Vol 24, No 4 (2022)

This paper presents the echocardiographic morphofunctional parameters of the myocardium of patients suffering from severe obstructive sleep apnea syndrome and their dynamics before and after treatment with the help of the “SYNAP” apparatus by creating a constant positive pressure on inspiration during sleep. All patients were divided into two groups: the experimental group suffering from severe obstructive sleep apnea syndrome and the control group without cardiovascular and respiratory diseases. After echocardiography, the experimental group underwent a course of continuous constant positive pressure on inspiration during sleep. The symptoms of severe obstructive sleep apnea syndrome were determined by the presence of daytime drowsiness, loud snoring, witnessed breathing interruptions, or awakenings due to shortness of breath or suffocation, in the presence of at least 30 obstructive respiratory complications (apnea, hypopnea, or excitement associated with respiratory effort) in 1 h of sleep. In the experimental group, remodeling of heart chambers was observed, manifested mainly by an increase in the volume of the left atrium, dilatation of the right ventricle, and development of myocardial hypertrophy of the left and right ventricles. The systolic function of the right ventricle and the diastolic dysfunction of the right and left ventricles decreased, and the systolic pressure in the pulmonary artery increased. A course of continuous constant positive inhalation pressure during sleep in the experimental group led to reverse remodeling of the heart chambers and improvement of the systolic function of the myocardium of both ventricles. A 3-month course of continuous constant positive pressure on inspiration during sleep led to a persistent decrease in systolic pressure in the pulmonary artery. The constant application of continuous, constant positive pressure on inhalation during sleep can prevent the progression of systolic and diastolic abnormalities and reverse these changes in the initial stages before serious structural changes can develop.

The study investigated the influence of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 on the reproductive health indicators of cadets of military educational organizations. In the Department of Assisted Reproductive Technologies at the Clinic of Obstetrics and Gynecology of the Kirov Military Medical Academy, 183 male cadets aged 21–27 years were divided into two groups and examined. The first group consisted of 132 cadets who had mild and moderate COVID-19, and the second group included 51 cadets without COVID-19 in the anamnesis. COVID-19 was found negatively affect the reproductive health of cadets. Individuals who previously had COVID-19 were found to have a significant decrease in the level of total testosterone and decreased concentration and mobility of sperm in the ejaculate. Moreover, in cadets without COVID-19 who were vaccinated with the combined vector vaccine “Gam-COVID-Vac,” the indicators of the hormonal profile and spermograms were within the reference values. The results indicate the need for further investigation of the effect of various negative factors, including severe acute respiratory syndrome coronavirus 2, on the reproductive health of cadets of military educational organizations. Moreover, the development of preventive, therapeutic, and rehabilitation measures will reduce the risk of infertility and reproductive losses, which is consistent with the interests of national projects on healthcare and demography.

The study examined the potential use of a multilevel personality questionnaire “Adaptability” during professional and psychological selection in the Armed Forces of the Socialist Republic of Vietnam. A total of 445 men aged 18–26 years who were indigenous Vietnamese living in the Socialist Republic of Vietnam and undergoing military service in the People’s Navy and Land Forces of the Socialist Republic of Vietnam were examined. An adapted version of the multilevel personality questionnaire “Adaptability-4” was used and translated to Vietnamese. The success of military professional activity was assessed based on the results of a survey of direct supervisors who evaluated their subordinates according to a specially designed questionnaire. Based on the statistical analysis of the results, the indicators of the multilevel personality questionnaire “Adaptability” were normalized, and a table was formed for the translation of “raw” scores into normalized scores (walls). A formula has also been developed to calculate the success rate according to the “discipline” criterion, which reveals significant differences between the “successful” group (average value 5.35 walls) and the “unsuccessful” group (average value 4.22 walls) at the level of difference p < 0.01. The results indicated that the modified version of the multilevel personality questionnaire “Adaptability-4” adapted for the military personnel of the Vietnamese People’s Army and Navy can predict the success of military professional activities according to the discipline domain. The questionnaire can be used during professional psychological selection in the Armed Forces of the Socialist Republic of Vietnam.

Surgical treatment of locally spread tumors of pelvic organs remains an urgent and complicated oncological problem. The recurrence rate after radical treatment ranges from 15.1% to 45.2%. The key to a successful and safe surgical intervention is careful planning and intraoperative navigation, including the use of augmented reality technology. The study presents the experience in the clinical testing of augmented reality technology in the surgical treatment of 11 patients. The paper also described the main stages of the algorithm. Radical operations with intraoperative application of augmented reality technology were performed in eight patients with favorable outcomes. One patient underwent palliative intervention, and two patients did not undergo surgery. In the eight patients who underwent surgery, the median operation time was 202.5 (117.5–282.5) min, the median volume of blood loss was 300 (187.5–625) mL, and the median duration of hospital stay was 21 (17.75––27.75) days. Three patients (37.55%) developed complications, namely, necrosis of the perineal edges of the wound, ascending pyelonephritis, and intrahospital pneumonia. No hospital fatality has been registered. In the postoperative morphological examination, a negative peripheral resection boundary (R0 resection) was achieved in all patients. Subsequently, these patients were referred for dynamic monitoring and systemic antitumor therapy. The application of an augmented reality algorithm in the surgical treatment of primary and recurrent pelvic tumors is feasible and reproducible in clinical practice. Augmented reality technology, with its innovative nature and obvious advantages, opens up certain prospects for improving the results of multivisceral resections of pelvic organs; however, further study and implementation in clinical practice are necessary.

