Bulletin of the Russian Military Medical Academy

The levels of development of cognitive mental processes and personal qualities among specialists of the Navy of the Socialist Republic of Vietnam undergoing military service under a contract were considered, and their relationship with military-professional success was assessed. In July 2023, specialists from the Kirov Military Medical Academy together with Vietnamese specialists of the Russian–Vietnamese Tropical Center, conducted a pilot psychological and psychophysiological examination of naval specialists of the Navy of the Socialist Republic of Vietnam to study the characteristics of cognitive mental processes (attention, memory, and thinking), motivational and personal qualities, and expert assessments of the success of military-professional adaptation. Statistically significant relationships between expert assessments of professional success and the level of development of cognitive mental processes, characteristics of the motivational sphere, neuropsychic stability, and psychological adaptation characteristics have been identified. The results showed sufficient validity and reliability of the methodological apparatus used for assessing cognitive mental processes and personal psychological adaptive abilities in relation to assessing their relationship with the success of military-professional adaptation, an effective solution of professional and service tasks. The possibility and prospect of considering them in professional psychological selection and medical and psychological (psychophysiological) support of professional activities, examination, and, if necessary, subsequent medical and psychological rehabilitation of naval specialists of the Socialist Republic of Vietnam to maintain a high level of their professional health, as well as the need for further research.

The effectiveness of anticoagulant therapy in the prevention and treatment of pulmonary artery thrombosis and the possibility of anti-inflammatory therapy in preventing this complication in clinical practice and experiments were assessed. Data from patients with a new coronavirus infection and those suffering from urgent noninfectious pathology with confirmed pulmonary artery thrombosis were retrospectively analyzed. The outcomes of anticoagulant therapy and anticoagulant therapy combined with glucocorticoid and/or anticytokine drugs were assessed. Histological preparations of the lung vessels of patients were examined. Using an experimental model of rats with induced thrombosis of the posterior vena cava, changes in the pulmonary artery branches were assessed in the main group administered with edible mussel (Mytilus edulis) hydrolyzate and the control group given a physiological solution. No statistically significant relationship was found between the therapeutic, intermediate, and preventive anticoagulant therapy regimens and mortality, changes in lung dynamics, and D-dimer levels in 313 patients with new coronavirus infection. No predominance of any anticoagulant therapy regimen used was found among deceased patients. Thirty-nine patients were treated with glucocorticoid and/or anticytokine drugs in the presence of anticoagulant therapy. No statistically significant relationship in the onset of thrombotic complications was found between the groups receiving therapy with glucocorticoid and anticytokine drugs. No differences were noted in the drug-induced pathomorphosis of the wall of the pulmonary artery branches in the group receiving anticoagulant therapy or in the group receiving a combination of anticoagulant therapy and glucocorticoid and/or anticytokine drugs. Pulmonary artery thrombosis developed in all 19 patients suffering from urgent noninfectious pathology, 11 of whom were under anticoagulant therapy. In 12 of 15 rats in the control group with thrombosis of the posterior vena cava, blood clots were found in the lumen of the pulmonary artery branches. In 14 rats of the main group administered M. edulis hydrolyzate, no blood clots were found in the pulmonary artery branches. Thus, the systemic effects of anticoagulant therapy were offset by the local prothrombotic effects of the vascular wall caused by inflammation. Glucocorticoid and anticytokine drugs did not affect inflammatory changes in the vascular wall and did not prevent pulmonary artery thrombosis. The introduction of M. edulis in the experiment prevented pulmonary artery thrombosis in the presence of posterior vena cava thrombosis, which indicates a promising direction in the search for pathogenetic prevention of this complication.

