High rates in the medical service works during the Great Patriotic War were achieved primarily due to the satisfactory organization of medical support for military operations and troops, in their leadership of which the leading role belonged to the heads of the medical service and the chief medical specialists of the Red Army and the Navy, as well as to the chief medical specialists of fronts, fleets and armies. During the war the main problems of the troops medical supply organization, wounded and sick treatment, as well as a number of sanitary and hygienic and anti-epidemic issues (the system of step-by-step treatment of the wounded and patients with evacuation to destination; gunshot wounds, burns, frostbites treatment, blood transfusion questions, etc.) were successfully solved under the leadership. During the war the many thousands of military doctors work was led by savants, organizers of health, and specialists with enormous knowledge, talent and i nexhaustible diligence.

«MINOCA» (myocardial infarction with nonobstructive coronary arteries) is a new term in cardiology, which combines a different group of pathological conditions, as a result of which myocardial infarction develops with non-obstructive coronary arteries. The article reveals the etiology and pathogenesis of MINOCA, which is divided into coronarogenic: non-obstructive atherosclerosis, coronary spasm, microvascular dysfunction, coronary artery dissection, muscle bridge and not coranorogenic: myocarditis, cardiomyopathy, thrombophilia, pulmonary embolism. The issues of diagnosis and differential diagnosis attract attention, which determines the further choice of management and treatment tactics. Currently, there are no recommendations for the management and treatment of patients with a diagnosis of MINOCA; accordingly, prevention methods have not been developed. The term «MINOCA» poses a number of questions for us, many of which remain open for further discussion and resolution.

The review contains an analysis of the most commonly associated factors with the formation of patient satisfaction with medical care according to international and Russian studies. A comparison of demographic, medical, ethnic, social and institutional factors associated with the formation of patient satisfaction with the medical care provided by the results of international and Russian studies. The sample size contained more than 15,500 scientific publications placed in three search databases, eLibrary, PubMed and Cochrane library. The procedure of content analysis among publications was carried out to assess the frequency of mention of given words. The analysis of frequency of occurrence of publications was carried out by means of search algorithms put in search engines eLibrary. PubMed and Cochrane library, after which the results were processed by parametric statistics methods (StatPlus Pro 5 was used). The data were studied over «all-time» periods and at a three-year search depth.
As a result, the most common factors were identified, such as: «personnel», «mental state», «institutional factors», «expecta tions», «attention», «diagnosis», «communications», «joint decisions» and «demographics». When comparing the data obtained in the Russian-language search engine eLibrary and English-language PubMed on the factors associated with the formation of patient satisfaction with medical care, specific differences were revealed.
The method of research used in this work allows us to identify not only the factors affecting patient satisfaction, as well as the level of interest of researchers to certain aspects of the problem. It seems reasonable and justified to use, in relation to the peculiarities of the model of domestic health care, the identified factors for the development of patient satisfaction management programs, and in fact, for the implementation of effective quality management of medical care.

Objective: sacubitrile/valsartan is superior to valsartan in modifying functional mitral regurgitation (MR) for the better thanks to the double inhibition of the renin-angiotensin and neprilysin system.
Material and methods. This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 90 patients with heart failure with chronic functional MR (secondary to left ventricular (LV) dysfunction). The primary endpoint was a change in the effective area of the regurgitation hole during the 12-month follow-up. Secondary endpoints included changes in the volume of regurgitation, the final systolic volume of the left ventricle, the final diastolic volume of the left ventricle, and the area of incomplete closure of the mitral valves.
Results. The decrease in the effective area of the regurgitation hole was significantly more pronounced in the sacubitrile/valsartan group than in the valsartan group (–0.048 ± 0.095 vs –0.012 ± 0.105 cm2; p = 0.032) in the treatment efficacy analysis, which included 90 patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference –7.3 ml; 95% CI 12.6–1.9; p = 0.009). There were no significant differences between the groups regarding changes in the area of incomplete closure of the mitral valves and LV volumes, with the exception of the index of the final LV diastolic volume (р = 0.044). There were no significant differences in the change in blood pressure between the two treatment groups.
Conclusion. Among patients with secondary functional MR, sakubitril/valsartan reduced MR more than valsartan. Thus, angiotensin receptor inhibitors and neprilysin can be considered for optimal drug treatment of patients with heart failure and functional MR.

