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Vol 22, No 4 (2020)

Clinical trials

Practical recommendations for prevention of development and progression of hypertension among the flight personnel of the Russian Aerospace forces

Trishkin D.V., Schegol’kov A.M., Makiev R.G., Fisun A.Y., Polovinka V.S., Gornov S.V., Cherkashin D.V., Kutelev G.G., Gornov V.V.


The article substantiates the relevance of studying the problem of early development and progression of hypertension among the flight personnel of the Russian Aerospace forces. The article analyzes the incidence of hypertension among aircrew in comparison with the incidence in the Armed forces and the population of the country. The article considers the most significant signs of early development and course of hypertension, which lead to early disqualification from flight work for medical reasons. The total risk of developing cardiovascular complications is assessed on the scale for assessing the risk of fatal cardiovascular disease over 10 years in the examined individuals with previously established and newly detected arterial hypertension and high levels of stress. Attention is drawn to the high prevalence of modifiable risk factors for cardiovascular pathology among the examined individuals against the background of occupational stress. It was found that people with diagnosed hypertension under the influence of a high level of professional stress are characterized by irrational changes in eating behavior, high prevalence of Smoking, increased alcohol consumption and low physical activity. In addition, stress-induced hypertension indicates a high risk of developing cardiovascular complications in the next 10 years and necessitates additional expansion of the range of measures for its prevention and correction. Practical recommendations for preventing the development and progression of hypertension among the flight personnel of the Russian Aerospace forces are presented. These recommendations are based on the analysis of the incidence of hypertension in flight personnel at the present stage, as well as the identified risk factors for developing hypertension, taking into account the specifics of flight work and conditions of military service of these specialists.

Bulletin of the Russian Military Medical Academy. 2020;22(4):8-11
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Сlinical and epidemiological profiles and tactics of patient’s management with myocardial infarction with non-obstructive coronary arteries

Trishkin D.V., Shulenin K.S., Cherkashin D.V., Kutelev G.G., Efimov S.V., Shishkevich A.N., Bobrovskaya E.E., Popova A.V., Bogdanov D.S.


A comparative analysis of clinical and epidemiological data and results of treatment of 7 patients suffering from myocardial infarction without obstructive coronary artery disease (main group) and 54 patients with their lesions (control group) aged 45,6±9,3 and 62,7±14,2 years, respectively. Both groups were dominated by men (85,7% and 72,2%, respectively). In the main group, dyslipidemia and hypertension were less common (14,3 and 28,6%, respectively) than in the control group (61,1 and 72,2%, respectively). At the same time, the former had a more burdened history of early cardiovascular events in close relatives in 28,6% of cases, and the latter-only in 5,6% of cases. Surgical tactics and features of double antiplatelet therapy in myocardial infarction without obstructive coronary artery disease did not differ from the standard approach. In both groups, active surgical tactics prevailed, consisting in performing percutaneous coronary intervention and installing a coronary stent in the infarct-related artery (85,7 and 83,3%, respectively). The choice of dual antiplatelet therapy in the main group did not differ from the control group and was characterized by a significantly higher frequency of clopidogrel administration (71,4 and 72,2%, respectively). When comparing the left ventricular ejection fraction before and after percutaneous coronary intervention, it turned out that in patients of the main group, in contrast to the control group, the value of the left ventricular ejection fraction did not change significantly (52,5±6,4 and 51,3±9,5, respectively). The etiology and pathogenesis of myocardial damage in patients suffering from myocardial infarction without obstructive coronary artery disease is characterized by significant heterogeneity, which requires additional examinations and differential diagnostics to identify the underlying causes of this condition.

Bulletin of the Russian Military Medical Academy. 2020;22(4):12-16
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Early bronchodilatory response to the first dose of indacaterol/glycopyrronium as an additional individual predictor of their effectiveness in the treatment of chronic obstructive pulmonary disease

Sharova N.V., Grishaev S.L., Cherkashin D.V., Efimov S.V., Kharitonov M.A., Zakharova A.I., Zakharova I.M.


The effectiveness of the early bronchodilatory response of the first dose of a fixed double combination of long-acting bronchodilators of various classes indacaterol/glycopyrronium and long-acting anticholinergics glycopyrronium and Tiotropium in patients suffering from stable chronic obstructive pulmonary disease is compared. It was found that in all patients included in the study and suffering from chronic obstructive pulmonary disease, changes in functional respiratory indicators were accompanied by positive and comparable dynamics of clinical signs: a decrease in the severity of shortness of breath, the impact of the disease on the quality of life and increased tolerance to physical activity. It was found that the combination of indacaterol/glycopyrronium provides rapid, pronounced and prolonged bronchodilation in patients suffering from chronic obstructive pulmonary disease compared to the separate use of glycopyrronium and Tiotropium. Consistent use of glycopyrronium and salbutamol leads to maximum bronchodilation, which makes it advisable to separate the use of prolonged bronchodilators when initiating therapy for chronic obstructive pulmonary disease. Therefore, there is a clinical feasibility of taking not only fixed combinations of bronchodilators of different classes, but also their consistent use. The results of an early bronchodilatory response to the first dose of indacaterol/glycopyrronium can be used as an additional individual predictor of their effectiveness in the treatment of chronic obstructive pulmonary disease.

Bulletin of the Russian Military Medical Academy. 2020;22(4):17-22
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The effect of a systemic inflammatory response on adaptive mechanisms and the state of homeostasis in patients with respiratory tuberculosis in combination with chronic obstructive pulmonary disease

Кaticheva A.V., Brazhenko N.A., Brazhenko O.N., Chuikova A.G., Nikolay A.V., Zheleznyak S.G., Tsygan N.V.


The influence of the systemic inflammatory response on the adaptive mechanisms and the state of homeostasis of the body in patients with respiratory tuberculosis against the background of chronic obstructive pulmonary disease is considered. It has been established that respiratory tuberculosis and chronic obstructive pulmonary disease are widespread among the population and are important causes of bronchopulmonary morbidity and mortality. Chronic obstructive pulmonary disease is determined in one third of newly diagnosed patients with respiratory tuberculosis. The combined course of respiratory tuberculosis and chronic obstructive pulmonary disease is a mutually aggravating condition. Comorbid pathology is much more difficult, accompanied by severe intoxication, disintegration of lung tissue and bacterial excretion. Biomarkers and the severity of the systemic inflammatory response are of great clinical and diagnostic value in chronic obstructive pulmonary disease. It was determined that the systemic inflammatory response in chronic obstructive pulmonary disease is characterized by endothelial dysfunction of the vascular wall, significant changes in white blood cells, changes in the protein spectrum of the blood, and lipid metabolism disorders. The manifestations of systemic inflammation and endothelial dysfunction, characteristic of chronic obstructive pulmonary disease, in patients with respiratory tuberculosis, aggravate the course of both diseases. The comorbid state is also characterized by a change in the lipid profile of patients, an increase in the content of total cholesterol and atherogenic fractions. These changes are interrelated with the state of adaptive mechanisms, homeostasis and reactivity of the organism. The state of homeostasis largely determines the development, course and outcome of pathological processes characteristic of tuberculous inflammation and inflammation in chronic obstructive pulmonary disease, and the increase in the effectiveness of the treatment is closely related to the restoration of homeostatic balance and reactivity of the body. The availability of methods for determining the homeostatic balance of the body in clinical practice, with their high information content, allows a personalized approach to the management of patients with comorbidity.

Bulletin of the Russian Military Medical Academy. 2020;22(4):23-27
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Programmed extracorporeal photochemotherapy in the complex treatment of systemic scleroderma

Manuilov A.S., Belskih A.N., Bardakov S.N., Apchel A.V., Tishko V.V., Zakharov M.V., Sokolov A.A., Ryabova T.S., Volkov K.Y., Vasylieva I.А.


The choice of non-drug methods for the treatment of systemic scleroderma is currently very limited. Several studies show that extracorporeal photochemotherapy can improve kidney and lung function and reduce skin fibrosis in patients with systemic scleroderma. We studied the dynamics of clinical and laboratory parameters in patients with systemic scleroderma with an assessment before and after 12 months against the background of complex treatment, which included programmed extracorporeal photochemotherapy. Indications for inclusion in the study was the ineffectiveness of standard therapy with glucocorticoids and cytostatics or the impossibility of their use, as well as signs of an unfavorable prognosis of the disease: diffuse form, high skin count (>14), rapid progression with a significant initial decrease in the glomerular filtration rate, forced vital capacity, high immunological activity (high titer of antinuclear factor and positivity for antibodies to Scl-70). When evaluating the results of complex treatment, a good clinical effect was observed in all patients: the induration of the skin decreased, the functionality of the lungs and kidneys increased. A significant decrease in the disease activity index was noted. These positive changes were the basis for a decrease in the daily dose of glucocorticoids. Significantly significant changes were observed in a decrease in the immunological activity of the disease: levels of C-reactive protein, erythrocyte sedimentation rate and immunoglobulin G, antinuclear factor titer and all types of circulating immune complexes. The results of our study confirm the data of other studies that demonstrated the positive effect of extracorporeal photochemotherapy as a component of the complex treatment of systemic scleroderma.

