Relevance. About 5 million people suffered from the large-scale Chernobyl nuclear power plant (CNPP) accident in 1986, mainly citizens of Russia and Republic of Belarus. Governments of these states and the Union State of Russia-Belarus created on December 8, 1999 have been consistently implementing for many years a set of targeted programs and measures to provide special, including high-tech, medical assistance to the Chernobyl accident survivors. Features, profiles, types and amount of high-tech medical care for the Chernobyl accident survivors need to be summarized and are the basis for improving its budgeting within the Union State. Intention. To identify, on the basis of long-term data, the features, main profiles, types and amount of high-tech medical care for survivors of the Chernobyl accident in 2014-2020.

Methodology. There were analyzed 843 medical records of Chernobyl accident survivors who received high-tech medical care in the multidisciplinary clinic N 2 of the Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia (St. Petersburg).

Results and Discussion. High-tech medical care for Chernobyl accident survivors implies waiting lists and forecast parameters, preliminary treatment of comorbidities and medical rehabilitation afterwards. Profiles, types, amount of hightech medical care over 2014-2020 are described. Most popular high-tech care included cardiovascular, traumatology and orthopedics and ophthalmology interventions.

Conclusion. Data provide an important basis for planning the types of high-tech medical care for the Chernobyl accident survivors within the framework of the targeted activities of the Union State.

Relevance. In our country, as part of the digitalization of healthcare, a number of organizational decisions have been made and are being implemented to optimize the medical evacuation of the sick and injured in emergency situations. The digital transformation of healthcare in order to address the issues of treatment correction, patient transportability and the feasibility of medical evacuation to the greatest degree is realized so far only in the form of telemedicine consultations. At the same time, the latest developments can already be applied, allowing the use of advanced information technologies, including artificial intelligence technologies, for each sick or injured during medical evacuation in the prehospital and hospital periods in the event of emergency response and during everyday work. One of such developments could be the creation of a portable isolated robotic medical module.

Intention: To justify the concept of a portable, isolated robotic medical module for the medical evacuation of the sick and injured using advanced medical digital technologies.

Methodology. Based on an analysis of the advanced medical equipment, medical materials, digital medical technologies, many years of comprehensive in-house experience in medical evacuation, an information and patent search was conducted for conceptual solutions to create a portable isolated robotic medical module (Module) for medical evacuation of the sick and injured in the daily life and emergency situations.

Results and Discussion. A key solution to the problem is to implement the following original ideas. Firstly, it is the “block” principle of layout of the Module structure. In the first (upper) block, robotic diagnostic and medical equipment, control systems and telemetry communications are installed. If you need to work offline, the unit is protected from external influences. The second (middle) block is designed to accommodate a patient who receives medical care. The unit can be completely isolated from the external environment, a comfortable internal environment is created and elements of a video communication system are placed. The third (lower) block contains systems for patient’s life support and autonomic operation, and can be delivered on board the vehicle separately from the first and second blocks. The mass of the third block is not critical for the mass of the

Module as a whole. Secondly, there is an idea of using special removable and replaceable shells to isolate the Module from adverse weather conditions. It is possible to use a removable cover made of protective materials. For the conditions of the Far North, these are heat-conserving materials, for the conditions of armed conflict - para-aramid fiber (Kevlar). Thirdly, ergonomic location of medical equipment above the patient provides convenient maintenance of equipment for medical manipulations. In this case, observation and treatment are not interrupted when moving the patient from one vehicle to another.

Conclusion. Advanced digital medical technologies in the medical evacuation of the sick and injured within the concept of a portable, isolated, robotic medical module can significantly reduce risks and apply a patient-oriented approach during the medical evacuation of each patient. This makes a significant contribution to the development of medical evacuation and practical medicine.

Relevance. Treatment of choice for patients with deep burns is early surgery, i.e. necrectomy with simultaneous plastic closure of the postoperative defect. However, technical implementation of necrectomy is still under debate.

Intention. To assess current scientific views on the use of tangential necrectomy in the surgical treatment of burn victims.

Methodology. A literature survey was carried out using PubMed database, the Google Academy search engine, and also resources of the Scientific electronic library (eLIBRARY.ru).

