a difficult task. In the study, the concentrations of biomarker proteins of amyloidosis and neurodegeneration in cerebrospinal fluid were determined. A total of 47 patients were examined (14 with a diagnosis of idiopathic normotensive hydrocephalus, 25 with Alzheimer's disease, 8 with their combination). The level of proteins in the cerebrospinal fluid was assessed using enzyme-linked immunosorbent assay (ELISA). Tablets for 96 samples were used to determine each of the evaluated indicators: the content of beta-amyloid (Aβ-42), tau protein (tau) and 218-phosphorylated tau protein (ftau). The neurodegeneration coefficients were calculated (ftau/Aβ-42, tau/Aβ-42). Specific cerebrospinal fluid changes in patients with idiopathic normotensive hydrocephalus were found to have higher levels of amyloid beta, a decrease in the content of tau and phosphorylated tau protein compared with patients with Alzheimer's disease. In the case of a combination of diseases (“comorbidity”), the presence of “intermediate” results by liquorological indicators is characteristic. A higher level of amyloid beta compared with Hakim-Adams syndrome indicates amyloidogenesis. We also revealed patterns of transformation of moderate cognitive impairment into dementia (according to the ratio of tau / Aβ-42 and ftau / Aβ-42).

291 patients were examined at the clinic, there were 191 male and 100 female patients, for the presence of left ventricular hypertrophy using echocardiography. All included patients were divided into 4 types depending on left ventricular remodeling. To determine the type of heart remodeling, we used the determination of the left ventricular mass index (the ratio of the left ventricular myocardial mass to the body surface area) using echocardiography, and the determination of the relative thickness of the left ventricular wall (the ratio of the doubled thickness of the posterior wall of the left ventricle to its end diastolic size). Arterial hypertension was detected in 186 patients: 117 males and 69 females. A statistical analysis of the data was carried out, which took into account the gender of the patients. We found the dependence of the type of remodeling on the level of blood pressure. According to the results of the study, it was found that the normal geometry of the left Известия Рос. Воен.-мед. акад. 2020. №1. Том 1 Прил.

The most common neurodegenerative diseases in the elderly and senile, the main manifestation of which are intellectualmnestic disorders, include Alzheimer's disease, mixed and vascular dementia, and idiopathic normal pressure hydrocephalus. Idiopathic normal pressure hydrocephalus, or the Hakim-Adams syndrome, is characterized by the expansion of liquor-containing spaces, which leads to a specific clinical picture: gait disturbance, cognitive deficit and dysuric disorders. The diagnosis is complicated by its combination with Alzheimer's disease in 75% of cases (the syndrome «AD-iNPH»). Magnetic resonance imaging is a method that helps in conducting differential diagnosis and determining further treatment tactics. The study revealed specific neuroimaging signs using several scales: iNPHRadScale, MTA scale of atrophy of the medial temporal lobe, GCA scale of global (diffuse) cortical atrophy, scale of atrophy of the parietal lobe (Koedam). There were examined 45 people which old was 50 to 90 years: 20 with a diagnosis of idiopathic normal pressure hydrocephalus, 17 with Alzheimer's disease, 8 with the «AD-iNPH» syndrome. It was found that Hakim-Adams syndrome is characterized by an expansion of cerebrospinal fluid cavities, which was confirmed by the iNPHRadScale scale: acute angle of the corpus callosum, presence of a high Evans index, expansion of sylvian fissures, periventricular hyperintensity, narrowing of paraphalcinar grooves without significant atrophy. Patients with «AD-iNPH» syndrome were characterized by the expansion of cerebrospinal cavities of the brain, obtuse angle of the corpus callosum, the presence of periventricular hyperintensity, a decrease in the height of the hippocampus and expansion of the choroid gap, diffuse atrophy of the brain substance, that is, a combination of dilatation and neurodegenerative processes. The atrophy of the substance of the brain was characteristic of patients with Alzheimer's disease, which is confirmed by the scales of atrophy of the medio-basal parts of the temporal and parietal lobes. It is necessary to comprehensively evaluate brain MR-images in patients with suspected idiopathic normal pressure hydrocephalus and Alzheimer's disease using several scales.

The article contains information about the tactics of surgical treatment of patients with acute pancreatitis of medium and severe severity of the disease. The relevance of the topic is dictated by the high frequency of the disease, a significant proportion of unsatisfactory treatment results, as well as the fact that generally accepted tactics for surgical treatment of patients with acute pancreatitis currently does not exist. The article presents the data that the most perspective tactics of multistage surgical treatment is. At development of infectious complications such approach allows to reduce lethality, in comparison with patients who have undergone open interventions. The first stage of surgical treatment of acute pancreatitis at development of acute liquid accumulations in the second week of the disease is more often carried out a little invasive interventions to reduce accumulation of toxic substances and to prevent polyorganic insufficiency. The first stage of surgical treatment can also be laparoscopic surgery, which is diagnostic in order to differentiate the disease and determine the severity of acute pancreatitis. The second stage of surgical treatment in the development of infectious complications may also be a minimally invasive surgery. At the second stage of the surgical treatment large size drainages are put in order to wash and clean the abdominal cavity from the aggregations formed there. The third stage of surgical treatment of acute pancreatitis is the open access operation, the task of this operation is necksrevestrectomy. Exactly such tactics of surgical treatment of acute pancreatitis of medium and heavy degree of severity is the most perspective as lethality of the given tactics is minimal and development of infectious complications occurred less often.

The study of comorbidity for the therapy personification is one of the methods for improving the myocardial infarction (MI) prevention of recent years. The data on the MI clinical features in young and middle-aged men suffering from bronchial asthma (BA) are few and contradictory. The research purpose is to assess risk factors for cardiovascular diseases (CVD), the course of myocardial infarction, and hemodynamic changes in men aged less than 60. They include men from 18 to 60 years old with type-I MI. The standard diagnostic algorithm was performed in the first 48 hours (1) and at the end of the third week of the disease (2). The patients were divided in two groups of comparable age: I - six patients with BI; II - a control group of 424 people without any lung diseases. The study showed that the main MI risk factors in men with BA were a history of chronic heart failure (HF), a hereditary burden of coronary heart disease, and atherogenic dyslipidemia. The patients with BA had atypical variants of the MI course with predominance of disease complications such as cardiac arrhythmias and cardiac asthma. Moreover, the patients with BA had more pronounced hemodynamic disturbances both in acute and subacute periods of MI. Such patients should stay under medical supervision to identify and treat chronic HF and should be further examined to exclude non-atherosclerotic variants of coronary artery disease or embolism.

At the moment, the disease has affected more than 44 million people and this figure is growing exponentially. Therefore, we can assume that Alzheimer's disease-the scourge of the future generation, its study is engaged in the best minds of our time. This problem has not escaped the cinema, which is able to reveal and give the General public the simplest explanation of the essence of the disease and transfer it to the place of a person with Alzheimer's disease, to feel the severity of the disease and the helplessness of such patients, both before themselves and before society. The purpose of the work is to assess the cinematic interest in Alzheimer's disease, to find all possible films and TV series where Alzheimer's disease may appear, to evaluate the signs of the disease in the characters of the pictures by psychoneurological criteria, to analyze the possibility of using cinematography in the field of raising awareness of the population and medical staff about this disease. According to the main keywords, the main films of cinema for 50 years were found with the help of special search services and additional scientific literature. This study allows us to see the peculiarity of the transmission of clinical symptoms of dementia by actors through their roles. According to a number of criteria, 28 films were included in the research list, which allowed to systematize the obtained data and information from the scientific literature. The subjects were evaluated: the first-the clinical symptoms of the disease, the second-the General ability to function in everyday life, the third-behavior. All of the above features were found, but cognitive disorders dominate. Behavioral disorders are also shown well, disorders of motor functions are presented less often. Most films are informative enough to convey the standard course of Alzheimer's disease.

