Vol 40, No 2 (2021)

Military and extreme medicine

Additive technologies in military affairs

Peleshok S.A., Fisun A.Y., Morozov A.V., Kalinin S.V., Eliseeva M.I.


In order to determine the features and main ways of using additive technologies within the framework of the scientific and business program of the International Military-Technical Forum “Army-2020”, a round table was held. In recent years, additive technologies have made a significant leap forward thanks to the improvement of electronic computing technology and software (software), the creation of a wide range of 3D printers that print using various modern methods and materials. The following industries are leading in the development of 3D printing as consumers: aircraft construction (33%), nuclear industry (30%), military-industrial complex (13%), as well as medicine (11%), education, etc. The summary contains part of the speeches of the speakers of the scientific event on the use of additive technologies in education and medicine. To achieve Russia’s position as one of the leaders in the global technology market, a network of educational institutions is developing and the provision of educational institutions with 3D printers. The country’s universities and, in particular, Bauman Moscow State Technical University began to develop professional competencies among graduates in the field of additive technologies, materials and equipment. Other universities use reverse engineering for research and development, the launch of new production. In medicine, models of complex elements of the human skeleton are created, in particular, individual bones and various projections of the skull, bones of the spine, hand and foot, as well as some models of organs from hard and semi-soft plastics to improve the educational process. The capabilities of 3D printing of mock-ups of organ pathologies are used for preoperative planning and rehearsal of an operation in thoracic and cardiovascular surgery, as well as for training students and doctors, modeling hemodynamics and testing medical devices. Alternative materials and methods for making splints and splints for fixing injuries and diseases of the upper limb are considered. To create ceramic products in dentistry, instead of injection molding and pressing, the technology of Lithography-based Ceramics Manufacturing printing with a suspension on foreign equipment was proposed. Three-dimensional printing has partially filled the need for personal protective equipment against the new coronavirus infection, in particular through the creation of reusable masks, various adapters, holders of face masks, linings on door handles, etc. The participants of the round table agreed that the results of scientific and innovative activities in the field of additive technologies should be tested, implemented and used in the educational process, practical activities, including military medicine (bibl.: 6 refs).

Russian Military Medical Academy Reports. 2021;40(2):5-12
pages 5-12 views

Problems of medical and biological support of the process of developing advanced bulletproof vests

Denisov A.V., Logatkin S.M., Demchenko K.N., Nosov A.M., Yudin A.B., Anisin A.V.


Currently, as part of combat equipment, body armor is the main tool designed for individual protection of a person’s torso from bullets, shrapnel and steel arms. Since March 1, 2019, GOST 34286-2017 has been introduced as a national standard of the Russian Federation, in which one of the assessed indicators of the resistance of armored clothing to the effects of means of destruction is the indicator of the reserve effect of the striking element when the protective structure is not penetrated, which should not exceed the value taken as the maximum permissible in the prescribed manner. In this case, the pre-armor effect of a striking element in case of non-penetration of the protective structure is assessed only after the completion of the development of a sample of armored clothing by the corresponding accredited organization. The existing methods for determining the permissibility of the reserve impact indicator when the protective structure is not penetrated can in principle be divided into medical, biological and technical, and technical. In the Russian Federation, the method using large laboratory animals, pigs weighing 80–90 kg, is mainly used to determine the level of the reserve impact in terms of the severity of the reserve contusion injury. While in NATO countries, human corpses, individual tissues and organs, as well as parts of carcasses of large animals are used to determine the same parameter. However, at present, both in our country and abroad, there is no single methodological approach to assessing the impact of armor when testing protective products. As a result of targeted research, it is necessary to scientifically substantiate the principles of modeling this effect when the body armor is not penetrated with the subsequent processing of standard methods of state testing of body armor. The tests must be based on a method that allows obtaining parameters expressed in digital values and correlated with the results of experiments on biological objects. It is this “numerical” parameter that should be taken as a criterion for assessing the permissibility of the level of shock impact when testing promising personal body armor (bibliography: 21 refs).

Russian Military Medical Academy Reports. 2021;40(2):13-20
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HLA typing methods used for organ and tissue transplantation

Kolyubaeva S.N., Myakoshina L.A., Eliseeva M.I., Glushakov R.I.