Recent data highlight a significant role of the gut microbiota in the pathogenesis of chronic kidney disease, particularly in its terminal stage. However, little is known about the features of intestinal dysbiosis in people undergoing programed hemodialysis. Changes in the intestinal microbiota and blood levels of uremic toxins of microbial origin in patients with terminal renal insufficiency receiving hemodialysis were analyzed. This cross-sectional study included 80 patients receiving hemodialysis and 20 individuals with normal kidney function. The state of the microbiocenosis of the colon was studied using a polymerase chain reaction with a commercial set Colonoflor 16 (premium) manufactured by Alfalab (Russia). Serum levels of trimethylamine and its metabolite trimethylamine-N-oxide were determined by liquid chromatography/mass spectrometry. The concentrations of indoxyl sulfate and p-cresyl sulfate were evaluated by enzyme immunoassay according to the instructions of a commercial kit. In patients undergoing programed hemodialysis, increased colonization of enterococci was combined with the reduction of lacto and bifidophlora, E. coli, ruminococci, bacteria producing short-chain fatty acids (Faecalibacterium prausnitzii, Eubacterium rectale, Roseburia inulinivorans, and Blautia spp.) and microorganisms involved in maintaining the integrity of the intestinal barrier (Bacteroides thetaomicron and Akkermansia muciniphila). In addition, high titer levels of representatives of opportunistic and even pathogenic flora were often found in this group. Intestinal dysbiosis in patients undergoing programed hemodialysis was accompanied by a significant increase in the concentration of uremic toxins in the blood. Compared with individuals with normal renal function, the trimethylamine level in patients undergoing programed hemodialysis was increased 22 times; trimethylamine-N-oxide, 23 times; indoxyl sulfate, 21 times; and p-cresyl sulfate, 5 times. Thus, patients receiving hemodialysis exhibited pronounced pathological changes in intestinal microbiocenosis, accompanied by a significant increase in serum levels of uremic toxins of microbial origin.

Currently, women in the Armed Forces of the Russian Federation are trained in higher flight educational institutions, including the Faculty of Fighter Aviation. In 2022, the first issue of female pilots was conducted. However, the existing selection system, including assessment and training of statokinetic stability, is based on male physiological characteristics and does not consider cyclic hormonal changes occurring in a woman’s body during the ovarian–menstrual cycle. Although the practice of allowing women to fly has been practiced for approximately 100 years, studies in the field of tolerability of statokinetic effects by women, including in different phases of the ovarian–menstrual cycle, have shown contradictory results. The tolerability of the statokinetic load by female servicemen in different phases of the ovarian–menstrual cycle was investigated, considering the nature of its course. Sixty-three female servicemen participated in the study. Taking into account the course of the ovarian–menstrual cycle, the patients were divided into three groups. Group 1 (n = 28) had a regular ovarian–menstrual cycle without premenstrual syndrome, group 2 (n = 26) had a regular ovarian–menstrual cycle with premenstrual syndrome, and group 3 (n = 9) were taking combined oral contraceptives. Physiological parameters (blood pressure and heart rate) were recorded before, during, and after the test. The statokinetic load was modeled by performing a rotational test of V.I. Voyachek “otolith reaction-10” in the follicular and luteal phases of the ovarian–menstrual cycle. The tolerability of statokinetic load in groups 1 and 3 in different phases of the ovarian–menstrual cycle were not different. In group 2, the luteal phase of the ovarian–menstrual cycle was characterized by a significant deterioration in the tolerability of the statokinetic load compared with the follicular phase of the ovarian–menstrual cycle and with the luteal phase in groups 1 and 3. In addition, in group 2, in the luteal phase of the ovarian–menstrual cycle, a change in the reactivity of the circulatory system to the presentation of a statokinetic load was noted, manifested by higher heart rates. Thus, the phases of the ovarian–menstrual cycle did not affect the tolerability of the statokinetic load in female servicemen with a regular ovarian–menstrual cycle without premenstrual syndrome and in women taking combined oral contraceptives. In female servicemen with a regular ovarian–menstrual cycle and premenstrual syndrome, the tolerance of statokinetic load was dependent on the phases of the ovarian–menstrual cycle and worsened in the luteal phase.