Bulletin of the Russian Military Medical Academy. 2020;22(4):28-32
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Application of autologous multipotent mesenchymal stromal cells for correction of liver function in patients suffering from alcoholic liver cirrhosis

Kotkas I.E., Masurov V.I., Bakulin I.G., Enukashvili N.I., Asadulayev S.M.


Clinical experience of application of autologous multipotent mesenchymal stromal cells in treatment of patient suffering from liver cirrhosis of alcoholic etiology is presented. A special feature is that the hepatocyte precursors were isolated directly from the patient’s liver tissue. The patient underwent laparoscopic surgery to obtain the largest volume of material and to be able to visually control the tissue sampling with minimal fibrotic changes. After liver tissue sampling, the patient was discharged for outpatient treatment in a satisfactory condition. Subsequently, the patient was re-admitted to the hospital. During repeated hospitalization, multipotent mesenchymal stromal cells in the amount of 20 million were injected into the arterial bed of the liver using x-ray endovascular technique. In the control study, 6 months after treatment, according to the 13C-metacetin test, normalization of liver function, regression of portal hypertension, and an increase in platelet levels were noted. There were no complications during this treatment. Treatment of patients suffering from cirrhosis of the liver is quite a serious and complex task. As a rule, the patient learns about his diagnosis already in the presence of complications, when the liver function is already significantly impaired. The propensity of the population to alcoholism leads to the formation of fibrosis, and subsequently cirrhosis of the liver. The absence of anti-fibrotic drugs contributes to the implementation of research to find alternative methods of treatment for this category of patients. In General, the use of autologous multipotent mesenchymal stromal cells is an effective and promising method, and research in this direction should be continued.

Bulletin of the Russian Military Medical Academy. 2020;22(4):33-36
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Сhronic gastritis: impaired motor-evacuation function of the stomach

Pavlovich I.M., Al’per G.A., Gordienko A.V., Proskunov D.I., Yakovlev V.V.


The effect of morphological changes in the gastric mucosa on the motor-evacuation function of the stomach was evaluated in 90 patients with chronic atrophic gastritis and 93 patients with chronic non-atrophic gastritis aged 18 to 82 years. Motor function disturbances were discovered of 90% of patients with chronic atrophic gastritis and 80,6% – with chronic non-atrophic gastritis. It was established that the pyloric insufficiency compared with its spasm was significantly more (p<0,01) often in chronic atrophic gastritis. Insufficiency of the lower esophageal sphincter in patients with atrophic gastritis was significantly (p<0,01). Insufficiency of the lower esophageal sphincter in combination with duodenogastric reflux in patients with chronic atrophic gastritis was significantly more (p<0,01) often observed during diffuse atrophy, i. e. when mucous membrane of stomach corpus and antrum is involved in the process. With the localization of atrophy in the antrum alone, pyloric insufficiency was observed significantly more (p <0,01) often than spasm. Thus, an interrelation between the insufficiency of the lower esophageal and pyloric sphincters with the diffuse atrophic process has been established. There are no significant differences of disorders of gastric motor function in patients with different types of chronic gastritis. Accelerated evacuation from the stomach with localization of atrophy in the mucous membrane of the stomach corpus is more (p <0,01) often observed in patients with chronic atrophic gastritis.

Bulletin of the Russian Military Medical Academy. 2020;22(4):37-42
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Features of diagnostics of the peripheral lymph nodes tuberculosis

Balasaniantc G.S., Dantsev V.V., Matinina M.S., Zarecky B.V., Muchaidze R.D.


The analysis of the features of diagnostics of peripheral lymph nodes tuberculosis in modern conditions is carried out. For this 28 case histories of patients suffering from tuberculosis of peripheral lymph nodes were studied and 85,7% of them had a combination of tuberculosis and infection caused by the human immunodeficiency virus. All patients were undergoing biopsies or surgery of lymph nodes, and the material was examined using microbiological molecular, genetic and histological methods. 85,7% of patients had relapses with different periods of time, on average, 3–4 years, and repeated periods of tuberculosis activation. At all patients the lymph nodes were enlarged, mainly cervical (71,4%) and axillary (67,9%), the sizes of nodes varied from 1 to 5 cm, on average, 2,2±1,6 cm. In 78,6% cases tuberculosis of peripheral lymph nodes was characterized by fluctuation of nodes and the discharge of 30 to 80 ml of odorless creamy pus. It was found that tuberculosis of peripheral lymph nodes is part of a widespread tuberculous lesions especially at patients with tuberculosis associated with an infection caused by the human immunodeficiency virus. Tuberculosis of peripheral lymph nodes develops simultaneously with a specific lesion of other groups of lymph nodes – intrathoracic (75%), intra-abdominal (57,1%), which allows to generalized tuberculosis of the lymphatic system. Fibrobronchoscopy showed in 35,7% patients residual bronchial tuberculosis changes, at 14,3% – an active fistulous form of bronchial tuberculosis. Microscopy of biopsy material was negative at 78,6% of cases, while cultural examination revealed Mycobacterium tuberculosis – in 100% and molecular genetic studies – deoxyribonucleic acid of Mycobacterium tuberculosis – in 64,3% patients.

Bulletin of the Russian Military Medical Academy. 2020;22(4):43-46
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Intraoperative multi-pulse transcranial electric stimulation: the effect of general anesthetics impact on the excitability of the pyramidal tract

Toporkova O.A., Aleksandrov M.V., Nazarov R.V., Chernyj V.S.


The results of intraoperative neurophysiological monitoring during neurosurgical treatment of pathological processes in the central nervous system are analyzed. The mechanisms of action of general anesthetics on the excitability of the pyramidal system during anesthesia with propofol and sevoflurane have been clarified. It has been established that anesthetics with different mechanisms differ in their effect on excitability and conductivity in the system «motor neuron of the cortex – pathways – alpha-motor neuron». Inhalation anesthetic sevoflurane causes a slowdown in the conduction of a nerve impulse and a violation of the mechanisms of convergence of excitation on the alpha-motor neuron of the spinal cord. In this regard, during general anesthesia with sevoflurane, in order to achieve the effectiveness of transcranial electrical stimulation, the number of stimuli in the package should be increased first with a relatively high stimulation current. Under general anesthesia with propofol, the processes of convergence of excitation are not inhibited, therefore, effective electrical stimulation is achieved by increasing the stimulation current with a stable number of stimuli. With an increase in doses of general anesthetic to a level at which periodic patterns are recorded on the electroencephalogram, a deep inhibition of the excitability and conductivity of the pyramidal system occurs. Under these conditions, effective performance of transcranial electrical stimulation is achieved with submaximal values of the current strength and the number of stimuli.

Bulletin of the Russian Military Medical Academy. 2020;22(4):47-52
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Comparative analysis of laboratory data of patients suffering from SARS-CoV-2-induced pneumonia and bacterial pneumonia

Ismailov D.D., Isaev T.A., Shustov S.B., Sveklina T.S., Kozlov V.A.


Comparative analysis of laboratory data of 46 patients suffering from pneumonia caused by SARS-CoV-2 and 12 patients - pneumonia of bacterial etiology is given. It was established that in patients with COVID-19 compared to patients with bacterial pneumonia, the level of direct bilirubin is 84% more, and thrombocrit is three times more, which can indicate intravascular hemolysis and activation of the hemostasis system. Sex differences in laboratory indicators in patients with COVID-19, which go beyond the known limits of the physiological norm, were not detected. However, in men, hematocrit, hemoglobin, and plasma creatinine values were statistically higher than in women, but the amount of C-reactive protein in women was 5 times greater. However, these laboratory measures in COVID-19 have low prognostic significance. Therefore, conventional laboratory measures do not reveal clinic-critical differences in bacterial pneumonia and pneumonia caused by SARS-CoV-2. When conducting multifactorial analysis, it turned out that the laboratory indicators of patients suffering from bacterial pneumonia are not clustered and it is impossible to form predictor models from them. While laboratory indicators of patients suffering from pneumonia caused by COVID-19 form a directed pathogenetic response of the body as a whole, which causes multi-branch associated changes in homeostasis. Unfortunately, the amount of data available to us did not allow a qualitative discriminant analysis, which, with a very large amount of data, could lead to discriminant equations that are resistant to random “emissions.” This would allow, according to the available key individual laboratory indicators, to identify patients suffering from COVID-19 in the early stages already in the first hours of admission to the clinic.

Bulletin of the Russian Military Medical Academy. 2020;22(4):53-58
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The development of complications of community-acquired pneumonia of a severe course against the background of parenteral poisoning with a mixture of narcotic substances

Gayvoronskiy I.N., Khalimov Y.S., Gayduk S.V., Lyanginen T.V., Partsernyak A.S., Litvinenko R.I.


