This review considers the main changes in our understanding of the etiology of peptic ulcer disease (PUD), its treatment and prevention. It is emphasized that the discovery of H. pylori infection and the implementation of eradication therapy did not solve all the issues related to PUD. Further investigation is needed to study the pathogenesis of idiopathic gastroduodenal ulcers, as well as ulcerative lesions of the stomach and duodenum, caused by various medications (non-steroidal anti-inflammatory drugs in particular).

The article deals with modern problems of integrative medicine. The authors give a critical evaluation of medical specialization and explain the need to develop interdisciplinary areas. The historical aspects of the problem are shown by the example of the development of one of the first interdisciplinary areas in medicine — cardioneurology.

Results of comparative assessment of level of antibodies of IgG to SARS-CoV-2 in dynamics at standard and complex methods of treatment with use of medicinal peptide medicine of a timus of a timalin for patients with COVID-19 are presented in article. It was found that as a result of standard treatment, patients showed a decrease in antibody levels by 53% after 104 days. The addition of thymalin to standard therapy slowed down the decline of this indicator. So, a similar indicator in patients who took thymalin was only 21%. This contributed to maintaining strained adaptive immunity. The detected immunomodulatory properties of the preparation of thymalin with respect to COVID-19 can be reflected both in the formation of an effective immune layer of the population through natural immunization, and in the process of antibody formation during vaccination of target contingents.

The issues of etiology, pathogenesis, clinical features and diagnosis of intracardiac infection are considered on the basis of the experience of surgical treatment of 3700 patients with infectious endocarditis. The principles of surgical interventions for various forms of infectious endocarditis, as well as for its most severe variants, accompanied by destruction of intracardiac structures and damage to other organs, are presented. The immediate and long- term results o f treatment and opportunities for their improvement are analyzed.

There is no indication when to perform thrombolytic or anticoagulant therapy in patients with moderate-high risk of early death in accordance with the stratification of the European society of cardiology.
The purpose of the study: to establish clinical, laboratory, and instrumental criteria for the choice of therapy volume optimization in patients with moderate-high risk of early death.
Material and methods. The study included 154 patients with pulmonary embolism (PE) of high, moderate-high, moderate-low risk of death. An analysis was performed to determine the most significant indications for thrombolytic therapy in PE.
Results. The presence of established «undoubted» criteria indicates the need for thrombolytic therapy. These include an increase in the size of the right ventricle compared to the left, paradoxical movement of the interventricular septum, hypokinesia of the right ventricle on еchocardiography. «Questionable» criteria were also identified: more than 50 mm Hg increased pulmonary artery pressure, more than 20 mm dilation of the inferior Vena cava, more than 3 cm dilatation of the right ventricle on еchocardiography, deep SIQIII on ECG, syncopal states in the anamnesis, increased NT-proBNP values, less than 90% arterial blood saturation. Thrombolytic therapy is indicated for patients with a combination of 2 or more of these criteria, in other cases anticoagulant therapy is prescribed.
Conclusion. The use of established criteria makes it possible to differentiate treatment of patients with moderate-high risk of early death and reduce the likelihood of developing chronic post-thromboembolic pulmonary hypertension by 2.9 times.