Concomitant inflammation in nephrogenic anemia is one of the most frequent complications among patients undergoing programmed hemodialysis, which can lead to the worst results of the correction of anemic syndrome. The study conducted a comparative analysis of the course of nephrogenic anemia in 31 patients with end-stage chronic kidney disease undergoing programmed hemodialysis. 2 groups were distinguished: the first group - 10 patients with laboratory signs of inflammation (C-reactive protein> 5.0 mg / l); the second group - 21 patients with no signs of inflammation (C-reactive protein <5.0 mg / L). The following laboratory parameters were evaluated: hemoglobin level, C-reactive protein, serum ferritin, gas transport function of venous blood. The quality of life of patients was assessed using the FACT questionnaire (the Functional Assessment of Cancer Therapy scale). According to the results of the study, it was found that patients with systemic inflammation have a functional iron deficiency (the median level of ferritin was 335.5 μg / l and 234.2 μg / lv in the first and second groups, respectively). In both groups, patients have similar laboratory indicators of hemoglobin level (median 98 g / l and 106 g / l in the first and second groups, respectively) and venous blood saturation (median 59.95% and 62.5%), which indicates high efficiency combination of erythro-poiesis-stimulating therapy with intravenous iron. At the same time, among patients with inflammation, a lower quality of life was observed (median scores on the FACT-An 40 and 29 scale). Concomitant inflammation in nephrogenic anemia does not affect the severity of peripheral tissue hypoxia. A statistically significant (p <0.05) inverse correlation was found between the activity of inflammatory markers (leukocytosis, C-reactive protein) and the hemoglobin level in the group of patients with inflammation.

One of the urgent problems in helping patients with chronic myeloid leukemia BCR / ABL1 + (CML) is the development of various types of toxicity of tyrosine kinase inhibitors (TKI), which may be based on impaired drug metabolism. The paper presents preliminary results of a study of the polymorphism of genes of the enzyme system involved in the biotransformation of drugs (genes CYP2C9, CYP3A4, CYP3A5, CYP4E2 and VKORC1) in patients with CML with or without symptoms of dasatinib intolerance. It was found that in patients with non-hematologic toxicity-specific effects of dasatinib therapy (recurrent pleural effusions), the frequency of occurrence of various single-nucleotide polymorphisms was 100% compared with the control group. Polymorphism rs2740574 (AG) of the CYP3A4 cytochrome isoenzyme gene, the main enzyme involved in dasatinib metabolism, was detected in 20% of subjects, based on which it was concluded that the functional activity of this enzyme is not a reliable predictive indicator of the toxic effect, but there can be one from the causes of its occurrence, which requires further study. It was also found that rs99232231 (GA) polymorphism of the VKORC1 vitamin K-reductase gene was detected in 60% of subjects; a decrease in the functional activity of this enzyme may be one of the causes of adverse events. The results obtained indicate the prospect of further development of the topic in order to search for new approaches to the choice of treatment for TKI and the prediction of complications in CML.

Alzheimer's disease has not been spared and painting, which is able to reflect changes in both the psychological and physical condition of the artist, which allows you to feel the severity of the disease and the helplessness of such patients, both in front of themselves and in front of society. Alzheimer's disease is characterized by several criteria, such as reduced cognitive abilities, where a large number of variations in memory loss are given high priority, regulatory functions and speech also suffer, and personality and behavior changes. However, special attention should also be paid to violations of the visual-spatial function. The aim of the work was to identify artists who suffered from Alzheimer's disease, analyze their work before the onset of the disease and during its progression, find the main signs of the disease in painting, and systematize these signs. We used the method of vertical and horizontal analysis, as well as a comparison method based on a number of NINCDS-ADRDA criteria that allow us to find and systematize the obtained data. The study revealed common features of pathological deviations in works of art by artists with Alzheimer's disease - the appearance of two-dimensionality and simplification (simplicity) in painting, the total number of angles decreases and their sharpness decreases, the deterioration of perspective and atmosphere in the image, the loss of meaning and content, sometimes there was a transition to abstraction, copying previous works when creating a new work. There was a decrease in the ability to perform previous work, a decrease in cognitive functions compared to the previous functional level, especially violations of visual and spatial functions and memory, as well as a decrease in regulatory abilities.

Modern approaches to drug therapy should be based not only on effectiveness, but also on a comprehensive assessment of the safety of drugs. Pharmakogenetic testing allows to define efficiency and safety of therapy, to choose the most effective medicine as prime therapeutic means that leads to reduction of quantity of the medical products necessary for adequate treatment. At present, advances in clinical genetics are associated with the isolation of alleles (variants) of various genes, the assessment of their frequency and the detection of associations of certain alleles with phenotypic manifestations, with an attempt to identify prognostic signs. On the basis of complex pharmakogenetic analysis is possible to identify significant of genetic markers in the prediction of the flow and effectiveness of pharma-cotherapy of arterial hypertension. The study involved 40 of patients with arterial hypertension. Performed pharmakogenetic testing with the study of polymorphisms of gene α-adductin. As a result of which it was possible to obtain results: “normal” alleles of the α-adductin G / G gene were found in the majority of the studied (29 out of 40 patients), while the “risk” allele of the α-adductin G / T gene and the “risk” allele T / T - in 11 studied patients, and the frequency of occurrence of the G / T allele is 4 times greater than the T / T allele. The identification of genetic markers in cardiology is subjected to intensive study and research in order to identify genetic risk. Thus,оn the basis of the results of genetic testing can not only build the forecast of disease, but also rationally choose the drug therapy, which helps to prevent the development of severe complications.

At the clinic of propaedeutics of internal diseases, 33 patients were selected for whom a severe degree of OSA was diagnosed by cardiorespiratory monitoring (YAG ≥ 30 sob / h). All patients had a history of drowsiness (drowsiness school according to the Epworth questionnaire 12 ± 3), the presence of snoring during sleep, and short-term respiratory arrest. Two groups were formed using telephone monitoring: the first group was patients with severe OSAS who purchased a device for CPAP therapy (15 people, 13 of them were men and 2 women), the second group were patients with severe OSAS who did not buy or only are going to purchase a device for CPAP therapy (18 people, 17 of them are men and 1 woman). When analyzing the data, it was found that patients who purchased a device for CPAP therapy 85% have good compliance with the therapy, use the device> 4 hours per night 80% of the nights. With good compliance with therapy, the average weight of the patients of the first group before the start of therapy was 132 ± 8 kg, then at the time of the survey the average weight decreased to 118 ± 5 kg. In patients of the second group without CPAP therapy, the average weight was 111 ± 8 kg, after a trial course and recommendations from the attending physician for weight loss, at the time of the survey, the average weight of the group decreased to 105 ± 5 1 kg. Based on these data, it can be concluded that patients of the first group on CPAP therapy reduced their weight from the original by 1%, in contrast to the second group, where the weight decreased by 6%. According to the results of the study, patients with OSAS who have good compliance with therapy have a higher percentage in weight loss compared with patients without CPAP therapy.

