Relevance. In December 1988, the Armenian Soviet Socialist Republic suffered a catastrophic earthquake in the area where lived up to 1 million people. The cities of Spitak, Leninakan, Kirovokan, Stepanavan and more than 300 other settlements were totally or partly destroyed. More than 25 thousand people died. The republic lost up to 40% of the production capacity. This Armenian tragedy showed a need for a system of prevention and elimination of natural and technogenic emergency situation. Owing to the experience from elimination of medical and sanitary consequences, main principles of Disaster medicine as a new branch of health care were coined.

Intention. To assess retrospectively experience of elimination of medical and sanitary consequences of December 1988 earthquake in the Armenian Soviet Socialist Republic using forces and assets of the USSR armed forces.

Methodology. The scientific literature on mitigation of consequences of earthquakes as indexed in the Russian state library and Scientific electronic library was studied. Personal experience and experience of participation of military-medical experts in mitigation of consequences of Spitak (Armenia) earthquake was analyzed and compared with current aspects of the theory and practice of disaster medicine.

Results and Discussion. Delivery of health care to the population was complicated since many medical institutions were destroyed; losses of military-medical service in earthquake area were at least 50–60 %. Soldiers and military physicians of the Transcaucasian military district were the first responders, and the leadership in mitigation of consequences was assigned mainly to the Ministry of Defense of the USSR and its Central military-medical administration. At the same time, more than 111 foreign states provided humanitarian aid. The main idea was to accumulate forces and assets for qualified medical care in close proximity to affected regions with subsequent air evacuation of injured to the cities of Yerevan, Tbilisi, Moscow and Leningrad. Further it became clear that more than 25 thousand people died, over 15 thousand were rescued from ruined buildings, 427 wounded died in hospitals, 140 thousand became disabled, 514 thousand became homeless.

Conclusion. The experience gained by the USSR during mitigation of consequences of technogenic and natural disasters of the second half of the 20th century required formation of the Russian Rescue Corps (RRC) as the State committee with the subsequent transformation in the separate Ministry of the Russian Federation for Civil Defence, Emergencies and Elimination of Consequences of Natural Disasters (Emercom of Russia). To deliver health care to wounded, sick and injured during emergency situations, the All-Russian Service for Disaster Medicine was established with the Service of Disaster Medicine within the Russian Defense Ministry as an important component.

Relevance. Post-traumatic shoulder instability is widespread in the population and has a high social significance. Low efficacy of shoulder instability treatment determined the development of more than 300 surgical methods.

Intention. The objective of the work is to study mid-term functional results of arthroscopic Latarjet surgery for treatment of shoulder instability with significant defects in the anterior edge of the scapula articular process and the humeral head.

Methodology. 68 arthroscopic Latarjet surgeries were performed over the period of 2013–2017 in the clinic No.2, Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia (St. Petersburg). There were analyzed the duration of surgery, the position of the coracoid process graft relative to the glenoid, functional evaluation of the treatment results.

Results. The average duration of a surgery was (91 ± 12) minutes. The time for the procedure reduced with the acquisition of skills. The graft was placed in the correct position (in the range of 02.30–05.30 o’clock of the imaginary dial) in 88% of cases. Only one episode of recurrent shoulder dislocation occurred in 9 months. The limitation of external shoulder rotation averaged to 7° (from 5 to 14°).

Conclusion. Mid-term clinical results of arthroscopic Latarjet surgery have confirmed that the procedure can be reliable and safe for performance as well as functionally advantageous.

Relevance. The conditions of military service, which significantly differ from civilian life, can cause health disorders in army conscripts that reduce the combat readiness and fighting efficiency of troops.

Intention. Identify the medical and statistical indicators of the morbidity of army conscripts in the Armed Forces (AF) of the Republic of Belarus and the Russian Federation.

Methodology. We conducted a random statistical analysis of medical reports on the health status of military personnel and on activities of the medical services (form 3/MED) from military units located in different military districts, branches and types of troops in which more than 60% of the total number of conscripts served in the AF of Belarus and Russia from 2003 to 2016. Counting and analysis unification of morbidity of conscripts was achieved using the International Classification of Diseases, Trauma and Causes of Death, the 10th review (ICD-10).

