Russian Military Medical Academy Reports

BACKGROUND: Treating penetrating abdominal wounds at levels 3–4 of medical care remains insufficiently standardized, and surgical tactics often depend on various factors and resource availability. This study analyzes surgical approaches used at these levels and identifies key factors that influence tactical decision-making.

AIM: This study aimed to analyze surgical tactics for treating patients with penetrating abdominal injuries in medical facilities at levels 3–4 of medical care during modern armed conflict.

METHODS: We retrospectively reviewed 142 medical records of patients with penetrating abdominal wounds. Patients were divided into three groups based on the surgical tactics used at levels 3–4: group 1, observation with reconstructive surgery performed at the analyzed level; group 2, second-look surgery; group 3, no surgical intervention.

RESULTS: We identified factors that significantly determine the need for surgery and statistically influence the choice of surgical tactics: traumatic shock grade II (p < 0.012), abdomen as the primary injury site (p < 0.010), and peritonitis (p < 0.001). Intestinal anastomosis was performed in 26.5% of patients with small bowel injury and was the predominant reconstruction method. For colon injuries, an intestinal stoma was created (18.3%). Layered closure was associated with 41.7% of relaparotomies at level 5. Treating peritonitis without vacuum assisted abdominal drainage is ineffective in 75% of cases.

CONCLUSION: Traumatic shock severity, abdomen as the primary injury site, and peritonitis are key factors determining the need for surgical intervention at levels 3–4. The high complication rate, particularly after rectal injury and non-vacuum drainage for peritonitis, highlights an urgent need to standardize treatment protocols according to clinical guidelines to improve outcomes.

BACKGROUND: Risk management in the provision of medicines to citizens within the framework of state guarantees is an important component of the pharmaceutical quality system and requires the introduction of modern approaches to risk management, including inventory management of medicines, quality control and timely delivery.

AIM: To conduct an analysis of risk management in the field of preferential drug provision to the population (using the example of certain territories of the North Caucasus region) in order to develop measures aimed at minimizing threats related to the quality of medical services and the availability of medicines.

METHODS: The research materials included content, structural and functional, marketing analyses and the questionnaire method.

RESULTS: The key areas of application of risk management procedures in relation to the quality of preferential drug provision are identified; the results of classification, identification and risk analysis are presented; risk assessment methods are described, their register is compiled, as well as risk management strategies are justified and specific risk management tools are proposed.

CONCLUSION: The main areas of application of risk management for the quality of preferential drug provision have been identified. A risk classification has been developed, risk identification and risk analysis have been carried out. Such quality risk assessment tools have been proposed and adapted for use in the healthcare system, as well as a version of the registry of risks of preferential drug provision.

BACKGROUND: Despite the importance of physical activity and physical performance indicators and their decisive influence on public health, no studies have examined the dependence of physical activity as a controllable parameter and physical performance as a derivative of physical activity level.

AIM: This study aimed to analyze how physical performance level depends on physical activity.

METHODS: We used two categories as physical activity criteria: one was a subjective characteristic of physical activity level (the level perceived by the individual) and another was the distance a person walks per day (average value). Admittedly, the second characteristic was also subjective, but it allowed a more accurate assessment of a person’s physical activity level. We applied nonparametric estimation of association strength using the χ² test and a nonparametric analogue of the correlation coefficient (association coefficient, C_a). The study identified five age groups according to WHO recommendations: 18–29 years, 30–44 years, 45–59 years, 60–74 years, and ≥75 years. The sample included 724 men (48.6%) and 765 women (51.4%).

RESULTS: We found no association between subjectively determined physical activity level and actual physical activity volume, except for a weak association in young and older men (18–29 years and 60–74 years). The perceived physical activity level cannot serve as a reliable criterion for actual exercise, and using perceived physical activity data for objective assessment is inappropriate across all age groups. It should also not be used as a criterion for evaluating interventions aimed at improving physical fitness and performance in the general population.

CONCLUSION: Quantitative analysis showed that the most accurate and adequate criterion for physical activity level—which ultimately affects both aerobic and anaerobic physical performance—is the average value of the distance that a person walks per the day. These associations are stronger in men and somewhat weaker in women, but the overall pattern remains consistent.

