bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and pathogenic features of entrapment neuropathy in patient’s hands with acromegaly
Authors: Nikishchencova A S , Zhulev S N , Zhulev N M , Khalimov Yu Sh , Zagrebelnaya O A , Karpenko M N , Alekseeva T M , Trofimova T N , Shiryaeva E V , Zhulev V S
Published: July 2021

For specification of entrapment neuropathies pathogenesis in patients with acromegaly clinical and electroneurophysiological trial of the nerveswere conducted. It was determined that motor disorders in patients with incomplete remission of an acromegalia were more often than in patients with full remission. A significant difference between the frequency of occurrence of sensitive disturbances in patients with incomplete and full remission of acromegalia was not revealed. Expression of disturbances of the majority of electroneurophysiological indicators was more appreciable in patients with incomplete remission. In patients with incomplete remission the moderated and expressed disturbances prevailed, and patients from full remission had mild disturbances. The neurologic symptomatology of tunnel neuropathies and electroneuromyography disturbances were more expressed in group with incomplete remission. Conservative therapy of tunnel neuropathies was more effective in patients with full remission of acromegaly. It was revealed that the durability of acromegalia and accompanying pathology of a patient also influences expression of neurologic symptomatology and effect of the treatment. The lesser the durability of acromegalia, the better treatment results of neuropathies. The data obtained with a magnetic and resonant tomography on growth existence round a tendon of a flexor, regional growth of a bone trapeze and augmentation of transversal section of a median nerve and as signal strength change from it allow to specify a pathophysiology of tunnel neuropathies in acromegalia. The combined use of an electroneuromyography and a magnetic and resonant tomography possesses high informational content in diagnostics of tunnel neuropathies. These methods allow giving an objective assessment of changes of neuromuscular changes in patients with a syndrome of the carpal channel with acromegalia. Specification of a pathogenesis of tunnel neuropathies allows carrying out correction of agents and treatment methods in patients with acromegalia, thus reaching good results of treatment in short terms.
Laboratory assessment of vitamin security of military service organism in the arctic zone of the Russian Federation
Authors: Kirichenko N N , Zakrevskiy V V , Konovalova I A , Smetanin A V , Dar’ina N I , Plkhkhotskaya Zh V
Published: July 2021

The content of vitamins A, E, D, C, B1, B2, B9 and B12 in plasma and serum of 156 servicemen serving in the Arctic zone of the Russian Federation in the autumn and spring periods using high-performance liquid chromatography, immunochemoluminescence, fluorimetric and spectrophotometric techniques were established. The study included men aged 18 to 25 years old, somatically healthy, the service life of at least four months from the time of the call. The military personnel are comparable in terms of physical health indicators, have received the same nutrition for a long time under the conditions of the barracks, had equivalent conditions of service and physical activity for a long period of time. In the examined servicemen, the prevalence of hidden (subclinical) forms of vitamin A, E, D, C, B1, B2 B9 and B12 deficiencies were found in both the traditional spring-summer and the epidemically dangerous autumn-winter period. The idea of the seasonal “spring” nature of vitamin deficiency has been revised - at the autumn point of the study, its prevalence was no less than in the spring, although there was indeed a spring deterioration in vitamin C and B1. It was concluded that the need for constant vitamin support for military personnel in the Arctic zone, improving the diagnosis of subclinical vitamin deficiencies, mainly due to the introduction of modern methods of laboratory diagnostics. A scheme of vitamin support is proposed by alternating the intake of a multivitamin preparation and a product enriched in vitamin C for 1 month.
Fundamental life motivations and prerequisites for their realization in young men
Authors: Ulyukin I M , Pilnik N M , Emelyanov V N , Bolekhan V N , Orlova E S , Kuzmin S G , Dergachev V B
Published: July 2021

Аbstract. Quality of life of young men in the view of existential compliance is considered. In its most general form, the term «existence» means «specifically human way of being», the main characteristic of which is the freedom of choice, that is the way of being a person, when he is constantly in a situation that asks him: «How does a man will be a person in this situation?». А person’s subjective assessment of his life was investigated by the technique of A. Langle and K. Orgler «Scale of Existence» in 42 practically healthy young men (24,12±1,1 years). Scores diagnosed on such scales as Self-distancing, Self-Transcendence, Freedom, Responsibility, Personality, Existentiality, and Fulfillment testify to the absence of grounds for the development of existential crisis (for a crisis of subjective evaluation of one’s own life). Thus, with the right medical and psychological support of young people, they have the ability to cope with themselves and with the world, and the feasibility of interaction with the internal and external demands and proposals presented to circumstances, correlating with their own values. At the same time, one should keep in mind that a possible conflict can lead to nervous breakdowns, decrease in the level of professional health (a professional fitness). In order to prevent this, it is necessary to identify persons at risk and prevent possible psychosocial adaptation disorders in advance, using direct methods of psychodiagnostic. To this end, both methods of psycho-counseling and solving personal problems through the provision of advice or other assistance are recommended.
Infringements of colonial resistance of microbiotic skin in patients suffering diseases of an ear, a throat and a nose on the background of diabetes mellitus
Authors: Khasiev N D , Shaposhnikova E B , Zhurkin M A , Shevchuk N I , Sadykov R R
Published: July 2021

