Vol 24, No 3 (2022)

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.

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.

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 4^th 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.

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.

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.

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.

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.

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.

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.

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.

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.