ECG Dispersion Mapping in Preclinical Diagnosis of Cardiovascular Diseases.

The aim of the study was to develop a method for diagnosing pre-nosological changes in the electrophysiological state of the myocardium in patients with somatoform dysfunction of the autonomic nervous system (SDANS) and risk factors for cardiovascular diseases using the ECG dispersion mapping method. MATERIALS AND METHODS: The study involved 109 male patients, 58 of them with SDANS, and 51 were healthy subjects. The patients with SDANS had the following risk factors for cardiovascular diseases, in decreasing order: stress (71% of cases), low physical activity (59%), smoking (57%), overweight and obesity (43%), anxiety (41%), low consumption of vegetables and fruit (36%), lack of extra aerobic physical activity (36%), excessive alcohol consumption (34%), depression (26%), total cholesterol ≥5 mmol/L (23%), and heart rate ≥80 (9% of the cases). All the subjects underwent clinical examination, laboratory investigation, ECG, ECG dispersion mapping, heart rate variability monitoring. RESULTS: Using the method of ECG dispersion mapping allowed a way for diagnosing pre-nosological changes in the electrophysiological state of the myocardium in male patients with SDANS, the basis of the pathogenesis of which is formed by the tension of the regulatory systems. Correlation between the total score according to the developed method, the RRNN value after 4 min of staying in orthostasis, and the "Myocardium" integral index has been proved. The diagnostic sensitivity of the proposed method with a threshold score of 8 was 80%, specificity - 70.8%. CONCLUSION: The developed method for assessing pre-nosological changes in the electrophysiological state of the myocardium which includes cardiovascular risk factors with a reclassifying potential, proves the development of pre-nosological changes in patients with SDANS in response to daily physical strain. The changes are associated with the tension of the electrophysiological state of the myocardium, an increased activity of the sympathetic division of the ANS being one of its pathogenetic mechanisms.

[Postoperative cerebral dysfunction]. / Posleoperatsionnaia mozgovaia disfunktsiia.

AIM: To study the structure, risk factors and methods of prevention of postoperative brain dysfunction on the example of coronary artery bypass surgery with cardiopulmonary bypass. MATERIAL AND METHODS: The study included 77 patients who undergone elective coronary artery bypass surgery at the beating heart (22 patients) or with cardiopulmonary bypass (55 patients, including 24 patients, who received cerebroprotective treatment with cytoflavin in the preoperative period). All patients underwent dynamic (pre- and postoperative) neurological, neuropsychological, instrumental examinations. RESULTS: The postoperative cerebral dysfunction was diagnosed in 34 (44,2%) patients. The frequency of the clinical types of postoperative cerebral dysfunction significantly differed: perioperative stroke - 3 (3,9%) cases, symptomatic delirium of the early postoperative period - 11 (14,3%) cases, delayed cognitive impairment - 28 (36,4%) cases. The risk factors of postoperative cerebral dysfunction after the coronary artery bypass surgery with cardiopulmonary bypass were identified. Preventive preoperative use of the neuroprotective drug cytoflavin reduces the severity of delayed cognitive impairment after the coronary artery bypass surgery with cardiopulmonary bypass and has a good safety profile. CONCLUSION: An analysis of the literature data and the results of our own studies show that postoperative cerebral dysfunction is the nosological entity with various etiological factors, pathogenetic mechanisms and the characteristic clinical types, which has an effect on the outcome of surgical treatment.

[Efim Anatolyevich Dyskin - the hero of the Defence of Moscow (To the 75th anniversary of the Battle of Moscow 1941-1942)].

Efim Anatolyevich Dyskin - the hero of the Defence of Moscow (To the 75th anniversary of the Battle of Moscow 1941-1942). Efim Dyskin - one of the first artilleryman, who awarded the title of Hero of the Soviet Union for a feat accomplished in the Battle of Moscow. After the war he finished the Military Medical Academy and later became a prominent domestic scientist - anatomist and morphologist, head of the general anatomy department, teacher of high school, Major General of the Medical Service. He created a scientific morphological school that developed guidelines for the features of the morphology of the different species of a gunshot wound and the impact of extreme factors of the military working on the body brow-century. Under the leadership of E.A.Dyskin conducted research on. the status of collateral circulation, functional anatomy of the digestive system, craniology, histoty of military medicine and the Military Medical Academy.

