Relevance. Annually, every third Russian citizen seeks emergency medical care. There are 2 types of emergency medical care, outpatient and inpatient one.

Intention. Assess outpatient vs inpatient medical services in the Russian Federation in 2014-2018.

Methods. Results of outpatient vs inpatient emergency medical care were analyzed based on data of Federal Statistical Monitoring.

Results and Discussion. In terms of emergency outpatient services in Russia in 2014-2018, emergency stations (departments) decreased by 14.3 %, incl. independent departments - by 25.6 %, due to their consolidation and centralization; ambulance calls decreased from 312.2 to 299.5 per 1000 people (by 4.1 %) and reached a regulatory limit as approved by State Guarantee of Free Medical Care to the Citizens of the Russian Federation; ambulance calls for trauma and poisoning decreased by 11.6 %, for sudden diseases and states - by 5.2 %; the number of patients cared by ambulance decreased from 313.6 to 300.9 per 1000 persons (by 4.0 %); ambulance calls for road accidents decreased by 24.9 %, the number of injured in road accidents decreased by 26.8 %, incl. fatalities by 34.2 %. The bed occupancy in emergency departments over 5 years improved. However, only 29 emergency inpatient departments exist, thus necessitating additional facilities in 56 regions of the Russian Federation.

Conclusion. For further improvement of emergency, including specialized, medical care the Ministry of Health of the Russian Federation suggested the regional centers of emergency care and disaster medicine. They will be responsible for medical evacuation in the whole region. Besides, intermunicipal and regional centers for emergency specialized medical care will improve quality and accessibility of the health care.

Intention. To compare results of treatment among patients with burn injury associated with alcohol and smoking in bed vs general burn injuries.

Methodology: The main study group included 60 patients with burns > 10 % TBSA, resulting from the ignition of the bed from an unfinished cigarette. The control group consisted of case histories of 330 patients with burns of similar area not associated with smoking in bed. Statistical data processing was performed using Microsoft Office Excel 2007 and IBM SPSS 20.0 using descriptive and non-parametric statistics.

Results: Multifactorial injuries due smoking in bed combine deep burns, inhalation injury and poisoning with combustion products (so-called sofa injury) and are much more common in men (p = 0.002). Alcohol intoxication significantly increases the risk of such injuries (p = 0.001). “Sofa injuries” need longer (p = 0.001) and more expensive (p = 0.05) treatment than other burn categories. Early excision is preferable with one-stage skin graft. If the radical excision fails, then a vacuum dressing should be considered for temporary wound closure. Mortality in this group reaches 53 % and significantly exceeds that from any other type of thermal injury (p = 0.002).

Conclusion: The so-called “sofa injury” is most common in middle-aged patients. Associated burn disease includes extensive deep burns of the trunk and upper extremities, usually with alcohol intoxication, inhalation injury and carbon monoxide poisoning. Most victims develop burn sepsis and multiple organ failure. Stratified excision is ineffective in most these patients. When excised to the fascia level, radical necrotomy can be achieved only in 60 % of cases. Taking these features into account helps to organize treatment correctly, optimize systemic therapy and create personalized surgical tactics, which should improve the results of treatment in patients with “sofa injury”. However, further clinical trials are necessary to confirm this theory.

Relevance. Medical evacuation of the wounded and injured in emergency situations of peacetime and wartime is an important component of medical support, which largely determines the effectiveness of medical care. The presence of a large number of victims forces us to use not only regular medical transport, but also any available vehicles for medical evacuation. Equipping vehicles with special modules and creating mobile medical technical devices that simultaneously solve the problem of monitoring physiological data, transport immobilization, transportation and treatment of the injured are certainly relevant.

Intention. To analyze the use and justify the prospects for the development of medical technical devices for medical evacuation of victims in emergency situations of peacetime and wartime.

Methodology. The subject of the study was the Russian and foreign experience in the medical evacuation of victims of emergency situation in peacetime and wartime. We conducted a retrospective analysis of the use of various systems and devices for the medical evacuation of the wounded and injured in emergency situations. The study of medical and technical characteristics, efficiency of use and development prospects of these devices was carried out using methods of historical analysis and comparison, logical analysis, expert estimates, system analysis and forecasting.

