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Vol 24, No 3 (2022)

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Research paper

Justification of tactical and technical sample requirements mass immunoprophylaxis dangerous infectious diseases in the Armed Forces of the Russian Federation

Misnokov O.P., Savelyev A.P., Stepanov A., Bychkov A.P., Kuzin A.A., Zobov A.E.


The results of the analysis of the current state of creating a technical means of mass immunoprophylaxis for dangerous infectious diseases are presented, including the technical level and trends in the development of developments on this problem in the Russian Federation and abroad. It was noted that in emergency situations of a biological nature, a vaccination campaign should be carried out in a short time with maximum personnel vaccination coverage, which is a massive undertaking. These requirements can be only be met with the use of mass vaccination in the form of needle-free, inhalation (aerosol) and oral vaccine administration methods. The wide use of these methods is constrained by a meager range of domestic oral vaccines, as well as the lack of technical means of mass immunization (aerosol generators, needleless injectors). This article shows that the needleless injector NI-30 (Russia) is the most appropriate for mass vaccination, in terms of technical level and operational characteristics. However, it cannot be recognized as fully meeting modern requirements due to a number of negative aspects, such as the rather large overall injector dimensions creating a large amount of obsolete structural materials. Thus, it is necessary to take into account the features of the available methods of vaccine administration when assessing the prospects for mass immunization, and it is necessary to substantiate the tactical and technical requirements for new generation samples in order to develop the technical means of mass immunization. Therefore, the development and introduction into practice of high-performance methods of mass immunization and the technical means for their implementation continues to be an urgent task.

Bulletin of the Russian Military Medical Academy. 2022;24(3):467-474
pages 467-474 views

Process approach in pharmacy organization management

Klimenkova A.A., Skripko A.A., Geller L.N., Golubenko R.A.


The classification of the pharmacy organization’s fields of activity is substantiated, the typology of pharmacy activity is formed, and the main groups of production processes involved in the process of creating pharmaceutical services and bringing pharmaceutical products to the end consumer are characterized. It was established that process approach is an important quality management principle. Process approach allows you to visualize the entire organization’s work and present its internal environment as a set of interrelated processes. Two directions of pharmacy organization activities are defined as: current activities, during which a finished pharmaceutical product is created, and development activities, aimed at improving the pharmacy organization’s activities. The four groups of processes involved in the creation of pharmaceutical services in one way or another were identified after applying the process approach (main, auxiliary, development processes, management processes). These process groups are characterized and grouped. The main goals — the roles performed in the pharmacy's activities, the result, as well as the final and intermediate consumers of these processes are defined for each of the groups of processes. A process-oriented model of the pharmacy organization management system was developed based on the process approach application. Building a network of processes, presenting each selected process in a visual and easier to understand form, as well as forming and approving a document regulating the algorithm for executing a specific process are included in the model. It is necessary to define the goals of the organization’s activities for the functioning of such a model: identify a set of processes that ensure the activities of a pharmaceutical organization, describe these processes by developing appropriate regulations and procedures, distribute areas of responsibility between performers, and develop a system of indicators and performance evaluation. Process approach is commonly an effective mechanism for influencing a pharmacy organization’s management system. The presented model contributes to improving the quality of pharmaceutical care provided to the population.

Bulletin of the Russian Military Medical Academy. 2022;24(3):475-480
pages 475-480 views

Smoking as one of the predictors of the severity of the condition of patients suffering from a new coronavirus infection

Mikhaylov A.А., Velibekov R.Т., Ivashinenko F.M., Litvinenko R.I.


The relationship between smoking and the lung damage volume in patients with a confirmed new coronavirus infection diagnosis, hospitalized in a temporary infectious hospital for the treatment of patients suffering from a new coronavirus infection and community-acquired pneumonia was evaluated. This was in the Odintsovo District’s Patriot Park of the Moscow region. Smoking cigarettes, both active and passive, as well as exposure to tobacco smoke on the body, are important upper and lower respiratory tract infection risk factors due to local immune response suppression. Nevertheless, data from a number of international studies indicate a significantly lower number of hospitalized smoking patients compared to non-smokers. These indicators were investigated as the percentage and degree of lung damage, smoking history, the number of cigarettes smoked per day, and the smoker's index. In the course of the study, the data on a smaller percentage of smokers admitted to inpatient treatment were confirmed in comparison with non-smokers and smokers in the general population. There was no statistically significant difference in the volume of lung damage between smoking and non-smoking patients according to the chest organs computed tomography. At the same time, there was an increase in the volume of lung tissue damage, depending on the smoking experience. This is apparently due to the irreversible changes formation in lung tissue against a long-term smoking background. The median age of smoking patients was 56 years with a variation from 46 to 68 years. The minimum and maximum ages were 29 and 82. The median lung lesion was 32% with a variation from 23% to 39%. The minimum and maximum lung damage is 10% and 40%, respectively. A moderate correlation was found between the smoking experience and the volume of lung damage. An increase in lung damage by 0.309% should be expected with an increase in smoking experience by one full year. There was also no statistically significant difference in the number of cigarettes smoked per day and the smoker’s index.

