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Vol 341, No 11 (2020)


Medical assistance to patients with viral hepatitis in the Armed Forces

Zhdanov K.V., Kozlov K.V., Shakhmanov D.M., Zhabrov S.S., Sukachev V.S., Gabdrakhmanov I.A., Ivanov K.S., Lyashenko Y.I., Bulankov Y.I., Yaremenko M.V.


The article presents the characteristics of the modern organization of medical care for service members of the Armed Forces with acute and chronic viral hepatitis, tied to the territorial system of medical support. The state of implementation of the requirements of the guidelines regulating the activities of infectious disease specialists on this problem is highlighted. The experience of treating patients over ten years is generalized, and the results obtained are compared with the civil health care system. In the structure of viral hepatitis in military personnel in peacetime, chronic forms prevail, among the latter - hepatitis C (more than 70%). In case of a deterioration of the sanitary and epidemiological situation (natural and human - made disasters, the conduct of hostilities), a significant increase in the proportion of acute viral hepatitis with the fecal - oral transmission mechanism can be expected. Modern etiotropic treatment’s effectiveness ensures the elimination of viral hepatitis C and long - term suppression of viral hepatitis B replication in more than 95% of patients.
Voenno-medicinskij žurnal. 2020;341(11):4-10
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Medical and statistical characteristics of the incidence of urolithiasis in the Armed Forces

Protoshchak V.V., Paronnikov M.V., Orlov D.N., Karpushchenko E.G., Kochetov A.G., Lazutkin M.V., Alentev S.A., Ovchinnikov D.V.


A statistical analysis of the annual medical reports of the medical service of military units, garrison, base, district (naval) hospitals, and military medical organizations of central subordination, the chief urologist of the Ministry of Defense from 2014 to 2018 was carried out. The indicators of general and primary morbidity, the need for dispensary dynamic observation and hospitalizations, labor losses, dismissals, and mortality in the group of diseases N20-N23 for various categories of military personnel (by conscription and by contract) and other contingents (pensioners and civilian personnel of the Ministry of Defense, family members of military personnel and pensioners of the Ministry of Defense, military personnel of different ministries and departments). A tendency to increase general and primary morbidity, the need for dispensary observation, labor losses, and dismissal rates in all categories of patients was revealed. The average values for sick service members under contract are comparable to those for the country’s civilian population, for conscripts and other contingents - lower. Under the contract, service members had higher general and primary morbidity rates, need for dispensary observation, hospitalization, labor losses, and mortality. The highest rates of dismissal were found among conscripts.
Voenno-medicinskij žurnal. 2020;341(11):11-18
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Voenno-medicinskij žurnal. 2020;341(11):18
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Forensic evaluation of the displacement of the spleen with a full stomach

Levandrovskaya I.A., Aseeva I.A., Pinchuk P.V., Kryukov E.V., Troyan V.N.


Until now, no studies have been conducted to study the localization and displacement of the spleen with a full stomach in a person in an upright position. This issue is critical since damage to the spleen in living individuals is most often caused when the victim is in an upright position or close to him. As a result of the study, it was found that in the majority of the examined (64%) with a full stomach, there was no change in the topography of the spleen from the initial one. In other cases (36%), displacement and changes in the orientation of the spleen’s longitudinal axis were noted. In 42% of the surveyed, a full stomach prevented the expulsion of the spleen. In 58%, it did not affect the mobility and displacement of the spleen, making it possible to exclude a full stomach factor in the formation of organ damage. The study results can be used in the production of forensic medical examinations to establish the features of the mechanism of the formation of spleen lesions, the conditions, and the time of their occurrence.
Voenno-medicinskij žurnal. 2020;341(11):19-22
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Prospects for the use of biomarkers for the diagnosis of acute respiratory distress syndrome (literature review)

Pugach V.A., Tyunin M.A., Ilinskii N.S., Gogolevskii A.S., Taborskaya K.I.


