Bulletin of the Russian Military Medical Academy

BACKGROUND: It is known that one of the basic processes developing in response to injury is insulin resistance. The mechanisms of development of insulin resistance at the present stage are not fully disclosed. There is an increasing amount of evidence indicating the role of the gastrointestinal microbiota in the development of insulin resistance.

AIM: Was to evaluate the dynamics of the triglyceride-glucose index in relation to the taxonomic composition of the microbiota of the gastrointestinal tract and blood in patients with combined musculoskeletal injury.

METHODS: 44 wounded with combined injury of the musculoskeletal system who were being treated at the clinic of military field surgery of the Military Medical Academy named after S.M. Kirov were examined. The patients underwent a standard examination with the calculation of an indirect indicator of insulin resistance, the triglyceride-glucose index. The microbiota of feces and blood was studied by sequencing 16S ribosomal ribonucleic acid.

RESULTS: The average value of the triglyceride-glucose index in the victims was 4.61 ± 0.22 units. In 79.5% of patients, the value of the triglyceride-glucose index exceeded 4.49 units, which indicates the presence of signs of insulin resistance. There were direct correlations of the triglyceride-glucose index with the level of total cholesterol, serum amylase, the presence of chronic pancreatitis, and a number of ultrasound parameters of the liver, gallbladder, and pancreas. The most significant direct links of the triglyceride-glucose index were established with the presence of Pseudoscardovia, Pyramidobacter, and Pediococcus in the intestinal microbiota, and with bacteria of the genera Bacillus and Pseudomonas in the blood serum. Moderate inverse associations of the triglyceride-glucose index with the presence of bacteria of the genera Scardovia, Actinomyces, and Allofournierella (synonym: Fournierella) in the feces were revealed, Butyricicoccaceae UCG-009, Lactobacillus crispatus wiggsiae not Scardovia species, In. blood serum — bacteria Bifidobacterium Rodova, Phascolarctobacterium, Hydrogenophilus, the type of Escherichia is not Phascolarctobacterium albertii faecium.

CONCLUSION: The established trends in the nature of changes in insulin resistance, depending on the timing of combat injury, indicate the dynamics of insulin resistance associated with the course of traumatic illness. Insulin resistance in the early period of traumatic illness, which develops in response to stress, blood loss, and tissue damage, can be considered as a compensatory and adaptive response within the framework of the concept of general adaptation syndrome, aimed primarily at eliminating energy deficiency. Therefore, it is necessary to conduct further research that can expand the understanding of the role of the bacterial microbiota as an important component of the gastrointestinal tract biotech complex in the development of metabolic changes in patients with injuries, as well as methods for their correction.

BACKGROUND: Recent studies showed a causal relationship between inflammation and atherogenesis with underlying ischemic heart disease. A novel coronavirus infection has been found to trigger a cytokine storm. Various anticytokine therapies have been used for the treatment. However, the impact of these interventions on ischemic heart disease remains unclear.

AIM: This study aimed to assess the impact of various anticytokine treatments initiated in the acute phase of novel coronavirus infection on ischemic heart disease post-COVID.

METHODS: The study included 272 patients with a history of ischemic heart disease. The patients had received various anticytokine therapies for novel coronavirus infection. They were followed up after recovering from novel coronavirus infection. The patients were stratified into two groups based on worsening of underlying ischemic heart disease (worsening vs no worsening).

RESULTS: The worsening of ischemic heart disease was significantly associated with novel coronavirus infection severity (χ²df = 2 = 28.406; p < 0.0001) and sex (in males, χ²df = 1 = 7.310; p = 0.007). Patients who had severe novel coronavirus infection and received combination anticytokine therapy in the acute phase of the infection were less likely to experience worsening of ischemic heart disease compared to those who received monotherapy for cytokine storm (p_1,4 = 0.016; p_3,4 = 0.024). A proposed model with a 68.8% accuracy rate estimates the worsening probability of ischemic heart disease after novel coronavirus infection using several factors, including sex, age, severity of symptoms, and concurrent treatment.

CONCLUSION: The findings indicate that inflammation plays a crucial role in ischemic heart disease and that the severity of novel coronavirus infection has a significant impact on its clinical course. Combination treatment for the cytokine storm that is associated with novel coronavirus infection in patients with underlying ischemic heart disease is correlated with better prognosis.

BACKGROUND: Acute uncompensated blood loss due to continuous external bleeding is a common cause of death among military personnel wounded in combat. Tourniquets have been recognized as the primary method to temporarily control bleeding. Successful injury management is predicated on the adherence to recommended guidelines for tourniquet application and replacement with blood flow restoration. For combined radiation injury, shorter tourniquet times are associated with extended radiation component.

AIM: This study aimed to establish the correlation between hemostatic tourniquet times and the course and outcome of moderate combined radiation and mechanical injuries in an experimental setting.

METHODS: The study included 60 male Soviet Chinchilla rabbits with an average body weight of 2.5–3 kg. The animals were exposed to a single dose (6 Gy) of uniform γ-radiation and had mechanical damage to tissues and a large artery of the limb with hemoexfusion of 30% of the circulating blood volume. The tourniquet time was 15, 45, or 120 minutes. A The mechanical component of the injury was initiated 1 hour post-exposure.