Bulletin of the Russian Military Medical Academy. 2022;24(3):481-488
pages 481-488 views

Optimization of interdepartmental electronic interaction of the military commissariat in the organization and conduct of medical examination of citizens subject to conscription

Myachin N.V., Ignatov Y.G., Cherkashin V.S., Koraev A.S., Gasparyan O.V., Gudkov D.N., Agapitov A.A., Fisun A.Y.


The military commissariat requests information characterizing their state of health in order to study the state of health of citizens subject to conscription before the next conscription of citizens for military service. An interdepartmental request for this information’s provision to medical organizations and institutions of medical and social expertise is encouraging to be issued in the form of an electronic document using a unified system of interdepartmental electronic interaction, taking into account the trends in the development of the public administration system. Interdepartmental interaction optimization through creation of an electronic interaction mechanism will allow military commissariats to promptly exchange information in real-time characterizing the citizens’ state of health subject to conscription for military service with medical organizations of the state and municipal health care system, and federal state institutions of medical and social expertise. The direct connection of the military commissariat to the state information system in the field of healthcare of the subject of the Russian Federation by means of cryptographic protection of information will contribute to improving the quality as well as deceasing the medical examination time of citizens subject to conscription, thus improving the efficiency of providing medical services to citizens in medical organizations. The public administration system was successfully reoriented to provide state and municipal services in a remote format during the unstable epidemiological situation caused by the pandemic of a new coronavirus infection. Optimization of interdepartmental electronic interaction will allow military commissariats to take additional preventive measures to avoid infection and avert the spread of a new coronavirus infection during the recruitment campaign. Modern digital technologies and solutions are able to provide a qualitative leap in the organization of conscription of citizens for military service, which can be implemented without significant financial costs in the short term. However, there is a growing need to involve a proper number of participants of the military command and other state authorities in solving this complex problem.

Bulletin of the Russian Military Medical Academy. 2022;24(3):489-496
pages 489-496 views

Clinical evaluation of the effectiveness of the gel of rare-cut acrylic polymers with a complex of natural antimicrobial peptides FLIP-7 in the treatment of borderline skin burns

Zinoviev E.V., Kostyakov D.V., Semiglazov A.V., Krylov P.K., Manukovskii V.A.


The effectiveness of the treatment of borderline skin burns using a gel of rare-sewn acrylic polymers with natural antimicrobial peptides FLIP-7 was evaluated. A total of 60 burned patients hospitalized in the Burn Center of Saint Petersburg Scientific Research Institute for First Aid named after I.I. Janelidze were examined during the period from 2019–2021. The following were evaluated: the general condition of patients, planimetric indicators, as well as the results of microscopic examination of smears-prints from the wound surface. This drug was established to be effective in the treatment of borderline skin burns from the first day of use. The burn wound areas upon use of FLIP-7 gel compared to wet-drying dressings and water-soluble ointment levomekol decreased by 6.25% and 8.6%, respectively. A complete restoration of the integrity of the skin was noted by the 7th treatment day, against the background FLIP-7 gel use. A complete restoration of skin integrity was noted by the 7th day of treatment, against the background of FLIP-7 gel use. The application of a hydrogel with a complex of natural antimicrobial peptides was demonstrated to have a pronounced antibacterial effect against most pathogenic microorganisms. Hence, the number of burn wound infection decreased by 35% by the 4th day from the treatment initiation. There was a possibility of reducing the analyzed indicator to 10% by the end of the week of local treatment with FLIP-7 gel, which indicates almost complete elimination of pathogenic microflora from the burn wound. It was proven that the humid environment conditions formed by hydrogel can stimulate the reparative regeneration processes. This was confirmed by the results of microscopic examination of smear prints, indicating a statistically significant increase in the concentration of fibroblasts on the wound surface by the 4th day of observation compared with the results obtained before treatment initiation with FLIP-7 gel. Not a single case of side effect or undesirable phenomenon was recorded during course of the clinical study. The gel of rare-stitched acrylic polymers with natural antimicrobial peptides FLIP-7 is an effective means of local treatment of borderline skin burns, which provides not only optimal conditions for the course of reparative regeneration processes, but also actively eliminates pathogenic microflora, including polyresistant microorganisms strains.

Bulletin of the Russian Military Medical Academy. 2022;24(3):497-504
pages 497-504 views

Biophysical parameters of the greater omentum after experimental extended liver resection

Leonov S.D., Panchenkov D.N., Rodin A.V.