Much attention is paid to the study of postoperative complications in traumatology, since they affect the outcome of surgical treatment, the duration of hospitalization, and also reduce the quality of life of patients. Among the postoperative complications in patients with a traumatological profile, special attention is paid to changes in the functions of the central nervous system in the postoperative period, which constitute postoperative cerebral dysfunction - a change in the structural and functional state of the brain of predominantly vascular origin, which occurs in surgical practice in the intraoperative or early postoperative periods, manifested in the form of transient or persistent dysfunctions of the nervous system. Postoperative cerebral dysfunction is pathogenetically heterogeneous, clinically polymorphic, and includes three clinical types: perioperative cerebral stroke, symptomatic delirium of the early postoperative period, and delayed cognitive impairment. A feature of the development of postoperative cerebral dysfunction in orthopedics may be fat and bone marrow cerebral embolism, which most often occurs when cement fixation is used. Cerebral embolism contributes to damage to the blood-brain barrier, swelling of the brain substance. It can potentiate and participate in the mechanisms of neuroinflammation, leading to the development of the above clinical types of postoperative brain dysfunction. But despite the detection of fat emboli in the middle cerebral artery by transcranial dopplerography in many patients with endoprosthetics of large joints of the lower extremities, the connection of this fact with the development of postoperative cerebral dysfunction has not yet been studied.

Myocardial infarction (MI) in young and middle-aged people is a socially significant problem, and arterial hypertension (AH) is one of the most important risk factors for cardiovascular complications. Despite the availability of studies on MI in the presence of AH, data on structural and functional changes in the heart and prognosis in men of young and middle age are few and contradictory. The purpose of the study was to study the structural and functional characteristics of the heart that affect the prognosis of young and middle-aged men in the acute and subacute periods of MI in the presence of AH to improve treatment and prevention. It is included 497 men from 19 to 60 years old with type I IM who, in the first 48 hours (1) and at the end of the third week of the disease (2), are performed the standard diagnostic algorithm. Patients were divided into four groups depending on the presence / absence of AH and age: up to 49 years (with AH (112 patients, without AH 75 patients) and 50-60 years (with AH 230 patients, without AH 80 patients). It was established that in the presence of AH there is a more pronounced systolic dysfunction. Such patients are more likely to have sudden cardiac death and cardiovascular complications, therefore this category of patients requires more careful monitoring for the timely detection and treatment of chronic heart failure and the prevention of cardiovascular catastrophes in the future.

We studied heart rate variability in patients with obstructive sleep apnea in comparison with a group of healthy individuals without OSAS. The results obtained during the study showed that in patients with OSAS, there is a decrease in both temporal and spectral indicators of heart rate variability. We studied such indicators as the variational range of RR (VAR), the average value of all RR intervals, which gives an idea of the main level of functioning of the sinus node (avNN), the standard deviation of all NN intervals (SDNN), the number of consecutive pairs of RR intervals that differ more than 50 ms divided by the total number of all RR-intervals (pNN50), the standard deviation of the inter-interval differences, which estimates the high-frequency component of variability (rMSSD), the average of 5-minute standard deviations for the entire record (SDNNidx), standard e deviation of the values of the average NN intervals obtained for all 5-minute sections into which the registration period is divided (SDANN), the power of the very low-frequency domain (VLF), the power of the low-frequency domain of the HRV spectrum (LF), the power of the high-frequency domain of the HRV spectrum (HF), weighted average variation of the rhythmogram (SVR). Thus, it has been shown that in people with a syndrome of obstructive sleep apnea, a disturbance of the sympathoglobal balance occurs, which is a favorable factor for the occurrence of cardiovascular diseases and, in some cases, to lead to death. The obtained results emphasize the need for a more thorough examination of patients with OSAS for the presence of cardiovascular diseases and to relate these patients to the group of increased risk of their occurrence.

The aim of the study was to analyze the long-term effictiveness of high-dose immunosuppressive therapy (HDIST) followed by autologous hematopoietic stem cell transplantation (AHSCT) in long-term observation (more than 20 years) of two MS patients. This therapy was performed for the first time in Russia at the S.M.Kirov Military Medical Academy. The therapy was carried out for the first time in Russia at the S.M. Kirov Military Medical Academy at the Department of Hematology and Clinical Immunology together with the Department of Nervous Diseases in 1999 and 2000. The research was carried out by long-term dynamic observation of changes in neurological status according to EDSS (Expanded Disability Status Scale), recording of disease exacerbations and control of brain magnetic resonance imaging (MRI) results. It has been established that as a result of conducting a HDIST with AHSCT, a record duration of more than twenty years of remission without any additional treatment is possible in comparison with other PITRS. At the same time, a high frequency of side effects was observed during the therapy. Thus, taking into account its high effictiveness, manifested as a regression of neurological symptoms and long-term long-term remission with no activity on MRI, HDIST with AHSCT is one of the promising methods of MS treatment. Significant frequency and severity of side effects requires further improvement of treatment technology as well as observation to assess the safety of this therapy.

Renal dysfunction (DP) in myocardial infarction (MI) significantly worsens the prognosis of the disease in men under 60 years of age. The aim of the study was to assess the significance of various factors for the development of DP at the end of the subacute period of myocardial infarction (MI) in men under 60 to improve prevention. It includes men from 18 to 60 years old with type I IM who, in the first 48 hours (1) and at the end of the third week of the disease (2), performed the standard diagnostic algorithm, which included complex echocardiography and lipid metabolism assessment. Patients were divided into two age-comparable groups: I - the study group, with a decrease in glomerular filtration rate at the end of the third week of MI less than 60 ml / min / 1.73 m2 (renal dysfunction (DP)) - 21 patients; II - without impaired renal function - 176 people. It was found that the most significant indicators of the risk of developing DP at the end of the subacute MI were the index of the final systolic volume of the left ventricle, the size of the left atrium, tachycardia of more than 108 per minute and hypertriglyceridemia (6.7 mmol / l or more) in the first hours of the disease in association with aneurysm of the left ventricle and its thrombosis, fibrillation and atrial flutter both before the development of MI and during the period of the disease. The combination of these factors with a history of unstable angina, prothrombin level (84% or more), GRACE value (134 points or more) and TIMI (8 points or more), dyslipidemia at the end of the subacute period of the disease indicates a high risk of developing DP in this period. The listed factors can be used to form a high-risk group for the development of this condition for more in-depth observation and prevention activities.

The high incidence of hemorrhoids, along with the frequent development of postoperative complications and relapses of the disease, does not allow one to doubt that improving the treatment results of patients with this pathology remains one of the urgent problems of modern surgery. The aim of the study was to evaluate the effectiveness of surgical treatment of hemorrhoids using the original technique of lateral ultrasonic dissection in the "cutting" mode. A comparative analysis of the immediate results of surgical treatment was performed in two groups of patients with 3-4 stages of chronic hemorrhoids. The main group included 20 patients in whom the original hemorrhoidectomy technique with lateral ultrasonic dissection was used. The control group consisted of 20 patients who underwent Milligan-Morgan hemorrhoidectomy using electrocoagulation. There was no statistically significant difference between the indicated groups by age, gender structure of patients, as well as by the main characteristics of the disease. Results of the comparative analysis demonstrated that the frequency of complications, the intensity of the pain syndrome, as well as the length of stay in the hospital among the representatives of the main group turned out to be less than in the control. Thus, the use of hemorrhoidectomy with lateral ultrasonic dissection in the “cutting” mode ensures a favorable course of the early postoperative period and accelerates the rehabilitation of patients.