The study presents an original methodology for assessing the quality of scientific activity of the units of the Military Medical Academy named after S.M. Kirov. As a tool for its solution, we used qualimetric evaluation of all possible areas of scientific activity of departments and criteria that characterize these areas. Qualimetric methods of expert survey and weighting of performance indicators and descriptive statistics were used. Twenty-five experts took part in structuring the scientific performance of the academy. The resulting structure included six main sections, each described by a specific set of attributes. The attributes were both quantitative and qualitative with certain graduations and units of measurement, each of which was assigned a weighting coefficient. The values of the coefficients were expressed in fractions of 1, and the sum was 1. The consistency of the experts proved to be quite high, and the coefficient of concordance was 0.82 (p < 0.001). Based on the comprehensive assessment of each division of the academy, a scale score was calculated, which helped in determining the rating of a division. A sigma (using the mean square deviation) estimate was chosen as a scaling tool, which shows that 68% of all complex estimates of the units being evaluated are expected in the range from the arithmetic mean minus sigma to the arithmetic mean plus sigma. That is, units with the value of a complex indicator that falls within this interval are recognized as units with an average assessment of scientific activity. Approximately 16% of units whose value of the complex indicator will be greater than the calculated interval will make up a group of units with scientific activity above the average, and the same number of units whose value of the complex indicator will be less than the calculated interval will make up a group of units with scientific activity as below the average. In general, following the structuring and weighting coefficients, a calculation complex was developed to determine the scientific status of a unit, which was performed using an Excel spreadsheet and can be used, along with the evaluation of educational and methodological activities, in the general evaluation of units.

The study discussed various possibilities of antithrombotic therapy in patients with diabetes mellitus. Patients with diabetes mellitus, regardless of whether they have cardiovascular diseases, have a high risk of thrombosis. A feature of the response to antiplatelet therapy is the higher resistance to acetylsalicylic acid and clopidogrel of patients with diabetes mellitus than patients without diabetes mellitus, which can reach 71.4% and 57.1%, respectively. With a decrease in the functional ability of the kidneys in patients with diabetic nephropathy, acetylsalicylic acid is a safe antiplatelet drug; the use of clopidogrel in these patients leads to an increase in the risk of general and cardiovascular mortality. In the absence of contraindications, acetylsalicylic acid is recommended for patients with diabetes mellitus for the secondary prevention of cardiovascular diseases and may be recommended for primary prevention in patients with high and very high cardiovascular risk. Clopidogrel is recommended for patients with diabetes mellitus only for the secondary prevention of intolerance to acetylsalicylic acid. With the development of acute coronary syndrome, patients with diabetes mellitus received double antiplatelet therapy using acetylsalicylic acid and any P2Y12 receptor blocker. In patients who received percutaneous coronary intervention, prasugrel or ticagrelor is recommended as the second component. Double antiplatelet therapy extended for >12 months is indicated for patients with diabetes mellitus with a very high cardiovascular risk and good tolerability. In non-valvular atrial fibrillation, direct oral anticoagulants, in the absence of contraindications, are the drugs of choice in patients with diabetes and creatinine clearance > 30 mL/min for dabigatran and > 15 mL/min for rivaroxaban and apixaban. With the development of terminal renal insufficiency, only warfarin has proven effectiveness. Combined antiplatelet and anticoagulant therapy is indicated for diabetes mellitus with coexisting atherosclerotic diseases with a high risk of thrombotic and low risk of hemorrhagic complications.