[Pharmacological tolerance to medical therapy of organophosphate poisoning and ways of tolerance management].

Authors consider causes of low efficiency of antidote therapy and ways of pharmacological tolerance management during medical treatment of organophosphate poisoning. One of the promising ways is a preventive antidote on the base of enzyme agents and allosteric modulators of a cholinesterase activity. Authors showed a expediency of a study of new acetylcholinesterase reactivators, its compositions and ways of drug delivery. Authors specified ways of searching for anticonvulsants from classes of quick-closing benzodiatines and NMDA-antagonists. Authors defined ways of improvement of methods of special antidotes delivery with targeted transport system. Authors made an assumption about the necessity of symptomatic treatment.

[Improvement of the health care delivery system in war-time: monitoring of servicemen's health status].

Authors came to conclusion that the constant monitoring of servicemen's health status allows the commanding officer to receive detailed information about combat effectiveness. In case of battle injury or trauma the information used by the medical service will be the base for early health care delivery and organization of evacuation. The information about health status of injured may be used as a base for diagnosis at all stages of evacuation. Authors came to conclusion that individual monitoring of health status will help to further health care delivery system and first stages of medical evacuation.

[Neurophysiologic mechanisms of combat post-extreme state of health].

The effects of ecological and occupational stress (EOS) on brain neurodynamics of Soviet and Afghanistan servicemen have been studied. The investigations have been made in Afghanistan. Neurophysiological characteristics of traumatic stress and consequences of combat trauma were studied in patients wounded in Afghanistan, in the acute phase as well as since 0.5-3 years after leaving the battlefield. The combined effect of combat situation, hot climate, highlands and desert forms EOS. It does not cause an adaptation process in servicemen. EOS is characterized by changes in bioelectrical indices of brain in interhemispheric relations both as a whole and in isolated rhythm components of EEG, by activating the stress limiting system. It exhibits pathopsychological and autonomic components which remain significant during 3 years after leaving the combat conditions. The formation of a general adaptation syndrome is prevented in explosion trauma under the influence of EOS.

[Direct evidences of calcium traffic through pacemaker channel].

Recently, it was shown that pacemaker f/HCN channel might be permeable not only for Na+ and K+, but also for calcium ions. Pacemaker channel HCN2 was expressed in ovarian cell culture of Chinese hamster. In the patch clamp experiments the calcium current with low amplitude 0.06±-0.87 nA and open probability 0.48% (±3.02 at -110 mV, n = 6, Ca2+ 2 mmol) was measured. HCN2-Ca2+ current significantly activated with cyclic adenosinemonophosphate by increasing of open probability and inhibited by specific If-blocker ivabradine. The calcium ion current was also shown in f-channels of neonatal rats ventriculocytes. Thus, the calcium ions conduction through HCN2 and native f-channel at physiological concentrations of extracellular fluid and physiological membrane potentials of cardiomyocytes was demonstrated.

[The cradle of military medicine].

The Kirov Military Medical Academy, included into the State Code of Particularly Valuable Objects of Cultural Heritage of the Peoples of the Russian Federation, plays an important role in national military-medical science and education during XVIII and XIX centuries. Today the Kirov Military Medical Academy consists of 7 faculties, 63 departments (52 military departments and 11 civil departments), 31 clinics (17 surgical clinics and 14 therapeutic clinics), center of extracorporeal detoxification, 3 departments, taking part in treatment and diagnostic process, 11 clinical subdivisions, research center consisting of 4 research subdivisions and 2 laboratories, and also 14 research laboratories, 32 supply subdivisions and publications department. Glorious staff and graduates of the Academy took part in all russian wars. All famous medical schools were founded in the Academy in XIX-XX centuries. At the present time the Kirov Military Medical Academy is the main military medical university, leading research center and treatment facility of the Armed Forces of the Russian Federation.