The analysis of objective research data obtained during the examination of patients suffering from chronic dacryocystitis is presented. The importance of modern as well as traditional methods was defined. It was shown that the modern diagnostic method - lacrimal endoscopy is indicative and informative, not only with confirmed chronic dacryocystitis but also in the absence of pathological changes in the lacrimal ducts in patients of the control group. The aim of the studi was to improve the quality of diagnosis of chronic dacryocystitis. There are traditional methods for diagnosing chronic dacryocystitis. They were also used in patients of the control group (without pathology of lacrimation) and in patients with chronic dacryocystitis. Refers to them sounding of the lacrimal ways, washing them with lacriminal cannulas, slit lamp biomicroscopy, color nasal lacrimal test 2% fluorescein sodium solution for its implementation, lacrimal endoscopy with lacrimal endoscope. A total of 20 patients were examined. In the control group of patients, with the help of lacrimal endoscopy, the normal appearance of the mucous membrane of the lacrimal tubules, lacrimal sac, the nasolacrimal duct was determined. Active patency of the tear ducts was confirmed by a positive color nasal lacrimal breakdown. When performing endoscopy of the lacrimal passages in patients of the second group, the criteria for pathological changes in the lacrimal sac and nasolacrimal duct, characteristic for chronic dacryocystitis, are determined: hyperemia, the presence of detachable, grayish folds of the mucous membrane, whitish-gray membrane in the area of stricture. The preliminary diagnosis of chronic dacryocystitis was also confirmed by traditional diagnostic methods: color lacrimal-nasal functional test, diagnostic sounding. and lacrimal lavage, dacryocystography. As a result of the study, it was found that lacrimal endoscopy significantly expands the possibilities of diagnosing chronic dacryocystitis, confirms and complements the data of traditional research methods, allows you to see structural changes along the tear ducts, determines the degree and level of obliteration. The combination of traditional diagnostic methods and lacrimal endoscopy allows the surgeon to choose the most appropriate way of surgical treatment of this pathology.

Recovery of motor activity of military personnel of power structures and athletes after aggravation of deforming arthrosis of the hip joint (coxarthrosis) remains today an unsolved problem. The causes of deforming arthrosis are contusions of the soft tissues of the hip joint, long-standing injuries of its capsule-ligamentous apparatus, long-term loads on the musculoskeletal system in athletes during training and competitions, as well as the impact of cold on the body. The consequences of untimely and ineffective treatment of osteoarthritis are expressed in a decrease in motor activity and quality of life, the inability for health reasons to maintain their physical fitness at the required level, the transition of a soldier to a dynamic observation group for medical reasons, a decrease in the quality of performing military professional duties for official purposes in daily activities and combat situations, the termination of military applied and other sports. Despite the wide range of different treatment methods, the issue remains very relevant. For this purpose, the Department of surgery for injuries and diseases of the extremities of the outpatient clinic of the Kirov Military medical Academy treated 35 servicemen suffering from coxarthrosis using intra-articular njection therapy with hyaluronic acid preparations. Assessment of the quality of life of patients and the condition of the affected joint before and after treatment was evaluated using clinical methods, SF SF-36 and the Vash questionnaire. The analysis of the obtained results allows us to speak about the effective treatment of coxarthrosis with hyaluronic acid preparations, which is reflected in the improvement of clinical signs, as well as the criteria for assessing the quality of life.

In field surgery, there is an acute question of stopping external bleeding [3]. In the literature, the effectiveness of time-sensitive temporary hemostasis agents has been well studied, but there are no data on the effectiveness of available tools. The aim of the study was to determine the effectiveness of improvised means of temporarily stopping external bleeding. In the course of scientific work, the improvised methods of temporarily stopping external bleeding (tourniquet, twist, waist belt, wire) were investigated in comparison with a timeline hemostatic tourniquet in a group of 30 people. The application time, pain, and application efficiency by the presence of a Doppler signal above the radial and posterior tibial arteries were studied. Statistical data processing was performed using the Chi-square test, the Fisher test and the Kruskal-Wallis test. The results showed that the cessation of blood flow when using the belt was observed only in 6 (20%) cases on the hip, in 15 ( 50%) cases on the shoulder; wires - on the thigh in 6 cases (20%) and 18 (60.0%) cases on the shoulder, which is much less common in comparison with a personnel harness (p <0.001). When using a braid-twist from a scarf, the cessation of blood flow on the shoulder was observed in 29 96.7%) cases and 25 (83.3%) cases on the thigh; time rope - in 28 (93.33%) and 22 (73.33%) cases, respectively (p = 0.37066). The average ( application time of the studied methods was 42.38 ± 1.41 sec. There were no statistically significant differences in the application time of the studied methods (p = 0.8 on the shoulder, on the thigh p = 0.06). When scoring shoulder pain, there were no statistically significant differences between the methods (p = 0.22), the average score was 2.01 ± 0.64 points, on the thigh - the data were statistically significant (p = 0.0038), the most painful was the twist - 2.95 ± 2.03 points, the least painful was the waist belt 1.07 ± 1.17 points. As a result, the low efficiency of the waist belt and wire as improvised means of temporarily stopping external bleeding was proved. The effectiveness of the twist-tow is comparable to a timeline hemostatic tourniquet.

The article gives a retrospective clinical study of 82 patients being treated at the clinic of faculty surgery named after S.P. Fedorov of the Military Medical Academy named after S.M. Kirov with the diagnosis "Acute cholangitis." Patients were divided into "no sepsis" (n = 42) and "with sepsis" (n = 40) groups. The following data were analyzed: clinical, surgical. In the postoperative period, early diagnosis of sepsis development was carried out in patients diagnosed with Acute cholangitis. The diagnosis was based on complaints, objective examination and laboratory and instrumental methods. Patients were assessed with diagnostic scales such as SOFIA, APACHE II, APACHE III, SAPS2, SAPS3.В the following analysis of their accuracy, sensitivity, specificity of prognostic positive and negative capacity, and statistical method of ratio OSH and Criterion Chi-square was used. The SOFIA scale in this study is the "gold standard" in the diagnosis of sepsis in patients with acute cholangitis. This is related to the least number of indicators among other scales, and the SOFIA scale does not require additional examination of the patient by another specialist. The APACHE III and SAPS3 scale requires a license agreement as opposed to a SOFIA scale. However, in our study, the use of the APACHE II scale showed the highest specificity (85.71%) and prognosticality of the negative result. The SAPS2 scale showed the greatest sensitivity (95.00%) and prognostics of the positive result. The most accurate scale is APACHE III, its accuracy is 73.17%. The lowest accuracy and sensitivity is SAPS3 (Se = 55.00%), (Ac = 64.63%).