The antigen system on the surface of human cells is responsible for recognizing foreign antigens. In organ transplantation, the immune system reacts to all foreign antigens that are different from the recipient’s antigens. In practice, solid organ transplantation is carried out with varying degrees of genetic discrepancy, while the main principle that should be followed to prevent acute and chronic transplant rejection reactions is to avoid unacceptable discrepancies. As a result, the diagnosis of typing genes of histocompatibility allows you to select a donor to which the recipient will not have sensitization. The article presents an analysis of various methods for typing human histocompatibility genes for organ and tissue transplantation. The discovery of the polymerase chain reaction was a new stage in the typing of human histocompatibility genes, which made it possible to develop new methods of gene typing. As a result, methods have been developed for typing genes using sequencers, including a new-generation MiSeq sequencer (Illumina, USА), a Massarray genomic time-of-flight analyzer (Agena Bioscience, USA). The use of sequencing has led to the possibility of simultaneous typing from 24 to 100 DNA samples. Modern technological solutions have made it possible to improve the 3rd generation NGS sequencers and provide a maximum productivity of up to 30 billion nucleotides per run, minimize restrictions on the length of DNA readings, as well as track parameters, control the sequencing process and conduct base-scaling in real time. Modern data using rapid genes typing of the human histocompatibility system (MinION Oxford nanopore) meet the needs of particularly sensitive recipients. Preliminary evidence suggests that this method will be more economical and efficient and will replace all previous ones over time (8 figs, bibliography: 40 refs).

Russian Military Medical Academy Reports. 2021;40(2):21-32
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Mechanisms of action of new oral coagulants

Kokorina A.A., Sokolova M.O., Slizhov P.A.


The article provides a brief description of drugs in the class of direct oral anticoagulants. The mechanisms of the therapeutic effect and the ways of excretion of drugs-inhibitors of blood coagulation factors Xa and IIa are considered. It was shown that all of them are characterized by high selectivity to the active centers of target molecules, successfully affect the coagulation cascade and have a quick therapeutic effect. A comparative analysis of drugs of the class of direct oral anticoagulants showed that rivaroxaban, apixaban, edoxaban, betrixaban (inhibitors of FXa) and dabigatran (inhibitor of factor IIa) do not have significant advantages over each other in terms of mechanism and speed of action. A comparison of the main characteristics of direct oral anticoagulants and the indirect anticoagulant warfarin is presented. It is shown that, first of all, the advantage of the former is associated with an immediate pharmacological response. The decision to prescribe this drug requires consideration of risk factors for the patient, such as age, the presence of chronic diseases of the gastrointestinal tract, liver and kidneys. The article presents the most frequent complications of anticoagulant therapy, as well as the mechanisms of action of specific and universal antidotes indicated for use in patients with life-threatening bleeding or in need of urgent surgery when using direct oral anticoagulants. However, such neutralizing agents have not yet found widespread use due to their high cost and low availability. Nevertheless, the emergence of direct anticoagulants on the market has undoubtedly led to significant progress in the treatment of thrombotic and cardiovascular diseases (1 table, bibliography: 28 refs).

Russian Military Medical Academy Reports. 2021;40(2):33-40
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Clinical medicine

Clinical case of eosinophilic granulomatous polyangiitis debuted by myocardial infarction

Kryukov E.V., Cherkashin D.V., Grishaev S.L., Turdialieva S.A., Mozharovskaya E.A., Sharova N.V., Kudrina O.M., Vorobyov S.L.


The article presents clinical observations demonstrating the difficulties of diagnostic search in establishing the diagnosis of systemic vasculitis associated with antineutrophil cytoplasmic antibodies, which include a rare disease – eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome). Carefully collected anamnesis, participation of specialists of different profiles, retrospective analysis of laboratory and instrumental data allowed to verify the diagnosis, to prescribe adequate therapy. The aim of the publication is to discuss the need for early diagnosis of eosinophilic granulomatosis with polyangiitis, which can improve the effectiveness of therapy and improve the overall prognosis for this disease, taking into account modern approaches based on the main provisions of international recommendations that were prepared in 2015 with the participation of leading experts from Europe, USA and Canada and were called to become the basis for choosing a personalized patient therapy strategy. In some cases, the diagnosis of eosinophilic granulomatous polyangiitis is complicated by the diversity of the clinical picture, the non-simultaneous appearance of the main symptoms and the violation of the stages of the process. In the differential diagnosis of systemic vasculitis, assessment of initial clinical manifestations, testing for the presence of antibodies to the cytoplasm of neutrophils, multispiral computed tomography of the chest organs and diagnostic biopsy of the affected tissues are crucial. In the histological conclusion, a picture of focal ulcerative-necrotic lesions of the nasal mucosa with signs of vasculitis and a pronounced eosinophilic cell component of inflammation was noted. The distinctive features of this case include the onset of the disease with the development of myocardial infarction and early damage to the hearing organ in the form of cochlear neuritis, complicated by sensorineural hypoacusis. The combination of high doses of glucocorticosteroids and cyclophosphamide is still the “gold” standard for the treatment of severe cases, but the use of biological agents such as rituximab or mepolizumab seems to be a promising therapeutic alternative (4 figs, bibliography: 3 refs).

