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Vol 23, No 1 (2021)

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Clinical trials

Ultra-low dose estradiol plus dydrogesterone: a role in prevention of the development and progression of atherosclerosis

Kryukov E.V., Popova L.V., Vasiliev S.V., Panevin T.S., Panevina A.S., Stromskaya U.A., Samoilova N.V., Makarov O.E.

Abstract

Active development of the "anti-aging medicine", attempts to slow down biological (including vascular) aging led to the creation of new pharmaceuticals including menopausal hormone therapy. The vascular wall protective mechanism of the hormones is not completely clear, but it was shown that natural estrogens are able to control the condition of the vascular wall, prevent platelet adhesion, control a range of metabolic and trophic and energy processes in the endothelium of the vascular wall, producing antithrombogenic factors, namely their inhibition contributes to the development of atherosclerosis. It is known that standard and low-dose estrogen may restore the impaired antithrombogenic potential of the vascular wall, provided its initial reduction does not exceed 20%. The issue of the role and possibilities of correction of the antithrombogenic activity of the vascular wall with ultra-low dose estradiol remained unresolved. As a "clinical model" for the study of this issue, we formed 2 groups of patients: in the study group patients received ultra-low dose estradiol plus dydrogesterone, subjects from the control group received beta-alanine. Three-year follow-up showed a decrease in antithrombogenic activity of the vascular wall in control subjects after 2 and 3 years of follow-up according to the M.V. Baluda's test versus subjects treated with ultra-low dose estrogen plus dydrogesterone. The decrease of the relative risk of reduction of the antithrombogenic activity of the vascular wall with the use of ultra-low dose estrogen plus dydrogesterone during the first two years was 2.3 times, and during the 3 years of follow-up — 3.8 times versus control. Thus, prescribing only ultra-low dose estradiol plus dydrogesterone for patients with normal antithrombogenic activity of the vessel wall at baseline reliably lowers the risk of long-term reduction of antithrombogenic potential of the vascular wall.

Bulletin of the Russian Military Medical Academy. 2021;23(1):9-14
pages 9-14 views

Partial papillosphincterotomy with balloon dilatation in the treatment of choledocholytiasis in patients with parapapillary diverticulum

Soloviev I.A., Musinov I.M., Koltsov V.A.

Abstract

Results of treatment of 42 patients suffering from choledocholytiasis and parapapillary diverticle are compared, by which for treatment limited papillosfincterotomy supplemented with endoscopic balloon dilatation is performed with results of treatment of 56 patients with similar pathology, by which traditional endoscopic papillosfincterotomy was performed. Limited papillosphincterotomy with endoscopic balloon dilatation resulted in complete lithoextraction in 92.9% of cases as compared to 92.8% with endoscopic papillosphincterotomy only; an adequate drainage of extrahepatic bile ducts was achieved in 100% and 96.4%, respectively (p > 0.05). With endoscopic papillosphincterotomy, full removal of all concretions with a diameter of less than one centimeter was achieved without mechanical lithotripsy; for concretions from 1 to 1.5 cm in size the mechanical lithotripsy was necessary in 45.5% of cases. Limited papillosphincterotomy with endoscopic balloon dilatation allowed lithoextraction of concretions with a diameter of up to 1.5 cm without mechanical lithotripsy in all patients. The mechanical lithotripsy for concretions with a diameter above 1.5 cm was necessary in 60% of cases for both methods. In the treatment arm, two (4.8%) cases with complications were observed, while in the control arm there were 13 (23.2%) cases (p = 0.012). Acute pancreatitis was the only postoperative complication for which significant difference was observed (р = 0.043). In addition, after endoscopic papillosphincterotomy the incidence of bleeding from the suture line was 3.6% and the incidence of perforation of diverticula was 3.6%; this required an open surgery. The above mentioned demonstrates the advantages of limited papillosphincterotomy with endoscopic balloon dilatation over endoscopic papillosphincterotomy to resolve choledocholytiasis in the presence of parapapillary diverticulum.

Bulletin of the Russian Military Medical Academy. 2021;23(1):15-22
pages 15-22 views

Perspectives of solution to the problem of persistent intra-abdominal hemorrhage at the prehospital stage

Golovko K.P., Samokhvalov I.M., Grishin M.S., Suprun T.Y., Nosov A.M., Dmitrieva E.V., Kovalevsky A.Y.

Abstract

A post-hoc analysis of 338 casualties demonstrating persistent intra-abdominal hemorrhage has been carried out, the proportion of this group being 16.5% in overall casualty structure or 64% in the group of casualties with abdominal injuries. Lethal outcome rate in the studied group was 13%, the complication rate was 53.2%. Traumatic shock was found in 86% of casualties, the greatest proportion was accounted for by the first and second degree (59.1%). Lethality rate in the case of the third degree traumatic shock and terminal state was 34.4%. Injured parenchymal organs and abdominal major vessels showed the greatest blood loss — 2348 ± 250 ml. The time of arrival of casualties with persistent intra-abdominal hemorrhage to the advanced trauma management stage or definitive surgical care stage was virtually similar amounting to 2.6 ± 0.4 hr. Injuries to hollow organs (34.1%) were most commonly found, injuries to parenchymal organs (24.9%) occurred less frequently, the rate of combination of injuries to abdominal internal organs was approximately the same (24.9%). Major vessels injuries were diagnosed only in one casualty (0.3%), while those combined with internal organs injuries — in 37(11%)of casualties. As regards favorable prognosis this group was considered to be the least perspective owing to high rate of hemorrhage and inability to achieve effective hemostasis at the prehospital stage. Thus, persistent hemorrhage was not profuse, and the majority of casualties (88.7%) should be considered as perspective “recipients” to achieve temporary hemostasis at the prehospital stage. It is this approach based on the principles of early pathogenetic management that could reduce the rate of complications and lethality in casualties with persistent intra-abdominal hemorrhage.

Bulletin of the Russian Military Medical Academy. 2021;23(1):23-32
pages 23-32 views

The topographo-anatomical conditions of reconstruction of the trunk and roots of the portal vein during gastropancreatoduodenal resection

Dzidzava I.I., Gayvoronsky I.V., Kotiv A.B., Alentyev S.A.

Abstract

Topographic and anatomical variants of vascular plastics in extended gastropancreatoduodenal resection are substantiated. The anatomical study was performed on 30 organ complexes and 5 not embalmed human corpses. Significant variability of the roots and tributaries of the v. portae and their location near the pancreas was revealed. The extended contact of the mesenteric-portal segment with the head of the pancreas promotes the involvement of the veins of the portal system in the tumor process. The magistral type of the structure of the superior mesenteric vein was revealed in 19 cases, the distributed type in 11, which determines the conditions for vascular reconstruction. In the experiment the possibility of creation the formation of the direct mesenteric-portal anastomosis after duodenectomy was established in case of shifting the mobilized root of the mesentery of the small intestine in the direction of the liver gate. If splenic vein resection is necessary, adequate blood outflow from the stomach, spleen, and pancreatic stump can be provided by forming a distal splenic-renal anastomosis or, with a sufficient length of the splenic vein, a splenic-portal anastomosis. Based on computed tomography angiographs and intraoperative data 29 patients underwent extended gastropancreatoduodenal resection followed by vascular reconstruction. Tumor invasion of the trunk of the portal vein on computed tomography angiograms was represented by offset and the contact of the tumor with portal vein for over 10 mm (in 7 cases), the displacement and deformation of the portal vein tumor (in 5 cases), tumor infiltration of more than 50% of the circumference of the portal vein (in 3 cases). Extended contact with the tumor was identified in 9 cases, confluence stenosis of the portal vein — in 5 cases. The tumor invasion into the portal vein, and the vascular system was restored by the formation of a port-portal anastomosis in 15 cases. Moreover at the reconstruction of mesenteric-portal segment we formed mesenteric-portal anastomosis in 10 cases. Also in 2 cases mesenteric-portal anastomosis in the confluence area of the iliac colon and jejunum tributaries was formed, in 1 case we formed anastomosis between the ileum-colon vein and the portal vein (with 1:2 diameter difference without patency disorders). In one single case we connected iliac colon vein wall with jejunum vein wall and formed anastomosis between them and portal vein. Distal splenorenal anastomosis was formed in 10 patients from this group. Spleno-portal anastomosis was formed in 3 patients above the junction of the portal and superior mesenteric veins.

