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Vol 23, No 4 (2021)

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Clinical trials

Metabolic and anxiety-depressive disorders in patients with polymorbid cardiovascular disease

Partsernyak A.S., Kryukov E.V., Tsygan V.N., Kurasov E.S., Ovchinnikov D.V.


The peculiarities of the influence of the metabolic disorders and depressive spectrum disorders in the development of polymorbid pathology are investigated. 160 male patients were examined, divided into three groups. The first group included 56 young men, 39–40.2 years old, body mass index 34.2–35 kg/m2, suffering from the polymorbid cardiovascular pathology, in which the presence of coronary heart disease, angina pectoris of the functional class I–II, arterial hypertension 2–3 degrees, obesity 1–2 degrees, depressive spectrum disorders was considered. The second group included 56 middle-aged men, 47.5–48.3 years old, body mass index 36.2–36.9 kg/m2 with a similar combination of diseases of the first group. The third (control group) included 48 young men, 39.6–40.9 years old, body mass index 24.1–24.9 kg/m2, suffering from the polymorbid cardiovascular pathology without the metabolic syndrome and obesity. The anthropometric status, glucose, insulin, total cholesterol, triglycerides, and low-density lipoproteins were assessed. Instrumental diagnostics of the coronary heart disease and hypertension was carried out, anxiety and depressive disorders were established based on the results of a questionnaire and a consultation with a psychiatrist. It was found that in a group of young and middle-aged patients suffering from the polymorbid cardiovascular pathology, in combination with a metabolic syndrome and depressive spectrum disorders, psychopathological disorders (borderline anxiety-depressive state) are associated with the metabolic disorders, high prevalence of pain-free form of myocardial ischemia and unfavorable variants of two-phase blood pressure rhythm during the day, according to the type of insufficient degree of reduction of nocturnal blood pressure — «non-dippers» and a steady increase in the night blood pressure — «night-peakers», which determines a high risk of cardiovascular complications.

Bulletin of the Russian Military Medical Academy. 2021;23(4):9-18
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Features of clinical and laboratory diagnostics of hantavirus infection at a prehospital stage

Kan E.A., Salukhov V.V., Rudakov Y.V., Kovalenko A.N., Golubtsov O.Y.


The features of clinical and laboratory diagnostics of hantavirus infection at the prehospital stage in the regions of the Northwestern Federal District is considered. The analysis of the terms of patients’ treatment from the moment of the appearance of the first symptoms of the disease was carried out. It was found that more than half of the patients sought a medical help during the height of the disease. The structure of hospitalizations of the patients with a hemorrhagic fever with renal syndrome who were admitted to inpatient treatment was studied; most patients were hospitalized by the ambulance team. The data of our own research are presented, indicating the predominance of the nonspecific symptoms in the onset of the disease. The overwhelming majority of the patients in the initial period of the disease had fever, severe headache, myalgia. Hemorrhagic syndrome was detected in a minimal number of the patients. The dynamics of the clinical picture of a hemorrhagic fever with the renal syndrome in patients admitted to hospitals in St. Petersburg was analyzed. Diversity and a rapid change of the symptoms and syndromes in dynamics were noted. In the structure of diagnoses of the direction, diseases of the respiratory system prevailed. A smaller proportion of a preliminary diagnoses were diseases of the gastrointestinal tract, pathology of the kidneys and urinary tract, diseases of the central nervous system, and only one patient was diagnosed with the hemorrhagic fever with renal syndrome. The laboratory parameters of the early period of the disease in patients were assessed. The most frequent and characteristic changes in the blood and urine parameters were revealed. Signs of hemoconcentration and thrombocytopenia were noted in almost half of the patients in the initial period of the disease. In a small part of outpatients, impaired renal nitrogen excretory function was found; the intensity of azotemia in the initial period of the diseases was low. Urine changes in the initial period were characterized by the moderate proteinuria, leukocyturia, erythrocyturia, cylindruria. The need for a thorough comparison of a clinical, laboratory, epidemiological data for a timely and correct diagnosis is noted.

Bulletin of the Russian Military Medical Academy. 2021;23(4):19-24
pages 19-24 views

Occupational stress as a risk factor and pathogenetic basis for the occurrence of cardiovascular diseases in naval specialists

Sobolev A.D., Kryukov E.V., Cherkashin D.V., Vypritsky P.A., Kutelev G.G., Sukhoroslova I.E., Nikashin A.N., Pastukhov A.V., Khomina V.V.


The relevance of cardiovascular diseases among the military personnel of the Russian Navy is reflected, as well as the role of occupational stressful load in the formation of a cardiovascular pathology. A single-stage study was carried out, which included 86 men aged 23–40 years, during the study were divided into two groups corresponding to the different occupational load. The profile of behavioral factors associated with the cardiovascular risk (anthropometric indicators, adherence to smoking, amount of alcohol consumed, food preference), as well as morphological and functional indicators of the system, was studied in servicemen exposed to and not exposed to factors caused by staying in the deep-sea technical means. blood circulation. The effectiveness of stress testing was assessed, which included the Reeder self-assessment scale for psychosocial stress, the hospital scale for anxiety and depression, a work stress questionnaire, and a differential assessment of the state of a reduced performance. It was revealed that the profile of cardiovascular risk in servicemen of both groups is low, however, there is a significant difference in the number of indicators (the amount of adipose tissue detected by bioimpedansometry, total cholesterol level, an increase in heart rate during the psychomental test, values of vascular age and scale of relative cardiovascular risk. The most informative method, which made it possible to identify significant differences between the studied groups, is the questionnaire of the work stress by C. Spielberg 1989, adapted by A.B. Leonova and S.B. Velichkovskaya, 2000. It was determined that the severity of the impact of occupational stress factors in the servicemen exposed to factors caused by their stay in the deep-sea technical means is lower than in servicemen in the control group, while the associations of indicators characterizing the circulatory system with the occupational stress factors are higher in the control group, which indicates the importance of the formation of stress resistance, achieved by a high requirements of the professional selection, regular training of professional skills, as well as the creation of a favorable professional climates.

Bulletin of the Russian Military Medical Academy. 2021;23(4):25-38
pages 25-38 views

Intraoperative electrocorticography: variants of periodic patterns in the structural epilepsy

Aleksandrov M.V., Kostenko I.A., Cherniy V.S., Tastanbekov M.M.


The results of intraoperative electrocorticography for patients with the structural epilepsy are influenced by two main factors: the action of general anesthetic and the mechanisms of epileptogenesis. Under the general anesthesia, there is a dose-dependent suppression of the bioelectrical activity of the brain; you could even register the “outburst-diminution” and “outburst-suppression” types of the periodic patterns. The study was carried out to classify the variants of periodic activity registered on the intraoperative electrocorticogram for patients with a structural epilepsy. The work was carried out during the examination and surgical treatment of the two groups of patients: 1) 19 patients (men/women — 10/9, 19–45 years old) with focal drug-resistant epilepsy; 2) 19 patients (men/women — 8/11, 28–68 years old) with structural epilepsy associated with the intracerebral tumors. All patients underwent surgical removal of the epileptic focus under a neurophysiological control. Surgical interventions were performed under the sevoflurane-based inhalation anesthesia in doses from 1.0−1.5 MAC (minimum alveolar concentration). Periodic activity on intraoperative electrocorticography was represented with the “outburst-suppression” type of patterns and patterns containing epileptiform discharge graph elements: “discharge- postdischarge depression,” “outburst-suppression” with discharges against the background of depression, “small electrical elements” with epileptiform discharges. The presence of discharge graph elements in the periodic patterns has a neurophysiological correlation with a drug-resistance in the structural epilepsy.

Bulletin of the Russian Military Medical Academy. 2021;23(4):39-46
pages 39-46 views

Unintentional bile duct injuries: prevention and treatment

Pryadko A.S., Romashchenko P.N., Sedletsky R.R., Aliev A.K., Yaraliev V.M.