Bioimpedance parameters of the large omentum after performing extensive liver resection in an experiment were evaluated. The study was performed on 20 Wistar rats that underwent median laparotomy under anesthesia, followed by liver resection with the removal of 70% of the organ. Invasive bioimpedance measurement of the liver and large omentum was performed before and immediately after extensive liver resection on days 3 and 14 after surgery using an original device for measuring the electrical impedance of biological tissues “BIM-II” at frequencies of 2 and 20 kHz with the calculation of the average impedance values at each frequency and measurement zone. Liver tissue was subjected to histological examination. The minimum values of the impedance of the large omentum were recorded on day 3 after extensive liver resection. By day 14, in both zones of the large omentum, the electrical impedance increased relative to day 3 of the postoperative period and did not differ significantly from the indicators before extensive liver resection. Immediately after extensive liver resection, the bioimpedance index in all animals decreased significantly at a frequency of 2 kHz. On day 3 after surgery, the electrical impedance of the liver parenchyma at a frequency of 2 kHz increased significantly. On day 14, the electrical impedance of the liver parenchyma did not differ from the indicators before extensive resection at frequencies of 2 and 20 kHz. A strong significant correlation was found between the electrical impedance of the large omentum and liver parenchyma. At a frequency of 2 kHz, the correlation coefficient of the liver parenchyma and the proximal part of the large omentum was 0.82 and that of the distal part was 0.87 (p < 0.05). A strong correlation was detected at a frequency of 20 kHz, with r = 0.93 and 0.74, respectively, in both parts of the gland. Thus, the electrical impedance of the liver parenchyma by day 3 of the experiment increased compared with values before extensive liver resection, whereas the large omentum decreased. We believe that studying the dynamics of the electrical impedance of the large omentum after extensive liver resection is promising in the development of diagnostic criteria for the severity of liver failure.

Bulletin of the Russian Military Medical Academy. 2022;24(3):505-510
pages 505-510 views

Acute kidney injury in severe pneumonia associated with COVID-19

Magomedaliev M.O., Korabelnikov D.I., Khoroshilov S.E.


The clinical and epidemiological features of acute kidney injury in severe and extremely severe pneumonia associated with coronavirus disease-2019 (COVID-19) are considered. An observational prospective study was conducted with the inclusion of 117 patients, including 75 men and 42 women, suffering from severe and extremely severe pneumonia associated with COVID-19, who were treated in the intensive care unit of the 1586th Military Clinical Hospital in 2020–2022. Acute kidney injury was diagnosed in 21 (17.9%) patients (stage 1 in 10, stage 2 in 4, and stage 3 in 7 patients), kidney dysfunction was recorded in 22 (8.8%) patients (serum creatinine was higher than normal, but does not reach the diagnostic criteria of Kidney Disease Improving Global Outcomes). Four patients underwent renal replacement therapy. The probability of kidney damage increases with age (the average age of the patients with acute kidney damage is 65 (58; 71) years, and those without acute kidney damage was 47.5 (41; 55) years; p = 0.0001). Compared with patients without acute kidney injury, patients with acute kidney injury scored higher on the scales NEW (p = 0.000975), SMRT-CO (p = 0.011555), and Sequential Organ Failure Assessment (p = 0.000042). Among those suffering from acute kidney injury, significantly more pronounced manifestations of systemic inflammation were determined (leukocytes, p = 0.047324; platelets, p = 0.001230; ferritin, p = 0.048614; and D-dimer, p = 0.004496). In the general cohort, the mortality rate was 22.2%, whereas a significant intergroup difference in mortality was observed, i.e., 52.4% in patients with acute kidney injury and 15.62% in those without acute kidney injury (Chi-squared criterion, 13.468; p < 0.001). Invasive artificial lung ventilation was performed in 19.66% of the patients, and a significant intergroup difference was identified, with 66.7% in patients with acute kidney injury and 9.38% in patients without acute kidney injury (Chi-squared criterion, 35.810; p < 0.001). The durations of treatment in the intensive care unit in patients with and without acute kidney injury were 9 (7; 14) and 6 (4; 10) days, respectively. After the treatment, all patients with acute kidney injury had fully recovered kidney function upon discharge. In general, acute kidney injury occurs in almost every fifth patient with severe and extremely severe pneumonia associated with COVID-19, aggravates the condition of patients, and increases mortality. The alertness of doctors regarding acute kidney injury and early diagnosis and timely nephroprotective treatment may reduce the possibility of adverse disease outcomes.

Bulletin of the Russian Military Medical Academy. 2022;24(3):511-520
pages 511-520 views

Case report

A rare clinical case of household gas leak leading to severe asphixia

Kryukov E.V., Gaiduk S.V., Goverdovskiy Y.B., Kuzmich V.G., Bogomolov A.B., Shapovalov I.D., Mihailov A.A., Lyanginen T.V., Vlasov S.S., Ivanov A.A.