Infringements of colonial resistance of a microbiota of a skin at the elderly, suffering diseases of an ear, a throat and a nose (an otitis, a tonsilitis, a sinusitis, etc.) are considered on a background of a diabetes. To study changes in quantitative and specific indicators of deep microbiota of the skin, the method of agar prints was used. It is established that the indicators of quantitative changes are associated with a metabolic disorder and may be factors predisposing to the development of other diseases against the background of diabetes mellitus. The revealed changes in the indices of colonial resistance in patients with diabetes mellitus are of interest as adaptive characteristics of the organism in diseases of the ear, throat and nose of various etiologies, and serve as a harbinger of deviations in the clinical and physiological status of patients with diabetes mellitus. Thus, in patients with diabetes mellitus, the composition of the microbiota of the skin corresponds to that of healthy individuals of the same age. Regardless of the type and stage of diabetes mellitus, they showed an increase in the number of colony-forming units of the deep layers of the skin of the forearm, which corresponds to the dysbacteriosis of the third-degree skin. In the structure of biocenoses, in patients of the otolaryngological profile, against the background of diabetes mellitus, changes that correspond to the dysbacteriosis of the skin of the IV degree are revealed. In this category of patients, there is a pronounced secondary immunodeficiency, which is manifested by inhibition of the investigated nonspecific immunity indices, which is a predisposing factor for the onset and development of a purulent infection. It is shown that dysbiosis can manifest itself with clinical local symptoms, and then with general disorders that aggravate the course of the underlying disease and complicate treatment. An integrated approach to this problem can be used for a more differentiated assessment of the prognosis of complications in patients with an otorhinolaryngological profile against diabetes mellitus and increasing the effectiveness of therapeutic and preventive care.
Development of a methodology for obtaining physiologically complete drinking water
Authors: Krivtsov A V , Sorokoletova E F , Seleznev A P , Andrianov A I , Andreev V P , Ischuk Yu V , Martinova E S , Korneeva A A
Published: July 2021

The current state of the problem of diselementosis in the territory of the Russian Federation is analyzed and a list of elements is identified, the lack of which in food and water has a negative impact on human health. The author substantiates the development of a technique for conditioning drinking water to achieve its physiological usefulness and prevent diselementosis among servicemen who serve in the Arctic zone of the Russian Federation, where snowmelt is the source of drinking water. A salt composition was selected for conditioning low-mineralized water. For this, the initial stream of low-mineralized water is divided into two approximately equal secondary waters, and those mineralizing components that form sparingly soluble compounds are introduced into different secondary streams, which are then combined in a common tank. It is shown that for all the criteria studied, conditioned water meets the requirements of chemical safety Sanitary rules and regulations 2.1.4.1074-01, and also contains essential macro- and microelements in quantities corresponding to the standards of physiological potency of drinking water according to Sanitary rules and regulations 2.1.4.1116-02. The method of conditioning drinking water when it is introduced into the practice of water supply for servicemen of the Ministry of Defense of the Russian Federation will improve the quality of drinking water by enriching with essential macro- and microelements, increasing its physiological usefulness, which will serve as an effective measure to prevent the morbidity of servicemen due to the imbalance of nutrient elements in the body.
The first domestic devices for intraosseous infusion - is the great advance of military medicine in pre-hospital stage enhancement
Authors: Samokhvalov I M , Golovko K P , Denisov A V , Telitsky S Yu , Zhirnova N A , Komiagin S E , Karpenko O D , Demchenko K N , Barakov Ya D , Stepanov A Yu
Published: July 2021