Presented herein is a rational program of prevention, diagnosis, and the surgical treatment of patients with the unintentional bile duct injuries. Examination results and surgical treatment of 1,117 patients, who underwent laparoscopic cholecystectomy for acute and chronic cholecystitis from 2005−2020, were studied. The criteria for inclusion in the study were “difficult” laparoscopic cholecystectomy (181 medical histories) and unintentional bile duct injuries resulting from laparoscopic cholecystectomy (95 patients). Laparoscopic cholecystectomy with a duration of > 60 min was considered “difficult”. A total of 181 (17.7%) medical cases with “difficult” laparoscopic cholecystectomy and 95 patients with unintentional bile duct injuries were selected for this study. Instrumental studies were performed using X-ray contrast techniques such as: percutaneous fistulography, percutaneous-transhepatic, or intraoperative cholangiography, as well as relaparoscopy, ultrasound, endoscopic retrograde, or magnetic resonance cholangiopancreatography. A program approach to assist the patients with cholelithiasis was developed. Program implementation allows timely prevention and diagnosis of the unintentional bile duct injuries with minimal postoperative complications. The identification of the risk factors for “difficult” laparoscopic cholecystectomy indicates the need to comply with the preventive measures to prevent unintentional bile duct injuries and dictates the implementation of the surgical intervention by the most experienced surgeons from the second or third-level medical organizations. The rational option of surgical intervention aimed to eliminate the biliary tract injuries based on the following assessment criteria: general somatic condition of the patient, presence of the infectious complications, damage scale, crossed duct diameter, damage mechanism, and damage to the vessel. The right choice of the surgical intervention ensures a reduction in the number of complications and mortality, and quality of life improvement in patients with the unintentional bile duct injuries.

Bulletin of the Russian Military Medical Academy. 2021;23(4):47-54
pages 47-54 views

The value of erythropoietin in the pathogenesis of anemia of chronic diseases in the rheumatic patients

Sakhin V.T., Kryukov E.V., Grigoriev M.A., Kazakov S.P., Sotnikov A.V., Gordienko A.V., Nosovich D.V., Rukavitsyn O.A.


The features of erythropoietin secretion in patients with a rheumatic pathology and anemia of the chronic diseases in comparison with patients having iron deficiency anemia, as well as the relationship between erythropoietin, hepcidin, proinflammatory, and antiinflammatory cytokines, have been investigated. 126 patients suffering from the rheumatic pathology were examined, including 34 men aged 36–55 years and 92 women aged 38–60 years. At the same time, 104 (82.5%) patients suffered from anemia, 22 (17.5%) patients did not have it. Patients suffering from anemia, depending on the leading pathogenetic factor, were divided into three groups such as: the 1st group — patients suffering from anemia of chronic diseases; 2nd group—patients suffering from a combination of anemia of chronic diseases and iron deficiency anemia; 3rd group—patients suffering from iron deficiency anemia. In patients suffering from anemia of chronic diseases, the maximum concentration of interleukin-6, hepcidin, and the minimum concentration of erythropoietin were detected in comparison with the patients suffering from iron deficiency anemia and patients suffering from anemia of chronic diseases, and iron deficiency anemia (p < 0.05). The maximum concentration of the erythropoietin has been established in patients suffering from iron deficiency anemia. About the concentrations of interleukin-10 and interleukin-1β, tumor necrosis factor-α, interferon-γ, no differences were found in the study groups. A direct correlation was found between the erythropoietin and erythrocytes (r = 0.57), hemoglobin (r = 0.41), hepcidin (r = 0.65). There was a strong negative correlation between the erythropoietin and interleukin-6 (r = –0.75), and a weak relationship with interferon gamma, tumor necrosis factor alpha, interleukin-10, and interleukin-1β (r < 0.3). Thus, for patients with a rheumatic profile, a specific molecular profile should be identified, leading to the development of anemia of the chronic diseases, which consists in increased concentrations of hepcidin and interleukin-6 in combination with the insufficient secretion of erythropoietin. The found changes fit into the structure of the previously proposed working version of the classification of anemia of chronic diseases (with a predominant iron deficiency, with disturbances in the regulatory mechanisms of the erythropoiesis, with an insufficient production of erythropoietin). Isolation of the leading factor in the development of anemia of chronic diseases in the future will allow for a more optimal approach to its correction, including with the targeted therapy drugs.

Bulletin of the Russian Military Medical Academy. 2021;23(4):55-62
pages 55-62 views

Development of a method for the identification of rs6265 polymorphism in the human brain neurotrophic factor gene

Kutelev G.G., Krivoruchko A.B., Trandina A.E., Morozova N.E., Cherkashin D.V., Ivanov A.M., Ovchinnikov D.V., Glushakov R.I.


The analysis and generalization of data from the literature sources characterizing the structural organization, regulation of expression, and functional activity of the neurotrophic factor of the human brain, which is one of the most common regulators of biological processes in the nervous system, is carried out. The results of numerous studies demonstrating the association of the brain-derived neurotrophic factor (BDNF) gene with the pathophysiology of the affective disorders are noted, and its contribution to the development of neuroplasticity is confirmed. The results of the design of a pair of primers and adaptation of the amplification reaction of the BDNF region with a length of 433 nucleotide pairs containing the polymorphic locus RS6265 are presented. Restriction endonuclease was selected. The sequence of primers, their localization, and correlation with the restriction site provided the separation of alternative alleles necessary for the successful identification of this marker. The use of the proposed technique made it possible to uniquely identify the genotype in 38 examined whole blood samples and identify the rare allelic variants. Also, the frequency of polymorphic variants of RS6265 of the BDNF gene was established in all the samples. There was an increase in the proportion of genotypes G/A and A/A of the RS6265 polymorphism of the BDNF gene in the group of examined systematically exposed to extreme factors. Identification of people with a rare A/A genotype of the RS6265 polymorphic locus of the BDNF gene is of a great importance for the monitoring system of long-term potentiation processes leading to the development of neuropsychic pathology. The possibility of implementing this method of genotyping in a typical laboratory using a polymerase chain reaction is proved. The proposed version of the polymerase chain reaction with the subsequent analysis of the polymorphism of the lengths of restriction fragments could be used as a fast, inexpensive, and reliable system for identifying single-nucleotide genetic polymorphisms.

Bulletin of the Russian Military Medical Academy. 2021;23(4):63-70
pages 63-70 views

Application of remote mobile monitoring using the “ECG-DONGLE” electrocardiograph in patients with chronic heart failure

Frolov D.S., Salukhov V.V., Izilyaeva E.A., Stepanenko I.A., Sveklina T.S.


The urgency of remote monitoring of the patient’s condition, early diagnosis, and timely detection of precursors of deterioration during chronic heart failure using the telemonitoring systems is substantiated. We examined 10 patients (4 women and 6 men aged 64 ± 12 years) suffering from a heart failure with a high risk of adverse outcomes, the mean left ventricular ejection fraction was 34.4% (32.1%; 37.6%), as well as 10 healthy men (control group, mean age 21 ± 3 years). Each participant was provided with a home monitoring and communication kit (tablet computer with the Internet access, mobile ECG-Dongle electrocardiograph). Also, an individual plan for the treatment of heart failure and associated diseases was developed for the participants. The resulting image using a mobile electrocardiograph “ECG-Dongle” fully corresponds to the data of a stationary 12-lead electrocardiograph. The use of monitoring the electrocardiogram using a remote access solves the problem of timely personalized identification of predictors of deterioration in the patient’s circulatory system, while helping to identify a possible cause of destabilization of the course of heart failure, which contributes to the timely correction of the therapy in the early stages. Mobile computing technologies for a remote access, data transfer, and information processing are now being introduced in telemonitoring systems. The remote rehabilitation monitoring system based on the mobile communication could be used as an auxiliary model of outpatient care in the management of patients suffering from a chronic heart failure. We believe that by using such systems, work with the patient could be more effective, namely, self-control of behavior and improved quality of life, which in turn, could lead to a decrease in the rate of the repeated hospitalizations and mortality of the patients suffering from a chronic heart failure.

Bulletin of the Russian Military Medical Academy. 2021;23(4):71-78
pages 71-78 views

Role of β2-microglobulin and lactoferrin in differential diagnosis of uremic pseudoperitonitis and peritonitis in patients with renal replacement therapy (program hemodialysis)

Zurnadzh’yantc V.A., Kchibekov E.A., Gasanov K.G.