The aim of the study was to identify the features of the clinical course and morphogenesis of infective endocarditis (IE) in HIVinfected injecting drug users with concomitant hepatitis C virus infection in comparison with the clinical and morphological picture of endocarditis in persons without drug dependence. It was found that the causative agent of IE in HIV-infected patients was staphylococcus aureus (71.8%), and in persons without drug dependence in the etiology of the disease the conditionally pathogenic flora prevailed. In HIV-infected drug-dependent patients, the tricuspid valve was affected (82.7%), and in persons without drug dependence — isolated aortic valve damage (40%) and combined mitral and aorticvalve lesions (36.4%). Purulent sepsis complications in drug-dependent patients with IE are less common than in patients without drug dependence due to immunosuppression, which is present in HIV-infected persons.

Introduction. Anemic syndrome (AS) is a common pathological condition in patients with chronic heart failure (CHF) and is recognized as an independent predictor of poor prognosis. A particular role is played by pathogenetically associated with CHF anemia. Mechanisms of its occurrence are being studied. An important role belongs to systemic inflammation, which is involved in the pathogenesis of anemia of chronic diseases (ACD). However, the contribution of cytokine-induced inflammation in patients with heart failure has not yet been fully investigated.
Material and methods. A total of 873 cases of patients with CHF were prospectively analyzed on the basis of the cardiology department of the SBHCI NNR «Nizhny Novgorod Regional Clinical Hospital n.a. N.A. Semashko». The main group consisted of patients with anemia pathogenetically associated with heart failure (n = 96), the control group (CG) (n = 35) patients with heart failure without anemia. The indicators of ferrokinetics were assessed and the systemic inflammation was compared by indicators of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and serum hepсidin.
Results. Patients of the main group had signs of functional iron deficiency (ID) and significantly higher values of cytokines and hepsidin compared with the CG. The relationship between the level of cytokines and hepsidin with the severity of CHF, hemogobin and chronic kidney disease was revealed.
Conclusion. An increase in the concentration of pro-inflammatory cytokines and hepcidin in patients with AS with decompensation of CHF is interrelated with functional ID and a decrease in hemoglobin level. This shows the role of cytokine-induced inflammation in the genesis of anemia in heart failure. The functional state of the kidneys makes a special contribution to these mechanisms. As CKD increases, the levels of inflammatory cytokines and hepcidin in these patients and their relationship with markers (CKD) increase.

The prevalence of age-related diseases, including age-related hypogonadism in men, have increased with improved life
expectancy of the population. This study is aimed at assessing the prevalence of age-related hypogonadism in healthy working middle-aged men and determining the relationships with cardiovascular risk factors.
Material and methods. Men who underwent annual medical examinations were additionally questioned to identify symptoms of age-related hypogonadism. Level of sex and gonadotropic hormones were measured in the study sample. Cardiovascular risk factors and cardiac risk were estimated in all recruited subjects.
Results. Age-related hypogonadism was diagnosed in 35 (32,1%) men. The prevalence of cardiovascular risk factors such as obesity, metabolic syndrome, and depression was significantly higher among men with age-related hypogonadism compared with men with normal testosterone levels.
Conclusion. Early diagnosis and treatment of age-related hypogonadism in middle-aged men is relevant for improving their quality of life and managing cardiovascular risk factors, thereby increasing the effectiveness of primary prevention of cardiovascular morbidity and mortality. When agerelated hypogonadism is diagnosed, optimal management strategy should be selected. The identified cardiovascular risk factors should be modified using a more aggressive approach.