Traumatic shock is considered to be the most common clinical form of a severe patient’s condition (63%). Timely and adequate blood volume resuscitation is one of the most important procedures in providing medical care to critically injured casualties and patients at the forward medical evacuation stage. The key to this problem, especially when the infusion therapy is needed at the pre-hospital stage, is the development of alternative (extravascular) techniques of plasma volume expander administration. The article presents the results of testing of the first domestic medical devices for intraosseous infusion in critically injured casualties and patients. At present, on commission of the Russian Ministry of Defense and with the scientific support of Kirov Military Medical Academy, domestic enterprises developed test samples of medical devices to provide intraosseous infusions: a «Disposable device for intraosseous infusion of solutions if there is no intravenous access, which was designed on the basis of a spring drive» - the index «VKI-P», developed by limited liability company «Novoplast-М» and a set for intraosseous infusion using an electric drive - the index « VKI-E», developed by limited liability company «Research engineering company «Spetsproekt». Assessment of performance of test samples of the medical devices for intraosseous infusions «VKI-P» and «VKI-E» was carried out using pathophysiologic model of traumatic shock in 14 experimental animals (pigs) by creating artificial blood loss of medium severity, 25% of circulating blood volume (in average 440 ml), followed by its resuscitation with intraosseous infusion of 0,9% solution of NaCl. As a result of the performed tests it was found that the device «VKI-P» and the set «VKI-E» provide for NaCl infusion in major vessels (with an intraosseous infusion), 750 ml of volume during 45-50 min, and can be used as an alternative access to provide infusion as a part of anti-shock therapy, which solves the problem of volume resuscitation when giving care to severely injured casualties and patients at the forward medical evacuation stages. These samples may be recommended for inclusion into the medical service list of complete supplies and the Medical Corps supply support, the Armed Forces of the Russian Federation.
Taxonomic and applied value of profiles utilization of protein amino acids of bacteria Acinetobacterbaumannii, Acinetobacterpittii, Acinetobacternosocomialis
Authors: Sivolodskii E P , Zueva E V
Published: July 2021

The profiles of utilization of 20 protein amino acids 118 strains of A. baumannii, 9 strains of A. pitti, 7 strains of A. nosocomial were studied. Utilization of amino acids was determined on a minimum salt agar with an amino acid as the only source of nitrogen and carbon. Species identification of acinetobacters was carried out by matrix-activated laser desorption/ionization with time-of-flight mass spectrometry with a database of Biotyper (by BrukerDaltonics Inc. Germany.) At A. baumannii was identified 14 profiles utilization of protein amino acids, of which the first 6 profiles included 87,3% of the strains. For the first time, a wide spread of A. baumannii strains that do not utilize L-histidine - 56 (47,4%) strains was established. Signs of utilization of L-histidine (His+) or lack of utilization (His-) persist steadily in repeated strains isolated from patients. It is proposed to subdivide all the strains of A. baumannii for two trophies: the «histidine-negative trophy (His-)», which does not utilize L-histidine as the sole source of nitrogen and carbon, and the «histidine-positive trophy (His+)», which utilize it, which will be useful for epidemiological surveillance. In bacteria, A. pittii and A. nosocomial are installed close phenotypic similarity with A. baumannii at the profiles of utilization of amino acids, which proves the validity of combining these species in a complex of A. calcoaceticus-A. baumannii. Bacteria of the species A. pittii and A. nosocomial has no«histidine-negative trophy (His-)», that distinguishes them from A. baumannii.
End-to-side neurorrhaphy: expectations and reality
Authors: Nisht A Yu , Fomin N F , Chirsky V S
Published: July 2021

An increasing number of injuries with damage of peripheral nerves, including a substantial number of injuries with extensive defects of large nerve trunks, requires improvement in approach to surgical treatment of patients. High-energy impact injuries in peacetime and wartime often lead to persistent violations of musculoskeletal apparatus, a significant part of which is due to injuries of peripheral nerves. During peacetime, various types of peripheral nerve injuries occur in 2-6% of trauma patients. In today’s armed conflicts, various types of peripheral nerve injuries occur in nearly 80% of neurosurgical patients and are mostly of combined injury. Improvements in surgical methods of recovery of lost innervation due to an injury are directly associated with the development of fundamental understanding of the nature of occurring degenerative and regenerative processes in damaged nerve fiber. Nerve suture is only the creation of appropriate conditions that contribute to regeneration of nerve fibers and recovery of lost functions. When extensive defects of nerve trunks exist, connection of distal part damaged nerve with side surface of the intact nerve is the alternative to traditional replacement of extensive defects with nerve grafts. Positive outcomes of such interventions that were seen during tests on laboratory animals led to trials of this method on patients and resulted in a number of positive outcomes as well. Despite the fact that the question of morphological substantiation of reinnervation processes of the distal portion of a damaged nerve is the cause of heated disputes among scientists, some surgeons make attempts to define a set of specific conditions needed to justify the use of end-to-side neurorrhaphy.
The selection of optimal methods for the determining the nutritional status of soldiers
Authors: Smirnova G A , Kravchenko E V , Konovalova I A
Published: July 2021