The significance of the serum concentrations of β2-microglobulin and lactoferrin of the patients on a renal replacement therapy (program hemodialysis) for differential diagnosis of uremic pseudoperitonitis and peritonitis is considered. The study included 56 patients with a suspected peritonitis, admitted urgently to the hospital, who received renal replacement therapy (programmed hemodialysis) in the history. The control group included 50 outpatients on a programmed hemodialysis. The study did not include patients with suspected peritonitis who did not receive programmed hemodialysis in the history. Serum concentrations of β2-microglobulin and lactoferrin were determined in the test groups. Serum β2-microglobulin concentration was found to be statistically higher than the normal in all the patients receiving a history of program hemodialysis procedures. The highest statistically significant concentration of β2-microglobulin was detected in patients with the suspected uremic pseudoperitonitis, both compared to the control group and the group of the patients with diagnosed peritonitis. The highest statistically significant concentration of lactoferrin was detected in patients with the suspected peritonitis receiving a history of program hemodialysis procedures, which is significantly higher both compared to the control group and the patients with a suspected uremic pseudoperitonitis. In the control group of outpatient patients receiving program hemodialysis procedures, no statistically significant differences in serum concentrations of β2-microglobulin and lactoferrin were detected. A statistically significant increase in the concentration of β2-microglobulin was found in uremic pseudoperitonitis, and lactoferrin in peritonitis. The obtained data do not exclude the possibility of using β2-microglobulin to diagnose the uremic pseudoperitonitis, and lactoferrin with a high probability makes it possible to establish the fact of peritonitis.

Bulletin of the Russian Military Medical Academy. 2021;23(4):79-84
pages 79-84 views

Risk factors and circulatory system pathologies in military personnel in the Arctic region

Kryukov E.V., Fisun A.Y., Halimov Y.S., Gaiduk S.V., Agafonov P.V.


Considering the remoteness of the Arctic region, its harsh climatic and geographical characteristics, complex sanitary and epidemiological situation, and peculiarities of a military labor, circulatory system pathologies are expected to significantly contribute to the morbidity structure of the personnel of the Armed Forces of the Russian Federation in the Arctic region. A comparative analysis of the occurrence of cardiovascular risk predictors such as: dyslipidemia, tobacco smoking, high blood pressure, abdominal obesity, negative psychosocial factors, poor diet, alcohol consumption, physical inactivity, individual signs of atherosclerosis, and circulatory system diseases in the servicemen of the Arctic region, and temperate climate was performed. The results of the analysis revealed that military service in the climatic and geographic conditions of the Arctic zone is associated with a higher prevalence of the negative psychosocial factors, diet disorders, bad habits, and an arterial hypertension. Negative psychosocial factors included: stress, increased anxiety, and the depression, which are explained by the remoteness and limited communication in the Arctic region and the “mainland,” poor prospects for the professional career growth and high-quality training of the family members, monotony, and low availability of the leisure activities. The higher prevalence of an arterial hypertension among the arctic servicemen was caused by the newly diagnosed arterial hypertension and a history of arterial hypertension. In a significant proportion of arctic servicemen, low-density lipoprotein values exceed the target values, which ensure the prevention of the atherosclerosis and its complications. This may contribute to the development of the hypertension and coronary heart disease, and requires a more careful selection of servicemen in the Arctic region with mandatory in-depth examinations of the circulatory systems and metabolism, including the electrocardiography, echocardiography, treadmill test, ultrasonography of the brachiocephalic arteries with the determination of the thickness of the “intima–media” complex, sphygmomanometer, and determination of the rigidity and biological age of the blood vessels, lipid profiling, and fasting glycemia.

Bulletin of the Russian Military Medical Academy. 2021;23(4):85-92
pages 85-92 views

Results of the work of the Military medical academy research institute of novel coronavirus infection problems through 2020–2021

Ivchenko E.V., Kotiv B.N., Ovchinnikov D.V., Bucenko S.A.


Novel coronavirus infection COVID-19 pandemic has become a serious test for the world’s population across the board — from individual to population. Introduced restrictive measures of self-isolation, observation, and quarantine, mostly known before the pandemic only to medical specialists, have become a forced “lifestyle” for most of the people across the globe, their specific adaptation to the new, unusual conditions of the existence and communication. Healthcare has faced off with an unknown infection, while traditional methods of the treatment showed their ineffectiveness at the initial stage. The results of the Research Institute of Problems of New Coronavirus Infection of the Military Medical Academy named after S.M. Kirov from April 2020 to present are listed. Work basis is formed by the scientific and clinical results of the Academy’s work during the COVID-19 pandemic. The experience of organizing sanitary, antiepidemic and preventive measures at the permanent disposition and in the field in the regions of Russia and abroad is presented. Developed, improved, and put into the practice methods of diagnosis and treatment of the patients, including the electron microscopic diagnostics of long-term carrier, ultrasound examination of the lungs, glucocorticosteroid therapy, helium–oxygen therapy, risk prediction algorithms and computer-aided evaluation of the degree of lung tissue damage, evaluation of the drug effectiveness are listed. In a separate section study related to the Russian vaccine “Gam-COVID-Vac,” the assessment of immunity after the disease, complex disorders, and in postvaccination cases, the use of the immune pathogen-reduced plasma, the mutual influence of various vaccines are presented. Methods of rehabilitation of convalescents, dispensary-dynamic observation, and military medical examination are studied and developed.

Bulletin of the Russian Military Medical Academy. 2021;23(4):93-104
pages 93-104 views

Monocytosis in patients with coronavirus pneumonia after treatment with glucocorticoids

Shperling M.I., Kovalev A.V., Sukachev V.S., Vlasov A.A., Polyakov A.S., Noskov Y.A., Morozov A.D., Merzlyakov V.S., Zvyagintsev D.P., Kozlov K.V., Zhdanov K.V.


Features of variation of peripheral blood leukocyte formula parameters in 86 patients with coronavirus pneumonia with leukocytosis with a background of glucocorticoid treatment were investigated. All patients were divided into 2 groups. Group 1 was 22 individuals who showed clinical signs of the bacterial infection (purulent sputum cough in combination with neutrophilic leukocytosis at hospital the admission). The 2nd group was made up of 64 patients with the glucocorticoids developed against the background of treatment with glucocorticoids (dexamethasone 20 mg/day or prednisolone 150 mg/day, intravenously for 3 days) leukocytosis >10 ×109/l without signs of a bacterial infection. It was found that in patients of the 1st group compared to the 2nd group, levels of the white blood cells and neutrophils significantly (p < 0.001) exceeded the reference values in the absence of a significant change in the number of monocytes. In patients of the 2nd group after a three-day intravenous application of the glucocorticoids on the 4th day of hospitalization, a statistically significant (p <0.001) increase in the number of neutrophils and monocytes was established. When comparing the quantitative parameters of the leukocyte formula between the 2nd group on the 4th day of the hospitalization and the 1st group at admission, there were no differences in the level of leukocytes and neutrophils. Number of monocytes in group 2 (1.11 (0.90; 1.34) × 109/l), on the contrary, statistically significantly (p < 0.001) exceeded their level in the 1st group (0.59 (0.50; 0.77) × 109/l). Thus, an indicator of the number of monocytes in the peripheral blood could be a promising differential diagnostic criterion for the genesis of the leukocytosis in patients with the COVID-19. This parameter may be one of the factors influencing the decision to prescribe the antibacterial therapy.

Bulletin of the Russian Military Medical Academy. 2021;23(4):105-112
pages 105-112 views

Dynamics of clinical features of schizoid personality disorder first diagnosed in military age

Grigoryeva E.A., Lisauskene O.V., Abritalin E.Y., Kolchev A.I.


The dynamics of the schizoid personality disorder of 45 conscripts recognized as unfit or partially fit for the military service was investigated. Anamnesis was studied, the severity of the mental disorders and the quality of social adaptation at the time of the call and over the next five years were assessed. Two types of the schizoid personality disorder have been identified: expansive and sensitive. For recruits with a predominance of the sensitive traits (32 (71.11%) people) were characterized by: formally intact intelligence, high level of education, isolation, disinterest in establishing, or maintaining close friendships, difficulties in the social interaction with strangers, avoidance of sexual contacts. Those surveyed with expansive character traits (13 (28.89%) people) were distinguished by a lower intellectual level, decisiveness, high capacity for work, egocentricity; relations with others were distinguished by the formality and an inability to empathize. Both groups were united by the features such as: social isolation, discomfort when communicating with people, inability to form emotional ties with others, underdeveloped empathy, detachment from the real goals, and turning to the sphere of inner experiences. Follow-up analysis in 5-year dynamics showed that the main psychopathological manifestations of the sensitive and expansive types (excessive sensitivity and asthenic affect, emotional coldness and stenic affect) are smoothed out, but they are complicated by the other additional symptoms (originality of hobbies, subjectivism of thinking, weakening of the activity of the mental processes, addictive manifestations) ... A distinct decrease in the level of general functioning in some patients may indicate a possible adverse pathomorphosis: schizoid personality disorder — schizotypal personality disorder — schizotypal disorder. The study indicates the feasibility of developing the therapeutic measures (pharmacological, psychocorrectional, social rehabilitation) in relation to the young patients suffering from schizoid personality disorder due to the further complication of the psychopathological picture, and the appearance of signs of an endogenous process in the several patients.