Results and Discussion. It is shown that the technical improvement of medical evacuation can be carried out either by creating a special medical transport, or by developing devices that allow evacuating victims in any kind of transport while monitoring physiologically important functions and the possibility of carrying out basic resuscitation measures. Types of special medical transport created in the 70-80s of the 20th century for the evacuation of victims and the provision of qualified assistance on board (including in flight) were analyzed: the Mi-8MB “Bissectrisa” ambulance helicopter, resuscitation and operational aircraft An-26M “Spasatel”, operational-resuscitation aircraft laboratory IL-76MD “Scalpel”. The main medical and technical characteristics of mobile devices currently used for medical evacuation - medical modules for helicopter (MMB) and aircraft (MMS), medical air evacuation module STRATAIRMEDEVAC, multifunctional evacuation, transportation and immobilization unit METIU, medical evacuation device for seriously wounded UMETR, mobile rescue intensive care unit MIRF, and patient’s life support platform for transport LSTAT are presented. Promising developments - the diagnostic medical treatment and transportation complex for maintaining human vital activity “Angel” and a multifunctional robotic medical system are described.

Conclusion. The use of special medical technical devices for medical evacuation makes it possible to increase the efficiency of medical care for the wounded and injured in emergency situations of peacetime and wartime.

Relevance. Digestive diseases are among the most common disorders affecting Chernobyl nuclear power plant (CNPP) accident recovery workers.

Intention - to assess the occurrence of atrophic changes in fundal and antral gastric mucosa, occurrence of H. pylori infection, and autoimmune gastritis in CNPP accident recovery workers in remote period. And to define connection between the obtained results and external radiation dose, duration of participation in recovery works, and the date of participation.

Methodology. 197 CNPP accident recovery workers were examined 30 years or more after the accident. 106 employees of the EMERCOM of Russia were included in comparison group. Levels of basal gastrin-17, pepsinogen I, pepsinogen II, anti- parietal cell antibodies, anti-H. pylori antibodies were evaluated in all the patients. Information on external radiation dose, duration of participation in recovery works, and date of participation was provided by North-West regional center of National Radiation Epidemiological Registry.

Results and discussion. Atrophic changes of gastric body mucosa were found in 12.7 % of CNPP accident recovery workers vs 8.1 % of patients (p < 0.01) in comparison group. Gastric antrum atrophy was also statistically significantly (p < 0.01) more common in CNPP accident recovery workers (24.4 %) than in comparison group (10.8 %), as well as atrophic pangastritis (2.0 % vs 0.9 %, p < 0.01). There was no statistically significant difference (p > 0.05) in anti-parietal cell antibodies between 2 groups: the test was positive in 39.1 % of CNPP accident recovery workers and in 37.7 % of comparison group patients. Meanwhile, increased levels of anti- H. pylori antibodies were observed in 70.1 % of CNPP accident recovery workers vs 28.2 % of comparison group patients (p < 0.05).

Conclusion. Atrophic changes in gastric body and fundal mucosa and H. pylori infection were more common in CNPP accident recovery workers than in patients of comparison group. There were no correlations between these changes and external radiation dose, duration of the participation in recovery works and the date of participation in CNPP recovery activities.

Relevance. Neoplasms tend to increase among the firemen and military personnel, according to their medical and statistical indicators. People with hazardous occupation are at high risk of malignancies. Thus, the issues of diagnostics, prophylaxis and treatment of oncology diseases and their thrombotic complications are of essential importance for this category of patients.

Intention. To analyze the literature data on the role of hemostatic system disorders, possible ways of prophylaxis and treatment of thrombotic complications in case of oncology diseases.

Results. Thrombotic complications affect negatively the antineoplastic therapy outcomes and become one of the leading death causes. The thrombosis in oncology patients 30-fold increases death risk due to the fatal thromboembolism and more aggressive neoplastic process. Hemostasis system disorders are caused both by neoplasms and their treatment. Low molecular weight heparin (LMWH) is considered a basis for thromboembolism prevention in oncology patients. LMWH decreases effectively the venous thromboses after surgery and during chemotherapy. Direct oral anticoagulants are promising medications for oral administration; they are indicated for patients with tumor-associated thromboses in case of a low bleed risk and absence of drug interactions with system chemotherapy.