RESULTS: In the combined radiation and mechanical injury model, prolonged tourniquet time was associated with a more adverse outcome. Specifically, 8 (80%) rabbits survived after a 15-minute tourniquet application, with 30% survival (3 rabbits) observed at 45 minutes and 20% (2 rabbits) at 120 minutes. Tourniquet time did not affect the onset of radiation component of the injury. Comparison of the groups with the reproduced model of the combined injury and isolated injury showed that the radiation component did not affect the survival of animals with combined radiation and mechanical injuries.

CONCLUSION: Prolonging tourniquet time is crucial in increasing animal mortality, with this effect being independent of the radiation component (in the specified experimental model). If we extrapolate the experimental data to humans, it can be concluded that individuals with combined radiation injury and those who suffer from isolated injury should be medically evacuated in a way that minimizes tourniquet time. Furthermore, it is critical to consider medical and tactical situations to ensure that the most effective methods for bleeding control are used.

BACKGROUND: Growing interest in microcirculatory disorders among cardiology patients is due to the crucial role of the microcirculatory system in disease pathogenesis and by the fact that it is a target for pharmacological agents from various classes.

AIM: The study aimed to evaluate the microcirculatory effects of antihypertensive therapy over a 6-month period in patients with hypertension.

METHODS: Overall, 277 patients (209 women and 68 men) diagnosed with stage 2 hypertension, grade 1–2, risk categories 2 and 3, were examined. Their mean age was 58.7 ± 6.3 years, with an average disease duration of 11.2 ± 1.6 years (group 1). The control group (group 2) included 56 healthy individuals with a mean age of 54.1 ± 6.4 years. The women were postmenopausal without clinical symptoms. Group 1 received either combined therapy with indapamide and lisinopril or monotherapy with nebivolol, indapamide, losartan, or lisinopril, as prescribed in outpatient care. Terminal blood flow was assessed at baseline and after 1, 3, and 6 months using laser Doppler flowmetry following standard protocols.

RESULTS AND DISCUSSION: After 6 months of antihypertensive treatment and reaching target blood pressure levels, a shift in microcirculation types was observed, with a decrease in the number of pathological ones. Microcirculatory parameters under monotherapy did not fully normalize peripheral perfusion and remained below the levels observed in the healthy control group. The closest values were noted in patients receiving unfixed combination of lisinopril and indapamide with normocirculatory microcirculation.

CONCLUSION: Analysis of the microcirculatory effects of prescribed therapy in patients with stage 2, grade 1–2 hypertension, risk categories 2–3, revealed variable responses at the microvascular level. This indicates that combination therapy with lisinopril and indapamide is a more rational approach.

BACKGROUND: Socially significant diseases are conditions that pose a threat to public health because of their high prevalence, temporary or permanent disability rates, elevated mortality, and substantial costs associated with prevention, treatment, and rehabilitation. In military healthcare, comprehending the trends of infectious morbidity among female servicemembers is still a critical concern.

AIM: This study aimed to analyze clinical characteristics of selected socially significant infectious diseases—tuberculosis, viral hepatitis, and human immunodeficiency virus (HIV) infection—among female servicemembers during a ten-year period (2012–2021).

METHODS: Using data from medical reports (Form 3/MED) and annual reports (Form 4/MED) from 2012 to 2021, the Department of Public Health and Healthcare Organization at the S.M. Kirov Military Medical Academy analyzed the primary and hospital morbidity, work loss, and discharge rates among female servicemembers diagnosed with tuberculosis, viral hepatitis, and HIV infection. The study also analyzed open-access statistical data on morbidity in the Russian Armed Forces. Diseases and diagnostic categories were coded in accordance with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision.

RESULTS: Tuberculosis, viral hepatitis, and HIV infection together accounted for approximately 4.7% of primary morbidity due to class I diseases. The average long-term incidence rates per 100,000 were 13.9 for tuberculosis, 34.9 for viral hepatitis, and 6.1 for HIV infection, corresponding to 1.2%, 3%, and 0.5% of the class I disease structure, respectively (4.7% in total). Primary morbidity among female service members was lower by factors of 4.2 (tuberculosis), 2.2 (hepatitis), and 10.3 (HIV) than the Russian general population. The average long-term discharge rates per 100,000 servicewomen were 3.7 for tuberculosis, 9.7 for viral hepatitis, and 4.1 for HIV infection, accounting for 13.9%, 34.2%, and 15.2% of total discharges within class I diseases, respectively—63.3% in total.

CONCLUSION: According to reportable morbidity types, a relatively low incidence of socially significant diseases was observed among female servicemembers. A disproportionately high percentage of discharges and deaths were caused by HIV infection. The documented rise in hospital morbidity, work loss, and mortality among female servicemembers due to HIV infection suggests delayed access to medical care. Key strategies for preventing these socially significant diseases include enhancing personal moral and medical literacy, promoting healthy lifestyles and health-preserving behavior, maintaining general hygiene, using barrier contraception, avoiding drug use, and ensuring timely access to medical care.