Bulletin of the Russian Military Medical Academy. 2021;23(4):113-120
pages 113-120 views

Comparative value of purine metabolites in preeclampsia and acute cerebral stroke

Oreshnikov E.V., Oreshnikova S.F., Vasilyeva E.N., Karpova T.V., Khabarova O.Y., Denisova T.G.


The values of the purine metabolites in preeclampsia and acute cerebral stroke were compared. A total of 33 patients with preeclampsia and 350 patients with an acute cerebral stroke were examined. The blood and liquor guanine, hypoxanthine, adenine, xanthine, and uric acid were determined by a direct spectrophotometry, in addition to conventional laboratory parameters. It has been established that there are clinical–pathobiochemical parallels between preeclampsia and the cerebral stroke, including by the features of purine metabolism. It is known that the most pronounced adverse metabolic indicator (marker, predictor) for both preeclampsia and the cerebral stroke is hyperuricemia. It was revealed that the favorable sign for stroke is the high values of oxypurines (hypoxanthine, xanthin, and uric acid) in the cerebrospinal fluid, and for preeclampsia their low levels. It has been shown that cerebrospinal fluid is not only the medium of administration of the drugs for spinal anesthesia, but also a source of valuable diagnostic and prognostic information, including in preeclampsia. Preeclampsia is metabolically like stroke with an unfavorable significance of hyperuricemia and diametrically antagonistic to stroke with a favorable value not increased, but a reduced concentration of hypoxanthine, xanthin, and uric acid in cerebrospinal fluid. The level of uric acid and other purines in patients suffering from a preeclampsia and in patients suffering from a cerebral stroke should be determined not only in the blood serum, but also, as far as possible, in cerebrospinal fluid.

Bulletin of the Russian Military Medical Academy. 2021;23(4):129-138
pages 129-138 views

Pituitary-gonadal system dysfunction in middle-aged men with an uncontrolled asthma

Kharitonov M.A., Salukhov V.V., Kuandykova M.V., Rudakov Y.V.


The functional state of the pituitary–gonadal system is investigated in 90 middle-aged men with the uncontrolled asthma and 35 healthy volunteers. According to the severity of the disease, the patients were stratified into two groups: moderate and severe. To assess the symptoms of an androgen deficiency and sexual dysfunction, the “Aging Males’ Symptoms” and the “International Index of the Erectile Function” were used. The activity of the pituitary–gonadal system was assessed by determining the serum levels of testosterone, sex hormone binding globulin, prolactin, estradiol, luteinizing and follicle-stimulating hormone as well as cortisol. It was found that in patients suffering from asthma, symptoms of androgen deficiency and sexual dysfunction are revealed significantly more often than in the healthy middle-aged men, and the severity of these disorders depends on the severity of the disease. At the same time, in patients suffering from asthma, before the treatment, there was a significant decrease in the serum level of androgens, cortisol, and an increase in the sex hormone binding globulin, luteinizing and follicle-stimulating hormone, depending on the severity of the disease, in comparison with healthy subjects. After the treatment, the levels of sex hormone binding globulin, luteinizing hormone and follicle-stimulating hormone were restored, while the levels of androgens and cortisol remained reduced. A significant decrease in the level of prolactin was detected only after the treatment in patients suffering from a severe asthma. Thus, in middle-aged men with an uncontrolled asthma, symptoms of androgen deficiency, and dysfunction of the pituitary–gonadal and reproductive systems are significantly more common than in the healthy individuals of the same age. Moreover, the severity of these disorders is influenced not only by the severity of the asthma, but also by the treatment with the systemic corticosteroids.

Bulletin of the Russian Military Medical Academy. 2021;23(4):121-128
pages 121-128 views

Relationship of creativity and genetic factors in military services in the conditions of the arctic region

Spivak I.M., Lemeshchenko A.V., Agafonov P.V., Khalimov Y.S., Zhekalov A.N., Gaiduk S.V., Spivak D.L.


The article examines the relationship between the creativity and genetic factors in a serviceman serving in the Arctic region with the special climatic and geographical parameters, a kind of sanitary and epidemiological situation, as well as the complexity of a military labor. A linear correlation analysis of the indicators of a creativity was carried out as one of the most important abilities of the personality, allowing timely response and adaptation to the changing conditions of the external social environment, and the polymorphism of four genes that take an active part in the process of the adaptation to the conditions of the Arctic region: the gene for the serotonin receptor 2A, the gene for angiotensin converting enzyme-1, the gene for neurotrophic factor, as well as the gene for alpha-actinin-3. It was found that the maximum level of verbal and imaginative creativity is observed in carriers of the Val / Val genotype of the neurotrophic factor gene, as well as the RR genotype of the alpha-actinin-3 gene. The carriers of these genotypes are characterized by a high production of neurotrophines that stimulate and support the development of neurons, which may determine the resistance of the central nervous system to unfavorable factors of the external social environment. In addition, the high level of expression of the alpha-actinin-3 protein, characteristic of carriers of the RR genotype of the alpha-actinin-3 gene, promotes accelerated regeneration of skeletal muscles, which may contribute to more optimal adaptation of the body to the harsh conditions of the Arctic region associated with an increased muscle load. When analyzing the angiotensin-converting enzyme gene, the observed patterns with the level of creativity turned out to be less clear, although the servicemen with the DD genotype of this gene showed a minimum level of creativity, which corresponds to the general idea of it as a “weaker” genotype in terms of the level of general body metabolism and the ability to be active. The characteristics of the creativity in genotypes II and ID of the angiotensin converting enzyme gene were statistically uncertain. The good tightness of the correlation of creativity with the Val/Val genotype of the neurotrophic factor gene, as well as the RR genotype of the alpha-actinin-3 gene, may indicate the advisability of including military personnel planned to be sent to the Arctic region in the examination plan to determine the level of creativity. This will optimize the process of selecting servicemen for service in the Arctic region, and prevent the development of maladjustment disorders, excluding persons with a low adaptive potential.

Bulletin of the Russian Military Medical Academy. 2021;23(4):139-146
pages 139-146 views

Evaluation of vaccine "Sputnik V” immunogenicity and reactogenicity when it is used in military personnel

Zhogolev S.D., Gorenchuk A.N., Kuzin A.A., Kulikov P.V., Zhogolev K.D., Apchel V.Y., Sergeev T.S., Lantsov E.V., Artebyakin S.V., Zharkov D.A.


The article presents the results of a study of the immunogenicity and reactogenicity of the vaccine Gam-COVID-Vac (Sputnik V) when used in military personnel undergoing military service on conscription. From 300 military personnel consistently vaccinated with one and two components of Gam-COVID-Vac at the intervals of 21 days, blood serum was obtained and examined three times: before vaccination, and 30 and 60 days after the introduction of the first component of the vaccine. In the blood serums, the content of Class G antibodies to the SARS-CoV-2 was determined by the method of solid-phase enzyme immunoassay. After immunization with the Gam-COVID-Vac vaccine, the average geometric titer of Class G antibodies to SARS-CoV-2 -in the blood serum of a military personnel obtained during the second and third examinations (5.02 log2 and 5.67 log2) increased by 2.4 and 2.7 times, respectively (p < 0.05), compared to the same indicator before the vaccination (2.11 log2). Total of 30 days after the introduction of the first component of the vaccine (Nine days after the introduction of the second component of the vaccine), Class G antibodies to the new coronavirus SARS-CoV-2 were detected in the 86.7% of military personnel, and after 60 days — in 92% of vaccinated. Studies have revealed moderate reactogenicity of the vaccine. Moreover, the proportion of postvaccination reactions in the first 3–5 days after the introduction of the second component of the vaccine was less after the introduction of the first component of the vaccine. So, if after the introduction of the first component of the vaccine, an increase in body temperature > 37 °C was observed in 20% of military personnel, then after the introduction of the second component only in 9%, and the share of local reactions decreased from 9−4%. There have been no cases of serious adverse events after immunization of military personnel with the Gam-COVID-Vac vaccine.

Bulletin of the Russian Military Medical Academy. 2021;23(4):147-152
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Molecular-genetic testing in preoperative diagnosis and choice of surgical tactics in patients with thyroid neoplasms

Romashchenko P.N., Maistrenko N.A., Ivanov A.M., Krivolapov D.S., Simonova M.S.