Bulletin of the Russian Military Medical Academy. 2021;23(1):33-40
pages 33-40 views

Intestinal endometriosis: features of clinical and morphological diagnostics

Pechenikova V.A., Danilova A.S., Kvarku V.E., Ramzaeva N.N.

Abstract

A clinical observation of the combined endometriotic lesion of the small intestine and the appendix is given below. Extragenital endometriosis is a rare pathology in which endometrioid heterotopies develop outside the reproductive system organs. At about 18–25% of women suffering from the pelvic organs endometriosis, the intestines are involved in the pathological process. In this regard, it is believed that in most cases its lesion is secondary while the primary lesion of the intestine with endometriosis is rarely observed and occurs as a result of hematogenous introduction of endometrial elements into the intestinal wall. Of all parts of the intestine, endometriosis most often affects the rectum and sigmoid colon (70−80%), then the jejunum, less often the cecum. The most rare gastrointestinal tract endometriosis localization is the appendix, the frequency of its lesion is 0.8%. It was carried out in a clinicopathologic analysis of 14 endometriosis cases in various parts of the intestine (4 cases of the small intestine lesions, 2 — rectosigmoid part of the large intestine, 2 — rectum, 2 — sigmoid colon, 3 — appendix, 1 — combined lesion of the small intestine and the appendix). In most cases, the clinical diagnosis of extragenital endometriosis is difficult, and as a rule women come with complaints typical of acute surgical pathology: intestinal obstruction, appendicitis. An important role in differential diagnosis is given to the ultrasound examination of the pelvic organs and abdominal cavity, magnetic resonance imaging, endoscopic research methods, as well as the connection of clinical symptoms with the menstrual cycle.

Bulletin of the Russian Military Medical Academy. 2021;23(1):41-50
pages 41-50 views

Experience of using the «Bark Vibrolung» device in the complex treatment of community-acquired pneumonia

Salukhov V.V., Kharitonov M.A., Makarevich A.M., Bogomolov А.B., Kazantsev V.A., Ivanov V.V., Chugunov A.A., Morozov M.A.

Abstract

Currently, much attention is paid to pathogenetic methods of treatment of community-acquired pneumonia. As a rule, pneumonia is accompanied by a violation of the balance of formation and discharge of bronchial secretions. In order to normalize the drainage function of the bronchi, both pharmacological and mechanical methods of influencing the muciliary clearance are successfully used. The comprehensive use of the entire arsenal of therapeutic capabilities allows you to minimize the duration of the patient's stay in a hospital bed, as well as speed up the process of restoring impaired lung functions after pneumonia. The study was conducted in the pulmonology Department of the district hospital of the Eastern military district. The effectiveness of using the device of vibroacoustic influence on the chest using the BARK VibroLUNG device in the treatment of community-acquired pneumonia was studied. In addition to the traditional therapy regimens, 5 to 7 sessions of hardware vibration massage were performed. In patients who received a course of vibroacoustic massage, there was a decrease in the duration of General intoxication, productive cough, and physical signs of lung tissue consolidation. Regression of the main clinical manifestations of pneumonia was accompanied by an increase in sputum discharge, simultaneously with a decrease in the time of its production. The main group of patients was characterized by the best time for normalization of acute-phase indicators, restoration of lung ventilation function, and resolution of pneumonic infiltration according to X-ray data. The use of a course of vibration exposure to the chest allowed to reduce the duration of stationary treatment by an average of 3 days.

Bulletin of the Russian Military Medical Academy. 2021;23(1):51-58
pages 51-58 views

Intraoperative infrared fluorescence angiography in surgery of peripheral nerve injuries

Svistov D.V., Isaev D.M., Gaivoronskiy A.I., Churikov L.I., Belyakov K.V.

Abstract

Often, when performing reconstruction of nerve trunks, between the ends of the damaged nerve, the presence of diastasis is noted, which requires significant nerve tension in order to overcome it. This, in turn, can lead to a violation of the blood supply to the nerve and damage to its ultrastructures, which leads to unsatisfactory treatment results. The possibility of using intraoperative infrared fluorescence angiography in reconstructive surgical interventions for peripheral nerve damage, in order to assess the degree of blood flow disturbance in the nerve trunk, is considered. In patients with a complete anatomical break during the operation, an attempt was made to overcome diastasis by measuring the tension force (up to 3 N) with which the nerve was affected. Infrared fluorescence angiography with indocyanine green was performed simultaneously. The obtained angiograms were analyzed, and the effect of the tension force on the change in blood flow in the nerve trunk was determined. It was found that when exposed to a force of up to 2 N, there is no significant change in the intraneural blood flow. At the same time, the effect of a force of 3 N is manifested on angiograms by a significant decrease in the volume of blood flow, which is usually due to constriction of the vessels due to their stretching. After reconstruction (microsurgical epineural suture), repeated angiography was performed to assess the safety and adequacy of blood supply to the nerve. It was revealed that the use of intraopreational angiography with indocyanin green is an affordable and easily feasible technique that allows to determine the safety and, equally important, the adequacy and efficiency of blood flow in the nerve trunk. This technique makes it possible to monitor the safety of blood flow in the nerve trunk, to study the mechanisms of compensation of blood supply to the nerve after microsurgical epineural suture, to assess the quality of comparison of nerve stumps along the axis, excluding the possibility of their "twist".

Bulletin of the Russian Military Medical Academy. 2021;23(1):59-66
pages 59-66 views

Сlinical and epidemiological characteristics of botulism

Cherenova L.P., Matsuy A.V., Cherenov I.V.

Abstract

Clinical and epidemiological characteristics of botulism in the Astrakhan region for the period from 2013 to 2019 are presented. 37 people with a diagnosis of Botulism were under observation. It was found that most often (28 (75.7%) cases) patients associated their disease with the use of canned home-made products. Canned vegetables (cucumbers, tomatoes, vegetable salad, eggplant, cabbage) were consumed by 18 (48.7%) people, mushrooms — 10 (27%), dried fish — 7 (18.9%), herring-balyk — 1 (2.7%) and home-made liver pate-1 (2.7%) patient. The incubation period in the observed patients was on average 2.4 days. It lasted 1–2 days in 24 (64.9%) patients, 3-5 days in 12 (32.4%) patients, and 6 days in 1 (2.7%) patient. According to the severity of the condition, 17 (45.9%) patients were hospitalized in the intensive care unit. Severe course of the disease was in 17 (45.9%) patients, moderate-in 20 (54.1%) patients. Early and persistent symptoms in all patients were marked muscle weakness, in 78.4% of patients — dizziness, in 83.8% of patients — difficulty walking and unsteadiness of gait. In 34 (91.9%) patients, the most pronounced symptoms were ophthalmoplegic: blurred vision, fog, «flies» in front of the eyes, inability to read the text. In General, up to 10 cases of botulism are registered annually in the Astrakhan region. Almost half of the patients (45.9%) have severe botulism. The disease is mostly sporadic and is associated with the use of canned vegetables and home-made mushrooms. In addition, cases of botulism associated with the use of dried fish have become more frequent in the Astrakhan region. Late hospitalization was observed in 1/3 of patients (11 (29.7%) cases) with botulism. This is due to untimely diagnosis at the pre-hospital stage and late access of patients to medical care.

Bulletin of the Russian Military Medical Academy. 2021;23(1):67-72
pages 67-72 views

Selection of retroperitoneal access during intervertebral disc endoprosthesis in lumbar spine

Priymak M.A., Kruglov I.A., Gaivoronski A.I., Kravtsov M.N., Bulyshchenko G.G.

