Bulletin of the Russian Military Medical Academy

Scientific-practical edition “Vestnik of Russian military medical Academy” is published quarterly. The journal is included in the list of leading reviewed scientific magazines and editions in which should be published basic scientific results of dissertations on competition of a scientific degree of doctor and candidate of Sciences.

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Vol 23, No 2 (2021)

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Clinical trials

Possibilities of the efficiency and safety control of rivaroxaban application in patients with atrial fibrillation
Kryukov E.V., Prokofiev A.B., Danko A.A., Dmitriev A.I., Melnikov E.S., Rodina T.A., Belkov S.A.

The results of a study of the concentration of rivaroxaban in the peripheral blood in patients with atrial fibrillation, receiving different doses of rivaroxaban, as well as in the case of developing hemorrhagic complications, are presented. 65 patients admitted for treatment for atrial fibrillation were examined. As an anticoagulant drug, rivaroxaban was prescribed at a dose of 15 or 20 mg once a day, depending on the state of renal function. The patients were divided into 3 groups depending on the prescribed dose of rivaroxaban and the presence or absence of hemorrhagic complications. At the same time, each patient underwent therapeutic drug monitoring of the drug. It was found that in patients, who received rivaroxaban at a dose of 15 mg, in 35% of cases its concentration in the blood was below the average minimum values. In patients, who received the drug at a dose of 20 mg, in 16% of cases its concentration in the blood serum exceeded the average maximum values. Patients treated with 15 mg of rivaroxaban lacked any hemorrhagic complications. In the group of patients with advanced hemorrhagic complications who received rivaroxaban at a dose of 20 mg, its serum concentration at all stages of therapeutic drug monitoring was significantly higher than the average maximum values and more than 4 times higher than in the control group (without hemorrhagic complications). The results of the study indicate the advisability of conducting therapeutic drug monitoring with the determination of rivaroxaban concentrations in the blood serum of patients receiving the drug, especially when they develop hemorrhagic complications.

Bulletin of the Russian Military Medical Academy. 2021;23(2):9-16
pages 9-16 views
Dynamics of endogenous interferon-alpha and -gamma production under the influence of ingaron therapy in patients with chronic epstein – barr viral infection with chronic fatigue syndrome
Rakityanskaya I.A., Ryabova T.S., Kalashnikova A.A., Manuilov A.S., Bel'skikh A.N., Apchel A.V.

The influence of antiviral therapy with ingaron on the dynamics of production of interferons α and γ and clinical effects in patients with chronic viral Epstein – Barr infection was studied. The study involved 51 patients (33 women and 17 men aged 35,27 ± 1,28 years) suffering from chronic infection caused by the Epstein – Barr virus. The duration of the disease from the appearance of the first complaints to laboratory confirmation of the Epstein – Barr virus infection and diagnosis was 2,23 ± 0,21 years. Determined the serum, spontaneous and induced production of cytokines interferons α and γ in serum and in the culture of lymphocytes. Three months after the end of antiviral therapy, in patients with an initially low level of induced interferon-γ, the production of interferon-γ increased. The absence of an increase in the production of induced interferon-γ in patients one and three months after the end of therapy with ingaron indicates the absence of the effect of the drug on the level of endogenous interferon-γ. It has been established that the initially low level of induced interferon-γ can be a marker of the positive effect of the therapy with ingaron. Correlation analysis revealed the effect of baseline interferon-γ induced on the clinical picture of the disease. Thus, initially a high level of induced interferon-γ (2706 ± 1058.94 pg/ml) inversely affects the development of sweating in patients (r = –0.506, p = 0,023; τ = –0.419, р = 0.021), and initially low level of the induced IFN-γ (287.2 ± 64.65 pg/ml) — on development of weakness (r = –0.405, р = 0.045; τ = –0.419, р = 0.037). In general, ingarone can be used in the therapy of patients with chronic Epstein virus — Bar infection at a dose of 500,000 IU every other day, at least 10 injections.

Bulletin of the Russian Military Medical Academy. 2021;23(2):17-28
pages 17-28 views
Characterological profile of cadets of the naval educational institution as an indicator of their professional adaptation
Zaitsev A.G., Soshkin P.A., Zabrodsky D.S.

A 2-stage comprehensive psychological and physiological examination of freshmen of a higher naval educational institution was carried out. At the first stage, characteristic profiles of cadets were determined. At the second stage, the identified characteristic profiles were correlated with the traditional criteria for military-professional adaptation. It was found that the most often examined young men (according to the Leonhard – Schmiszek technique) have such character accentuations as hypertimicity (81.8%) and demonstrability (53.1%), less often — stuck (39.3%), pedanticity (19.6%), emotion (18.2%), exaltation (15.4%), and even less often — cyclothymic (8.4%), excitability (7.7%), anxiety (2.8%) and dysthymic (2,1%). Cadets assigned to the “passive-aggressive” stereotype group manage worse in the main disciplines than cadets from other groups. Cadets with “passive-aggressive” stereotype have lower academic performance as compared to other groups. They have lower expert scores in discipline, neuropsychic stability, communication skills, credibility in a team and level of general culture. In addition, in cadets of this group, the mobility of the main nervous processes at the level of the motor analyzer is somewhat lower to the comparison group. The study showed that the characterological features in the form of mixing or opposing accentuations of characters revealed in cadets play in favor of their personal development, health and successful study only in about 20–40% of cases. In other cases, these character features do not contribute to this and can develop into personal disorders incompatible with military service during the training process. Based on the results of the study, psychological and pedagogical tasks were formulated to improve the system of selecting of cadets for naval educational institutions and to improve their professional education.

Bulletin of the Russian Military Medical Academy. 2021;23(2):29-38
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Intraoperative seizures occurrence in cortical mapping of eloquent areas
Toporkova O.A., Aleksandrov M.V., Tastanbekov M.M.

The effect of structural epilepsy on the frequency of intraoperative convulsive seizures is assessed when mapping functionally significant areas of the cerebral cortex during resection of intracerebral neoplasms. The work is based on the analysis of the results of intraoperative neurophysiological studies at the Polenov Neurosurgical Institute. For the period 2019–2020 87 intraoperative mappings of eloquent cortex were carried out during resections of intracerebral neoplasms: 79 mappings of the motor cortex and 16 mappings of auditory-speech areas during operations with awakening. When mapping the motor zones of the cortex, the frequency of seizures was 5.1%, while mapping the auditory-speech zones with awakening — 18.75%. The division of cases of intraoperative convulsive seizures into two groups: seizures arising from motor mapping and seizures associated with the mapping of auditory zones — reflects differences in factors that affect the excitability of the cerebral cortex. In motor mapping, stimulation occurs against the background of general anesthesia, unlike waking operations. The intensity of stimulation in auditory mapping is higher than in motor mapping in motor mapping. Formally, the current used in motor mapping is significantly higher than in mapping auditory zones. In general, with the development of intraoperative convulsive seizures, the current intensity of cortical stimulation does not exceed the average values required to stimulate functionally significant cortical zones. The presence of epileptic syndrome in patients with intracerebral tumors cannot be considered as a predictor of intraoperative seizure development when performing motor mapping under general anesthesia as well as during surgery with awakening for mapping of motor or auditory verbal zones.

Bulletin of the Russian Military Medical Academy. 2021;23(2):39-44
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Revealing of propensity to development of stress-induced somatic diseases in military university cadets based on psychophysiological, psychological and psychosocial characteristics
Zelenina N.V., Fedotkina I.V., Nazarov S.S., Yusupov V.V.