Doctors of the clinic of military field therapy of the Military Medical Academy named after S.M. Kirov, the experience of successful treatment of community-acquired pneumonia of a severe course with the development of complications against the background of parenteral poisoning with a mixture of narcotic substances in a young patient was obtained. An important feature in the treatment tactics of this patient was the impossibility of antidote therapy with naloxone (a competitive opioid receptor antagonist) due to the presence of signs of respiratory failure, hypoxic and tissue hypoxia. As a result of the systemic treatment in the young patient, it was possible to arrest a significant septic process and multiple organ disorders of vital functions that arose due to severe endotoxic damage. An important factor in ensuring the survival of patients with severe pneumonia against a background of immune depression due to the use of toxic substances is the rational selection of an antibacterial drug or combinations of antibiotic therapy, constant monitoring of vital functions with prompt correction of emerging disorders, as well as the need to use modern high-tech treatment methods. This example clearly shows the need for urgent, systematic and complex intensive care in a number of manipulations performed in people with complications of community-acquired pneumonia, suffering from drug addiction. In addition, it is important to minimize the time from the detection of a poisoned person to the start of emergency measures, as well as their further evacuation to the stage of providing qualified and specialized medical care. Thus, modern medicine continues to face an extremely urgent problem of drug use by the population. A significant number of people with drug dependence syndrome do not seek medical help for various reasons, continuing to use illegal drugs.

Bulletin of the Russian Military Medical Academy. 2020;22(4):59-66
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Safety assessment of preoperative oil chemoembolization with nanoparticle albumin-bound paclitaxel in patients with pancreatic head adenocarcinoma

Pavlovskii A.V., Statsenko A.A., Popov S.A., Moiseenko V.E., Polikarpov A.A.


Results of combined treatment of 36 patients suffering from pancreatic head ductal adenocarcinoma are evaluated, including preoperative chemotherapy using nanodispersed albumin-stabilized paclitaxel (nab-paclitaxel) in intraarterial oil chemoembolization or intravenous administration and radical surgical treatment. Intraarterial oily chemoembolization of the pancreatic head consisted of the introduction of 17 patients (main group) into the gastroduodenal artery of an emulsion of super-liquid lipiodol (Lipiodol Ultra Fluid) in an aqueous solution of nab-pacliaxel 50 mg/m2 and gemcitabine 400 mg/m2. 19 patients (control group) were administered nab-paclitaxel 100 mg/m2 and gemcitabine 1000 mg/m2 intravenously according to standard guidelines. Safety and tolerability assessment of combined treatment with preoperative application of nab-paclitaxel was carried out in advance. Pil-preserving pancreatoduodenal resection is considered safe on day 7–10, after completion of preoperative chemotherapy with nab-paclitaxel. The use of nab-paclitaxel in preoperative intraarterial oily chemoembolization of the pancreatic head requires extension of the pancreatic crossing boundary to body level. Postoperative lethality and 4th degree complications according to the Clavien-Dindo classification were not observed. In the main group, grade 3a complication was observed in 2 (12%) patients and was represented by bleeding from acute gastric erosions resolved endoscopically. In the control group, complications of degree 3 were also noted in 2 (11%) patients and were represented by: one bleeding from acute stomach erosions that required endoscopic hemostasis and an intraabdominal abscess allowed by percutaneous drainage. In the main group, complications of the 2nd degree were recorded in 8 (47%) patients: in 3 (17%) patients the formation of pancreatic fistula was noted, in 4 (23%) postoperative pancreatitis was detected, and in 1 (6%) gastrostasis phenomena that required conservative therapy. In the control group, complications of the 2nd degree were observed in 11 (58%) patients and were presented: pancreatic fistulae – in 2 (10%) patients, postoperative pancreatitis – in 6 (31%) and gastrostasis – in 3 (16%) patients. The most common complication observed in both groups was the suppression of a postoperative wound, corresponding to the 1st degree of severity: in the main group in 5 (29%) patients, in the control group in 7 (37%) patients. Thus, the use of intraarterial oil chemoembolization with nab-paclitaxel as a preoperative antitumor treatment can be considered safe.

Bulletin of the Russian Military Medical Academy. 2020;22(4):67-71
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Mental burn out in young persons with COVID-19-infection

Uliukin I.M., Sechin A.A., Orlova E.S., Bolekhan V.N., Shuklina A.A.


Currently, both in our country and around the world, there is an epidemic of coronavirus infection – COVID-19. A list of its main forms of syndromes and complications is known. Against this background, people who have undergone COVID-19 may develop a mental burnout syndrome, which at its core has a manifested growing emotional exhaustion, due, first of all, to the tension of the workload among the representatives of the human-to-human profession. Features of mental burnout were studied in 62 convalescents 90 days after discharge from the hospital. A feature of the study is the fact that it is almost impossible to select a control group for the disease under study. Therefore, psychological indicators were compared between different clinical forms of COVID-19. There were no statistically significant differences between the indices of the subscales of the «Burnout Syndrome» Questionnaire in different forms of COVID-19. Psycho-emotional exhaustion in all convalescents is weakly expressed, personal distance is not expressed, professional motivation is high in 100% of cases. Moreover, in patients with pneumonia caused by COVID-19, this figure was 90%. At the same time, the index of mental burnout in survivors of COVID-19 has an average value. In a number of cases, emotional exhaustion was revealed, which was combined with physical overwork; however, it did not significantly affect the indicators of mental burnout, which indicates adequate medical and psychological support of patients in the course of treatment.

Bulletin of the Russian Military Medical Academy. 2020;22(4):72-75
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Experimental trials

Differences in the perception of digital information of aviation operators depending on the degree of extraversion

Sinelnikov S.N., Naturalnikov I.O., Blaginin A.A., Agadzhanyan O.S.


Considers the influence of the degree of extraversion on the perception of digital information by aviation operators. The analysis of the results of solving the Schulte tables by the test subjects on the «NS-Psychotest» hardware complex based on the recording of the eye track, performed using a stationary eye tracking device «RED250mobile eye tracking device» was carried out. While performing the search function, the number of saccadic movements, their amplitude, and the search time for a given digital value were registered. It has been revealed, that introverts during realization eyes search function perform less saccadic movements and spend less time on it than extraverts do. Significant differences have been found during resolving search tasks depending on degree of extraversion. Some interconnections of extension the latent period of the saccade with complication of solving process the cognitive problem were also found. It was found out, that increase in speed of saccadic movements of eyes leads to low efficiency of results of search task execution. Results of conducted research emphasize value of individual approach to medical flight service taking into account psychological features of flight crew in conditions of rapid progress in aviation technologies and means of visualisation of flight information. The obtained data reveal some features of information perception by operators of complex ergatic systems, the study of which in the future will help to maintain the reserves of attention in a continuous stream of incoming data, and thereby reduce the load on the visual analyzer and increase the reliability of professional activities of flight crew.

Bulletin of the Russian Military Medical Academy. 2020;22(4):76-81
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Peculiarities of the course of radiation-mechanical injuries during modeling of bone-muscular trauma of the limbs in expirement

Slukhay S.I., Golovko K.P., Drachev I.S., Remizov D.V.


Experimental data on the course of the wound process and changes in the internal organs of animals during acute radiation sickness are presented. Morphological changes in the wound and with a fracture of the femur, on the model of combined radiation-mechanical conduction in 30 experimental animals (rats). It was found that wounds after primary surgical treatment often suppurate, and the performed osteosynthesis in fractures of tubular bones turns out to be an untenable delivery of metal structures. An unfavorable course of the wound process is noted in the form of pronounced purulent-necrotic changes in soft tissues, which leads to the appearance of degenerative-dystrophic changes in internal organs in experimental animals. The development of the infectious process in the wound, radiation damage is more severe, while the lethality increases by 20–23%. The total area and thickness of the newly formed granulation tissue is 1,5–2 times less than in non-irradiated animals. As a consequence of the disturbance of reparative processes during the development of the mutual burdening syndrome, the consolidation of the fracture with radiation injury to rats was completed in 28,5–1,2 days, while in non-irradiated animals it was already by 20–23 days. The reason for the death of animals is purulent-septic complications in 21 (73%) irradiated rats. Sepsis due to St. aureus was noted in 14 (66,6%) rats and St. epidermalis – in 2 (9,5%) animals. Colibacillary sepsis was recorded in 5 (23,8%) rats. Thus, in the conditions of the use of weapons of mass destruction, radiation-mechanical damage will occupy one of the leading places in the structure of sanitary losses. At the same time, the simultaneous effect of radiation and a mechanical factor on the body forms one of the most dangerous variants of damage, in which a favorable outcome is predicted only in milder forms of acute radiation syndrome and provided that surgical treatment is timely.

Bulletin of the Russian Military Medical Academy. 2020;22(4):82-86
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Decellularized matrix of the small intestine. Technology for obtaining, evaluating and using directions

Kokorina A.A., Kromsky S.V., Kriventsov A.V., Mikhailova E.V., Pak N.V., Kondratenko A.A., Sigareva L.P., Sidorin V.S., Kostina O.V., Onishchenko L.S., Aleksandrov V.N.


Matrix (scaffold, matrix, framework, template) is a bioresorbable or non-bioresorbable material that can be filled with stem or somatic cells in/ex vivo in order to obtain a tissue-engineering structure for restoration of a lost organ, part of an organ, tissue. Scaffold must be to the extent necessary strong, non-immunogenic, bioactive. The porosity of the matrix must be open, the surface is rough and, most importantly, the matrix must contain factors of chemotaxis of endo- or exogenous origin, cell adhesion of their proliferation, differentiation. In this context, on the example of creating a decellularized small intestine matrix, a number of fundamental issues are highlighted regarding the choice of matrix material, its production technology, matrix evaluation in accordance with the criteria that correspond to the matrix for tissue engineering, and possible directions for its use. As a result, a non-immunogenic extracellular matrix of the small intestine was obtained by the method of detergent-enzymatic perfusion decellularization, which was sufficient in characteristics for use in various areas of tissue engineering, including plasty of defects of the skin, mucous membranes, small intestine, etc.