Russian Military Medical Academy Reports. 2021;40(2):41-48
pages 41-48 views

Features of the structure of cardiovascular diseases risk factors for complicated myocardial rupture myocardial infarction in young and middle-aged men

Izmuhanov A.S., Gordienko A.V.


AIM: Myocardial rupture currently remains in most cases a fatal complication of myocardial infarction.

OBJECTIVE: To study the features of the structure of cardiovascular risk factors in men under 60 years old with complicated myocardial infarction to improve prevention.

MATERIALS AND METHODS: The study included men 19–60 years old with type I myocardial infarction. The patients were divided into two groups age-comparable: I – studied, with myocardial rupture – seven patients; II – control, without breaks – 558 patients. A comparative analysis of the frequency of observation of the main and additional factors of cardiovascular risk in the selected groups was performed.

RESULTS OF THE STUDY: In the patients of the study group, frequent (four or more times a year) colds were observed more often than in the control group (42.9 and 14.8%, respectively; p = 0.04), the internal organs foci of infections (85.7 and 40.3%; p = 0.049), bypass surgery (57.1 and 10.2%; p < 0.0001) and continuous cardiac pacing (28.6 and 0.5%; p < 0.0001) in medical history. The presence of arterial hypertension (28.5 and 67.6%; p = 0.03) and foci of oral cavity infections (0 and 20.3%; p = 0.049) reduced the risk of myocardial rupture. In the study group, the levels of total cholesterol (4.3 ± 0.3 and 5.8 ± 1.2 mmol/l); p = 0.02), low-density lipoproteins (2.7 ± 0.1 and 4.2 ± 1.2 mmol/l); p = 0.04) and triglycerides (0.7 ± 0.1 and 2.6 ± 1.8 mmol/l); p = 0.008) were lower than in the control.

CONCLUSION: Combinations of these cardiovascular risk factors indicate an increased risk of myocardial rupture. It is advisable to use them for predictive modeling of this event and the formation of risk groups for the purpose of timely prevention, (bibliography: 18 refs.).

Russian Military Medical Academy Reports. 2021;40(2):49-54
pages 49-54 views

Anemia of chronic diseases as an interdisciplinary problem

Bondarchuk S.V., Golovko K.P., Ovchinnikov D.V.


Anemia is believed to be a medico-social problem affecting a great part of population. Anemia of chronic diseases represents a considerable number of these disorders, which is particularly challenging for long-standing inflammatory processes, systemic diseases and neoplasms. Pathogenesis of this type of anemia is characterized by complex and miltifactorial nature. Pathogenesis is based on disturbance of erythropoietin synthesis and erythropoiesis precursor cells sensitivity, hyperproduction of factors inhibiting erythropoiesis (tumor necrosis factor, interleukins), disturbance of iron metabolism and other hemopoiesis co-factors. Anemia aggravates associated underlying disease course. Quality of life and overall survival deteriorate. Treatment efficacy for anemia influences the time of patient recovery, as well as success of treatment of other diseases. Iron deficiency and erythropoiesis disturbance, similar to hypoferric anemia, are of great importance. However, iron therapy may aggravate patient’s condition, hence differential diagnosis of this anemia type and true iron deficiency anemia has a great practical value. In the treatment of anemia in the presence of chronic diseases and anemia in the presence of hematologic diseases, the goal of the treatment is generally limited by the improvement of patient’s quality of life, target value of hemoglobin for transfusion or erythropoiesis stimulating therapy remaining the subject for discussion. Hemoglobin target determination in individuals with cardiac and pulmonary insufficiency who are on chemotherapy, is critically important, because it is this category of patients that does not demonstrate generally accepted target values of hemoglobin, the level of which is not always indicative of hypoxia absence. The review presents current data on diagnosis, treatment of chronic disease anemia (1 figure, 2 tables, bibliography: 12 refs).

