Bulletin of the Russian Military Medical Academy

BACKGROUND: International and Russian guidelines for non-surgical management of liver injuries are based primarily on data from civilian trauma care and the experience of armed conflicts in previous years. However, the question of whether it is possible to use non-surgical management for liver injuries in a Level 3 military field hospital during mass casualty admissions remains relevant.

AIM: To analyze the results of providing medical care in military personnel with liver injuries, including those managed non-operatively, in a Level 3 military field hospital during mass casualty admissions.

METHODS: Upon admission to a Level 3 military field hospital, all patients (n = 159) with gunshot wounds to the liver, including cases with thoracoabdominal and combined wounds, were initially examined by the duty surgeon, followed by physical examination, vital sign monitoring, and standard laboratory and instrumental tests.

RESULTS: The non-surgical management of liver injuries was used in 53 patients (group 1): 31 (58.5%) had a shrapnel penetrating abdominal wounds with isolated liver injury, 12 (22.6%) had thoracoabdominal wounds with right lung and liver involvement, and 10 (18.9%) had combined chest and abdominal wounds with lung and liver involvement. Laparotomy was performed in 45 patients (group 2) with liver injuries but no other abdominal organ damage. Of these, 23 (51%) had thoracoabdominal wounds and 3 (6.6%) had combined chest and abdominal wounds (with lung and liver involvement). A further 61 patients (group 3) had liver injuries with associated abdominal trauma (small and large bowel, kidneys, stomach, gallbladder, spleen, duodenum, or bladder); all underwent laparotomy.

CONCLUSION: These findings support the use of non-operative management for selected liver injuries in a Level 3 military field hospital. Strict adherence to selection criteria can reduce unnecessary laparotomies and optimize resource utilization during mass casualty admissions.

BACKGROUND: The treatment of large post-traumatic tissue defects in the extremities is an urgent problem at the intersection of regenerative medicine, traumatology and orthopedics, and plastic and reconstructive surgery due to the increasing frequency of such injuries, prolonged treatment, and high complication rates.

AIM: To develop a method for filling a large soft tissue and bone defect in the shoulder girdle after a gunshot wound to the upper limb, and to demonstrate the potential of a new method for shoulder joint arthrodesis using autotransplantation and a patient-specific implant made using additive manufacturing (3D printing).

METHODS: A visual analog scale, a brief upper limb disability questionnaire, the Constant–Murley scale, and a specialized scale for assessing shoulder joint condition were used for subjective assessment of treatment outcomes.

RESULTS: After the surgical procedures, all patients (n = 35) had a maximum bone graft length of 16.5 cm, a minimum length of 7 cm, a minimum limb shortening of 0 cm, and a maximum limb shortening of 5.5 cm. After 3 and 6 months, all patients underwent multidetector computed tomography (MDCT) and scintigraphy to monitor the process of bone graft remodeling and the formation of glenohumeral arthrodesis. 18 months after shoulder arthrodesis, the intensity of pain on a visual analogue scale decreased from 8 to 1 point (p < 0.001). Indicators of functional deficit on a brief questionnaire of inability of the upper limb decreased from 85 to 23 points (p < 0.001). A significant improvement was also recorded on the Constant–Murley score, from 8 to 43 points, and on the specialized scale for assessing the condition of the shoulder joint, from 15 to 62 points (p < 0.001), which reflects a significant improvement in the support and strength function of the limb in the absence of active movements in the shoulder joint.

CONCLUSION: Glenohumeral arthrodesis for severe gunshot wounds, implemented as part of a developed protocol, namely: debridement of the lesion site and soft tissue defect reconstruction, planning of bone reconstruction, patient-specific digital modeling, and virtual planning of surgery using patient-specific 3D-printed titanium systems, has shown that controlled interfragmentary compression and reliable integration of the bone graft can achieve high stability and good upper limb function even in extremely complex cases.

BACKGROUND: Due to the active use of modern high-maneuverable aircraft in various regions of the world, there is still a need for medical support for pilots in order to ensure the efficiency and safety of flights. In this regard, it is important to study the reactions of pilots' bodies to the factors of their professional activities. One of the most significant issues is the dynamics of pilots' functional state during the pre-flight period and the severity of their pre-takeoff conditions.

AIM: To assess pilots' pre-flight functional state.

METHODS: The study was conducted in field conditions with the participation of flight personnel who performed flights on modern high-maneuverable aircraft. Physiological and psychophysiological assessments were performed 24 hours before the start of the flight shift and on the day of the flights during the medical preflight examination. Seventeen pilots participated, divided into two age groups: 11 pilots aged 26 to 35 (group A) and 6 pilots aged 35 to 47 (group B).