It was found that the frequency of stress-induced somatic diseases in cadets during 4–5 training years increased from 0 in the I cours to 10% in the V–VI courses. The first place in frequency is occupied by diseases of the digestive system (K00–K93 according to the International Statistical Classification of Diseases and Related Health Problem 10th revision), during the training their level increased from 0 to 7.3%. Diseases of the circulatory system (I00–I99) increased to 2.7%. Based on the psychophysiological, psychological and psychosocial indicators of the surveyed cadets, a discriminant analysis was performed and a linear classification function model for predicting the propensity to stress-induced somatic diseases was obtained. The model is statistically significant, the percentage of correct classifications is 95.8%, that indicates a good separation ability of this model. The stability of the model indicators during the entire training period is shown, so that makes it possible to use it as a prognostic model and apply to identify propensity of the junior cadet to developing stress-induced somatic diseases. Timely identification of cadets who are prone to developing stress-induced somatic diseases and personalized approach to psychological correction will contribute to the prevention of somatic health disorders, the increasing of efficiency and reliability of activity and the professional longevity of future military specialists. The indicators included in the model shows that the propensity to stress-induced somatic diseases is determined by both innate features (the speed of nervous processes and the ratio of inhibition and stimulation in the central nervous system, typological properties of the personality), and acquired skills of social behavior (coping models and psychosocial characteristics of the personality), as well as stress-induced neurotic manifestations which accumulated in the process of personal development. Psychological correction should be aimed at awareness and self-disclosure of their personal characteristics while developing the desired behavioral and social interaction skills, as well as training in mental self-regulation skills.

Bulletin of the Russian Military Medical Academy. 2021;23(2):45-52
pages 45-52 views
Otorhinolaryngological contusions in mine-explosive injury
Gorokhov A.A., Mironov V.G., Kasatkin A.N., Baytemirova N.N., Koroleva K.Y.

Modern trends in the conduct of military conflicts dictate their own characteristics of the formation of the size and structure of sanitary losses of the otorhinolaryngological profile. Combat trauma to the organ of hearing is characterized not only by an increase in the total number of sanitary losses, but also by various features of the course of the wound process. The organ of hearing, with the development of weapons, becomes an increasingly unprotected and vulnerable area of impact of mine explosive weapons. However, such important characteristics as treatment, duration, and outcomes of ear, throat, and nose contusions are not sufficiently presented for adequate organization of medical support. Otorhinolaryngological contusions were considered in the total mass of contusion sanitary losses with a predominance of closed brain injury and often without taking into account otorhinolaryngological contusions. Victims completed treatment in separate medical battalions, hospitals and wards for the lightly wounded. The number of injured by shrapnel and concussion increases with the use of explosive weapons, due to an increase in associated wounds. The experience of the Great Patriotic War showed that otorhinolaryngological shell-shocked patients in frequency account for about 32.5% of all shell-shocked, therefore, in 67.5% of the remaining shell-shocked otorhinolaryngological contusions were concomitant, the main manifestation of the trauma was a closed brain injury. Otorhinolaryngological shell-shocked patients are a special case of general contusion or concussion-contusion syndrome from the direct impact of a sharp drop in air pressure during explosions. The leading manifestation of otorhinolaryngological contusion syndrome is vestibular and auditory disorders, decreased hearing acuity with a whole eardrum, which occurred in all victims. There were also neurological abnormalities such as short-term loss of consciousness, dizziness, fading nystagmus, stuttering, etc., which subsided a few days after the start of conservative therapy.

Bulletin of the Russian Military Medical Academy. 2021;23(2):53-58
pages 53-58 views
Psychological status of elderly patients suffering arterial hypertension in metabolic syndrome against the background of chronotherapy
Agarkov N.M., Okhotnikov O.I., Korneeva S.I., Moskaleva E.O., Moskalev A.A., Kolomyets V.I., Markelova A.M.

Arterial hypertension in the metabolic syndrome in the elderly contributes to the formation of cognitive disorders and anxiety-depressive disorders. It is shown that the severity of these deviations of the psychological continuum significantly decreases after 1 year, under the influence of an antihypertensive fixed combination of amlodipine, mesinopril and rosuvastatin in the chronotherapy mode (evening reception), than in the traditional application (morning reception in the equivalent dosage of 5/10/10 mg per day in both cases. The dynamics of cognitive impairment in chronotherapeutical approach in patients 60–74 flights from arterial hypertension with metabolic syndrome is characterized by a significant increase in the average score on a scale MMSE, f source 17.8 ± 0.3 to 23.5 ± 0.4 points (р < 0.001), against 16.9 ± 0.3 to 20.4 ± 0.4 points (р < 0.001) in the morning taking the drug. Situational anxiety decreased from 40.8 ± 2.2 to 30.6 ± 1.8 points (р > 0.05) and from 40.0 ± 2.5 to 32.1 ± 2.0 points (р > 0.05), personal anxiety from 48.8 ± 2.0 to 25.4 ± 1.9 (р < 0.001) and from 44.9 ± 1.9 to 30.7 ± 1.7 (р < 0.01) points in the evening and morning the reception, respectively. Depressive disorders decreased slightly more significantly in chronotherapy (14.1% vs. 7.7%) than in the traditional scheme, but despite this, both cases with (groups) corresponded to depressive spectrum disorders. The results obtained indicate that chronotherapy is more effective than the traditional use of a fixed combination of amlodipine, lisinopril and rosuvastatin in arterial hypertension with metabolic syndrome.

Bulletin of the Russian Military Medical Academy. 2021;23(2):59-66
pages 59-66 views
Prevention of hemorrhagic complications during hybrid interference in the sleepy and coronary arteries under conditions of hypo-agregation and hypocaagulation
Kazantsev A.N., Chernykh K.P., Baghdavadze G.S.

Hemorrhagic complications in patients after hybrid interventions including percutaneous coronary intervention and carotid endarterectomy are analyzed. Demonstrate a new method of hemostasis and wound drainage after carotid endarterectomy. It was found that at the preoperative stage, the coagulogram parameters were within the normal range, but the aggregatogram showed hypoagregation for two of the four inducers in all 84 operated patients. After the completion of the second stage of revascularization, the absolute partial thrombosed time in all patients was five to six times higher than normal in the coagulogram parameters. According to the aggregatogram, there was a total hypo-aggregation. All acute hematomas after carotid endarterectomy requiring revision were formed in patients with the traditional method of hemostasis and wound drainage after carotid endarterectomy (p = 0.038), which was associated with more frequent damage to the cranial nerves (p = 0.0002). Thus, the combined endpoint, including the indicator of cranial nerve damage + acute hematoma in patients with the traditional method of hemostasis and wound drainage after carotid endarterectomy, significantly exceeded it in patients who used a new tactic (local hemostatics with minimal electrocoagulation and installation of two drains in the paravasal and clitoral space) (p < 0.0001). There were no cases of wound complications in the area of carotid endarterectomy. Thus, the new technique of hemostasis and wound drainage after carotid endarterectomy against the background of hypocoagulation and hypoagregation has shown its effectiveness and preventive role in the prevention of hemorrhagic complications, damage to the cranial nerves.

Bulletin of the Russian Military Medical Academy. 2021;23(2):67-74
pages 67-74 views
A new molecular-genetic panel in the algorithm of diagnosis and treatment in patients with tiroid nodules
Romashchenko P.N., Maistrenko N.A., Krivolapov D.S., Simonova M.S.