Abstract

The morphometric parameters and surgical areas of risk of retroperitoneal approach were studied for endoprosthetics of intervertebral discs in the lumbar spine to reduce trauma and reduce the risk of complications. The study included 110 patients operated on in the period from 2017 to 2020 (72 men, 38 women) in the neurosurgical department of the 1586 Military Clinical Hospital. The average age of the patients was 44.9 ± 15.4 years. According to the localization of access to the lumbar spine, the patients were distributed as follows: LIII–LIV — 8 (7.3%), LIV–LV — 46 (41.7%), LV–SI — 56 (51%). It was found that, for the intervertebral disc LV – SI, the length of the skin incision was 92.5 (80; 100) mm, the length of the surgical wound was 80 (80; 110) mm, the thickness of the subcutaneous fat layer was 30 (15; 40) mm, the depth of the wound was to the spine — 85 (70; 120) mm, the depth of the wound to the spinal canal — 125 (107.5; 152.5) mm, the angle of operation in the horizontal plane at the level of the spine — 52 (47; 59.5) degrees. On the basis of the anthropometric data of patients, the optimal length of the skin incision was determined for performing the retroperitoneal approach (120 mm for level LIII–LIV, 100 mm — for level LIV–LV). Three variants of the inferior vena cava bifurcation have been identified for different levels of intervertebral discs in the lumbar spine: high bifurcation, left common iliac vein mainly overlaps the left half of the LIV–LV intervertebral disc and does not overlap the LV–SI intervertebral disc; middle bifurcation, left common iliac vein overlaps the central part of the intervertebral discs LIV–LV and LV–SI; low bifurcation, inferior vena cava overlaps the right side of the intervertebral disc LIV–LV, inferior vena cava and left common iliac vein completely overlap the intervertebral disc LV–SI. The data obtained can be used when planning retroperitoneal access to the lumbar spine in order to reduce the trauma of the operation.

Bulletin of the Russian Military Medical Academy. 2021;23(1):73-80
pages 73-80 views

Possibilities of preclinical diagnosis of anthracycline cardiotoxicity using the technique of "speckle-tracking echocardiography"

Kryukov E.V., Golubtsov O.Y., Tyrenko V.V., Semelev V.N., Makiev R.G.

Abstract

In case of antitumour anthracyclines therapy of patients with non-Hodgkin lymphomas the possibility of using speckle-tracking echocardiography is being considered. It was found that patients with non-Hodgkin lymphomas have early violations of the left ventricular myocardium during the course of antitumor chemotherapy using anthracyclines. They are characterized by reducing of longitudinal deformation of the myocardium with a gradual spread from the apical to the basal segments of the left ventricle. A statistically significant reduction in global and segmental systolic deformation after the 4th course of chemotherapy (cumulative dose of doxorubicin 333.5 ± 88.5 mg/m2) is the earliest marker of left ventricular mechanical dysfunction, appearing before the development of diastolic dysfunction and ejection fraction reduction of the left ventricular. Early violations of myocardial mechanics in the dynamics of the course of antitumour therapy with anthracyclines are identified in the apical area of the left ventricle, it can be connected with circulatory failure in this area. Violations of myocardial mechanics in the apical area of the left ventricle can be an erly predictor of ischemia of this area with possible progression to global contractile muscle dysfunction of the left ventricular. The global longitudinall deformation of the left ventricular myocardium in contrast to ejection fraction of the left ventricular is more sensitive to myocardial damages against the backdrop of chemotherapy using anthracyclines. So, it can be used as an early preclinical marker of myocardial damage, that takes echocardiography closer to the most advanced methods of myocardial visualization.

Bulletin of the Russian Military Medical Academy. 2021;23(1):81-88
pages 81-88 views

Glucagon-like peptid-1 in obese and diabetic patients after bariatric interventions

Volkova A.R., Semikova G.V., Mozgunova V.S., Maltseva M.N., Bondarenko V.L., Katysheva N.S.

Abstract

The relationship between the level of glucagon-like peptide-1 and repeated weight gain was evaluated in 31 patients suffering from grade II–III obesity and type 2 diabetes mellitus after bariatric interventions for 3 years. It was found that the level of stimulated glucagon-like peptide-1 significantly increased by the third day after sleeve gastroplasty and gastroschunt compared to the initial parameters (p = 0.001 for obese patients; p = 0.000 for obese patients and diabetes mellitus). In the plateau phase (body weight retention) after bariatric intervention, the level of stimulated glucagon-like peptide-1 in obese patients and patients suffering from obesity in combination with diabetes mellitus did not significantly differ from the indicators of healthy individuals. There was no association between the level of glucagon-like peptide-1 and repeated weight gain. This may be due to the limited contribution of glucagon-like peptide-1 to body weight dynamics after bariatric interventions and the predominance of patient compliance. Thus, the level of stimulated glucagon-like peptide-1 at baseline, on the third day and in the plateau phase after bariatric intervention was not associated with the value of repeated weight gain.

Bulletin of the Russian Military Medical Academy. 2021;23(1):89-94
pages 89-94 views

Demographic characteristics and radiological features of pneumonia cases in military personnel

Shirinova F.V.

Abstract

The influence of demographic factors on the prevalence of community-acquired pneumonia among military personnel, depending on the climatic and geographical conditions for 2006–2019, was studied. 266 servicemen aged 18–26 years were examined. The diagnosis of community-acquired pneumonia was made on the basis of clinical and radiological data. In addition, the medical records of patients suffering from pneumonia were checked, who were diagnosed with clinical and radiological indicators, but who were not hospitalized, but were sent for outpatient treatment. It was found that new recruits are much more likely to suffer from community-acquired pneumonia (18 years — 70 (26.3%) people, 19 years — 66 (24.8%) people, 20 years — 49 (18.4%) people. At the age of 25, the incidence of pneumonia among military personnel decreases by 1.9%, and at the age of 26 — by 0.4%. At topical radiological diagnostics, there was a significant prevalence of left-sided lower lobe pneumonia. Of the 266 recruits, the frequency of hypothermia was found in 207 (90.8%) people. Repeated cases of pneumonia accounted for only 9.2%. We believe that the movement of military personnel to another climatogeographic region should be identified with an important risk factor for the development of community-acquired pneumonia. This circumstance should be taken into account when carrying out preventive measures. Thus, community-acquired pneumonia among military personnel is most common in recruits during the first 6 months of service. This is due to such risk factors as acclimatization, reduced reactivity of the body when adapting to the conditions of military service and "mixing" when forming units from recruits.

Bulletin of the Russian Military Medical Academy. 2021;23(1):95-100
pages 95-100 views

Features of the development of traumatic pancreatitis with gunshot wounds to the abdomen

Myasnikov N.I., Panov V.V., Ba M.R., Kim I.Y., Chakalsky K.B., Chernyshev M.A., Samokhin O.I., Panov A.A.

Abstract

The features of the development of traumatic pancreatitis in gunshot wounds of the abdomen, which present difficulties in timely diagnosis, are considered, hypotheses are formulated for studying the problem. Two clinical cases of developing traumatic pancreatitis against the background of a gunshot wound to the abdomen with indirect damage to the pancreas are presented. Without taking into account the peculiarities of the formation of the wound canal relative to the organs of the abdomen, in conditions of limited diagnostic potential, there is a high probability of late diagnosis of traumatic pancreatitis, especially in indirect damage. Injuries to the organs of the upper half of the abdomen can be risk factors for indirect damage to the pancreas due to the effect of lateral impact energy and the formation of a temporary pulsating cavity. In general, the management of such wounded in a surgical hospital with limited diagnostic capabilities or with stage treatment in a local military conflict requires the surgeon to know the peculiarities of the course of traumatic pancreatitis, which make it possible to prevent the development of complications in a timely manner. The development of traumatic pancreatitis in penetrating gunshot wounds to the abdomen is not always a consequence of direct pancreatic injury. This circumstance must always be taken into account during a diagnostic laparotomy.

Bulletin of the Russian Military Medical Academy. 2021;23(1):101-108
pages 101-108 views

Laboratory monitoring of indices in burnt during infection COVID-19

Zinoviev E.V., Manukovskiy V.A., Kostyakov D.V., Tsygan V.N., Apchel A.V., Soloshenko V.V., Pivovarova L.P., Ternovoy D.A.