Combined pathology occupies a special place in the modern development of methods for the prevention of myocardial infarction (MI). Patients with myocardial infarction and peptic ulcer disease (PUD) are difficult to curate due to significant limitations in therapy. PUD negatively affects the prognosis of MI. In this regard, the study of the characteristics of the course of MI in young and middle-aged men with PUD for their use in the development of individual prophylaxis seems relevant. The purpose of the study was to study the characteristics of risk factors for cardiovascular diseases, the clinical course, structural and functional state of the myocardium, hemodynamics and quality of life in men under 60 with MI and PUD to improve preventive measures. It includes men from 18 to 60 years old with type I IM who underwent standard diagnostic research methods. Patients were divided into two groups: I - the studied, with PUD - 109 patients; II - without concomitant diseases of the digestive system - 358 patients as a control group. The incidence of PUD is 19.2% among young and middle-aged men with MI. The course of the disease in this group of patients is less favorable in the total number of complications, the frequency of thrombosis, bleeding, supraventricular tachycardia and incomplete atrioventricular block. The presence of a history of the disease with a higher frequency of inpatient treatment, coronary angiography, unstable angina pectoris in combination with more pronounced signs of heart failure in the first hours of myocardial infarction over a large circle of blood circulation indicates increased risks of side effects of standard hypocoagulation therapy in this group against microcirculatory disorders in the digestive organs, what needs to be considered when treating these patients.

The analysis of the data of literary sources of domestic and foreign researchers on the problem of the occurrence and development of nosocomial infections in general and in the surgical departments in particular is carried out. The relevance of the study is confirmed by the following data: the spread of nosocomial infections in the Russian Federation is 2.5 million annually; the minimum damage inflicted by them in Russia alone is approximately 6-7 million rubles. The data of foreign scientists have been studied, suggesting that infections in the field of hirirurgic intervention were recorded in 13% of cases after performing "clean" operations, in 16% after and in 29% after < contaminated>. In St. Petersburg, with selective studies, the frequency of infections in the field of surgical intervention revealed 9% of patients among 1,500 operated It was revealed that the number of potential causative agents of nosocomial infections increases every year due to opportunistic bacteria that differ in biological characteristics from hospital strains and have multiple drug antibiotic resistance. A retrospective and prospective analysis of the frequency of occurrence of microorganisms in patients of the surgical department of 2008-2019 was carried out. The microbial spectrum and prevalence of nosocomial infection pathogens in the surgical department were investigated. An epidemiological analysis of the causative agents of nosocomial infection in patients with pneumonia, infections in the surgical field and urinary tract, as well as with generalized infections, was carried out. The analysis of the bacterial flora of the clinical microbiological culture of the wound discharge, sputum, urine and blood was carried out. The following microorganisms were most prevalent in these samples: Staphylococcus aureus, Acinetobacter baumannii, Candida albicans, Klebsiella pneumonia. A tendency to increase the proportion of Candida albicans in patients of the surgical department, as well as a high prevalence of Staphylococcus epidermidis in blood cultures, was revealed.

Nowadays, in the thyroid surgery a great experience of using different variants of minimally invasive approaches, including endovideosurgical and da Vinci surgical robotic technologies. However, there are still no approved recommendations (protocols) for the application of these approaches; indications and contraindications remain the subject of debate and rely on the experience of the individual authors. Based on the indicated positions the purpose of our study was to determine the criteria for selecting patients with surgical diseases of the thyroid and parathyroid glands for the reasonable implementation of optimal minimally invasive surgical interventions. The article analyzes the results of a comprehensive medical examination and treatment of 417 patients with surgical diseases of the thyroid and parathyroid glands, who were operated by using various minimally invasive procedures. The medical examination of patients was conducted under international protocols and management guidelines. The patients were divided into four groups based on the nature of the minimally invasive techniques used: the 1st (n = 151) includes the patients, who underwent minimally invasive nonendoscopic thyroidectomy; the 2nd (n = 141) - is a minimally invasive video-assisted thyroidectomy; the 3rd (n = 110) - is an endoscopic thyroidectomy with the use of axillo-bilateral-breast approach; the 4th (n = 15) - is a transoral endoscopic thyroidectomy vestibular approach. It was stated that the main criteria that determine the rationale for minimally invasive interventions on the thyroid gland are: the nodule size and the thyroid volume; hyperfunctioning thyroid and clinical thyroiditis; substernal extension; extrathyroid extension and the necessity of implementation of central neck dissection due to central and laterocervical lymph node metastases. The application of the determined criteria based on the integrated use of modern diagnostic techniques for patients with surgical diseases of the thyroid and parathyroid glands can justify the selection of optimal surgical interventions, avoid unreasonable operations, to avoid increasing of the frequency of specific complications, reduces surgical trauma and duration of stay in hospital, improves cosmetic outcome and enhances the quality of life of the patients.

Adverse indicators of morbidity and mortality from myocardial infarction (MI) with a high frequency of detection of cardiovascular diseases (CVD) risk factors actualizes the search for ways to improve their prevention. The purpose of the study: a assess the risk profile of CVD in men younger than 60 years with MI, depending on the outcome of the nearest to improve prevention. It includes men from 18 to 60 years old with MI of type I with a glomerular filtration rate of 30 or more ml/min/1.73 m2. In addition to the standard diagnostic examination, patients underwent a targeted search for the presence of primary and secondary risk factors for CVD. Patients were divided into two age-comparable groups: I - the study group; 30 patients who died during the first eight weeks of the disease; II - survivors - 536 patients. It has been established that the main risk factors for CVD in the group of adverse outcomes are tobacco using, physical inactivity, signs of social and psychological maladaptation, seasonal deterioration and hereditary burden of coronary heart disease, alcohol abuse and a history of heart failure. Hypertension, overweight, diabetes mellitus and chronic foci of infection were observed somewhat less frequently. The closest unfavorable prognosis was associated with smoking, alcohol abuse, signs of social maladaptation, the presence of MI and heart failure, as well as a history of revascularization. The use of these indicators will help to improve the characteristics of the developed forecast models and the effectiveness of prevention. Statistical treatment of data packets performed using Statistica 10.0 and SAS JMP software applications 11. Quantitative indices are represented as: M ± S, where M - average; and S - standard deviation. The significance of differences was determined by U-Mann-Whitney test. For binary and nominal terms it was evaluated by chi-square test. The level of statistical significance when received error probability less than 0.05.

Currently, one of the significant problems of critical conditions is the early diagnosis of their development, determination of the stage of an existing critical condition, prerequisites, including those identified only by instrumental methods of research, as well as the course of the disease, as well as the dynamics of the course of the disease. Currently, there is a constant search for new or improvement of existing diagnostic methods that will be able to accurately reflect the condition of the patient, the degree of development of the disease and the dynamics of its course. One of the most important requirements for the required research method is the safety of the patient, because in a patient in critical condition, any intervention in the body can lead to the development of complications and adversely affect the severity of the disease. Modern methods for the study of hemodynamics involve intervention in the body, so their use is not always justified, and sometimes even risky. In this work, a hemodynamic research method using the Angioscan-01p instrument was considered. It is based on infrared technology, which does not affect the body, but can be used to obtain data on the state of the vascular wall and characteristics of the endothelial function. In the course of the work, the advantages of this method were demonstrated and the clinical significance was justified, results were obtained that describe the relationship between clinical and laboratory parameters and indicators obtained using the AngioScan-01P instrument, and the effect of the state of the body on indicators reflecting endothelial function is described.