Results and Discussion. The analysis allows us to conclude that at present tangential necrectomy for burn injuries is not generally approved. There is no convincing data on its indications, acceptable areas of simultaneously excised tissues and ex cision depth are not determined, the technique for performing tangential necrectomy using an electrodermatome has not been developed. There is no information on effective methods for closing postoperative defects using tangential excision of a scab.

Conclusion. Thus, tangential necrectomy indications as well as acceptable areas of simultaneously dissected tissues and the depth of excision, tangential necrectomy technique via electrodermatome for closing postoperative wound defects need evidence-based justification.

Relevance. Today gastric cancer is still one of the oncologic diseases most often leading to death. H. pylori eradication reduces risk of gastric cancer, but its efficacy depends on gastric mucosa state. Atrophy of gastric mucosa is more common in Chernobyl nuclear power plant (CNPP) accident recovery workers than in patients who have not been involved in CNPP accident recovery works. It seems especially important to investigate the features of antibiotics transport to H. pylori colonization area in this contingent.

Intention – to determine the features of amoxicillin secretion by gastric mucosa in CNPP accident recovery workers with atrophic and nonatrophic gastritis undergoing H. pylori eradication.

Methodology. 65 CNPP accident recovery workers were divided into groups depending on state of gastric mucosa according to endoscopic and histological examination, immunosorbent assay of pepsinogens I and II and gastrin-17 basal serum levels. On the first day of eradication therapy, gastric secretion samples were obtained via nasogastric probe 30, 60, 120, 180 and 240 minutes after oral amoxicillin administration. Drug concentrations in gastric secretion were assessed via liquid chromatography-mass spectrometry.

Results and discussion. Amoxicillin concentrations in gastric secretion samples were lower (р < 0.01) in patients with atrophic antral gastritis than in patients with normal gastric mucosa and atrophic fundal gastritis. Patients with fundal atrophy were characterized by lower amoxicillin concentrations 30 and 60 (p = 0.02) minutes after drug intake than in patients with normal gastric mucosa, and higher concentration in the 120th (p < 0.01) and 180th (p = 0.02) minute than in patients with antral atrophy. Amoxicillin concentrations in patients with antral atrophy were lower (p < 0.01) than in non-atrophy group in the 30th, 60th and 120th minute. In the 240th minute, amoxicillin concentrations in patients with fundal atrophy exceeded concentrations in both other groups (p < 0.01). Amoxicillin concentration peak was registered in patients with fundal and antral atrophy in the 180th minute, in patients without atrophy – from the 30th to 120th minute.

Conclusion. Atrophy of gastric mucosa is characterized by decreased transport of orally administered amoxicillin from bloodstream to gastric lumen. Depending on gastric mucosa state, amoxicillin concentrations in gastric secretion should be evaluated at different time points after drug administration: in patients with atrophic gastritis – in the 180th minute, in patients without atrophy – in the 120th minute. While predicting the efficacy and choosing H. pylori eradication regimen, morphological and functional state of gastric mucosa should be taken into account.

Relevance. Sleeplessness is a non-motor disorder that reduces the daily activity of patients with Parkinson’s disease.

Intention. To evaluate the effectiveness of the drug “Melaxen” (melatonin) in the treatment of patients with sleep disorders and daytime sleepiness in patients with Parkinson’s disease and previous radiation exposure.

Methodology. Fifty patients with Parkinson’s disease (Stage I–II according to Hen-Yar, duration of 3.5 to 6.5 years), previous radiation exposure and current sleep disorders were examined. On average, patients aged (65.8 ± 5.8) years. Most of them were employees of various departments of the Russian Emercom and Defense Ministry. On average, 38 male patients spent (56.1 ± 27.0) days in the area of radiation exposure, with exposure dose of (21.4 ± 11.9) roentgen equivalent man (rem). Female patients-inhabitants of radiation contaminated areas most likely received mean effective dose of 9 mSv (0.9 rem) per person. During treatment of Parkinson’s disease with “Levodopa” in the average daily dosage of (562.5 ± 62.5) mg (stable dose after the start of melatonin), 39 (78 %) of them also received dopamine receptor agonists at a dose of (1.0 ± 0.25) mg / day, the drug Melaxen (melatonin) was used to correct sleep disordersfor over 28 days at a daily dose of 3 mg taken 30–40 minutes before sleep daily. The clinical and psychological state of the patients was studied twice before and after completion of the course of treatment using scales to study the quality and individual significance of sleep, the hospital anxiety and depression scale (HADS), certain cognitive tests and individual sleep diaries.

