Vol 40, No 1 (2021)

The relevance of the study is associated with the formation of a complex of stress factors of the environment in relation to graduates of higher military educational institutions and lies in the need for a systematic solution to the problem of adaptation of medical officers to professional activities in the Arctic. The aim of the study is to develop promising directions for the prevention of diseases and increase the efficiency of medical officers on the basis of a systematic study of medical-geographical, military-professional and socio-psychological factors in the formation of stable adaptation in graduates of higher military educational institutions. An original questionnaire “Adaptation” has been developed, which allows assessing the impact of the complex impact of stress factors. A systematic approach has been applied to assess the contribution of medical-geographical, professional factors, as well as lifestyle. Based on the results of the regression analysis, prognostic models of the influence of factors on the psychophysiological indicators of health, as well as correlations between the three groups of factors and the adaptive capabilities of the organism of military personnel, were obtained. It is concluded that the adaptation of military personnel in the Arctic is more intense in comparison with the redeployment in the subtropics and temperate latitudes. Ensuring high performance of young officers requires the planning and implementation of preventive measures based on monitoring the medical and geographical situation, preliminary adaptation to upcoming service activities, the development of infrastructure for everyday life and recreation of the families of military personnel, scientific support for the problem of redeployment of troops, including the adaptation of young officers. Ensuring high efficiency of young officers requires planning and implementation of preventive measures based on monitoring the medical and geographical situation, preliminary adaptation to the upcoming service activities, development of the infrastructure of everyday life and recreation for families of military personnel, scientific support of the problem of redeployment of troops (1 table, bibliography: 11 refs).

This article is devoted to the patterns of changes in the QRS complex and the ST-T segment in patients with a new coronavirus infection. The article presents the results of a comparison of electrocardiogram data in 70 patients with COVID-19 who were treated in 1st Department of Internal Medicine Postgraduate Training from April to July 2020. Each patient had at least two electrocardiograms taken (at the beginning and at the end of the disease). In the course of the work, a new method for measuring the area of the teeth P, T, QRS complex and ST-T segment was developed and described using the dynamic mathematical program GeoGebra Classic 6.0 by correlating the millimeter grids of the electrocardiogram and the program and further constructing an irregular shape taking into account the polarity of the teeth and segments. According to the study, the sum of the ST-T segment areas in all 12 leads is statistically significantly greater at the end of the disease in individuals over 30 years old. It is also significantly higher in the right thoracic leads (V1-V2) in for all ages. Probably, these changes are associated with the severity of the underlying disease and, consequently, with the overload of the right parts of the heart.

AIM: revealing microstructural brain connectivity alterations in patients with paranoid schizophrenia.

MATERIALS AND METHODS: 25 patients diagnosed with paranoid schizophrenia were examined. The control group was 30 healthy people without neurological and somatic diseases. Studies were carried out on the Philips Ingenia magnetic resonance tomograph, with a magnetic field strength of 1.5 T using the DTI pulse sequence. Data processing was carried out using the tractographic module “DSI Studio”.

RESULTS: According to the group assessment of the obtained tractographic brain data, significant differences in microstructural connectivity in the group of patients with paranoid schizophrenia were detected. A pathological conglomerate of cortical-subcortical structure connectivity was found, different from the sets of normal connections in the control group, consisting of a cingulate gyrus, hippocampus and thalamus. Such a pathological control center is one of the possible tractographic patterns of schizophrenia. In our opinion, the pathological connectivity of the hippocampus and thalamus, as one of the main components of the limbic system of the brain, reduces the controlling emotional function of the cingulate cortex, the control center of this system. In this case, excessive connectivity of the hippocampus with the cingulate cortex may indicate an incorrect implementation of their interaction, which also affects the occurrence or progression of emotional-will disorders. The thalamus, being the center of transmission of sensory and motor information from the sensory organs, can transmit incorrect redundant data about what is happening around the body and participate in the formation of auditory and visual hallucinations. Also, the pathological work of the thalamus may be involved in the progression of autism. Thus, the patient is increasingly losing touch with reality, increasingly preferring unknowingly fantasy, erasing ties with reality. Data from one of the characteristics of the artiformal neural network – the clustering coefficient – were significantly increased in patients compared to the control group, which may indicate the presence of excess, abnormal microstructural connectivity in the network.