In our country and abroad in recent years as one of the main indicators of the status of nutrition, in addition to the body mass index, is the percentage of body fat, which can be determined by a fairly wide range of techniques. In the daily practice of a military doctor, there are often no complex and expensive devices to determine the fat component of the body, such as a widespread bioimpedance analysis of body composition. The article provides many options for determining the fat component of the body. It coliperometric facts technique (the technique of Durnin - Womersley, J. Matiegka in the modification of M. M. Dyakonov, Jackson - Pollock, Gallagher, and others) and circumferential techniques (methods, used in the naval and land forces of the United States of America, the methodology developed in the Y. M. C. A. and its modification). The results were compared with the results of bioimpedance analysis of body composition. To compare the accuracy of the coincidence of the results obtained by the methods used, the method of the mean square error of the model was used. Then the correlation analysis was carried out and regression models were built.The comparative analysis revealed the most informative methods of determining the fat component of the body, which are recommended to use in the practice of a military doctor at different levels of medical care for soldiers. Fat mass can be estimated by the percentage of fat in the body, determined using the caliper-Pollock method, in the presence of calliper- compass, or circumferential technique used in the naval forces of the United States of America.
Possibilities of using endovascular methods of treatment of patients with critical limb ischemia in regional vascular centers
Authors: Movchan K N , Suhov V K , Artyushin B S , Shlojdo E A , Shlomin V V , Levina A A
Published: July 2021

General information about the activity of specialists of the regional vascular centers of St. Petersburg in 2011-2015 is presented. and on the private results of the work of the staff of the center of one of the city’s multidisciplinary hospitals with an assessment of the data on the cases of treatment of 403 patients with critical limb ischemia against the background of arterial lesions of atherosclerosis. Four groups of patients were identified: 278 patients who underwent open reconstruction of the arteries of the lower extremities; 51, who underwent endovascular revascularization; 15, who underwent hybrid surgical interventions. Revascularization was not performed in 55 patients. Among the open operations, loop endarterectomy from the aortoiliac and femoral-popliteal segments (190) and shunting arterial reconstructions (45) prevailed. In endovascular interventions, femoral-popliteal-tibial segments were predominantly corrected - 37 cases. Hybrid operations in 100% of cases are performed through accesses through the femoral arteries. In case of refusal of reconstruction due to the absence of an anatomic substrate for the reconstruction of the vessels, primary amputation of the lower limb (15), lumbar sympathectomy (14) were performed. In 30 cases, angiotropic therapy was performed. Complications of open surgical interventions in the early postoperative period were revealed in 21,6%, endovascular - in 15% of cases, hybrid operations were noted in 13,3% (in total91 complications in 70 patients). Thrombosis of the vascular reconstruction area (35%) and inadequacy of perfusion of limb tissues in permeable vessels (19,7%) prevailed in the structure of complications. There were no lethal outcomes. In general, the use of endovascular and hybrid reconstructions of the vascular bed in specialized divisions of medical organizations in patients with critical limb ischemia with multifocal atherosclerosis contributes to a significant reduction in the frequency of negative consequences of surgical revascularization of the lower extremities.
Substantiation and development of rational economic and pharmaceutical mechanisms of drug supply of certain categories of citizens attached to military medical organizations
Authors: Miroshnichenko Yu V , Scherba M P
Published: July 2021

Despite the positive changes in the regulation of the accordance of benefits at the federal and regional levels, this problem has not been sufficiently studied so far in the area of organizational and legal interaction between civil and military healthcare. The current order of drug supply to certain categories of citizens attached to military medical organizations results in an unjustified expenditure of resources and an increase in the burden on healthcare, which indicates the irrationality of the existing mechanisms of drug supply. In this regard, it is necessary to develop rational economic and pharmaceutical mechanisms, as a set of methods for managing and interacting the entities that determine the order of drug supply for certain categories of citizens, while optimizing the financial, information and material resources of military and civilian healthcare. Theoretical approaches to the formation of rational economic and pharmaceutical mechanisms of drug supply are presented. Rational economic and pharmaceutical mechanisms of drug supply of certain categories of citizens attached to military medical organizations have been substantiated and developed. The characteristic of integration and coordination mechanisms of interaction of military and civil health on drug supply of certain categories of citizens in a single legal space is given. As the basic mechanisms of coordination of interaction are given: information exchange; standardization; direct supervision. The results of an assessment of sound and developed rational economic and pharmaceutical mechanisms of drug supply in the areas of organizational, social and economic efficiency are presented. It is noted that the implementation of the mechanisms of drug supply in the system of preferential drug supply can contribute to the formation of a system of drug supply balanced with the available resources of the country’s population; the formation of economic and social responsibility at each level of decision-making; the optimization of transparency and controllability of financial flows; the optimization of the financial burden on the federal, regional and departmental budgets; the equal access to medicines for all categories of citizens; guaranteed drug supply to socially vulnerable groups of the population.
Organization of the treatment of the wounded and sick in medical institutions in Saratov during The Great Patriotic War. Deployment of evacuation hospitals in the initial period of the war (June 1941 - June 1942)
Authors: Sokolov V A , Murylev Yu A , Murylev V Yu , Yakimov D K
Published: July 2021