Results and Discussion. According to the clinical and psychological tests, Melaxen (melatonin) contributed to improving the quality of sleep, mental well-being, activity, some cognitive functions, reducing daytime sleepiness and anxiety. The optimization of the mental state was also reflected in the personal diaries of sleep quality. A number of indicators only tended to improve, probably due to short-term studies.

Conclusion. In patients with Parkinson’s disease, “Melaxen” was associaeted with improved sleep quality, decreased daytime sleepiness and severity of anxiety and depression, and also increased concentration.

Relevance. One of the most reliable and robust indicators of the health of military personnel is dismissal due to health reasons, it is practically not affected by external distortions, and dismissal-related nosologies are determined in hospital and subsequently approved by military medical experts.

Intention. Analysis of the dismissal rate due to health reasons among conscripts in the Republic of Belarus for 16 years (2003-2018).

Methodology. We conducted a statistical analysis of annual medical reports about the state of health and morbidity of conscripts (form N 3/MED) and annual reports about medical examination (form N 5/CVVK). Dismissal rates for the entire service time and for the periods I (0–6 months), II (7–12 months) and III (13–18 months) were identified and analyzed. Dismissal-related nosologies were correlated with the codes of the International Statistical Classification of Diseases, Behavioral Disorders and Injuries, 10th revision (ICD-10).

Results and Discussion. The average annual dismissal rate for conscripts from the Armed Forces of the Republic of Belarus for 16 years from 2003 to 2018 amounted to (15.62 ± 0.58) ‰, including (8.11 ± 0.36) ‰ in the first period of service, (5.24 ± 0.28) ‰ in the II period and (2.27 ± 0.09) ‰ in the III period, i.e. 51.9, 33.5 and 14.6 %, respectively in the structure of dismissal for the entire period of service. The main reasons for the dismissal of conscripts from the Armed Forces of the Republic of Belarus were mental and behavioral disorders (ICD-10 chapter V), digestive diseases (chapter XI), diseases of the musculoskeletal system and connective tissue (chapter XIII), cardiovascular system diseases (chapter IX) and skin and subcutaneous tissue diseases (chapter XII) with levels of (4.74 ± 0.35), (2.74 ± 0.31), (2.13 ± 0.18), (1.80 ± 0.30) and (0.73 ± 0.09) ‰, respectively. In the structure of dismissal, the rates of these diseases amounted to 77.7 %. When analyzing the leading classes, during the periods of service the military-epidemiological significance of dismissals due to mental disorders and behavioral disorders (chapter V), cardiovascular system diseases (chapter IX), skin and subcutaneous tissue diseases (chapter XII) turned out to decrease, and military-epidemiological significance of dismissals due to diseases of the digestive system (chapter XI) increased. In addition, during periods of service the number of dismissals of conscripts with certain infectious and parasitic diseases (chapter I), with injuries, poisoning and some other consequences of external causes (chapter XIX) increased. Most commonly, conscripts were dismissed from the Armed Forces of the Republic of Belarus due to diseases of the esophagus, stomach and duodenum (K20–K31 according to ICD-10), personality and behavioral disorders in adulthood (F60– F69), neurotic, associated with stress, and somatoform disorders (F40–F48), other heart diseases (pericarditis, endocarditis, etc., I30–I52) and mood disorders (affective disorders, F30–F39). In the structure of dismissal, percentages amounted to 13.7, 9.1, 6.3, 4.1 and 4.1 %, respectively; in total – 37.3 %.

Conclusion. The medical and statistical indicators of dismissal can help calculate the likelihood of health disorders associated with daily life and military service, and determine the strategy of the medical service in taking measures for recreation and rehabilitation of potential and actual conscripts.

Relevance. The long-term use of the Olkhovsk bog as a natural filter on the way of the liquid discharges of the Beloyarsk Nuclear Power Plant (BNPP) led to radionuclide contamination of the Olkhovsk bog-river system that became a source of secondary pollution.