The high frequency of the detection of follicular thyroid tumors requires the development of the most effective new methods for their differential diagnosis to early verification of well-differentiated cancer, reduce the number of unjustified surgical interventions, select their rational volume, and improve the treatment results. The use of molecular genetic research methods in preoperative diagnostics and the choice of surgical tactics in patients with the thyroid neoplasms was substantiated. To optimize the algorithm of diagnosis and treatment, a retrospective analysis of the results of examination and surgical treatment of 100 patients with the thyroid neoplasms was carried out, the diagnosis of which was supplemented by the determination of molecular genetic markers in the cellular material of the puncture fine-needle biopsy using a flow fluor-cytometry and polymerase chain reaction. The diagnostic significance of the preoperative determination of the tumor marker Galectin-3, the V600E mutation of the BRAF gene in the puncture material in the detection of thyroid cancer and the choice of the rational surgical tactics was assessed. The prognostic value of the sodium iodide symporter in the development of a thyroid cancer resistance to postoperative radioactive iodine therapy has been established, which makes it possible to substantiate the need to expand the scope of the surgical intervention. The use of an optimized diagnostic and treatment algorithm, considering a new molecular genetic research methods in this category of the patients, contributes to the choice of individualized surgical tactics, depending on the nature of the pathological process.

Bulletin of the Russian Military Medical Academy. 2021;23(4):153-160
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Surgical treatment strategy in patients suffering from post-traumatic coccygodynia

Khominets V.V., Nagorny E.B., Nadulich K.A., Teremshonok A.V., Kudyashev A.L., Strelba A.A.


Clinical effectiveness of coccus removal in post-traumatic coccigodinia is evaluated. The study included 34 patients with diagnosed post-traumatic coccigodinia who underwent surgical treatment in resection or coccyx removal volume. A long history of trauma-related pain syndrome and ineffective conservative treatment were noted in all patients. The exclusion criteria were: inflammatory or oncological process, chronic urogenital diseases, previously undergoing operations on the lumbosacral spine, complicated by the course of the hernia of the intervertebral disc with root syndrome and neurological disorders. Before the operation, patients underwent manual examination, radiography (in direct and lateral projections) and computed tomography of the sacrum and coccyx, examination of the gynecologist (for women) and urologist (for men), examination of the proctologist, according to the indications — magnetic resonance imaging of the spine in order to exclude hernia of the intervertebral disc with neural compression and dermoid cysts of the copcystic. Evaluation of treatment results was performed using a visual analogue pain scale and a verbal 5-point operation satisfaction scale. The observation period was from 1 year to 4 years. Cupping of pain syndrome after surgery was noted in 28 (82.4%) cases, in 6 (17.6%) patients there was a decrease in the intensity of pain syndrome with discomfort only after a prolonged sitting position. 5 (14.7%) patients were "satisfied" with surgery, 28 (82.4%) patients were "completely satisfied", in one (2.9%) case there was "doubtful satisfaction" with surgery. Thus, surgical treatment of coccigodinia in the volume of partial or complete coccyx removal is indicated in cases of ineffectiveness of conservative treatment in its post-traumatic instability. Surgical intervention leads to the cessation of pain syndrome and allows patients to return to their previous physical activity.

Bulletin of the Russian Military Medical Academy. 2021;23(4):161-170
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Experimental trials

Features of flight information perception in shaping the flight concept

Kotov O.V., Sinelnikov S.N., Naturalnikov I.O., Savin A.V., Drobot I.A., Gerasimenko E.A., Vyborov E.M.


This study determines the peculiarities of perception of aerobatic information in shaping the horizontal flight concept for operators who do not have experience in simulator training. The skill formation assessment in 10 flights was conducted using time indicators and generalized piloting error calculation based on the task. The program of activity concept shaping is developed using complex sensorimotor reactions at the 3rd stage of flight to increase the attention reserves of operators. The distribution of attention was analyzed when recording the coordinates of eye fixation in the designated visual zones using the mobile oculography system SMI ETG 2 WirelessAnalysPro. The number of eye fixations is established to increase with increased flight experience. Over each flight, the operator spends less time on the perception and evaluation of flight information from a particular device, thus the speed of changing saccadic eye movements increases, and the duration of the fixations themselves decreases. The proposed method of step-by-step flight concept shaping during the performance of the task of the horizontal flight showed high efficiency of developing motor and sensory skills. The development of such modular programs for training take-off and landing may significantly improve the principles of simulator training. The obtained data reveal the peculiarities of aerobatic information perception by operators of complex ergatic systems, with the prospect of increasing the reliability of professional activity of young pilots in the transition to real practical flights.

Bulletin of the Russian Military Medical Academy. 2021;23(4):171-178
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The influence of glyprolins on the behavior of laboratory animals under experimental hyperthyroidism

Sergalieva M.U., Tsibizova A.A., Abdulkadyrova E.I., Andreeva L.A., Samotrueva M.A., Myasoedov N.F.


This study aimed to determine the peculiarities of behavioral reactions and psychoemotional status of laboratory animals in experimental hyperthyroidism conditions against the background of introducing peptides of glyproline series (selank and tripeptide Pro-Gly-Pro). All experiments were conducted on white non-linear male rats, which were divided into groups consisting of 10 individuals. The first group consisted of control rats that received intraperitoneal water for injection in equi-volume. The second group consisted of individuals with experimental hyperthyroidism modeled by intragastric administration of L-thyroxine “Berlin-Chemi” Germany) at 150 mcg/kg/day for 21 days. The third and fourth groups were animals with a hyperthyroidism model and received intraperitoneal Selank and Pro-Gly-Pro at 200 mcg/kg/day for 21 days after the hyperthyroidism model development. The behavioral activity determination of laboratory animals was conducted using the “Open Field” method, which is widely used in the analysis of approximate research activity, locomotive stereotyping, and the emotional reactivity level of rodents. The level of animal anxiety was assessed using the Raised cross-shaped maze method. The study revealed that experimental hyperthyroidism due to the introduction of L-thyroxine is accompanied by an increased level of the anxiety-depressive state in the behavior of male rats. The study on the effects of selank and its structural analog Pro-Gly-Pro on the psychoemotional status of male rats using Open Field and Raised cruciform labyrinth methods revealed that the recovery of the approximate research motor activity of laboratory animals is noted, which indicates the psychomodulatory activity of glyproline neuropeptides, in experimental hyperthyroidism conditions.

Bulletin of the Russian Military Medical Academy. 2021;23(4):179-186
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The adhesive properties of the “Tachocomb” hemostatic plate with prostheses of the brain dura mater

Vinogradov V.V., Alekseev D.E., Svistov D.V.


The adhesion of the Tahokomb hemostatic plate of Takeda (Japan) to the solid cerebral membrane prostheses from materials of various origins was experimentally investigated to determine which of them the implants under study best provide tachocomb fixation and contribute to the prevention of postoperative liquorrhea and infectious complications resulting from leaks in the subdural space. It was found that the greatest adhesion of tachocomb was revealed to xenogenic prostheses having collagen in their composition, which characterizes them as optimal prostheses for plasticizing defects of the solid cerebral membrane from the point of view of sealing the subdural space. Intermediate values were observed in the study of prostheses of combined origin, and the lowest adhesion of tachocomb was observed with respect to synthetic prostheses. Of some interest are new composite substitutes for the hard brain (NeoDura, Medprin), created as a mix of synthetic and organic materials. The surface texture of these solid cerebral membrane analogues approaches collagen implants in characteristics, and is similar to the structure of the native solid cerebral membrane. Based on the data obtained, we can talk about the priority use of solid braincase prostheses based on animal collagen - not only due to the high adhesion parameters of tachocomb to them, but also due to other qualities: resorbability, facilitating the deposition of recipient fibroblast materials on the surface.

Bulletin of the Russian Military Medical Academy. 2021;23(4):195-202
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The stimulating effects of exometabolites of microalgae chlorella vulgaris on the lactic acid bacteria bacillus coagulans

Markin I.V., Zhurbin E.A., Potapov P.K., Shchelkanova E.S., Molodchenko A.N., Stepanenko N.I.