RESULTS: The change in the functional state of group A pilots during the pre-flight period is characterized by optimal tension of the regulatory systems and a moderate sympathetic shift in the autonomic balance, which corresponds to the pre-takeoff functional state and is considered normal. No similar changes were observed in group B.

CONCLUSION: Young pilots under the age of 35 have a pronounced state of pre-takeoff tension, which may be due to insufficient development of flight skills or psychophysiological preparation for flights. The severity of pre-takeoff tension in pilots may be influenced not only by age and total flight time, but also by the specifics of psychophysiological preparation for flights.

BACKGROUND: In modern published data, there are options for modifying platelet-rich plasma therapy by combining different methods of administration or using it in combination with hyaluronic acid preparations, which has a synergistic effect, but the nature of this interaction is not fully understood. The combined use of platelet-rich plasma with other intra-articular chondroprotectors has also not been sufficiently studied, which necessitates further research.

AIM: To evaluate the effect of various chondroprotectors for intra-articular injection: bioactive extract from small sea fish, chondroitin sulfate, collagen-containing implant, hyaluronic acid, and polynucleotides on the functional activity of platelets in platelet-rich plasma.

METHODS: Platelet-rich plasma was obtained by single centrifugation (415 g, 8 min) of blood from patients with knee osteoarthritis. Samples of preserved venous blood and platelet-rich plasma were subjected to hematological analysis. The samples were then divided into control (platelet-rich plasma) and experimental groups (platelet-rich plasma combined with extract from small sea fish (Ambene® Bio), chondroitin sulfate, collagen-containing implant, hyaluronic acid, and polynucleotides). Platelet aggregation was assessed using the G. Born method modified by Z.A. Gabbasov, and platelet activation was assessed in a calcium-free environment using small-angle scattering.

RESULTS: It was found that only the extract from small sea fish statistically significantly inhibited adenosine diphosphate-induced platelet aggregation, with an amplitude of 54.6% (95% CI 51.9–57.4; p < 0.001), while the other chondroprotectors did not have a significant effect. In this case, the extract from small sea fish demonstrated the most pronounced effect on spontaneous platelet activation, with an amplitude of 26.9% (95% CI 24.4–29.4; p < 0.001), and the maximum increase in the duration of their active state, with an amplitude of 58.4% (95% CI 53.9–62.9; p < 0.001). Chondroitin sulfate, hyaluronic acid, and polynucleotides caused moderate platelet activation, with an amplitude of 14.3%–15%, and its prolongation, with an amplitude of 18.6%–19.2%, without statistically significant differences between them. The collagen-containing implant did not significantly affect the functional activity of platelets.

CONCLUSION: Chondroitin sulfate, hyaluronic acid, polynucleotides, and, to a greater extent, small sea fish extract act as platelet activators in platelet-rich plasma, contributing to the prolongation of this process. The combined use of platelet-rich plasma with small sea fish extract, chondroitin sulfate, hyaluronic acid, and polynucleotides potentially provides a longer exposure of growth factors in the injection site, offering potential for enhancing the effectiveness of local injection therapy.

BACKGROUND: The use of telemedicine consultations in the Armed Forces of the Russian Federation remains high due to the large number of military medical organizations and remote garrisons in Russia and abroad, the lack of experience and knowledge of medical specialists in rare diseases, and the active participation of the Armed Forces of the Russian Federation in modern armed conflicts.

AIM: To evaluate the effectiveness of telemedicine technologies for infectious disease patients in the military healthcare system based on an analysis of requests and protocols for telemedicine consultations, and identify ways to improve them.

METHODS: A retrospective analysis of 3674 requests for telemedicine consultations in 2022–2024 was performed. Based on the results of the final consultation protocols, 560 cases related to infectious pathology were analyzed.

RESULTS: Infectious diseases accounted for 15.2% of consultations. The most common were viral-bacterial pneumonia (37.4%), novel coronavirus infection (12.2%), HIV infection (11%), and hepatitis C (8.8%). More than 35% of patients were in a critical condition, 44.3% in intensive care units. Emergency and urgent consultations accounted for 41.4%. In 44% of cases, telemedicine consultations were conducted to determine treatment strategy, and in 19.3% of cases, to decide whether to transfer the patient to the next stage of medical care. There was an increase in the number of cases of socially significant infections and a decrease in the number of cases of the novel coronavirus infection. A multidisciplinary approach was used in only 32.5% of cases. Among the 136 cases of socially significant infections analyzed, comorbidity accounted for 22.1%.