Abstract

The results of laboratory and instrumental studies are analyzed in 46 victims with skin burns of various localization, area and depth of the lesion infected with COVID virus 19 hospitalized in the burn center of Saint-Petersburg Research Institute of Ambulance named after I.I. Dzhanelidze in 2020. The control group included 46 patients with similar severity lesions who were treated at the center in 2018. The data on the general condition of patients, clinical and biochemical blood tests, coagulogram, gas composition, general urine analysis, and X-ray data were assessed. It was found that in the groups of lightly and severely burned and patients in 75.9 and 64.9% of cases, respectively, X-ray examination and computed tomography of the chest organs did not reveal infiltrative changes in the lungs, despite the positive results of virological studies. In the second half of the incubation period, in comparison with the data obtained in the control group, deviations in the following indicators were stated: hemoglobin, hematocrit, leukocytes, neutrophils, lymphocytes, immature granulocytes, erythrocyte sedimentation rate, levels of total protein, creatinine and blood fibrinogen from 1.6% up to 18 times. In other analyzed parameters, no changes were noted. When comparing the data obtained in the second half of the incubation period with the results of laboratory studies of uninfected patients in the group of severely burned patients, significant differences were established among the thrombocyte readings (39.2% less), platelet count (42.9% less), and in the group of lightly burned — the number of erythrocytes (less by 11.8%), hemoglobin (less by 19.4%), hematocrit (less by 16.2%) and eosinophils (less by 71%), total protein (less by 5.6%) and creatinine (less by 12.2%). Providing medical care to patients during the pandemic caused by the new coronavirus infection COVID-19 is a challenge for the healthcare system. The results obtained are the first step towards understanding the features of the course of typical pathological processes caused by burn injury and the new coronavirus infection COVID-19.

Bulletin of the Russian Military Medical Academy. 2021;23(1):109-120
pages 109-120 views

POSSIBILITIES OF PRECLINICAL DIAGNOSIS OF ANTHRACYCLINE CARDIOTOXICITY USING THE TECHNIQUE OF “SPECKLE-TRACKING ECHOCARDIOGRAPHY”

Kryukov E.V.

Abstract

In case of antitumour anthracyclines therapy of patients with non-Hodgkin lymphomas the possibility of using
speckle-tracking echocardiography is being considered. It was found that patients with non-Hodgkin lymphomas have
early violations of the left ventricular myocardium during the course of antitumor chemotherapy using anthracyclines. They
are characterized by reducing of longitudinal deformation of the myocardium with a gradual spread from the apical to the
basal segments of the left ventricle. A statistically significant reduction in global and segmental systolic deformation after the
4th course of chemotherapy (cumulative dose of doxorubicin 333.5 ± 88.5 mg/m2) is the earliest marker of left ventricular
mechanical dysfunction, appearing before the development of diastolic dysfunction and ejection fraction reduction of the left
ventricular. Early violations of myocardial mechanics in the dynamics of the course of antitumour therapy with anthracyclines
are identified in the apical area of the left ventricle, it can be connected with circulatory failure in this area. Violations of
myocardial mechanics in the apical area of the left ventricle can be an erly predictor of ischemia of this area with possible
progression to global contractile muscle dysfunction of the left ventricular. The global longitudinall deformation of the left
ventricular myocardium in contrast to ejection fraction of the left ventricular is more sensitive to myocardial damages against
the backdrop of chemotherapy using anthracyclines. So, it can be used as an early preclinical marker of myocardial damage,
that takes echocardiography closer to the most advanced methods of myocardial visualization.

Bulletin of the Russian Military Medical Academy. 2021;23(1):91-100
pages 91-100 views

Experimental trials

Topographical, anatomical and neurosurgical aspects of "end-to-side" nerve repair

Nisht A.Y., Fomin N.F., Orlov V.P.

Abstract

The article presents the results of a comprehensive anatomical and experimental study of individual variability in the structure and topography of motor branches of peripheral nerves in relation to the justification of methods for selective reinnervation of tissues by the "end-to-side" neurorrhaphy. It was found that relatively longer branches of peripheral nerves with a small number of connecting inter-arm collaterals characteristic of narrow and long limbs create conditions for less traumatic mobilization of motor branches. In cases with relatively wide and short extremities mobilization of peripheral nerves is complicated by the presence of a large number of collateral branches and intra-trunk connections, which are often damaged when separate bundles that make up the mobilized branches of the donor or recipient nerve are isolated from the main nerve trunk. It has been shown that potential recipient nerves should be motor branches of peripheral nerves, the preservation of which is of fundamental importance for the function of the corresponding segment of the limb. To create conditions conducive to selective reinnervation of functionally significant muscle groups of the upper limb, we have developed, justified from anatomical positions, and tested in an experiment on anatomical material methods for connecting the distal motor branches of peripheral nerves by the "end-to-side" neurorrhaphy. The main idea of accelerated recovery of the thumb opposition in injuries of the median nerve is to reinnervate the muscles of the elevation of the I finger due to nerve fibers that are part of the deep branch of the ulnar nerve. For this purpose, surgical techniques have been developed for connecting the recurrent motor branch of the damaged median nerve mobilized at the level of the wrist with the edges of a surgically formed perineurium defect on the lateral surface of the bundles that make up the deep branch of the ulnar nerve. In another clinical situation, in patients with radial nerve injuries, for the muscle reinnervation, а method is proposed for neurotisation of the deep motor branch of the radial nerve by the end-to-side suture to the lateral surface of the median nerve. We assume that performing the "end-to-side" nerve suture at the level of the base of the hand in the cases of proximal damage to the median nerve will reduce the time of reinnervation of the muscles of the thumb elevation by 400–450 days. Transposition of the deep branch of the damaged at the proximal level radial nerve with "end-to-side" neurorrhaphy to the median nerve — by 250–300 days (based on the total length of the shoulder and forearm, which is about 50 cm and the rate of regeneration of nerve fibers 1 mm per day). Accordingly, with higher injuries (brachial plexus), the gain in the time of reinnervation of the distal segments will be even greater. In our opinion, the results can be used as a basis for further clinical research on the development of methods for selective tissue reinnervation in cases with isolated injuries of the peripheral nerves.

Bulletin of the Russian Military Medical Academy. 2021;23(1):121-128
pages 121-128 views

Experimental substantiation of the optimal technique for choosing the rotation of the femoral component of the knee endoprosthesis

Khominets V.V., Gaivoronsky I.V., Kudyashev A.L., Semenov A.A., Bazarov I.S., Semenova A.A.

Abstract

There was experimental justification of the optimal technique for choosing the rotation of the femoral component of the knee joint endoprosthesis carried out in this research. The individual morphometric characteristics of the femoral condyles and the condition of the collateral ligaments were taken into account in the experiment. The research was conducted on polymer-embalmed preparations of the knee joint, which were divided into three groups, according to the forms of the femoral condyles. We used the standard technique of positioning the resection block and the technique of individual selection of the rotation of the resection block (rotation of the femoral component of the endoprosthesis), based on the assessment of individual morphometric characteristics of the femoral condyles and the state of the auxiliary elements of the knee joint. To implement this surgical approach, typical resections of the proximal condyles of the tibia and distal condyles of the femur were performed, which technically did not differ from the sawdust used in the standard procedure. Then the knee joint was flexed to an angle of 90°, Homan retractors were removed and two laminar dilators (Laminar Spreader) were installed in the gap between the proximal tibial sawdust and the posterior parts of the lateral and medial condyles of the femur. This technique provided isometric tension of the fibular and tibial collateral ligaments of the knee joint. Then carried out the positioning of the femoral resection block "four in one". In this case, only the line of the proximal tibial sawdust was used as a reference point, for which the posterior flange of the resection block was positioned parallel to the sawed upper articular surface of the tibia. It is established that the use of the considered technique of positioning the femoral resection block ensures the formation of a uniform flexor gap, regardless of the variant anatomy of the femoral condyles. Thus, there was research a uniform flexion gap in the experiment, which ensured isometric movements in the knee joint and its stability at the control points of the amplitude after implantation of the trial or final components of the endoprosthesis.

Bulletin of the Russian Military Medical Academy. 2021;23(1):129-134
pages 129-134 views

Dynamics in the content of the cytokines in the bronchoalveolar lavage fluid in rats after acute inhalation intoxication by clorine and pyrolysis products, containing hydrogen chloride

Potapov P.K., Gennad`evich P.G., Rogovskaya N.Y., Babakov V.N., Basharin V.A.