Results and their analysis. The average annual level of the general morbidity of conscripts in the AF of Belarus was (2860.7 ± 98.6) ‰, primary disease incidence (1638.2 ± 79.1) ‰, the need for dispensary observation - (93.5 ± 9.5) ‰, hospitalization – (931.6 ± 44.2) ‰, days of disability – (8406 ± 327) ‰, dismissing for health reasons – (15.80 ± 0.64) ‰. The duration of 1 case of disability was (9.3 ± 0.2) days, death rate per 100,000 people per year – (35.06 ± 5.01). The average annual level of these indicators among conscripts in the AF of Russia was (1849.3 ± 55.7) ‰, (1026.5 ± 56.3), (125.9 ± 7.8), (916.2 ± 54.3), (10 173 ± 376), (18.32 ± 1.23) ‰, (11.3 ± 0.3) days and (45.41 ± 6.37) deaths, respectively. Data relatively independent from the human factor (hospitalization, dismissing, mortality) were practically similar. It should be noted that the curves of these indicators had statistically significant congruencies, which indicated the influence of similar factors on their formation. A quite similar structure of the military and epidemiological significance of health disorders is established for conscripts in the AF of Belarus and Russia. Traumas, poisoning and some other consequences of external causes (ICD-10 Chapter XIX) ranked first, diseases of respiratory system (Chapter X) ranked second, and diseases of digestive system (XI), diseases of the circulatory system (IX), diseases of the musculoskeletal system and connective tissue, mental and behavioral disorders (V) occupied places from 3 to 7. Some outstanding features were also revealed during generalized evaluation: skin and subcutaneous tissue diseases (Chapter XII) prevailed in Belorussian conscripts and some infectious and parasitic diseases (ICD-10 Chapter I) – in Russian conscripts.

Conclusion. Preventive measures against leading diseases will contribute to improving the health status of conscripts. Based on the established medical and statistical indicators, probabilities of specific health disorders in military can be calculated.

Relevance. Mortality and unsatisfactory results of treatment with polytrauma are high, which is explained by the lack of an effective system of organizing specialized medical care for this category of victims.

Intention. To study the effectiveness of organizing specialized medical care for polytrauma in the Level I Trauma Center of St. Petersburg Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze.

Methods. The 5-year (2013–2017) experience in the provision of specialized medical care in closed co-traumatic injuries in the trauma center of the St. Petersburg Research Institute of Emergency Care n.a. I.I. Dzhanelidze was analyzed. Of 3852 patients, 2970 had closed combined injuries, 882 – various wounds. 44.7 % of the victims with closed and 33.1 % with other injuries had signs of traumatic shock on admission.

Results and Discussion. Owing to the up-to-date methods of examination and treatment of patients, treatment and tactical prognosis by “T”-criterion and Damage Control approach, mortality in severe closed co-trauma was reduced from 18.1 % in 2013 to 9.9 % in 2017, and in other injuries – from 7.4 to 2.3 %, respectively. An advanced effective system of specialized medical assistance to victims of polytrauma has been created at the present time in St. Petersburg.

Conclusion. Аn experience of the Level I Trauma Center of Saint Petersburg Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze as the oldest in the city and the country convincingly confirms the correctness of the modern concept of medical care in case of severe closed combined injuries. Our Trauma Centers uses the whole arsenal of diagnostic and treatment facilities of multi-profile hospitals with the involvement of various specialists, which results in reducing mortality and complications in polytrauma.

Relevance. The relevance of this study is determined by the need to improve existing and develop new samples of medical protection equipment.

Intention. Identify problems and prospects for using peptide and protein compounds as medical radiation protective agents.

Methodology. Domestic and foreign publications devoted to the prospects of the development of medical prevention and therapy radiation protective agents, to the effectiveness of the use of peptide drugs including when using permeation enhancers were studied.

Results and Discussion. Peptide compounds can be considered as promising radiation protective agents, including the inhalation pathway of peptide administration may be an attractive alternative to the injection. To increase the bioavailability of macromolecules, it’s advisable to use permeability enhancers, which can act as protease inhibitors and auxiliary substances with surface-active properties. The most versatile action shows bile salts (glycoholic, taurocolate), fatty acids (yamnova, palmitic and linoleic), neionogennye surfactants, cyclodextrins.

Relevance. New units commissioning at the operating nuclear power plants may be associated with an increase in the radiation load on environment and human beings. The 4th Unit BN-800 was commissioned at the Beloyarsk nuclear power plant (BNPP) in 2016. The Beloyarsk artificial lake created in 1959–1963 serves as a cooling pond. A radioecological study of the cooling pond was performed in 2014 before the BN-800 Unit commissioning. Its results were published in the issue No. 2 of the present journal in 2016.

Intention. The objective of the work is to show (comparing with the results of the previous research) the effect of the BN-800 Unit commissioning on the cooling pond radioecological state.

Methodology. The samples of water and macrophytes (Potamogeton pectinatus, Ceratophyllum demersum, Spirogyra, Cladophora) were examined at the reference points of the cooling pond.