The issues of the deployment of hospitals in the city of Saratov in the initial period of the Great Patriotic War are considered. The article briefly describes the decisions of the State Defense Committee, which initiated the reorganization of the civil health of our country for the solution of the tasks of wartime. The medical-geographical factors that determined the expediency of deploying evacuation hospitals in Saratov and the region are indicated. The great role of leading specialists in clinics and departments of the Saratov Medical Institute in the deployment and specialization of evacuation hospitals was underscored. Their management of day-to-day clinical work and advice helped not only to maintain the high quality of medical care provided to the wounded and sick, but also contributed to the growth of the professional skills of physicians who do not have sufficient experience in treating a variety of combat pathologies. The statistics on the number of hospital beds in Saratov hospitals is given. Data on the structure of the wounded in the first year of the war for treatment in medical institutions of the city and the region are presented. The efforts made by party and city authorities to increase the capacity of the Office of the45th local evacuation center are highlighted. The importance of the problem of retraining, additional specialization, training of new medical personnel is shown. Using a variety of time and content of training programs allowed to significantly staff the deployed evacuation hospitals at the expense of residents of the city and the region.
Optimization of internal quality control system of health care for children needing rehabilitation after neuroinfections
Authors: Samoylova I G
Published: July 2021

The results of the implementation of a three-tier system of internal quality control of medical care for children in need of rehabilitation after neuroinfections are presented. In 2015, a three-tier internal control system was developed at the clinic of the Children’s Research and Clinical Center for Infectious Diseases. The importance of introducing a new approach was determined by the severity of the patients at this clinic. The severity of the condition of children is due to the effects of neuroinfections. In addition, the quality of medical care is an essential element of improving the health care system in modern conditions. After the introduction of this system, the number of examinations carried out at the first level (heads of clinical departments) increased, at the second level (deputy chief physician for medical work and quality of medical care) decreased. The number of detected defects increased, but the quality factor of medical care turned out to be quite high and fell into the group of «insignificant deviations». The main defects are defects in filling in medical documentation and redundancy in laboratory and instrumental research. The leading position in the structure of defects is occupied by defects in filling in medical documentation with a specific weight of 32,4%. With the introduction of a new quality control system, the average length of stay of a patient in the rehabilitation department came close to the one prescribed in medical and economic standards. Revealed quite a large percentage of diagnostic studies that are not included in the medical and economic standards, that is, additional. This fact indicates the need to revise the medical and economic standards in the direction of expansion, taking into account the need. The third level of the internal control system is designed to assess the corrective actions taken as a result of audits at the first two levels of the internal control system. In general, the three-tier system has certainly improved the quality of care.
Continuous medical education and topical issues in teaching of microbiology
Authors: Moskalev A V , Sboychakov V B , Karapac M M
Published: July 2021

The situation and revealed problems of a continuous medical education of experts of various specialities are characterized and ways of their decision are offered. The terms, which let a continuous medical education abroad to become a basic educational system are analyzed. Also, limitations, which have not allowed the continuous medical education to replace traditional formation with study on cycles of licensed departments in the Russian Federation are analyzed. It is established that the basic problem of a continuous medical education is economic. Problems of education of a bacteriologist are reflected in detail. It is shown that such specialities as bacteriologist and virologist require stationary training on profile departments for professional skill improvement, and elements of a continuous medical education can be considered only as additional. Recommendations of elimination of these limitations, which were generated in the course of optimization of educational process, are offered. Also, variants of complex educational process which carries elements of the continuous one are offered. As prominent aspects of optimization of educational process for bacteriologists it is offered to return such a kind of training as specialization on a workplace that will allow to receive necessary specific practical skills. The authors conclude that in connection with the revealed problems it is necessary to consider training on profile departments as the main and variants of a continuous medical education existing at the moment - as additional.
Modern ideas about the methods of surgical organ-preserving treatment of kidney cancer
Authors: Samartseva E E , Nosov A K , Petrov S B
Published: July 2021

Renal cell carcinomas account for about 3% of all cancers in adults. The annual increase in the detection of this disease is 2,9%, which is due both to a true increase in the number of cases and to the widespread introduction of modern research methods (ultrasounds examination, computerized tomography, magnetic resonance imaging) that allow us to detect small asymptomatic lesions. This, in turn, makes it possible to perform organ-preserving surgical interventions. Comparative analysis of long-term results of treatment in patients after kidney resection does not differ from those after radical nephrectomy, at the same time, the functional results of organ-preserving surgical interventions are more attractive, especially in patients with an initially present renal dysfunction. Currently, there are three methods of performing organ-preserving operations: open, laparoscopic and robot-assisted kidney resection. Contrary to the general interest in the problem of nephron-preserving surgery of renal cell carcinomas, the choice of operative access while performing kidney resection remains the subject of discussion. In this light, the use of intermuscular mini-lumbotomy access can act as an optimal replacement for laparoscopic access or resection from traditional lumbotomy. This technique of operative intervention allows to combine the positive properties of both minimally invasive procedure (laparoscopic resection) and open surgical intervention: reduction of the volume of blood loss and duration of the operation, reduction of hospitalization time, fewer late complications, good cosmetic result. Also, the issues of processing the resected surface of the organ, the time of ischemia, and the choice of the vascular clamp when clamping the renal artery, the distance from the tumor edge to the line of resection are also disputable. In addition, the functional results of organ-preserving resections of the kidney are not sufficiently studied in the long term after surgical interventions.
Professor T.Ya. Aryev. The first experience of the management of the clinical department (to the 110th anniversary of his birth)
Authors: Sokolov V A , Yakimov D K
Published: July 2021

