Vol 41, No 2 (2022)

BACKGROUND: When studying new and effective methods of treating acute respiratory distress syndrome, an immunogenic model of lung injury occupies a special place. To date, the search for the optimal strategy and regimen for the use of glucocorticoids in the development of acute respiratory distress syndromе is relevant.

AIM: The article evaluates the effectiveness of various schemes of systemic anti-inflammatory therapy with glucocorticoids in an experimental model of acute LPS-induced lung injury.

MATERIALS AND METHODS: The study was conducted on 100 outbred male rats. Acute lung injury was modeled using an experimental model of direct acute lung injury by a single intratracheal injection of lipopolysaccharide (LPS) from the cell wall of the bacterium Salmonella enterica (Sigma-Aldrich) at a dose of LD50 (20 mg/kg). All animals were divided into groups (20 each): 1 — intact rats; 2 — control group (LPS + saline); 3 — LPS + dexamethasone 0.52 mg/kg (small doses); 4 — LPS + dexamethasone 1.71 mg/kg (average doses); 5 — LPS + dexamethasone 8 mg/kg (high doses). The drugs were administered intraperitoneally once a day for 3 days. Dexamethasone doses were calculated using the interspecies dose transfer method using a factor that takes into account differences in body surface area.

RESULTS: It has been established that an experimental model based on the endotracheal administration of S. enterica leads to the development of mortality from pulmonary causes. According to a preclinical study, the systemic use of low doses of dexamethasone (0.52 mg/kg) was found to be better than higher doses (1.71 mg/kg, 8 mg/kg) in the treatment of acute LPS-induced lung injury.

BACKGROUND: The study is devoted to the damage to the great vessels of the limbs and the surgery of temporary prosthetics of the main arteries during the advanced stages of a medical evacuation. A retrospective analysis of the database containing information from the register of combat injuries of the first and second Chechen campaigns was carried out, from which cases of temporary prosthetics of arteries performed in advanced medical institutions were analyzed.

AIM: The analysis of the cases of temporary artery prosthetics that have been carried out at the advanced medical institutions as well as the improvement of the technique of temporary prosthetic operations with respect to the use of the tool designed and developed by the authors- a three-branch mechanical deep vasodilator.

MATERIALS AND METHODS: A total of 14 wounded who underwent the temporary prosthetics operation were analyzed. The main indication for the patients to undergo surgery was uncompensated ischemia according to the classification of V.A. Kornilov, however, based on the data of the register, the operation was also performed on 5 wounded with compensated ischemia and 3 wounded with irreversible ischemia. At the same time, secondary amputations were performed on only 2 of the 14 wounded. Among the wounded with temporary prosthetics, not a single fatal outcome was detected, despite the presence of a terminal condition in one wounded person (more than 45 points on the “MFS-VD” scale (military-field surgery – vascular damage)). On average, for both Chechen campaigns, the average duration of the functioning of the temporary prosthetics was 8.1 ± 3.4 hours, provided that the role of the temporary prosthesis was mainly performed by their polyvinyl chloride tubes, and the prevention of thrombosis was carried out by local intraoperative administration of a heparin solution. To optimize the temporary prosthetics, the authors designed and manufactured (with the participation of MIZ-Vorsma) a special tool — a three-branch vasodilator, which facilitates the operation. The effectiveness of a three-branch vasodilator was studied on three anesthetized large biological objects (pigs weighing 45–51 kg) during the operation of the femoral arteries temporary prosthetics (diameter of the vessels from 3.9 to 4.3 mm) with a linear installation polyvinyl chloride prosthetics with a length of 3 cm and an outer diameter of 5 mm (a system from drip injection of infusion solutions). In the contralateral limb, temporary prosthetics was introduced without the use of a three-branch vasodilator. The ends of the prosthesis were fixed with ligatures to the artery wall. The time of manipulation without taking access to the artery into account with one assistant for temporary prosthetics was 41.1 (39.3–43.4) seconds, without temporary prosthetics — 59.3 (56.8–59.9) seconds. Manipulations with temporary prosthetics without the use of three-branch vasodilator were twice complicated by episodes of vaso slippage from the wall of the prosthesis, which led to massive bleeding. Such cases were not noted when using the expander.