Russian Military Medical Academy Reports. 2021;40(2):55-61
pages 55-61 views

Biomedical research

Topical issues of cardiovascular disease in patients with new coronoviral infection COVID-19. Clinical and morphological study

Zbyshevskaya E.V., Makeeva T.I., Bitakova F.I., Bakholdina M.N., Sivtsova E.V., Semenova G.M., Zaytseva O.B.


In about 30% of cases, Sars-CoV-2 pneumonia is complicated by damage to the cardiovascular system – myocardial infarction, pulmonary embolism, strokes, which are often fatal. There is still little data on the relationship between clinical manifestations and structural changes in the cardiovascular system during a new coronavirus infection. The material for the study was the data of the case histories and autopsies of 185 patients suffering from COVID-19 infection in the period September–December 2020. In the deceased patients, a higher percentage of lung tissue damage was recorded on CT data, and a low level of oxygen saturation at the time of hospitalization. Most of the patients had a history of cardiovascular disease, diabetes mellitus, chronic kidney disease, and cancer. The pronounced course of systemic immune inflammation was manifested by a high average level of indicators such as D-dimmer, ferritin, C-reactive protein and fibrinogen. Among the causes of death, respiratory failure prevailed against the background of infectious-toxic shock. Damage to the cardiovascular system was manifested by the development of acute myocardial infarction, pulmonary embolism, stroke. Evaluation of the data of postmortem examination revealed a higher prevalence of stroke and a lower incidence of pulmonary embolism and acute myocardial infarction. In a histological study, damage to the cardiovascular system is represented by direct damage to the myocardium in the form of microcytolysis of cardiomyocytes with the development of necrotic areas. The data obtained from the analysis of the study results allow us to draw conclusions about the relationship between the severity of the course of a new coronavirus infection and the frequency of damage to the cardiovascular system, as well as make assumptions about individual links in the pathogenesis of cardiovascular disease in COVID-19 (1 figure, 2 tables, bibliography: 10 refs).

Russian Military Medical Academy Reports. 2021;40(2):63-68
pages 63-68 views

Psychophysiology and medical psychology

Differential diagnosis of states of operability in young people who have had COVID-19 infection

Uliukin I.M., Sechin A.A., Rassokhin V.V., Orlova E.S., Shuklina A.A.


AIM: to assess the peculiarity of the state of working capacity in the process of rehabilitation in young people after suffering COVID-19 infection.

MATERIALS AND METHODS: We examined 62 convalescents who underwent COVID-19 (men aged 22.83 ± 0.37 years) 90 days after discharge from the hospital. The main clinical forms (CF) of COVID-19 in this study were inapparent form (20 people – 32.25%), acute respiratory viral infection (22 people – 35.49%), pneumonia without respiratory failure (20 people – 32.25%). The diagnostics of all clinical cases of COVID-19, examination, treatment and discharge of patients from the hospital were carried out in accordance with the regulatory documents. The psychodiagnostic study was carried out according to the Questionnaire “Differential Diagnosis of Conditions of Decreased Performance” by A.B. Leonova and S.B. Velichkovskaya. All surveyed received voluntary informed consent to participate in the study.

RESULTS: In most cases, in all groups, the degree of severity of states of working capacity is regarded as low, which is probably due to asthenic syndrome after a previous illness, and psychological fatigue, due, in particular, to the presence of post-traumatic stress disorder syndrome.

CONCLUSION: The states of reduced working capacity and the effectiveness of professional activity are very diverse, therefore, the peculiarities of the mental state can be understood only on the basis of identifying really acting motives of activity, which are manifested in reflexive assessments of the real situation and the behavior of the individual, taking into account their emotional coloring. Therefore, in order to substantiate corrective and rehabilitation measures in the case of a state of reduced working capacity and the effectiveness of professional activity, a differentiated assessment of these conditions is required, which requires the work of a multidisciplinary rehabilitation team (2 tables, bibliography: 32 refs).

Russian Military Medical Academy Reports. 2021;40(2):69-75
pages 69-75 views


Development of the composition and technology of effervescent tablets for the prevention of cerebral circulation disorders in the elderly

Listov K.N., Yakovlev R.A.