This study aimed to determine the stimulating effect of exometabolites of microalgae Chlorella Vulgaris IPPAS C-2 — indole compounds that are cultured on wastewater model solution. The purification process of a model wastewater solution with Chlorella Vulgaris microalgae obtained biomass of microalgae with a high lipid content (up to 50%), whereas the residual concentrations of pollutants in the solution were ammonium cations of 1.5 mg/l and phosphate anions of 3.5 mg/l. The residual concentration of microorganisms in the purified model sample of wastewater does not exceed 0.3 million CFU/ml. Growth factors of indole nature, which are external metabolites of microalgae, were also found in the solution. Purified effluents were used in the microbiological synthesis of lactic acid to confirm the stimulating effect of accumulated metabolites. The control sample was a nutrient medium based on malt germ extract. The glucose concentration in all samples is the same and is 140 g/l. A strain of lactic acid bacteria Bacillus coagulans B-10468 was used as a test culture. The highest concentration of lactic acid bacteria (100 million cells/ml) was observed in a sample containing microalgae metabolites. This concentration is 1.7 times higher than in the control sample. In the future, the growth rate of Bacillus coagulans cells slowed down since the concentration of lactic acid reached the limit values of 30–50 g/l on the 3rd day, which contributed to the bacterial cell growth inhibition. The use of a growth stimulator based on treated wastewater by microalgae in the cultivation of bacteria of the species Bacillus coagulans B-10468 increases the specific rate of accumulation of bacterial biomass (0.27 day–1), which is 26% more than in the control sample; increases the yield of lactic acid (120 g/l) by 25% compared with the traditional stimulant — malt sprouts. The lactic acid production using growth stimulants from wastewater treatment with microalgae will reduce the cost of its production. The use of this technological solution will provide an opportunity to reduce the cost of polymer, polylactide, which is one of the main materials for additive technologies.

Bulletin of the Russian Military Medical Academy. 2021;23(4):187-194
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Experimental justification of directions for improving the methodological support of professional psychological selection of candidates for training in universities of the ministry of defense of the Russian Federation

Zelenina N.V., Fedotkina I.V., Yusupov V.V.


This experimental study aimed to determine the possibility to increase the effectiveness of predicting the success of training and military-professional adaptation by applicants to universities of the Russian Federation Ministry of Defense by including professional psychological selection, an indicator of previously unused psychological survey methods and complex visual-motor reaction. Therefore, we examined the cadets of the V–VI courses and used the results of the same groups of cadets when they pass the professional psychological selection. Mathematical and statistical data processing was carried out by discriminant analysis. The long-term forecast of successful training according to the professional psychological selection indicators is ineffective, and 61.7% of cadets have high academic performance. The inclusion of complex visual-motor reaction indicators significantly increases the reliability of the long-term forecast of high academic performance to 85.7%, overcoming the critical threshold of 75%. Additionally, by the end of the training, 10%–12% of cadets developed chronic stress-induced somatic diseases, such as circulatory system (I00–I99 according to the International Statistical Classification of Diseases and Related Health Problem 10th revision) and digestive system diseases (K00–K93), indicating imperfect military-professional adaptation and reducing the professional activity reliability. Adding the study of complex visual-motor reaction indicators and a method that evaluates the neurotic manifestations to the existing tests in the professional psychological selection procedure is necessary to predict the propensity to stress-induced somatic diseases. The indicators in the prediction models of academic performance and propensity to stress-induced somatic diseases are different, which reflects the significant difference in their biopsychosocial mechanisms. Placing a double filter in the decisive selection rule is necessary to identify people with a forecast of high academic performance and identify stress-resistant people who are not prone to stress-induced somatic diseases among them. Developing weighting coefficients of every test block is necessary to conclude; however, the existing approach is assumed to be equivalent, that is, at variance with the complex biopsychosocial mechanism of professional reliability.

Bulletin of the Russian Military Medical Academy. 2021;23(4):203-212
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Public Health

Comparative pharmacoeconomic analysis of metastatic colorectal cancer treatment

Petukhova Y.Y., Eliseeva E.V., Apanasevich V.I., Petukhova A.G., Ovodova A.V.


Every year, the pharmacological market offers new medicines to increase the survival rate and improve the quality of life of patients with cancer. However, while significantly exceeding the cost of existing methods of pharmacotherapy, new technologies often lead to only a small increased efficiency. Budget resources of health care dictate the need for a rational choice of pharmacotherapeutic options for malignant neoplasms that meet the principles of ensuring maximum results and accessibility for the entire population. An important role in solving this problem is played by such a direction of pharmacoeconomic analysis as the “cost-effectiveness” method. Colorectal cancer is one of the three oncological diseases that cause the greatest socio-economic burden for the state, which is associated with the highest costs of the Russian Federation health care system. Concurrently, in the last decade, a much more favorable prognosis has been identified for patients with metastatic colorectal cancer due to the development of effective approaches to antitumor pharmacotherapy. Conducting a pharmacoeconomic review that takes into account both clinical and economic indicators when using classic chemotherapy regimens and new targeted drugs will determine the effectiveness of finances that are spent to combat this malignancy. Additionally, the need to further individualize the therapy of patients suffering from metastatic colorectal cancer and lower prices for modern antitumor drugs is undeniable.

Bulletin of the Russian Military Medical Academy. 2021;23(4):213-220
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The effectiveness of the approximation of specialized medical care to the sanitary losses zone using the multidisciplinary surgical reinforcement groups

Ovcharenko A.P., Lemeshkin R.N., Rusev I.T., Severin V.V., Prokin I.G., Tolstosheev V.N.


The analysis of the organization and results of specialized surgical care in peacetime and wartime is presented. It is demonstrated that in order to comply with the principle of bringing medical care closer to the zone of emergency situations and/or combat operations, it is important to recruit military medical staff as multidisciplinary specialized surgical groups of medical reinforcement. By the forces and means of such a group, the conversion of medical institutions located closely to the centers of sanitary losses is carried out, followed by the reception of victims and the provision of emergency specialized (including high-tech) medical care of the surgical profile. The analysis of the reinforcement of the stages of medical evacuation for the provision of specialized (including high-tech) medical care of the “surgery” profile was carried out. During providing medical care to the injured and wounded in the North Caucasian armed conflict in the second half of the 20th — early 21st centuries, the best results were achieved by deploying multidisciplinary military hospitals of the 1st echelon on the basis of garrison located near the area of military operations. The 1st echelon hospitals were reinforced by multidisciplinary medical reinforcement groups from military medical organizations of central subordination. Specialized (including high-tech) surgical medical care provided in multidisciplinary hospitals of the first echelon included general surgical procedures (35.4%), operations on the chest and abdominal cavity (19.8%), interventions performed by “narrow specialists” (otorhinolaryngological, maxillofacial, ophthalmological, urological) — 17.7%, trauma operations (17.0%), interventions on arterial and venous vessels (8.2%), as well as on the brain (2.4%). During the evaluation of the experience of the medical reinforcement groups, their medical and statistical indicators are presented and proposals are made to change their staffing structures, taking into account the spectrum of damaging factors and the range of lesions in the event of natural and man-made emergencies, as well as during modern wars and armed conflicts.

Bulletin of the Russian Military Medical Academy. 2021;23(4):221-234
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Effect of the inhalation inhibitor PDE-4 CHF6001 on some pathogenetic links in chronic obstructive pulmonary disease development

Salukhov V.V., Kharitonov M.A., Pivovich A.V., Voloshin N.I.


CHF6001 is a new inhaled phosphodiesterase-4 inhibitor that is safe and well tolerated by both healthy people and patients with bronchial asthma. The effect of CHF6001, in addition to standard triple therapy for chronic obstructive pulmonary disease, was evaluated on some inflammatory markers in induced sputum and blood in 61 patients (54 completed the study) with chronic obstructive pulmonary disease and chronic bronchitis. From October 2016 to November 2017, a multicenter, three-period (every 32 days), tripartite, placebo-controlled, double-blind, complete block cross-sectional study was conducted in Great Britain and Germany. Patients were treated by CHF6001 at doses of 800 or 1600 µg, or the corresponding placebo using the dry powder inhaler NEXThaler. The induced sputum was collected on day 1 before the treatment and days 20, 26, and 32 after the treatment. Blood was also collected on day 1 before the treatment and day 32 before and after the treatment. Result analyses took into account the inflammatory biomarkers in induced sputum and blood, respiratory function, and symptoms and side effects. CHF6001, which supplements triple therapy in patients with moderate to severe chronic obstructive pulmonary disease and chronic bronchitis, was well tolerated and significantly reduces the number of key biomarkers of airway inflammation in sputum and blood after 32 days of treatment. CHF6001, administered by inhalation, creates a high therapeutic concentration in the lungs compared with other systemic phosphodiesterase-4 inhibitors and improves the therapeutic index due to anti-inflammatory effects while minimizing the possible side effects typical of the latter.