Diseases of the cardiovascular system in most economically developed countries occupy a leading position among the causes of morbidity, disability and mortality. In 60-80% of patients with obliterating atherosclerosis of the vessels of the lower extremities with multiple and distal forms of pathology, severe ischemia develops, leading to amputation of the limb in 20-30%. Objective: based on the data of X-ray contrast angiography, show the features of arterial blood supply to the lower third of the leg and ankle joint and evaluate the compensatory potential. The images of 20 patients with atherosclerosis obliterans of the lower extremities were studied. Thus, we can say that the compensatory blood flow in these areas is well developed. But a large number of anastomoses on angiograms with atherosclerosis was not characterized by adequate blood supply, in this regard, it was manifested by the depletion of the compensatory capabilities of the vascular bed and its gradual defeat, resulting in ischemia and foot necrosis.

A study was carried out on the topic “Modern Features of the Biomechanism of Physiological Childbirth”. The most favorable is the biomechanism of childbirth in the front view of the embryonic insertion of the fetal head in the first position. With such a biomechanism of childbirth, the fetal shank passes through the planes of the small pelvis of the malm with an oblique size, and at the second moment of the biomechanism of childbirth it makes an internal rotation of the head by 45 degrees, and therefore there are fewer complications both from the side of the fetus and the mother. Clinical observations have shown that more often labor begins in the rear view of the occipital insertion of the fetal head, the internal rotation of the fetal head occurs 135 degrees when moving from the wide part to the narrow part of the pelvic cavity or on the pelvic floor. The result of this rotation is the transition of the fetus to the anterior view of the occipital insertion. A tendency towards an increase in the frequency of asnKLITIC insertion of the fetal head, especially in the posterior view, a change in the position of the fetus, even after the birth of the fetal head during its external rotation, is determined. The revealed features of the biomechanism of physiology births were more often observed with premature outflow of amniotic fluid, lengthened the duration of the pernode of expulsion, and increased the frequency of injuries of the maternal soft birth canal. Studying the peculiarities of the biomechanism of childbirth with various insertions of the fetal head is necessary for timely changes in the tactics of labor management, including changes in approaches to obstetric manual benefits in order to reduce injuries to the mother and the fetus.

The study of the functional state of the colon is important not only for the objectification of its pathology, but also in the planning of treatment of its diseases. Compared to evacuation, an assessment of the motor function of the colon is not so common in clinical practice. However, the data obtained in this case are often very valuable and convenient for understanding the dysfunction of the colon. This study reports a study of the contractile response of the sigmoid colon to dilation of the rectal ampule in patients with complaints of constipation. To assess the motor function of the sigmoid colon, the method of balloon manometry was used. Using a recording device with three pressure sensors and a computer for data processing in the Exel program, studies were performed in 9 patients with slow-transit chronic constipation and in 6 patients with irritable bowel syndrome with constipation. In a rectal ampoule, a rubber balloon fixed to a catheter was inflated with air until distinct urge to defecate appeared, and against this background, the motor reaction of the distal part of the sigmoid colon was evaluated. It was found that dilation of the rectal ampoule leads to inhibition of the contractile activity of the sigmoid colon. This reflex (inhibitory recto-sigmoid motor reflex) was detected both in patients with irritable bowel syndrome and in patients with chronic constipation. The conclusion is drawn on the importance of a functional study of the sigmoid colon, which allows not only to identify dysfunction of the nervous structures of the intestine, but can also be used to justify the option of forming an intestinal anastomosis after resection of the colon in patients with chronic constipation.

The fact that the scientific substantiation and promotion worldwide of the method of Ilizarov is the greatest achievement of domestic medicine, and the method of its use in filling bone deficit of upper and lower extremities have become the gold standard treatment of such patients [7]. It is known that frequent causes of the formation of a massive bone defect are injuries from projectiles with high kinetic energy, local infection, cancer, and excessive surgical aggression [4]. For a long time, the preservation of limb function in such patients was possible only in the case of non-focal transosseous compression-distraction osteosynthesis with non-free bone grafting according To G. A. Ilizarov [7]. However, the duration and result of treatment often did not fully satisfy both the patient and the attending physician [1]. The use of regenerative medicine in the practice of restoring the structural properties of damaged tissues with the help of bioactive implants allows us to count on solving difficult clinical cases in modern traumatology and surgery [12]. The question of replacing extensive defects in long tubular bones has always been relevant for both damage surgery and Oncology. Bone defects often require, in addition to the use of extra-focal transosseous compression-distraction osteosynthesis with non-free bone grafting according to GA. Ilizarov, using bone grafts or prosthetics. Titanium alloy is now widely used in dentistry and orthopedic surgery due to its relative bio-inertness and excellent mechanical and biological properties [5]. Titanium and its combined alloys are superior to all materials available in surgery that are used to replace bulk bone defects [6]. With the advent and development of 3D printing methods using metals, new opportunities for the use of titanium and its alloys have emerged, and it is now possible to create high-precision porous structures to replace bone defects in accordance with clinical needs. During the work, a prototype of the prosthesis model was developed and created using 3D printing, which is promising for further development and implementation in clinical practice

The experience of treatment of 35 patients with acute vascular trauma of limbs aged 20-50 years (29 of them are men (83%)) who were treated at the clinic of military field surgery of the S.M. Kirov Military Medical Academy was analyzed during the period from 01.01.2001 to 01.07.2011. Assessment of the immediate results of surgical treatment was performed using the original database that accumulates information on the treatment of patients with injuries of the main vessels of the limbs. The criterion for the development of surgical treatment tactics was the modified VPH-MESS scale, which makes it possible to predict with high reliability the need for amputation or the ability to save the limb. It was shown that half of the victims were delivered to the clinic with a shock of the I-II degree (46%), 43% were in a terminal state, every tenth victim was admitted to the clinic without signs of shock. The average VPH-MESS score was 6.77 ± 1.80. During surgical treatment (73% emergency operation), halting of profuse external bleeding in half of the cases was done without applying a vascular suture, in a quarter with a vascular suture, auto-venous prosthetics were performed to two victims. 59% of patients in the postoperative period had complications. It was shown that 62% of the victims retained their bearing ability, the sensitivity and movements of the injured limb were restored, the range of movements was reduced in 15%, 20% had a markedly reduced sensitivity and limited amplitude of movement. Additionally, long-term results of their treatment (from 1 year to 7 years) were analyzed in 12 patients using the questionnaire for assessing the quality of life of SF-36. The quality of life of victims with damage to the vessels of the extremities in the long term after treatment corresponds to the quality of life of healthy people: the level of generalized physical health component (RSH) was 51.01 ± 5.4, generalized psychological component of health (MSN) was 57.89 ± 3.9. The indicator of the psychological component of health significantly exceeds the parameter of the physical component of health (p<0.05).