The results of the analysis of literature data on the problem of diagnosis and prediction of the course of acute respiratory distress syndrome of various etiologies are presented. The relevance of research in this area is determined by the high prevalence of severe respiratory distress syndrome development as a non - specific complication of many diseases and injuries in peacetime and wartime. Considering etiological factors, the most informative biomarkers of lung tissue damage were significant for early diagnosis and prediction of the syndrome’s course. As a promising direction, the development of a diagnostic multi - marker panel is substantiated, which allows assisting at the stages of medical evacuation to study critical levels of interleukin-6, interleukin-8, angiopoietin-2, vascular endothelial growth factor, the soluble form of the receptor for the final glycosylation products, and surfactant protein D, as well as markers of endothelial glycocalyx destruction and hemostatic system dysfunction. The variety of etiological factors causing acute respiratory distress syndrome indicates the need to continue the search for biomarkers with the highest diagnostic and prognostic significance.
Voenno-medicinskij žurnal. 2020;341(11):23-28
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Voenno-medicinskij žurnal. 2020;341(11):28
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Spontaneous violation of the integrity of the inferior vena cava wall

Esipov A.V., Pinchuk O.V., Obraztsov A.V., Yamenskov V.V., Grigor’ev K.B., Rakov A.A.


The current literature data on an extremely rare and severe pathology - a spontaneous violation of the inferior vena cava wall’s integrity with the formation of a retroperitoneal hematoma - are summarized. The data of our own experience of treating three patients with this pathology are presented. One of them was operated on with subsequent death. The rest were treated conservatively; the outcome was favorable. The individual probable causes of the development of spontaneous large retroperitoneal venous hematoma and the features of the right choice of treatment tactics were analyzed. The value of correctly selected anticoagulant therapy in the treatment of such patients is shown. It is concluded that surgical interventions for spontaneous violation of the inferior vena cava’s integrity can be undertaken only for health reasons if the refusal of the operation will inevitably lead to an unfavorable outcome.
Voenno-medicinskij žurnal. 2020;341(11):29-34
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Peripheral nerve injuries with extensive defects: experimental and topographic - anatomical approaches to substantiate accelerated tissue reinnervation

Nisht A.Y., Fomin N.V., Chirskii V.S.


The article presents the results of a study in an experiment on laboratory animals’ peculiarities of muscle reinnervation and regeneration of a damaged peripheral nerve after its connection with an intact nerve in the «end - to - side» type. Evaluation of the results of restoration of tissue innervation after the link of the distal segment of the damaged nerve with the intact donor nerve, as well as the topographic and anatomical characteristics of the functionally significant branches of the peripheral nerves of the upper limb indicate the potential use of the peripheral nerve suture of the «end - to - side» type as one of the methods of tissue reinnervation for peripheral nerve injuries. In case of high proximal fractures, selective reinnervation of individual branches of the damaged nerve in the distal segments of the extremities will allow, in a shorter time, compared with the direct reconstruction of the nerve trunk at the level of injury, to restore the contractile activity of functionally essential muscle groups.
Voenno-medicinskij žurnal. 2020;341(11):35-38
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The evolution of the treatment of purulent - inflammatory hand diseases

Kim D.Y., Kolodkin B.B., Kokorin V.V., Karpov N.A., Moiseev D.N., Kondakov E.V.


The article shows the historical path of purulent surgery, the evolution of treatment and diagnosis. Domestic and foreign authors’ contribution to the formation and development of purulent hand surgery is briefly characterized and evaluated. The relationship between the development of medical technology and the results of treatment of patients, as well as the long - term effects of various treatment methods, are demonstrated. The problem of treating purulent wounds of the hand has not lost its relevance. At the same time, surgical treatment remains the most crucial stage of medical care for patients. Presented are modern approaches to the treatment of purulent - inflammatory processes in hand. Even though the method of treating purulent - inflammatory diseases of hand has not undergone significant changes and consists in opening the purulent focus and its adequate drainage and rehabilitation, thanks to the extensive possibilities of instrumental diagnostics, the risk of complications are minimized, and treatment of the patient becomes as useful as possible.
Voenno-medicinskij žurnal. 2020;341(11):39-44
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Assessment of the status of small subpopulations of T-lymphocytes in various immunemediated diseases

Markelova E.V., Knysh S.V., Malkov V.A., Lazanovich V.A., Shumatov V.B., Ershov A.V., Karpitskaya S.A., Sukhoterin A.F., Il’ichev R.I., Gusev A.V.