Bulletin of the Russian Military Medical Academy. 2020;22(4):87-90
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Comprehensive rationale for the use of immune plasma for septic patients

Skripay L.A., Vilyaninov V.N., Skripay A.A.


Data of accounting and reporting documents of the Center (blood and tissues) are analyzed retrospectively) the Kirov military medical Academy for the period from 2017 to 2019 on the use of blood components in septic conditions of patients in clinics of the Kirov Military medical Academy. The volume of issued immune plasma for patients suffering from septic complications in 2017, it was 154 doses (33,9 l), in 2018, it was 196 doses (43,1 l), in 2019, it was 389 doses (72,1 l). It was found that in patients suffering from septic complications on the second day after transfusion of blood components, the levels of the studied indicators of the inflammatory process did not change unambiguously. Thus, in patients who received immune plasma transfusion, there was a decrease in white blood cells by 1,5×109/l on the next day after the component was transfused. At the same time, there was a direct decrease in rod-shaped neutrophils, monocytes, erythrocyte sedimentation rate and a decrease in body temperature. In patients who were transfused fresh frozen plasma, white blood cells increased by 0,5×109/l and slightly – monocytes. A slight decrease in platelets in septic patients of group 1 after transfusion of immune plasma indicates the active participation of these cells in the reactions of antibacterial immunity. This can be considered as a favorable prognosis for a particular patient, since there is a direct relationship between the decrease in the number of platelets and the duration of stay in hospital treatment, as well as the overall outcome of the disease. The level of circulating immune complexes in patients of both groups after transfusions of blood components remained within normal values. Levels of fibrinogen, prothrombin, and albumin changed significantly in each group. At the same time, the level of fibrinogen after transfusions increased, and prothrombin changed in different directions. In the treatment of patients, the use of immune plasma activates the system of cells of the body’s antibacterial defense and improves the positive dynamics in treatment. In modern economic realities, testing plasma samples to suppress the growth of microbial colonies is justified, since it helps to reduce the volume of transfused blood components for severe septic patients.

Bulletin of the Russian Military Medical Academy. 2020;22(4):91-94
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Anatomycal features of the ethmoidal labyrinth and nasal cavity structures in childhood

Markeeva M.V., Aleshkina O.Y., Tarasova N.V., Gaivoronsky I.V.


The morphotopometric variability of the ethmoidal labyrinth and the parameters of the nasal cavity for 87 children’s cranium (1–21 years) has been determined. The growth of the ethmoidal labyrinth and the nasal cavity occurs undulating and unevenly. The increase of the height of the ethmoidal labyrinth begins earlier than its width and length from 2–3 years to 13–16 years old. Growth periods the height of ethmoidal labyrinth occur for 2–3 years, 8–12 and 13–16 years; widths – 4–7, 8–12 and 17–21 years; length – 4–7, 8–12 and 13–16 years. At the ethmoidotomy in the infant and early childhood, the smallest size of the ethmoidal labyrinth should be taken into account: width – 7–8 mm, height – 14–16 mm, length – 27–29 mm, so in these age periods there is a high risk of damage of the cribriform and orbital plates ethmoid bone with the development of iatrogenic complications. The nasal cavity штchildren expands posteriorly as well as in adults. In the infancy, the width of the nasal cavity at the back corresponds to the width in the front section, from 2 years prevails than in front and by adolescence becomes larger for 3–3,5 mm. Knowing these age–related features of the structure of the children’s nasal cavity, during surgery the rhinosurgeon when shifting the middle nasal shells medially or laterally should ensure to maintain the physiological model of the nasal cavity. In infancy, the width of the ethmoidal labyrinth is larger than the width of the nasal cavity by 38,5%, and by adolescence this ratio increases to 76,8%. The length of the nasal cavity increases from 4–7 years to adolescence, the length of the ethmoidal labyrinth grows parallel to the maximum length of the nasal cavity and it is less for more than a half in all children’s age groups: in the infancy by 74%, in adolescence – by 85.1%. The height of the nasal cavity is twice the height of the labyrinth in any childhood age, the distance from the bottom of the nasal cavity to the lower edge of the middle nasal shell must be correlated with the distance above the level of the average nasal shell during intranasal surgeries and do not exceed it for the introduction of tools.

Bulletin of the Russian Military Medical Academy. 2020;22(4):95-99
pages 95-99 views

Investigation of specific activity and harmlessness of simultaneous administration of vaccines in complex immunoprophylaxis of dangerous infectious diseases

Khirina N.P., Dobrynin V.M., Stepanov A.V., Stepanov N.N., Popov S.V., Khlopunova O.V., Dobrynina I.A., Shchelgachev V.V.


Experimental study of specific activity and harmlessness of simultaneous application of five vaccines (abdominal, Zonne dysentery, viral hepatitis A, meningococcal and live yellow fever vaccine) in complex immunoprophylaxis of dangerous infectious diseases was carried out. It has been found that the simultaneous administration of these vaccines is safe and has high immunogenicity and protective efficacy for each infection not inferior to, and in some cases superior to, vaccines administered separately. In particular, the immunogenicity of vaccines against typhoid fever and viral hepatitis A administered jointly was four times higher than with their separate administration, which may indicate the presence of a certain adjuvant effect on the part of other vaccines, as well as the absence of antagonism in their joint use. It was revealed that complex vaccinations do not negatively affect the functional state of cells involved in the initial stage of immunogenesis. The absence of a negative effect of complex vaccinations on the components of nonspecific resistance of the body was almost completely confirmed in the conditions of infection of immunized animals with influenza virus, that is, in modeling heterologous infection. In addition, immunization with a complex of vaccines does not lead to allergic animals, which is confirmed by the absence of any manifestations of allergic reactions or anaphylactic activity.

Bulletin of the Russian Military Medical Academy. 2020;22(4):100-106
pages 100-106 views

Immunoprotective therapy for suppression of humoral immune response induced by hypoxia and toxemia

Alexandrov V.N., Zarubin I.V., Kondratenko A.A., Mikhaylova E.V., Kromskiy S.V., Sigareva L.P., Gorichny V.A., Pak N.V., Slizhov P.A., Kokorina A.A.


The possibility of using preparations limiting toxemia and hypoxia, in particular inhibitors of proteoletic enzymes and antihypoxants, as preparations having immunoprotective activity is considered. Under the conditions of the experimental model of severe mechanical injury on mice-hybrids of the first generation F1 (CBA×C57BL6), the immunoprotective activity of such antihypoxants as amtisol and a derivative of 1, 2, 4-triazino-5, 6 indole, as well as a counterkal, a drug limiting toxemia and a cationoacceptor preparation of dimexide, administered to immunized erythythermal It has been shown that in the body of mice receiving antihypoxants, contrical and dimexide accumulate significantly more antibody-forming cells compared to their number in animals of the control group. Thus, amtisol, a derivative of 1, 2, 4-triazino-5, 6 indole, contrical and dimexide can be considered not only as preparations for pathogenetic therapy of trauma, but also as immunoprotectors – drugs that indirectly limit the formation of post-traumatic immunodeficiency and the risk of infection in an immunocompromised host. The risk of infectious complications and the generalization of the inflammatory process in patients after severe mechanical injury is more than 50%. Prevention of infectious complications of traumatic disease should be comprehensive and aimed at correcting the function of the immune system.

Bulletin of the Russian Military Medical Academy. 2020;22(4):107-110
pages 107-110 views

The course of delayed right-sided post-traumatic diaphragmatic hernia with dislocation of the liver into the chest cavity

Yasyuchenya D.A., Asyamov K.V., Dzizawa I.I., Salukhov V.V., Chugunov A.A., Bogomolov A.B., Nikolaev A.V., Grozovsky Y.R.


A rare clinical case of delayed post-traumatic hernia of the right dome of the diaphragm with dislocation of the liver into the chest cavity without dysfunction of the liver, lungs, and the absence of hemodynamic disturbances is described. At the outpatient stage, during the planned fluorography in patient N, in the projection of the lower lobe of the right lung, a single round-shaped darkening with dimensions 114×99 mm was revealed. To clarify the diagnosis, the patient was admitted to the clinic of hospital surgery military medical Academy named after S. M. Kirov in a planned manner. Based on the results of the examination and a thorough collection of anamnesis, the final diagnosis was established: «Right-sided post-traumatic hernia with dislocation of the liver into the chest cavity». This complication is extremely rare. The literature describes isolated clinical examples of such a pathology. This is due to the peculiarities of the anatomical structure, namely, with the «protective» function performed by the liver. It prevents other organs of the peritoneal cavity from lobbying into the chest cavity. However, in this unique case, liver migration after a closed abdominal trauma was described. It is not unimportant that this clinical case was accompanied by a meager clinical picture, the absence of complaints from patient N., and normal indicators of the method performance of laboratory diagnostic techniques. The mortality rate for diaphragm ruptures can reach 31% in the first days after injury. Therefore, the diagnosis of diaphragmatic hernia requires exclusion in all patients with chest and / or abdominal trauma.