This article systematizes data on the topography, origin levels, branching types, length, diameter, angle of origin from the aorta, and the aorto-mesenteric distance of the superior mesenteric artery (SMA). Classical and aberrant branching patterns are described, including the artery rising from the thoracic segment of the aorta. Quantitative data are provided on the frequency of the celiacomesenteric, splenomesenteric, and hepatomesenteric trunks. Variants of the hepatic, right renal, and splenic branches originating from the SMA are discussed. Particular attention is given to the diameter of the abdominal aorta at the level of the SMA origin and the spatial relationship between the superior mesenteric, celiac trunk, and inferior mesenteric arteries. The anatomical variants of the arteries supplying the small intestine are described, including their quantitative parameters and specific features of the arcade anastomosis formation. Special focus is placed on the variant anatomy of the ileocolic, right colic, and middle colic arteries supplying the right colon. Morphometric data highlight the common, sex-specific, and individual angioarchitectonic features of these vessels. A wide range of variants concerning the origin, branching, trajectory, and distribution patterns of the branches of the SMA were noted, with some sex- and age-related characteristics traced. Understanding the topographic and morphometric characteristics of the SMA is crucial in clinical practice when planning a wide range of diagnostic and surgical interventions, as well as for applying modern interventional technologies. Simultaneously, the extensive anatomical variability of the SMA necessitates targeted research considering age, sex, and anatomical type in adults.

This review highlights current Russian and international scientific data on the role of vitamin D in a wide range of physiological processes, with a special emphasis on its extraskeletal functions, clinical implications, and manifestations. A search and analysis of the medical scientific data from 2004 to 2023 was undertaken using the databases eLibrary.RU, the Russian National Library, and the Fundamental Library of the S.M. Kirov Military Medical Academy, and the international search platforms PubMed and Medscape. Key scientific publications were reviewed, including outcomes from preclinical studies on laboratory animals utilizing vitamin D supplements and clinical studies involving patients with vitamin D deficiency. It examines vitamin D metabolism and its involvement in the immune function, as well as in the cardiovascular, respiratory, digestive, endocrine, nervous, reproductive, and other systems. Vitamin D deficiency is clearly reflected in the development, pathogenesis, and progression of diverse prevalent human diseases, including infectious, chronic inflammatory, allergic, systemic autoimmune, and various neoplastic conditions. The article highlights key historical milestones in the discovery of vitamin D and its metabolites, their health impacts, and the role of vitamin D deficiency in disease development. Preclinical and clinical studies have largely validated the effects of vitamin D at the cellular, tissue, and organ levels, including its role in regulating the function of various physiological systems as well as cellular proliferation and differentiation. Numerous long-term prospective studies are ongoing, linking low vitamin D levels to a wide spectrum of human diseases. This continues to generate considerable scientific interest and enthusiasm for exploring the effects of dietary vitamin D supplementation on human health, despite inconsistent results from clinical studies.

May 3, 2024, marks the 130th birth anniversary of Nikolai N. Yelansky (1894–2024), a well-known Russian transfusiologist and internationally renowned surgeon, professor, and lieutenant general of medical service. Yelansky is known for his contributions in military field surgery, particularly in the treatment of gunshot wounds to soft tissues, the chest, and long bones and traumatic shock. However, his achievements in experimental physiology, transfusiology, and blood donation remain underappreciated. Although Yelansky’s focus was clinical practice, his commitment to Pavlov’s physiological doctrine left a distinct mark on his scientific works. Over his career, Yelansky published 146 scientific articles on clinical surgery issues. Under his supervision, 9 doctoral and over 30 candidate dissertations were defended. By instilling his students’ autonomy, initiativeness, professional dedication, and self-sacrifice, he took joy in their successes. Yelansky’s students included outstanding figures in medicine such as Academician M.I. Kuzin and Professors O.S. Shkrob, E.I. Zakharov, L.V. Uspensky, A.A. Begelman, M.A. Chistova, V.S. Pomelov, V.G. Ryabtsov, N.M. Yanchur, M.M. Dykhno, and A.A. Kazansky. His gift for scientific foresight is reflected in his research, which often directed Russian surgical development. In the viewpoint of his student Kuzin, this was attributable to the exceptional character of Yelansky—his tremendous industriousness, modesty, and profound humanity. The formation of his worldview, including his scientific outlook and the diversity of his professional endeavors, stemmed from his childhood and adolescence and from the sociopolitical structure and economic foundations of the state at the time. Yelansky’s contributions to his homeland were marked by numerous honorary titles, government decorations, and awards. These include Hero of Socialist Labor (1964); three Orders of Lenin (1946, 1954, and 1964); four Orders of the Red Banner (1942, 1944, 1945, and 1951); the Order of Alexander Nevsky (1945); the Order of the Patriotic War, 1st class (1943); two Orders of the Red Star (1939 and 1940); and “For the Capture of Budapest”, “For the Capture of Vienna”, “For the Victory over Germany in the Great Patriotic War of 1941–1945” and “For the Victory over Japan” medals.