卷 27, 编号 3 (2025)

BACKGROUND: A significant feature of military operations is the widespread use of unmanned aerial vehicles to carry explosive devices, ensuring their targeted delivery and impact at different levels of the human axial skeleton. This factor significantly impacts the anatomy and topography of blast injuries. This is evidenced by a greater diversity of injury patterns compared to previous scenarios, wherein contact mine (contact) blast injuries resulting in lower extremity damage were more prevalent. Consequently, investigating the injuring effects of abdominal blasts is of significant relevance.

AIM: The work aimed to determine the incidence of abdominal blast injuries and analyze their clinical and anatomical characteristics using available experimental findings on the mechanogenesis of this type of combat injury.

METHODS: The study focused on the clinical and anatomical characteristics of abdominal blast injuries. A comparative analysis of the clinical progression of traumatic syndrome and surgical outcomes between two patient groups was conducted. The main and control groups included 52 wounded patients with blast injuries and 65 patients with shrapnel wounds, respectively. The study groups were comparable in injury severity and baseline condition, with the abdomen being the primary localization of injuries in all cases.

RESULTS: Clinical and anatomical signs of primary blast injury effects were found in 10.3% of patients with abdominal shrapnel wounds. The study found that brisance and shock-wave injuries accounted for 46% of cases in the control group and 100% in the main group. The overall complication rate was 48.1% and 38.5% in the main and control groups (p > 0.05) respectively, with significant differences (p = 0.07) in Clavien–Dindo grades III–IV between the groups.

CONCLUSION: Primary blast injury effects have a significant negative impact on traumatic syndrome progression in patients with abdominal blast injuries. This includes a higher incidence of pulmonary and soft tissue infections and an increased risk of intestinal perforations caused by intestinal anastomotic leaks and acute ulcers.

BACKGROUND: During the Great Patriotic War, craniocerebral combat wounds were classified. Currently, gunshot wounds demonstrate a greater variety, severity, and extent of tissue injury in craniocerebral regions on the periphery of the wound canal compared to wounds from past wars. Furthermore, advanced diagnostic techniques that can identify previously undescribed cerebral wound canals, which were generally considered fatal, are now available. Thus, new classification systems for craniocerebral gunshot wounds are required.

AIM: The work aimed to broaden the fundamental classification of craniocerebral gunshot wounds by including the current clinical and anatomical findings, facilitating a more comprehensive clinical diagnosis.

METHODS: The assessment findings and treatment outcomes of two groups of wounded patients were analyzed. Group 1 included 127 patients with craniocerebral gunshot wounds who had been treated in a military hospital during the Soviet–Afghan War. Group 2 comprised 67 wounded participants of modern armed conflicts who were treated at the Neurosurgery Clinic of the Kirov Military Medical Academy.

RESULTS: A contemporary clinical and anatomical classification of craniocerebral gunshot wounds was developed. This classification includes posterior cranial fossa (the cerebellum and brainstem) wounds. The proposed classification offers a framework for more accurate triaging based on injury severity. This facilitates decision-making for surgical prioritization, including in scenarios involving mass admissions. Primary attention should be given to patients with wound canal passing through the cortex and white matter of the brain. Generally, the more convex trajectory of the wound canal is associated with less severe brain injury. Surgical procedures are performed after stabilization of vital signs in patients with wound canals passing through the first-level (e.g., subcortical structures, ventricles, and brainstem) and second-level (e.g., cortex and cerebellar hemispheres) brain structures. The prognosis of these wounded patients largely depends on the severity and extent of damage to vital brain structures.

CONCLUSION: The developed clinical and anatomical classification is beneficial for elucidating the nature of craniocerebral gunshot wounds, facilitating a targeted triage of admitted wounded patients, ensuring surgical prioritization, and predicting the prognosis and outcome of craniocerebral wounds.

BACKGROUND: In total, 30 ixodid tick species were found on the Crimean Peninsula. Their epidemiological importance was directly correlated with the pathogenicity of the infectious agents that they may transmit. One such established etiological agent is Rickettsia conorii, a representative of the spotted fever group rickettsiae. Rhipicephalus sanguineus ticks serve as both a vector and reservoir for R. conorii. Studying the prevalence of pathogenic agents among the ixodid ticks is particularly crucial given Crimea’s status as a health resort and a center for resort-based medicine.