Abstract

It is known that inhalation exposure to chlorine and hydrogen chloride leads to damage to the respiratory system up to the development of acute pulmonary edema in victims. No data on the mechanisms of development of pulmonary edema upon exposure to hydrogen chloride have been found in the available literature. The study was carried out on white outbred male rats, which were divided into 3 groups: Group I — control; Group II — animals were intoxicated with chlorine at a dose of 1.5 median lethal concentration (30 min); Group III — animals were intoxicated with hydrogen chloride at a dose of 1.5 median lethal concentration (30 min). Immediately after exposure to the studied toxicants, as well as after 1, 3 and 6 h, the lung coefficient and the content of cytokines (interleukins-1β, 6, 10 and interferon-γ) in the bronchoalveolar lavage fluid were determined in animals. It was revealed that an increase in the lung coefficient (p < 0.05) in animals in groups II and III was accompanied by a significant increase (1.5 times) in the content of the studied cytokines in the bronchial-alveolar lavage fluid compared with animals in group I. III an increase (p < 0.05) in the content of cytokines is recorded later — only 3 hours after exposure, while it is significantly lower than in animals of group II at all studied periods. Thus, intoxication with hydrogen chloride leads to a slower development of pulmonary edema and an increase in the content of both pro (interleukins-1β, 6) and anti-inflammatory cytokines (interleukin-10, interferon-γ) in the bronchial-alveolar lavage fluid compared to animals, exposed to chlorine intoxication.

Bulletin of the Russian Military Medical Academy. 2021;23(1):135-142
pages 135-142 views

Determination of barometric criteria for rupture of atherosclerotic plaques in the brachiocephalic arteries

Maistrenko D.N., Ivanov A.S., Generalov M.I., Nikolaev D.N., Stanzhevsky A.A., Molchanov O.E., Oleshuk A.N., Kokorin D.M., Maystrenko A.D., Soloviev A.V., Chegemov A.A., Stepanov A.A., Eshchik S.M.

Abstract

The sequence of determining determination of the critical value of blood pressure for the occurrence of dissection of atherosclerotic intima of the internal carotid artery according to the experimental study. Atherosclerotic lesion of the brachiocephalic arteries was modeled on a vascular silicone phantom of the carotid arteries, in which the surgical material (intact annular area of atherosclerotic intima with plaque), obtained after eversion endarterectomy in a patient with atherosclerotic lesions, was placed and fixed in the region of the mouth of the internal carotid artery. A total of 30 models were created. To determine the critical values of the pressure on the intima with the plaque, at which it ruptures, balloon catheters were used, controlling the pressure with a manometer. The results were compared with the preoperative data of ultrasound and computed tomography examinations of patients. Dissection of the intima in the area of the plaque occurred in 6 cases at a pressure of 150–180 mm Hg; in 9 cases at 180–200 mm Hg, in 3 cases at a pressure of more than 200 mmHg, in 12 when exposed to more than 300 mm Hg. All patients, whose intima ruptured at a pressure of less than 200 mm Hg, had a fluid component of the plaque on preoperative examination, and in 6 patients, the critical pressure on the plaque was 150 mm Hg., there was also a thinned "cover" of the plaque. In the rest of the cases, the plaques were stable without a liquid component. Dissection of the intima in these cases did not occur when the exposure value was more than 300 mm Hg. The presence of a fluid component in an atherosclerotic plaque of the carotid artery in combination with a thinned «cover» of the plaque indicates the extreme danger of its destruction and embolism during a hypertensive crisis. The degree of stenosis of the carotid artery was found to be a less significant risk factor for unstable plaque rupture than the presence of a fluid component.

Bulletin of the Russian Military Medical Academy. 2021;23(1):143-152
pages 143-152 views

Public Health

Military medical organizations capability in delivery of specialized medical care in radiation emergencies

Kryukov E.V., Bulka K.A., Chekhovsky Y.S., Karamullin M.A., Halimov Y.S., Basharin V.A., Drachev I.S., Gaiduk S.V.

Abstract

Nuclear and radiation safety remains one of the most important components of the national security of our country. The increasing requirements for the medical care system in the Armed Forces of the Russian Federation in case of peacetime acute radiation injuries are due to the impossibility of completely eliminating the risks of radiation emergencies as a result of natural disasters, industrial radiation accidents and the threat of nuclear terrorism. The peacetime three-level system of medical support in the Armed Forces of the Russian Federation has been developed. It is designed to guarantee the first aid, primary predoctor care, primary doctor care and primary specialized health care for victims of acute radiation injuries by medical units, formations and organizations in the territorial zone of responsibility. In 2017 it was completed a research work "Improving the organization of therapeutic care in acute radiation injuries at the stages of medical evacuation in radiation accidents". An analysis of medical service capabilities to provide specialized, high-tech medical care in radiation injuries showed the relevance of the clinical base development in military medical organizations and the importance of interaction with radiological medical centers of other ministries, agencies and services. The solution of these tasks will be facilitated by the creation of a specialized infrastructure on the basis of military medical organizations of the district (fleet), which is providing necessary conditions for the provision of medical assistance to victims of the radiation emergency.

Bulletin of the Russian Military Medical Academy. 2021;23(1):153-162
pages 153-162 views

Sanitary-parasitological condition of the environmental objects of the Astrakhan region

Arakelyuan R.S., Galimzyanov K.M., Maslyaninova A.E., Deeva T.M.

Abstract

The sanitary and parasitological state of environmental objects of the Astrakhan region is analyzed. It was found that out of 689 samples taken and studied from various environmental objects, 114 (16,5%) did not meet sanitary and parasitological standards. The share of soil samples taken was 554 (80,4%), of which 107 (19,3%) did not meet sanitary and parasitological standards. In 83 (15%) cases, living larvae of Strongyloides stercoralis were found, in 12 (2,1%) — fertilized eggs of Ascaris lumbricoides, in 10 (1,8%) — eggs of Toxocara canis, in 1 (0,2%) sample mixed invasions were noted: fertilized eggs of Ascara canis of 126 (18,3%) washes from hard surfaces, 4 (8,6%) were unsatisfactory (in 7,35% of cases, fertilized eggs of Ascaris lumbricoides were found and in 1,25% — eggs of Enterobius vermicularis. Dead larvae of Anisakis simplex were found in 3 (0,4%) fish samples examined. All 6 (0,9%) river water samples complied with sanitary and parasitological standards. The presence of living strongilid larvae and toxocar eggs in the soil indicates its contamination with faeces of infected animals. The presence of people or about flooding or flooding of these objects sewer drains allows to assume existence of oosperms of ascarids in the soil about her pollution by excrements. The presence of eggs of ascarids and pinworms on various household surfaces indicates non-compliance with the rules of personal hygiene of persons infected with ascarids and/or pinworms who use these household appliances. The presence of aniacid larvae in the internal organs of fish is not a contraindication for its sale to the population.

Bulletin of the Russian Military Medical Academy. 2021;23(1):163-168
pages 163-168 views

Development of patenting of domestic inventions for the surgical treatment of injuries of the shoulder joint

Evdokimov V.I., Vetoshkin A.A.

Abstract

Domestic patents for inventions on surgical treatment of shoulder joint injuries are analyzed. The database of the Federal Institute of Industrial Property of Rospatent was searched. Eliminating the so-called search noise, we created an array of 215 patents for inventions for the surgical treatment of shoulder injuries (registration mainly from 01/01/1994 to 09/30/2020). The average annual number of patents for inventions was 7 ± 1. Surgical treatment methods were presented in 74.3% of inventions, and devices (surgical instruments, endoprostheses, etc.) — in 25.7%. In some inventions, both methods and devices were patented. Inventions for the surgical treatment of shoulder joint instability accounted for 23.4%, for the treatment of tendons and periarticular tissues — 8.9%, for osteosynthesis of the bones of the shoulder joint — 21.9%, for surgical devices and instruments — 14.2%, for methods and shoulder arthroplasty devices — 13.4%; other inventions (on assessment of lesions, the likelihood of a favorable outcome of surgery, pain relief, etc.) — 18.2%. It is necessary to optimize the domestic inventive activity in areas of medicine to prevent a shotage of domestic medical equipment or tools in case of sanctions imposed by certain foreign states.