The increase in the number of patients with thyroid nodules requires the development of the most effective methods of preoperative diagnosis, allowing timely detection and differentiation of follicular neoplasia and highly differentiated cancer. A comprehensive study was carried out, which made it possible to optimize the diagnosis and choice of therapeutic tactics in patients of this category through the use of a new molecular genetic panel. Results of examination and surgical treatment of 60 patients suffering from benign and malignant thyroid gland formations are analyzed, pre-operative diagnosis of which was supplemented by immunocytochemical and molecular genetic methods of studying cellular material obtained during fine-needle aspiration biopsy. The threshold value of the Galektin-3 expression level for the differential diagnosis of follicular neoplasia in the direction of adenomas or well-differentiated thyroid cancer was determined. The significance of the BRAF V600E gene mutation in the detection of papillary thyroid cancer, the features of its clinical course and the determination of rational surgical tactics was proved. The limit value of the sodium-iodide symporter for predicting the resistance of thyroid cancer to radioactive iodine therapy, which determines the need to expand the scope of surgical intervention, has been established. The place of these molecular genetic markers in the algorithm of diagnosis and treatment in patients with thyroid nodules was determined.

Bulletin of the Russian Military Medical Academy. 2021;23(2):75-82
pages 75-82 views
Cognitive and anxiety-depressive disorders in patients with age-related macular degeneration and cataracts
Agarkov N.M., Yablokov M.M., Konyaev D.A., Popova N.V.

Cognitive impairment and anxiety-depressive disorders in patients with age-related macular degeneration and cataract of old age are considered. 125 patients 60–74 years old suffering from age-related macular degeneration combined with cataract were examined at the Tambov branch of the interdisciplinary scientific and technical complex "Eye Microsurgery named after Academician S.N. Fedorov". 74 patients of similar age without age-related macular degeneration served as controls. Anxiety was assessed by the Spielberger – Hanin questionnaire, depressive status by the "Center for Epidemiological Studies — Depression scale". The validity of the differences was determined by the Mann – Whitney's U-criterion. It was established that among elderly patients suffering from age-related macular degeneration combined with cataract, cognitive deficits, an average level of personal anxiety, a significant specific gravity with an average level and an increased level of personal anxiety, depressive disorders, and in the control group — a low level of anxiety and the absence of generally depressive disorders. Therefore, age-related macular degeneration increases the incidence of cognitive and anxiety-depressive impairment, and patients suffering from this ophthalmic pathology need geriatric examination and correction of cognitive and anxiety-depressive impairment. In general, macular degeneration is the leading cause of vision loss in old age and can contribute to the development of cognitive and anxiety-depressive disorders, which are practically unexplored among this contingent.

Bulletin of the Russian Military Medical Academy. 2021;23(2):83-90
pages 83-90 views
Surgical treatment of the consequences of a gunshot wound to the lumbar spine using endoscopic techniques
Bulyschenko G.G., Gayvoronsky A.I., Liev P.S., Kuznetsov M.V., Svistov D.V.

A clinical case of treatment of a patient with long-term consequences of a gunshot wound to the lumbar spine with a follow-up period of fifteen years is presented. In the last year and a half, the repeatedly recurrent retroperitoneal phlegmon associated with a foreign body of the lumbar spine has prompted a decision on the issue of surgical treatment (removal of a foreign body - a bullet). The location of the foreign body and previous experience with endoscopic foreign body removal played a decisive role in the choice of surgical tactics. Removal of the wounding projectile was performed using a percutaneous transforaminal endoscopic approach. The choice of such an approach was dictated by the peculiarity of the location of the foreign body (coaxial with the endoscopic tube in the foraminal approach), as well as sufficient experience in using the technique of percutaneous endoscopic surgery. At the same time, the conversion plan was worked out in sufficient detail with both posterolateral and anterior open approaches with the involvement of appropriate specialists. So, in case of failure, it was planned to transfer endoscopic access to “open,” using the already installed working tube of the endoscope as a conductor to a foreign body. In case of inefficiency, for some reason, this version of the operation was planned for the next, third stage: wound suturing, patient turning on the back with a right-hand retroperitoneal approach to the anterior-lateral surface of LI and LII bodies. Fortunately, the purpose of the operation was achieved using the most gentle version of the allowance. The given clinical case testifies that the technique of percutaneous transforaminal endoscopic surgery is not limited in indications to the treatment of degenerative-dystrophic diseases of the spine.

Bulletin of the Russian Military Medical Academy. 2021;23(2):91-98
pages 91-98 views
Diagnosis and t-staging of gastric cancer: comparison of standard computed tomography and computed-tomographic pneumogastrography
Amelina I.D., Shevkunov L.N., Karachun A.M., Mikhnin A.E., Nesterov D.V.

The advantages of computed tomographic pneumogastrography with the possibility of three-dimensional visualization and virtual gastroscopy in diagnosing gastric cancer are considered. The study included 479 patients with histologically diagnosed gastric cancer who were treated at the National Medical Research Center of Oncology named after N.N. Petrov from 2011 to 2018. 232 patients received preoperative chemotherapy. All patients underwent surgery: 70 —in the volume of endoscopic dissection, 40 — proximal subtotal resection, 166 — distal subtotal resection, 203 — gastrectomy. All patients at the preoperative stage underwent staging computed tomography on a 64-slice X-ray computed tomograph: 208 patients underwent computed tomography according to the standard protocol without targeted preparation of the stomach for the study, 271 patients with targeted preparation of the stomach for the study according to the computed tomographic pneumogastrography protocol. The sensitivity of the computed tomography in assessing the T-stage was assessed by comparison with pathomorphological data. Of the 208 patients who underwent computed tomography according to the standard protocol, a gastric cancer was detected in 111 (53.4%), out of 271 patients who underwent computed tomography pneumogastrography, a gastric cancer was detected in 267 (98.52%), which is a statistically significant difference in comparing computed tomography methods (Pearson, χ² — 144.223, df = 1; p < 0.001). There are statistically significant differences when comparing computed tomography according to the standard protocol and computed tomographic pneumogastrography in detecting gastric cancer for all tumor categories: T/yT1 — 8.2 and 94.4% (Pearson, χ² — 99.205, df = 1; p < 0.001), T/yT2 — 47.8 and 100% (Pearson, χ² — 24.681, df = 1; p < 0.001), T/yT3 — 72.3 and 100% (Pearson, χ² — 33.114, df = 1; p < 0.001), T/yT4 — 90.0 and 100% (Pearson, χ² — 4.789, df = 1; p = 0.029) respectively. There are also statistically significant differences when comparing the sensitivity of computed tomography according to the standard protocol and computed tomographic pneumogastrography in determining tumor invasion for all tumor categories: T/yT1 — 0 and 69.4% (Pearson, χ² — 67.880, df = 1; p < 0.001), T/yT2 — 26.1 and 71.1% (Pearson, χ² — 11.666, df = 1; p < 0.001), T/yT3 — 32.9 and 84.6% (Pearson, χ² — 54.900, df = 1; p < 0.001), T/yT4 — 73.3 and 95.7% (Pearson, χ² — 7.916, df = 1; p = 0.005) respectively. In general, the sensitivity of the computed tomography according to the standard protocol for determining the T-stage of gastric cancer was 28.4%, computed tomographic pneumogastrography — 77.1% (Pearson, χ² — 113.505, df = 1; p < 0.001). Computed tomographic pneumogastrography with the possibility of three-dimensional visualization and virtual gastroscopy significantly increases the indicators of the effectiveness of diagnosing gastric cancer — both early forms (category T1) and with deeper invasion (categories T2–T4), demonstrates high sensitivity in determining T/yT-stages.