A rare case of severe asphyxia in a young patient due to household gas leakage WAS presented. The patient was found in an unconscious state with signs of respiratory failure at home, requiring respiratory support at the prehospital stage. The patient had a picture of damage to the circulatory organs with the development of acute myocardial ischemia without damage and reactive hydropericardium, respiratory organs in the form of hypoxic pulmonary edema, complicated by the development of bilateral community-acquired pneumonia, hydrothorax and severe respiratory failure, damage to the nervous system with the development of hypoxic encephalopathy with loss of consciousness and bilateral pyramidal syndrome, digestive organs with the development of reactive posthypoxic hepatopathy. Upon admission to the clinic of the field therapy of the Military Medical Academy of S.M. Kirov, which required hospitalization of the patient in the intensive care unit. It was possible to fully stop severe multiple organ damage that developed as a result of acute hypoxic exposure as a result of the complex treatment. This clinical case clearly demonstrates the importance of emergency, systematic and full-fledged intensive care at all stages of providing care to people with acute hypoxic lesions of organs and systems, including severe community-acquired pneumonia and hypoxic myocardial dystrophy. The influence of the early intensive care initiation and timely evacuation at the stage of qualified and specialized medical care on the effectiveness of therapeutic measures is discussed as this plays a fundamental role in the survival of this category of patients. In general, with timely and full-fledged therapeutic measure implementation aimed at treating complications, even severe acute hypoxic organs lesions and systems are reversible, although this may require long-term inpatient treatment and rehabilitation measures in a military sanatorium-resort organization condition of a therapeutic profile, as well as conducting a military medical examination to establish the fitness category for further military service.

Bulletin of the Russian Military Medical Academy. 2022;24(3):521-528
pages 521-528 views

Сourse features of a new coronavirus infection in a comorbid patient

Kharitonov M.A., Ivanov V.V., Grishaev S.L., Maltseva O.A., Bulka E.S., Bulka K.A.


The appearance of a new coronavirus infection (COVID-19) in 2020 caused by the SARS-CoV-2 virus set tasks for doctors of various specialties to quickly diagnose, treat, and develop effective rehabilitation measures. The medical community’s knowledge about the respiratory tract lesions pathogenesis course in COVID-19 is going to improve, but the key accents placement in understanding this pathology course continues today. Suspected SARS-CoV-2 virus reference points are as follows: vascular endothelial dysfunction, coagulopathy, thrombosis resembling the antiphospholipid syndrome. Treatment is carried out in accordance with general recommendations aimed at the average patient despite the higher secondary infectious complications risk in patients suffering from cancer and a high severe COVID-19 risk. A successful inpatient treatment experience in patients suffering from comorbid pulmonary pathology and a new coronavirus infection is demonstrated on a separate example. The treatment duration and the complexity of selecting a rehabilitation measures course were due to the patient's history of central squamous cell lung cancer, surgical intervention (bilobectomy), radio- and chemotherapy, as well as complications in the form of pulmonary embolism. The concomitant respiratory pathology was differentiated (chronic obstructive pulmonary disease) during examination and treatment and basic therapy was selected, which made the medical rehabilitation stage more effective. The patient's condition required a more careful selection of combined anti-inflammatory, broncholytic, mucolytic, and antibacterial therapy than in patients without concomitant pathology. Treatment and a complex of rehabilitation measures, normalization of respiratory function, compensation for concomitant bronchopulmonary pathology was possible to be achieves as a result of the diagnosis of concomitant bronchopulmonary pathology. Careful diagnostic search and optimal treatment of all somatic pathology are important factors in the selection of adequate therapy for elderly patients suffering from coronavirus infection with comorbid pulmonary pathology.

Bulletin of the Russian Military Medical Academy. 2022;24(3):529-536
pages 529-536 views


Some features of the coronavirus infection course in bronchial asthma patients

Kharitonov M.A., Burkova Y.S., Salukhov V.V., Sapronova A.S.


The outbreak of a new coronavirus infection was officially recognized by the World Health Organization as a global pandemic since March 11, 2020. The pandemic is currently gradually receding, the number of patients is also steadily decreasing. However, these circumstances are not grounds to believe that the virus has been definitively and irrevocably defeated. For this reason, the world medical community is still concerned about the coronavirus’ impact on the course and outcome of various chronic bronchopulmonary diseases. Bronchial asthma has been recognized as one of the leading forms of human somatic pathology throughout the history of mankind and medicine. It is quite natural that the focus of the researchers' attention turned out to be questions about the SARS-CoV-2 virus’ impact on patients suffering from bronchial asthma, starting with the peculiarities of the course of combined pathology and ending with the peculiarities of therapy and subsequent rehabilitation. The issues of coronavirus infection and bronchial asthma pathogenesis were considered. The research data on some features of the development and course of a new coronavirus infection in patients with this profile were analyzed and summarized. The low coronavirus infection prevalence among patients with an allergic bronchial asthma form compared with other phenotypes is shown among such features, data on the effect of eosinophilia on the course of infection are presented, and the basic therapy’s positive effect using inhaled glucocorticosteroids and/or monoclonal antibodies (biological therapy) in severe asthma, is shown in the form of a protective effect that provides a lighter coronavirus infection course. The main features of patient management suffering from bronchial asthma in the conditions of a pandemic are the organization of stable medical control in online telemedicine once monthly, regular examinations in accordance with the severity of the course of the disease and the correction of basic therapy to achieve complete control over the course of asthma.