Bulletin of the Russian Military Medical Academy. 2021;23(1):169-176
pages 169-176 views

Literature reviews

The need to create and implement a platform for managing the professioyal reliability of military personnel of the armed forces of the russian federation, based on the principles of personalizet medicine

Kutelev G.G., Cherkashin D.V., Trishkin T.V., Kryukov E.V., Fisun A.Y., Marchenko M.A., Shulenin K.S., Krivoruchko A.B., Sobolev A.D.

Abstract

The article analyzes modern federal programs aimed at preserving the health and well-being of the population and creating a comfortable and safe environment for life and work. The article describes the arsenal of strategic directions for assessing the risk of developing diseases, diagnostic approaches and scientific principles that contribute to the successful implementation of evaluation measures. The possibility of clarifying the cardiovascular risk in the study of the role of military-professional factors in the formation of cardiovascular pathology in military personnel of the Armed Forces of the Russian Federation is discussed. The article analyzes the effectiveness of traditional diagnostic methods used by the medical service, as well as ways to improve this efficiency when using molecular genetic studies to search for associations with risk factors for neuropsychic and cardiovascular pathology. The article considers the practical necessity of creating a professional reliability management platform based on the principles of personalized medicine, which contributes to prolonging professional longevity and improving the combat readiness of servicemen of the Armed Forces of the Russian Federation. Such a method of implementing the professional reliability management platform will significantly increase the informativeness of traditional methods of early diagnosis of cardiovascular and neuropsychic pathology.

Bulletin of the Russian Military Medical Academy. 2021;23(1):177-186
pages 177-186 views

Features of immunopathogenesis of a new coronavirus infection

Gumilevskiy B.Y., Moskalev A.V., Gumilevskaya O.P., Apcel V.Y., Tsygan V.N.

Abstract

The main biological characteristics of viruses of the Coronaviridae family are presented. The features of the immunopathogenesis of these infections are analyzed. It was found that the structural proteins of the spine, membrane, envelope and nucleocapsid play an important role in the immunopathogenesis of COVID-19 infection. They are associated with hyperactivation of neutrophils and monocytes-macrophages, secreting large amounts of pro-inflammatory cytokines and chemokines. This contributes to the development of a «cytokine storm» and an unfavorable prognosis of the disease. A particularly high risk of developing pneumonia exists against the background of an increase in the production of: macrophage inflammatory protein-1 alpha, macrophage chemotactic protein, interleukin 8. At the height of infection in some patients, macrophages and dendritic cells infected with SARS-CoV-2 lose their ability to produce type I interferons and pro-inflammatory cytokines. On the part of cellular immunity, a significant decrease in the number of CD4+ and CD8+-lymphocytes was noted. Among IgG sub-isotypes, IgG3 antibodies had the highest reactivity, and IgG1 antibodies were less reactive. Antibodies to spike protein with low specificity or low titer do not neutralize the virus and contribute to the contamination of immunocompetent cells via Fc receptors. Low-affinity antibodies or their low levels can contribute to increased cell sensitivity to SARS-CoV-2 and the development of severe forms of COVID-19 disease.

Bulletin of the Russian Military Medical Academy. 2021;23(1):187-198
pages 187-198 views

Modern approaches to the diagnosis of alcoholic liver disease

Zhirkov I.I., Gordienko A.V., Yakovlev V.V., Serdyukov D.Y.

Abstract

The article presents up-to-date information about diagnostic methods for one of the most common and socially significant hepatological diseases-alcoholic liver disease. The most frequent clinical manifestations of this pathology are asthenic, dyspeptic, right hypochondrium, cholestatic, neurological, edematous-ascitic and hemorrhagic syndromes. Validated questionnaires are intended for standardized alcohol use screening, the «gold standard» among which is the «AUDIT» questionnaire aimed at identifying alcohol use disorders. Most of the physical signs of chronic alcohol abuse are presented in the modified LeGo grid. Direct indicators (markers) of laboratory diagnosis of alcohol use include the determination of phosphatidyl ethanol and ethyl glucuronide in blood serum and urine; ethyl glucuronide and fatty acid ethyl esters in hair; ethanol, aminotransferase, peroxidase, ethylglucuronide, ethyl sulfate, haptoglobin, etc., in saliva. Indirect markers include macrocytic anemia, neutrophilic leukocytosis, increased activity of gamma-glutamyl transpeptidase, transaminases, de Ritis coefficient, bilirubin, alkaline phosphatase, serum immunoglobulin A and gamma globulins. Determination of carbohydrate-deficient transferrin is recommended as a preferred marker of alcohol intoxication. In order to determine the degree of fibrosis, predictive diagnostic serum tests are used, both non-proprietary («APRI», «Forns») and commercial («Fibrometer», «Hepascore», «Fibrospect» etc.). The methods of visual diagnostics of liver diseases include ultrasound, magnetic resonance and computed tomography, which can determine steatosis, exclude other causes of liver damage, reveal signs of severe fibrosis or cirrhosis, as well as their complications, but none of them allows to establish the etiology of the lesion. A promising direction is to determine the degree of steatosis when measuring the controlled parameter of ultrasound attenuation, implemented in the «Fibroscan» apparatus. The most accurate methods for diagnosing steatosis today are magnetic resonance imaging of the liver in the mode of determining the proportion of fat, weighted by proton density, and proton magnetic resonance spectroscopy. To determine the degree of fibrosis, a transient, two-dimensional shear wave and magnetic resonance elastography are used. Biopsy followed by morphological examination is the «gold standard» for the diagnosis of alcoholic liver disease, which confirms the presence of liver damage, establishes its stage and often allows confirming alcoholic genesis. However, this procedure has a number of significant drawbacks, so it is advisable to use non-invasive diagnostic techniques for screening, primary examination and further monitoring of the patient’s condition in dynamics. 

Bulletin of the Russian Military Medical Academy. 2021;23(1):199-206
pages 199-206 views

Assessment of the working conditions under exposed to noise and infrason

Mironov V.G., Khasiev N.D., Isachenko V.S., Korolevа K.Y.

Abstract

Currently in healthcare of the Russian Federation created a system of measures to combat the harmful effects of industrial noise on workers. However, the level of specific and nonspecific morbidity rates the effect of industrial noise is not reduced, and the incidence of occupational diseases tends to increase. This is due to several reasons, including a large number of sources of noise, not enough high quality of medical examinations, lack of and low effectiveness of means of individual protection from noise and others. Noise is one of the leading places among the harmful physical factors in the Armed forces of the Russian Federation. Features noise resulting from the operation of military equipment and armament is its high intensity, intermittent nature, the presence in the spectrum of low and infrasonic frequencies. Noise exposure leads to the development of diseases, primarily of the organ of hearing, increase in total morbidity and the reduction of military-professional health. In the normative documents of the military medical service the noise is not identified as a harmful factor leading to the development of occupational diseases that were not fully developed the issues of professional selection and medical examination of noise pathology. System noise control should be comprehensive and include organizational and technical measures, special assessment of working conditions, monitoring of noise sources, the presence and correct application of means of protection against noise professional selection, clinical monitoring, medical examination, treatment and preventive measures. Existing in the Armed forces of the Russian Federation the system of measures for the fight against harmful impact of noise on military personnel requires revision in accordance with the existing state legislative framework.

Bulletin of the Russian Military Medical Academy. 2021;23(1):207-214
pages 207-214 views

Artificial intelligence using for medical diagnosis via implementation of expert systems

Kotiv B.N., Budko I.A., Ivanov I.A., Trosko I.U.