CONCLUSION: Telemedicine consultations are an effective tool for improving the quality of diagnosis and treatment of infectious diseases, especially in patients in severe condition and in remote garrisons. They provide access to expert knowledge, optimize patient routing, and reduce the risk of complications. It is necessary to expand the multidisciplinary approach and improve early diagnosis at the pre-hospital stage.

The article analyzes available published sources that describe modern aspects of assessing the efficiency of using medical organization resources in the Russian Federation. Today, there are numerous methods and techniques for assessing the efficiency of medical organization resource utilization; however, none of them can be fully applied to a military medical organization operating within the medical evacuation support system of the Armed Forces of the Russian Federation. This is due to the use of the military medical organization's resource base as a stage of medical evacuation under conditions that significantly impact performance indicators that are not taken into account in existing evaluation methods. In order to implement control over the efficiency of the use of resources of military medical organizations in the system of medical evacuation support, it seems most appropriate to conduct a medical-economic assessment by comparing the results of medical activities with the financial costs of achieving them. In addition, it is necessary to develop standard performance indicators for military medical organizations and methods for predicting the magnitude and structure of casualties, in order to calculate and distribute the incoming flow of wounded during their mass admission to the hospital stage of medical evacuation. The results of the medical and economic assessment should serve as the basis for making appropriate management decisions aimed at improving the medical and economic efficiency of using the bed capacity, material resources, and human resources of military medical organizations, and, as a result, improving the quality and efficiency of medical care.

This review analyzes Russian and international published data on the diagnosis and treatment of patients with postoperative ventral hernias. The growing number of such patients reflects the increasing volume of surgical interventions. We summarize the main risk factors and mechanisms of hernia development following surgery, as well as current prevention strategies. Modern diagnostic methods, including computed tomography, are discussed; this imaging modality allows clarification of the number, location, and size of hernia defects, assessment of hernia sac volume, and evaluation of the remaining abdominal cavity capacity to identify patients with complex hernias. For preoperative preparation, techniques using local muscle relaxants and various methods of anterior abdominal wall muscle stretching have been proposed. A wide range of surgical treatment options is available, including minimally invasive techniques. Non-tension alloplastic mesh repair remains the standard of care, with retromuscular and preperitoneal mesh placement—performed via open, endoscopic, or robot-assisted approaches—demonstrating the best long-term outcomes for most postoperative ventral hernias. The integration of advanced surgical technologies, enhanced recovery after surgery (ERAS) principles, patient-reported outcomes, and evidence-based medicine data enables continuous improvement in treatment outcomes. Modern ventral hernia surgery offers effective solutions; however, it requires careful preoperative planning and individualized surgical technique selection for each patient to achieve optimal results. Despite the wide array of available diagnostic, preoperative, and surgical modalities, personalized treatment strategies are essential to improve quality of care, reduce hernia recurrence rates, and minimize complications.

August 21, 2026 marks the 30th anniversary of the death of Professor Tigran Karapetovich Dzharakian (1909–1996), a Major General of the Medical Service. The name of T.K. Dzharakian is inextricably linked with the creation and development of a new scientific field in the Soviet Union: military radiology. The Military Medical Museum has established and maintains a personal archive of Professor T.K. Dzharakian, which allows us to trace the career trajectory of this scientist, who was instrumental in establishing the Research Institute of Military Medicine, and to appreciate his organizational skills and contributions to science. T.K. Dzharakian began his career as a locksmith's apprentice, worked on the construction of the Rostselmash plant, and later served in the Red Army. According to his own recollections, the image of the physiologist I.P. Pavlov captured his imagination and determined his future career choice. Dzharakian's exceptional personal qualities—including his immense work ethic, modesty, determination, integrity, high level of organization, and exacting standards for his subordinates, as well as his perseverance in seeing tasks through to completion—were instrumental in shaping his scientific worldview and his multifaceted career as a leader. T.K. Dzharakian graduated from the S.M. Kirov Military Medical Academy of the Workers' and Peasants' Red Army, completed his postgraduate (adjunct) training, defended his dissertation, and worked at the Department of Normal Physiology. He then began his productive work at the Research Problem Laboratory of the S.M. Kirov Military Medical Academy, where his talent as a scientist and administrator—and his role as one of the founders of military radiology in the Soviet Union—was fully revealed.