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The article presents the experience of treating wounded K., 29 years old, who, as a result of the suicide bombing of a homemade shell-free explosive device in a moving car of the St. Petersburg Metro 03.04.2017 received a severe mine-explosive combined wound to the head, chest and limbs with a fragmented blind skull. The trauma was accompanied by brain damage, a fracture of the cranial vault bones, lungs contusion, and fragmented fracture of the right tibia bones. The patient underwent sequential bifrontal decompressive craniotomy, external fixation of the right shin bones fractures, blocked intramedullary osteosynthesis of the latter, dura mater plasty, cranioplasty with a titanium plate after its computer modeling. The complex treatment allowed the patient to be discharged from the hospital after 4 months in a satisfactory condition.

Active development of pipeline transport of gas and oil with increasing working pressure to 120 atm. increases the need for pipes with large wall thickness that correspond the requirements of the DNV OS-F101 standard. Quality of continuously cast billets is decisive for improving quality of sheet metal for main pipelines. Inheritance of cast structure imperfections by a hot-rolled sheet leads to structural heterogeneity of the strip and the layered nature of the fracture surface and adversely affects the mechanical properties and corrosion resistance. Structural heterogeneity of rolled products is appeared in the form of axial ferrite-martensitic metal banding and metal banding in the main section of the sheet consisting of a mixture of ferritic and pearlitic grains — pearlitic metal banding. The flatness in the axial zone of the rolled products is due to axial chemical heterogeneity which is objectively formed during crystallization of the continuously cast billet and further phase transformations. The axial chemical inhomogeneity does not resolve despite the recrystallization of the structure and deformation and the high content of alloying elements contributes to the formation of the martensite phase and large carbonitride precipitates. The cause of pearlite bands is considered usually to be the presence of dendritic segregation. According to us the reason of this metal banding is the shift of the temperature front of γ → α transformation parallel to the sheet surface in depth as a result of which before the next volume of formed ferrite the concentration of carbon dissolved in austenite increases with the subsequent formation of pearlite. The enrichment of austenite proceeds along the boundaries preserved from the δ → γ transformation during cooling the slab and the formed pearlite structure repeats the shape of the boundaries of these grains in the section parallel to the sheet plane.

The article presents a clinical case of the successful treatment of a patient with traumatic separation of the upper limb and massive damage to the soft tissues of the upper shoulder and chest. The effectiveness of applying the damage control principles and the method of local negative pressure for the prevention of local and systemic infectious complications is emphasized.

The article presents a case of treating the patient with extrapleural thoracoabdominal injury with heart and esophageal trauma. Examination of the patient in a shock trauma operating room, the use of minimally invasive technologies (thoracoscopy, laparoscopy) allowed to choose the right treatment tactics, timely identify all injuries and eliminate them. The presented clinical observation demonstrates the feasibility of using video thoracoscopy and video laparoscopy in hemodynamically stable patients with penetrating thoracoabdominal wounds to detect damage to the heart and esophagus.

Reasons for breakage of welding rod and wire at drawing are analyzed. It is shown that the basic reason for breakage is microphysical tree-like segregation which is caused by irrational addition of boron-containing material at after-furnace treatment, low effectiveness of steel continuous casting process, unproven technology of metal electromagnetic agitation in a mold at continuous casting. Peculiarities of alloyed elements liquation, both in welding rod and wire are studied. It is shown that non-uniformity of boron, manganese and silicon distributions in the longitudinal and transversal welding rod cross sections will become the main reason for increasing wire breakage during further drawing.

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.

Most Russian enterprises are working to reduce costs, to improve the processes employed, and to boost profitability. An example of this in the metallurgical industry is reduction of the cost per 1 t of sorbitized wire rod produced.

Specialized medical care to victims of road accidents in St. Petersburg is delivered at 6 level I and 3 level II trauma centers. Annually, each of 6 level I trauma centers gives treatment to about 600 patients, each of 3 level II trauma centers - 10 times less, other hospitals - to about 300 patients. Mortality rate after severe mechanical trauma at the level I trauma centers is about 15%, at the level II trauma centers - about 20% and at other hospitals (not specialized in severe traumas) - 37%. The importance of improvement of the trauma centers financing, the need to deliver patients by mobile resuscitation teams, and other problems have been discussed. The article has shown that St. Petersburg has a better system of medical care of road accident victims than other regions of Russia. The main principles of this system are as follows: early delivery of patients to trauma centers; the need to respect the rules of the "golden hour"; performance of full resuscitation both at the pre-hospital (on the spot and during delivery) and the hospital stage of treatment; the need of examination and treatment of patients regardless of illness severity; opening of anti-shock surgical trauma centers at multi-specialty hospitals providing round-the-clock laboratory, radiation, and endoscopic studies; use of doctors of all specialties; early evaluation of types and severity of injuries according to developed algorithms by using non-invasive, minimally invasive and invasive methods.

The evolution in methodological approaches to the analysis of bar rolling at Nosov Magnitogorsk State Technical University is discussed. The basic principles of the models developed with changes in rolling technology, groove configurations, and the requirements on hot-rolling mills are outlined.

This article describes a technology for making construction-grade reinforcement bars at the LPZ plant, the mechanical properties of the bars, and innovations made at the plant to improve these properties.

