Russian Military Medical Academy Reports

Background: This article explores the anatomical structure of the chest wall, with a particular focus on the extrapleural space, its radiologic visualization, and its role in the development of certain pathological processes following thoracic injuries and trauma. Among the pathological mechanisms involved in severe combined injuries that lead to life-threatening complications, the entry of air into internal body cavities is particularly significant. One such complication is tension pneumothorax. According to the clinical guidelines issued by the Main Military Medical Directorate, pleural drainage is recommended as a therapeutic measure at the stage of qualified or specialized medical care upon diagnosis of pneumothorax, regardless of its type.

AIM: To assess the diagnostic capabilities of imaging modalities for identifying extrapleural emphysema in chest injuries and trauma.

MATERIALS AND METHODS: The primary imaging techniques for diagnosing pneumothorax are chest radiography and ultrasound. According to both domestic and international literature, these methods demonstrate high specificity, approaching 100%.

RESULTS: In our study, systematic use of computed tomography revealed distinctive radiologic signs of air in the extrapleural space in the absence of parietal pleura damage. On radiographs, these conditions appear as a radiolucent stripe along the inner surface of the chest wall. On ultrasound, they are visualized as a “sandy beach” sign with absent visceral pleural sliding, which is often mistakenly interpreted as pneumothorax. In such cases, attempts to drain the pleural cavity increase the likelihood of chest tube misplacement into the extrapleural space due to disrupted anatomical relationships within the chest wall layers. In cases of inadequate medical management during patient transport, subcutaneous emphysema tends to progress.

CONCLUSION: Thus, identifying air in the extrapleural space helps avoid unnecessary invasive procedures and additional iatrogenic injuries. Our study identified key radiographic features that distinguish extrapleural emphysema from pneumothorax: predominant localization in the basal regions, well-defined borders, and the presence of concurrent subcutaneous emphysema and pneumomediastinum.

Background: The modernization of the Naval Forces of the Socialist Republic of Vietnam and the growing complexity of their technological infrastructure have led to increased specialization of roles and professional competencies among naval personnel. This process is accompanied by progressively differentiated requirements for the development of specific psychophysiologic and personality-based professionally important qualities essential for the effective execution of duties and combat missions. Assessing and considering the level of development of these specialized psychophysiologic and personality traits during the stage of professional selection supports the rational assignment of military personnel and the optimization of training across key naval specialties. In turn, this contributes to improved efficiency and reliability in the performance of professional duties by naval specialists.

AIM: to identify the psychophysiologic and personality-based professionally important qualities required for successful mastery of the main groups of naval specialties.

MATERIALS AND METHODS: The study involved psychologic and psychophysiologic assessments of naval personnel from various specialties within the Naval Forces of the Socialist Republic of Vietnam. A set of methods was used to evaluate neurodynamic and psychomotor properties, cognitive functions (attention, memory, and thinking), as well as motivational and personality traits. In addition, expert evaluations of the trainees’ academic and military-professional performance across different specialties were conducted. The results were analyzed using Spearman rank correlation coefficients r and the Kruskal–Wallis analysis of variance. In all cases, the measure of statistical significance for the results of the calculations was a significance level not exceeding 0.05 (p ≤0.05).

RESULTS: The study identified specific professionally important qualities required for the main groups of naval specialties.

CONCLUSION: The study revealed professionally important psychophysiologic characteristics that support more effective performance within selected naval specialty profiles: organizational (command), operational, and engineering-technical. This pilot study demonstrated statistically significant differences among specialty groups in terms of psychologic and psychophysiologic professionally important qualities. The most pronounced difference between personnel in the organizational, engineering-technical, and operational profiles compared with support personnel was observed on the Aspiration for Specialization scale of the Military-Professional Motivation Questionnaire, which reflects the depth and stability of motivation to master a specific military specialty. The most optimal psychophysiologic parameters and functional state indicators were found among personnel in the engineering-technical profile.

Background: In modern armed conflicts, wounds and injuries of various etiologies have become an inherent component of combat operations. The main research directions concerning such injuries are aimed at identifying causal relationships between the nature of the trauma, the features of its acute phase, and the development of complications, including acute kidney injury. A review of the literature revealed sufficient information on the leading pathophysiological mechanisms underlying the development of acute kidney injury. However, early diagnostic methods for this complication have not yet been developed, which prompted the conduct of this study.