Intention. To assess the radioecological state of the BNPP liquid waste zone based on a special system for monitoring environmental pollution by long-lived radionuclides.

Methodology. Samples of water, bottom sediments, and soils were studied at the reference points of the bog-river system.

Results and Discussion. Over the 35 years of the BNPP operation, pollution of the upper layers of bottom sediments has decreased due to redistribution of radionuclides with surface runoff, depth migration and radioactive decay. After the reconstruction of discharges, the removal of radionuclides into open hydrographic network decreased by 2–3 times and amounted to 48.2 ∙ 10⁶ Bq ∙ year^–1 for ⁹⁰Sr and 94.8 ∙ 10⁶ Bq ∙ year–1 for 137Cs. The migration of radionuclides to adjacent Olkhovsk bog-river system territories is still limited by the coastal strip of flooded soils.

Conclusion. Radioecological situation in the Olkhovsk bog-river system is potentially dangerous. Migration processes (movement of the pollution front along the drain vector) can result in increased transfer of radionuclides into an open hydrographic network and require constant monitoring. For a balanced assessment of the radiation hazard of Olkhovsk bogriver system, it is necessary to assess current stocks of radionuclides.

Relevance. Human industrial and economic activities and the related problem of emergency situations over the past decades require the new generation of skin personal protective equipment (PPE) with improved protective and ergonomic characteristics.

Intention – To present technical and ergonomic characteristics of protective materials and modern skin PPE developed at the Kazan Chemical Research University.

Methodology. Technical and ergonomic characteristics of universal protective insulating material LTL-1-2 and chemical protective fabrics FCM-P and TL-3 developed by employees the Kazan Chemical Research University are presented.

Results and Discussion. According to the principle of protective action and the type of materials they are made of, there are filtering or insulating types of skin PPE. Insulating PPE is made of airtight materials (rubberized fabrics, polymer films) with extremely slow penetration of toxic and aggressive substances (both gaseous and liquid phases). Filtering PPE helps against chemical hazards (vapors, gases, fine aerosols and various types of dust). Air and vapor permeable materials are used for manufacturing special clothes against physical hazards (open flames, high-energy electromagnetic radiation, heat flows, etc.). Filtering PPE is normally used for routine operations in industries where exposure to harmful and dangerous factors is possible, or for accidents in areas that exclude exposure to the liquid phase. A fundamentally new combination type of skin PPE has protective properties of both categories.

Conclusion. Modern protective materials and PPE made of these materials provide high protection, from a technical and ergonomics point of view, against various hazards for personnel of chemically hazardous industrial facilities.

Relevance. Professional activities of firefighters and rescuers are usually associated with aggressive chemical exposure with increased physical exertion and psychological stress. Therefore, for professional selection and monitoring the health status of firefighters and rescuers of EMERCOM of Russia it is necessary to evaluate the activity of cytochrome P450 isoenzymes that are directly involved in detoxification pathways in the liver.

Intention. To evaluate the activity of the CYP3A4 enzyme by phenotyping methods and to establish the frequency of allelic variants of the gene of this enzyme (rs2740574 and rs4987161 polymorphisms) in firefighters and rescuers of EMERCOM of Russia for targeted treatment, rehabilitation and prevention.

Methodology. Polymorphisms (rs2740574 and rs4987161) of the CYP3A4 gene and also CYP3A4 activity by the ratio of 6-β-hydroxycortisol / cortisol in the urine were determined during routine periodical medical examination of 64 rescuers and firefighters of rescue units of EMERCOM of Russia. The average age of examined persons was (29.8 ± 5.5) years; 30 of them are rescuers of the North-West Regional Search and Rescue Squad and 34 are firefighters of the territorial fire departments of St. Petersburg.