Idiopathic normotensive hydrocephalus is one of the most common brain diseases in older people. The most urgent issue in the study of normotensive hydrocephalus is its differential diagnosis with other neurodegenerative and vascular pathologies of the brain. Currently, more studies have examined the concentration of biomarkers in the cerebrospinal fluid of patients with idiopathic normotensive hydrocephalus and other brain diseases to understand the pathophysiological processes in the pathogenesis of neurodegenerative diseases. The overwhelming majority of these studies have focused on the biomarkers of the cerebrospinal fluid in only one anatomical area: the ventricles of the brain or the lumbar subarachnoid space. However, only a few studies have conducted a comparative assessment of the composition and concentrations of biomarkers in ventricular and lumbar cerebrospinal fluid in the same patients. We believe that the difference in the content of biomarkers in different areas may be crucial in the choice of treatment methods for patients with idiopathic normotensive hydrocephalus. The lumbar cerebrospinal fluid is more “polluted”–the content of nearly all biomarkers in the lumbar subarachnoid space is higher than that of the cerebrospinal fluid in the ventricles of the brain. Of the two most commonly used basic surgical techniques for the treatment of idiopathic normotensive hydrocephalus, ventriculoperitoneal and lumboperitoneal bypass surgery, preference is given to lumboperitoneal bypass surgery, which avoids complications associated with damage to the parenchyma of the brain and, most importantly, drains the “dirtier” cerebrospinal fluid with a higher concentration of proteins from the lumbar space. Instead of lumboperitoneal bypass surgery, we proposed a new combination of two surgical procedures–the combination of endoscopic triventriculocysternostomy and ventriculoperitoneal bypass surgery. With such a combination, we believe that drainage of the cerebrospinal fluid from the ventricles and the subarachnoid space of the cisterns of the base of the brain will be more effective than the traditional ventriculoperitoneal shunting because the concentration of proteins involved in the progression of degenerative diseases of the brain will decrease more actively.

Both well-known basic cellular and humoral factors of the adaptive antiviral immune response, which play an important role in the effectiveness of immunological reactions to inhibit viral infections, and new factors with which the efficiency of the functioning of cellular and humoral mechanisms of a specific immune response is associated are considered. This is, first of all, the presence of “naive” T-lymphocytes in the macroorganism, programmed to recognize a specific viral antigen. In addition, this is facilitated by various receptor specificities of T-lymphocytes, of which there are more than 20 million. The diversity of receptor structures was believed to be associated with the functioning of genes that activate recombinase. The development of antiviral cell-mediated mechanisms depends on interleukins 12, interferon-γ, and the transcriptional activator T-bet. An imbalance in the ratio of T-helper cell types 1 and 2 can lead to memory cell damage. Th-17 plays a central role in controlling the immune response to viral infection. The balance between activated cytotoxic CD-8+/T-helper cells and T-regulatory lymphocytes determines the risk of immunopathology. An excess of effector cells leads to immune-mediated damage, a lack of chronicity of a viral infection. One of the controlling mechanisms that ensure minimal damage to cells and tissues is the assembly of a cytoplasmic protein complex in antigen-presenting cells–inflammasomes. The intensity of inflammatory processes depends on whether the virus is cytopathic. The effectiveness of the humoral immune response is also attributed to the fact that one plasma cell can secrete more than 2,000 antibody molecules per second. One of the powerful properties of the adaptive antiviral immune response is the development of immunological memory by different types of memory T cells. To date, at least three subpopulations of memory T cells with different activation requirements have been identified. Thus, determining how each of these types of memory T-lymphocytes contributes to the long-term antiviral protection of the macroorganism is an urgent task.

Nikolay Anatolyevich Maistrenko is a prominent specialist in the field of abdominal and endocrine surgery, oncology, and organization of specialized surgical care. For 24 years, he headed the Department and Clinic of Faculty Surgery named after S.P. Fedorov Military Medical Academy of S.M. Kirov. With his direct participation in the clinic, the structural units became modernized, which were equipped with modern equipment to provide high-tech surgical care. Under the direction of Academician of the Russian Academy of Sciences N.A. Maistrenko, the range of scientific research conducted in the clinic and together with other research institutions of Saint Petersburg (i.e., Research Institute of Oncology named after N.N. Petrov, Institute of Physiology named after I.P. Pavlov, and Research Institute of Emergency Medicine named after I.I. Dzhanelidze) has significantly expanded. The main areas of scientific activity of Professor N.A. Maistrenko are the development of organizational, tactical, and technical issues of providing surgical care to patients with gastroenterological profile; study of long-term results of organ-preserving operations and resection interventions for complicated gastric and duodenal ulcers; research on the problem of choledocholithiasis using laparoscopic, endoscopic, and non-surgical methods of its elimination; introduction of new diagnostic and therapeutic technologies in surgical endocrinology; study of the possibilities of laparoscopic interventions in emergency surgery of acute diseases and abdominal organ injuries; development of topical aspects of colorectal surgery using new technologies when performing sphincter-preserving operations; and surgical treatment of chronic pancreatitis. Academician N.A. Maistrenko is the author and co-author of more than 750 scientific papers, including 28 monographs and manuals. Under his direction, 13 doctoral and 19 master’s theses were defended. Eighteen teaching aids, workshops, and lectures have been published on various sections of endocrine and abdominal surgery. Nikolay Anatolyevich Maistrenko is a vivid example of how aspiration, diligence, and discipline ensure the achievement of the highest goals, and love for his specialty guarantees great professional success.