Bulletin of the Russian Military Medical Academy. 2021;23(4):235-246
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Application aspects of medications for inhalation at the prehospital stage of medical evacuation

Ivanov I.M., Ivchenko E.V., Yudin M.A., Vengerovich N.G., Nikiforov A.S., Drachev I.S., Stepanov A.V.


This study aimed to determine the aspects of inhalation application of drugs as medical means of protection against lesions by factors of radiation, chemical, and biological nature at the prehospital stage of medical evacuation. Advantages of inhalation administration of drugs and use of individual inhalers of portable type over parenteral and oral administration methods are described. The existing drugs that are most suitable for inhalation at the prehospital stage of medical evacuation include emergency prevention and treatment of toxic pulmonary edema, analgesics, antiradiation, drugs for arresting radiation primary reaction, agents for accelerated radionuclides elimination, and antibacterial and antiviral agents. This list is conditioned by the rapid achievement of the protective effect of the drug during inhalation, both due to the local action in the area of the “entrance gate” of the intake of damaging agents and the accelerated absorption and systemic action on target organs. This study presents data on existing and promising inhalation drugs (antidotes for warfare agents, recombinant forms of acetyl- and butyrylcholinesterase) and technical means of their delivery (a metered aerosol inhaler, a metered dry powder inhaler) in the Armed Forces of the European North Atlantic Treaty Organization bloc and the United States for the prevention and treatment of damage e to chemical agents, as well as the prospects of radiomitigator usage (granulocyte-macrophage colony-stimulating factor) by inhalations for acute radiation syndrome treatment and inhalation of complexones of radioactive isotopes. The prospects of inhalation in combination with bronchodilators in the development of acute respiratory failure and toxic pulmonary edema on the background of poisoning with the use of a metered-dose powder inhaler are described. The introduction and use of a metered-dose dry powder inhaler at the prehospital stage of medical evacuation determines the need for its development, taking into account the specifics of the drug usage, as well as the need to unify the dosage form of drugs in combination with one type of inhaler (single-dose or multi-dose).

Bulletin of the Russian Military Medical Academy. 2021;23(4):247-256
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Radiation-induced oral mucositis — radiation-induced oral mucositis: pathogenesis, risk factors, clinical manifestations, prevention, and treatment

Legeza V.I., Antushevich A.E., Klimov A.G., Zagorodnikov G.G., Reznik V.M., Aksenova N.V.


This study presents the modern concepts of pathogenesis, risk factors, etiology, clinical manifestations, prevention, and treatment of oropharyngeal mucositis, one of the main complications of radiation therapy for head and neck region cancer. The leading role in the mechanisms of disease development belongs to rapidly dividing cells of the basal layer of the oropharyngeal mucous membrane. This damage is due to both direct (excitation and ionization) and indirect (accumulation of active oxygen and nitrogen compounds, activation of transcription factors, hyperfunction of pro-inflammatory cytokines, etc.) action of ionizing radiation on the most important biological molecules and supramolecular structures (polynucleotides, nucleoproteins, phospholipids, etc.). The main risk factors for mucositis include the localization and size of the tumor, the amount of radiation dose to the oral region, and individual body characteristics (young age, pernicious habits, metal structures of dentures, a history of periodontal disease, etc.). The disease severity is described from mild (erythema and moderate pain that does not require analgesia) to severe (ulceration, hemorrhage, necrosis, and other symptoms) to establishment necessary prescription of effective means of pathogenetic and symptomatic therapy. The main means and methods of prevention of radiation-induced mucositis include the following: non-steroidal anti-inflammatory drug benzydamine, means of protection against oxidative stress glutamine, and drugs with a complex stimulating effect on wound healing processes. Drug therapy for mucositis involves the use of benzydamine; the tricyclic antidepressant doxepin; and a gel consisting of polyvinylpyrrolidone (Belclaiz), mucolytic acetylcysteine. When non-narcotic analgesics are ineffective, low doses of opiates (fentanyl, morphine, and methadone) are used in oral, transdermal, or parenteral dosage forms, as well as low-intensity laser therapy. The most important components of the etiopathogenetic therapy of the disease include antiviral drugs (acyclovir and valacyclovir) and fungicides (clotrimazole, fluconazole, and itraconazole). Enteral nutrition difficulty indicates nasogastric or nasojejunal tube usage, and in more serious cases, surgical methods such as gastro- or jejunostomy.

Bulletin of the Russian Military Medical Academy. 2021;23(4):257-264
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Khalimov Y.S., Tsepkova G.A., Vlasenko A.N.


One of the variants of pneumoconiosis is berylliosis, which is caused by dust or vapors of metallic beryllium that is widely used in space, aviation and nuclear engineering, rocketry, instrument making, etc. Therefore, beryllium intoxication is possible in employees of the above-mentioned industries who have contact with metallic beryllium or its compounds, as well as in workers of the mining industry who extract beryllium from ore. The incidence of berylliosis among workers who have contact with beryllium and its compounds is 0.3%–7.5%. People with different contact periods became sick from several days to 10 or more years. However, no direct relationship was found between the concentration of a toxic substance in the body and the severity of intoxication. The pathogenesis of the toxic effects of beryllium and its compounds is not definitively realized. Numerous scientific studies have established their toxic, pro-inflammatory, allergic, and carcinogenic effects. Berylliosis has acute and chronic forms. Acute forms are relatively rare and usually occur in emergencies in smelting or casting shops of industrial enterprises and mild, moderate, or severe forms. Outcomes of acute beryllium poisoning vary from complete recovery with complete normalization of the X-ray findings to the development of interstitial pneumosclerosis with interstitial lung tissue compaction, transition to a chronic form, or death. The mortality rate in beryllium pneumonia reaches 20%. Death occurs at 2–3 weeks of the disease, and in extremely severe cases, patients die on the first day due to respiratory center paralysis. Chronic berylliosis is either the outcome of acute intoxication with beryllium and its compounds or as a primary chronic form that occurs in interstitial or granulomatous forms. The prognosis depends on prompt disease detection and treatment initiation. Berylliosis diagnosis is based on the data of a professional history assessment, information about possible beryllium contact, and a characteristic clinical and radiological picture and positive beryllium tests. A lung biopsy is performed for diagnosis in severe cases. Berylliosis has no specific treatment, thus the therapy is exclusively pathogenetic and symptomatic. The scope and treatment measures depend on the form, disease severity and stage, and depth of the respiratory system lesion. Berylliosis prevention includes the improvement of the production process and use of air-purifying respirators and special protective clothing to limit contact with beryllium and its compounds that are contained in the surrounding air, which refers to preliminary and periodic medical examinations that are performed once every 2 years. The examination of the patient’s ability to work should be decided with the stages of berylliosis and pathological process activities.

Bulletin of the Russian Military Medical Academy. 2021;23(4):265-272
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Education news

Formation and development of radiation pathology education of the department of military field therapy of Military medical academy named after S.M. Kirov

Vlasenko A.N., Matveev S.Y., Khalimov Y.S.


The first step in teaching the military radiology problems at the Military Medical Academy named after S.M. Kirov was its creation. The department of combat properties in 1953 discovered the destructive effects of atomic weapons and anti-nuclear protection. Since 1955, the clinical aspects of radiation injuries have been taught at the newly created Department of Military Field Therapy. The absence of specialized patients determined the clinical and experimental orientation of teaching. In June 1961, sailors who are injured from a nuclear submarine accident of the Northern Fleet K-19 were treated at the military field therapy clinic. The experience gained in the process of their examination and treatment was introduced into the educational process. The department created an archive of patient histories and accumulated a large number of blood and bone marrow preparations of patients with varying degrees of radiation sickness severity at different periods of its course and time after treatment completion. Since 1972, the Department of Military Field Therapy has been teaching the clinical aspects of radiation pathology and the organizational issues of providing therapeutic assistance with it in wartime, starting with the stage of first medical aid, as well as issues related to the nature of radiation injuries in peacetime and the organization of therapeutic assistance for victims of radiation accidents and disasters. The first years of this century were marked by the introduction of a competency-based approach to a higher specialized educational process improvement. The department prepared educational materials intended for cadets of the faculties of training doctors, residents, and students of the faculty of postgraduate and additional education to ensure its implementation in the educational process. An additional professional advanced training program, “Diagnostics and treatment of radiation injuries”, for 72 hours has been developed, providing the possibility of training specialists in an electronic educational environment. The transfer of educational and methodological materials to electronic media is conducted.