Bulletin of the Russian Military Medical Academy. 2020;22(4):111-116
pages 111-116 views

Public Health

Problematic use issues military medical terminology in the disaster medicine service ministry of defense of the Russian Federation

Lemeshkin R.N., Kotenko P.K., Savchenko I.F., Kosyakov G.V., Blinov V.A., Sinkievich A.V., Stepanov A.V., Chepurnenko D.А., Klimzov А.G.


The health care of the Russian Federation and its medicine of accidents industry were undergoing systemic changes that required, inter alia, reappraisal of approaches to the work of specialist doctors in federal ministries, agencies and services in the implementation of joint activities during the elimination of medical and sanitary consequences of emergencies of various genesis. It is noted that during interpersonal communication, medical specialists often encounter various understandings and paths of special professional terms, which often leads to a decrease in the quality of organization of interaction and management. A particular feature of the use of military-medical terminology in the Disaster Medicine Service of the Russian Federation was its mixing with the terminological definitions of specialists from other federal ministries, agencies and services, which in some cases significantly complicates management communication. A scientific search has been carried out using content analysis, rank-based dispersion analysis of data, sociological and linguistic analysis to study the most used terms that characterize such concepts as «wounded», «sick» and «affected», «injured», «patient», «medical and sanitary care», «treatment and evacuation support», «medical care», and terms characterizing types of care. The most significant, according to experts, terms that reflect the practical activities of medical specialists and allow them to master at the proper level the training programs for personnel of higher qualifications in the field of «disaster medicine» were the terms «affected in an emergency», «patient» (3,77±0,82 points), as well as «treatment and evacuation support» (4,67±0,55 points) and « medical support» (4,2±1,1 points). Meaningful terminological contradictions that can lead to a violation of organizational integrity are also identified of the system of medical and evacuation support of troops (forces) and the population during the elimination of medical and sanitary consequences of emergency situations by the forces and means of the medical service of the Armed Forces of the Russian Federation as not always reflecting the specific conditions of activity and organization of interaction of medical specialists of federal ministries, agencies and services. All this requires harmonization (bringing to a common understanding) of the relevant terminology for the application of military-medical terminology in the Disaster Medicine Service of the Russian Federation.

Bulletin of the Russian Military Medical Academy. 2020;22(4):117-126
pages 117-126 views

Medical Support of Combat Operations and Naval Air Force Losses in the Great Patriotic War

Luchnikov E.A., Chernikov O.G., Mavrenkov E.M.


The paper addresses the contribution of the Naval Air Force and its medical service to the victory in the Great Patriotic War of 1941-1945. Organizational and staff structure, medical support of combat operations, the dynamics, level and structure of operational attrition and non-battle sanitary losses of the Naval Air Force air and ground crews are studied by categories and by the periods of the war, including the major operations, separately for each fleet. Detailed analysis of the experience of search and rescue operations and aeromedical evacuation as specific components of the medical service of the Naval Air Force is presented. The management procedures of medical supplies and recreation of the air crews to prevent their exhaustion are studied. For instance, since it was impossible to provide professional and specialized medical aid to the wounded from the fleet air force units, it had to be provided at the naval and combined-arms levels of medical evacuation. Only a small number of air base infirmaries were staffed by qualified surgeons. Difficulties in organizing the medical supplies were caused by frequent movements of air force units, often in the closest vicinity to the enemy; and also, by the lack of special unified medical packs. Based on the experience of medical support for search and rescue operations, the most effective search and rescue of flight personnel was organized using water-planes. During the war, naval aviation pilots evacuated thousands of wounded people to the rear of the country. The specifics of the fleet aviation missions characterize the structure of sanitary losses and their ratio to the irretrievable losses of flying personnel during the four years of the war. Due to a significant combat load on the pilots, the command was obliged to organize their rehabilitation in the form of short-term vacation at adapted recreation centers. Based on the information available from literature and archive sources, the successful experience and faults in the medical support of the combat missions of the Air Force as the striking component of the Navy during the Great Patriotic War are analyzed, and respective detailed conclusions are made.

Bulletin of the Russian Military Medical Academy. 2020;22(4):127-134
pages 127-134 views

Modernization of the medical property rationing system for health resort organization Ministry of defense of the Russian Federation

Miroshnichenko Y.V., Dolgih S.V., Rodionov E.O., Kirsanova A.A.


In recent years, the leadership of the Ministry of defense of the Russian Federation has carried out a number of measures to modernize the health resort facilities in the country’s military health resorts. During their implementation, health resort organizations were significantly reconstructed, acquired a new organizational and staff structure, and advanced medical technologies were introduced into their work. These changes have led to the need to modernize the system for providing medicines and medical products to sanatorium organizations of the Ministry of defense of the Russian Federation. The modernization was carried out in the course of several scientific studies in 2018–2019. It is based on the approaches to sanatorium-resort provision, medical and medical-psychological rehabilitation that have been formed recently. In its development, an integrated approach was used, based on the principles of project management, taking into account the features of each military health resort in modern socio-economic conditions. A detailed analysis of the factors affecting the functioning of the military health resorts and structural-logical grouping of tasks, allowing the model normalization to form a system of rationing medical property of the sanatorium-resort organizations of the Ministry of defence of the Russian Federation. The result is an optimal structure of the rates of supply of medical supplies to military resorts, which allows us to match organizational structure and needs for different types of medical (pharmaceutical) activity. For the first time, the structure of norms for the supply of medical equipment to health resort organizations provides for norms for the supply of medicines for medical and medical-psychological rehabilitation. Describes the new supply of medical equipment, reveals their features and application procedure. The first results of the introduction of a new system of rationing medical equipment in the practical activities of military health care are presented.

Bulletin of the Russian Military Medical Academy. 2020;22(4):135-141
pages 135-141 views

Features of sanitary and anti-epidemic (preventive) measures among the personnel of camp training events in military educational organizations in the context of the spread of the new COVID-19 coronavirus infection

Kuzin A.A., Zobov A.E., Lantsov E.V., Yakovlev A.G., Panov A.A., Kalimullin O.A., Lemeshchenko A.V., Artebyakin S.V.


The experience of medical maintenance for assembly events annually held on the basis of the educational process of the Military Medical Academy named after S.M. Kirov. The main directions of the organization of sanitary and anti-epidemic (preventive) measures among the personnel at each stage of the camp gathering have been determined. It is shown that at the preparatory stage it is advisable to develop additional plans that concretize sanitary and anti-epidemic (preventive) measures for the stages of the camp gathering. At the stage of accepting participants, the main direction is the organization of events that prevent the introduction of infection with the arriving personnel. At the main stage of the camp training, the leading role belongs to disinfection measures. At the stage of departure of participants, the main efforts should be focused on minimizing the potential risk of infection along the route and the introduction of infection into their military units. The features of disinfection are described depending on the type of object being processed. The results of testing a designed device for fixing dispensers with a skin antiseptic on the basis of a unified military stand in a camp gathering are presented. The features of the organization of medical control over the material and household provision of the personnel of the training camp are stated. The basic principles of prophylaxis and anti-epidemic protection during assembly activities in the context of the spread of COVID-19 have been formulated.

Bulletin of the Russian Military Medical Academy. 2020;22(4):142-147
pages 142-147 views

Epidemiological features and clinical variants of inflammatory bowel diseases in St. Petersburg in the setting of outpatient practice

Purgina D.S., Solovyev M.V., Lyalina L.V., Rassokhin V.V.


Epidemiological features and clinical variants of inflammatory bowel diseases in St. Petersburg in conditions of outpatient practice are considered. It was established that among patients suffering from ulcerative colitis in the Vyborg and Frunze regions, women predominate in a ratio of 1:2. At the same time, more than 50% of cases of ulcerative colitis and Crohn’s disease come from the age of 20–49 years. The vast majority of patients examined with ulcerative colitis experienced a moderate attack. In more than half of cases, left-sided localization was noted with endoscopic activity of 2–3 points on the Schroeder scale, rectal lesion was observed in 22% of cases, total colitis was detected in only 14%. In general, the incidence and prevalence of ulcerative colitis in the Vyborg and Frunze regions is higher than Crohn’s disease. However, more extensive and lengthy studies of the problem are needed, but there are some difficulties associated with the lack of a unified registration base for patients suffering from inflammatory bowel diseases. Given that the incidence of ulcerative colitis and Crohn’s disease is higher among women and more than 50% of patients are of the most able-bodied age (20–49 years), inflammatory bowel disease is a group of highly relevant and socially significant diseases. Lower figures for the incidence and prevalence of inflammatory bowel diseases compared with those of developed countries indicate insufficient detection, diagnostic and clinical features of these diseases, as well as the need to optimize specialized medical care in places of residence of patients suffering from inflammatory bowel diseases. Nevertheless, currently in St. Petersburg and the Leningrad Region a fairly effective system of early detection and dynamic observation of patients suffering from ulcerative colitis has been created, which includes the activities of therapists and gastroenterologists of polyclinics, endoscopists and specialists of centers for the treatment of inflammatory bowel diseases of academic and university clinics.

Bulletin of the Russian Military Medical Academy. 2020;22(4):148-155
pages 148-155 views

Comparative analysis of the economic costs of treating patients with non-infectious diseases of internal osteosynthesis

Khominets V.V., Tegza V.Y., Foos I.V., Pugaev E.M.