Aims. We comparative investigated the frequency, precipitating factors, lifetimes and predictive factors of survival in patients with liver cirrhosis (LC) and acute-on-chronic liver failure (ACLF).
Material and methods. We collected data from 310 hospitalized patients with LC. Patients divided into groups: 1 — patients with compensation of LC; 2 — patients with decompensation of LC, but without organ failure (OF) and 3 — patients with ACLF. Diagnostic criteria for ACLF based on consensus recommendations of EASL. Survival was assessed according to the Kaplan-Meier method.
Results. 48 patients with LC reported clinical signs of ACLF. 28-day mortality was in 4,8% of patients without ACLF and in 42,0% of patients with ACLF. 90-day mortality of patients with ACLF was 50% versus 11.6% in patients without ACLF. 6-month survival rate of patients with the development of acute decompensation with organ failure was only 33,3%. The lifetimes of patients with ACLF was only 136,65 ± 18,96 days. The predictive factors of survival of patients with LC and ACLF are: the number of organ failure, indicators of CLIF-SOFA and MELD, Child-Pugh score, degree of hepatic encephalopathy, leukocytosis, hyperbilirubinemia, hypercreatininemia and increased INR.
Conclusion. The prevalence of ACLF in patients with LC is 15,5% and develops against a background of stable compensated or decompensated CP. The frequent trigger of ACLF is infection, which causes acute decompensation with the development of multiple organ failure and a high incidence of short-term mortality. The 28-day mortality rate in patients with ACLF was 8.7 times greater than the mortality rate in patients with decompensated LC without ACLF.

Introduction. Tibial lengthening is one of highly popular surgical procedures that can be associated with complications of the knee joint related to surgical intervention or baseline changes in the bones forming the knee.
Objective. To explore preoperative and postoperative changes in the bones forming the knee joint of patients with tibial shortening of different etiology.
Material and methods. Radiography and multislice computed tomography (MSCT) were performed for 48 achondroplasia patients, 15 subjects with subjectively low height, 25 patients with vitamin-D resistant rickets (MRI produced for 20 patients), 56 patients with Blount’s disease (MSCT produced for 10 cases) before and after tibial lengthening or deformity correction.
Results. The findings showed that tibial lengthening was accompanied by limited function of the knee even in absence of evident articular changes. Good results could be ensured with adequately performed lengthening technique and proper control of muscle condition and rehabilitation program to be meticulously followed. Patients with baseline problems in the joints were shown to have progressive changes in the knee joints during tibial lengthening, however, they were not critical and could provide a normal function at a long-term follow-up.
Conclusion. Tibial lengthening as a complicated biomechanical and morphological process is accompanied by changes in the knee joint and can be successfully accomplished with adequate technique applied and rehabilitation program performed. Chnages in the knee were more evident in patients with baseline disorders in the anatomy and architechtonics of the femoral and tibial condyles, however, improved biomechanical parameters of the limb allowed us to obtain positive outcomes and good function in almost all the cases.

The paper presents the characteristics of anthropometric indicators and assessment of eating behavior of pregnant women with obesity. 213 pregnant women with abdominal obesity diagnosed before pregnancy (main group) were monitored. The control group consisted of 80 women who had a normal body mass index before pregnancy. When analyzing the differences in anthropometric indicators between the studied groups of pregnant women, statistically significant differences in the parameters of weight, BMI, OT/O ratio were revealed.
The average BMI in pregnant women of the main group was 39,5 ± 0,57 kg/m2, which was 1,6 times higher than in women of the control group. In pregnant women with obesity, the ratio of OT/OB corresponded to 0,90 ± 0,004, which significantly exceeded the value of this indicator in women of the control group. Weight gain after the first pregnancy was indicated by 80 (37,5%) women of the main and 38 (47,5%) — control group. Evaluation of the eating behavior of obese patients showed that the nature of nutrition in almost half (48,0%) of obese women was irrational and excessive (3,8% in the control group), and 12,8% of patients abused various tonic drinks. Obese women are undoubtedly at high risk for developing complications during pregnancy.

Paraneoplastic syndromes diagnosed in 7–10% of patients with malignancies in general. PNS accompany bronchogenic lung, breast, ovarian, prostate, kidney and uterus cancers most often. Neoplastic process can cause by both the acute and the chronic inflammatory response with pathologic changes of the connective tissues and vascular in various organs and systems. Diagnosis of paraneoplastic syndromes is difficult often. However, some signs should cause of rheumatologist the oncologic alertness, which were found in patients with rheumatic masks of neoplasms. Among such signs include: the occurrence of rheumatic diseases in an abnormal age; the absence of sexual dimorphism, is typical of many rheumatic diseases; the difference between the severity of clinical manifestations and the general condition of the patient with an index of inflammatory activity; the absence of separate clinical and laboratory signs typical one or another rheumatic disease; the appearance of new symptoms, not characteristic of the rheumatic diseases.
As a clinical example to illustrate the difficulty of diagnosis, this article describes a clinical case of adenocarcinoma of the prostate in 74-year-old men presenting as polymyalgia rheumatica.