AIM: To identify factors influencing the risk of acute kidney injury in combat casualties and to determine the frequency of the leading pathogenetic mechanisms in the early phase of traumatic disease.

MATERIALS AND METHODS: A prospective analysis was conducted involving 104 patients with wounds who were admitted to the 1602 Military Clinical Hospital of the Ministry of Defense of the Russian Federation (Rostov-on-Don) between January and March 2024. Upon admission to the multidisciplinary hospital, the severity of patients’ conditions was assessed using the admission condition scale developed by the Department of military field surgery. Based on the assessment results, patients were divided into three categories: 1—patients with decompensated traumatic disease (score >34; 17 patients, 16.4%); 2—patients with subcompensated traumatic disease (score 25–34; 49 patients, 47.1%); 3—patients with compensated traumatic disease (score ≤24; 38 patients, 36.5% of the total). Assessment included medical history, evaluation of vital signs, 24-hour urine output measurement, complete blood count, urinalysis, serial blood chemical analysis (three measurements), electrocardiography, and chest X-ray. Statistical processing of the experimental data was performed using SPSS Statistics 27 (IBM).

RESULTS: As a result of the study, diagnostic factors influencing the risk of this complication in the early phase of traumatic disease were identified, including hemoglobin, hematocrit, creatinine, estimated glomerular filtration rate, urea, 24-hour urine output, and potassium levels; their statistical significance was confirmed. Based on the intergroup analysis of the obtained data, no cases of acute kidney injury were recorded in the group of patients with compensated traumatic disease. The incidence of acute kidney injury was 82.3% among patients with decompensated traumatic disease and 24.5% among those with subcompensated disease. Of the 26 patients diagnosed with acute kidney injury, 12 (46.1%) presented with a non-oliguric form. The leading pathogenetic mechanisms were prerenal acute kidney injury due to hypovolemia (69.2%), renal injury associated with rhabdomyolysis (23%), and metabolic acidosis (8.3%).

CONCLUSION: The results obtained in this study indicate a high incidence of acute kidney injury (up to 25%) among patients with wounds and injuries in modern armed conflict, with prerenal mechanisms being the predominant pathogenetic variant. Due to the limited diagnostic value of standard methods, particularly in patients presenting with the non-oliguric form, it is essential to develop a comprehensive approach to the diagnosis of acute kidney injury in wounded and injured individuals. This approach should incorporate modern laboratory biomarkers and be applied during the early phase of traumatic disease.

Background: The study of infectious disease epidemiology among military personnel has long been a priority in military medicine. The COVID-19 pandemic underscored the critical role of pathogen genetic variability in shaping the patterns of the disease, serving as a demonstrative case for applying Belyakov’s (1983) theory of self-regulation of parasitic systems. Although numerous studies have addressed the epidemiologic aspects of COVID-19 in various organized communities, the specific characteristics of the disease among service members of the Armed Forces of the Republic of Kazakhstan remain insufficiently studied, underscoring the importance of the present research.

AIM: to investigate the epidemiologic characteristics of novel coronavirus disease (COVID-19) in the Armed Forces of the Republic of Kazakhstan through the lens of the theory of self-regulation of parasitic systems.

MATERIALS AND METHODS: A retrospective epidemiologic analysis was conducted to assess COVID-19 incidence among military personnel and the civilian population of the Republic of Kazakhstan. Data were obtained from departmental military medical statistical reports of the Armed Forces (Form 2/med) and publicly available official statistics provided by the National Center for Public Health under the Ministry of Health of the Republic of Kazakhstan. The comparative trends in COVID-19 incidence rates among military personnel and the civilian population were examined, along with the identification of epidemiologic features across the military-administrative territories of the Armed Forces of the Republic of Kazakhstan. A combination of epidemiologic and mathematical-statistical methods was used for data analysis and interpretation.

RESULTS: The study demonstrated that the genetically determined ability of the infectious agent to alter its epidemiologically significant properties (e.g., transmissibility, pathogenicity) in response to implemented anti-epidemic measures is a key factor influencing epidemic intensity. This adaptation may manifest as an increase in the number of cases, changes in disease severity and clinical forms, shifts in distribution across population groups, and other epidemic patterns.

CONCLUSION: The genetic plasticity of pathogenic microorganisms, activated in response to changes in human population characteristics, significantly influences the regional epidemiologic features of disease spread. These patterns must be considered when designing epidemic control systems in structured military settings.

