Vol 26, No 3 (2024)

A simulation finite-element model of the destruction process of biomaterials of the human musculoskeletal system under shock-wave effects of a contact explosion is substantiated to predict the nature and extent of damage to the lower limbs, including designing special explosion-proof shoes. The physical and mechanical properties of the biological tissues of human lower limbs and their behavior under local shock-wave action were analyzed. The mechanical behavior of each biological material as part of a mathematical model of a human lower limb was selected. The original finite-element model of the human lower limb symmetrically interacted with the main components of its anatomical structures. The developed computational model was verified using data obtained from the results of experiments on mechanical and shock-wave effects. A specialized program for processing the received data was created, which implements an algorithm for processing received graphic images of changes in pressure indicators and accelerations over time to obtain tolerance curves. Several numerical calculations were performed to simulate contact detonation through the protective composition of the developed model of the lower limb. Pressure and acceleration tolerance curves were derived from the results of the calculations, animations of the behavior of anatomical structures of the lower limb under shock-wave action were created, and the propagation of the pressure field within them was visualized. In the future, the proposed method of conducting “virtual” tests can be employed to solve application issues of testing to protect the lower extremities of sappers. In general, the use of computer modeling techniques will help reduce the time and cost of producing new samples of protective products in the interests of the country’s defense capability.

The bacteriostatic effects of human umbilical cord-derived matrices and hydrogels were examined. The use of biomimetics based on the extracellular matrix of extraembryonic organs, including the human umbilical cord, is promising for regenerative medicine and tissue engineering. Cell-free products from the extracellular matrix of various human organs and tissues are resistant to intentional bacterial contamination. Two acellular scaffolds prepared using different human umbilical cord decellularization protocols and two derived hydrogels were evaluated for their bacteriostatic properties. Two clinical cases of the use of lyophilisates of umbilical cord-derived hydrogels were described. The compositions of human umbilical cord-derived acellular matrices and hydrogels were studied using biochemical analysis techniques. The sensitivities of Staphylococcus aureus and Escherichia coli to umbilical cord-derived matrices and hydrogels were assessed using culture techniques, and metabolic activities of bacteria were also examined. Human umbilical cord-derived acellular matrices and hydrogels consist of collagens and contain proteins and glycosaminoglycans. A significant bacteriostatic effect of hydrogels against Escherichia coli was detected during the first 16 h of incubation, regardless of the type of detergents used for their preparation. The matrices did not show a bacteriostatic effect, which indicates that the hydrolysis of structural components contributes to the release of substances with bacteriostatic activities. The effect was presumed to be due to the influence on the level of metabolic activity of microorganisms. The use of powdered lyophilized hydrogels derived from human umbilical cord as an adjunct to autodermal graft in the treatment of infected deep wounds in two volunteer patients promoted healing without infections. In general, the use of hydrogel lyophilisates from acellular human umbilical cord as an additional treatment allows for the engraftment of skin autografts and promotes the healing of extensive deep wounds at risk of infection.

The effectiveness of intraoperative neurophysiological monitoring of the segmental apparatus for the regulation of pelvic functions during surgical treatment of tumors in the caudal spinal cord was assessed. In this study, 99 patients with extramedullary and intramedullary spinal cord tumors at the Th11–S5 vertebral levels who received neurosurgical treatment were examined. Based on the extent of intraoperative neurophysiological monitoring, patients were divided into two groups: group 1 underwent standard monitoring of the pyramidal system, and group 2 underwent extended monitoring of pelvic organ functions, which was based on the recording of the bulbocavernosus reflex. Neurological examinations were conducted for all patients before surgery and in the early postoperative period (10–14 days). Twelve months after the surgery, a telephone survey of the complaints of pelvic organ dysfunction was conducted. The surgical outcomes of both groups were compared. Pelvic organ dysfunctions in the preoperative period were identified in 25%–30% of the patients in each group. In the examination 10–14 days after surgery, pelvic organ dysfunctions were found in 20 (48.8%) patients in group 1 and in 16 (27.6%) in group 2. At 12 months after surgery, the dysfunction rate increased from 56.1% (n = 23) in group 1 to 29.3% (n = 17) in group 2. Non-monitoring increased the risk of pelvic organ dysfunctions by 2.5 times in the early postoperative period (odds ratio, 2.50 (1.07–5.79)) and 3.08 times after 1 year (odds ratio, 3.08 (1.35–7.11)). Monitoring of pelvic functions reduced the risk of pelvic organ dysfunctions first identified in the early postoperative period by 5.2 times (odds ratio, 0.192 (0.04–0.80)). Thus, intraoperative continuous monitoring of the state of the segmental apparatus for regulating pelvic functions helps minimize the risk of postoperative development of pelvic disorders in patients with tumor lesions of the caudal parts of the spinal cord. Pelvic monitoring increases the functional permissibility of the operation, maintaining or improving the quality of life of the patients.