The aim of the study was to evaluate the immediate results of treatment of high-risk PE developed against the background of COVID-19, and to analyze the features of the clinical course.
Material and methods. The study is based on the experience of treatment applied to three patients with pulmonary embolism (PE) that developed against the background of COVID-19. The group under consideration is represented by males. The average age was 41 ± 3.1 years old. Verification of the primary diagnosis of COVID-19 was based on positive results of polymerase chain reaction, supplemented by the results of computed tomography. The formation of high-risk PE was noted on the 5th–7th day from the moment of hospitalization. There was also a decrease in SO₂ below 85%, РаО₂ — below 76 mm Hg, Borg index > 8, which required non-invasive high-flow ventilation. Catheterization of the right chambers of the heart with a Swan–Ganz catheter revealed an increase in systolic pressure in the right ventricle to 57 ± 1.2 mm Hg, and diastolic pressure to 13 ± 0.34 mm Hg. Pulmonary hypertension increased up to 70 mm Hg. Changes in the biochemical analysis of blood consisted in increasing the level of troponin I to 0.65 ± 0.14 ng/ml, С reactive protein — to 5.42 ± 2.1 mg/l, and creatine phosphokinase — to 324 ± 23.1 units. An increase in the D-dimer level was observed (0.68 ± 0.11 mg/l). Systemic thrombolysis actilyse was performed in all the cases.
Results. Positive clinical dynamics was observed up to 15 hours after thrombolytic therapy. The level of SO₂ came back to the initial values and was in the range 93–96% and RaO₂ — from 86–92 mm Hg by the end of the first day after the intervention. The average pressure gradient in the pulmonary artery was 32 ± 4.12 mm Hg at the time of discharge, and at the peak — 44 ± 5.3 mm Hg.

The article describes a clinical case of synchronous gastric tumors (highly differentiated carcinoid and gastric adenocarcinoma) in a 74-year-old patient without carcinoid syndrome. The review of literature data characterizing modern methods of diagnosis and treatment of this pathology is presented.

The article presents materials on military-field therapy for the entire period of the journal publication (1920–2020). Over the past years the journal published about 240 scientific articles on various problems of military-field therapy: 20 — on organizational issues, more than 120 — on clinical problems , about 50 — jubilee and historical articles, and more than 50 — dedicated to personalities.

Congratulating the wonderful journal “Clinical Medicine” that has played a significant role in the development of medical care in Russia on the centennial anniversary, the surgical community also celebrates the centenary of the birth of modern military field surgery.
An article “Great surgery in the frontline of the field army” was published by the surgeon-consultant of a number of fronts of the Russian army in World War I, professor of the Military Medical Academy V.A. Oppel in 1916, and the monograph “Organizational issues of the advanced surgical frontline of the army” appeared in 1917. V.A. Oppel was the first to formulate the idea of stage treatment of the wounded in these works and a number of other ones. From the point of view of stage-by-stage treatment, the wounded receives a surgical measure where this measure is needed; the wounded person is evacuated as soon as his health condition allows it.
However, such an approach may seem unrealistic in large-scale wars because military environment often precluded the possibility of providing assistance to the wounded in the place where they needed it. It was not always possible to comply with the contraindications for the evacuation of the wounded. During the world wars, the system of stage-by-stage treatment of the wounded was more a theory, but it was successfully applied practically, and highly improved, during local wars of the late XX — early XXI centuries.

The Department of radiology and radiology with the course of ultrasound diagnostics of the Military Medical Academy celebrated its 90th anniversary. The Military Medical Academy was the first medical institution in Russia, which immediately after the discovery of x-rays formed the main directions of development of the discipline: research in the field of radiation physics, clinical direction and military radiology, as well as educational and methodological work. The basics of radiology were taught to 5th-year students at the Academy as early as 1897, two years after the discovery of x-rays by V. K. Roentgen. Since 1914, the first courses of military x-ray technicians were organized at the Academy, and in 1923 an independent course of radiology was introduced and the teaching of a new discipline was given a clinical orientation. Glorious traditions were formed at the Department solely due to a remarkable galaxy of scientists who worked within its walls and were at the origins of Russian clinical radiology. These are Professor Mikhail Isaevich Nemenov, academician of the AMN, Professor Georgy Artemyevich Zedgenidze, Professor Leonid Davidovich Lindenbraten, corresponding member of the AMN, Professor Albert Nikolaevich Kishkovsky and many other bright names. Over the years, the Department of radiology of the Academy became recognised as a major educational and scientific center for training and improvement of highly qualified professionals, not only medical institutions of the Ministry of defense of Russia, but also the health of the country. Currently, the staff of the Department is on the rise, carrying out high-level research activities and a complex of everyday radiation studies for the needs of the Academy’s clinics, medical institutions in St. Petersburg and the North-West region.