Bulletin of the Russian Military Medical Academy. 2021;23(2):99-106
pages 99-106 views

Experimental trials

Influence of sexual cycle phases on cognitive abilities and physical endurance
Filippova E.B., Lesova E.M., Murgaeva N.V.

We researched the dependence of cognitive abilities, mostly connected to functions of right and left hemispheres, and physical endurance on phases of sexual cycle. We discovered that on the first day of the cycle the number of correct tasks, connected with functions of the right hemisphere, was bigger than in the middle of the cycle, while no difference was detected in tasks, connected with functions of the left hemisphere. In the beginning of the cycle all test subjects correctly answered more "right hemisphere" questions, than during the ovulation phase, in the middle of the cycle the majority of test subjects correctly answered more "left hemisphere" tasks. We assume that sexual steroids moderate functional differences, connected with functions of right and left hemisphere. Precisely, low level of sexual steroids in the beginning of the cycle helps to activate functions of the right hemisphere, while steroids’ concentration in the middle of the cycle stops those functions. The level of heartbeat under the physical load was bigger in the luteal phase than before the ovulation; with the increase of load the heartbeat decreased before the ovulation and increase in the luteal phase. We assume that increased content of estrogens before the ovulations lead to decrease in physical endurance, while the decrease of concentration of estrogens in the luteal phase increased this endurance. Therefore, influence of sexual steroids helps to activate functions, which characterize specific psychological and physical status of women sex, particularly verbal abilities, lower abilities for visual analysis, and lower physical endurance of women.

Bulletin of the Russian Military Medical Academy. 2021;23(2):107-112
pages 107-112 views
Differential types of reflexivity in young people against the backdrop of the COVID-19 epidemic
Ulyukin I.M., Prezhogin S.A., Kovalishin I.M.

Differential types of reflexivity (as human activities aimed at understanding their own actions) were studied in 66 persons against the background of the COVID-19 epidemic in order to effectively carry out medical, psychological and social interventions in order to maintain epidemiological well-being in society during the current epidemic. It was established that in all examined persons the indicators of scales, the methodology used do not significantly differ from the data obtained earlier by its authors. The surveyed contingent is reliably dominated by systemic reflexion (the indicators of which are comparable to those of those years when there were no such significant global shocks) with a lower (compared to the control group) level of introspection and quasi-reflexion. The bigger variability of data, received by D.A. Leontyev and E.N. Osin, in comparison with our data is caused probably by temporary aspect, various professional contingent of the examined persons, and the relevant processes flowing nowadays in society. Thus, the absence of significant differences from the data obtained earlier is probably due to the cultural and age characteristics of the examined. This indicates the possibility of adequate medical and psychological support for this category of persons against the background of the current COVID-19 pandemic.

Bulletin of the Russian Military Medical Academy. 2021;23(2):113-118
pages 113-118 views
Development of technology for producing essential fatty acids from hydrolysates of high-fat fish
Kuprina E.E., Grishina E.S., Yakkola A.N., Manuilov A.N., Demidov P.I., Ivnenko Y.G.

The technology for obtaining biologically active substances of a lipoid nature, enriched with omega-3 acids, from waste from the processing of hydrobionts by means of electrochemical hydrolysis and cryoconcentration has been developed. A comparative analysis of the composition of wastes from cutting herring and trout is carried out, and the expediency of their use for obtaining biologically active substances of a lipoid nature is shown. A technological scheme has been developed and fat yields have been determined when it is obtained from fish waste by an electrochemical method. The fatty acid composition of the fat obtained by the electrochemical method has been determined. It was found that cryoconcentrated fat obtained from wastes from trout and herring cutting by the electrochemical method has a significantly increased content of omega-3 acids and, accordingly, biological value compared to edible and medical fish oil from the liver of the cod family. It was found that during cryoconcentration, the concentration of polyunsaturated fatty acids increases, reaching values close to 90%, which allows the resulting product to be classified as biologically active additives. It was shown by calculation that to create functional fish-based food products from fish of the salmon family, it is sufficient to introduce 4 g of the obtained biologically active additive per 100 g of the product. There is also an improvement in the organoleptic properties of foods from lean fish species. It has been shown that in order to meet 30% of the recommended daily intake of omega-3 acids in the development of functional food products based on rainbow trout and Atlantic herring, it is necessary to introduce 1.98 g and 1.8 g of cryoconcentrated fish oil. After encapsulation in nanocapsules, the drug will be suitable for enrichment with omega-3 acids in any food products, which is the subject of further research.

Bulletin of the Russian Military Medical Academy. 2021;23(2):119-130
pages 119-130 views
Experimental evaluation of the radiomodifying efficiency of low-intensity electromagnetic radiation in acute x-ray irradiation of mice
Kokaya G.N., Kokaya A.A., Kozyakov V.P., Zavirsky A.V., Zatsepin V.V., Basharin V.A., Tsygan V.N., Mavrenkov E.M.

It was found that acute exposure to ionizing radiation at doses of 7.5 and 8 Gy leads to the development of bone marrow syndrome of acute radiation sickness in mice. On the 7th day after exposure at doses of 7.5 Gy and 8 Gy, the mortality rate of animals was 66.7%, on the 10th day 83.3 and 86.7%, and by the 14th day it reached 91.7 and 100%, respectively. Prophylactic exposure to electromagnetic radiation from a helium-neon laser modulated with preparations with the tissue of the hypothalamic structures of the brain, spleen and bone marrow of a newborn mouse (P1-4) before X-ray irradiation at doses of 7.5 and 8 Gy contributed to a decrease in the mortality of animals from acute radiation sickness during the first 14 days, which was 28.6 and 50%, respectively. However, with this method of protective action, by the 22nd day after the radiation damage of 7.5 Gy, the mortality rate reached 64.3%, and 8 Gy-90%. On the contrary, with a therapeutic and preventive method of exposure to electromagnetic radiation by a helium-neon laser modulated by drugs with tissue from hypothalamic structures of the brain, spleen and bone marrow of a newborn mouse (R1-4) after a radiation lesion at a dose of 7.5 Gy, the mortality on the 25th day was 23.3%, and 8 Gy — 30% and remained at this level for more than 30 days. We believe that the increase in the resistance of mice to ionizing radiation and the different nature of the course of acute radiation sickness with preventive and therapeutic methods of exposure is due to several factors. On the one hand, it is the realization of antihypoxic, antioxidant effects when exposed to electromagnetic radiation modulated by drugs with tissue from hypothalamic structures of the brain, spleen and bone marrow of a newborn mouse. On the other hand, the effect of electromagnetic radiation modulated by the preparation of the bone marrow and spleen of a newborn mouse has a cytoprotective effect on the bone marrow cells of mice with acute radiation sickness. It is also possible that this effect contributes to adequate neuroimmune regulation in the development of acute radiation sickness in mice.

Bulletin of the Russian Military Medical Academy. 2021;23(2):131-138
pages 131-138 views

Public Health

Medical and statistical indicators of injuries among servicewomen in the armed forces of the russian federation (2003–2019)
Khominets V.V., Evdokimov V.I., Sivashchenko P.P., Vetoshkin A.A., Ivanov V.V.