Long-term clinical outcomes and incidence of degenerative diseases of the adjacent proximal segment during personalized lumbar transforaminal fusion were prospectively assessed. According to the created register, the observational prospective multicenter study included 209 patients who underwent primary open transforaminal lumbar fusion according to generally accepted indications at the LIV–SI vertebral level between 2015 and 2019, and in these patients, adjacent vertebral motion segment had initial degeneration of the adjacent segment in varying severity levels. The risk of developing degenerative adjacent segment disease on the proximal spinal motion segment was assessed using an original method (Patent 2762496 of the Russian Federation, December 21, 2021, Bulletin No. 36). The surgical technique in relation to the adjacent spinal motion segment was determined according to the algorithm for personalized implementation of open transforaminal lumbar fusion. Instrumental parameters were studied in the preoperative period, and development of degenerative adjacent segment disease in the long-term postoperative follow-up was examined at 65 (60–74) months. After a comprehensive assessment of the risk of developing a degenerative adjacent segment disease, monosegmental open transforaminal lumbar fusion was performed in 75 patients, open transforaminal lumbar fusion with interspinous stabilization of the adjacent vertebral motion segment in 69, and involvement of the adjacent vertebral motion segment in rigid stabilization in 65. The incidence of degenerative adjacent segment disease was 4.9% (n = 10). Thus, a comprehensive assessment of the risk of developing degenerative adjacent segment disease and a personalized algorithmic approach to performing open transforaminal lumbar fusion can significantly improve long-term clinical results and reduce the incidence of this degenerative disease in a minimum 5-year follow-up period.

This study conducted a functional assessment of the results of magnetic resonance imaging in comparison with electroencephalography of 348 young pilots of the Higher Military Pilot School named after the Hero of the Soviet Union A.K. Serov who were deemed “healthy” during the medical flight commission. Magnetic resonance imaging revealed expansion of the cerebrospinal fluid spaces of varying degrees and localization in 41(11.8%) pilots after the medical flight commission, which is a contraindication for flight service. However, many congenital structural features of the brain detected by magnetic resonance imaging are normal anatomical variants. When deciphering all electroencephalograms, deviations from the norm were noted in 41(11.5%) cases, including α- and β-rhythms. In 1 (0.3%) patient, changes were also detected by magnetic resonance imaging and electroencephalography. Deviations in electroencephalograms were not associated with the changes detected by magnetic resonance imaging. Thus, the detected changes in the electroencephalograms of 1 (0.3%) pilot had not clear effects, and magnetic resonance imaging detected cerebrospinal fluid space expansion up to 10 mm in the retrocerebellar region. The study emphasized the need to clarify the techniques in medical flight commission in relation to flight personnel with such “findings” to objectively predict the real risk in relation to further service. Therefore, additional studies in young pilots with identified characteristics are necessary by comparing magnetic resonance imaging and electroencephalogram findings with respect to exercise testing, mental function, and learning potential.