Increasing the level of antioxidants in the human body plays an important role in increasing longevity. Studies on small laboratory animals showed that in the main group with an increased content of antioxidant enzymes, life expectancy was 20% higher than in the comparison group with age and heart diseases. Thus, the hypothesis is confirmed that a high content of active free radical molecules causes aging and the data obtained on small laboratory animals will increase the human lifespan. This fact is associated with the occurrence of heart and oncological diseases, as well as other age-related pathologies. In order to prevent the development of the above diseases, a drug was developed with an innovative composition of complex-compatible components. The experimental drug contains substances with an increased content of antioxidants for the prevention of cerebrovascular accidents, such as dihydroquercetin and black grape extract. And also vitamins and amino acids: succinic acid, ascorbic acid, glycine. The choice of the composition of the experimental drug was carried out on the basis of the antioxidant properties of these groups of substances, which are widely known, and their combined use will become a potentiated synergy of the selected components and complement their effect. Due to the fact that the classical technology for the production of effervescent dosage forms does not allow combining the components of the composition of the experimental drug, the task of developing an individual technology for combining the acid and alkaline fractions of the formulation by separating the components at the stage of the technological process of drying the raw material was solved. Thanks to this, it became possible to separate the granulation of acid and alkaline components, which made it possible to stabilize the tabletting mixture (3 tables, bibliography: 8 refs.).

Russian Military Medical Academy Reports. 2021;40(2):77-82
pages 77-82 views

History of medicine

Natalya Nikolaevna Kholodkovskaya: at the origins of bibliographic work at the Military Medical Academy

Mamaуeva S.A., Kormilitsyna A.A., Kravtsova L.L.


The purpose of this publication is to comprehensively and fully disclose the contribution of the scientist bibliographer Natalya Nikolaevna Kholodkovskaya to the work of the bibliographic department of the fundamental library of the Military Medical Academy. The preparation of the materials for this article is timed to coincide with two significant dates: in 2021, the bibliography department of the library of the Military Medical Academy will celebrate 90 years and the 130th anniversary of the birth of N.N. Kholodkovskaya. The article is devoted to the pages of the biography of N.N. Kholodkovskaya, her professional development and major achievements in the field of bibliographic activity. In the choice of the profession of Natalya Nikolaevna, the influence of her father, the famous professor, the outstanding zoologist and the original lyric poet Nikolai Aleksandrovich Kholodkovsky, can be traced. For 45 years – from 1921 to 1966 – N.N. Kholodkovskaya worked in the fundamental library of the academy, in different years she held the positions of a scientific bibliographer, head of the department, and from December 2, 1938 to September 1939, she headed the library. With the name of N.N. Kholodkovskaya connected the creation of the bibliography department, the first head of which she became. During the Great Patriotic War N.N. Kholodkovskaya was in besieged Leningrad and helped preserve the richest library fund. The main directions of the work of the bibliography department under the leadership of N.N. Kholodkovskaya were: preparation of bibliographic lists of literature, execution of written or oral address, clarifying, factual information on various topics; deep bibliographic development of large planning topics; development of the reference and bibliographic apparatus, replenishment of the auxiliary reference fund; preparation of written and oral translations, preparation of abstracts of articles on military medicine from foreign journals and books. The translations were regularly published in the Military Medical Journal. N.N. Kholodkovskaya compiled a number of valuable indexes that have not lost their significance. Among them: “Bibliographic index of Russian literature on military medicine”, “Materials for the history of the Military Medical Order of Lenin of the Academy S.M. Kirov”, “The effect of penetrating radiation on the body”, “Sleep therapy” and others. The current profile bibliographic information of the structural divisions of the Academy and individual specialists was at a high level in accordance with their scientific and educational needs and requests. The scientific novelty of the article lies in the fact that this is the first attempt at scientific understanding of the work of the bibliography department of the library of the Military Medical Academy, in attracting previously unpublished documents, memoirs of contemporaries. As a result of the preparation of the publication, materials were found and analyzed that give a more complete picture of the personality and professional merits of N.N. Kholodkovskaya; about its role in the creation and development of the bibliography department, in the confirmation of the principles and methods of bibliographic work, which are adhered to in the department to this day (17 figs, bibliography: 26 refs).

Russian Military Medical Academy Reports. 2021;40(2):83-94
pages 83-94 views

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