[Sergey Petrovich Botkin is the founder of Russian therapeutic school].

The paper gives basic facts from the life and work of Sergey Petrovich Botkin, one of the coryphaei of Russian medicine, who played a prominent role in the formation and development of Russian clinical medicine and became the founder of the most well-known therapeutic school in Russia. S.P. Botkin's greatest merit is emphasized to be his neurogenic theory of medicine, which has played a great role in the understanding of physiological and pathological processes in the entire organism.

[Adaptation to military-professional work].

Theoretical and practical aspects of a problem of adaptation to military-professional work are considered. Neurophysiological mechanisms of adaptation of military men to conditions of hot mountain-desert climate are revealed. Condition of the opioidergic system is shown at fighting stress, and its role in occurrence of illness of adaptation is described. Influence of extreme factors of a hot climate mountain-desert district is accompanied by infringement of interhemisphere mutual relations and psychosomatic changes.

[The system of rehabilitation of specific functions of the female body of patients with benign ovarian neoplasm after urgent operations].

The authors have developed a system of medical rehabilitation of specific functions of the body of troops of women with benign ovarian neoplasm after urgent operations. As a result, the frequency of inflammatory complications was reduced to 4.8%, menstrual function was restored in 9.6-14.5% of cases, endocrine--in 9.1-14.5%, sexual--in 7.8-17.4%, reproduction--in 37.5%, to ensure good quality of life--in 74.6-92.3% cases.

[Prevention of recurrence of benign ovarian tumors in women of reproductive age after urgent operations].

A comprehensive analysis of the survey and emergency surgical treatment 152 troops of women of reproductive age for benign tumors and tumor-like formations of ovaries, who applied to gynecological Otdleneiya Garrison Military Hospitals in the Far East region from 1999 to 2009 is made. For patients characterized by the predominance of ovarian tumor formation in 65.1% of benign ovarian tumors (34.9%). In patients of reproductive age undergoing surgery for benign ovarian tumors implementation of the proposed rehabilitation system allows you to restore reproductive function in 37.5% of cases for 1 year after surgery and recurrence of ovarian neoplasms during the observation period of 2 years.

[Regulation of blood circulation in the surgical correction of portal hypertension].

56 patients with portal hypertension were examined who underwent decompressive shunt surgery. Cardiorhytmography and integral rheography body were performed in different stages. In the late postoperative period, there were positive changes in the autonomic regulation of functions: reduced tension index and sympathetic influence on heart rhythm, increases the value of other indicators of heart rate variability. Due to an increase in heart rate and peripheral vascular resistance normalizes blood pressure while reducing the values of cardiac output. There is a further normalization of the reactivity of blood circulation: arterial pressure and vascular resistance during the functional test remained at a constant level of magnitude of shock and cardiac index significantly increased and then decreased to the level of the original values, which corresponds to the reaction apparently healthy. Disorders of regulation, state and reactivity of blood flow in portal hypertension, manifested: 1. Reduction of heart rate variability with a significant increase in sympathetic activity of autonomic nervous system. 2. Reduction of cardiac output and vascular resistance, heart rate, changes in physiological determination of hemodynamic parameters: Blood pressure is determined only by the vessel resistance. 3. Reduction of blood pressure in response to breath holding test.

[The contribution of the Military Medical Academy to space exploration].

The article examines the contribution of the Military Medical Academy as an educational, research and medical institutions in the establishment and development of the national Russian manned spaceflight. Lists the names of the Academy's scientists, working in laboratories and in the Cosmonaut Training Center. In 1958 the academy was formed Department of Aviation Medicine from the research laboratories of aviation medicine, psychophysiology, and encephalography, a division of pressure chambers and furnaces. Direct contribution to the preparation of the first manned space flight made by graduates of the academy, E.A. Karpov (the first chief of Cosmonauts Training Center. Yuri Gagarin) and I.A. Kolosov. Over the half century history of the Russian Space Military Medical Academy, prepared and sent to the CPC Gagarin more than 110 of its graduates.