A comparative analysis of the economic costs of revision surgical treatment of 121 patients with non-infectious complications of internal osteosynthesis and 59 patients who underwent primary osteosynthesis for fractures of the long bones of the limbs with an uncomplicated course was carried out. General economic costs include direct and indirect costs. It was found that the total costs for the treatment of patients suffering from non-infectious complications of internal osteosynthesis of the long bones of the extremities, who are in the clinic of military traumatology and orthopedics. G.I. Turner of the Military Medical Academy in the period from 2007 to 2018 revision surgery was performed, amounted to 279637238 rubles, which corresponds to 2311051,55 rubles per patient. At the same time, the total costs for the treatment of patients with fractures of the long bones of the extremities without complications amounted to 44960873 rubles (762048,69 rubles per patient). The total cost per patient with a non-infectious complication of internal osteosynthesis of the femur was 2540499,54 rubles (483824,85 – straight, 2056674,69 – indirect), of the leg bones – 2333762,17 rubles (474501,47 – straight, 1859260,70 – indirect), the humerus – 1830362,75 rubles (399942 – straight, 1430420,75 – indirect), the bones of the forearm 1804664,6 rubles (339700 – straight, 1464964,6 – indirect). It was revealed that due to failures after primary osteosynthesis of limb fractures and complications, the costs associated with the direct and indirect costs of their treatment increase. In this regard, further research is needed to improve the treatment of complications of internal osteosynthesis and to develop a set of measures for their prevention. This is important both for the patient and for the health care system as a whole.

Bulletin of the Russian Military Medical Academy. 2020;22(4):156-160
pages 156-160 views

Medical and statistical indicators of injuries among officers in the Armed Forces of the Russian Federation (2003–2019)

Evdokimov V.I., Sivashchenko P.P., Ivanov V.V., Khominets V.V.


Injury indicators for officers of the Armed Forces of Russia in 2003–2019 are analyzed. A selective statistical analysis of medical reports on the state of health of personnel according to the form of 3/МЕD military units was carried out, in which about 80% of the total number of officers of the Armed Forces of Russia served. Injury indicators by type of medical and statistical reporting were correlated with the groups in the 19th class «Injuries, poisoning and some other consequences of exposure to external causes» (S00-T98) of the International Statistical Classification of Diseases and Health Problems, 10th revision. The average annual level of injuries of officers from 2003 to 2019 was 17,59±1,37, their share in the structure of primary morbidity in all classes of the International Statistical Classification of Diseases and Health Problems, the 10th revision was 4,2±0,4%, the contribution to the structure of injuries of all servicemen of the Armed Forces of Russia was 32%. The average annual level of hospitalization, its share and contribution were 10,89±1,64‰, 6,1±0,5 and 26,3%, respectively. The average annual level of days of labor loss, their share and contribution amounted to 352,2±26,8‰, 8,4±0,7 and 33,8%, respectively. The average annual level of dismissal, its share and contribution were 0,38±0,70‰, 5,1±09 and 26%, respectively. The average annual mortality rate, its share and contribution amounted to 48,03±3,84 per 100 thousand officers, 39,6±1,9 and 40,7%, respectively. The dynamics show a decrease in the level and proportion of injuries in the structure of the analysed medical and statistical types of incidence. The level and structure of injury groups in the 19th grade of the International Statistical Classification of Diseases and Health Problems, the 10th revision, as well as the structure of types of injuries of body regions are presented. A military epidemiological assessment of the significance of injuries for negative consequences for the health of officers was designed. Structure and dynamics of injury circumstances structure are shown. Medical and statistical indicators of injuries among officers determine the strategy and tactics of safe conditions of military-professional activity, injury prevention, health and rehabilitation measures.

Bulletin of the Russian Military Medical Academy. 2020;22(4):161-167
pages 161-167 views

Sanitary and parasitological state of water bodites in the Аstrakhan region

Arakelyan R.S., Shendo G.L.


The article analyzes the sanitary and parasitological state of water bodies in the Astrakhan region in 2015–2019. A total of 16683 laboratory studies of water samples were conducted during the analyzed period. The number of samples taken from various environmental objects was 15253 (91,4%), of which 2595 (17%) were water samples taken from various water bodies. Of the last 82 (3,2%), samples did not meet sanitary standards. Centralized water supply was tested for parasitic contamination in 666 (25,7%) samples, swimming pool water in 947 (36,5%) samples, open water (river water) in 696 (26,8%) and wastewater in 286 (11%) samples. Of the 635 (24,5%) water samples collected in 2015, 14 (2,2%) did not meet hygiene standards. Of the 671 (25,9%) samples taken in 2016, 32 (4,8%) samples showed positive findings. Percentage of water samples collected and examined in 2017 it accounted for 463 (17,8%) of all water samples studied during the analyzed period, of which 14 (3%) did not meet sanitary standards. The share of water samples selected and tested for parasitic indicators in 2018 was 518 (22,4%), of which 18 (3,5%) samples did not meet the hygiene standards. In 2019, compared to previous years, the number of water samples taken for parasitic indicators decreased several times and amounted to 308 (11,9%), of which positive findings were noted in 4 (1,3%) samples. The absence of positive findings in water samples taken from Central water supply facilities indicates high-quality filtration and prevention of these facilities. The presence of cysts of pathogenic intestinal protozoa, as well as eggs and larvae of helminths in water samples taken from swimming pools and open reservoirs indicates fecal contamination of these objects. The presence of positive findings in wastewater samples indicates that sewage treatment plants do not provide reliable deworming and disinfection of wastewater.

Bulletin of the Russian Military Medical Academy. 2020;22(4):168-171
pages 168-171 views


Methods for studying genetic modifications

Moskalev A.V., Gumilevskiy B.Y., Apchel V.Y., Tsygan V.N.


Objects and modern methods of genome editing are considered. The immune system of prokaryote and their protective mechanisms that prevent the purposeful editing of the genome for the benefit of the researcher is characterized. This mechanism in prokaryotes are cluster regulatory interspatial short palindrome repetitions. The number of such repetitions varies from object to object, which ultimately makes it impossible to get the perfect standard model. Three types of such systems that have their own mechanism for generating proteins have now been identified. The proteins, which are now most commonly used to edit the genome and identify areas of proto-special adjacent motifs, are described. Detailed characteristics of the organization of the immune system prokaryote and phases of its activity are given. Three types of short-palin re-recurrence systems have now been identified, and the teams are being identified as cluster regulatory interspatial short palindrome repetitions-Cas9. Each system uses its own mechanism to generate proteins that catalyze the fission of nucleic acids. The type II cluster regulatory interspatial short palindrome repetitions system is most commonly used, better adapted to edit the genome because of its simplicity. It has been established that the cluster regulatory interspatial short palindrome repetitions-Cas9 system can be used for point editing of the genome and in eukaryotes. This is done either through non-homological annexation of the end, or by homologically directed reparation. A promising variant of genetic modeling is the use of the enzyme-endonuclease Cpf1, which is the effector protein of the cluster regulatory interspatial short palindrome repetitions-Cas V type systems. Cpf1 is smaller than the enzyme protein Cas9 and for the system to function only require specers of ribonucleic acid, without additional ribonucleic acid. Unlike Cas9, which cuts both chains of deoxyribonucleic acid in the same place, Cpf1 generates an incision, creating «ticky» ends that can be used to insert interesting sequences by complementing and ligation. It is likely that the system using the enzyme-endonuclease Cpf1 will be more convenient than the system where the protein is used – Cas9, as the range of editing of the controlled genome of ribonucleic acid is expanded to make the necessary edits.

Bulletin of the Russian Military Medical Academy. 2020;22(4):172-182
pages 172-182 views

Surgical methods of treatment of chronic heart failure and their place in modern clinical recommendations

Kotsoeva O.T., Koltsov A.V., Tyrenko V.V., Ialovets A.A.


This review discusses a number of aspects of surgical methods for treating severe chronic heart failure: resynchronizing therapy, mechanical circulatory support systems, and heart transplantation. Surgical methods for the treatment of heart failure are a rapidly developing field of modern cardiology and cardiac surgery. The main surgical method of treatment was and remains orthotopic transplantation of a donor heart. The advent of implantable systems has affected the problem of heart transplantation. Over the past decade, the use of mechanical circulatory support systems has grown significantly. At the moment, there are 3 main directions: creating devices for auxiliary blood circulation, various modes and methods of electrical stimulation of the myocardium, creating devices that mechanically remodel the heart chambers (left ventricle). All of these directions to some extent (depending on the evidence base) have found their place in modern recommendations for the treatment of chronic heart failure. The use of mechanical left ventricular remodeling shows good results in patients suffering from symptomatic heart failure, which leads to a significant and persistent decrease in the volume of the left ventricle and improvement of its function, symptoms and quality of life. Despite the fact that at the moment the geography and prevalence of their use is small, the number of implanted devices will only grow. Thus, given the need for frequent hospitalizations and high treatment costs, it is necessary to improve modern methods of surgical treatment of severe and terminal heart failure, make them more accessible, which will affect the duration and quality of life of these patients.