AIM: This work aimed to assess the role of ixodid ticks in the circulation of R. conorii and other spotted fever group rickettsiae.

METHODS: The ticks were collected from the vegetation, from April to September, for >7 years (2016–2022). For this, flagging and dragging methods, as well as the examination and combing of large and small livestock, horses, dogs, cats, and hedgehogs, were employed. During the outbreaks of Mediterranean spotted fever, ticks were collected from the foci of infection in humans and domestic animals. Genetic markers of rickettsiae were detected using real-time polymerase chain reaction followed by species identification.

RESULTS: In total, nine ixodid tick species were identified from the collected specimens. Overall, the most abundant species were Haemaphysalis punctata (42.9%), Rhipicephalus sanguineus (20.8%), Hyalomma marginatum (15.5%), and Ixodes ricinus (12.8%). The collections were predominated by H. punctata in 2016 (75.5%), H. marginatum in 2017 and 2021 (58.2% and 24.6%, respectively), I. ricinus in 2018 (59.5%), and R. sanguineus in 2019 (47.9%). The DNA of eight spotted fever group rickettsiae species, including R. conorii, R. massiliae, R. sibirica subspp. mongolotimonae, R. slovaca, R. aeschlimannii, R. monacensis, R. helvetica, and R. raoultii were detected in the collected ticks. R. conorii was found in R. sanguineus and H. marginatum. For the first time on the Crimean Peninsula, R. massiliae was detected in R. sanguineus; R. slovaca in Dermacentor marginatus, H. marginatum, H. punctata, R. sanguineus, and I. ricinus; R. mongolotimonae in H. marginatum and R. sanguineus; and R. helvetica in I. ricinus. The greatest diversity of the spotted fever group rickettsiae was recorded in R. sanguineus and H. marginatum.

CONCLUSION: This study established the role of ixodid ticks in the circulation of eight species of spotted fever group rickettsiae on the Crimean Peninsula. They included R. conorii, R. massiliae, R. slovaca, R. raoultii, R. aeschlimannii, R. mongolotimonae, R. monacensis, and R. helvetica. The DNA sequences of R. conorii, R. massiliae, R. slovaca, and R. raoultii were deposited in the GenBank database. These findings on the quantitative and species composition of the ixodid fauna, tick infection rates, and genetic diversity of the detected rickettsiae highlight the need to expand laboratory capabilities, apply a risk-oriented approach, and implement corrective measures to the epidemiological surveillance system of spotted fever group rickettsioses on the peninsula.

BACKGROUND: Hypoxia has been identified as a crucial factor in the pathogenesis of the novel coronavirus infection, with studies demonstrating its role in inflammatory processes and complications. Hypoxia-inducible factor 1-alpha plays a critical role in regulating the body’s adaptation to oxygen deficiency. A comprehensive investigation of variations in hypoxia-inducible factor 1-alpha in patients with new coronavirus infection allows for elucidating the pathogenetic mechanisms of the disease and identifying promising therapeutic targets.

AIM: The work aimed to evaluate the role of hypoxia-inducible factor 1-alpha in the compensation and adaptation of the body to hypoxic stress during novel coronavirus infection.

METHODS: From January 2020 to March 2022, 295 patients were assessed at the Naval Therapy Clinic of the Kirov Military Medical Academy, with 272 of them diagnosed with the novel coronavirus infection. The patients were divided into three age groups based on the World Health Organization’s classification: group 1, young age (207 patients); group 2, middle age, (56 patients); and group 3, elderly age (32 patients). Serum hypoxia-inducible factor 1-alpha was measured using an enzyme immunoassay. Statistical data were processed using GraphPad Prism 8 and IBM SPSS Statistics. Statistical significance was set at p < 0.05.