CONCLUSION: The study confirms the presence of microstructural and neural network changes in the hippocampus, thalamus, cingulate cortex and basal ganglia. These changes are peculiar tractographic semiotic signs of brain pathology in paranoid schizophrenia. This study is a step in the search for a tool to identify the features of neuroplasticity disorders in this disease and schizophrenia screening (2 figures, 3 tables, bibliography: 13 refs).

AIM: Walking disorders are a frequent consequence of stroke. New technologies, such as the use of robotic exoskeletons, can help with recovery, but their effectiveness has not yet been sufficiently proven.

MATERIALS AND METHODS: Forty-two patients with spasticity and walking disorders (stroke duration from 1.5 to 4 years) were included in the study. The Tardieu Scale, Modified Ashworth scale, Medical Research Council Scale, 10 Meter Walk Test, Rivermead Mobility Index, Berg Balance Test, Rankin scale, and a Visual Analog Scale (to assess patient satisfaction with treatment) were used in assessments. The patients were randomized into 2 groups (n = 22 & 20): the first group received exoskeleton walk training with the powered exoskeleton, ExoAtlet, and the second group received physical therapy sessions, each for 1 hour daily over 10 days. Clinical evaluations of patients were performed at 3 timepoints: baseline (Day 1), and 12.

RESULTS: Comparison of both groups at the second timepoint showed significantly better results (p < 0.05) in the first group vs the second group. Walking speed increased due to balance training, correction of postural disorders, spastic muscle stretching, and stretch reflex suppression.

CONCLUSION: The wearable powered ExoAtlet exoskeleton is a promising technology for improving walking (2 tables, bibliography: 13 refs).

Increasingly, in various spheres of activity, specialists of management bodies use simulation tools to optimize the work of medical organizations of different levels and directions. It should be noted that in the available literature no information was found on the use of the described method for modeling the process of providing medical care simultaneously in several objects of the medical service with a description of their interaction. Simulation modeling makes it possible to assess the load both on individual stages and on the entire evacuation direction before the direct involvement of the forces and means of the medical service. The aim of the study was to create a system for analyzing and visualizing data used to optimize decision-making on the distribution of forces and means of the medical service in the evacuation direction using simulation modeling. We used literature data, schemes for deploying the stages of medical evacuation, timing of treatment and evacuation measures, the power and structure of the flows of the wounded and sick. Simulation modeling was carried out in the Anylogic software. The discrete-event model is built on the basis of the mathematical apparatus and calculation tasks that are used to assess the time indicators of the implementation of medical and evacuation measures. These include such parameters as the start time of medical care, the average waiting time for the provision of medical care to the wounded and sick in the queue, and other parameters. The simulation model makes it possible to display information about the load on individual units or stages, which makes it possible to quickly assess the total load on the direction and make a decision on the transfer of forces and means of the medical service to a more loaded section of the evacuation direction. The introduction of simulation modeling into the activities of the medical service of the Armed Forces of the Russian Federation will make it possible to efficiently control the quality of medical and evacuation measures in the entire evacuation direction (4 figures, 1 table, bibliography: 15 refs).

AIM: to determine the prospects for the preventive endoprosthetics of the abdominal wall at preventing the development of postoperative ventral hernias.

MATERIALS AND METHODS: A meta-analysis of the literature data performed to determine the effectiveness of preventive endoprosthetics for the prevention of ventral hernia formation. Topographical study has been conducted to explore the most promising levels of the mesh location.

RESULTS: During the meta-analysis it has been found that performing preventive endoprosthesis of the anterior abdominal wall t in the preperitoneal space reduces the frequency of ventral hernias. There were no significant differences in the frequency of infectious complications and serom in the experimental and control groups according to studied publications. During the preparation it has been distinguished that between the transverse fascia and the peritoneum there is a preperitoneal fascia consisting of two leaves, which is most manifest in the lateral parts. In the umbilical region above linea arcuata the preperitoneal fascia is thinned and represented by separate fibers that are difficult to differentiate as a structure between the transverse fascia and the peritoneum. In the lateral parts of the abdominal wall, the preperitoneal fascia is well expressed. It has been distinguished that the retroperitoneal fascia, formed by the junction of two sheets of the Gerot fascia continues into the fascia between the transverse fascia and the peritoneum.