Results and Discussion. It was found that 137Cs decreased in the water by 1.4–5.9 times in all reference points (including the 4th NPP Unit discharge channel) compared to 2014. Potamogeton pectinatus (from the 4th NPP Unit discharge channel) had 3.1 times less 137Cs and 1.4 times less 90Sr than macrophytes from the Pyshma river area below the dam.

Conclusion. The BN-800 Unit commissioning was not associated with additional radiation load on the artificial lake. It does not deleteriously affect the natural purification processes after the 1st and 2nd BNPP Units decommissioning. The further preservation of the Beloyarsk artificial lake natural resources assumes a systematic radioecological monitoring to determine the level of long-lived radionuclides in main natural components of the cooling pond.

Sampling from the cooling pond, sample preparation, 137Cs and 90Sr concentration measurement in water and aquatic plants as well as interpretation of results are performed in the framework of the State Task of the Institute of Plant and Animal Ecology, Ural Branch of the Russian Academy of Sciences.

Relevance. High efficiency of hypertonic (hyperosmolar) solutions in acute blood loss is known. However, data on changes in the body, developing as a result of infusion of such drugs (including cooled) in the providing of care after acute blood loss is limited or absent. This fact complicates the development of tactics in their use, especially in emergency situations at low temperatures.

Intention. To reveal features of functional and laboratory indicators In experiments on animals as a result of infusion of warm (+22 °С) or the cooled (–3 °С) hypertonic solution based on hydroxyethyl starch and sodium chloride (HyperHAES, further – HHES) at the acute blood loss of 50 % of blood volume (BV).

Methodology. Animals (20 male sheep) with modeled blood loss were distributed into 2 experimental and 2 control groups of 5 animals each. Sheep in the 1st experimental group were placed in the heat chamber with temperature –7 °С for 15 min. Then they underwent the intravenous infusion of a cooled HHES at a dose of 4 ml/kg of weight through the jugular vein with a disposable syringe (volume 20 ml) evenly with a speed of 60 ml per minute. After that they were left in the heat chamber until the time of 1 hour in total. Individuals in the 2nd experimental group were injected with an equivalent volume of warm solution during the corresponding periods of the experiment at an external temperature of +22 °C. 1 hour after beginning of the infusion all animals were intravenously injected with colloidal solution based on hydroxyethyl starch (“Voluven”) at an external temperature of +22 °C. During 1 day the dynamics of rectal temperature, arterial pressure, heart rate and respiratory movements, osmolarity of blood plasma and content of osmotically active components, quantitative indicators of red blood were evaluated.

Results. Animals at a temperature of +22 °C or at a temperature of –7 °C died in (82 ± 3) min and (70 ± 5) min (p < 0.05) respectively after the start of exfusion. Intravenous fluids (warm or cooled HHES) ensured the survival in 100 % of cases. As a result of blood loss, subsequent infusion of cooled HHES and following presence in the heat chamber, rectal temperature in sheep decreased by 4.9 °C (14.2%, p < 0.05) relative to the initial values. Two and 4 min after infusion of cooled or warm HHES systolic blood pressure increased by 24.9 % (p < 0.05) and 14.9 % (p < 0.05), respectively, and were restored to the normal level during the following 40 min. Infusion of “Voluven” contributed to the stabilization of blood pressure within 1 day after infusion of HHES. Blood loss led to increased heart rate by 2.1 times (p < 0.05), infusion of HHES slightly reduced the severity of tachycardia. Within 10 minutes after the introduction of cooled HHES, dynamics of heart rate was less stable. Infusion of warm or cooled HHES increased osmolarity of blood plasma by 9.5–9.9 % (p < 0.05), which was associated with an increase of sodium and glucose concentrations in blood. Infusion of “Voluven” reduced osmolarity of blood plasma, which became similar to initial values at the end of Day 1 after infusion of HHES. Blood loss, infusion of HHES and “Voluven” decreased quantitative indicators of red blood via removal of red blood cells from the bloodstream, as well as compensatory and post-transfusion hemodilution.

Conclusion. The infusion of warm or cold hypertonic saline (HyperHAES) ensures the survival of experimental animals in post-hemorrhagic period. The positive effect of the drug is associated with compensatory haemodilution (including increased osmolarity of blood plasma), as well as with better functioning of the cardiovascular system. Specific cooled HHES effects include an earlier and pronounced rise in blood pressure. Considering changes in functional and laboratory parameters after infusion of warm or cooled HHES, a reliable system should be developed to remove casualties from emergency areas and to take earlier and complete diagnostic and treatment measures.