Bulletin of the Russian Military Medical Academy. 2022;24(3):537-546
pages 537-546 views

Polymorphisms of leukocyte genes human and congenital antigen immunity associated with different the severity of the course of the new coronavirus infections

Butusov A.M., Krusko O.V., Potapov P.K., Derevyankin D.S., Zagranichnov V.D., Malyshkin S.S., Zhurbin E.A.


The most significant single nucleotide human leukocyte antigen genes polymorphisms and innate immunity genes associated with varying degrees of acute respiratory infection severity are considered–COVID-19 caused by the SARS-CoV-2 coronavirus. As data accumulated, it became clear that the SARS-CoV-2 virus exhibits significant regional, ethnic, and individual specificity. This is due to the population groups’ genetic characteristics. This is necessary to reliably know the human genotype relationship with the COVID-19 course severity (asymptomatic, mild, moderate, severe, and extremely severe up to fatal outcomes) for more successful therapy and vaccination. At the same time, it was also known that the innate immunity system is on the first line of defense against the pathogenic penetration into the body, and the human leukocyte antigen system encodes molecules of the same name on the surface of cells that present various antigens, including viral infection pathogens, and determine the severity of the course of many diseases; therefore, these systems’ genes. This approach makes it possible to assess the likelihood of a severe and extremely severe disease course in healthy and infected people, which in turn contributes to the correct therapy strategy, pharmacotherapy, and vaccination, as well as to create new antiviral therapeutic and preventive medicines. The genetically determined immune response heterogeneity to SARS-CoV-2 infection requires further study, since there is no unambiguous opinion about the leading mechanism that determines disease severity.

Bulletin of the Russian Military Medical Academy. 2022;24(3):547-556
pages 547-556 views

Perioperative infarction and myocardial injury: risk factors, mechanisms of development and clinical and epidemiological features

Shulenin K.S., Cherkashin D.V., Solovyev I.A., Kuchev R.D., Popova A.V.


Тhe concept, risk factors, mechanisms, clinical and epidemiological, and angiographic features of perioperative ischemic injury and myocardial infarction were considered. Perioperative myocardial infarction is one of the most common complications (up to 3.6%) in non-cardiac surgical interventions and is characterized by high in-hospital mortality, reaching 25%. Most patients with this pathology (up to 65%) do not have typical symptoms of myocardial ischemia due to anesthesia and sedation. Pathogenetic mechanisms of perioperative myocardial infarction development continues to be actively studied. A critical increase in myocardial oxygen demand is indicated as the leading cause in some studies. Angiography reveals rupture of the coronary plaque and atherothrombosis in more than half of patients, according to other data. These contradictions point to the need for further epidemiological studies using coronary angiography with a focus on risk factors and triggers of this complication. In addition, the concept of perioperative myocardial injury in recent years has been formulated in the scientific literature. This is understood as ischemic damage that occurs in the first 30 days after surgery. Recent studies have shown that it can occur in 16% of surgical patients and is associated with a 6-fold increase in mortality within 1 month after surgery and a 2.5-fold increase within a year. It is important that perioperative myocardial injury does not include cases of non-ischemic etiology myocardial injury, for example, due to pulmonary embolism, sepsis, or electrical cardioversion. Thus, the assessment and understanding of risk factors for the development of perioperative myocardial ischemia is of great practical importance in optimizing the patient selection and preparation for surgical treatment.

Bulletin of the Russian Military Medical Academy. 2022;24(3):557-566
pages 557-566 views

The possibility of using perfluorocarbon compounds for virus-associated pneumonia treatment

Sofronov G.A., Murzina E.V., Lazarenko D.Y., Buryakova L.V., Krylova T.G.


The issues of practicality in using perfluorocarbon gas transport emulsions (or pure perfluorocarbons) in severe virus-associated pneumonia treatment were considered, including those caused by coronavirus infection. Perfluorocarbons are fully fluorinated carbon compounds, on the basis of which artificial blood substitutes have been developed — gas transport perfluorocarbon emulsions for medical purposes. Perfluorocarbon emulsions were widely used in the treatment of patients in critical conditions of various genesis at the end of the last–the beginning of this century, accompanied by hypoxia, disorders of rheological properties and microcirculation of blood, perfusion of organs and tissues, intoxication, and inflammation. Large-scale clinical trials have shown a domestic plasma substitute advantage based on perfluorocarbons (perfluoroan) over foreign analogues. It is quite obvious that the inclusion of perfluorocarbon emulsions in the treatment regimens of severe virus-associated pneumonia can significantly improve this category’s treatment results after analyzing the accumulated experience. A potentially useful area of therapy for acute respiratory distress syndrome is partial fluid ventilation with the use of perfluorocarbons as respiratory fluids as shown in the result of many studies on animal models and existing clinical experience. There is no gas-liquid boundary in the alveoli, as a result of which, there is an improvement in gas exchange in the lungs and a decrease in pressure in the respiratory tract when using this technique, due to the unique physicochemical properties of liquid perfluorocarbons. A promising strategy for improving liquid ventilation effectiveness using perfluorocarbon compounds is a combination with other therapeutic methods, particularly with moderate hypothermia. Antibiotics, anesthetics, vasoactive substances, or exogenous surfactant can be delivered to the lungs during liquid ventilation with perfluorocarbons, including to the affected areas, which will enhance the drugs accumulation in the lung tissues and minimize their systemic effects. However, the indications and the optimal technique for conducting liquid ventilation of the lungs in patients with acute respiratory distress syndrome have not been determined currently. Further research is needed to clarify the indications, select devices, and determine the optimal dosage regimens for perfluorocarbons, as well as search for new technical solutions for this technique.