Bulletin of the Russian Military Medical Academy. 2020;22(4):183-191
pages 183-191 views

Elastography in the diagnosis of fibrosis in chronic diffuse liver diseases

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


The presents modern information about a non-invasive instrumental technique for assessing fibrotic changes in the liver – elastography. The data on the history of the origin of the term «elastography» are presented, several of its definitions are given, and attention is also paid to the main principle of the technique – percussion, which is traditionally used in an objective study of a patient. The facts about the dual terminology of the technique in the literature are presented, in which some authors use the term «elastography», and the other part – «elastometry». When analyzing the literature, it turned out that in foreign sources the term «elastography» is much more often used, and both names of the method are used in Russian. Given the greater prevalence of the «elastography» option, it is more logical to use it, but each of these names has its own right to exist. Definitions are given for the basic physical concepts associated with the elastography method – «elasticity», «rigidity» and Young’s modulus of elasticity. From the point of view of application in clinical practice, elastography techniques can be divided into four groups: compression elastography, which is more often used in oncodiagnostics, transient, point and two-dimensional shear wave elastography, used in the diagnosis of liver fibrosis. Physical classification involves dividing elastography into two types: static, which includes compression elastography, and dynamic, which includes transient, point and two-dimensional shear wave elastography. Transient elastography is implemented in devices of the FibroScan family, point elastography – in ultrasound scanners from «Hitachi Aloka», «Siemens» and «Philips», two-dimensional shear wave elastography – in devices from «Supersonic Imagine», «Toshiba», «Siemens», «Mindray», «General Electric». The widest range of possibilities for assessing liver fibrosis is provided by two-dimensional shear wave elastography. The combined use of several techniques is expected to increase the diagnostic accuracy in determining fibrosis. Magnetic resonance elastography has the greatest accuracy among elastographic techniques, but its application is limited due to the complexity and high cost of equipment, therefore, this technique has not yet found wide application in clinical practice.

Bulletin of the Russian Military Medical Academy. 2020;22(4):192-195
pages 192-195 views

Neuroimmunoendocrine support of general biological organism reactions to adverse external factors

Stepanov A.V., Seleznev A.B., Ponomarev D.B., Apchel V.Y., Ovchinnikova A.S.


This paper presents the summarized information on the mechanisms of neuroimmunoendocrine organism reaction to external adverse impacts (irrespective of their etymology), and on the key elements in these reactions development. It is found that adverse external factors are responsible for a change of an organism’s functional state, involving neuroendocrinal and immune systems in the (stress) reaction formation. Neuroendocrinal and immune systems act like coordinators of the intersystemic and interorgan relations in the setting of both adaptive and pathological processes. The combination of feed-forward and feedback (positive and negative) connections controlled by hormones, neuromediators, neuropeptides, cytokines and their corresponding receptors, serves as the basis of neuroendocrinal and immune systems interaction. Through mediators and hormones, the neuroendocrinal system modulates the immune system, and the latter can modulate functions of the former due to its cytokine network. Along with humoral mechanisms, the vagal nerve which enables the «reflectory» control of immunity, is the key component of the system providing the functional unity of nervous and immune system. The conversion of immune signals to neural ones is done through activation of vagal afferent fibers by proinflammatory cytokines, whereas its efferent fibers, forming the «cholinergic anti-inflammatory pathway», ensure the descending central nervous system effects which prevent the hyperactivation of innate and adaptive immune reactions. The body balance control is based on the integrative activity of nervous, endocrinal and immune systems – both under normal and pathological conditions (traumas, infections, stress, physical and chemical exposures, etc). The systematization of information about the coordinated neuroimmunoendocrine interaction provides background for theoretical underpinning of the upcoming trends in search of means and ways to correct the negative influence of adverse external factors on a living organism.

Bulletin of the Russian Military Medical Academy. 2020;22(4):196-200
pages 196-200 views

Improving revision operations for restoration of the anterior cruciate ligament of the knee joint in military personnel

Khominets V.V., Rikun O.V., Grankin A.S., Fedorov R.A., Fedotov A.O., Bazarov I.S., Konokotin D.A.


The analysis of foreign and domestic scientific publications of recent years, devoted to the problem of revision reconstructions of the anterior cruciate ligament of the knee joint in young and middle-aged patients with high functional demands. The key directions for improving the treatment of this category of patients have been determined. It was found that the main trend in the improvement of revision reconstructions of the anterior cruciate ligament of the knee in patients with high functional demands, which primarily include professional athletes and military personnel, is the desire for enhanced stabilization of the joint by eliminating residual, primarily rotational instability and increasing protection the main graft from high stress overload. Of particular importance is a strictly individual approach to the choice of the method of revision reconstruction of the anterior cruciate ligament, which makes it possible to implement the principles underlying the primary plastic of the ligament. The solution of these two problems requires, firstly, a more detailed examination of patients in order to identify factors of increased risk for the development of recurrent joint instability, which must be eliminated during surgical treatment. Secondly, the strict anatomical nature of restoration, and more often reconstruction, of the main and auxiliary functionally incompetent stabilizing structures of the joint against an unfavorable anatomical background caused by previous operations in the form of bone defects and deformities of the condyles with destruction of hyaline cartilage and previously resected menisci. Third, the use of reinforced grafts of increased strength for the reconstruction of the anterior cruciate ligament, as the main structure that stabilizes the joint. Moreover, such reinforcement can be direct, by strengthening the cruciate ligament graft directly, or indirectly, by strengthening the anterolateral part of the joint. The most appropriate is a combination of these two directions in order to obtain the maximum positive effect. Promising options for extra-articular reinforcement today are anatomical reconstruction of the anterolateral ligament and lateral extra-articular tenodesis of the iliotibial tract as part of the anterolateral joint complex. This makes it possible to compensate for the forced resections of the menisci and, without correction, at least at the first revision, the increased posterior inclination of the articular surface of the tibial condyles. The main advantages of these operations in combination with the reconstruction of the anterior cruciate ligament are their proven efficiency, versatility, technical simplicity and availability, which are of particular importance for the introduction into wide clinical practice of trauma departments of military hospitals.

Bulletin of the Russian Military Medical Academy. 2020;22(4):201-207
pages 201-207 views

Legal and clinical aspects of emergency burns

Sokolov V.A., Shpakov I.F., Butrin Y.L.


The key questions concerning particular sections of the topic «Burns in Emergencies» are presented. Particular attention is paid to the presentation of terminology. For this, the wording of the Federal Laws, Government Resolutions and Orders of the Ministry of Health of the Russian Federation were used. In accordance with the latter, the classification of emergency situations is given, as well as the criteria by which their damage is assessed. It has been established that the involvement of the forces and means of the Ministry of Defense in the elimination of the consequences of emergency situations is spelled out in the Federal Law. In addition, an argument is made on what basis the citizens of the Russian Federation are obliged to constantly improve their knowledge and practical skills in studying numerous issues of protecting the population, providing assistance to victims, in carrying out emergency rescue operations, etc. situations that led to massive burns. Key features of burns as injuries sustained in emergency situations are formulated. Also, aggravating circumstances are listed that negatively affect the general condition of the victims. The role and place of clinical guidelines as a fundamental development governing the sequence of the organization and content of medical care for those burned at the stages of medical evacuation are indicated. Attention is drawn to the legal significance of the problem.

Bulletin of the Russian Military Medical Academy. 2020;22(4):208-211
pages 208-211 views

The Ladoga Tragedy of September 17, 1941: Underreported Facts

Shevchuk I.A., Arutyunyan L.V., Petreev I.V.


The topic of studying the history of the great Patriotic war, which is still relevant, is reflected. One of the little – known pages of the besieged Leningrad is presented-the story of the death of people in the Ladoga tragedy on September 17, 1941 on barge No. 752. It considers the beginning of water evacuation from the blockaded Leningrad. Based on the memories of participants in those events and a number of documents, the paper discloses the factors that resulted in mass death of Red Navy officers, among whom were cadets and officers of the Dzerzhinsky High Navy Engineering School, Ordzhonikidze Navy Hydrographic School, graduates of the Naval Medical Academy, and their family members. The reasons of the tragedy were significant overload of the barge, underestimated unfavourable weather forecasts, lack of evacuation plan, unsuitable floating craft for transporting people, and neglected safety. Archival materials made it possible to reconstruct the barge sinking. Surge of Hitler’s troop attacks in early times of the Great Patriotic War predetermined a less-than-prompt organisation of evacuation from Leningrad. This also was due to the fact that pre-war mobilisation plans did not consider mass evacuation measures and, accordingly, there were no clear tried and true plans. The authors of the article present separate archival summaries of the said events.

Bulletin of the Russian Military Medical Academy. 2020;22(4):212-219
pages 212-219 views

Education news

Student scientific circle as a form of tutor’s support

Odin V.I.