Bulletin of the Russian Military Medical Academy. 2021;23(4):273-280
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Organization and practical seminars on histology and embryology in the remote format using the electronic educational environment of Military medical academy named after S.M. Kirov

Lobachev I.V., Odintsova I.A., Rusakova S.E.


Practical experience of the organization and training at the Department of Histology with a course of embryology in the Military Medical Academy, St. Petersburg in a temporary remote format condition of training related to the pandemic due to a Coronavirus Disease-2019 (COVID-19) is provided. Therefore, educational activity was corrected and methodical work directions and the possibility of program technological support are specified. Necessary educational and reference information was in due time made to the cathedral section of the electronic educational environment of the Academy and multimedia textbooks and manuals are updated and expanded. Separate methodological features of remote classes in histology and embryology are characterized. Of which, one is studying the digitized histologic medicines on the educational presentations without microscopes. For digitization, the sites of medicines, which most reflected the features of the fabric structure of the body, cytovery tectonics details, and histologic structure of morphofunctional units, were chosen. Knowledge control of students was carried out by tests, education, research, and visualized histologic tasks. The problematic issues connected with the remote form of education of future medical officers are revealed. Of which, one is limited opportunities of the electronic educational environment based on the volume of the provided computer information. The role and the place of remote technologies in the educational activity of military medical higher education institutions are defined. The attention for remote format training in medical school is an additional internal classroom occupation that is paid and cannot be fully replaced.

Bulletin of the Russian Military Medical Academy. 2021;23(4):281-288
pages 281-288 views

Medicine history

Robert Erskine — the first archiater and creator of military medicine and military medical education in Russia

Milasheva N.V., Ovchinnikov D.V., Samoilov V.O.


This study aimed to analyze many archival published documents and contemporary testimonies at the beginning of the 18th century, which reflects little-known facts of medicine history. The creation history of military medicine in Saint Petersburg, an integral part of the military history of Russia, was presented against the background of the most important events of the Northern War against Sweden (1700–1721) and military reform. The role of Robert Erskine (1677–1718), the reformer of Russian medicine, the head of the entire military medical service of Russia since 1706, the first Russian archiater, Surgeon in Ordinary to the King, and loyal companion and friend of Peter I was carefully studied, as he played a crucial role in establishing military medicine and medical education in Russia, mainly in Saint Petersburg. R. Erskine, who had encyclopedic-level knowledge, was also the creator and head of the Kunstkamera, the first public natural science museum in Russia (1714). The report of the head of the Moscow hospital on Yauza, Doctor N.L. Bidloo, to the Holy Synod (1722) with description and analysis of the most important facts of the Russian medicine history was also studied. Detailed documents on the number of sick and wounded people in Saint Petersburg since 1708 were presented. Not only military hospitals but also medical students in the military capital of Russia before 1715, had been documented. The documentary lists of Navy doctors from Saint Petersburg and lists of medical students who “stayed in Saint Petersburg” at the Navy Hospital, with the indication of the salary by articles (categories) for 1710, as well as documents on the number of sick and wounded people of the ground forces for 1712 and 1713 (Russian State Archives of the Navy), were presented. The medical staff lists of the Russian army for 1711 were examined. The absence of a large specialized medical complex at Vyborg side and insufficient suitable hospitals of any medical units located in wooden barracks at other territories cannot be proof of the absence of any hospitals until 1715 or medical schools until 1733. Ignorance of the military history of Russia can lead to numerous mistakes by historians who are interested in military medicine.

Bulletin of the Russian Military Medical Academy. 2021;23(4):289-300
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Theory and practice of pharmacy at the Military Medical Academy: formation and development history

Miroshnichenko Y.V., Bunin S.A., Kononov V.N., Perfiliev A.B., Golubenko R.A., Enikeeva R.A., Merkulov A.V., Kostenko N.L., Shcherba M.P.


The activity of the pharmaceutical school of the Military Medical (Medico-Surgical) Academy in various historical periods is presented to ensure the state interest and national security. Scientists and employees of the Academy have been training highly qualified pharmaceutical personnel for different levels of national health care for more than two centuries, and fundamental and applied research is conducted to create new drugs and medical devices, as well as organizing the provision of medical equipment to troops (forces). The role of the pharmaceutical profile department of the Academy includes textbook and teaching aid development, regulatory legal framework improvement that governs medical equipment provision, military units and military medical organizations in modern socio-economic conditions, and innovative sample creation of complete, medical, mobile, and special medical equipment. A brief description of dissertations in the field of pharmacy by the teaching staff and students of the Academy, which had a significant impact on the development of national health care, is given. The prospects for the introduction of advanced educational technologies for training cadets and students, residents, and masters, as well as researching within the framework of national projects in various scientific pharmaceutical specialties, are shown.

Bulletin of the Russian Military Medical Academy. 2021;23(4):301-312
pages 301-312 views

The role of professor I.A. Sapov in the development of the department of physiology of diving and rescue affairs of the Military Medical Academy named after S.M. Kirov

Zverev D.P., Bobrov Y.M., Myasnikov A.A., Andrusenko A.A., Shitov A.Y.


Historical materials about the life and work of Ivan Akimovich Sapov, head of the Department of Physiology of Diving and Rescue Affairs of the Military Medical Academy named after S.M. Kirov, Major General of the Medical Service, Doctor of Medical Sciences, Professor, Chief Physiologist of the Navy, Laureate of the Union of Soviet Socialist Republics State Prize, Honorary Member of the Physiological Society named after I.M. Sechenov, Honorary Chairman of the Scientific Society of Barotherapists of St. Petersburg and the Leningrad Region, Honorary Doctor of the Military Medical Academy, Honorary Academician of the Russian Academy of Natural Sciences, and an outstanding scientist in the field of naval medicine. I.A. Sapov created a scientific school, of which the main areas of activity include the development of hyperbaric physiology and diving medicine, the physiology of labor of naval specialists and the habitability of ships of the Navy, methods of barotherapy, and medical support for emergency rescue operations at sea. The multifaceted activities of I.A. Sapov as Head of the Department of Physiology of Diving and Rescue of the Military Medical Academy named after S.M. Kirov, improved the educational, methodological, and research work at the department in the interests of the Navy. The work that was conducted on the instructions of the Academy of Sciences and the Council of Ministers of the Union of Soviet Socialist Republics in planning and coordinating scientific research in the country on topical problems of hyperbaric physiology and diving medicine, the development and use of the World Ocean, the human adaptation to Antarctica, the medical support of ship trips, and the improvement of providing qualified medical assistance to diving personnel and seafarers both under normal conditions and during search and rescue operations at sea.

Bulletin of the Russian Military Medical Academy. 2021;23(4):313-322
pages 313-322 views

The oldest surgical departments of the Military Medical Academy history and continuity

Ovchinnikov D.V.


For a long time, the date of the Military Medical Academy foundation remains debatable, thus the origins of the first departments and earlier disciplines or professorships also have differences. This study analyzes the jubilee academic publications of 1898, 1998, and 2008 series of dissertations, reports on research works, and essays on the history of departments that were systematically and separately prepared in the 1890s, 1940s, and 1990s for the anniversaries of departments. The documents were studied based on the Complete Collection of laws of the Russian Empire, several archival documents, and records in the historical form of the Academy and literary sources. The origins of the formation and transformation of the oldest surgical departments are traced to the example of departments of general, faculty, hospital, and military field surgery. Over time, views on the history of departments have changed in publications of different years; however, the continuity passes or, conversely, does not pass from one department to another without clear reasons. Based on the analysis, the proposed view of the historiography of departments in the context of Academy continuity with hospital schools at the General St. Petersburg Land and Admiralty hospitals and the Main Medical School is considered justified. Thus, the oldest surgical department of the Academy may be the successor of the first professorial position of the surgical department of the Main Medical School that was established on 07.15.1786. The second oldest in the modern department was allocated on 01.29.1829 from the department of I.F. Bush in the form of a surgical clinic department. Created at the suggestion of N. I. Pirogov, the Department of Hospital Surgery was established by a personal decree of 03.11.1841 by N. N. Elansky, and then by I. M. Talman on 06.10.1937. A new surgical department was created, which was twice created anew in the whirlwind of reforms in 1930.

Bulletin of the Russian Military Medical Academy. 2021;23(4):323-332
pages 323-332 views

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