The provision of state guarantees to citizens with medical care is achieved by compliance with clinical recommendations by medical organizations. However, acute diseases (conditions) caused by excess radiation were excluded from the relevant pathologies for the development of appropriate clinical recommendations. The current events increase the relevance of acute radiation pathology for the healthcare system and determine the high risk of such cases among the personnel of radiation-hazardous facilities and population. The necessity of developing national clinical guidelines for the prevention, diagnosis, treatment, and rehabilitation of acute radiation injury victims is substantiated. Based on an analytical review of the databases of NEB, PubMed, and Medline for 1970 to 2023 on the problem of prevention, diagnosis, treatment, and rehabilitation of individuals exposed to excess radiation and analysis of the regulatory framework governing the process of creating clinical recommendations in the Russian Federation on the provision of medical care to victims of acute radiation injuries, the main terms and their definitions relevant to acute radiation pathology were formulated, which must be unified when developing clinical recommendations. The basic classification of acute radiation lesions is presented, systematizing the variety of possible clinical forms of diseases (conditions) and their etiopathogenetic variants based on the characteristics of the types of ionizing radiation sources and individual characteristics of the conditions of acute radiation exposure. Variants of working clinical classifications of acute radiation lesions based on the generalization of the experience in the country and the world on the systematization of acute radiation pathology were determined. In general, the expediency of developing a group of clinical recommendations for the prevention, diagnosis, treatment, and rehabilitation of acute radiation injuries, covering all the various current clinical forms of diseases caused by excess (uncontrolled, unregulated, emergency) exposure, is justified. The task of determining the current list of diseases (conditions) and groups of diseases (conditions) caused by excessive human exposure in the dose range that can lead to the development of acute radiation lesions is of practical importance both for departmental medicine and the country’s healthcare system.

The study presents the results of the analysis of available literary sources covering the historical and modern aspects of assessing the quality of medical care in the healthcare systems of the Russian Federation and some foreign countries and shows the relevance and feasibility of improving the methodology for assessing the quality of medical care in the Armed Forces of the Russian Federation. At present, many methods are used for assessing the quality of medical care in the healthcare system of the Russian Federation; however, none of them contains an exhaustive set of criteria that would allow assessing the quality of medical care provided in full. In the Armed Forces of the Russian Federation, the methods used to assess the quality of medical care are also not perfect, which leads to a decrease in the effectiveness of management decisions and thereby a decrease in the effectiveness of military medical organizations and units. To this end, active development of assessment indicators and criteria for the quality of medical care, introduction of new assessment methods, including the use of automated data accounting and analysis tools, and improvement of the procedures and standards of medical care are necessary. The most promising area is the use of comprehensive methods for assessing the effectiveness and quality of medical care, which have recently become widespread. Their application provides comprehensive control over compliance with medical care requirements and allows us to investigate the conditions wherein it is indicated, assess the degree of patient satisfaction, and helps optimize the assessment procedure. In addition, to improve the effectiveness, continuity in the implementation of control measures performed at various levels both within the medical organization and with the participation of departmental and state control bodies must be ensured. To do this, close interaction of all control bodies must be organized, and their activities must be integrated into a single quality management system for medical care. The results of the assessment of the quality of medical care can help determine the main directions of the development of the medical and diagnostic process and optimize the work of medical personnel, which increases the importance of work aimed at improving the assessment methodology. In addition, the quality control of medical care in the Armed Forces of the Russian Federation must be further improved.

The main stages of the development of the Russian medical and pharmaceutical industry in 2010 are presented in the context of the dominance of large foreign companies producing medicines and medical devices in the pharmaceutical market. This reflects the political and economic restrictive measures illegally taken against Russia by the European Union, the United States of America, and some other unfriendly countries and has influenced the dynamics of the development of the medical and pharmaceutical industry in our country. To harmonize approaches to the production and quality control of medicines, this paper presents the stages of large-scale reforms on the transition of the Russian pharmaceutical industry to standards of good manufacturing practice and the implementation of state programs aimed at modernizing the industrial segment of the pharmaceutical industry. As part of the improvement of the standardization system of medicines, the study also presents the characteristics of the XIII, XIV, and XV editions of the State Pharmacopoeia of the Russian Federation published during the study period, in the development of which employees of the Military Medical Academy named after S.M. Kirov participated. The role and purpose of the creation of the developed Pharmacopoeia of the Eurasian Economic Union, approved by the Board of the Eurasian Economic Commission, is also reflected in this paper. This article describes the phased implementation of federal target programs, state programs, and other strategic plans and measures of nonfinancial support from the state, which have significantly expanded competencies in the field of development and production of medicines and medical devices and increased their output during the period analyzed. The development of medicines and increasing their production volumes with the help of pharmaceutical clusters, which acted as the “locomotives” of the industry, and various projects in establishing the production of innovative medical products with the help of the Industrial Development Fund, which increased the investment attractiveness of these sectors of the national economic complex, played an important role. The results revealed the essence of the changes concerning the revival of the activities of industrial pharmacies, considering a personalized approach to the treatment of patients. The study also presents an assessment of the Pharmaceutical industry Development Strategy for the period up to 2030.