The work presents little-known facts of the service of Professor T.Ya. Arieva in the post of the head of theDepartment of Military Surgery of the Military Medical Faculty S.M. Kirov at the Saratov Medical Institute in the period1951-1958. Arriving to a new duty station as a member of the staff of teachers from the Military Medical Academy, hesupported the command of the faculty of medical institute in a short time was able to staff the cathedral team and begin thecurrent work. Possessing significant personal scientific and pedagogical experience and the technique of performing complexsurgical interventions, he was able to effectively organize on a scientifically grounded principles the methodology of teachingdiscipline on the basis of a city clinical hospital. In his work he successfully used the rational distribution of study time, theoptimal schedule of the day of medical and nursing staff. As the head of the department T.Ya. Aryev paid much attentionto the professional growth of the teaching staff, regularly summarized in the press the accumulated experience, shared anddiscussed with colleagues promising ways to improve the pedagogical process. Scientific and clinical work complementedeach other, allowed not only to find answers to urgent questions and problems of medical science, improve the effectivenessof treatment of patients, but also to identify the most gifted listeners and teachers of the department. Such students are T.Ya.Aryev, as M.I. Lytkin and N.E. Povstyanoy, working under his leadership, became later known physicians and scientists, headsof surgical departments in large universities, created their own scientific schools. Service in Saratov allowed to accumulateT. I Aryev considerable experience in the management of the surgical department. It was this factor, combined with personalqualities, that enabled him to lead the first in our country chair of thermal defeats of the Military Medical Academy S.M.Kirov. Under his leadership, the team created a well-known clinic not only in our country but also abroad, a large scientificand educational center, which became a real school of professional skill for a large number of specialists.
The modern view on сomplex diagnostics of the liquorrhea
Authors: Subkhanov K S , Alekseev D E , Cherebillo V Yu , Svistov D V , Abdulkerimov Kh T , Konovalov P P , Glukhaniyk V D
Published: July 2021

A modern approach to the complex diagnosis of liquorrhea, both transcranial and nasal, is considered. The terminology and the most common and used variants of classification of liquorrhea are given. An epidemiology and causes of liquorrhea according to the modern literature are described. The history of the study of cerebrospinal fluid and various methods of its study are briefly presented. Special attention is paid to the review of modern methods of diagnosis of liquorrhea which were described in the literature. Both simple samples of «halo-test» and «handkerchief» and high-tech endoscopic methods of visual diagnostics are considered. The data of various authors on the effectiveness of intrathecal administration of fluorescein, indigocarmin and other dyes is presented, their shortcomings are noted. The methods of laboratory diagnosis of liquorrhea by determining the level of glucose, protein and specific for cerebrospinal fluid biomarkers β -transferrin and β-TP are described. The role of neuroimaging methods of examination, such as multispiral computer tomography, cisternography, magnetic resonance imaging and radionuclide studies, in the diagnosis of liquorrhea was determined. Based on the analysis of the literature data and their own experience, the authors present an improved algorithm of complex diagnosis of liquorrhea, including the collection of complaints and anamnesis of the disease, general laboratory diagnostic complex, objective examination (including rhinoscopy), consultations by other specialists, bedside methods of diagnosis of liquorrhea, laboratory methods of verification of cerebrospinal fluid and radiation diagnostic techniques.
Evolution of gastrostomy in palliative medicine
Authors: Gavshchuk M V , Gostimsky A V , Zavyalova A N , Barsukova I M , Karpatsky I V , Lisovsky O V , Gostimsky I A
Published: July 2021