Bulletin of the Russian Military Medical Academy. 2022;24(3):567-580
pages 567-580 views

Physiological features of development and options for technology for obtaining pluripotent stem cells

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


Topical issues related to the technology of isolation and mechanisms of development of pluripotent stem cells and their application in medicine are considered. The isolation, as well as the subsequent use of stem cells, still remains an unsolved problem both from a scientific point of view and especially in practical health care. There are three ways to produce pluripotent stem cells. First, they can be obtained in vitro from cell culture of the inner layer of early eggs. These are embryonic stem cells. Second, they can be obtained from somatic cells, as a result of the introduction of a group of genes that induce pluripotency. These are induced pluripotent stem cells. Finally, they can be obtained by transplanting the nucleus of somatic cells into an enucleated secondary egg. The microenvironment of the egg contributes to the reprogramming of the nucleus to a state close to the zygote. Mouse embryonic stem cells have many embryonic markers on their surface: carbohydrate receptors — CD15, alkaline phosphatase, factor 4 like Kruppel, estrogen-bound receptor, transcription factor CP2 like 1, T-box transcription factor and gastrulation homeobox brain 2. Embryonic mouse stem cells differentiate from the internal mass of cells at the stage of preimplantation, epiblast. This is established by comparing gene expression profiles and directly isolating embryonic stem cells from epiblasts of 4.5-day-old fertilized eggs. Embryonic stem cells derived from mouse embryos of later stages of development lose markers of pluripotency. Approximately 3 days after the elimination of the leukemia inhibition factor, the expression of the Oct4 gene leads to the loss of specificity markers by cells of the early embryo. Currently, the reprogramming of pluripotency is an active area of research in which significant technological progress has been made. So, the original gene cocktail consisting of four genes is used: Oct4, Sox2, Klf4 and cMyc. The obtained types of embryonic stem cells of mouse and human, from fertilized blastocysts, induced pluripotent stem cells undoubtedly exist. However, this does not apply to pluripotent stem cells derived from postnatal animals, humans, or from extraembryonic sources such as amniotic fluid or cord blood. Despite the fact that many laboratories are working to obtain stem cells from these objects, unfortunately, there is little reproducibility in this work, and the properties of the resulting cells and even their existence are still the subject of controversy.


Bulletin of the Russian Military Medical Academy. 2022;24(3):581-592
pages 581-592 views

Genetic pattern of the COVID-19 course and reinfection

Krusko O.V., Novikova E.A., Potapov P.K., Petrova A.G.


A new coronavirus infection (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out at the end of 2019 in Wuhan (China). The disease has become a global pandemic and claimed more than 6 million lives after spreading rapidly around the world. Issues related to the complicated course of COVID-19 mechanisms continue to be the subject of active study. It is known that morbidity and mortality increase dramatically with increasing age and concomitant diseases, including obesity, diabetes, cancer, and cardiovascular diseases. Although most infected people recover, even young and otherwise healthy patients can get sick with this disease. In this regard, an urgent task is to search for specific genetic factors that can explain the predisposition of people to infection and the development of a severe COVID-19 form. Human genetic determinants can provide the scientific basis for disease prediction and the development of personalized therapies to counteract the epidemic. In addition, cases of repeated infection with SARS-CoV-2 are increasingly being registered, which occurs 1–6 months after initial infection on average and depends on the virus genome structure. Studies conducted on sequencing viral genomes have shown that some patients were re-infected with the same strain of coronavirus, while others were different. This, in turn, causes researchers concerns about the effectiveness of immunity after infection and vaccine reliability. The genetic characteristics of a person and a virus commonly determine the tendency for reinfection. It is difficult to determine the true COVID-19 reinfection prevalence, which is explained by the low detectability of asymptomatic reinfection and the fact that many patients with a mild course of the disease were not tested at an early stage of the pandemic. Therefore, the true prevalence of reinfection with COVID-19 does not reflect the current reality. There are many more cases of reinfection than are described in the literature. In this regard, the true contribution of a virus’ genetic features to reinfection of COVID-19 can be determined only after population studies, and when developing immunization programs against a COVID-19, it is necessary to take into account the prevalence of reinfection in the population.