[Medical supply of long flies].

The article presents a characteristics of main negative factors, disimproving a functional condition and working capacity of airmen in long flies: long stay in a working pose, necessity of using of summer form, of defense form and oxygen-breath means, peculiarities of eating in fly, solving of nature-imposed necessity, relative sensor deprivation, sameliness of environment, high level of noise, hypokinesia, high nervous-emotional tension in conditions of air refueling, temperature fall, difference of barometric pressure, desynchronisms. Were given practical recommendations on maintenance of functional and working capacity of members of flying staff, realizing long flies.

[Directions of improvement of psycho-physiological supply of professional activity of specialists of manipulation of spacecrafts].

Were determined components of systems of guarantee of security of activity of specialists of manipulation of spacecrafts (SC): abidance by general organizational-methodological rules and principles of work, excluding violations in organization of duty, preventing of nonfulfillment and failure of sessions of control by SC, determination and deleting negative factors of operative activity, guarantee of safety of system "man-mechanism-environment." Were determined peculiarities of activity of specialists of manipulation of spacecrafts, their professionally important qualities, which had to be considered in effectuating of professional psycho-selection. Were shown regularities of changes in functional state and professional working capacity of operators of command-measured complexes during daily duty and during cycle of a year. Was made a conclusion about necessity of improvement of system of psychophysiological accompaniment of activity of specialists of manipulation of SC.

[S. P. Botkin--the founder of the domestic clinical gerontology].

The first in the world large-scale gerontology investigation where 2620 elderly patients were examined was carried out by guidance professor S. P. Botkin in St.-Petersburg. The results were published in 1890 in the special book and consisted of 93 papers, including 102 tables.

[Psychoemotional stress and somatic diseases in veterans of special risk units].

Participants of nuclear-powered submarine accident liquidation and special risk units' veterans participating in surface nuclear weapon tests as well as in liquidation of their consequences have been examined. It has been established that functional state of this category of people is difficult to interpret only in the context of radioactive irradiation effect or injuring stress factor exposure. This state is determined by a complex of psychotraumatic factors tending to become aggravated and characterizing by their individual significance and absolute or relative insolvability. In most representatives of this category the disease is manifested by psychopathologic syndrome of neurotic disorders (low spirits, emotional lability, asthenia, anxiety) and somatic disturbances as dysfunction of the cardiovascular, respiratory, digestive and other systems. The results obtained provide the pathogenetic substantiation of efficient ways and methods for rehabilitation of the special risk units' veterans. The data prove the necessity of appropriate correction of cardiovascular disorders in practically healthy servicemen residing under conditions of psychoemotional tension.

[Immunopathogenesis of viral hepatitis C. Immunological markers of the disease progression].

Results of studies of immune response during hepatitis C virus (HCV) infection were reviewed in order to reveal immunologic markers of the disease progression. Genetic heterogeneity of HCV and immunogenetic features of the host determine heterogeneity of immune response to the virus and differences in the course of the disease and outcomes. Spontaneous elimination of HCV-infection in acute phase occurs due to vigorous and sustained multispecific Th1-response toviral antigens. During such response proliferation of virus-specific CD4+ T-cells and secretion of IFN-gamma by them are observed, otherwise chronic hepatitis develops. Great importance in persistence of HCV as well as in quantitative and functional suppression of HCV-specific CD8+ T-cells has increased number of CD4+ CD25+ regulatory T-cells. Cellular immune response plays a key role not only in the elimination of HCV, but also in liver pathology associated with HCV-infection. Progression of the process and shift to its chronic form are also associated with decrease of production of IFN-gamma, alpha, IL-2 by peripheral blood mononuclear cells and increase of TNF-alpha, IFN-gamma, IL-4, IL-2r levels in blood serum.