The chronic immuno - inflammatory syndrome causes many pathological conditions, including chronic persistent viral diseases and sepsis. An objective assessment of the cellular component of immunity is necessary for adequate management of patients and evaluation of the effectiveness of treatment. To assess the change in the cellular immunity link for various immune - mediated diseases, the immunogram indices of 3 groups of patients were studied: 1st - with chronic herpetic infection, 2nd - with a combination of chronic herpetic infection and Epstein - Barr virus infection, 3rd - with sepsis. As a result, in the 1st group, an imbalance in the ratio of Th1 and Th2 towards the prevalence of Th1 was registered; in the 2nd and 3rd groups of patients, a pronounced predominance of Th2 subpopulation of T - lymphocytes was revealed. A distinctive feature of the immunograms of patients in the 2nd group was an increased content of Treg cells, and in the 3rd group, there was an obvious deficiency of B - lymphocytes (p<0.05).
Voenno-medicinskij žurnal. 2020;341(11):45-50
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Genomic and epigenomic determinants of atherosclerosis in male military personnel

Gordienko A.V., Serdyukov D.Y., Fedorova A.S.


The modern medical community is actively discussing predicting and preventing multifactorial diseases, such as atherosclerosis, metabolic syndrome, and oncopathology. Almost every significant risk factor in humans has a specific genetic determination. Statistics show that 12% of the population has a burdened family history of cardiovascular disease. In research on the human genome study, special attention is paid to single - nucleotide polymorphisms and associated mutations, leading to the development of diseases of the circulatory system. The article presents population frequencies, phenotypes, and the results of our studies of genetic polymorphisms of several relevant genes associated with the development of atherosclerosis, obesity, leptin resistance, arterial hypertension, and type 2 diabetes mellitus. The modern views on epigenetic heredity are presented on the example of methylation of deoxyribonucleic acid, its influence on the genome, and phenotypic manifestations of atherosclerosis.
Voenno-medicinskij žurnal. 2020;341(11):50-56
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Forecasting the effectiveness of military specialists’ activities based on the results of an express assessment of their functional state

Erofeev G.G., Pankratov V.V., Maksimov S.G., Ermolaeva S.A., Solopov O.Y.


An express assessment of the functional state of military specialists of emergency rescue teams was carried out according to indicators of physiological and psychophysiological functions that are most significant for the professional activities of personnel in the elimination of the consequences of accidents with nuclear materials. Using integral indicators according to the criteria of functional readiness to perform combat training tasks and the probability of erroneous actions during their implementation, a forecast of the effectiveness of these specialists’ professional activities was carried out. The proposed methodological approach has shown, under model conditions, high information content, and reliability of the obtained prognostic estimates. A significant array of data was obtained, which can also be used to develop methods for predicting the effectiveness of personnel performing daily combat training tasks and improve the system of professional psychological selection and psychophysiological support for the professional activities of emergency rescue teams.
Voenno-medicinskij žurnal. 2020;341(11):57-63
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Voenno-medicinskij žurnal. 2020;341(11):63
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Methodological principles of diagnosis and rehabilitation treatment of asthenopia

Ovechkin I.G., Yudin V.E., Yaroshenko V.P., Budko A.A., Matvienko V.V., Kozhukhov A.A., Gadzhiev I.S., Shakula A.V.