To analyze the rates of injuries in servicewomen in the Russian Armed Forces with injuries in the leading groups for 17 years (2003–2019). We conducted a selective statistical analysis of reports on the health status of personnel in the form 3/MED of military units, in which about 80% of the total number of servicewomen served. Injury rates by medical statistic reporting were correlated with the 19th-grade groups «Injury, poisoning and certain other consequences of external causes» (S00–T98) by the International Statistical Classification of Health-Related Diseases and Problems, 10th Review. The average annual rate of injuries (primary incidence) of servicewomen in 2003–2019 was 11.70 ± 0.82‰, its share in the structure of primary morbidity for all classes of International Statistical Classification of Health-Related Diseases and Problems, 10th Review was 1.7 ± 0.2%, hospitalizations — 6.89 ± 0.54‰ and 2.5 ± 0.2%, days of labor-loss — 239.5 ± 17.8‰ and 3.7 ± .3%, dismissal 0.11 ± 0.02‰ and 1.2 ± 0.2%, mortality rate 22.87 ± 4.41 per 100,000 servicewomen and 18.0 ± 1.6%. The dynamics show a decrease in the level and proportion of injuries in the statistical reporting analyses. The most pronounced injuries in servicewomen were with knee and lower leg injuries (International Statistical Classification of Health-Related Diseases and Problems, 10th Review Chapter XIX, block 9, S80–S89), ankle and foot injuries (block 10, S90–S99), wrist and hand injuries (block 7, S60–S69), head injuries (block 1, S00–S09), elbow and forearm injuries (block 6, S50–S59). The structure of the types of injuries to the areas of the body is presented. Conducted military-epidemiological evaluation of the negative impact of injuries on the health of servicewomen. The found medical and statistical indicators of traumatism can determine the safe conditions of activity, prevention of injuries, health-improving and rehabilitation measures among servicewomen.

Bulletin of the Russian Military Medical Academy. 2021;23(2):139-154
pages 139-154 views
Analysis of statistical indicators of the population of Saint Petersburg with malignant neoplasms of pancreas
Moiseenko V.E., Pavlovsky A.V., Granov D.A., Kochorova L.V., Dodonova I.V., Khizha V.V., Yazenok A., Yakovenko T.V.

Morbidity and mortality from pancreatic cancer is an urgent medical and social problem. Evaluation of statistical indicators in dynamics makes it possible to identify organizational and clinical problems in providing care to patients with malignant neoplasms of the pancreas. Medical and statistical indicators of incidence of malignant pancreatic neoplasms in St. Petersburg residents are evaluated. The assessment of medical and statistical indicators of the incidence of malignant neoplasms of the pancreas in residents of St. Petersburg. Statistical data were studied for the period from 2014 to 2019. The increase in the "rough" indicator of primary morbidity changed from 417.99 per 100 thousand population in 2014 to 505.6 in 2019. In the structure of primary cancer incidence, the indicator of active detection of pancreatic cancer glands in 2014 amounted to 3.6%, in 2019 — 3.8%. The proportion of patients with diagnoses confirmed morphologically increased from 48.9% to 61.4%. The proportion of patients with newly diagnosed stage IV of the disease changed from 39.5% in 2014 to 51.4% in 2019, and in patients with stage III in 2019 it was 33.3% (a decrease in comparison with 2014 — 15.3%). In 2019, the disease was diagnosed at stage II in 15.2% of patients. The proportion of patients with stage I in 2019 was 6.6%, this indicator in 2014 was registered at the level of 19.2%. From 2014 to 2019, the one-year mortality rate did not change and amounted to 67.9 and 67.4%, respectively (the decrease was 0.7%). Over the past 5 years, there has been no significant downward trend in the "rough" incidence and mortality rates from pancreatic cancer. However, in the dynamics, there was an increase in the number of patients registered for 5 or more years, and an increase in the accumulation index of the contingent of patients with pancreatic cancer.

Bulletin of the Russian Military Medical Academy. 2021;23(2):155-164
pages 155-164 views


The main pathogenetic mechanisms of hypercoagulation in diabetes and the possibility of its drug correction
Kryukov E.V., Kuchmin A.N., Umanskaya E.P., Nagorny M.B., Shevelev A.A.

Disorders in the blood coagulation system play an important role in the development of cardiovascular pathology in diabetes. Factors that cause them are hyperglycemia, insulin deficiency, insulin resistance, dyslipidemia, oxidative stress. The most significant changes are observed in the vascular-platelet link of hemostasis. Diabetes is characterized by morphological and functional changes in the endothelium of blood vessels. The activity of platelets increases, which is manifested by their high level of spontaneous aggregation and increased sensitivity to the action of activating factors. The role in the disturbance of hemostasis is played by increasing the activity of the von Willebrand factor, reflecting damage to endothelial cells. Diabetes is characterized by an increase in the activity of plasma clotting factors (I, II, III, VII, VIII, IX, XI, XII and XIII), activation of the callicrein-kinin system. In some cases, this correlates with the development of complications of diabetes. Characteristic disorders in the coagulation inhibition system are a decrease in the activity of antithrombin III, reduced formation of thrombin-antithrombin complexes, reduction of thrombomodulin and protein C. In diabetes, there is a decrease in fibrinolysis, due to a decrease in the expression of tissue activator plasminogen and an increase in the level of the inhibitor of the activator plasminogen. The possibilities of drug correction of hypercoagulation factors in diabetes are to achieve glycemic control with sugar-reducing drugs and elimination of dyslipidemia through hypolipidemic therapy. The most well-studied sugar-lowering drug that improves the state of the blood clotting system is metformin. The system of hemostasis in diabetic patients is positively affected by statins both due to the direct hypolipidemic effect, and by improving endothelial function and increasing fibrinolysis.

Bulletin of the Russian Military Medical Academy. 2021;23(2):165-174
pages 165-174 views
Problems and prospects for the use of stem cells in transplantation
Moskalev A.V., Gumilevsky B.Y., Apchel V.Y., Cygan V.N.

The problems of organ and tissue transplantation are the lack of organs for transplantation and the rejection of transplants. Therefore, the issue of obtaining organs and tissues for transplantation with stem cells is being studied. Although this idea is promising, it is associated with many problems. To do this, you need to use several populations of cells on a substrate with a complex composition of nutrient environments: nutrients, growth factors, oxygen, regulatory factors. Intercellular interaction is provided by the factors they secrete, or it occurs directly with intercellular contact. This contributes to the fact that stem cells in test tubes can differentiate into other types of tissues and maintain their biological activity indefinitely, which they cannot in vivo. This approach of tissue engineering provides the possibility of obtaining whole organs for implantation. However, technical problems are associated with increased cell adhesion to plastic, the presence of a universal basis for cell nutrition, which can contain more than 100 components. There is a possibility of contamination, which can lead to serious errors in the experiment. Stem cells must have distinct mutational properties and the ability to restore telome cells. Prolonged use of the same nutrient medium can lead to genetic changes and significantly alter the physiological properties of cells. Cryopreservation can be an important aspect of the solution. The goal of tissue bioengineering is to create whole artificial organs, or at least areas of organized tissue that could be transplanted to patients. Currently, such operations are relatively simple for tissues such as artificial skin consisting of epidermal and fibroblast layers, or small cartilage implants obtained in vitro. Several cell types in stable shape are planned to be used in one environment. In this case, one type of cell can be replaced by another. This stability is provided by a variety of secreted factors by different types of cells that ensure their vitality. Decellularization removes all components involved in immune rejection of grafts, so this raises the prospect of creating an unlimited supply of organs for transplantation. However, acute reactions can develop associated with the participation of dendritic cells, macrophages, neutrophils, natural killers. Starting from the moment of transplantation, conditions for immune rejection are created, arising as a result of surgery with the development of acute inflammation. The intensity of immune reactions against the graft largely depends on the degree of non-conformity of alleles of the main complex of histocompany capacity of the donor and recipient. This match is studied using a variety of methods, including the use of antibodies or sequencing of deoxyribonucleic acid.