The role of plant-derived polysaccharides in human life is determined by their increasing impact on health and on preserving and enhancing human resources. Considering the multifunctional effects of polysaccharides on the human body, it appears appropriate to expand the scope of research on plant raw materials rich in these compounds. In this context, one approach involves engaging researchers in the search for new plant sources of polysaccharides, investigating their pharmacological effects, and developing new medicinal products based on them. The use of plant-derived polysaccharides as therapeutic and preventive agents is a relevant and increasingly important area in medical practice. Polysaccharides are high-molecular-weight compounds formed by condensation of monosaccharide residues and their derivatives linked by glycosidic bonds. Chemical modification, such as sulfation, is a potential strategy for improving physicochemical properties, as well as enhancing the bioavailability and stability of polysaccharides. The diversity of natural resources provides continuously renewable sources of plant-derived polysaccharides and creates broad opportunities for studying their pharmacological properties. The review includes fundamental and applied studies indexed in bibliographic databases (such as PubMed, ScienceDirect, Google Scholar, CyberLeninka, and eLibrary). The scientific data search was conducted using the keywords полисахариды растительного происхождения (plant-derived polysaccharides), фитопрепараты (phytopharmaceuticals), and химическая модификация полисахаридов (chemical modification of polysaccharides). This review presents an analysis of current data on plant-derived polysaccharides, highlighting the scientific and technological prerequisites for their application in the pharmaceutical industry in the near future. A comprehensive evaluation of plant-derived polysaccharides use as therapeutic and preventive agents incorporates perspectives from both Russian and international researchers. These findings indicate a pressing need for detailed investigation of the physicochemical properties of individual polysaccharides exhibiting pronounced immunomodulatory, antioxidant, and prebiotic activities.

Obstructive sleep apnea affects the function and performance of virtually all organs and systems. Its impact on the lungs is expected, given shared anatomical pathways and its influence on key physiological processes related to gas exchange, which contribute to the development and progression of bronchopulmonary diseases. Pathogenetic interactions between obstructive sleep apnea and bronchopulmonary diseases are complex and insufficiently addressed in the Russian scientific sources. A hallmark of obstructive sleep apnea is oropharyngeal collapse, leading to transient airflow limitation, marked fluctuations in intrathoracic pressure, and recurrent hypoxia and hypercapnia. The subsequent cytokine-mediated inflammatory cascade, combined with mechanical stress on lung tissue, contributes to pulmonary damage and may aggravate conditions such as chronic obstructive pulmonary disease, asthma, interstitial lung diseases, pulmonary hypertension, and others. Despite available evidence on the impact of obstructive sleep apnea on the course of specific lung diseases, clinicians often fail to recognize and/or adequately consider this condition, leaving patients without appropriate treatment. This review includes fundamental and clinical studies, systematic reviews, and narrative reviews describing the association between obstructive sleep apnea and other respiratory diseases. Data searches were conducted in MEDLINE, PubMed, Google Scholar, Scopus, and eLibrary. The search strategy consisted of keyword queries including синдром обструктивного апноэ сна (obstructive sleep apnea), хроническая обструктивная болезнь легких (chronic obstructive pulmonary disease), бронхиальная астма (bronchial asthma), саркоидоз (sarcoidosis), and заболевания легких (lung diseases). A total of 38 publications in Russian and English were included. The aim of this review is to analyze and summarize current evidence on the relationship between obstructive sleep apnea and bronchopulmonary diseases in order to improve awareness among healthcare professionals regarding the clinical course of obstructive sleep apnea in combination with other lung diseases.

Whey protein has emerged as a promising therapeutic agent in clinical nutrition due to its high-quality protein content and bioactive components. This systematic review evaluates the effects of whey protein supplementation on wound healing and infection prevention by analyzing 53 clinical and experimental studies published between 2015–2025. The results showed that whey protein significantly accelerated wound healing through a variety of mechanisms, including increased collagen synthesis, tissue regeneration, and epithelialization. Its immunomodulatory properties are particularly prominent, with studies showing decreased levels of pro-inflammatory cytokines (IL-6, TNF-α) and increased immune markers (IgG, IL-10). This review identified whey protein isolate (WPI) and hydrolyzed whey peptides as the most effective formulations, with optimal results achieved at doses of 30–40 g/day for 3–4 weeks. In addition, topical applications show a strong antibacterial effect against common wound pathogens. These findings support the use of whey protein as an adjuvant therapy in postoperative recovery, geriatric care, and malnutrition management. The review concludes with practical recommendations for clinical implementation and emphasizes the need for further research to standardize protocols as well as evaluate long-term outcomes in different patient populations.

