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The development of a system of therapeutic, diagnostic, and organizational measures to improve specialized medical care for members of the Armed Forces of the Russian Federation with urolithiasis is scientifically substantiated. The study was conducted in 3 stages. At the first stage, the principal functions of the system of specialized urological care for patients with urolithiasis were singled out, and possible ways of their realization were determined. At the second stage, planning options for the system were formulated and described. In the third stage, the criteria for analyzing the system, estimation of their superiority, and scientific substantiation of the rational concept were elaborated. Three systems of providing specialized urological care to patients with urolithiasis with the conditional names, including proposed, real, and adaptive, were formulated and put forward. The proposed system was based on the principle of the maximum volume of specialized medical care according to the urology profile in the district hospitals of each military district and hospital of the Northern Fleet. The real system has a four-stage structure, which was based on staged treatment of patients with urolithiasis receiving the maximum treatment in organizations of central subordination. In the adaptive system, its conceptual basis is the central military medical organizations, and the volume of care in the remaining hospitals is determined by the chief urologist of the Ministry of Defense of the Russian Federation. Using hierarchy analysis, a pairwise comparison of each concept was performed, and the proposed system has the highest priority index. Generally, to improve the specialized care for members of the Armed Forces of the Russian Federation with urolithiasis, we have developed and scientifically proved the system of the organizational treatment and diagnostic measures that assume the decentralization and standardization of the urological care for patients with urolithiasis, staff reorganization, provision of modern equipment, professional training of the medical staff, improvement of research potential, and interaction with medical institutions of the civilian population.

The peculiarities of the influence of the metabolic disorders and depressive spectrum disorders in the development of polymorbid pathology are investigated. 160 male patients were examined, divided into three groups. The first group included 56 young men, 3940.2 years old, body mass index 34.235 kg/m2, suffering from the polymorbid cardiovascular pathology, in which the presence of coronary heart disease, angina pectoris of the functional class III, arterial hypertension 23 degrees, obesity 12 degrees, depressive spectrum disorders was considered. The second group included 56 middle-aged men, 47.548.3 years old, body mass index 36.236.9 kg/m2 with a similar combination of diseases of the first group. The third (control group) included 48 young men, 39.640.9 years old, body mass index 24.124.9 kg/m2, suffering from the polymorbid cardiovascular pathology without the metabolic syndrome and obesity. The anthropometric status, glucose, insulin, total cholesterol, triglycerides, and low-density lipoproteins were assessed. Instrumental diagnostics of the coronary heart disease and hypertension was carried out, anxiety and depressive disorders were established based on the results of a questionnaire and a consultation with a psychiatrist. It was found that in a group of young and middle-aged patients suffering from the polymorbid cardiovascular pathology, in combination with a metabolic syndrome and depressive spectrum disorders, psychopathological disorders (borderline anxiety-depressive state) are associated with the metabolic disorders, high prevalence of pain-free form of myocardial ischemia and unfavorable variants of two-phase blood pressure rhythm during the day, according to the type of insufficient degree of reduction of nocturnal blood pressure non-dippers and a steady increase in the night blood pressure night-peakers, which determines a high risk of cardiovascular complications.

January 19, 2021 marks the 75th anniversary of the birth of one of the leading Russian neurosurgeons, Academician of the Russian Academy of Sciences Boris Vsevolodovich Gaidar. Eight years at the head of the Department and Clinic of Neurosurgery at the Military Medical Academy and 7 years at the head of Military Medical Academy, when his talent as a teacher and leader was most clearly revealed. Academician B.V. Gaidar is one of the countrys leading scientists in the field of treatment of combat injuries of the central nervous system (craniocerebral trauma and mine-explosive wounds of the central nervous system), vascular neurosurgery, and neurooncology. He made a major contribution to solving the issues of organizing specialized neurosurgical care in the Armed Forces in peacetime and in wartime. He personally took part in providing medical assistance to the wounded during the armed conflict in the North Caucasus. B.V. Gaidar represented Russian science at international forums in Austria, Germany and the United States of America, in 2005 he led the organization of the World Congress on Military Medicine for the only time in our country. During the years of leadership of the S.M. Kirov Military Medical Academy B.V. Gaidar carried out a large-scale reconstruction and re-equipment of a number of leading surgical clinics, which contributed to the progressive development of the academys scientific schools. B.V. Gaidar created a scientific school of neurosurgeons, prepared a rich legacy of articles, textbooks and monographs, his merits were recognized by the scientific community and the state. Celebrating the anniversary, Boris Vsevolodovich continues to actively engage in scientific work, training, counseling critical patients, passionately defending the interests of the Military Medical Academy.