Bulletin of the Russian Military Medical Academy. 2021;23(2):175-186
pages 175-186 views
Immunological aspects of SARS-CoV-2 coronavirus damage
Minnullin T.I., Stepanov A.V., Chepur S.V., Ivchenko E.V., Fateev I.V., Kryukov E.V., Tsygan V.N.

In 2020 the whole world was faced with an epidemiological outbreak caused by a new coronavirus SARS-CoV-2. The information available to date suggests that the newly isolated SARS-CoV-2 coronavirus should be assigned to superantigens, the main manifestations of which, as it is known, are suppression of nonspecific resistance factors and suppression of innate immunity mechanisms associated with the formation of a systemic inflammatory response in the form of cytokine storm and pathological activation of phagocytes in the lung tissue with its alteration and subsequent fibrosis. In this case, it is quite difficult and sometimes even impossible to observe the formation of fully-fledged specific immune answer on the effect of such antigens. This, along with the high infectious nature of the disease and the associated mortality, requires special attention to the underlying immunopatomechanism(s). Perhaps that is why little information has been obtained regarding the immunogenic properties of the newly isolated SARS-CoV-2 coronavirus so far, as well as, most importantly, about the structures of the virus itself responsible for the formation of specific immunity to it. The latter will serve as the basis for patient management and vaccine development. Nevertheless, a certain point of view on this issue is already beginning to form, as tools for detecting specific antibodies are being actively developed, as well as modern diagnostic tests for coronavirus, which include real-time polymerase chain reaction, real-time reverse transcription polymerase chain reaction and isothermal amplification mediated by reverse transcription. The presented analysis makes it possible to expand the understanding of the issue concerning the immunopathogenesis of COVID-19, the mechanisms of the onset and development of the disease in a living organism, the formation of an immune response to the new coronavirus, and also to determine the therapeutic tactics of managing patients with severe coronavirus infection. Elucidating the mechanisms of the emergence and development of a new coronavirus infection can help scientists, general practitioners, clinicians, and laboratory physicians respond correctly to the COVID-19 pandemic.

Bulletin of the Russian Military Medical Academy. 2021;23(2):187-198
pages 187-198 views
Abdominal obesity and adipocyte metabolic activity: criteria for "health" and "neutrality"
Serdyukov D.Y., Gordiyenko A.V., Sokolov D.A., Dydyshko V.T., Zhirkov I.I.

The last decades of the late 20th and early 21st centuries have seen a rapid growth of non-infectious diseases such as abdominal obesity, prehypertension, hypertension, diabetes mellitus type 2. According to official data, preobesity is diagnosed in 40.1% of the adult population of Russia; 21.6% of Russians are obese; and only 36.3% of our fellow citizens have normal body weight. The combination of obesity, hypertension, diabetes mellitus type 2 and atherogenic dyslipidemia are the criteria for metabolic syndrome — a proven risk factor for progression and complicated course of cardiovascular disease. The scientific community is actively discussing about the appropriateness of singling out a group of patients with “metabolically healthy” obesity and criteria for its diagnosis, but the hormonal activity of adipose tissue is not evaluated. Leptin is involved in the metabolism of glucose and fatty acids, and leptinresistance is an important prognostic marker of the complicated obesity. On the based of our own scientific data results, the concept of “metabolically neutral” obesity - obesity with normal adipokines activity (leptin concentration < 3.5 ng/ml) without signs of insulinresistance was formulated and proposed. It was shown that in this metabolic type of obesity the prevalence of dyslipidemia was 1.7 times, prediabetes — 2 times, atherosclerosis of common carotid arteries — 1.5 times lower than in “metabolically healthy” obesity. Determining the level of leptin in uncomplicated obesity allows stratifying patients into groups with normal and increased adipokines activity. The highlighting of the “metabolically neutral” type of obesity is considered by us to be practically justified, as it allows to determine the stage of the disease at which the frequency of metabolic and cardiovascular disorders is still minimal and non-drug prevention is necessary. Exceeding the threshold of leptin level > 3.5 ng/ml in obesity may require a more aggressive lifestyle correction, and possibly an early start to drug therapy.

Bulletin of the Russian Military Medical Academy. 2021;23(2):199-206
pages 199-206 views
Approaches to antihypertensive therapy in patients predisposed to symptomatic hypotension and syncope
Barsukov A.V., Glukhovskoy D.V., Emelyanova K.E., Vasilyeva I.A.

The management of a hypertensive patient with a history of syncope is aimed at maintaining a balance between cardiovascular and hypotensive (syncope) risks. The article presents an analysis of the literature data regarding the relationship between these clinical problems, and also draws practical conclusions that allow to ensure the optimal reduction in blood pressure in the interests of preventing cardiovascular diseases without the threat of drug-related hypotension (fainting). Variants of syncope in patients with arterial hypertension are summarized, depending on the association with antihypertensive therapy. There presented an expert opinion on the recommended target level of systolic blood pressure (120 mm Hg) in hypertensive patients under 70 years of age with a low syncope but high cardiovascular risk, as well as the target level of systolic blood pressure (140 mm Hg) in patients with high syncope and low cardiovascular risk or in elderly and / or frail individuals with hypertension. There noted the admissibility of bringing the systolic blood pressure to the target value up to 160 mm Hg in persons with severe frailty or disability. Examples of normal and pathological (hypotensive) patterns of hemodynamic response in persons with hypertension to long-term passive orthostasis obtained during the tilt test and influencing the decision-making on the activity of antihypertensive therapy are given. The importance of an interdisciplinary team approach with the participation of experts in regulatory circulatory disorders and geriatrics, which can significantly improve the quality of management of patients with a combination of hypertension and syncope, is stated.

Bulletin of the Russian Military Medical Academy. 2021;23(2):207-218
pages 207-218 views
Molecular aspects of creating vaccines for the prevention of poisoning ribosome-inactivating proteins of plant origin: current situation, problems of vaccine development
Myasnikov V.A., Stepanov A.V., Miteva O.A., Nikishin A.S., Gogolevsky A.S., Al-Shehadat R.I.