RESULTS: Hypoxia-inducible factor 1-alpha correlated with both age and novel coronavirus infection severity, peaking among elderly patients with severe forms of the disease. Hypoxia-inducible factor 1-alpha decreased during recovery, indicating the adaptive response to hypoxic stress termination. In the group of elderly patients, higher hypoxia-inducible factor 1-alpha values were associated with mild novel coronavirus infection, which was related to existing comorbidities.

CONCLUSION: The findings corroborate the hypothesis that hypoxia-inducible factor 1-alpha is a valuable prognostic marker for hypoxic complication severity in patients with the novel coronavirus infection and confirm its potential as a therapeutic target. Further studies are needed to elucidate the molecular mechanisms of its regulation and develop pharmacological treatment strategies for hypoxic disorders.

BACKGROUND: The pathogenesis of the long-term effects of neurotoxic agents remains poorly understood. Tissue specificity, as a qualitative characteristic of the toxic effect, involves selective metabolic process remodeling in specific tissues.

AIM: The work aimed to evaluate the tissue specificity of metabolic changes in the long-term effects of acute toxic exposure.

METHODS: An experimental study was performed on rats. The toxic agents used were 1.6 mg/kg of phenylcarbamate, 11.5 g/kg of methanol, and 300 mg/kg of lead acetate. The parameters of lipid peroxidation and the antioxidant system were determined using standard biochemical techniques on day 30 after toxic exposure.

RESULTS: In the groups of intact animals and those that survived the exposure, lipid peroxidation and the antioxidant system were found to be tissue-specific. The most significant effect, which was common for body tissues, was the shift in diene conjugates, as toxic exposure was followed by a significant decrease in tissue specificity. Regarding the tissue concentration of malondialdehyde, which shows the activity of lipid peroxidation, phenylcarbamate and lead induced an increase in tissue-specific response to toxic effects. This finding showed the selective effect on individual links of oxidative stress in tissues.

CONCLUSION: Lipid peroxidation and antioxidant system activity can be considered markers for evaluating the effect of toxic agents on metabolic processes in various tissues. A higher brain tissue sensitivity to the toxic effects can be demonstrated by a higher growth rate of diene conjugates (phenylcarbamate and lead acetate), glucose-6-phosphate dehydrogenase, and superoxide dismutase (methanol). A hepatic tissue-specific response was evidenced by increased activity of glucose-6-phosphate dehydrogenase (phenylcarbamate and methanol) and decreased activity of superoxide dismutase (methanol and lead acetate). The kidneys were particularly susceptible to the impaired utilization of reduced glutathione (methanol) or its formation (lead acetate). The compensatory activation of superoxide dismutase (methanol and lead acetate) was a marker of splenic tissue-specific response.

This review analyzed Russian and international studies focused on intestinal dysbiosis in patients with functional colonic stoma. Moreover, it evaluated current approaches to the diagnosis and treatment of intestinal dysbiosis to prevent complications. Dysbiosis, defined as an imbalance of the intestinal microflora, is a significant concern for patients with colonic stomas, as surgery modifies intestinal anatomy and physiological functions, thereby affecting the composition and functional activity of the microbiota. Dysbiosis can worsen the postoperative period and reduce the patient’s quality of life. A colonic stoma may be an unavoidable consequence of various diseases, such as colorectal cancer, inflammatory bowel disease, and injury. Such an outcome can result in dysbiosis caused by altered intestinal content passage, impaired motility, and local inflammatory processes. A comprehensive understanding of the mechanisms underlying dysbiosis in patients with functional colonic stoma and its clinical symptoms, diagnostic approaches, and strategies allows for improving the quality of medical care for this patient population and the implementation of personalized approaches to dysbiosis prevention and treatment. The role of microbiota in maintaining intestinal homeostasis and its effect on overall health were emphasized. Furthermore, the review covers available diagnostic techniques, including fecal microbiology, molecular genetic methods, and metagenomic analysis, which provide an accurate assessment of the microflora. Potential complications associated with dysbiosis are highlighted. Various strategies for the treatment of dysbiosis have been proposed, including metabiotics and autologous fecal microbiota transplantation. Available assessments and individualized treatment strategies have been shown to improve the quality of medical care for patients with functional colonic stomas and prevent complications.