CONCLUSION: Preventive endoprosthesis of the anterior abdominal wall is an effective and safe method of preventing the formation of postoperative ventral hernias. The anterior abdominal wall is characterized by a complex multifascial structure, which is of fundamental importance for various types of surgery. Between the transverse fascia and the peritoneum there is preperitoneal fascia which is represented by two leaflets. It’s continuation is the retroperitoneal fascia (5 figures, 2 tables, bibliography: 8 refs).

The rapid development of aviation technology entails the need to increase the quality of ergonomic support. This is due to the fact that for the safe implementation of activities, the pilot has to use the entire amount of attention, not rarely, at the limit of his capabilities. The color of the instrument scales, the contrast of the information feed, and other information perception conditions can significantly complicate the evaluation of the flight instrument readings. This is especially true with the transition of most modern aircraft from analog display of instrument readings to digital. The study examines the features of perception of digital information by operators of aviation profile with different color background of the stimulus material. The analysis of the results of the solution by operators of 3 Schulte tables and 3 Schulte–Platonov tables on the combined hardware complex “NS-Psychotest” with the system of fixing the coordinates of the eye-stationary eye tracking “RED250mobile eye tracking device”. When performing the eye search function, the number of visual fixations and the task completion time were calculated. It was found that when searching for digital values on Schulte tables with a white background, the number of eye fixations was less than when performing a similar task on black-and-red Schulte–Platonov tables. Accordingly, it also took less time to solve black-and-white tables. A trend was found showing that the search for digital values represented in the Schulte–Platonov tables on a red background was carried out by operators faster than on a black background. Further study of this topic can contribute to the development of proposals for ergonomic support of aircraft, which in turn will help to maintain the reserves of attention of operators in a continuous stream of incoming data (2 figures, 1 table, bibliography: 13 refs).

The share of eye injuries in Russia is from 3 to 8% of the total number of injuries in peacetime. Eye trauma is one of the three main causes of vision disability and accounts for 22.8%. In wartime, the mass admission of wounded with damage to the organ of vision requires prompt decisions on their sorting, treatment, rehabilitation, dismissal, or return to duty. In peacetime, mechanical trauma to the eye is associated with the disability of the working population and large material costs. Considering the relevance of mechanical trauma to the eye, ophthalmologists around the world are constantly investigating the features of the pathogenetic mechanism, diagnosis, and treatment. Retrospective studies are based on the analysis of clinical cases, which are not always homogeneous. Experimental damage modeling has a long history. Attempts to simulate mechanical eye trauma have been made since the 40s of the XX century. Mathematical models are calculated based on known data: thickness, density, the elasticity of tissues, this makes it possible to predict the result of exposure to a wounding agent. Unfortunately, in these models, it is difficult to reproduce the entire complex of pathomorphological changes. The created models fulfilled the assigned tasks but had certain drawbacks. In each subsequent experiment, the reproducibility improved and the model approached the desired one as accurately as possible. Specialists of the Professor V.V. Volkov Ophthalmology Department S.M. Kirov Military Medical Academy since the 40s. are engaged in solving this problem. For the first time in an experiment, B.L. Pole proved that closure of eyeball wounds with corneal and scleral sutures has an advantage over conjunctival covering. B.V. Monakhov et al. created an installation for inflicting mine-explosive injury to the eye. In the experiment, M.M. Shishkin inflicted a combined eye injury by striking the sclera with a knife with a rectangular blade and firing an air rifle at the knife handle. B.A. Kanevsky et al. reproduced a D-type gunshot open eye injury shot from an air rifle with a multi-compression piston pump. The creation of models that reproduce the mechanical trauma of the eye made it possible to study it in an experiment, which improved the quality of diagnostics and reduced the proportion of disability in this pathology (bibliography: 24 refs).