In the “pilot – aircraft – environment” system, the pilot is a decisive link and plays an important role in ensuring the reliability of this system. During the flight, the pilot works under constant exposure to adverse factors. Thus, the professional activity of a pilot is characterized by high emotional stress and severe physical and mental stresses. The influence of high-altitude factors on the health and performance of the pilot and outcomes of high-altitude flights in an emergency were considered. During these flights (altitude of >4000 m), one of the most dangerous situations is the emergency depressurization of the aircraft cabin. In this case, explosive decompression occurs, which can cause the death of the pilot and loss of the aircraft. A decrease in partial pressure leads to acute hypoxia, and a rapid decrease in barometric pressure causes high-altitude decompression disorders. The protective equipment used by pilots when performing high-altitude and stratospheric flights was presented. The system and methodology of psychophysiological preparation for high-altitude flights were analyzed, which included theoretical training, flight personnel’s familiarization with the effect of hypoxic hypoxia on the body, assessment of the tolerance to moderate hypoxia during hyperbaric ascents, selection and adjustment of protective equipment, and training in breathing and speech under excess pressure. The shortcomings in medical support for psychophysiological training of pilots of the Air Force of the Socialist Republic of Vietnam were revealed. Based on a comprehensive analysis of modern approaches, medical support for flights must be improved, and the psychophysiological training of Vietnamese Air Force pilots for high-altitude flights must be substantiated..

Domestic and foreign studies have examined the clinical manifestations, diagnosis, and surgical treatment of patients with complicated bulbous duodenal ulcers. Elibrary.ru, the Russian National Library, and PubMed were searched for relevant scientific medical literature published between 1926 and 2023. The search focused on literature data on evidence-based medicine. Bulbous peptic ulcers occurred in 3.6–17% with duodenal ulcers. It often has an atypical clinical course and is at risk of severe complications such as ulcerative bleeding, decompensated duodenal stenosis, and ulceration. Surgical intervention is technically difficult. Despite the expansion of diagnostic capabilities, in most cases, the exact localization of the ulcer in the postbulbar area was revealed only during an intraoperative revision of the duodenum. Surgical treatment of patients with complicated corneal ulcers is associated with a high risk of damage to important anatomical structures, postoperative complications, and high mortality. Existing methods of surgical treatment of complicated bulbous ulcers are associated with increased risk of intra- and postoperative complications, such as damage to the bile ducts, pancreatic ducts, large blood vessels, development of acute postoperative pancreatitis, and duodenal stump failure, which lead to frequent adverse immediate and long-term results and mortality. The issue of choosing the optimal surgical treatment methods for complicated corneal ulcer remains definitively unresolved. Although numerous techniques are available, none is perfect. In general, peptic ulcer disease and its complications remain relevant in modern surgery. Compared with stomach and duodenal bulb ulcers, few studies have been devoted to complicated bulbous ulcers, specifically on the peculiarities of their clinical manifestations, diagnosis, and treatment.

The main results of proactive and planned scientific research carried out in the 2010–2020s and aimed at creating regulatory legal acts and official documents of the Ministry of Defense of the Russian Federation regulating the functioning of the medical supply system for troops (forces) are presented. The sequence and key stages of the formation of a harmonious regulatory legal framework for the medical supply system for troops (forces) are reflected. The concept of rationing medical equipment for formations, military units, military medical and other organizations in peacetime and war is substantiated. The research design is shown, based on a comprehensive study of the need for various types of medical equipment in the provision of established types of medical care, including specialized and high-tech, and also taking into account the potential of the domestic medical and pharmaceutical industries. The fundamental directions for improving the legal regulation of mechanisms for providing medical equipment to troops (forces) are presented, taking into account trends in military development and military-economic support for state defense. Changes in the drug provision of military personnel, including those injured (diseases) while performing combat and special missions, are disclosed. The leading role of the teaching staff of the Military Medical Academy named after. CM. Kirov in integrating an integral regulatory legal framework for the medical supply system for troops (forces). In general, the activities aimed at updating the regulatory legal framework of the medical supply system of troops (forces) and its harmonization with legislative and regulatory legal acts of the Russian Federation, regulatory legal acts of federal executive authorities, as well as regulatory legal acts and official documents of the Ministry of Defense of the Russian Federation are “lively” and dynamic. In the 2010s-2020s, thanks to the creative joint activity of specialists of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation, scientists and employees of the Military Medical Academy named after S.M. Kirov, it was possible to develop (rework) a large array of normative legal acts and official documents of the Ministry of Defense of the Russian Federation regulating the implementation of the measures provided for the provision of medical equipment to troops (forces) in the prevailing military-strategic and socio-economic conditions.