Relevance. Intoxication by depleted uranium is possible at uranium mining and processing enterprises, as well as during military conflicts.

Intention. To identify possible immunological disorders that develop after acute exposure to depleted uranium in the early and delayed periods.

Methods. The study involved 30 outbred rats and 60 СВА mice. Soluble uranium (VI) salts and microcrystalline dispersed mixed uranium oxide were administered via intratracheal + intragastric + cutaneous routes. The relative amount of T-lymphocytes, apoptotic and necrotic cells, the production of tumor necrosis factor, the level of circulating immune complexes, the phagocytic activity of neutrophils, the development of a delayed-type hypersensitivity reaction, the production of immunoglobulins were evaluated in this study.

Results and Discussion. 14 days after the acute exposure to depleted uranium salts, T-helpers and the functional activity of T-lymphocytes decreased; antibody production and the number of cytotoxic T-cells increased as well as the necrotic cells and apoptotic death of immunocytes. All identified changes were transient. The indices returned to normal 60 days after the exposure.

Conclusion. The results can be used to provide medical assistance to persons after acute exposure to depleted uranium.

Relevance. The interrelation of the state of the upper gastrointestinal tract with the change of bone mineral density (BMD) is proved. It is known that hormonal regulation plays a key role against the background of complicated gastroduodenal pathology. Its effect on target organs hormones are mediated by specific receptors, but the level of expression of steroid hormone receptors and vitamin D in acid-dependent diseases of the stomach and in concomitant metabolic disorders in bone tissue remains not sufficiently investigated.

Intention. The aim is to study the content of steroid hormone receptors and vitamin D in the duodenal mucosa and their hormones in blood serum in patients of different age groups with acid-dependent diseases of the stomach and changes in IPC.

Methodology – 30 rescuers of EMERCOM of Russia – men aged 23 to 54 years 30 [27; 32] and 74 liquidators of consequences of accident on Chernobyl NPP (ChNPP) aged from 55 to 80 years 59 [55; 71] were examined. Histological examination of duodenal mucosa, immunohistochemical study of vitamin d receptors (DR), androgens (AR), estrogens alpha (ER-α) and beta (ER-β), progesterone (PR) and glucocorticoids (GR) and their hormones in the blood.

Results and Discussion. All patients were diagnosed with chronic gastritis and chronic duodenitis. Violation of IPC and osteopenic syndrome was found in 40 % (12) of rescuers and 64.8 % (48) of liquidators. It was found that in duodenal mucosa in liquidators of consequences at ChNPP, receptors DR (74 %), AR (52.7 %) and ER-β (37.8%) are statistically reliably detected, and PR (0 %) and GR (0 %) are not determined in comparison with patients of rescue group, respectively DR (30 %), AR (0 %) and ER-β (0 %), PR (73.3 %), GR (73.3 %) (p < 0.001) Statistically significant correlation between decrease of IPC and osteopenic syndrome in liquidators with AR and ER-β in mucosa and decrease of testosterone and estradiol in blood was revealed. Whereas in rescuers, these manifestations are associated with the presence of PR and GR in the mucosa and the normal level of hormones in the blood serum (p < 0.05). Cytoplasmic localization of PR and DR receptors may indicate a violation of the mechanism of binding of progesterone to its receptor at the cellular and molecular level and the participation of vitamin d in the pathogenesis of osteopathic syndrome.

Conclusion. The revealed differences of hormone-receptor interactions in osteopenic syndrome in liquidators of consequences at ChNPP, on the one hand, and in men (without radiation factor), rescuers, do not exclude both the commonality of its pathogenesis, presenting different stages characteristic of different age groups, and the presence of two multidirectional mechanisms of osteoporosis development, which requires further study.

Relevance. The number of starving people throughout the world as well as global financial costs related to the development of alimentary-dependent conditions and diseases constantly increase. Intention. To review the scientific literature on the problems of metabolic and pathophysiological disorders caused by longterm starvation in human organism.

Methodology. The available domestic and foreign sources of scientific information were studied.

Results and Discussion. Paper describes the data on the pathogenesis of prolonged famine, on the endo- and exogenous causes of starvation, on qualitative and quantitative types of starvation, as well as the changes in metabolism of various organs and systems in completely starving organism during all periods of complete starvation (that of emergency, long-term adaptation, and decompensation) with their detailed endocrine-metabolic features. The results of the main research works by the Leningrad physicians who lived and worked in besieged Leningrad during the Great Patriotic War are recalled.

Conclusion. The information presented is important for biomedical science and health practice as well, since emergencies can be associated with prolonged starvation of people in the modern world.