On February 2, 2024, the prominent Russian morphologist, head of the department of normal anatomy at the Kirov Military Medical Academy to MD, Dr. Sci. (Med.) Professor Ivan V. Gaivoronsky. Ivan V. was born in the town of Kadievka, Voroshilovgrad region, in 1954.

On February 2, 2024, a prominent Russian morphologist, Professor Ivan V. Gaivoronsky became the head of the Department of Normal Anatomy at the Kirov Military Medical Academy to Doctor of Medical Sciences. Ivan V. was born in the town of Kadievka in the Voroshilovgrad region in 1954.

In 1973, after graduating from the Starooskolsky Medical School, he entered the Kirov Military Medical Academy, from which he graduated in 1979 with a gold medal. He then studied in an adjunct course at the Department of Normal Anatomy. After completing his studies and defending his dissertation within the walls of his native alma mater, he worked his way up from a teacher to the head of one of the oldest departments, the Department of Normal Anatomy, which he has headed for 35 years. Professor I.V. Gaivoronsky pays great attention to solving modern scientific problems of morphology: collateral circulation, medical craniology, morphology of a gunshot wound, applied problems according to the needs of surgical practice, study of individual and typical characteristics of the human body, development of innovative technologies for the production and preservation of anatomical preparations for scientific and educational purposes, and improvement of the educational process in the departments of morphological profile and history of anatomy. He created a scientific morphological school, which trained 11 doctors and 63 medical science candidates. Professor I.V. Gaivoronsky is the author of polymer embalming technology, which has radically changed the principle of teaching fundamental medical disciplines. Thanks to the development of numerous innovative areas, numerous scientific studies, and use of the latest equipment in the educational process, the Department of Normal Anatomy of the Kirov Military Medical Academy, under the leadership of Professor I.V. Gaivoronsky, became one of the best methodological and scientific centers in the Russian Federation, dealing with the most pressing problems of modern morphology. For his great contribution to the development of domestic science and the organization of the educational process, Professor I.V. Gaivoronsky was twice awarded the Government of the Russian Federation Prize in the field of education. He was awarded the honorary titles “Honored Scientist of the Russian Federation” and “Honored Worker of the Higher School of the Russian Federation”, Academician of the Russian Military Medical Academy, and Honorary Doctor of the Kirov Military Medical Academy. He was also awarded the Order of Honor and the Medal of the Order for Services to the Fatherland, II degree.

February 22, 2024, marks the 50^th anniversary of Pavel N. Romashchenko, a famous scientist, specialist in the field of endocrine, abdominal surgery, and oncology, corresponding member of the Russian Academy of Sciences, Doctor of Medical Sciences, professor, and colonel of the medical service. For more than 30 years, his life has been inextricably linked with the S.P. Fedorov Faculty of Surgery of the Military Medical Academy names after S.M. Kirov, where he worked his way up from a cadet to the head of the department. In the walls of his alma mater, he evolved into a brilliant clinician, scientist, and leader, defended his doctoral dissertation, and received the title of professor. His fundamental work, as well as scientific research conducted in the clinic under his leadership, substantiated diagnostic and treatment algorithms and expanded the possibilities of using innovative and minimally invasive technologies in endocrine and abdominal surgery. Over the years of P.N. Romashchenko’s leadership of the department and clinic, much has been done to improve it with modern equipment, allowing it to perform various surgical and diagnostic interventions as part of the provision of specialized and high-tech surgical care. P.N. Romashchenko was awarded the honorary title “Honorary Doctor of the Russian Federation”. Under his leadership, 2 doctoral and 10 candidate dissertations were defended. P.N. Romashchenko is the author of more than 460 scientific works, including 14 monographs on various areas of endocrine and abdominal surgery. Currently, Pavel Nikolaevich successfully manages various scientific research as well as training scientific, pedagogical, and medical personnel.