The concept of a student scientific circle as a form of tutor training is presented. The history of the circle movement in Russian universities of imperial Russia is analyzed, starting with the circle organized by Professor Schwartz in 1781 and continued in the Soviet Union. The data on the state support of students’ research work in the post-war period, including state documents of title and measures of financial support, are presented. The traditional student scientific circle is a circle of those wishing to educate themselves in addition to the planned curriculum, by conducting their own research and publishing the results. As a result, an activity-level specialist is formed from a graduate of the circle. In contrast to the traditional one, the tutor-type training circle forms the circle member as a future specialist not only at the activity level, but also at the project and, preferably, conceptual levels. Methodologically, the task of a tutor-type training circle is not only to teach the circle members the practical skills of conducting scientific research, but, first of all, in personalized work to achieve anthropological goals, to create a reasonable, creative, effective personality who can create, plan and design. In the conditions of the rapid development of modern science, the construction of the future is proceeding at a rapid pace and is associated with the active implementation of the results of scientific experiments in all aspects of human life, which requires active suppression of everyday consciousness. At the same time, due to the risk of a landslide dehumanization, the circle member, as a scientist, needs to lay down humanitarian values that define the individual as a person who shares the ideals of goodness and justice. Thus, the student scientific circle is a system in which a new generation of honest and effective scientists and high – class specialists is formed under the guidance of a tutor.

Bulletin of the Russian Military Medical Academy. 2020;22(4):220-227
pages 220-227 views

Medicine history

The science of eye diseases in Saint Petersburg in the XVIII century

Milasheva N.V., Samoilov V.O.


A brief overview of the state of Russian medicine of the XVII century is presented firstly. The main attention is paid to the treatment of eye diseases during the XVIII century and the influence of famous foreign doctors and scientists on the origin and formation of Russian ophthalmology and its scientific basis. Special attention is paid to the role of the outstanding Dutch doctor and world-famous scientist G. Burhaave, who was called «the teacher of the whole Europe», in the development of medicine and identification of ophthalmology as an independent section of medicine and as a special discipline. This contributed to the further development of ophthalmology not only in Europe but also in Russia. The important role of the Vienna ophthalmology school and its representatives, including G.Y. Beer, Y. Bart, J.Ya. Morenheim and others, is stated in relation to the formation of the Russian scientific school of ophthalmology, which was the successor of Vienna best traditions. Great attention is paid to scientific papers and textbooks on ophthalmology published in the XVIII century in Russian. We also studied the student book by G. Burhaave «Public lectures on eye diseases …» that was the main textbook of the XVIII century for medical students throughout Europe and was published in Russia in 1798. We also analyzed the little-known in Russia handwritten document from the funds of the Russian State Historical Archive – an essay by the Austrian doctor of medicine and surgery Professor J. Ya. Plenka «Doctrina de morbisoculorum» («Doctrine of Eye Diseases») translated into Russian by the doctor of medicine A. Maslovsky (1798). A. Maslovsky dedicated the translation of this recognized in Europe scientific work to the Chief Director of the Medical College Baron A. I. Vasiliev. On September 23, 1818, according to the Highest Order of Emperor Alexander the I the first department of optics in Russia was established at the Saint Petersburg branch of the Medical and Surgical Academy with the approval of doctor of medicine and surgery I. E. Grubi in the position of full professor.

Bulletin of the Russian Military Medical Academy. 2020;22(4):228-235
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Grigory Vitalievich Khlopin is the pride of Russian hygiene science

Subbotina T.I., Krivtsov A.V., Andriyanov A.I., Sorokoletova E.F., Smetanin A.L., Ichuk Y.V.


Historical materials about the life and work of G.V. Khlopin, an outstanding scientist and hygienist, who created his own large scientific school. The main activity of which was the development of prevention and public hygiene. Biographical data are given, and scientific activity in the pre-revolutionary and Soviet periods is analyzed. The main directions of research work in the field of General hygiene, water supply hygiene, food hygiene, school hygiene, work in the field of anti-epidemic and anti-chemical protection are presented. The role of G.V. Khlopin in the formation and development of experimental hygiene is emphasized. The article describes his many-sided activities as a Professor of the Department of hygiene at the Military medical Academy, as well as his organizational and pedagogical activities, which laid the foundations for teaching hygiene at the higher medical school based on numerous textbooks and manuals published by him. The author notes the encyclopedic nature of knowledge, the great erudition of the scientist in all matters of hygiene, his unflagging ability to work, which made it possible to create capital guidelines on hygiene based on the works of domestic researchers. Attention is drawn to the activities of G.V. Khlopin in the creation of the «Institute of preventive Sciences named after Z.P. Solovyov», organized with the aim of improving the educational process and research activities, as well as his work as a consultant to the Main military sanitary Department of the Workers ‘and peasants’ red Army. A high assessment of the work of G.V. Khlopin, who holds the rank of full state Councilor, for the benefit of Russia, is the award of the order of St. Nicholas. Vladimir and SV. Stanislav, and in the years of Soviet power – conferring the honorary title of honored scientist.

Bulletin of the Russian Military Medical Academy. 2020;22(4):236-242
pages 236-242 views

The post-war period of the scientific work of Professor T.Ya. Arieva. Research and publication topics for the period 1946–1958

Sokolov V.A., Mamaeva S.A., Butrin Y.L.


The results of the search, restoration and systematization of research topics and publications of the first head of the Department of Thermal Injuries of the Military Medical Academy named after S.M. Kirov professor Tuviy Yakovlevich Ariev in the post-war period. The presentation of the material is connected with the urgent tasks that the faculty of the Academy solved in the first years after the end of the Great Patriotic War. The objective difficulties of the work of scientists in Leningrad in the second half of the 1940s are underlined. Nevertheless, T.Ya. Aryev, like many of his colleagues, was able to summarize the clinical material accumulated in front-line medical institutions in the shortest possible time and, only 4 years after returning from the army, to defend his doctoral dissertation. The high quality of the research performed is evidenced by the fact that the materials obtained formed the basis for a separate chapter in the multivolume edition «The Experience of Soviet Medicine in the Great Patriotic War 1941–1945». In addition, T.Ya. Ariev took part in writing several more chapters in this work, the topics of which were also related to the topic of his doctoral dissertation research. He willingly shared the knowledge gained, the experience of preparing for the defense of dissertations and the principles of scientific leadership with young scientists and their leaders. Continued service as head of the Department of Military Field Surgery at the Saratov Military Medical Faculty allowed him to accumulate invaluable experience in the formation and leadership of the scientific and clinical team. Analysis of the subject matter of publications in the 1950s. testifies to the intensive work on improving the diagnosis and treatment of urgent surgical pathology in peacetime. About the high authority among colleagues that T.Ya. Ariev for 4 years of service at the faculty is evidenced by the right to give a speech. The experience accumulated in Saratov will allow him not only to head, but also to effectively manage for many years the first department and clinic of thermal injuries in our country, created in 1960 at the S.M. Kirov.

Bulletin of the Russian Military Medical Academy. 2020;22(4):243-246
pages 243-246 views


Review of A.A.Budko, D.A. Zhuravlev’s book «The Mersy of victory. Medical assistance to american citizens in soviet hospitals during World War II»

Krylov V.M.


Научное издание «Милосердие победы. Оказание медицинской помощи американским гражданам в советских лечебных учреждениях в период Второй мировой войны» заслуженного врача Российской Федерации доктора медицинских наук, профессора А.А. Будко и кандидата исторических наук Д.А. Журавлева издана в 2020 г. и посвящена 75-летнему юбилею Победы во Второй мировой войне. Источником создания этой работы стали уникальные материалы из фондов архивов и музеев, выявленные авторами книги.

Bulletin of the Russian Military Medical Academy. 2020;22(4):247-248
pages 247-248 views


In memory of Georgiy Nicolaevich Tsibulyak

Samokhvalov I.M., Badalov V.I., Tiniankin N.A., Liashedko P.P., Golovko K.P.


The biography of colonel of Medical Corps, professor Georgiy Nicolaevich Tsibuliak (1932–2020) is presented. In 1956 G.N. Tsibuliak graduated from the Kirov Military Academy being awarded with gold medal. When being a cadet, he got actively engaged in research. In 1961 G.N. Tsibuliak defended candidate’s dissertation on the injury treatment in casualties damaged by ionizing radiation, took part in the study of multiple injuries occurring in atomic tests. After graduating from the medical residency he stayed in War Surgery department of the Academy, was eventually assigned as a senior lecturer, the head of the research laboratory carrying out the study of shock and terminal state. In1966 he defended a doctorate in pathogenesis, clinical findings and treatment of tetanus. G.N. Tsibuliak became one of the leading advocates for the concept of «traumatic shock in individuals». This fact that at present emergency physicians and surgeons dealing with traumatic shock consider to be an axiom, is scientifically based, and was gained through hard routine work in treating severely injured casualties. From 1976 to 1982 Georgiy Nicolaevich was Surgeon-in-Chief in Group of Soviet Forces in Germany. In 1990–1993 he was in charge of research laboratory dealing with combat surgical trauma in the Academy. Since 1993 G.N. Tsibuliak had retired from active duty, holding the position of a professor at the War Surgery department. He is the author of more than 200 scientific papers, including 7 monographs. G.N. Tsibuliak was closest associate of A.N. Berkutov in studying traumatic shock in casualties, took an active part in formation of a new clinical specialty – resuscitation.

Bulletin of the Russian Military Medical Academy. 2020;22(4):249-252
pages 249-252 views

Guidelines for authors

Guidelines for authors


The journal "Bulletin of the Russian Military Medical Academy" accepts articles and messages on the most significant issues of educational and methodological, scientific and scientific-practical, treatment-and-prophylactic and clinical work.

Bulletin of the Russian Military Medical Academy. 2020;22(4):261-262
pages 261-262 views

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