Based on the accumulated experience, the methodological principles of diagnostics and rehabilitation treatment of asthenopia among military specialists of visually strenuous labor were formulated: a differentiated approach to the implementation of these measures; use in an outpatient setting of a multidisciplinary method of restorative treatment, differentiated and consistent use of apparatus treatment; stages of treatment and rehabilitation measures (outpatient, at home). The need to take steps to prevent asthenopia, and an integrated approach to carrying out rehabilitation treatment is emphasized.
Voenno-medicinskij žurnal. 2020;341(11):64-66
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The effectiveness of complex standard and osteopathic methods of treatment of patients with post - traumatic stress disorder

Matvienko V.V., Buchnov A.D., Egorova I.A., Budko A.A.


The functional state of the organism of 30 former military men - participants of local military conflicts, at the age of 55-60 years, with post - traumatic stress disorders, was assessed. The effectiveness of complex standard and osteopathic treatment methods of patients with post - traumatic stress disorders has been revealed.
Voenno-medicinskij žurnal. 2020;341(11):66-69
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Correction of arterial hypertension and psycho - emotional stress with a transcutaneous electrical stimulator «AVR - 051»

Bratilova E.S., Kachnov V.A., Tyrenko V.V., Fisun A.Y., Patsenko M.B.


The results of testing the «AVR-051» electro stimulator on two groups of patients comparable in age, sex, and degree of arterial hypertension are presented. In the 1st group (n=40), the transcutaneous electro stimulator «AVR-051» was used, in the 2nd (n=41) - the placebo «AVP-051». Before and 14 days after using a pacemaker or placebo, the 24-hour blood pressure profile was assessed in both groups, the EQ-5D quality of life questionnaire and the PSM questionnaire were completed. The totality of the data indicates that only against the background of the use of the «AVR-051» electro stimulator (group 1) there is a tendency towards a decrease in the mean systolic and diastolic blood pressure, an increase in its variability at night, a decrease in the time index of systolic and diastolic blood pressure, as well as improving the psycho - emotional state of patients.
Voenno-medicinskij žurnal. 2020;341(11):69-71
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Voenno-medicinskij žurnal. 2020;341(11):71
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To the 400th anniversary of the military medical service of Russia: from origins to the formation

Trishkin D.V., Budko A.A.


The article examines the history of the development of state military medicine in Russia. Thanks to research carried out in the Military Medical Museum, the date of the army medical service formation was revealed. The features of the state military health care formation in Russia and military health management bodies are shown. The formation of military hospitals in Moscow and St. Petersburg until the end of the 18th century is traced. The development of the system of training national medical personnel is assessed. All this led to the creation in 1805 of the main governing body of military medical affairs in the Russian Empire and the formation of a developed military medical service system in the state.
Voenno-medicinskij žurnal. 2020;341(11):72-78
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Strategic Missile Forces Medical Service celebrates 60th anniversary

Gnashko O.M., Kachurovskii I.A., Rascheslavskii B.Y.


The system of medical support in the Strategic Missile Forces (Strategic Missile Forces) was formed, considering the specifics of the troops’ organizational and staff structure and their deployment areas, the specifics of service by personnel. In August 1960, a military command body was created - the Strategic Missile Forces’ medical service. In 1963-1964 the Central Military Clinical Hospital of the Strategic Missile Forces was formed, hospitals were reorganized into military hospitals. New military hospitals, polyclinics, medical centers, health resorts, pioneer camps, etc. were built. Experienced tactical and special exercises were regularly conducted in the troops to work out organizing medical and evacuation measures. In 1997, when the military units of the Strategic Missile Forces, the Military Space Forces, and the Rocket and Space Defense Troops were united, the grouping of forces and means of the medical service increased. In reforming the Armed Forces and reducing the Strategic Missile Forces, the system of medical support was rebuilt and improved. In 2010, the governing body of the medical service of the Strategic Missile Forces was liquidated, military hospitals of missile formations were reassigned to district military hospitals as their branches and structural units. In 2013, the medical service as a governing body for the organization of medical support for the military department was restored.
Voenno-medicinskij žurnal. 2020;341(11):78-86
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Voenno-medicinskij žurnal. 2020;341(11):87-92
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Voenno-medicinskij žurnal. 2020;341(11):92-96
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