This article evaluates the medical and sanitary measures associated with the naval engagement between the cruiser Varyag and the Japanese squadron. The analysis of scientific data and archival sources made it possible to examine not only the work of the ship’s medical staff but also the contributions of medical personnel from neutral countries, as well as the activities of the Japanese Red Cross Society in providing care to wounded Russian sailors. We conclude that the medical care actually provided to the wounded was delivered in the necessary volume, despite the enemy’s use of new types of weapons that had not previously been used in combat conditions; the cruiser was medically and sanitarily prepared for the naval battle, and the crew was trained in self-aid and mutual aid methods. Initial first aid to the sailors was provided properly and in the required volume; the evacuation of the wounded under the protection of the Japanese Red Cross Society and their treatment by its staff were necessary, and the subsequent medical work by Japanese specialists was performed with sufficient skill, ensuring the wounded received attentive care and rehabilitation. The medical aspects of this “short but intense cruiser battle” were later used by contemporaries to develop proposals aimed at enhancing the combat effectiveness of warships and improving medical support within the navy.

Pulmonary sequestration is a rare congenital lung malformation characterized by a dysplastic segment of pulmonary parenchyma that lacks normal connection to the tracheobronchial tree and receives blood supply from aberrant systemic arteries—most commonly from the aorta and its branches. Two types of sequestration are distinguished based on the location of the abnormal lung tissue relative to the visceral pleura: intralobar and extralobar sequestration. Clinical presentation ranges from asymptomatic incidental imaging findings to symptomatic cases with varying degrees of respiratory or infectious manifestations depending on lesion size and location. Surgical approach depends on sequestration type, making accurate preoperative diagnosis essential. Currently, contrast enhanced computed tomography (CT) is highly informative for evaluating parenchymal changes in the abnormal lung segment, as well as vascular anatomy. This article briefly reviews the etiology and clinical features of pulmonary sequestration and illustrates CT parenchymal and vascular signs that help diagnose and differentiate sequestration types. CT parenchymal findings are highly variable, depending not only on sequestration type but also on the duration of recurrent inflammation in the abnormal segment and the presence of associated congenital airway malformations. The CT semiotics of parenchymal changes in this condition have not been systematized in the literature; different authors provide different descriptive features, focusing on individual signs. The key diagnostic sign of pulmonary sequestration is an aberrant artery arising from the systemic circulation (either from the systemic or pulmonary circuit). Venous drainage and the characterization of sequestration boundaries are important imaging features for differentiating sequestration types (intralobar vs. extralobar). However, diagnosis is complicated by sequestra with mixed venous drainage into both the pulmonary and systemic circuits, which does not always allow assignment to a specific type.

Miroslav M. Odinak, a distinguished neurologist and healthcare administrator, was born on January 19, 1946, in the village of Borivtsi, Chernivtsi Oblast. After graduating from medical school and serving in the Air Force, he began his career at the S.M. Kirov Military Medical Academy in 1973. He rose through the ranks from a resident to the head of the Department of Nervous System Diseases (1994–2014), eventually becoming Chief Neurologist of the Russian Ministry of Defense. Under his leadership, the department became a leading center for training military neurologists, implementing cutting-edge treatment and diagnostic methods. Vascular departments, a resuscitation and intensive care unit for neurological patients, and traditional and functional diagnostic departments were established. M.M. Odinak made a significant contribution to the development of Russian neurology, initiating the first thrombolysis procedures for stroke in Russia, high-dose immunosuppressive therapy for multiple sclerosis, and stem cell transplantation for ALS. He founded the scientific school “Study of Diseases and Injuries of the Nervous System.” He is the author of over 640 scientific papers, including 14 monographs. He supervised the defense of 24 doctoral and 45 candidate dissertations. He is a Corresponding Member of the Russian Academy of Sciences, an Honorary Doctor of the Military Medical Academy, and has been awarded the Order of the Badge of Honor and other state awards. He is also the winner of the All-Russian Physicians’ Competition (2015). Colleagues and students congratulate M.M. Odinak on his 80th birthday, recognizing his invaluable contribution to the development of neurology and healthcare.