The article analyzes modern federal programs aimed at preserving the health and well-being of the population and creating a comfortable and safe environment for life and work. The article describes the arsenal of strategic directions for assessing the risk of developing diseases, diagnostic approaches and scientific principles that contribute to the successful implementation of evaluation measures. The possibility of clarifying the cardiovascular risk in the study of the role of military-professional factors in the formation of cardiovascular pathology in military personnel of the Armed Forces of the Russian Federation is discussed. The article analyzes the effectiveness of traditional diagnostic methods used by the medical service, as well as ways to improve this efficiency when using molecular genetic studies to search for associations with risk factors for neuropsychic and cardiovascular pathology. The article considers the practical necessity of creating a professional reliability management platform based on the principles of personalized medicine, which contributes to prolonging professional longevity and improving the combat readiness of servicemen of the Armed Forces of the Russian Federation. Such a method of implementing the professional reliability management platform will significantly increase the informativeness of traditional methods of early diagnosis of cardiovascular and neuropsychic pathology.

In case of antitumour anthracyclines therapy of patients with non-Hodgkin lymphomas the possibility of using speckle-tracking echocardiography is being considered. It was found that patients with non-Hodgkin lymphomas have early violations of the left ventricular myocardium during the course of antitumor chemotherapy using anthracyclines. They are characterized by reducing of longitudinal deformation of the myocardium with a gradual spread from the apical to the basal segments of the left ventricle. A statistically significant reduction in global and segmental systolic deformation after the 4th course of chemotherapy (cumulative dose of doxorubicin 333.5 88.5 mg/m2) is the earliest marker of left ventricular mechanical dysfunction, appearing before the development of diastolic dysfunction and ejection fraction reduction of the left ventricular. Early violations of myocardial mechanics in the dynamics of the course of antitumour therapy with anthracyclines are identified in the apical area of the left ventricle, it can be connected with circulatory failure in this area. Violations of myocardial mechanics in the apical area of the left ventricle can be an erly predictor of ischemia of this area with possible progression to global contractile muscle dysfunction of the left ventricular. The global longitudinall deformation of the left ventricular myocardium in contrast to ejection fraction of the left ventricular is more sensitive to myocardial damages against the backdrop of chemotherapy using anthracyclines. So, it can be used as an early preclinical marker of myocardial damage, that takes echocardiography closer to the most advanced methods of myocardial visualization.

Summary Background We developed a heterologous COVID-19 vaccine consisting of two components, a recombinant adenovirus type 26 (rAd26) vector and a recombinant adenovirus type 5 (rAd5) vector, both carrying the gene for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein (rAd26-S and rAd5-S). We aimed to assess the safety and immunogenicity of two formulations (frozen and lyophilised) of this vaccine. Methods We did two open, non-randomised phase 1/2 studies at two hospitals in Russia. We enrolled healthy adult volunteers (men and women) aged 18–60 years to both studies. In phase 1 of each study, we administered intramuscularly on day 0 either one dose of rAd26-S or one dose of rAd5-S and assessed the safety of the two components for 28 days. In phase 2 of the study, which began no earlier than 5 days after phase 1 vaccination, we administered intramuscularly a prime-boost vaccination, with rAd26-S given on day 0 and rAd5-S on day 21. Primary outcome measures were antigen-specific humoral immunity (SARS-CoV-2-specific antibodies measured by ELISA on days 0, 14, 21, 28, and 42) and safety (number of participants with adverse events monitored throughout the study). Secondary outcome measures were antigen-specific cellular immunity (T-cell responses and interferon-γ concentration) and change in neutralising antibodies (detected with a SARS-CoV-2 neutralisation assay). These trials are registered with ClinicalTrials.gov, NCT04436471 and NCT04437875. Findings Between June 18 and Aug 3, 2020, we enrolled 76 participants to the two studies (38 in each study). In each study, nine volunteers received rAd26-S in phase 1, nine received rAd5-S in phase 1, and 20 received rAd26-S and rAd5-S in phase 2. Both vaccine formulations were safe and well tolerated. The most common adverse events were pain at injection site (44 [58%]), hyperthermia (38 [50%]), headache (32 [42%]), asthenia (21 [28%]), and muscle and joint pain (18 [24%]). Most adverse events were mild and no serious adverse events were detected. All participants produced antibodies to SARS-CoV-2 glycoprotein. At day 42, receptor binding domain-specific IgG titres were 14 703 with the frozen formulation and 11 143 with the lyophilised formulation, and neutralising antibodies were 49·25 with the frozen formulation and 45·95 with the lyophilised formulation, with a seroconversion rate of 100%. Cell-mediated responses were detected in all participants at day 28, with median cell proliferation of 2·5% CD4+ and 1·3% CD8+ with the frozen formulation, and a median cell proliferation of 1·3% CD4+ and 1·1% CD8+ with the lyophilised formulation. Interpretation The heterologous rAd26 and rAd5 vector-based COVID-19 vaccine has a good safety profile and induced strong humoral and cellular immune responses in participants. Further investigation is needed of the effectiveness of this vaccine for prevention of COVID-19. Funding Ministry of Health of the Russian Federation.