The article analyzes the world experience in methods of applying of stomach nutritional fistula. Different methods of gastrostomy are described, their classification is given. The advantages and disadvantages of common surgeries are outlined. The most often used traditional surgeries are: gastrostomy by Stamm, Topver and tubular gastrostomy. Complication rate of these operations led to a further search for minimally invasive techniques: percutaneous puncture, laparoscopic gastrostomy, and laparoscopically- assisted percutaneous endoscopic gastrostomy. A significant disadvantage of minimally invasive puncture techniques is the need to purchase relatively expensive disposable sets for primary installation and replaceable low profile tubes. The cost of these supplies in Russia is much higher than the money allocated in the obligate medical insurance system, which makes the method economically unprofitable for medical institutions and patients. Partially, the costs could be reduced by the use, as a gastrostomy tube, a Foley urinary catheter. There are several studies that have confirmed economic advantages and absence of a reliable difference in the number of complications and duration of use such tubes. However, some complications are reported: migration of catheter into the duodenum with the development of obstruction, decreased comfort and quality of life. The conducted study showed absence of classification of gastrostomy types and their complications. The final consensus in clinical use of different types of gastrostomy in different situations is absent. There is a tendency to decrease rate of traditional laparotomical operations in favor of less invasive interventions making it difficult for adequate analyzing. In cases with need for revision, biopsy and fundoplication, laparoscopic or laparoscopically-assisted percutaneous endoscopic gastrostomies are preferred which has proven itself in children. For a group of palliative patients of elderly age with high risk and doubtful prognosis, minimally invasive puncture gastrostomes are more appropriate.
Ethical aspects of modern use of animals in experimental studies
Authors: Denisov A V , Cheprakova V A , Anisin A V , Bezrukov S I
Published: July 2021

Laboratory animals have been widely used in biomedical research for centuries, and there is as much debate about the validity and acceptability of it. Since ancient times there are rules and moral practices, the law fixes the responsibility for the cruel treatment of animals. Currently, developed countries have accepted laws to protect animals, which are implemented through sophisticated mechanisms. Worldwide there is a growing recognition that attention to the observance of animal rights is one of the indicators of the civilization of society. Unfortunately, in Russia, the question of legislative regulation of moral concepts of animal treatment is highly relevant. Currently, in our country, there is no an effective system of control and punishment for violations of the rules of treatment of animals, so that the government cannot effectively influence the institutions in which do not apply ethical and legal norms of work with experimental animals. In addition, in the schools of biomedical and veterinary science, not enough attention is paid to the teaching of bioethics and the ethics of experiment on animals, which makes the level of training of graduates not corresponding to the modern requirements of the civilized countries of the world. It is necessary to develop a new modern documentary base in accordance with the spiritual, scientific and legal guidelines adopted throughout the world, which will determine not only the world recognition of domestic scientific research but also will be a clear indicator of the level of development of morality and civilization of Russia.
Polymorbidity: definition, classifications, prevalence, estimation methods and practical significance
Authors: Voronin S V , Cherkashin D V , Bersheva I V
Published: July 2021

Based on the analysis of Russian and foreign literary sources, the definition of the concept of polymorbidity is given, its classification, information on prevalence, measurement methods and practical significance are given. It is emphasized that at present in the literature the concepts of polymorbidity, comorbidity, multimorbidity coexist, while there is no universally accepted definition of them. This uncertainty is historically conditioned and is associated with the use of these concepts by various scientific schools. In most modern literary sources, polymorbidity (multimorbidity) refers to a combination of two or more chronic diseases in one patient. At present, a considerable number of different methods of measuring polymorbidity are used, which have their own advantages and disadvantages, and a universal method has not been developed. The most convenient for assessing polymorbidity is currently recognized polymorbidity index Charlson. Due to the lack of unified approaches to the measurement of polymorbidity, as well as taking into account the fact that studies are conducted in different population samples, the published figures for the prevalence of polymorbidity vary considerably. Emphasis is placed on the fact that polymorbidity is a multifaceted problem that has not only clinical but also economic and social importance, which requires a further in-depth study.
Work organization of evacuation hospitals in Saratov during the Battle of Stalingrad
Authors: Sokolov V A , Murylev Yu A , Yakimov D K , Murylev V Yu
Published: July 2021

The work organization of evacuation hospitals in Saratov during the Stalingrad battle is analyzed. A brief description of the medical issues of the Stalingrad strategic defensive operation is given. The factors that determined the evacuation of a significant number of wounded and sick Red Army soldiers to the medical facilities of the Local evacuation point-45 are indicated. Statistical data are provided on the number of people taken to treatment and sent to other rear hospitals who suffered from the site of the crucial battle of the Great Patriotic and World War II. The importance of using railway, water and motor vehicles for the evacuation of the wounded and sick was noted. The issues of the organization of sanitary and hygienic and antiepidemic work in Saratov and the region in the period of approaching the front, high crowding of the local population and arriving refugees, as well as the constant arrival of ambulance transports are considered. The enormous role of the Saratov Medical Institute staff in medical and consulting work in evacuation hospitals was emphasized. Their high professional training, constant search of non-standard ways of solving complex problems arising in the course of daily clinical activity, allowed to achieve high results in the work of medical institutions, to save the lives of a large number of wounded soldiers and commanders of the Red Army. The contribution and main directions of medical and scientific activity of leading specialists of the medical institute in the considered historical period of time are highlighted.
Pages of history and achievements of the Department of Normal Anatomy of the Military Medical Academy named after S.M. Kirov
Authors: Gaivoronsky I V , Nichiporuk G I
Published: July 2021