RESULTS: As a result, the analysis of cases of temporary prosthetics of the main arteries of the limbs demonstrated the high effectiveness of the intervention aimed at stopping bleeding and maintaining temporary perfusion of the limb. Secondary amputations were performed on 14% of the wounded (2/14), no fatal cases have been reported. The tool developed to facilitate temporary prosthetics surgery can shorten the term of intervention, reduce intraoperative blood loss, limit the number of assistants and can be recommended for practical use in the advanced stages of evacuation.

BACKGROUND: Peritonectomy is an integral part of cytoreductive surgery, accompanied by a fairly high incidence of postoperative complications and mortality. In this regard, the improvement and development of easy-to-perform, low-traumatic and safe methods of peritonectomy are topical in oncology.

AIM: Based on experimental studies to develop a technology of pneumodissection of the peritoneum using carbon dioxide insufflation and evaluate its effectiveness.

MATERIALS AND METHODS: The study was conducted on 10 non-embalmed corpses of deceased people whose cause of death is not related to tumors of the abdominal cavity and pelvic organs. The Karl STORZ Thermoflator 26432020-1 Insufflator (FSZ registration certificate 2011/09444, dated 12/21/2017), carbon dioxide cylinders with a volume of 20 liters, silicone lines 1.5 meters long, 1 cm in diameter; Seldinger puncture needle 18 G; flexible polypropylene bougie 16 G were used.

RESULTS: The conducted experimental study made it possible to develop and test a method of total parietal peritonectomy based on the technology of peritoneal pneumodissection using carbon dioxide insufflation. The analysis of the obtained results made it possible to define the concept of a new technology as a method of tissue separation based on the insufflation of carbon dioxide into the connective tissue layers of the retroperitoneal space for the purpose of safe dissection of anatomical structures.

CONCLUSIONS: Peritoneal pneumodissection using gas insufflation is a new and promising technology with a number of obvious advantages. First of all, they include ease of execution, low injury, high safety and, probably, ablasticity, which can potentially create conditions for the prevention of unintentional dissemination of tumor cells in the abdominal cavity. The data obtained as a result of the experimental study allow us to conclude that pneumodissection of the peritoneum using carbon dioxide insufflation is an effective method of performing total parietal peritonectomy and can be used in performing cytoreductive surgical interventions in patients with peritoneal carcinomatosis.

BACKGROUND: The prevalence of overweight in the Russian population is increasing every year. A diet with an excessive amount of easily digestible carbohydrates, low physical activity contribute to the rapid development of obesity at a young age. In Russia, 26% of the male population and 30% of women are overweight. When examining obese patients, the adipokine activity of adipose tissue is not taken into account in daily medical activities. The current concept of metabolically healthy obesity causes certain discussions in the scientific community due to diagnostic difficulties in stratifying overweight patients into metabolically “healthy” and “unhealthy”.

AIM: was to characterize the lipid and carbohydrate profile, as well as to evaluate changes in the vascular wall in men with metabolically neutral obesity after a 3–4-year curation period.

MATERIALS AND METHODS: The hospital therapy clinic analyzed the case histories of 93 patients aged 30 to 45 years. The study group of patients was examined twice: initially and 3–4-years after the initial examination. An anthropometric profile was examined in the designated sample of patients, a study of biochemical blood analysis was performed, and an assessment of the cardiovascular system was carried out.

RESULTS: of the study showed that the metabolically neutral type is characterized by a low frequency of metabolic profile disorders, as well as parameters of the cardiovascular system.

CONCLUSIONS: The probability of developing new cases of prediabetes, type 2 diabetes mellitus and initial atherosclerosis is maximal in patients with previously diagnosed insulin resistance and metabolically healthy obesity, minimal — with normal body weight and in patients with metabolically neutral obesity.

BACKGROUND: Importance in assessing the course and prognosis of myocardial infarction is given to the study of a combination of two or more chronic diseases in one patient, interconnected by a single pathogenetic mechanism. Urological diseases are not among the most common in myocardial infarction, but during this period they significantly worsen the quality of life, increase the cost of treatment and are also associated with a worse prognosis.

AIM: To study the development of acute urinary retention during the acute and subacute periods of myocardial infarction risk factors in men under 60 years old to improve prevention and outcomes.

MATERIALS AND METHODS: The study included men aged 19–60 years with type I myocardial infarction. Patients were divided into two age-comparable groups: I — study group, with acute urinary retention — 22 patients; II — control, without urination disorders — 644 patients. A comparative analysis of the main and additional cardiovascular risk factors observation frequency, the features of the clinical course in the selected groups were performed. Pearson’s Chi-square method was used to analyze the risks of developing acute urinary retention.