Relevance. Northern territories make up to 70 % of Russia. About 11.5 million people, mainly migrants, live in the Far North. Migration to the extreme conditions of the Far North facilitates adaptation, new pathways of protein, fat, carbohydrate, micro - and macronutrient metabolism. If the functional reserves decompensate, chronic diseases develop and life expectancy decreases.

Intention. Evaluate the influence of extreme conditions of the Far North on the bone mineral density in male military personnel.

Methodology. We examined 60 servicemen aged 25-45 who served > 5 years in the Far North (Severomorsk). The control group included servicemen (n = 41) from the North-Western region (St. Petersburg). All the servicemen underwent dualenergy X-ray absorptiometry using a densitometer “Osteometer DTX 200” and vitamin D testing in the blood.

Results and Discussion. The analysis of the obtained data showed a significant decrease in the level of vitamin D (29 ± 11.5) nmol/l and a significant decrease in the Z-criterion (0.1 ± 1.7) SD (p < 0.05) in the servicemen from the Far North. Correlations between Z-criterion and vitamin D levels, body mass index and muscle strength were established. Correlations between Z- criterion and vitamin D levels, body mass index and dynamometry reflect the natural process of reducing bone mineral density due to the low insolation in all the subjects.

Conclusion. A significant deviation of vitamin D and bone mineral density from normal values was found in military personnel serving in the Far North and North-West of Russia. The revealed decrease in endogenous synthesis in the skin due to insufficient insolation and inadequate intake of this vitamin from food are the causes of vitamin D deficiency.

Relevance. Increasing prevalence of concomitant pathology among the Chernobyl accident recovery workers is associated with long-term adverse health effects. Due to a significant role of dyslipidemia, microbiological disorders of the gastrointestinal tract should be assessed along with individual indicators of cholesterol metabolism.

Intention. To study the features of the gut microbiome composition in the Chernobyl accident recovery workers.

Methods. Lipid metabolism was assessed based on the total cholesterol in the blood serum. Parietal intestinal microbiota was studied via gas chromatography-mass spectrometry of microbial markers. The study group consisted of 94 Chernobyl accident recovery (1986-1990) workers aged 53-80 years with various somatic pathology.

Results and discussions. It was found that patients with elevated serum cholesterol had numerous microbial markers of Lactobacillus and Rhodococcus in the mucosal layer of the intestine, as well as aerobic bacteria which are the sign of dysbiosis. The most pronounced differences in the structure of the interrelations of “useful” and other intestinal microorganisms are associated with Lactobacillus. Representatives of “useful” gut microbiome, in addition to Lactobacillus, obviously correlate with each other.

Conclusion. According to the study results, there is a relationship between gut microbiome composition and lipid metabolism. Lipid metabolism disorders are associated with qualitative and quantitative changes in the composition of gut microbiome in Chernobyl recovery workers. No statistically significant correlations were observed between parameters under study and radiation exposure or the year of participation in recovery work.

Relevance. It is justified by the need to study panic states in healthy and sick individuals, the difficulty correcting acute and chronic anxiety disorders, and the search for modern, effective and safe methods of correction.

Intention. To study intrapersonal fears and anxiety as components of the current mental state in people with panic disorder when exposed to the method of formation and activation of artificial stable functional connections (ASFC).

Methodology. The sample consisted of 60 individuals with panic disorder (F 41.0 according to ICD-10) in the interattack period, 18 of them participated in the correction program, while 20 healthy individuals were examined as a control group. The dynamics of indicators of the current mental state of the subjects was studied using Taylor questionnaires, questionnaire of current personal fears and Lusher test, and a standardized personality inventory. Formation and activation of ASFC was conducted using rhythmic photostimuli with given frequencies.