The research presents a brief historical sketch of the formation of the Department of Normal Anatomy of the Military Medical Academy. CM. Kirov. Reflected pre-academic period of development of anatomy in St. Petersburg. The contribution of outstanding scientists, anatomists, heads of the department: P.A. Zagorsky, I.V. Buyalsky, N.I. Pirogov, V.L. Gruber, A.I. Tarenetsky, I.E. Shavlovsky, V.N. Tonkov, B.A. Long-Saburov and E.A. Dyskin. It is noted that at present, the department continues to develop traditional research areas (collateral circulation, neuromorphology, functional anatomy of various parts of the vascular system, the history of anatomy and museum work), modern research is being carried out (the study of the structural transformations of the microcirculatory bed and nervous system when exposed to various extreme factors, innovative technologies for the manufacture and preservation of natural biological objects, anatomical measurement of various organs and systems of human body). In this case, the priority areas are polymeric embalming, modern applied anatomical and clinical research and medical craniology. Much attention is paid to the improvement and integration of the educational process with related theoretical and clinical disciplines, in particular - to ensure its functional and clinical orientation. It is shown that as a result of the done work, the Department of Normal Anatomy of the Military Medical Academy at the beginning of the XXI century secured the status of the leading scientific and methodological centre of Russia for the study and development of the most pressing problems of modern morphology.
Life and work of Henry Ivanovich Turner (on the 160th anniversary of his birth)
Authors: Morgoshia T Sh , Apchel V Ya , Syroezhin N A
Published: July 2021

The main life stages of scientific and practical activities of Henry Ivanovich Turner are presented. It is noted that initially G.I. Turner was interested in problems far from orthopedics: acute purulent processes in the right ileal fossa, the cecum and the appendix. In 1892 G.I. Turner defended his doctoral thesis on «the anatomy of the cecum and the vermiform Appendix in relation to the pathology of perityphlitis». In 1894, Turner was admitted to the degree of assistant Professor of clinical surgery, reading two lectures, he was confirmed in this rank. In 1895, held the appointment of Turner Professor of desmurgy and machineryi Military Medical Academy. He revived the teaching of the subject and translated it into «practical ground». Thanks to the energetic work of Turner as an organizer was revived by the Department of desmurgy and machineryi Military Medical Academy and Surgical Museum of the Academy. Under Henry I. the Museum has been enriched with new type of instruments, dressings, and splints, collection of damaged bones, who helped in the study of desmurgy. This collection has survived to the present day and has more than 800 drugs and has no analogues in the country. A lot of effort and energy gave G.I. Turner to help sick children, handicapped, vocational rehabilitation of crippled children. For many years he supervised the work of an orphanage in St. Petersburg (St. Lachtinskaia, 12), which in 1932 was transformed into the research Institute of child disability in the name of G.I. Turner. This Institute became the organizational and methodical centre of childhood disability in the Soviet Union.
The activities Imperial military medical academy during First World War
Authors: Gadylgareev V G , Fedorin S V
Published: July 2021

Some aspects of the state of the Imperial Military Medical Academy before the beginning of the First World War, the activities of the Academy to train military doctors for the army during the war before the events of October 1917 are presented. The imperialist development path introduced Russia at the beginning of the 20th century in a complex knot both external and internal political and economic contradictions, that influenced the activities of the academy. The sad experience of the Russian-Japanese war of 1904-1905 demanded an introduction to the educational process of military and military-medical disciplines. Since 1907, the Main Military Medical Directorate has proposed the introduction of compulsory study by students of the Academy of military regulations, military administration, military field surgery with radiology and field surgery, military hygiene, the theory of searchable diseases and epidemics, «military medical service» according to the programs approved by the military minister. Despite the fact that such «militarization» during the period of ongoing military reforms was acutely perceived by both students and the Conference, referring to the overload of curricula, the requirements of the time created prerequisites for further development in the second half of the 19th and early 20th centuries scientific schools. Outstanding global discoveries in the field of medicine by the beginning of the First World War allowed the Academy to preserve the status of the main scientific center of medicine, and not only the military, Russian Empire. On the eve of the First World War, Russian military medicine accumulated a wealth of experience both in organizing medical care at the front and in evacuating the wounded and sick and in matters relating to the theoretical justification and practice of treating wounds and diseases. The frontline experience of introducing the latest methods and advanced technologies for treating the wounded, contributing to the further development of military medicine, was noted.