The study presented the main aspects of conducting Bayesian network meta-analysis as a method of indirect comparisons using mathematical models. To describe the performance of the Bayesian network meta-analysis, codes for the random-effects and fixed-effects models were included. The models were written in Component Pascal and run in the JAGS program. To allow cross-reference of results, data used for modeling purposes were generated data from the article by D. Hu, A.M. O'Connor, S. Wang et al. [6]. The R language and rjags package were used to load data into the model and run the program. To determine the best model, model adequacy indicators were used, such as total residual deviation, and leverage and deviation information criterion were calculated using the original R code. A graphical method was also used to determine the adequacy of the models using the ggplot2 package. An example of constructing a network of evidence based on available results on the effectiveness of drugs from clinical trials was considered, taking into account the assumptions of transitivity and heterogeneity. Indirect and direct comparisons to determine the true estimates of drugs were possible. The elements of Bayesian statistics, such as prior and posterior probabilities and likelihood, and the advantages of using them in meta-analysis were explained. The mathematical apparatus of the generalized linear model was presented in both general and specific forms, using binomial output data to obtain relative estimates of the effects of therapies. An explanation of how the models work is presented. The random-effects model showed superiority over the fixed-effects model in the comparison of adequacy metrics. To achieve better adequacy, data must be carefully downloaded from publications, and informative priors selected. In general, Bayesian synthesis is a distinct and important type of network meta-analysis. It is unique because it uses a probabilistic approach to data analysis. Understanding the basic principles of Bayesian statistics is also an important aspect of the successful use of this method in various research fields. However, for effective application of this method, attention must be paid to careful data preparation and the choice of priors. With informative prior distributions and proper implementation, Bayesian synthesis can produce more accurate and reliable results than other meta-analysis methods. Bayesian synthesis is a method of statistical data analysis recognized worldwide and in the Russian Federation..

July 5, 2024 marked the 70^th anniversary of the famous military surgeon, Honored Doctor of the Russian Federation, former Chief Surgeon of the Ministry of Defense and head of the Department of Military Field Surgery of the Military Medical Academy named after S.M. Kirov, corresponding member and honorary Doctor of the Military Medical Academy named after S.M. Kirov, Doctor of Medical Sciences, Professor, retired Colonel of the medical service Igor M. Samokhvalov. After graduating from the Academy, I.M. Samokhvalov served in the Airborne Troops as a military doctor, then as a surgeon of a separate medical battalion. In 1981, I.M. Samokhvalov entered the adjunct course at the Department of Military Field Surgery and successfully defended his thesis for the degree of Candidate of Medical Sciences on traumatic disease in limb injuries. I.M. Samokhvalov — a participant in combat operations in Afghanistan (1980, 1987–1988) and in the North Caucasus (1994–1995). He provided assistance to victims of the earthquake in Armenia in 1988. The generalization of the experience gained was framed in the form of a doctoral dissertation on combat trauma of blood vessels. In 2007, I.M. Samokhvalov was appointed head of the Department of Military Field Surgery, then from 2010 to 2022 he was elected head of this department. As Chief Surgeon of the Ministry of Defense of the Russian Federation, in the difficult conditions of the reduction of the Armed Forces, he carried out work to improve the quality of surgical care. Professor I.M. Samokhvalov is one of the country’s leading specialists in military field surgery, polytrauma surgery, and angiotraumatology. He developed the concept of optimizing the provision of surgical care to the wounded and the tactics of “damage control” in a hybrid war, on the basis of which the current guidelines for military field surgery were prepared. He led the creation of a line of modern domestic individual means of providing assistance to the wounded. He proposed the concept of temporary intracavitary hemostasis in abdominal injuries with ongoing intra-abdominal bleeding. Professor I.M. Samokhvalov has established a school of military field surgeons, 11 doctors and 26 candidates of medical sciences have been trained. Since 2022, Igor M. continues to work at his native department as a professor and is (concurrently) a leading researcher at the Department of Combined Injuries of the St. Petersburg Scientific Research Institute of Emergency Medicine named after I.I. Janelidze.