RESULTS: The structure of cardiovascular risk factors in the study group differed from the control group in a higher frequency of coronary artery bypass surgery in the medical history (I: 31.8%; II: 8.4%; p = 0.0002) and pacing (9.1 and 0.5%; respectively; p < 0.0001), as well as fibrillation and/or atrial flutter in the medical history (27.3 and 9.2%; p = 0.005), chronic cerebrovascular insufficiency (77.3 and 51.3%; p = 0.02), alcohol abuse (63.6 and 25.2%; p < 0.0001), frequent (four and more per year) colds (27.3 and 12.6%; p = 0.04), cardiac arrhythmias and conduction disorders at the onset of coronary artery disease (61.9 and 24.9%; p = 0.0007), smoking for 20 years or more (36.4 and 16.8%; p = 0.003), chronic kidney disease (46.7 and 16.2%; p = 0.02), chronic infection foci of internal organs (77.3 and 39.4%; p = 0.002), urinary (27.3 and 8.6%; p = 0.006) and cholelithiasis (13.6 and 5.4%; p = 0.006). Among the features of the clinical course of the disease, the study group was distinguished by a higher incidence of multiple complications of myocardial infarction (100 and 44.0%; p < 0.0001), severe and extremely severe condition of patients (59.0 and 19.6%; p < 0.0001). Asystole (absolute risk: 42.1%; relative: 18.0; p < 0.0001), hydrothorax (absolute risk: 41.7%; relative: 15.9; p < 0.0001), the patient’s severe condition in the first hours of illness (absolute risk: 100%; relative: 36.5; p < 0.0001), alcohol abuse (8.0%; 4.9; p < 0.0001), smoking (absolute risk: 4.4%; relative: 8.0; p = 0.01) and onset of CHD with heart rhythm and conduction disturbances (7.7%; 4.6; p = 0.0001) were the most significant predictors of acute urinary retention.

CONCLUSIONS: Patients with acute urinary retention are characterized by a more severe course of myocardial infarction. Combinations of listed above factors indicate an increased risk of developing this complication. It is advisable to use them for predictive modeling and the formation of risk groups for early prevention.

BACKGROUND: Up to 30% of patients with acute pancreatitis suffer from the severe form of the disease, of which 30% of cases are lethal, significantly rising to 80% at the development of infectious complications.

AIM: To improve treatment results of patients with acute pancreatitis due to early diagnostics of infectious complications.

MATERIALS AND METHODS: Expression of CD64 antigen on neutrophil membrane (DC64 index of neutrophils) was studied using a flow cytometer “Cytomics FC500” (Beckman Coulter, USA) using 3-color combination of direct monoclonal antibodies “Beckman Coulter”: СD14FITC/CD64PE/CD45PC5. Material was whole blood.

RESULTS: A direct correlation of moderate strength with the development of sepsis was found for both the procalcitonin value and C-reactive protein concentration at this period of illness. However, no relations of endogenous intoxication markers with the development of infectious complications were found (correlation coefficients less than 0.4). Thus, it should be noted that the difference in the indices of the studied parameters of the CD64 antigen expression in the groups began to increase exactly during the 2–3rd week of the disease.

CONCLUSION: Based on the literature data, we formulated a working hypothesis, which states that the degree of CD64 receptor expression on peripheral blood neutrophils is an early marker of infectious complications of acute pancreatitis. The value of average fluorescence intensity index of molecules CD64 equal to 10 conventional units was accepted as a threshold value with regard to the development of IE, and the value of 15 conventional unitsas a threshold value with regard to sepsis. The study was conducted in a prospective group of 28 patients. In accordance with the provision of the working hypothesis, the patients were divided into 3 groups depending on the level of average fluorescence intensity index of molecules CD64. Expression of the CD64 receptor on peripheral blood granulocytes as an early laboratory marker of infectious complications of the disease was studied for the first time. We determined sensitivity and specificity, optimal terms of the given research, detected regularities of CD64 expression changes in the course of acute pancreatitis, correlations with other clinical and laboratory indexes, including prospective markers of infection (procalcitonin, C-reactive protein), with the integral scales of severity estimation of patients with acute destructive pancreatitis. Determination of the level of the receptor CD64 expression on the peripheral blood neutrophils showed that this marker reflects the dynamics of the disease course and gives the possibility of the early diagnostics of the infectious complications of acute pancreatitis. The use of this method provides additional information about the development of the surgical infection. It is important that the changes of CD64 antigen expression in dynamics outrun other markers of systemic inflammatory response and sepsis. CD64 antigen expression data on peripheral blood neutrophils is an additional factor in determining differentiated surgical tactics in phase I of the disease’s development with regard to acute fluid collections in patients with acute pancreatitis.