The results and discussion. The study of the current mental state of 60 people with panic disorder showed significant excess of normative indicators of anxiety and fears. At the same time, undirected paroxysmal fear was the leading symptom in 100% of cases. The division of the total sample into male (42 %) and female (58 %) subgroups showed a gender difference in the structure of actual intrapersonal fears. Heterogeneous anxiety was revealed in people with panic disorder. 18 patients underwent a course of correction by the method of formation and activation of ASFC. There were significant positive changes in the clinical picture and in indicators of anxiety and intrapersonal fears, also when compared with the control group. The correlation analysis showed disconnection between the indicators of anxiety and fears after the correction course.

Conclusion. Changes in the main components of the current mental state in people with panic disorder are shown: a decrease in the level of anxiety and fears, loss of correlation between them and indicators of the SMIL scale. The positive experience of using the method of formation and activation of ASFC via photostimulation of a given frequency in persons with panic disorder in the interattack period in connection with the correction tasks was revealed.

Relevance. Terrorist threats in the world are numerous, therefore biomedical consequences of terrorist attacks should be studied, along with their prevention.

Intention. Analyze the biomedical consequences of terrorism in Russia and worldwide in 2005-2018 and calculate scientometric indicators of articles in the field of terrorism indexed in the Russian Science Index and Scopus.

Methodology. The registered terrorist attacks and their biomedical consequences were studied in the world and in Russia according to the Global Terrorism Index, the EMERCOM and the Russian Ministry of Health. The abstract-bibliographic databases of the Russian Science Citation Index and Scopus were searched for journal scientific articles and whether these articles were considered relevant by readers.

Results and Discussion. In 2005-2018 annually (8.1 ± 1.3) thousand terrorist attacks were registered in the world with (19.2 ± 3.4) thousand fatalities, including the terrorists themselves, and sanitary losses amounted to (25.4 ± 2.9) thousand people. In the period under study, these indicators tended to increase. On average, there were (2.4 ± 0.2) dead and (3.7 ± 0.4) injured per 1 terrorist attack in the world. The average annual economic damage from terrorism amounted to (51.7 ± 7.9) billion US dollars. According to the EMERCOM of Russia, in 2005-2017 (there were no terrorist attacks in 2018) 57 major terrorist attacks were recorded, in which 366 people were killed and 1717 people were injured. On average, 6-7 people died and 30 people were injured per 1 major terrorist attack. The ratio of dead and injured was 1 : 4.7. Over the same period, according to the Russian Ministry of Health, 1,100 terrorist attacks were recorded, in which 898 people died and 4,860 people were injured. On average, 1 person was killed and 4-5 people were injured per terrorist attack. The ratio of fatalities and injured was 1 : 5.4. A decrease in the number of terrorist attacks, irrevocable and sanitary losses is noted. Injured with extremely severe injuries due to terrorist attacks amounted to 8.1 %, severe - 18.2 %, moderate - 30.4 %, mild injuries - 43.4 %. Over time, there is a decrease in the proportion of extremely severe and severe conditions of injured, relative stabilization of the proportion of moderate conditions, and an increase in mild conditions. It is necessary to continue work on coordination of registration of emergencies in the EMERCOM of Russia and the Ministry of Health of Russia to improve reservation of funds to eliminate their consequences. The search in the Russian Science Citation Index and Scopus revealed 18,334 and 12,836 scientific articles, respectively, including 4,200 and 151 publications on biomedical consequences of terrorist attacks, over 2005-2018. There is a high demand for articles on the biomedical consequences of terrorism in Scopus: 81.5 % of publications were cited at least once, the average number of citations per article was 15.31. In the Russian Science Citation Index the scientometric indices were much smaller - 44.4 % and 1.70, respectively.

Conclusion. The analysis of publications showed that use of medium and high power ionizing radiation sources, toxic chemical and biological agents in terrorist acts in the world is possible only if they are stolen from state organizations or if they are transferred by state organizations to third parties. At the same time, it should be noted that in the modern world, none of the countries, including Russia, can be recognized as adequately prepared to confront nuclear (radiological), chemical and biological terrorism. The most likely counteraction to such terrorist attacks are international conventions on the production, control and non-proliferation of highly toxic agents in the world. Databases of the Russian Science Index and Scopus open up great information to researchers on the study of terrorism. In addition to improving the innovative content of domestic articles, Russian scientists should include more citations from colleagues.