Various techniques for the treatment of patients with pancreatic head pseudocysts are available. This review analyzed scientific data on the feasibility and effectiveness of these methods, with the results as basis for selecting an individualized treatment approach. Data were searched in PubMed, Google Scholar, and eLIBRARY.RU. The sources used were published between 2014 and 2024, with some valuable studies dating back to 2008. In selecting scientific articles, their practical relevance to the topic was considered. Notably, modern clinical practice records an increasing incidence of pancreatic pseudocysts, with approximately 1.6–4.5 cases per 100,000 population annually. Concurrently, pancreatic head pseudocysts tend to have a more severe course, often leading to complications and complicating treatment. These pseudocysts are characterized by fibrous tissue formation in the pancreatic head and cephalic pancreatitis development. The treatment of patients with pancreatic head pseudocysts is extremely challenging. Currently, minimally invasive techniques are often employed in treating patients with pancreatic head pseudocysts. However, in cases of pancreatic head pseudocysts, these methods do not always yield favorable outcomes. Complications and recurrences frequently occur, requiring repeated interventions and even open surgery. The scientific sources lack a systematic presentation of treatment approaches for this patient category, and there is no consensus on the matter. A revision of methodological strategies for this issue, based on the principles of evidence-based medicine, is required to evaluate the effectiveness of various surgical treatments for patients with pancreatic head pseudocysts. Overall, the problem of surgical treatment for pancreatic head pseudocysts is clinically relevant and warrants further investigation.

This article outlines the key milestones in the development of the Research Laboratory of Military Therapy. The laboratory was founded in 1981 during the height of the armed conflict in Afghanistan, when a high incidence of morbidity (particularly infectious diseases), a large number of complications in the wounded, and the prolonged and recurrent course of somatic conditions resulted in sanitary losses equating to combat losses. In 1984, based on data obtained in Afghanistan, Professor Novitsky formulated and substantiated the fundamental concept of chronic adaptive overstrain syndrome, elucidated its mechanisms, and defined its clinical manifestations. One of the laboratory’s research areas was the study of the health status of individuals living in the areas of Belarus, Ukraine, and Russia contaminated with radioactive fallout from the Chernobyl nuclear power plant disaster. In 1996, studies were conducted at the Luga Artillery Range to examine the effects of air blast waves of varying intensity on the physical performance and conditioned reflex activity of laboratory animals, enabling the assessment of the potential use of new actoprotective agents. In collaboration with the Department of Military Field Therapy, the laboratory’s staff investigated the characteristics of somatic conditions in individuals engaged in chemical weapons destruction. The Research Laboratory of Military Therapy staff developed and implemented a modern system for the medical examination of military personnel engaged in work with chemical weapons. Currently, the laboratory addresses research issues in areas such as improving the diagnosis, prevention, and treatment of injuries caused by highly toxic compounds; studying the chromosomal apparatus of cells in cases of occupational exposure to various chemicals and acute poisonings; and experimentally justifying the prevention and treatment of hepatotropic poisonings using glutathione disulfide- and inosine-containing drugs. In an organotypic culture model, changes in cell proliferation of various tissues under the influence of alkylating agents and the potential of using selected coded amino acids and oligopeptides to mitigate toxic effects were studied. In addition, organizational measures for preventing maladaptation disorders in military personnel serving in the Arctic zone of the Russian Federation have been proposed. Furthermore, the laboratory has examined the state of cellular and humoral immunity in patients with novel coronavirus infection.

The Editorial Board regrets that an incorrect term was used in the title of the published article by Hoang H.T et al. "Track-Etched Membranes for Flap-Sparing Skin Grafting" (Bulletin of the Russian Military Medical Academy. 2025;27(2):165–174. doi: 10.17816/brmma650761 ).

The correct title should read: Track-Etched Membranes for Economical Skin Grafting.

The Editorial Board assures readers that this error could not significantly affect perception or interpretation of the information given in the article. The title has been corrected in its online version, and the article and issue files have been updated accordingly.