The number of road accidents, fatal outcomes and victims exceeded in 1.5 times in Saint-Petersburg in comparison with Moscow. At the average, 600 victims were treated in each of 6 first-level traumatology centers every year. The quantity of patients, who were admitted to 3 second-level traumatology centers, numbered 10 times less. About 300 people entered to others hospitals. The lethality consisted of 15%, 20% and 37%, respectively. There are a lot of matters, that should be discussed, such as an importance of better treatment financing of multitrauma by using compulsory medical insurance system, an optimization of pre-admission treatment and a necessity of patient delivery by mobile medical team using the anaesthesiology and resuscitation.

We have inspected 60 patients with septic complications. Pathogenesis features of this diseases were researched with the help of special methods, particular changes of haemoreologic properties of blood were investigated, methods of treatment of sepsis are justified. Teleological antibacterial therapy, regional perfusion, leicotransfusions, antihypoxid therapy, differentiated infusion-transfusion therapy, medical plasmaferesis, strictly individually supplemented conventional antisepsis therapy, have allowed mortality among patients by gynecological sepsis. For patients from the researched group was lost, that were 6,7%. The uterus was saved at 41 patients, so were saved the uterine appendages and there functional abilities (hereinafter at 9 women from this group were labor).

Therapeutic-diagnostic videothoracoscopy was used in complex treatment of hemothorax in 86 patients for isolated and combined stab-slash wounds and closed traumas of the chest. Thoracoscopy was not used in 321 patients with the same pathology taken as control. It was found that videothoracoscopy used for medium and big hemothorax always allowed the doctors to make the precise topical diagnosis of chest injury and due to medicinal endosurgical manipulations the thoracotomies were made 2.1 times more rarely, the duration of pleural drainage was 2.2 times shorter. Complications of the traumatic disease were 1.6 times less often, the time of in-patient treatment and lethality 1.3 times less.

The authors propose morpho-functional and medico-strategy classification of mechanical injuries of the chest. In addition to traditional principles, special attention is given to concurrency, plurality, possible shocks, domination of the injuries as one of the basic concepts of wound dystrophy. The proposed classifications of mechanical injuries of the chest substantially supplement traditional principles, allow not only correct and full diagnosing and decision on the most rational strategy of treatment of patients with combined traumas, but also give a complex of reliable criteria for a scientific generalization of the results of clinical investigations.

The authors describe specific features of the diagnosis and emergency medical care at the prehospital period developed on the basis of treatment of more than 5000 patients with isolated and combined injuries of the chest and abdomen. The importance of using the resuscitation-surgical teams, the syndrome diagnostics and stabilization of vital functions at the place of the accident is stressed as well as admittance of the casualties as quickly as possible to an up-to-date specialized multitype traumatology center.

Laboratory studies of the influence of the staphylococcal endotoxin on functional properties of thrombocytes and clinical observations of patients with a pronounced syndrome of endotoxicosis have shown an important role of endotoxinemia in pathogenesis of the arising thrombocytopathies. Possibilities of the medicamentous protection of blood plates from the damaging action of endotoxinemia are considered.

The study of arteriovenous ratio of medium-molecular oligopeptides level in 32 patients with acute infectious lung destructions has established an important detoxicating role of the lungs in endotoxemia syndrome during pulmonary-pleural suppurations. It has been found that, with the pronounced endotoxemia syndrome, during catabolic phase of the disease the lungs turn from toxin filter into their source. Detoxicating capacity of the lung parenchyma was shown to be more dependent on the severity of general metabolic disturbances than on the dissemination of suppurative lung destruction.

Positive hemorheological effect was found in using therapeutical plasmapheresis in combination with extracorporeal blood oxygenation. Indications and contraindications for therapeutical plasmapheresis are discussed in the paper.

It was shown that plasmapheresis included in the complex program of intensive therapy of patients with acute pyo-septic lesions of the lungs and pleura allowed to effectively arrest manifestations of endotoxicosis and to improve results of treatment of this category of patients. Extracorporeal hemoxygenation of small volumes added to plasmapheresis at the expense of inclusion of dialyzer DIP-02-02 in the extracorporeal contour considerably reinforced the detoxicating effect of plasmapheresis at the expense of nonspecific biotransformation of toxins.

An examination of 110 patients with septic injuries of the lungs (acute pneumonia without purulent destruction, acute abscessing pneumonia, gangrene and lung abscess) has established that lung parenchyma plays an important role in the regulation of functional properties of thrombocytes. Growth of unfavourable thrombocytic lesions were shown to accompany an increase of sizes of purulent-destructive lesions of the lungs. The suppression of coagulolytic and barrier function of the lungs was found to be associated with the appearance of thrombotic complications.

The results of the clinico-laboratory analysis conducted in 69 patients with varying forms of acute purulent surgical infections have shown that the therapeutic plasmapheresis is attended by the improvement of the disease clinical picture, and attenuation of endotoxicosis by day 3 after the perfusion. Indications and contraindications for plasmapheresis in critical patients are considered, the causes of unsuccessful plasmapheresis procedures are analyzed, the ways for the improvement of this operation are outlined.

Partial megakaryocytograms were studied in patients with acute infectious destructions of the lungs. Acid phosphatase and glycogen megakaryocytic levels, overall number of megakaryocytes elucidated the role of the central link of the system megakaryocyte--platelet in the onset of thromboembolism and hemorrhagic complications arising in the above patients. Inefficiency of megakaryocytopoiesis in pulmonary and pleural acute pyo-destructions is under discussion.