In the structure of heart valve defects, the aortic valve is most often susceptible to pathological changes - 64.5%. Conservative treatment of valvular heart disease is mainly aimed at reducing the severity of heart failure, at a certain stage the implementation of a surgical operation becomes a vital manipulation. The aim of the study was to evaluate the frequency and determine the structure of postoperative cerebral dysfunction during surgical correction of acquired aortic valve defects, as well as to compare it with other cardiac surgery for heart valve defects in cardiopulmonary bypass. We examined 134 patients (86 men and 48 women, average age 64 years), who underwent planned operations for prosthetics of heart valves in conditions of cardiopulmonary bypass. Postoperative cerebral dysfunction was diagnosed in 41% (55 of 134 patients). The incidence of postoperative cerebral dysfunction during prosthetic surgery for aortic stenosis is 49% with the following structure: perioperative stroke 4.3%, symptomatic delirium of the early postoperative period 25.5% and 29.8% delayed cognitive impairment. In patients with other operations on the heart valves, postoperative cerebral dysfunction was diagnosed in 36.8%: perioperative stroke 1.15%, symptomatic delirium of the early postoperative period, delayed cognitive impairment 23.2%. There were no significant differences in the incidence of perioperative stroke and delayed cognitive impairment (p>0.05). Acute clinical types of postoperative cerebral dysfunction and symptomatic delirium early postoperative period were significantly more often (p<0.05) detected after prosthetics for aortic stenosis.

Mechanical jaundice is the most widespread and severe syndrome of surgical diseases of hepatopancreatobiliary zone. Modern development of surgical technologies allows applying one- or two-stage surgical interventions in this category of patients. Single-stage tactics is characterized by performing a radical surgical intervention, but is associated with a high frequency of postoperative complications and lethality, reaching up to 60 - 70% [9,10]. Two-stage approach is conditioned by drainage of bile ducts and execution of radical surgical intervention after elimination of mechanical jaundice phenomena that takes on the average from 4 to 6 weeks. This approach reduces the frequency of postoperative lethality development up to 30% [16, 19], but increases the frequency of infectious complications development [20] and is associated with the increase of time before the radical operation, which becomes key in patients with mechanical jaundice of tumor origin, because no more than 16% are resectable at the moment of mechanical jaundice manifestation [10]. Thus, correct assessment of hepatic insufficiency and choice of the most rational approach are the key points of patient management. Objective of the study: to improve treatment results of patients with mechanical jaundice. Materials and methods. The examination of 17 patients with mechanical jaundice who were treated in the clinic of general and hospital surgery was carried out. The interrelation between the severity of mechanical jaundice according to E.I. Galperin, hepatic insufficiency determined by the green clearance test in Indocyanine, the state of coagulation link of hemostasis revealed by means of low-frequency piezotromboelastography and development of postoperative complications was assessed. Piezotromboelastography and Indocyanine green clearance test demonstrated a relationship to surgical complications. They are accessible, minimally invasive, promising to be introduced into a broad clinical practice. However, the accumulation of material, its analysis, and systematization of data are required.

The training of military surgeons to assist the wounded is one of the fundamental directions for improving the medical support of troops. One of the most effective forms of training surgeons in the treatment of severe wounds and injuries is considered to be continuing education courses in trauma centers of the first level. For military surgeons this center is the Department of Field Surgery of the Military Medical Academy named after S.M. Kirov. However, in recent years, due to the steady decrease in the number of incoming wounded, the demonstrativeness of the educational process, the possibility of real participation of students in the treatment process have decreased. To increase the efficiency of training of military surgeons, to improve their manual skills, it is necessary to introduce new forms of training. The most promising of them is the introduction of combined practical courses using simulators and real tissues. The first such course in Russia was practical course on damage surgery SMART (Modern Methods and Algorithms for the Treatment of Wounds and Injuries), created by the teaching staff of the Department of Military Surgery of the Military Medical Academy named after S.M. Kirov, during course participants were given the opportunity to listen to a short lecture cycle on pressing issues of damage surgery and military field surgery, as well as to work out the most relevant life-saving surgical operations and manipulations that form the basis of Damage Control tactics. The aim of the study was to substantiate the introduction of practical courses for surgeons on issues of field surgery and to evaluate their efficiency. The efficiency of the SMART training course has been proven by testing the initial and final level of knowledge of 55 participants.

The research work is devoted to the development of a method for an objective assessment of the postoperative inflammatory response in patients undergoing combined intervention (cataract phacoemulsification with endoscopic laser cyclodestruction) in comparison with standard cataract phacoemulsification. Performing a combined intervention can significantly improve visual function, as well as simultaneously reduce intraocular pressure. The question arises about the safety and effectiveness of this tactic in comparison with standard phacoemulsification. In this regard, it is of great interest to compare the postoperative inflammatory response, as well as the creation of an algorithm for its objective assessment. As a result of a study based on optical coherence tomography, a method was developed that allows to evaluate objectively the postoperative inflammatory response. The purpose of this study is to develop an algorithm and conduct an objective analysis of the severity of the postoperative inflammatory response in patients undergoing combined intervention (cataract phacoemulsification with endoscopic laser cyclodestruction) in comparison with standard phacoemulsification. The study involved 30 patients (30 eyes). The main group - 15 patients (15 eyes) with uncompensated open-angle glaucoma in various stages and an initial complicated cataract. The control group consisted of 15 patients (15 eyes) with an initial age-related cataract. On the morning of the day after the intervention, patients of both groups underwent optical coherence tomography of the anterior segment of the eye. During the analysis, 10.0 ± 7.5 inclusions were detected in the main group, and 2.5 ± 2.3 in the control group. The difference is statistically significant (p <0.001). The developed algorithm allows you to objectively assess the degree of inflammatory reaction in the anterior chamber of the eye. Comparison with the control group virtually eliminates the effect of phacoemulsification on the inflammatory response. During the analysis of the severity of the postoperative inflammatory reaction, a greater number of inflammatory inclusions were revealed after a combined intervention.

Noise, being a general biological stimulus, affects all organs and systems of the body. When exposed to noise, certain physiological changes and pathological conditions develop, which depend on specific conditions: the level and nature of the noise, the duration of its exposure. Noise occupies one of the leading places among the adverse factors in the Armed Forces (AF), its impact leads to a decrease in military professional capacity and an increase in the incidence of military personnel. This is facilitated by the high mechanization and power supply of weapons and military equipment, the absence and insufficient number of personnel protection from noise (collective and individual), which in most cases have low acoustic efficiency. In the Sun, noise was not identified as a harmful factor leading to the development of occupational pathology; the issues of professional selection and examination of noise pathology were not fully developed. Military personnel who have been exposed to intense noise for a long period of time have diseases of noise genesis, which, however, in accordance with the regulatory legal documents in force in the Armed Forces, are not considered occupational diseases. After dismissal from the Armed Forces, such persons are not adequately protected socially, since the causal relationship of the pathology revealed in them has the phrase “the disease was received during the military service” instead of the necessary disease was received while performing military service duties (“military trauma”).

An important direction in improving the prevention of internal diseases in recent years is the reviewing of comorbidity for individualization of therapy. At the same time, data on the prevalence of risk factors for myocardial infarction (MI) in young and middle-aged men suffering from chronic lung diseases (CLD) are contradictory. The aim of the study was to assess risk factors for cardiovascular diseases (CVD) in men under the age of 60 with MI and CLD. It includes men from 18 to 60 years old with type I IM who, in the first 48 hours [8] and at the end of the third week of the disease [1], performed the standard diagnostic algorithm. Patients were divided into two age-comparable groups: I - with chronic lung disease (chronic bronchitis (136 patients) and bronchial asthma (6 patients)); II - without lung diseases - 424 patients as a control group. It has been established that the prevalence of CLD among men with MI younger than 60 years is 25.1% (bronchial asthma - 1.1%, chronic bronchitis - 24.0%). The predominant risk factors for MI in men younger than 60 years old with CLD are smoking (95.1%), atherogenic dyslipidemia (92.0%), chronic foci of infections of the internal organs (75.4%), hereditary burden of hypertension (54.2 %) and ischemic heart disease (40.8%), winter season (40.8%), non-ulcer pathology of the digestive system (26.1%), frequent colds (24.6%) and extrasystole (19.7%) history. The selection of risk groups among men under 60 years of age with this combination with the correction of modifiable risk factors will improve the results of prophylaxis and prognosis in such patients.