Bulletin of the Russian Military Medical Academy. 2022;24(3):593-604
pages 593-604 views

History of medicine

Development of hygienic properties doctrine for clothing and shoes citing previous Academicians of the Union of Soviet Socialist Republics Academy of Medical Sciences, Fedor Grigorievich Krotkov

Logatkin S.M., Yudin A.B., Terentyev L.P., Altov D.A., Vlasov A.A.


The data on the initial testing stage of clothing, shoes, and combat equipment in the Research Testing Center of Military Medicine and Military Medical Equipment–the replacement of the Research Sanitary Institute of the Red Army. A brief historical information about the hygienic research of materials for clothing and clothing itself in Russia was provided. The fundamental study basis of clothing and footwear conducted by F.G. Krotkov were the works of many of his predecessors — scientists of the Military Medical Academy and heads of the oldest hygiene department in Russia (Professors A.P. Dobroslavin, V.A. Levashev, P.E. Kalmykov, N.F. Galanin et al.). Additionally, three research directions were formed as the clothing doctrine gradually developed. The first was concerned about the materials research for clothing creation, second was the study of the created clothing with the help of devices in the laboratory, and the third was the study of the functional state of the human body in the evaluated clothes. The role of F.G. Krotko–the first head of the hygienic department of the said institute in the formation of requirements for clothing and footwear of military personnel. F.G. Krotkov conducted a hygienic assessment of hats adopted in the Red Army in 1931; in 1932, he examined the fabrics of military uniforms; in 1935, hygienic requirements for the mountain troops’ uniforms were developed with his direct participation; and in 1936 — ski units. A hygienic assessment of the uniform of military personnel was carried out in the shortest possible time in 1941 under his leadership. The hygienic requirements for clothing and footwear were formulated by F.G. Krotkov based on the results of these experimental studies. The relevance of the developed requirements for clothing and footwear in the present time is noted.

Bulletin of the Russian Military Medical Academy. 2022;24(3):605-610
pages 605-610 views

First dissertation in medical geography at the Medico-Surgical Academy

Soldatov E.A., Mamaeva S.A.


Little-known scientific facts related to the circumstances of writing and defending the dissertation for the Medico-Surgical Academy Eduard Blaschke entitled "Medical topography of the Novo-Arkhangelsk port, the main Russian settlement in North America” were considered. Medical topographic descriptions of various territories and settlements of the Russian Empire were numerous in the 18th–19th centuries, but dissertation studies of this kind are rare. The authors of the article carried out a bibliographic work covering a wide range of reliable sources in order to identify the earliest dissertation research in the field of medical geography. According to updated information, E. Blaschke’s work stored in the library of the Kirov Military Medical Academy was the first scientific work in the history of the Medical and Surgical Academy in the field of medical geography, presented as a dissertation for the degree of Doctor of Medicine. The dissertation was written based on E. Blaschke’s materials and stay in the Russian colonial possessions in North America as the head doctor of the Novo-Arkhangelsk Hospital. Local living conditions, lifestyle, occupation, and nature of work and leisure of the population were systematically described, and as a result, due to all these reasons, since endemic diseases can be associated not only with climatic causes the endemic specificity of the incidence of the inhabitants of this region, and with a wider range of local territorial factors. E. Blaschke’s medical-geographical research was of great scientific and practical importance for its time. It was timely and relevant, but today this work is not known to a wide range of specialists, which, of course, has a significant gap in the knowledge of the history of the formation and development of medical geography, which needs to be replenished. The historical research conducted by the authors of the article allows us to highly appreciate the role of graduates of the Medical and Surgical Academy in healthcare system’s organization in the Russian colonial possessions in America: all the chief doctors of the central hospital of the settlements were its graduates. Of particular interest is the experience of E. Blaschke in combating the smallpox epidemic in the Aleutian Islands and the local population’s mass vaccination.

Bulletin of the Russian Military Medical Academy. 2022;24(3):611-620
pages 611-620 views

Two views on the family succession problem with regards to Nikolai Platonovich Bisenkov and Leonid Nikolaevich Bisenkov anniversaries

Kotiv B.N., Fomin N.F., Dzidzava I.I., Barinov O.V., Boytsova J.A.