Abstract

Modern biomedical technologies development affords to provide the doctor with colossal amount of information about patient’s organism condition. However, the opportunity of using this data for medical diagnosis fully now is a distantive perspective only. The reason is a human’s limited ability in assessment and interpretation this data arrays. The solution seems in artificial intelligence and expert systems wide introduction to medicine. Currently, almost all authors consider various options for constructing artificial neural networks as a way to implement artificial intelligence. This approach, which goes back to the fundamental theorem of A.N. Kolmogorov, the works of V.I. Arnold and Hecht-Nielsen [3], demonstrates excellent capabilities in a number of pattern recognition problems, which are reduced to revealing hidden details against the background of input noises. Much less often is mentioned such a method of modeling formal thinking as expert systems, which arose in the 1960s and then went into the shadows. Since the inception of cybernetics, computer programmers have tried to reproduce the mechanism of human thinking, that is, the task was to teach the computer to "think". The first known results in the field of creating and using intelligent systems were laid by the work of Norbert Wiener and G.S. Altshuller. At the same time, the creation of intelligent systems was reduced to the development of programs that solve problems using a variety of heuristic methods based on the property of human thinking to generalize.

Bulletin of the Russian Military Medical Academy. 2021;23(1):215-224
pages 215-224 views

The psychosocial impact on society of the COVID-19 epidemic

Bolekhan V.N., Ulyukin I.M., Shulyatyeva E.V.

Abstract

The issues of psychosocial and other impact of COVID-19 on the epidemiological specificity of the disease are considered in the interests of effective medical, psychological and social interventions to preserve the epidemiological well-being in society during the period of the COVID-19. It is shown that the spread of this disease had a sharply negative impact on the economy, in particular, of our country, since for a long time certain industries that served as sources of budget revenues were “paralyzed”, and the population’s ability to pay sharply decreased, the volume of financial inflows into the service sector decreased, which is reflected in the field of public health. Therefore, within the framework of the anti-crisis COVID-19 measures, one can single out such areas as education, employment, support for vulnerable groups and information support, which are carried out in various countries based on the existing practices, methods and financial capabilities. In addition, the fact that the current outbreak of COVID-19 provokes stigmatization and discriminatory behavior of society towards representatives of certain ethnic groups, as well as towards people suspected of having contact with carriers of the SARS-CoV-2 coronavirus infection, is of great epidemiological significance. The widespread prevalence of COVID-19 is believed to be not a pandemic, but a syndemia (not just comorbidity, but an integration that identifies biological and social interactions important for prognosis, treatment and health policy), characterized by biological and social interactions between conditions and conditions, interactions that increase a person’s susceptibility to harm or worsen their health. Thus, in the case of COVID-19, the fight against non-communicable diseases (hypertension, obesity, diabetes, cardiovascular and chronic respiratory diseases, cancer, snake bites, epilepsy, kidney disease and sickle cell anemia) and socioeconomic inequality will also become a prerequisite for its successful containment.

Bulletin of the Russian Military Medical Academy. 2021;23(1):225-232
pages 225-232 views

The possibility of using biomedical cell product in the treatment of chronic glomerulonephritis

Sigareva L.P., Kokorina A.A., Kondartenko A.A., Slizhov P.A., Ekaterina E.V., Alexandrov V.N., Solovyov A.A.

Abstract

The basic principles of rational treatment of glomerulonephritis are considered, based on etiology, clinical manifestations and pathomorphological variants of its different forms. Today it has been established that glomerulonephritis can be primary (the etiology is usually unknown) and secondary, when the disease occurs against the background of concomitant pathology (systemic lupus erythematosus, vasculitis, hepatitis, oncological diseases, chronic viral and bacterial infections). The participation of various pathological, genetic and systemic factors in the development of various forms of glomerulonephritis has been shown. The characteristic clinical picture of manifestations of different forms of the disease and the degree of involvement of different renal structures in them are described. Against the background of the severity of the course and prevalence of various forms of glomerulonephritis, it is especially important to develop therapeutic approaches aimed at the full restoration of kidney function and cure of patients. One of such approaches is the use of biomedical cell products based on allogenic mesenchymal multipotent stromal cells and hematopoietic stromal cells. A number of studies have confirmed that the best results can be achieved with the use of cell products in complex therapies with standard treatment methods (use of cytostatics and steroid anti-inflammatory drugs) and alternative drug approaches (combination of monoclonal antibodies and polyenzyme drugs). At the same time, the use of standard and alternative techniques does not lead to a complete recovery of patients, but only transfers the course of the disease from the exacerbation phase to remission. The relevance of further development of biomedical cell products of allogeneic mesenchymal multipotent bone marrow stromal cells is shown, verification of their safety and efficacy in preclinical and clinical studies.

Bulletin of the Russian Military Medical Academy. 2021;23(1):233-242
pages 233-242 views

THE NEED TO CREATE AND IMPLEMENT A PERSONALIZED MEDICINE BASED ON THE PRINCIPLES OF A PLATFORM FOR MANAGING THE PROFESSIONAL RELIABILITY OF MILITARY PERSONNEL OF THE ARMED FORCES OF THE RUSSIAN FEDERATION

Kutelev G.G.

Abstract

The article analyzes modern federal programs aimed at preserving the health and well-being of the population and creating a comfortable and safe environment for life and work. The article describes the arsenal of strategic directions
for assessing the risk of developing diseases, diagnostic approaches and scientific principles that contribute to the successful
implementation of evaluation measures. The possibility of clarifying the cardiovascular risk in the study of the role of militaryprofessional factors in the formation of cardiovascular pathology in military personnel of the Armed Forces of the Russian
Federation is discussed. The article analyzes the effectiveness of traditional diagnostic methods used by the medical service,
as well as ways to improve this efficiency when using molecular genetic studies to search for associations with risk factors
for neuropsychic and cardiovascular pathology. The article considers the practical necessity of creating a professional reliability management platform based on the principles of personalized medicine, which contributes to prolonging professional
longevity and improving the combat readiness of servicemen of the Armed Forces of the Russian Federation. Such a method
of implementing the professional reliability management platform will significantly increase the informativeness of traditional
methods of early diagnosis of cardiovascular and neuropsychic pathology.
Keywords: professional reliability; personalized medicine; professional l

Bulletin of the Russian Military Medical Academy. 2021;23(1):
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Medicine history

On the life of the defender of the fatherland and pathologist of professor Dmitry Pavlovich Svistelin

Ukrainets R.V., Korneva J.S.

Abstract

Svistelin Dmitry Pavlovich was born on November 27, 1923 in the town Seredina-Buda in the Ukrainian Soviet Socialist Republic. During the Great Patriotic War, he served in the 164th Tank Brigade of the 16th Tank Corps, which took part in the Battle of Kursk. In one of the battles, Dmitry Pavlovich was severely wounded, but after the Victory of the Soviet Union he found the strength and entered the medical faculty of the Lviv State Medical Institute and graduated form it in 1951. Subsequently, Dmitry Pavlovich came to Smolensk, where he became a postgraduate at the Department of Pathological Anatomy of the Smolensk State Medical Institute. From that moment he paid his debt to the Motherland already as a doctor being the head of the pathological department of the Smolensk Regional Psychiatric Hospital. Subsequently, Dmitry Pavlovich began to teach at the Department of Pathological Anatomy and became interested in scientific activities under the guidance of Professor Vladimir Gerasimovich Molotkov, who later guided him for both his candidate’s and doctoral dissertations. Having achieved a great success in the pathological anatomy and becoming a professor, Dmitry Pavlovich decided to return to practice again. In 1996, he shifted to the post of pathologist in the expert-organizational-advisory department of the Smolensk Regional Institute of Pathology, which even today bears his name due to his outstanding work both for pathological anatomy in general and for Smolensk medicine. For services to the Motherland both as a defender of the Fatherland and as a doctor, Dmitry Pavlovich Svistelin has such awards as the Order of the Patriotic War, 2nd degree, as well as the badge «Excellence in Public Health». On June 16, 2006, at the age of 82, Professor Dmitry Pavlovich Svistelin passed away and was buried at the New Cemetery in Smolensk.

Bulletin of the Russian Military Medical Academy. 2021;23(1):243-246
pages 243-246 views

Honorary doctor of the military medical academy professor V.V. Volkov (To the 100th anniversary of his birth)

Kulikov A.N., Reituzov V.A., Sobolev A.F., Kirillov Y.A., Shamrey D.