Annually over 2,000,000 new cases of non-small-cell lung cancer are diagnosed worldwide. Preoperative N-staging is the most important diagnostic step to determine the prognosis and tactics of further treatment of patients with lung cancer. 20-30% of patients with early stage NSCLC have local or distant recurrence of the disease and 5-year survival in these patients varies from 40 to 85.5%. In this context, there is a need to develop new methods for intraoperative evaluation of regional lymph nodes. One of these methods is the detection and histological examination of a signal lymph node. This approach allows to perform a targeted evaluation of the first lymph node on the path of tumor spread in order to determine the state of the remaining regional lymphatic collectors. However, today there is no “ideal” method for detecting a signal lymph node. It requires developing new approaches to visualizing the pathways of lymph outflow. Objective: compare and evaluate the effectiveness of using methylene blue solutions to visualize lymphatic outflow pathways in laboratory animals (outbred rat). Animals were randomized into 2 groups - 8 in each. The first group was injected subcutaneously in the left thigh with a 1% aqueous solution of methylene blue, the second group - solution of methylene blue with human serum albumin. Depending on the time of exposure, animals were divided randomly into 4 subgroups - 15, 30, 45 and 60 minutes. There was evaluated the effectiveness of marking the pathways of lymph out-flow from the injection site. The effectiveness of marking the pathways of lymph outflow from the injection site was evaluated. As a result of the study, it was demonstrated that the use of a 1% methylene blue solution allows us to adequately visualize the pathways of lymph outflow. The disadvantage of the drug is migration to the next order LN with an exposure lasting 30 minutes. A solution of methylene blue in combination with human serum albumin has a comparable quality of LN visualization. However, it has a slow (> 60 minutes) migration, which is preferred during surgery.

Mortality from cardiovascular diseases in the Russian Federation is one of the highest in the world and is 575 per 100,000 inhabitants for January-November 2019. The main causes of death from cardiovascular disease are the progression of chronic cardiovascular failure and sudden cardiac death. The risk of sudden cardiac death is determined based on history, physical examination, laboratory and instrumental studies. Those at risk should be given preventive measures to prevent and reduce the likelihood of sudden cardiac death. One of the causes of sudden cardiac death is coronary heart disease, which can occur in people with thrombophilia. In Russia, the number of registered venous thrombosis is 145-200 cases annually (per 100,000 population), with more than 70% of cases being subclinical, posing a risk of fatal thromboembolism and cardiovascular diseases. The goal of our work was to study the polymorphism of genes, which are single-nucleotide replacements of the bases associated with thrombophilia, and their effect on the development of sudden cardiac death. The peculiarity of many variant (polymorphic) genes is that over time they may not appear. Pathological symptoms occur only under additional conditions (surgery, obesity, pregnancy, use of hormonal contraceptives, increased levels of homocysteine in the blood, long period of immobility, etc.). The study involved 80 people who were tested for blood using DNA technology kits. Modicified risk factors for cardiovascular diseases have been identified.

One of the main diagnostic methods in ophthalmology is visual aquity examination. It is one of the most important examinations for revealing of aggravants, malingerers and dissimulaters for expert maters. Survey data of visual acuity research is comparing in 2 groups of tables (tables for visual acuity research: Golovin-Sivtsev’s table, Landolt’s rings; tables for assessment the distance of optotypes’ recognition). The disappearing distance of optotypes’ recognition (shapes with a complex contour profile) was measured. They have a unique particular - the closeness of recognition and detection thresholds, what increases the accuracy of visual acuity accuracy measurements and researchers’ attention to them. As a result of the exploration, we brought to light that the optical profile of the optotype has influence on the distance of it’s recognition, and also depends on the complexity of the configuration. It is easier to detect optotypes in the form of a vanishing Landolt ring for probationers, as opposed to"bar worlds". The results’ coincidence to observing the size of optotypes depends on the complexity of the configuration and it is due to internal irradiation ("crowding effect" - a phenomenon of visual perception). The provided data gives possibility to understand that the degree of correlation may differ due to different ranges presented in the article. The exploration and modification of tables allow us to improve the methodology for visual acuity studying and increasing the accuracy of the result, without departing from modern standards. Modified optotypes viden the possibilities of accurate determination of visual acuity in cases of simulation of aggravatio and dissimulatio.

The improvement of restorative treatments for patients with knee gonarthrosis has so far remained one of the most pressing and complex problems of modern reabilitology. Despite the wide range of drugs available, and the manipulations and physiotherapy methods used, the recovery of motor activity in military personnel when gonarthrosis is exacerbated remains a difficult task, requiring an integrated approach to its solution. To this end, the Department of Surgery of Injuries and Limb Diseases of the Clinic of Outpatient and Polyclinic Care of the S.M. Kirov Military medical academy treated 70 soldiers with gonarthrosis of the knee joint with intra-articular injection therapy hyaluronates (Armaviscon). Clinical method, radiation diagnostic methods were used to assess the initial condition of the affected joint and clinical effectiveness. The clinical study included military personnel whose military work involves heavy loads on the lower limbs between the ages of 21 and 84 suffering from deforming arthrosis. Analysis of the obtained data showed safety and sufficient effectiveness of "Armaviskon" application in treatment of knee joint gonarthrosis in patients. The highest efficacy of the drug was observed at the early stages of gonarthrosis development.

The urgency of the treatment of inguinal hernias is due to the widespread occurrence of this pathology (3-7% of the population), a significant incidence of people of working age (40% of all cases of hernias), and a relatively high relapse rate (10-30%). The first publications on the development of transabdominal preperitoneal plasty (TAPP) technique are appearing in Russia, while the minimum relapse rate (0.8-2.2%) is reported. The negative features of laparoscopic operations include postoperative neuralgia and paresthesia, the development of hematomas and the accumulation of serous fluid in the inguinal region, a long period of development of the technique, the high cost of equipment and supplies. Domestic explants and herniostaplers appeared on the market. There are single reports of the results of their use. This requires dynamic screening of the immediate and long-term results of the use of new materials, the study of the consequences of treatment at the stage of acquiring operational experience. Objective: to generalize the accumulated experience and study the immediate and long-term results of transabdominal preperitoneal plasty. Direct results for 2 months were studied in 60 patients. Of these, 45 were questioned in a remote period. The quality of life was assessed using the standard SF-36 Health status survey. 12 out of 45 patients surveyed underwent examination and ultrasound. The results of the use of explants and staplers of domestic and foreign production are compared. An analysis of the data revealed a good quality of life for patients in the distant postoperative period after TAPP, a low relapse rate, which gives reason to continue using this method. There were no statistically significant differences in the frequency of complications in patients with the installation of domestic and foreign explants and the fixators used. A small number of observations require further research.