It is known that N.I. Pirogov sharply criticized nepotism in his diary in the history of the Imperial Medical and Surgical Academy in the middle of the 19th century, designating this phenomenon with the term “nepotism.” The great surgeon and patriot’s position caused goes against other examples when family relations became a springboard into our academy’s future. It is a rare coincidence when the same family celebrates the major father and son anniversaries. The family of Professors Bisenkov marked two anniversaries in 2021. The dates’ coincidence became the reason for the analysis of the relations that developed at different stages of a complex life associated with wars, surgery, and teaching. Most of the article’s authors witnessed the exchange of life and surgical experience of the Professors Bisenkovs, and were participants in the acute discussions and course of scientific research in the thoracic surgery field. Nikolai Platonovich Bisenkov lived by the plans, creative successes, and failures of his son and compared his front-line experience as a medical battalion surgeon with new surgery possibilities. His insight and critical assessment of the changes that he learned about through daily information from his son were surprising, about the current clinical work of the department. Many new research technologies were initiated at the Department of Operative Surgery, which was headed by Bisenkov Sr., thanks to close contact through his son in the clinic for the highest level and fame known to surgeons of all the Soviet Union’s republics. Personal views, creative, and scientific continuation of Nikolai Platonovich was found to be in continuation in his son. Leonid Nikolaevich defined the main paradigms of his work as the introduction into the clinical practice of the department of video thoracoscopic interventions for breast injuries, original a minimally invasive treatment method of purulent-septic diseases, the development of the most complex surgical interventions — extended and combined resections for paracancrotic changes in patients with lung cancer, as well as simultaneous operations for polyneoplasia, high-quality training of young surgeons. Nikolai Platonovich and Leonid Nikolaevich Bisenkov had warm relations as father and son, as two comrades, as two surgeons with combat experience, and as two brilliant scientists.

Bulletin of the Russian Military Medical Academy. 2022;24(3):621-626
pages 621-626 views

Medical supply system peculiarities for the troops (force) during the Afghanistan territory armed conflict (1979–1989)

Miroshnichenko Y.V., Perfiliev A.B., Kostenko N.L.


Medical service activity in organizing medical equipment provisions to a limited contingent of Soviet troops (forces) during the armed conflict in Afghanistan (1979–1989) was presented. It was established that thanks to the medical supply specialists’ competent work in the most difficult conditions in the shortest possible time during the creation and build-up of Soviet troops (forces) grouping, a medical supply system adapted to the specific conditions of activity was formed, functioning in three, largely isolated areas. The work medical supply units and institutions to provide troops (forces) with medical equipment during the armed conflict is shown, as well as the problematic issues of their functioning, which were successfully resolved thanks to the involvement of students from the faculty of Military Medical Academy named after S.M. Kirov. It reflects the priority tasks facing the medical supply system during the withdrawal period of a group of Soviet troops (forces) from Afghanistan, including providing local population assistance and its armed forces by transferring not only buildings, structures, medical service units, but also part of the medical property. The features of certain drug provision for the medical evacuation and military hospitals stages were presented, particularly injection and infusion solutions, as well as medical oxygen. The operational experience of the troops (forces) medical supply system during the armed conflict in Afghanistan was analyzed, and a number of contradictions were identified, which were later successfully eliminated. The medical supply specialists’ role was emphasized, whose professionalism and dedication made it was possible to solve all the tasks facing them in providing troops (forces) with medical equipment. In general, military units and military medical organizations that were part of a limited contingent of Soviet troops were provided with medical equipment within their actual need, which contributed to the timely provision of medical care and treatment of the wounded and sick, as well as maintaining a high level of the troops’ (forces) combat capability.

Bulletin of the Russian Military Medical Academy. 2022;24(3):627-636
pages 627-636 views


The Vasily Ilyich Kopanev contribution in the fundamental and practical training of aviation doctors (95th anniversary)

Blaginin A.A., Shabalin V.N.


The milestones of the life and creative path of one of the scientific school of aviation and space medicine’s heads are presented here, Vasily Ilyich Kopanev–doctor of medical sciences, professor, Honored Scientist of The Russian Soviet Federative Socialist Republic, Major-General of Medical Service. Professor V.I. Kopanev’s scientific and pedagogical activity is widely known for his studies of the psychophysiological features of flight specialists’ work and the search for ways to correct the functional state of the body. Vasily Ilyich studied the dynamics of the vestibular analyzer indicators under the Karyolis acceleration action. Priority developments of vestibular stability issues, and hidden forms of pilots and cosmonauts’ motion sickness are attributed to V.I. Kopanev. He made a significant contribution to the study of the psychophysiological features of long-range, military transport pilots’ work, as well as marine and helicopter aviation. The merit of V.I. Kopanev and his students’ work and study on the physiological mechanisms of adaptation to the conditions of weightlessness of cosmonauts is undeniable. Vasily Ilyich was a highly qualified pedagogue and organisator. He has an important role in the development of the structure-logical teaching scheme the academy’s aviation doctors and preparation of the list of practical skills and abilities that are subject to be worked off in teaching lessons. Under his leadership, the department of aviation and cosmic medicine shaped the air force’s faculty of training doctors. In education, he was paid considerable attention to the practical application of teaching and to the improvement of the department laboratory base in accordance with the requirements of everyday professional activities of aviation doctors. Under his leadership, the training base was reconstructed with the creation of thematic classrooms. With his fruitful research and pedagogical work, V.I. Kopanev made a significant contribution to the development of domestic aviation and space medicine, particularly in the formation of the Russian system of medical support for space flights.

Bulletin of the Russian Military Medical Academy. 2022;24(3):637-642
pages 637-642 views

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