This article reviews the current understanding of the mechanism of action of the toxin, the clinical effects of ricin and abrin intoxication and how these relate to current and continuing prospects for vaccine development. The threat of bioterrorism worldwide has accelerated the demand for the development of therapies and vaccines against the ribosome-inactivating proteins. The diverse and unique nature of these toxins poses a challenge to vaccinologists. This paper will review the mechanism of toxicity and vaccines development to protect against the highly toxic plant-derived ribosomal toxins. Vaccine development is further complicated by the fact that as bioterrorism agents, abrin and ricin would most likely be disseminated as aerosols supplies. Our understanding of the mechanisms by which these toxins cross mucosal surfaces, and importance of mucosal immunity in preventing toxin uptake is only rudimentary. Research is now aimed at developing recombinant, attenuated vaccines based on a detailed understanding of the molecular mechanisms by which these toxins function. The evolution of the development of specific immunoprophylaxis of acute ricin poisoning from native toxoid to genetically engineered subunit vaccines based on the method of targeted mutagenesis is traced. The past several years have seen major advances in the development of a safe and efficacious ricin toxin vaccine. These vaccines are discussed in the context of the toxicity and structure of ricin. In this review we summarize ongoing efforts to leverage recent advances in the design and use of vaccines.

Bulletin of the Russian Military Medical Academy. 2021;23(2):219-228
pages 219-228 views
Norm and human health
Malov Y.S., Borisov I.M.

The concept of «norms» is common to biology and medicine. It represents the essence of any phenomenon. In medicine, human health is expressed through the category of norm. The basis of the construction of the norm (normology) should be based on the principle of correspondence of morphofunctional properties of the organism to the environment, and not their nature. And then indicators that reflect the stability of a living non-equilibrium system or the state of an adapted organism will characterize (normal) human health. The norm is always stable, otherwise it will not be the norm. The science of human health developed through analysis — the decomposition of a complex whole into simple parts. In this case, the object disappeared as a whole, as a system with all its inherent features. The norm was derived from the fitness, balance of the body with the environment. Recently, it has become possible to consider a person as a system that is determined by the relationship of the whole and its parts (the golden ratio). In biology, the golden ratio manifests itself in many ways, from the structure of polypeptides to the human body. The study of a living organism as a system allowed us to establish the harmonic essence of its structure. The idea of the harmony of the world of systems is connected with the relations of "opposites" within the object. The "golden opposites" of healthy people are a kind of norm reference. What brings "opposites" to unity is harmony. Harmony is closely related to the golden ratio. Golden harmony is the basis of human health. Mathematical expression of harmony, symmetry — a method of assessing (norm) human health. Deviations from the "golden" relations can be used in medicine as indicators (criteria) for the diagnosis of pathological disorders.

Bulletin of the Russian Military Medical Academy. 2021;23(2):229-236
pages 229-236 views

Education news

Experience in the educational process at the department of hospital therapy in the pandemic of the new coronavirus infection (COVID-19)
Pavlovich I.M., Makoveeva O.V., Vasilyev V.N., Golikov A.V., Vasilyeva I.A., Chumak B.A.

The introduction of distance learning into the practice of educational process at the Military Medical Academy named after S.M. Kirov is justified in the context of the pandemic of the new coronavirus infection COVID-19. The modern principles of distance learning are presented. The experience of distance learning at the Department of Hospital Therapy of the Military Medical Academy named after S.M. Kirov during the COVID-19 pandemic is described. Aspects of the organization and teaching of the discipline “Hospital Therapy” in cadets and students of the 6th year in distance learning are considered. Practical training using an electronic information environment included studying theoretical material using an electronic textbook, watching a lecture presentation, and testing. Solving situational problems with pre-diagnosis, appointment of a plan of examination and treatment of patients allowed to preserve the practical component of the classes. The positive and negative aspects of distance learning are discussed. The data of the anonymous questionnaire of 70 cadets and students of the 6th year of the Faculty of Medicine on satisfaction with the educational process in the distance learning mode are given. The questions concerned the organization, merits and disadvantages of distance learning at the department in conditions of self-isolation of teachers and students. The experience of teaching has shown that cadets and students have high motivation, organization, good enough skills to work in the mode of distance learning. This has contributed to rapid adaptation to a new form of training in the face of the COVID-19 pandemic. In general, teachers and students are satisfied with the remote learning process. However, distance learning, according to most teachers and students, cannot fully provide a practical part of the future doctor’s training program. Positive experience of the department has shown that distance learning can be considered as an alternative to traditional learning in the conditions of self-isolation of teachers and students in the pandemic of the new coronavirus infection COVID-19.

Bulletin of the Russian Military Medical Academy. 2021;23(2):237-242
pages 237-242 views
Disease as a result of violations of the symbiotic relationship between the host and the microbiota with pathogens
Tkachenko E.I., Grinevich V.B., Gubonina I.V., Kravchuk Y.A., Apcel V.Y., Ivanyuk E.S.

Recent achievements in many sciences have led to an understanding of the need to form new ideas about the nature of human relationships with the environment and the inner world, his health, the principles of disease formation and their prevention. There has been a transition from a collection of achievements of various sciences to a holistic paradigm that unites a person as an organism and as a person, his inner and surrounding world. It became obvious that this could not be done within the framework of the previous general theories of medicine. To this end, the authors propose a new theory of medicine: "the theory of noospheric-anthropogenic harmony". From the standpoint of this theory, the mechanisms of the relationship of microbiota and pathogens with the protective and acceptive immunity of a healthy and sick person, as well as the mechanisms of microbiota regulation, are considered. The paradigm of dysbiosis as the cause of many diseases and main homeostatic mechanisms that provide symbiotic relationships of microbiota, immunity and its role in the mechanisms of natural tolerance and formation of various disease, such as, autoimmune ones and tumors, require a change in the acceptedtreatment and prevention. A new approach should be based on using a new class of drugs — metabiotics, which in their term influence microbiota.

Bulletin of the Russian Military Medical Academy. 2021;23(2):243-252
pages 243-252 views

Medicine history

Contribution of professor Tuviy Yakovlevich Aryev to development of topical issues of thermal trauma. Main research and publications for 1958-1972
Sokolov V.A., Mamaeva S.A., Butrin Y.L., Gerasimova A.A.

The data on the experience of creating the first specialized departments for the treatment of victims of thermal injury in the Soviet Union are presented. Outstanding representatives of military medicine took an active position in this process: I.I. Dzhanelidze, S.S. Girgolav, I.S. Kolesnikov, B.N. Postnikov, T.Ya. Ariev, etc. The topic of their scientific research and publications, as well as of colleagues from various research and medical institutions in our country, indicates that burns and frostbite were a very urgent scientific problem for scientists of that time. However, due to objective reasons, the studies were carried out separately, were often aimed at solving particular problems, and had no confirmation in a clinical setting. The situation changed radically after the creation in 1960 at the Military Medical Academy named after S.M. Kirov Department of Thermal Injuries with a clinic for 100 beds. Its first boss was T.Ya. Ariev. A highly qualified scientist, a comprehensively trained surgeon, a teacher with extensive work experience, an experienced methodologist was able to form a team of like-minded people in a short time. Under his leadership and with his direct participation, the department began to solve a wide range of urgent scientific problems associated with thermal injury. This is evidenced by the list of topics and titles of publications that were found in the fundamental library of the Military Medical Academy named after S.M. Kirov. A careful attitude to the publications of that time is of great educational value for the student cadets, trainees, students and all employees of the academy. Thus, we preserve the memory of those representatives of military medicine who created the history and glory of our academy.

Bulletin of the Russian Military Medical Academy. 2021;23(2):253-260
pages 253-260 views
Military surgery research laboratory — yesterday, today, tomorrow…
Denisov A.V., Golovko K.P., Nosov A.M., Alisov P.G., Dmitrieva E.V.