Background: Peripheral nerve injuries represent a significant medical and social concern both in peacetime and during armed conflict. These injuries require prolonged inpatient care and frequently result in long-term disability. In response to peripheral nerve damage, retrograde reactive changes occur in the parent neurons and associated spinal cord cells. Understanding these processes may allow for more accurate predictions of clinical outcomes and recovery timelines. Elucidating the response of the lumbar spinal cord segment to peripheral nerve injury and subsequent treatment may enhance therapeutic efficacy.

AIM: To examine the regularities of reactive changes in the spinal cord segment following neurotmesis in order to improve the strategy and tactics of treating patients with this pathology.

MATERIALS AND METHODS: Experimental neurotmesis of the sciatic nerve was surgically induced in six male Wistar rats. Three animals received ipidacrine for seven days, whereas the remaining three served as untreated controls.

RESULTS: This electron microscopy study examined changes in the lumbar segment of the spinal cord seven days after neurotmesis, with and without ipidacrine treatment. Retrograde processes following sciatic nerve injury affected not only the parent neurons of the damaged fibers but also nerve fibers, glial cells (including oligodendrocytes), and the microcirculatory bed. Qualitative and quantitative differences in spinal cord morphology were observed between the experimental and control groups, and morphological predictors of successful recovery were identified.

CONCLUSION: The results of this study demonstrated that a 7-day course of ipidacrine administration following sciatic nerve neurotmesis exerted a beneficial effect on adaptive neuroplastic processes in the lumbar segment of the spinal cord.

The issue of motivating students of general education institutions under the Russian Ministry of Defense who require orthodontic care is examined from the perspective of creating conditions that foster their interest in engaging with dental specialists to achieve favorable treatment outcomes. A key aspect involves the development of individualized programs that align medical objectives with the personal interests of the students. For example, the use of digital technologies such as 3D bite modeling visually illustrates the stages of treatment, thereby enhancing student engagement. The role of caregivers and dental professionals extends beyond supervision; they are also responsible for fostering a trust-based environment that takes into account the age-related and sociopsychological characteristics of adolescents. For students aged 10 to 18 years, motivation is fostered by emphasizing improvements in appearance, which directly influence social adaptation, self-confidence, status within the peer group, and the development of leadership qualities. Incorporating elements of gamification into the motivational framework—such as awarding points or certificates for adherence to medical recommendations—helps reinforce discipline and responsibility throughout the course of treatment. In addition, joint meetings with parents or guardians and educational seminars on the significance of orthodontic health enhance external support. For students under continuous supervision, psychologic comfort is essential: peer group discussions of treatment success and open communication with healthcare professionals help reduce anxiety. This comprehensive approach not only improves treatment efficiency but also promotes goal-directed behavior in adolescents, which is particularly relevant to their future selection of a military occupational specialty. The integration of medical, educational, and social support thus establishes a solid foundation for developing motivated, disciplined, and healthy personnel for the Ministry of Defense of the Russian Federation.

Acute aortic syndrome refers to a group of life-threatening conditions characterized by acute injury to the aortic wall, primarily involving disruption of the intima and media. Acute aortic syndrome encompasses a spectrum of interrelated and overlapping clinical and morphological entities, including classic aortic dissection, intramural hematoma, penetrating aortic ulcer, and limited intimal tear. Differentiation of these variants based on clinical presentation and physical examination findings is not feasible. Imaging plays a pivotal role, and definitive diagnosis and classification of acute aortic syndrome variants are possible only through imaging studies. Multidetector computed tomography, transesophageal echocardiography, and magnetic resonance imaging are the primary imaging modalities used for the diagnosis of acute aortic syndrome, with contrast-enhanced multidetector computed tomography considered the gold standard. When classical imaging signs of a specific type of acute aortic syndrome are present, diagnosis is generally straightforward. However, a broad spectrum of imaging findings exists. In some cases, a single computed tomography scan may not allow for reliable differentiation among acute aortic syndrome variants. This limitation arises from the fact that these pathological entities may occur independently, progress from one to another, or coexist. The pathophysiology and clinical course of intramural hematoma and penetrating atherosclerotic ulcer of the aorta remain subjects of ongoing debate. In particular, the classification of intramural hematoma as a distinct acute aortic syndrome variant continues to be controversial. This article provides a concise overview of the current understanding of the pathophysiology, natural history, prognosis, and multidetector computed tomography-based diagnosis of the less common acute aortic syndrome variants, specifically intramural hematoma and penetrating atherosclerotic ulcer.