Results and Discussion. According to the results of genotyping of rs2740574 polymorphism of the CYP3A4 gene, EMERCOM employees were divided into 2 groups depending on the presence or absence of a minor allele: “poor” and “rapid” metabolizers (9.4% and 80.6%, respectively). According to the results of genotyping of the rs4987161 polymorphism of the CYP3A4 gene, the examined were classified as “rapid” metabolizers, because patients with a minor allele were not identified. Depending on the ratio of 6-β-hydroxycortisol / cortisol in the urine, the activity level of CYP3A4 was “normal” in 67 %, “poor” in 13 % and “rapid” in 20 % of cases. The ratio of 6-β-hydroxycortisol / cortisol in the urine tended to increase with an increase in work experience and age. No relationship between the studied polymorphic variants of the CYP3A4 gene and the established enzyme activity was observed.

Conclusion. Genotyping methods made it possible to identify allelic variants of the CYP3A4 gene that could affect the functionality of the enzyme; however, no association of the studied polymorphisms with enzyme activity was found. In such cases, in the absence of informative genetic markers, it is recommended to evaluate the enzyme activity by phenotyping methods.

Relevance. Professional activity of specialists in many industries in modern society takes place in difficult conditions. Anesthesiologists-resuscitators are subject to significant adverse effects of physical, chemical, biological, psychophysiological and psychological nature. Therefore, the risks of stress, as well as professional burnout and mental maladjustment increase, leading to decreased effectiveness and quality of professional activities, to adverse changes in personality, deterioration of health, relationships with colleagues, patients, relatives.

Intention. To identify the impact of negative labor factors on the occurrence and development of professional burnout among anesthesiologists-resuscitators.

Methodology. 95 anesthesiologists-resuscitators from the Arkhangelsk region took part in the study. Research methods: questionnaires, psychological testing, mathematical and statistical processing of empirical data.

Results and Discussion. 65.3 % of anesthesiologists-resuscitators demonstrated psychological components of professional burnout syndrome, namely emotional exhaustion, increased fatigue, dissatisfaction with their professional activities and their results, as well as emerging health problems and general maladjustment. 76.6 % of the surveyed consider their professional activity as extreme. According to anesthesiologists-resuscitators, the most frequent negative factors of the labor process are psychophysiological and psychological ones (high responsibility, unexpectedness, lack of time, suffering and grief of other people, high loads). Anesthesiologists-resuscitators with most frequent occurrence and negative impact of psychophysiological and psychological factors, in comparison with other factors, have higher rates of organizational stress, psychological determinants of professional burnout and maladaptation disorders. Anesthesiologists-resuscitators with most frequent occurrence and negative impact of physical, chemical and biological factors, in comparison with psychophysiological and psychological ones, have less intensive professional burnout and organizational stress. They benefit from better communication skills, behavioral regulation and normative social behavior.

Conclusion. The pronounced relationships between the psychological determinants of professional burnout (emotional exhaustion, work stress, health disorders and general maladjustment) and the psychophysiological and psychological factors of the labor process of anesthesiologists-resuscitators show the constructive and diagnostic validity of the study. Most correlations were found with such factors of professional activity, as novelty and strangeness, lack of time, unexpectedness of complex professional situations, ambiguity, uncertainty of these situations, observed and perceived violation of public order, which led to severe injuries in victims, the great significance of events and understanding of personal involvement.

Relevance. Professional activity requires professionals of the Emercom of Russia to be constantly ready for physical and emotional overload, and to develop self-regulation skills. Their ability to maintain internal well-being often determines the outcome of emergency rescue, search and other urgent work.

Intention. To study individual and personal characteristics of cadets of the Institute of the State Fire Service of the EMERCOM of Russia as psychological predictors of emotional and personal well-being.

Methodology. The study involved 300 male cadets using such diagnostic methods as Self-Assessment of Emotional and Personal Well-being, Deviant Behavior, and Minnesota Multiphasic Personality Inventory.

Results and Discussion. According to the Self-Assessment of Emotional and Personal Well-being, 56 % of respondents have positive self-assessment (high and increased level of emotional and personal well-being), and 44 % – negative one (reduced and low). A lack of military-professional orientation, a tendency to addictive behavior, suicidal risk, aggression, anxiety, rigidity, low intensity and breadth of social contacts were associated with manifestations of emotional and personal distress in cadets.

Conclusion. The studied individual and personal characteristics are predictors of emotional and personal well-being in cadets. The obtained data can be used for professional psychological selection in educational institutions of the Emercom of Russia, as well as for psychological prevention and correction to improve the psychological readiness of cadets for professional activities.