Abstract

The main milestones of the life path, creative, clinical, scientific and pedagogical activity of Hero of Socialist Labor, laureate of the State Prize of the Union of Soviet Socialist Republics, Honored Scientist of the Russian Soviet Federative Socialist Republic, Honorary Doctor of the Military Medical Academy named after S.M. Kirov Professor Major General Medical Service Veniamin Vasilyevich Volkov are presented. His fundamental research in such sections of ophthalmology as the organization of specialized assistance in the Armed Forces, ophthalmotraumatology, combined lesions and burns of the eyes, vitreoretinal pathology, glaucoma, ophthalmoncology, visual organ physiology, lacrimation pathology, development and introduction of lasers into ophthalmological practice, made him one of the most authoritative specialists in domestic and world ophthalmology. In 1967, V.V. Volkov headed the Department of Ophthalmology, which he led 22 years before his dismissal from the Armed Forces on September 20, 1989. His multifaceted educational, medical and scientific activities were awarded numerous awards and titles. Employees of the Department of Ophthalmology of the Military Medical Academy named after S.M. Kirov are proud that they are students of the school of Professor V.V. Volkov, and the teachers of the older generation were lucky to work together with a scientist who made a significant contribution to the development of Soviet and Russian ophthalmology, whose works received widespread world recognition. Professor V.V. Volkov is a scientist who formed the scientific school of the Department of Ophthalmology of the Military Medical Academy named after S.M. Kirov in its modern form. Therefore, in 2019, the department was named after him.

Bulletin of the Russian Military Medical Academy. 2021;23(1):247-254
pages 247-254 views

Chronicle

HONORARY DOCTOR OF THE MILITARY MEDICAL ACADEMY PROFESSOR V.V. VOLKOV (TO THE 100TH ANNIVERSARY OF HIS BIRTH)

Kulikov A.N.

Abstract

SUMMARY: The main milestones of the life path, creative, clinical, scientific and pedagogical activity of Hero of Socialist
Labor, laureate of the State Prize of the Union of Soviet Socialist Republics, Honored Scientist of the Russian Soviet Federative
Socialist Republic, Honorary Doctor of the Military Medical Academy named after S.M. Kirov Professor Major General Medical Service Veniamin Vasilyevich Volkov are presented. His fundamental research in such sections of ophthalmology as the
organization of specialized assistance in the Armed Forces, ophthalmotraumatology, combined lesions and burns of the eyes,
vitreoretinal pathology, glaucoma, ophthalmoncology, visual organ physiology, lacrimation pathology, development and introduction of lasers into ophthalmological practice, made him one of the most authoritative specialists in domestic and world
ophthalmology. In 1967, V.V. Volkov headed the Department of Ophthalmology, which he led 22 years before his dismissal
from the Armed Forces on September 20, 1989. His multifaceted educational, medical and scientific activities were awarded
numerous awards and titles. Employees of the Department of Ophthalmology of the Military Medical Academy named after
S.M. Kirov are proud that they are students of the school of Professor V.V. Volkov, and the teachers of the older generation
were lucky to work together with a scientist who made a significant contribution to the development of Soviet and Russian
ophthalmology, whose works received widespread world recognition. Professor V.V. Volkov is a scientist who formed the
scientific school of the Department of Ophthalmology of the Military Medical Academy named after S.M. Kirov in its modern
form. Therefore, in 2019, the department was named after him.

Bulletin of the Russian Military Medical Academy. 2021;23(1):
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ANNIVERSARIES

Twenty years at the head of the department and clinic of nervous diseases of the military medical academy named after S.M. Kirov (on the occasion of the 75th birthday of corresponding member of the russian academy of sciences Miroslav Mikhailovich Odinak)

Litvinenko I.V., Tsygan N.V.

Abstract

The main aspects of the biography and scientific and pedagogical activities of the outstanding Russian neurologist, Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences Miroslav Mikhailovich Odinak are presented. Key professional and organizational achievements are considered. Particular attention is paid to the implemented innovative methods of treatment, such as the first systemic thrombolysis operation in St. autologous stem cell transplant for the treatment of amyotrophic lateral sclerosis, the world’s first autologous dendritic cell transplant for the treatment of multiple sclerosis was performed. In the same way, under the guidance of Professor M.M. Odinak, an increase in the bed capacity of the clinic of nervous diseases was carried out, a department of intensive care and intensive care and a day hospital was formed, a department of traditional medicine with rooms for psychotherapy, reflexology, manual therapy, thermal relaxation was opened; department of functional diagnostics of the clinic of nervous diseases with rooms for neurofunctional studies, ultrasound studies, dopplerography, studies of the function of the autonomic nervous system; a physiotherapy department with a hydropathic center, a video electroencephalographic monitoring department and a polysomnography department.

Bulletin of the Russian Military Medical Academy. 2021;23(1):259-262
pages 259-262 views

PATRIARCH OF MILITARY NEUROSURGERY

Kryukov E.V.

Abstract

SUMMARY: January 19, 2021 marks the 75th anniversary of the birth of one of the leading Russian neurosurgeons,
Academician of the Russian Academy of Sciences Boris Vsevolodovich Gaidar. 8 years at the head of the Department and
Clinic of Neurosurgery at the Military Medical Academy and 7 years at the head of Military Medical Academy, when his talent
as a teacher and leader was most clearly revealed. Academician B.V. Gaidar is one of the country’s leading scientists in the
field of treatment of combat injuries of the central nervous system (craniocerebral trauma and mine-explosive wounds of the
central nervous system), vascular neurosurgery, and neurooncology. He made a major contribution to solving the issues of organizing specialized neurosurgical care in the Armed Forces in peacetime and in wartime. He personally took part in providing
medical assistance to the wounded during the armed conflict in the North Caucasus. B.V. Gaidar represented Russian science
at international forums in Austria, Germany and the United States of America, in 2005 he led the organization of the World
Congress on Military Medicine for the only time in our country. During the years of leadership of the S.M. Kirov Military Medical Academy B.V. Gaidar carried out a large-scale reconstruction and re-equipment of a number of leading surgical clinics,
which contributed to the progressive development of the academy’s scientific schools. B.V. Gaidar created a scientific school
of neurosurgeons, prepared a rich legacy of articles, textbooks and monographs, his merits were recognized by the scientific
community and the state. Celebrating the anniversary, Boris Vsevolodovich continues to actively engage in scientific work,
training, counseling critical patients, passionately defending the interests of the Military Medical Academy.

Bulletin of the Russian Military Medical Academy. 2021;23(1):
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Patriarch of military neurosurgery

Kryukov E.V., Svistov D.V.

Abstract

January 19, 2021 marks the 75th anniversary of the birth of one of the leading Russian neurosurgeons, Academician of the Russian Academy of Sciences Boris Vsevolodovich Gaidar. Eight years at the head of the Department and Clinic of Neurosurgery at the Military Medical Academy and 7 years at the head of Military Medical Academy, when his talent as a teacher and leader was most clearly revealed. Academician B.V. Gaidar is one of the country’s leading scientists in the field of treatment of combat injuries of the central nervous system (craniocerebral trauma and mine-explosive wounds of the central nervous system), vascular neurosurgery, and neurooncology. He made a major contribution to solving the issues of organizing specialized neurosurgical care in the Armed Forces in peacetime and in wartime. He personally took part in providing medical assistance to the wounded during the armed conflict in the North Caucasus. B.V. Gaidar represented Russian science at international forums in Austria, Germany and the United States of America, in 2005 he led the organization of the World Congress on Military Medicine for the only time in our country. During the years of leadership of the S.M. Kirov Military Medical Academy B.V. Gaidar carried out a large-scale reconstruction and re-equipment of a number of leading surgical clinics, which contributed to the progressive development of the academy’s scientific schools. B.V. Gaidar created a scientific school of neurosurgeons, prepared a rich legacy of articles, textbooks and monographs, his merits were recognized by the scientific community and the state. Celebrating the anniversary, Boris Vsevolodovich continues to actively engage in scientific work, training, counseling critical patients, passionately defending the interests of the Military Medical Academy.

Bulletin of the Russian Military Medical Academy. 2021;23(1):255-258
pages 255-258 views

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