Presents the history of organization and development of a unique research unit of the Military Medical Academy named after S.M. Kirov, which is engaged in conducting field experiments and field tests using laboratory animals. The history of the laboratory starts in 1982 with the organization of the combat trauma research laboratory, led by an experienced abdominal surgeon, holder of post-doctoral degree in medicine, professor, colonel of Medical Corps V.A. Popov. Within a short time, the research laboratory succeeded in staffing with highly qualified interdisciplinary team, including surgeons, pathophysiologists, critical care physicians, biochemists, morphologists, microbiologists. This gave the opportunity to carry out research on modern combat trauma not only in the experiments with laboratory animals and on the treatment of casualties admitted to the Academy’s clinics, but also in the combat environment of Afghanistan war — as a mobile interdisciplinary team based at medical institutions of the 40th Army. In June 1993 the Combat Trauma research laboratory was combined with the Shock and Terminal State research laboratory, as a result the War Surgery research laboratory was organized, which joined War Surgery department. The laboratory activity focused on in-depth study of problems of experimental surgery and wound ballistics, pathobiochemistry and pathomorphology of ballistic wound. In July 5, 2011, because of staffing measures the laboratory became part of a newly formed research department (experimental medicine) of the Research Center of the Academy. Then laboratory scientists proceeded with the development of traditional research directions: the study of modern wound ballistics, assessment of weapons damage and protective characteristics of individual body protective facilities (body armor, helmets), carried out in terms of War Surgery, as well as the study of a new type of weapon — "nonlethal" weapon, the development of unbiased diagnostic tests and complication prognosis for casualties with multiple trauma, optimization and improvement of treatment policy under variety of conditions. At present, the research laboratory (War Surgery) specialists in cooperation with colleagues of War Surgery department are actively involved in the studies devoted to investigation of combat surgical trauma, effectiveness of modern individual armor, development of medical items and technologies treatment of casualties, taking an active part in the educational process.

Bulletin of the Russian Military Medical Academy. 2021;23(2):261-272
pages 261-272 views


Professor I.P. Skvortsov the author of the first domestic manual of military hygiene for officers and army doctors
Zholus B.I., Petreev I.V.

In 2021, it was 100 years since the death of a prominent domestic hygienist, Professor Irinarch Polikhronievich Skvortsov (1847–1921), son of a clergyman, after getting medical education at the Kazan Imperial University and the title of a physician in 1871 he worked for a short time in the position of zemstvo doctor in the Samara Governorate. In 1872 he was admitted to the Kazan Imperial University Department of Hygiene and till the end of his life devoted his scientific and pedagogical activity to hygiene. Irinarkh Polikhrontovich improved his knowledges in hygiene in the years 1873–1874 under the guidance of Professor A.P. Dobroslavin at the Imperial Medical and Surgical Academy Department of General, Land and Naval Forces Hygiene where defended his Doctor of Medicine degree thesis in 1874. In 1877, I.P. Skvortsov, associate professor of hygiene at the Imperial Kazan University, published the first in Russia "A short course of military field hygiene for officers and military doctors". Of particular interest is one of the annexes of this course, entitled "Instructions for protecting the health of military ranks of the army" ("Highly approved" on December 2, 1876), which is certainly an important element in the history of hygiene of military personnel. Later Professor I.P. Skvortsov headed the Department of Hygiene of the Warsaw and Kharkov Universities, and finished his career at the Kiev University. The creative heritage of this prominent Russian hygienist professor I.P. Skvortsov is comprehensive and multifaceted but is not fully known by modern specialists.

Bulletin of the Russian Military Medical Academy. 2021;23(2):273-278
pages 273-278 views


Samoilov Vladimir Olegovich (on the 80th anniversary of his birth)
Ponomarenko G.N., Golubev V.N., Antonenkova E.V., Korolev Y.N., Savokina O.V.

The article briefly covers the scientific, pedagogical and creative activities of Vladimir Olegovich Samoilov, whose life and fate have been associated with his alma mater for more than six decades. May 7, 2021 Vladimir Olegovich Samoilov turned 80 years old. Vladimir Olegovich — Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Retired Major General of the Medical Service, Honorary Doctor of the Military Medical Academy named after S.M. Kirov. Vladimir Olegovich made a significant contribution to the emergence of an independent scientific discipline in medical universities of the country — medical biophysics, which began to study the fundamental problems of metabolism and bioenergetics at the molecular, cellular and systemic levels. Samoilov developed original training courses in biophysics and medical electronics and headed the Department of Medical Physics for 14 years. Together with the staff of the department, he revived and rebuilt the teaching of higher mathematics and general physics at the Academy on the basis of the deductive method. Since 1974 Biophysics is taught at the Military Medical Academy named after S.M. Kirov as a system of physical and physico-chemical processes underlying life activity. In 1988, V.O. Samoilov was appointed Deputy Head of the Academy for Academic and Scientific Work. In the next six years, under his leadership, the system of basic military medical education was restructured. In 2001 Vladimir Olegovich headed the Department of Normal Physiology. During the difficult time of the change of generations, the department reorganized the educational process and resumed scientific research on the main sections of normal physiology. He formed one of the brightest scientific academic schools, which consists of seven doctors and 22 candidates of science.

Bulletin of the Russian Military Medical Academy. 2021;23(2):279-282
pages 279-282 views
Naval hygienist Zun Andrey Vadimovich: professionalism, erudition and fidelity to traditions
Petreev I.V., Zun S.A., Shevchuk I.A.

We are considering the main aspects of the professional activity of an outstanding naval hygienist, alumnus of the Faculty of residency training for the Naval Service of Military Medical Academy named after S.M. Kirov (1964), Candidate of Medical Sciences (1971), Higher Senior Officer (graduate education “hygiene”) of the Scientific Research Center of the Academy (1975), Associate Professor at the Department of Naval and Radiation Hygiene (2004), retired Colonel of the Medical Service — Zun Andrey Vadimovich. Having gained a unique experience in medical practice as the Head of the medical service of a diesel-electric submarine of the Baltic Fleet and having completed his postgraduate studies at the Department of Naval and Radiation Hygiene (Military Medical Academy named after S.M. Kirov), Andrey Vadimovich successfully defended his thesis for the degree of Candidate of Medical Sciences (graduate education «hygiene») on the topic "Hygienic characteristics of the working conditions of specialists working on the fleet shore installations of the Naval Service, working with components of rocket fuel". After this more than 45 years of his professional activity were devoted specifically to the preventive medicine trend — hygiene. The main professional achievements of Andrey Vadimovich undoubtedly include the study of the physiological effect of negative air ions in closed premises with conditions of oxygen deficiency, the study of the workplace hygiene of coastal missile systems specialists, as well as the hygienic characteristics of military clothing. Andrey Vadimovich has been also teaching such academic disciplines as naval and radiation hygiene, as well as medical ecology for all categories of Academy students. He is a veteran of the Armed Forces and Military Medical Academy named after S.M. Kirov. Andrey Vadimovich considers the success of his son and grandson as the main achievement of his life. His son Sergey followed the path taken by his father and graduated from the Faculty of Residency Training for the Naval Service of Military Medical Academy named after S.M. Kirov, also he deployed downrange on submarines, and then became an Associate Professor of the Psychiatry Department at the Academy. The grandson of Andrey Vadimovich, Pavel, graduated from the University of Information Technologies, Mechanics and Optics. After he completed his postgraduate studies at the same University, his area of expertise is computer modeling of the circulatory system.

Bulletin of the Russian Military Medical Academy. 2021;23(2):283-286
pages 283-286 views

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