The Kirov Military Medical Academy is the main training center for military doctors of the Ministry of Defense of the Russian Federation. Great Russian scientists worked within the walls of the Academy: N.I. Pirogov, I.M. Sechenov, S.P. Botkin, I.P. Pavlov, V.M. Bekhterev. Many scientists of the Military Medical Academy, who have ma

The Kirov Military Medical Academy is the main training center for military doctors of the Ministry of Defense of the Russian Federation. Great Russian scientists worked within the walls of the Academy: N.I. Pirogov, I.M. Sechenov, S.P. Botkin, V.V. Pashutin, I.P. Pavlov, V.M. Bekhterev. Many scientists of the Military Medical Academy, who have made a huge contribution to domestic and world medical science, began their scientific activities in their student years. Deep professional knowledge and love for the profession have always distinguished the students of the Military Medical Academy. These remarkable qualities were especially vividly manifested during wars, epidemics, and other social upheavals. The command of the Academy, the teaching staff have always supported the students’ desire for scientific research. A landmark event was the creation of the Theoretical medicine circle in 1910 under the patronage of the Academy Conference. For almost half a century of history (since 1910), with varying intensity, there was a School of Scientific Societies at the Academy and at various departments, which involved its students in scientific activities. The formal date of establishment of the Military Medical Academy named after S.M. Kirov “Military Scientific Society of cadets and trainees of the Academy” in its current form is 1950 (order of the Head of the Academy No. 812 of August 16, 1950). Military scientific activity of trainees and cadets is a form of independent work aimed at acquiring deep and solid knowledge in military professional activities. It is closely connected with the educational process and is in line with the scientific work of the departments and research units of the Academy. Students develop individual scientific topics, and at the meetings of the circles the completed works and current medical problems are discussed. The best works are heard at the annual conferences of listeners. In recent years, the level of scientific activity of students of all courses and all faculties has increased markedly. Students have at their disposal the latest medical equipment, extensive clinical material, electronic computing technology in complex mathematical processing of scientific materials, the help of teachers, the rich heritage of scientific medical schools. At present, the “Military Scientific Society of cadets and trainees of the Academy” of the Military Medical Academy is an effective forge of personnel to maintain the scientific potential of the Academy and the development of its scientific schools.

de a huge contribution to domestic and world medical science, began their scientific activities in their student years. Deep professional knowledge and love for the profession have always distinguished the students of the Military Medical Academy. These remarkable qualities were especially vividly manifested during wars, epidemics, and other social upheavals. The command of the Academy, the teaching staff have always supported the students' desire for scientific research. A landmark event was the creation of the Theoretical medicine circle in 1910 under the patronage of the Academy Conference. For almost half a century of history (since 1910), with varying intensity, there was a School of Scientific Societies at the Academy and at various departments, which involved its students in scientific activities. The formal date of establishment of the Military Medical Academy named after S.M. Kirov "Military Scientific Society of cadets and trainees of the Academy" (VNKS) in its current form is 1950 (order of the Head of the Academy No. 812 of August 16, 1950). Military scientific activity of trainees and cadets is a form of independent work aimed at acquiring deep and solid knowledge in military professional activities. It is closely connected with the educational process and is in line with the scientific work of the departments and research units of the Academy. Students develop individual scientific topics, and at the meetings of the circles the completed works and current medical problems are discussed. The best works are heard at the annual conferences of listeners. In recent years, the level of scientific activity of students of all courses and all faculties has increased markedly. Students have at their disposal the latest medical equipment, extensive clinical material, electronic computing technology in complex mathematical processing of scientific materials, the help of teachers, the rich heritage of scientific medical schools. At present, the ISS of the Military Medical Academy is an effective forge of personnel to maintain the scientific potential of the Academy and the development of its scientific schools.